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Jadhav AP, Desai SM, Gupta R, Baxter BW, Bartolini B, Krajina A, English JD, Nogueira RG, Liebeskind DS, Veznedaroglu E, Budzik RF. Delayed Functional Independence After Neurothrombectomy (DEFIANT) score: analysis of the Trevo Retriever Registry. J Neurointerv Surg 2023; 15:e148-e153. [PMID: 36150897 DOI: 10.1136/jnis-2022-019232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/03/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Chronological heterogeneity in neurological improvement after endovascular thrombectomy (EVT) for large vessel occlusion (LVO) stroke is commonly observed in clinical practice. Understanding the temporal progression of functional independence after EVT, especially delayed functional independence in patients who do not improve early, is essential for prognostication and rehabilitation. We aim to determine the incidence of early functional independence (EFI) and delayed functional independence (DFI), identify associated predictors after EVT, and develop the Delayed Functional Independence After Neurothrombectomy (DEFIANT) score. METHODS Demographic, clinical, radiological, treatment, and procedural information were analyzed from the Trevo Registry (patients undergoing EVT due to anterior LVO using the Trevo stent retriever). Incidence and predictors of EFI (modified Rankin Scale (mRS) score 0-2 at discharge) and DFI (mRS score 0-2 at 90 days in non-EFI patients) were analyzed. RESULTS A total of 1623 patients met study criteria. EFI was observed in 45% (730) of patients. Among surviving non-EFI patients (884), DFI was observed in 35% (308). Younger age (p=0.003), lower discharge National Institutes of Health Stroke Scale (NIHSS) score (p<0.0001), and absence of any hemorrhage (p=0.021) were independent predictors of DFI. After age 60, the probability of DFI declines significantly with 5 year age increments (approximately 7% decline for every 5 years; p(DFI)= 1.3559-0.0699, p for slope=0.001). The DEFIANT score is available online (https://bit.ly/3KZRVq5). CONCLUSION Approximately 45% of patients experience EFI. About one-third of non-early improvers experience DFI. Younger age, lower discharge NIHSS score, and absence of any hemorrhage were independent predictors of DFI among non-early improvers.
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Affiliation(s)
- Ashutosh P Jadhav
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Shashvat M Desai
- Department of Neuroscience, HonorHealth, Scottsdale, Arizona, USA
- Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Rishi Gupta
- Neurosurgery Wellstar Health System, WellStar Medical Group, Marietta, Georgia, USA
| | - Blaise W Baxter
- Department of Neurointerventional Radiology, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
| | - Bruno Bartolini
- Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Antonin Krajina
- Department of Radiology, University Hospital Hradec Kralove, Hradec Kralove, Královéhradecký, Czech Republic
| | - Joey D English
- Department of Neurology, California Pacific Medical Center, San Francisco, California, USA
| | - Raul G Nogueira
- Department of Neurology, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - David S Liebeskind
- Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, Los Angeles, California, USA
| | - Erol Veznedaroglu
- Department of Neurosurgery, Drexel University Department of Neurology, Philadelphia, Pennsylvania, USA
| | - Ronald F Budzik
- Department of Radiology, Riverside Methodist Hospital, Columbus, Ohio, USA
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2
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Tao C, Qureshi AI, Yin Y, Li J, Li R, Xu P, Sun J, Liao G, Yue X, Shi H, Liu Y, Ma Z, Zhang J, Xiao G, Xu B, Xu C, Su J, Zhou W, Huang S, Yang W, Chen H, Li W, Li Y, Liu D, Yu C, Yuan G, Wan C, Liang W, Chen C, Shi X, Wang J, Wu Y, Cai X, Shen C, Li K, Fang P, Wang M, Chen Z, Li T, Cheng G, Sun Y, Wang Y, Zhang H, Chen J, Xu X, Wang Y, Geng W, Ni C, Chen C, Liu Y, Min J, Zhang Y, Liang Y, Wen C, Baxter BW, Nogueira RG, Hu W. Endovascular Treatment Versus Best Medical Management in Acute Basilar Artery Occlusion Strokes: Results From the ATTENTION Multicenter Registry. Circulation 2022; 146:6-17. [PMID: 35656816 DOI: 10.1161/circulationaha.121.058544] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The authors compare the effectiveness and safety of endovascular treatment (EVT) versus best medical management (BMM) in strokes attributable to acute basilar artery occlusion (BAO). METHODS The present analysis was based on the ongoing, prospective, multicenter ATTENTION (Endovascular Treatment for Acute Basilar Artery Occlusion) trial registry in China. Our analytic sample comprised 2134 patients recruited at 48 sites between 2017 and 2021 and included 462 patients who received BMM and 1672 patients who received EVT. We performed an inversed probability of treatment weighting analysis. Qualifying patients had to present within 24 hours of estimated BAO. The primary clinical outcome was favorable functional outcome (modified Rankin Scale score, 0-3) at 90 days. We also performed a sensitivity analysis with the propensity score matching-based and the instrumental variable-based analysis. RESULTS In our primary analysis using the inversed probability of treatment weighting-based analysis, there was a significantly higher rate of favorable outcome at 90 days among EVT patients compared with BMM-treated patients (adjusted relative risk, 1.42 [95% CI, 1.19-1.65]; absolute risk difference, 11.8% [95% CI, 6.9-16.7%]). The mortality was significantly lower (adjusted relative risk, 0.78 [95% CI, 0.69-0.88]; absolute risk difference, -10.3% [95% CI, -15.8 to -4.9]) in patients undergoing EVT. Results were generally consistent across the secondary end points. Similar associations were seen in the propensity score matching-based and instrumental variable-based analysis. CONCLUSION In this real-world study, EVT was associated with significantly better functional outcomes and survival at 90 days. Well-designed randomized studies comparing EVT with BMM in the acute BAO are needed. REGISTRATION URL: www.chictr.org.cn Unique identifier: ChiCTR2000041117.
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Affiliation(s)
- Chunrong Tao
- Stroke Center and Department of Neurology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Y., J.L., R.L., P.X., J.Sun, W.H.)
| | - Adnan I Qureshi
- Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis (A.I.Q.)
| | - Yamei Yin
- Stroke Center and Department of Neurology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Y., J.L., R.L., P.X., J.Sun, W.H.)
| | - Jie Li
- Stroke Center and Department of Neurology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Y., J.L., R.L., P.X., J.Sun, W.H.)
| | - Rui Li
- Stroke Center and Department of Neurology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Y., J.L., R.L., P.X., J.Sun, W.H.)
| | - Pengfei Xu
- Stroke Center and Department of Neurology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Y., J.L., R.L., P.X., J.Sun, W.H.)
| | - Jun Sun
- Stroke Center and Department of Neurology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Y., J.L., R.L., P.X., J.Sun, W.H.)
| | - Geng Liao
- Department of Neurology, Maoming People's Hospital, Guangdong, China (G.L.)
| | - Xincan Yue
- Department of Neurosurgery, Zhoukou Central Hospital, China (X.Y.)
| | - Hongchao Shi
- Department of Neurology, Nanjing First Hospital, China (H.S.)
| | - Yongchang Liu
- Department of Neurovascular Intervention, Cangzhou Central Hospital, China (Yongchang Liu)
| | - Zhengfei Ma
- Department of Neurology, Suzhou Municipal Hospital, China (Z.M.)
| | - Jinghua Zhang
- Department of Neurology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (J.Z.)
| | - Guodong Xiao
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, China (G.X.)
| | - Bo Xu
- Department of Neurology, Qingdao Central Hospital, Qingdao University, China (B.X.)
| | - Chenghua Xu
- Department of Neurology, Taizhou First People's Hospital, China (C.X.)
| | - Junfeng Su
- Department of Neurology, Jingzhou Central Hospital, China (J.Su)
| | - Wensheng Zhou
- Department of Neurology, Hunan Provincial People's Hospital, Changsha, China (W.Z.)
| | - Shuchun Huang
- Department of Neurology, Hospital 302 Attached to Guizhou Aviation Group, Guizhou, China (S.H.)
| | - Weimin Yang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China (W.Y.)
| | - Hongbing Chen
- Department of Neurology and Stroke Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (H.C.)
| | - Wei Li
- Department of Neurology, The First Affiliated Hospital of Hainan Medical University, Haikou, China (W.Li)
| | - Yongkun Li
- Department of Neurology, Fujian Provincial Hospital, Fuzhou, China (Y.Li)
| | - Dezhi Liu
- Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, China (D.L.)
| | - Chuanqing Yu
- Department of Neurology, The First Affiliated Hospital of Anhui University of Science and Technology, Huainan, China (C.Y.)
| | - Guangxiong Yuan
- Department of Emergency, Xiangtan Central Hospital, China (G.Y.)
| | - ChaoBin Wan
- Department of Neurology, Liangxiang Hospital, Fangshan District, Beijing, China (C-B.W.)
| | - Wenbao Liang
- Department of Neurology, Karamay Central Hospital, China (W.Liang)
| | - Chun Chen
- Department of Neurology, The First Affiliated Hospital of Kunming Medical University, China (Chun Chen)
| | - Xueying Shi
- Department of Neurology, Anqing Hospital Affiliated to Anhui Medical University, China (X.S.)
| | - Junjun Wang
- Department of Neurology, General Hospital of Wan-bei Coal and Electricity Group, The Third Hospital Affiliated of Bengbu Medical College, Suzhou, China (J.W.)
| | - Yingchun Wu
- Department of Neurology, ORDOS Central Hospital, ORDOS, China (Y.Wu)
| | - Xueli Cai
- Department of Neurology, Lishui Municipal Central Hospital, China (X.C.)
| | - Chunyun Shen
- Department of Neurology, Central People's Hospital of Zhanjiang, Guangdong, China (C.S.)
| | - Kai Li
- Department of Neurology, Heze Municipal Hospital, China (K.L.)
| | - Pu Fang
- Department of Neurology, The First Affiliated Hospital of Nanchang University, China (P.F.)
| | - Ming Wang
- Department of Neurology, Nanyang Second General Hospital, China (M.W.)
| | - Zhongjun Chen
- Department of Neurosurgical Intervention, Dalian Municipal Central Hospital, China (Z.C.)
| | - Tong Li
- Department of Neurology, The Second People's Hospital of Nanning, China (T.L.)
| | - Guangsen Cheng
- Department of Neurology, The First Affiliated Hospital of Medicine Macau University of Technology, Zhuhai, China (G.C.)
| | - Yaxuan Sun
- Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan, China (Y.S.)
| | - Yan Wang
- Department of Neurology, Chengdu Fifth People's Hospital, China (Y.Wang)
| | - Hui Zhang
- Department of Neurosurgery, The Second Affiliated Hospital of Bengbu Medical College, China (H.Z.)
| | - Jie Chen
- Department of Neurosurgery, Tongling People's Hospital, China (J.C.)
| | - Xiaohui Xu
- Department of Neurology, Taizhou Municipal Hospital, China (X.X.)
| | - Youmeng Wang
- Department of Neurology, Fuyang People's Hospital, China (Y.Wang.)
| | - Wanjie Geng
- Department of Neurology, Taihe County People's Hospital, China (W.G.)
| | - Chuyuan Ni
- Department of Neurology, Huangshan People's Hospital, China (C.N.)
| | - Changchun Chen
- Department of Neurology, The Second People's Hospital of Anhui Province, Hefei, China (Changchun Chen)
| | - Yan Liu
- Department of Neurology, Jingjiang People's Hospital, the Seventh Affiliated Hospital of Yangzhou University, China (Yan Liu)
| | - Jie Min
- Department of Neurosurgery, Jingzhou First People's Hospital, China (J.M.)
| | - Yongcheng Zhang
- Department of Neurology, Affiliated Hospital of Jinggangshan University, Ji'an, China (Y.Z.)
| | - Yong Liang
- Department of Neurology, Changsha First Hospital, China (Y.Liang)
| | - Chao Wen
- Department of Neurology, Taiyuan Central Hospital, China (C.W.)
| | | | - Raul G Nogueira
- Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Stroke Institute, PA (R.G.N.)
| | - Wei Hu
- Stroke Center and Department of Neurology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Y., J.L., R.L., P.X., J.Sun, W.H.)
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Mokin M, Waqas M, Fifi JT, De Leacy R, Fiorella D, Levy EI, Snyder K, Hanel RA, Woodward K, Chaudry I, Rai AT, Frei D, Delgado Almandoz JE, Kelly M, Arthur AS, Baxter BW, English J, Linfante I, Fargen KM, Turk A, Mocco J, Siddiqui AH. Intravenous alteplase has different effects on the efficacy of aspiration and stent retriever thrombectomy: analysis of the COMPASS trial. J Neurointerv Surg 2021; 14:992-996. [PMID: 34649935 DOI: 10.1136/neurintsurg-2021-017943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/30/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND There is conflicting evidence on the utility of intravenous (IV) alteplase in patients with emergent large vessel occlusion (ELVO) treated with mechanical thrombectomy (MT). METHODS This was a post hoc analysis of the COMPASS: a trial of aspiration thrombectomy versus stent retriever thrombectomy as first-line approach for large vessel occlusion. We compared clinical, procedural and angiographic outcomes of patients with and without prior IV alteplase administration. RESULTS In the COMPASS trial, 235 patients had presented to the hospital within the first 4 hours of stroke symptom onset and were eligible for analysis. On univariate analysis, administration of IV alteplase prior to MT was found to be significantly associated with favorable outcomes (modified Rankin scale (mRS) 0-2 at 3 months; 55.6% vs 40.0% in the MT-only group, P=0.037). However, on multivariate analysis, only baseline (pre-stroke) mRS, admission National Institutes of Health Stroke Scale (NIHSS) score and age were identified as independent predictors of favorable outcomes at 3 months. We found higher final thrombolysis in cerebral infarction (TICI) 2b/3 rates in patients without the use of alteplase prior to the aspiration first approach (100.0% vs 87.9% in IV altepase +aspiration first MT, P=0.03). In the stent retriever first group, final TICI 2b/3 rates were identical in patients with and without IV alteplase administration (87.5% and 87.5%, P=1.0). CONCLUSIONS Prior administration of IV alteplase may adversely affect the efficacy of aspiration, but does not seem to influence the stent retriever first approach to MT in patients with anterior circulation ELVO.
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Affiliation(s)
- Maxim Mokin
- Department of Neurosurgery and Brain Repair, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Muhammad Waqas
- Department of Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Johanna T Fifi
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Reade De Leacy
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David Fiorella
- Department of Neurosurgery, Stony Brook University, Stony Brook, New York, USA
| | - Elad I Levy
- Department of Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Kenneth Snyder
- Department of Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Ricardo A Hanel
- Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA
| | - Keith Woodward
- Fort Sanders Regional Medical Center, Knoxville, Tennessee, USA
| | - Imran Chaudry
- Neurosurgery, Prisma Health Upstate, Greenville, South Carolina, USA
| | - Ansaar T Rai
- Interventional Neuroradiology, West Virginia University Rockefeller Neuroscience Institute, Morgantown, West Virginia, USA
| | - Donald Frei
- Interventional Neuroradiology, Radiology Imaging Associates, Englewood, Colorado, USA
| | | | - Michael Kelly
- Neurosurgery, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Adam S Arthur
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
| | | | - Joey English
- Neurology and Radiology, University of California San Francisco (UCSF), San Francisco, California, USA
| | - Italo Linfante
- Baptist Cardiac and Vascular Institute, Miami, Florida, USA
| | - Kyle M Fargen
- Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Aquilla Turk
- Neurosurgery, Prisma Health Upstate, Greenville, South Carolina, USA
| | - J Mocco
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
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4
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Nogueira R, Haussen DC, Liebeskind DS, Jovin TG, Gupta R, Saver JL, Jadhav A, Budzik R, Baxter BW, Krajina A, Bonafe A, Malek AR, Ana Paula N, Mohammaden M, Zhang Y, Morgan P, Ji M, Bartolini B, English J, Albers G, Mlynash M, Lansberg MG, Michael F, Pereira V, Veznedaroglu E. Abstract P467: Clinical Effectiveness of Endovascular Stroke Treatment in the Early and Extended Time Windows. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.p467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose:
The clinical efficacy of mechanical thrombectomy (MT) has been unequivocally demonstrated in multiple randomized clinical trials (RCTs). However, these studies were performed in carefully selected centers and utilized strict inclusion criteria. We aim to assess the clinical effectiveness of MT by comparing the specific RCT populations with corresponding patient cohorts derived from a prospective registry.
Methods:
A total of 2008 patients from 76 sites across 12 countries were enrolled in a prospective open-label MT registry. Patients were categorized into the corresponding cohorts of the SWIFT-Prime, DAWN, and DEFUSE 3 trials based on the age, baseline NIHSS, occlusion site, IV tPA use, pre-morbid mRS and time to treatment criteria used in the RCTs without considering specific parenchymal imaging findings. Baseline and outcome variables were compared across the corresponding groups.
Results:
As compared to the treated patients in the actual trials, registry-derived patients tended to be younger and had lower baseline ASPECTS. In addition, time to treatment was earlier and the use of IV tPA and general anesthesia were higher in DAWN- and DEFUSE 3-registry derived patients versus their corresponding trials. Reperfusion rates were higher in the registry patients. The rates of 90-day good outcome (mRS 0-2) in registry-derived patients were comparable to those of the patients treated in the corresponding RCTs (SWIFT-Prime, 64.5% vs 60.2%; DAWN, 50.4% vs 48.6%; Beyond-DAWN: 52.4% vs 48.6%; DEFUSE 3, 52% vs 44.6%, respectively; all P>0.05). Registry-derived patients had significant less disability than the corresponding RCT controls (ordinal mRS shift OR, P <0.05 for all).
Conclusion:
Our study provides favorable generalizability data for the safety and efficacy of thrombectomy in the “real-world” setting and supports that patients may be safely treated outside the constraints of RCTs and strict guidelines.
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Affiliation(s)
| | | | | | | | | | | | | | - Ron Budzik
- Riverside Methodist Hosp/Ohio Health Rsch Institute, Columbus, OH, USA, Columbus, OH
| | | | - Antonin Krajina
- Dept of Radiology, Univ Hosp Hradec Kralove, Czech Republic, Czech, Czech Republic
| | - Alain Bonafe
- Dept of Neuroradiology, CHU Montpellier, France, Montpellier, France
| | | | | | | | | | | | - Minyi Ji
- Stryker Neurovascular, Fremont, CA, USA, Fremont, CA
| | - Bruno Bartolini
- Dept of Radiology, Interventional Neuroradiology Unit, Lausanne Univ Hosp, Lausanne, Switzerland
| | - Joey English
- Dept of Neurology, California Pacific Med Cntr, San Francisco, CA, USA, San Francisco, CA
| | - Gregory Albers
- Dept of Neurology, Stanford Stroke Cntr, Palo Alto, CA, USA, Palo Alto, CA
| | - Michael Mlynash
- Dept of Neurology, Stanford Stroke Cntr, Palo Alto, CA, USA, Palo Alto, CA
| | | | | | - Vitor Pereira
- Dept of Med Imaging, Univ of Toronto, Toronto Western Hosp, Toronto, Canada, Toronto,, Canada
| | - Erol Veznedaroglu
- Dept of Neurosciences, Drexel Neurosciences Institute, Philadelphia, PA, USA, Philadelphia, PA
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5
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Mocco J, Siddiqui AH, Fiorella D, Alexander MJ, Arthur AS, Baxter BW, Budzik RF, Froehler MT, Hanel RA, Lena J, Persaud S, Puri AS, Rai AT, Wintermark M, Woodward K, Zhang X, Turk A. POSITIVE: Perfusion imaging selection of ischemic stroke patients for endovascular therapy. J Neurointerv Surg 2021; 14:126-132. [PMID: 33632884 DOI: 10.1136/neurintsurg-2021-017315] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 01/22/2021] [Accepted: 01/22/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The PerfusiOn imaging Selection of Ischemic sTroke patIents for endoVascular thErapy (POSITIVE) trial was designed to evaluate functional outcome in patients with emergent large vessel occlusion (ELVO) presenting within 0-12 hours with pre-specified bifurcated arms of early and late window presentation, who were selected for endovascular thrombectomy with non-vendor specific commercially available perfusion imaging software. Recent trials demonstrating the benefit of thrombectomy up to 16-24 hours following ELVO removed equipoise to randomize late window ELVO patients and therefore the trial was halted. METHODS Up to 200 patients were to be enrolled in this FDA-cleared, prospective, randomized, multicenter international trial to compare thrombectomy and best medical management in patients with ELVO ineligible for or refractory to treatment with IV tissue plasminogen activator (IV-tPA) selected with perfusion imaging and presenting within 0-12 hours of last seen normal. The primary outcome was 90-day clinical outcome as measured by the raw modified Rankin Scale (mRS) with scores 5 and 6 collapsed (mRS shift analysis). RESULTS The POSITIVE trial suspended enrollment with the release of results from the DAWN trial and was stopped after the release of the DEFUSE 3 trial results. Thirty-three patients were enrolled (21 for medical management and 12 for thrombectomy). Twelve of the 33 patients were enrolled in the 6-12 hour cohort. Despite the early cessation, the primary outcome demonstrated statistically significant superior clinical outcomes for patients treated with thrombectomy (P=0.0060). The overall proportion of patients achieving an mRS score of 0-2 was 75% in the thrombectomy cohort and 43% in the medical management cohort (OR 4.00, 95% CI 0.84 to 19.2). CONCLUSION POSITIVE supports the already established practice of delayed thrombectomy for appropriately selected patients presenting within 0-12 hours selected by perfusion imaging from any vendor. The results of the POSITIVE trial are consistent with other thrombectomy trials. The statistically significant effect on functional improvement, despite the small number of patients, reinforces the robust benefits of thrombectomy. CLINICAL TRIAL REGISTRATION NCT01852201.
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Affiliation(s)
- J Mocco
- Neurosurgery, The Mount Sinai Hospital, New York, New York, USA
| | - Adnan H Siddiqui
- Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - David Fiorella
- Neurosurgery, Stony Brook University, Stony Brook, New York, USA.,SUNY SB, Stony Brook, New York, USA
| | | | - Adam S Arthur
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.,Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | | | | | - Michael T Froehler
- Cerebrovascular Program, Vanderbilt University, Nashville, Tennessee, USA
| | - Ricardo A Hanel
- Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA
| | - Jonathan Lena
- Neurosciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Steven Persaud
- Neurosurgery, The Mount Sinai Hospital, New York, New York, USA
| | - Ajit S Puri
- Radiology, University of Massachusetts, Worcester, Massachusetts, USA
| | - Ansaar T Rai
- Neurointerventional Radiology, West Virginia University, Morgantown, West Virginia, USA
| | - Max Wintermark
- Radiology, University of Virginia, Charlottesville, Virginia, USA
| | - Keith Woodward
- Britton Woodward, Britton Woodward, Knoxville, Tennessee, USA
| | - Xiangnan Zhang
- Neurosurgery, The Mount Sinai Hospital, New York, New York, USA
| | - Aquilla Turk
- Neurosurgery, Prisma Health Upstate, Greenville, South Carolina, USA
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6
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Nogueira RG, Mohammaden MH, Haussen DC, Budzik RF, Gupta R, Krajina A, English JD, Malek AR, Sarraj A, Narata AP, Taqi MA, Frankel MR, Miller TR, Grobelny T, Baxter BW, Bartolini BM, Jenkins P, Estrade L, Liebeskind D, Veznedaroglu E. Endovascular therapy in the distal neurovascular territory: results of a large prospective registry. J Neurointerv Surg 2020; 13:979-984. [PMID: 33323503 DOI: 10.1136/neurintsurg-2020-016851] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/13/2020] [Accepted: 11/13/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND There is a paucity of data regarding mechanical thrombectomy (MT) in distal arterial occlusions (DAO). We aim to evaluate the safety and efficacy of MT in patients with DAO and compare their outcomes with proximal arterial occlusion (PAO) strokes. METHODS The Trevo Registry was a prospective open-label MT registry including 2008 patients from 76 sites across 12 countries. Patients were categorized into: PAO: intracranial ICA, and MCA-M1; and DAO: MCA-M2, MCA-M3, ACA, and PCA. Baseline and outcome variables were compared across the PAO vs DAO patients with pre-morbid mRS 0-2. RESULTS Among 407 DAOs including 350 (86.0%) M2, 25 (6.1%) M3, 10 (2.5%) ACA, and 22 (5.4%) PCA occlusions, there were 376 DAO with pre-morbid mRS 0-2 which were compared with 1268 PAO patients. The median baseline NIHSS score was lower in DAO (13 [8-18] vs 16 [12-20], P<0.001). There were no differences in terms of age, sex, IV-tPA use, co-morbidities, or time to treatment across DAO vs PAO. The rates of post-procedure reperfusion, symptomatic intracranial hemorrhage (sICH), and 90-mortality were comparable between both groups. DAO showed significantly higher rates of 90-day mRS 0-2 (68.3% vs 56.5%, P<0.001). After adjustment for potential confounders, the level of arterial occlusion was not associated with the chances of excellent outcome (DAO for 90-day mRS 0-1: OR; 1.18, 95% CI [0.90 to 1.54], P=0.225), successful reperfusion or SICH. However, DAO patients were more likely to be functionally independent (mRS 0-2: OR; 1.45, 95% CI [1,09 to 1.92], P=0.01) or dead (OR; 1.54, 95% CI [1.06 to 2.27], P=0.02) at 90 days. CONCLUSION Endovascular therapy in DAO appears to result in a comparable safety and technical success profile as in PAO. The potential benefits of DAO thrombectomy should be investigated in future randomized trials.
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Affiliation(s)
- Raul G Nogueira
- Department of Neurology, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mahmoud H Mohammaden
- Department of Neurology, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Diogo C Haussen
- Department of Neurology, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ronald F Budzik
- Department of Neuroradiology, Riverside Methodist Hospital, Columbus, Ohio, USA
| | - Rishi Gupta
- Department of Neurosciences, WellStar Health System, Atlanta, Georgia, USA
| | - Antonin Krajina
- Department of Neuroradiology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Joey D English
- Department of Neurology, California Pacific Medical Center, San Francisco, California, USA
| | - Ali R Malek
- Neurointerventional & Comprehensive Stroke Program, Saint Mary Medical Center, Long Beach, California, USA
| | - Amrou Sarraj
- Neurology, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Ana Paula Narata
- Department of Radiology, Diagnostic and Interventional Neuroradiology Section, Regional University Hospital Centre Tours, Tours, Centre, France
| | - Muhammad Asif Taqi
- Department of Neurology, Vascular Neurology of Southern California, Thousand Oaks, California, USA
| | - Michael R Frankel
- Department of Neurology, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Timothy Ryan Miller
- Department of Radiology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Thomas Grobelny
- Advocate Neurovascular Center, Advocate Health Care Library Network, Park Ridge, Illinois, USA
| | - Blaise W Baxter
- Department of Radiology, University of Tennessee, Chattanooga, TN, USA
| | | | - Paul Jenkins
- Division of Biostatistics, Stryker Neurovascular, Fremont, California, USA
| | - Laurent Estrade
- Department of Interventional Neuroradiology, Centre Hospitalier Regional Universitaire de Lille, Lille, France
| | | | - Erol Veznedaroglu
- Department of Neurosciences, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
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7
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Mokin M, Waqas M, Fifi J, De Leacy R, Fiorella D, Levy EI, Snyder K, Hanel R, Woodward K, Chaudry I, Rai AT, Frei D, Delgado Almandoz JE, Kelly M, Arthur AS, Baxter BW, English J, Linfante I, Fargen KM, Turk A, Siddiqui AH, Mocco J. Clot perviousness is associated with first pass success of aspiration thrombectomy in the COMPASS trial. J Neurointerv Surg 2020; 13:509-514. [PMID: 32680875 DOI: 10.1136/neurintsurg-2020-016434] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Clot density (Hounsfield units, HU) and perviousness (post-contrast increase in the HU of clot) are thought to be associated with clot composition. We evaluate whether these imaging characteristics were associated with angiographic outcomes of aspiration and stent retriever thrombectomy in COMPASS: a trial of aspiration thrombectomy versus stent retriever thrombectomy as first-line approach for large vessel occlusion. METHODS Clot density and perviousness were measured by two independent operators who were blind to all the final angiographic and clinical outcomes. The association of clot density and perviousness with the Thrombolysis In Cerebral Infarction (TICI) scale after first pass was assessed using univariate and multivariate analysis. RESULTS Among all patients enrolled in COMPASS, 165 were eligible for the post-hoc analysis (81 patients in the aspiration first and 84 in the stent retriever first groups). Overall mean perviousness of clot was significantly higher in patient with mTICI 2b-3 after first pass (28.6±22.9 vs 20.3±19.2, p=0.017). Mean perviousness among patients who achieved TICI 2c/3 versus TICI 2b versus TICI 0-2a in the aspiration first group varied significantly (32.6±26.1, 35.3±24.4, and 17.7±13.1, p=0.013). The association of perviousness with first pass success was not significant in the stent retriever group. Using multivariate analysis, high perviousness (defined as cut-off >27.6) was an independent predictor of TICI 2b-3 (OR 3.82, 95% CI 1.10 to 13.19; p=0.034). CONCLUSIONS Clot perviousness is associated with first pass angiographic success in patients treated with the aspiration first approach for thrombectomy.
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Affiliation(s)
- Maxim Mokin
- Neurosurgery, University of South Florida, Tampa, Florida, USA .,Neurosciences Center, Tampa General Hospital, Tampa, Florida, USA
| | - Muhammad Waqas
- Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Johanna Fifi
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Reade De Leacy
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David Fiorella
- Neurosurgery and Radiology, Stony Brook University, New York, New York, USA
| | - Elad I Levy
- Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Kenneth Snyder
- Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Ricardo Hanel
- Stroke & Cerebrovascular Center, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA
| | | | - Imran Chaudry
- Neurosurgery, Prisma Health Upstate, Greenville, South Carolina, USA
| | - Ansaar T Rai
- Interventional Neuroradiology, West Virginia University Rockefeller Neuroscience Institute, Morgantown, West Virginia, USA
| | - Donald Frei
- Interventional Neuroradiology, Radiology Imaging Associates, Englewood, Colorado, USA
| | | | - Michael Kelly
- Neurosurgery, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Adam S Arthur
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.,Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | | | - Joey English
- California Pacific Medical Center, San Francisco, California, USA
| | - Italo Linfante
- Baptist Cardiac and Vascular Institute, Miami, Florida, USA
| | - Kyle M Fargen
- Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Aquilla Turk
- Neurosurgery, Prisma Health Upstate, Greenville, South Carolina, USA
| | - Adnan H Siddiqui
- Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - J Mocco
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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8
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Alexander MJ, Zauner A, Gupta R, Alshekhlee A, Fraser JF, Toth G, Given C, Mackenzie L, Kott B, Hassan AE, Shownkeen H, Baxter BW, Callison RC, Yu W. The WOVEN trial: Wingspan One-year Vascular Events and Neurologic Outcomes. J Neurointerv Surg 2020; 13:307-310. [PMID: 32561658 DOI: 10.1136/neurintsurg-2020-016208] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Prior studies evaluating the Wingspan stent for treatment of symptomatic intracranial atherosclerotic disease have included patients with a spectrum of both on-label and off-label indications for the stent. The WEAVE trial assessed 152 patients stented with the Wingspan stent strictly by its current on-label indication and found a 2.6% periprocedural stroke and death rate. OBJECTIVE This WOVEN study assesses the 1-year follow-up from this cohort. METHODS Twelve of the original 24 sites enrolling patients in the WEAVE trial performed follow-up chart review and imaging analysis up to 1 year after stenting. Assessment of delayed stroke and death was made in 129 patients, as well as vascular imaging follow-up to assess for in-stent re-stenosis. RESULTS In the 1-year follow-up period, seven patients had a stroke (six minor, one major). Subsequent to the periprocedural period, no deaths were recorded in the cohort. Including the four patients who had periprocedural events in the WEAVE study, there were 11 strokes or deaths of the 129 patients (8.5%) at the 1-year follow-up. CONCLUSIONS The WOVEN study provides the 1-year follow-up on a cohort of 129 patients who were stented according to the current on-label use. It provides a more homogeneous patient group for analysis than prior studies, and demonstrates a relatively low 8.5% 1-year stroke and death rate in stented patients.
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Affiliation(s)
- Michael J Alexander
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Alois Zauner
- Department of Neurosurgery, Stroke and Neurovascular Center of Central California, Santa Barbara, California, USA
| | - Rishi Gupta
- Neuroscience Department, WellStar Medical Group, Marietta, Georgia, USA
| | - Amer Alshekhlee
- Department of Neurology, SSM Health, St. Louis, Missouri, USA
| | - Justin F Fraser
- Department of Neurological Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Gabor Toth
- Cerebrovascular Center, CCF, Cleveland Heights, Ohio, USA
| | - Curtis Given
- Baptist Health Lexington, Lexington, Kentucky, USA
| | - Larami Mackenzie
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Brian Kott
- Department of Radiology, MultiCare Health System, Tacoma, Washington, USA
| | - Ameer E Hassan
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Blaise W Baxter
- Department of Radiology, University of Tennessee, Knoxville, Tennessee, USA
| | - R Charles Callison
- Department of Neurology, Lawnwood Regional Medical Center and Heart Institute, Fort Pierce, Florida, USA
| | - Wengui Yu
- Department of Neurology, University of California Irvine, Irvine, California, USA
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9
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Ganesh A, Menon BK, Assis ZA, Demchuk AM, Al-Ajlan FS, Al-Mekhlafi MA, Rempel JL, Shuaib A, Baxter BW, Devlin T, Thornton J, Williams D, Poppe AY, Roy D, Krings T, Casaubon LK, Kashani N, Hill MD, Goyal M. Discrepancy between post-treatment infarct volume and 90-day outcome in the ESCAPE randomized controlled trial. Int J Stroke 2020; 16:593-601. [PMID: 32515694 DOI: 10.1177/1747493020929943] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Some patients with ischemic stroke have poor outcomes despite small infarcts after endovascular thrombectomy, while others with large infarcts sometimes fare better. AIMS We explored factors associated with such discrepancies between post-treatment infarct volume (PIV) and functional outcome. METHODS We identified patients with small PIV (volume ≤ 25th percentile) and large PIV (volume ≥ 75th percentile) on 24-48-h CT/MRI in the ESCAPE randomized-controlled trial. Demographics, comorbidities, baseline, and 24-48-h stroke severity (NIHSS), stroke location, treatment type, post-stroke complications, and other outcome scales like Barthel Index, and EQ-5D were compared between "discrepant cases" - those with 90-day modified Rankin Scale(mRS) ≤ 2 despite large PIV or mRS ≥ 3 despite small PIV - and "non-discrepant cases". Multi-variable logistic regression was used to identify pre-treatment and post-treatment factors associated with small-PIV/mRS ≥ 3 and large-PIV/mRS ≤ 2. Sensitivity analyses used different definitions of small/large PIV and good/poor outcome. RESULTS Among 315 patients, median PIV was 21 mL; 27/79 (34.2%) patients with PIV ≤ 7 mL (25th percentile) had mRS ≥ 3; 12/80 (15.0%) with PIV ≥ 72 mL (75th percentile) had mRS ≤ 2. Discrepant cases did not differ by CT versus MRI-based PIV ascertainment, or right versus left-hemisphere involvement (p = 0.39, p = 0.81, respectively, for PIV ≤ 7 mL/mRS ≥ 3). Pre-treatment factors independently associated with small-PIV/mRS ≥ 3 included older age (p = 0.010), cancer, and vascular risk-factors; post-treatment factors included 48-h NIHSS (p = 0.007) and post-stroke complications (p = 0.026). Absence of vascular risk-factors (p = 0.004), CT-based lentiform nucleus sparing (p = 0.002), lower 24-hour NIHSS (p = 0.001), and absence of complications (p = 0.013) were associated with large-PIV/mRS ≤ 2. Sensitivity analyses yielded similar results. CONCLUSIONS Discrepancies between functional ability and PIV are likely explained by differences in age, comorbidities, and post-stroke complications, emphasizing the need for high-quality post-thrombectomy stroke care. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT01778335.
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Affiliation(s)
- Aravind Ganesh
- Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Bijoy K Menon
- Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
- Department of Radiology, University of Calgary, Calgary, Canada
- Departments of Community Health Sciences and Medicine, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, Calgary, Canada
| | - Zarina A Assis
- Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
- Department of Radiology, University of Calgary, Calgary, Canada
| | - Andrew M Demchuk
- Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
- Department of Radiology, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, Calgary, Canada
| | - Fahad S Al-Ajlan
- Department of Neurosciences, King Faisal Specialist Hospital, Riyadh, Saudi Arabia
| | - Mohammed A Al-Mekhlafi
- Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
- Department of Radiology, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, Calgary, Canada
| | - Jeremy L Rempel
- Department of Radiology, University of Alberta, Edmonton, Canada
| | - Ashfaq Shuaib
- Stroke Program and Department of Medicine, University of Alberta, Edmonton, Canada
| | - Blaise W Baxter
- Department of Radiology, University of Tennessee, Erlanger Hospital, Knoxville, TN, USA
| | - Thomas Devlin
- Department of Neurology, University of Tennessee, Erlanger Hospital, Knoxville, TN, USA
| | - John Thornton
- Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David Williams
- Department of Geriatric & Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Alexandre Y Poppe
- Department of Neurosciences, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Canada
| | - Daniel Roy
- Department of Radiology, CHUM, Université de Montréal, Montreal, Canada
| | - Timo Krings
- Department of Medical Imaging, University Health Network, University of Toronto, Toronto Western Hospital, Toronto, Canada
| | - Leanne K Casaubon
- Division of Neurology, Stroke Program, University Health Network, University of Toronto, Toronto Western Hospital, Toronto, Canada
| | - Nima Kashani
- Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
- Department of Radiology, University of Calgary, Calgary, Canada
| | - Michael D Hill
- Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
- Department of Radiology, University of Calgary, Calgary, Canada
- Departments of Community Health Sciences and Medicine, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, Calgary, Canada
| | - Mayank Goyal
- Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
- Department of Radiology, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, Calgary, Canada
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10
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Fargen KM, Ansari SA, Spiotta A, Dabus G, Mokin M, Brown P, Wolfe SQ, Kittel C, Kan P, Baxter BW, De Leacy R, Milburn J, Munich SA, Ducruet AF, Reeves A, Fraser JF, Starke RM, Jadhav AP, Mack WJ, Arthur AS, Pride L, Sheth SA, Rai AT, Leslie-Mazwi T, Hirsch JA. Influence of thrombectomy volume on non-physician staff burnout and attrition in neurointerventional teams. J Neurointerv Surg 2020; 12:1199-1204. [PMID: 32245843 DOI: 10.1136/neurintsurg-2020-015825] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/09/2020] [Accepted: 03/16/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Burnout takes a heavy toll on healthcare providers. We sought to assess the prevalence and risk factors for burnout among neurointerventional (NI) non-physician procedural staff (nurses and technologists) given increasing thrombectomy demands. METHODS A 41-question online survey containing questions including the Maslach Burnout Inventory-Human Services Survey for Medical Personnel was distributed to NI nurses and radiology technologists at 20 US endovascular capable stroke centers. RESULTS 244 responses were received (64% response rate). Median (IQR) composite scores for emotional exhaustion were 25 (15-35), depersonalization 6 (2-11), and personal accomplishment 39 (35-43). Fifty-one percent of respondents met established criteria for burnout. There was no significant relationship between hospital thrombectomy volume, call frequency, call cases covered, or length of commute. On multiple logistic regression analysis, feeling under-appreciated by hospital leadership (OR 4.1; P<0.001) and working with difficult/unpleasant physicians (OR 1.2; P=0.05) were strongly associated with burnout. At participating centers, nurse and technologist attrition was 25% over the previous year. Over 50% of respondents indicated they had strongly considered leaving their position over the last 2 years. CONCLUSIONS This survey of US NI non-physician procedural staff demonstrates a self-reported burnout prevalence of 51%. This was driven more by interaction with leadership and physician staff than by thrombectomy procedural volume and stroke call. Attrition among NI non-physician procedural staff is high.
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Affiliation(s)
- Kyle M Fargen
- Neurological Surgery, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Sameer A Ansari
- Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alejandro Spiotta
- Neurosciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Guilherme Dabus
- Interventional Neuroradiology and Neuroendovascularl Surgery, Miami Cardiac & Vascular Institute and Baptist Neuroscience Center, Miami, Florida, USA
| | - Maxim Mokin
- Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - Patrick Brown
- Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Stacey Q Wolfe
- Neurosurgery, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Carol Kittel
- Neurological Surgery, Winston Salem, North Carolina, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | | | - Reade De Leacy
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - James Milburn
- Radiology, Ochsner Medical System, New Orleans, Louisiana, USA
| | - Stephan A Munich
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Alan Reeves
- Radiology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Justin F Fraser
- Neurological Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Robert M Starke
- Department of Neurosurgery & Neuroradiology, University of Miami & Jackson Memorial Hospital, Miami, Florida, USA
| | | | - William J Mack
- Neurosurgery, University of Southern California, Los Angeles, California, USA
| | - Adam S Arthur
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.,Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Lee Pride
- Neuroradiology, UT Southwestern, Dallas, Texas, USA
| | - Sunil A Sheth
- Neurology, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Ansaar T Rai
- Interventional Neuroradiology, West Virginia University Hospital, Morgantown, West Virginia, USA
| | | | - Joshua A Hirsch
- NeuroEndovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
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11
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Ospel JM, Kashani N, Wilson AT, Fischer U, Campbell BCV, Sylaja PN, Yoshimura S, Rabinstein AA, Turjman F, Mitchell P, Kim BM, Cherian MP, Heo JH, Baxter BW, Podlasek A, Foss M, Menon BK, Almekhlafi MA, Demchuk AM, Hill MD, Saposnik G, Goyal M. Endovascular treatment decision in acute stroke: does physician gender matter? Insights from UNMASK EVT, an international, multidisciplinary survey. J Neurointerv Surg 2019; 12:256-259. [DOI: 10.1136/neurintsurg-2019-015003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/08/2019] [Accepted: 07/12/2019] [Indexed: 11/03/2022]
Abstract
Background and purposeDifferences in the treatment practice of female and male physicians have been shown in several medical subspecialties. It is currently not known whether this also applies to endovascular stroke treatment. The purpose of this study was to explore whether there are differences in endovascular treatment decisions made by female and male stroke physicians and neurointerventionalists.MethodsIn an international survey, stroke physicians and neurointerventionalists were randomly assigned 10 case scenarios and asked how they would treat the patient: (A) assuming there were no external constraints and (B) given their local working conditions. Descriptive statistics were used to describe baseline demographics, and the adjusted OR for physician gender as a predictor of endovascular treatment decision was calculated using logistic regression.Results607 physicians (97 women, 508 men, 2 who did not wish to declare) participated in this survey. Physician gender was neither a significant predictor for endovascular treatment decision under assumed ideal conditions (endovascular therapy was favored by 77.0% of female and 79.3% of male physicians, adjusted OR 1.03, P=0.806) nor under current local resources (endovascular therapy was favored by 69.1% of female and 76.9% of male physicians, adjusted OR 1.03, P=0.814).ConclusionEndovascular therapy decision making between male and female physicians did not differ under assumed ideal conditions or under current local resources.
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12
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Ospel JM, Kashani N, Goyal M, Menon BK, Campbell BCV, Fischer U, Turjman F, Mitchell P, Yoshimura S, Podlasek A, Rabinstein AA, Wilson AT, Kim BM, Baxter BW, Cherian MP, Heo JH, Foss M, Demchuk AM, Sylaja PN, Hill MD, Saposnik G, Almekhlafi MA. Time of day and endovascular treatment decision in acute stroke with relative endovascular treatment indication: insights from UNMASK EVT international survey. J Neurointerv Surg 2019; 12:122-126. [DOI: 10.1136/neurintsurg-2019-014976] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 11/03/2022]
Abstract
Background and purposeThe decision to proceed with endovascular thrombectomy should ideally be made independent of inconvenience factors, such as daytime. We assessed the influence of patient presentation time on endovascular therapy decision making under current local resources and assumed ideal conditions in acute ischemic stroke with level 2B evidence for endovascular treatment.Methods and materialsIn an international cross sectional survey, 607 stroke physicians from 38 countries were asked to give their treatment decisions to 10 out of 22 randomly assigned case scenarios. Eleven scenarios had level 2B evidence for endovascular treatment: 7 daytime scenarios (7:00 am–5:00 pm) and four night time cases (5:01 pm– 6:59 am). Participants provided their treatment approach assuming (A) there were no practice constraints and (B) under their current local resources. Endovascular treatment decisions in the 11 scenarios were analyzed according to presentation time with adjustment for patient and physician characteristics.ResultsParticipants selected endovascular therapy in 74.2% under assumed ideal conditions, and 70.7% under their current local resources of night time scenarios, and in 67.2% and 63.8% of daytime scenarios. Night time presentation did not increase the probability of a treatment decision against endovascular therapy under current local resources or assumed ideal conditions.ConclusionPresentation time did not influence endovascular treatment decision making in stroke patients in this international survey.
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Zaidat OO, Mueller-Kronast NH, Hassan AE, Haussen DC, Jadhav AP, Froehler MT, Jahan R, Ali Aziz-Sultan M, Klucznik RP, Saver JL, Hellinger FR, Yavagal DR, Yao TL, Gupta R, Martin CO, Bozorgchami H, Kaushal R, Nogueira RG, Gandhi RH, Peterson EC, Dashti S, Given CA, Mehta BP, Deshmukh V, Starkman S, Linfante I, McPherson SH, Kvamme P, Grobelny TJ, Hussain MS, Thacker I, Vora N, Chen PR, Monteith SJ, Ecker RD, Schirmer CM, Sauvageau E, Chebl AB, Derdeyn CP, Maidan L, Badruddin A, Siddiqui AH, Dumont TM, Alhajeri A, Taqi MA, Asi K, Carpenter J, Boulos A, Jindal G, Puri AS, Chitale R, Deshaies EM, Robinson D, Kallmes DF, Baxter BW, Jumaa M, Sunenshine P, Majjhoo A, English JD, Suzuki S, Fessler RD, Delgado-Almandoz J, Martin JC, Liebeskind DS. Impact of Balloon Guide Catheter Use on Clinical and Angiographic Outcomes in the STRATIS Stroke Thrombectomy Registry. Stroke 2019; 50:697-704. [DOI: 10.1161/strokeaha.118.021126] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Osama O. Zaidat
- From the Mercy Health St. Vincent Mercy Hospital, Toledo, OH (O.O.Z.)
| | | | | | - Diogo C. Haussen
- Emory University School of Medicine, Atlanta, GA (D.C.H.)
- Grady Memorial Hospital, Atlanta, GA (D.C.H., R.G.N.)
| | | | | | - Reza Jahan
- University of California, Los Angeles, CA (R.J., J.L.S., S.S., D.S.L.)
| | | | | | - Jeffrey L. Saver
- University of California, Los Angeles, CA (R.J., J.L.S., S.S., D.S.L.)
| | | | - Dileep R. Yavagal
- University of Miami Miller School of Medicine/Jackson Memorial Hospital, FL (D.R.Y., E.C.P.)
| | - Tom L. Yao
- Norton Neuroscience Institute, Norton Healthcare, Louisville, KY (T.L.Y., S.D.)
| | - Rishi Gupta
- WellStar Neurosciences Network, WellStar Kennestone Regional Medical Center, Marietta, GA (R.G.)
| | | | | | - Ritesh Kaushal
- Advanced Neuroscience Network/Tenet South Florida, Coral Springs (N.H.M.-K., R.K.)
| | | | - Ravi H. Gandhi
- Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.)
| | - Eric C. Peterson
- University of Miami Miller School of Medicine/Jackson Memorial Hospital, FL (D.R.Y., E.C.P.)
| | - Shervin Dashti
- Norton Neuroscience Institute, Norton Healthcare, Louisville, KY (T.L.Y., S.D.)
| | | | | | - Vivek Deshmukh
- Providence St. Vincent Medical Center, Portland, OR (V.D.)
| | - Sidney Starkman
- University of California, Los Angeles, CA (R.J., J.L.S., S.S., D.S.L.)
| | | | | | - Peter Kvamme
- University of Tennessee Medical Center, Knoxville (P.K.)
| | | | | | - Ike Thacker
- Baylor University Medical Center, Dallas, TX (I.T.)
| | - Nirav Vora
- OhioHealth Riverside Methodist Hospital, Columbus (N.V.)
| | - Peng Roc Chen
- Memorial Hermann Texas Medical Center, Houston (P.R.C.)
| | | | | | | | | | | | | | - Lucian Maidan
- Mercy San Juan Medical Center and Mercy General, Carmichael, CA (L.M.)
| | | | | | | | | | | | | | | | | | - Gaurav Jindal
- University of Maryland Medical Center, Baltimore (G.J.)
| | - Ajit S. Puri
- University of Massachusetts Memorial Medical Center, Worcester (A.S.P.)
| | - Rohan Chitale
- Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.)
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Liebeskind DS, Zhang Y, Veznedaroglu E, English J, Baxter BW, Budzik RF, Bartolini BM, Krajina A, Malek A, Sarraj A, Nogueira RG, Gupta R. Abstract WP111: Who Needs Neuroprotection With Endovascular Stroke Therapy? Findings From the Trevo Retriever Registry. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.wp111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Combined neuroprotection with endovascular therapy may improve clinical outcomes of only a subset of individuals treated for acute ischemic stroke. The risk/benefit profile of adjunctive treatment may not warrant neuroprotection with successful reperfusion, yet many other individuals have poor outcomes despite revascularization. We hypothesized that optimal candidates for adjunctive neuroprotection may be defined by analyses of subjects with poor clinical outcome despite successful reperfusion in the Trevo Retriever Registry.
Methods:
The Trevo Retriever Registry dataset was analyzed to define the subset of cases with poor clinical outcome (day 90 mRS 4-6) after successful reperfusion (eTICI 2b50, 2b67, 2c, 3). Multivariate analyses were used to identify predictors of poor outcome using these distinct definitions of successful reperfusion. The influence of covariates, including TLSW, baseline clinical and imaging variables (e.g. ASPECTS, ASITN collateral grade), on defining such optimal neuroprotective candidates was delineated.
Results:
Successful reperfusion adjudicated by core lab, defined as eTICI ≥ 2b50 included 1,162 subjects, with eTICI ≥ 2b67 in 920, eTICI ≥ 2c in 652 and eTICI 3 in 209. Poor outcome (day 90 mRS 4-6) occurred in 316/1162 (27%) with eTICI ≥ 2b50, 243/920 (26%) with eTICI ≥ 2b67, 172/652 (26%) with eTICI ≥ 2c and 61/209 (29%) with eTICI 3. Across all subsets, multivariate analyses to predict poor outcome after successful reperfusion identified increased age (per year, OR 1.04-1.05, all p=<0.02) as a factor, adjusting for withdrawal of care. Expectedly, greater baseline NIHSS severity predicted greater day 90 disability (OR 1.07-1.08, all p<0.001). TLSW was a predictor only with eTICI ≥ 2b50 (per hour, OR 1.02, p=0.039). History of diabetes was a factor only with eTICI ≥ 2b50 and eTICI ≥ 2b67 (OR 2.05-2.19, p<0.001). Worse collateral grade (ASITN 0-1) was the most potent predictor (OR 2.27-2.71 versus ASITN 2, p=0.027-0.052; OR 3.85-4.35 versus ASITN 3-4, all p=0.003).
Conclusions:
Neuroprotection combined with endovascular therapy may optimally target stroke patients with worse collaterals, diabetes or increased age. Trial design for neuroprotection with revascularization in AIS should leverage these data.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ali Malek
- St. Mary's Med Ctr, West Palm Beach, FL
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15
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Liebeskind DS, Zhang Y, Veznedaroglu E, English J, Baxter BW, Budzik RF, Bartolini BM, Krajina A, Malek A, Sarraj A, Gupta R, Nogueira RG. Abstract WMP4: Fast versus Slow Progressors in Real-World Data From the Trevo Retriever Registry: Collaterals Dominate Time to Reperfusion in Clinical Outcome After Thrombectomy. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.wmp4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Time to reperfusion (TTR) is commonly cited in clinical outcome after endovascular treatment of acute ischemic stroke, yet collaterals may set the pace of ischemia. Real-world data on fast and slow progressors also remain scarce. We analyzed the impact of TTR on clinical outcome in real-world data using core lab adjudicated angiography, interventional steps and corresponding reperfusion.
Methods:
16 key time intervals were calculated from workflow (time of symptom onset, door, picture, puncture) and core lab metrics (clot visualization, first deployment, first reperfusion, final angiography) in real-world data from the Trevo Retriever Registry. These 16 variations of TTR were analyzed overall and by collateral status (ASITN 0-1 versus 2 versus 3-4) to determine the relationship with 90-day clinical outcomes.
Results:
Real-world data on endovascular therapy from 1,441 subjects in the Trevo Retriever Registry were analyzed to relate TTR with clinical outcomes. Overall metrics for TTR are shown in Table 1. TTR was not linked with collateral status. Using a multivariate model incorporating known predictors, there was no influence of TTR using any of the 16 definitions on clinical outcome. Better collateral status on DSA prior to revascularization showed a potent relationship with 90-day mRS (p<0.001) and better probability of functional independence (aOR 1.4, 95% CI 1.2, 1.7) per grade of collateral flow.
Conclusions:
Collaterals transform time to reperfusion, linking fast and slow progressors with subsequent clinical outcomes. TTR may be standardized based on these 16 key epochs in endovascular stroke therapy to document workflow metrics. Time is relative, even when measured with detailed, standardized metrics.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ali Malek
- St. Mary's Med Ctr, West Palm Beach, FL
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16
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Almekhlafi MA, Kunz WG, Menon BK, McTaggart RA, Jayaraman MV, Baxter BW, Heck D, Frei D, Derdeyn CP, Takagi T, Aamodt AH, Fragata IMR, Hill MD, Demchuk AM, Goyal M. Imaging of Patients with Suspected Large-Vessel Occlusion at Primary Stroke Centers: Available Modalities and a Suggested Approach. AJNR Am J Neuroradiol 2019; 40:396-400. [PMID: 30705072 DOI: 10.3174/ajnr.a5971] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 12/06/2018] [Indexed: 12/24/2022]
Abstract
The overwhelming benefit of endovascular therapy in patients with large-vessel occlusions suggests that more patients will be screened than treated. Some of those patients will be evaluated first at primary stroke centers; this type of evaluation calls for standardizing the imaging approach to minimize delays in assessing, transferring, and treating these patients. Here, we propose that CT angiography (performed at the same time as head CT) should be the minimum imaging approach for all patients with stroke with suspected large-vessel occlusion presenting to primary stroke centers. We discuss some of the implications of this approach and how to facilitate them.
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Affiliation(s)
- M A Almekhlafi
- From the Departments of Radiology and Clinical Neurosciences (M.A.A., B.K.M., M.D.H., A.M.D., M.G.), University of Calgary, Calgary, Alberta, Canada
| | - W G Kunz
- Department of Radiology (W.G.K.), University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - B K Menon
- From the Departments of Radiology and Clinical Neurosciences (M.A.A., B.K.M., M.D.H., A.M.D., M.G.), University of Calgary, Calgary, Alberta, Canada
| | - R A McTaggart
- Departments of Neurology, Diagnostic Imaging, and Neurosurgery (R.A.M., M.V.J.), Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - M V Jayaraman
- Departments of Neurology, Diagnostic Imaging, and Neurosurgery (R.A.M., M.V.J.), Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - B W Baxter
- Department of Radiology (B.W.B.), Erlanger Medical Center, Chattanooga, Tennessee
| | - D Heck
- Department of Radiology (D.H.), Forsyth Medical Center, Winston Salem, North Carolina
| | - D Frei
- Swedish Medical Center (D.F.), Denver, Colorado
| | - C P Derdeyn
- Department of Radiology (C.P.D.), University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - T Takagi
- Department of Neurosurgery (T.T.), Hyogo College of Medicine, Nishinomiya, Hyögo, Japan
| | - A H Aamodt
- Department of Neurology (A.H.A.), Oslo University Hospital, Oslo, Norway
| | - I M R Fragata
- Department of Neuroradiology (I.M.R.F.), Centro Hospitalar Lisboa Central, Lisbon, Portugal
| | - M D Hill
- From the Departments of Radiology and Clinical Neurosciences (M.A.A., B.K.M., M.D.H., A.M.D., M.G.), University of Calgary, Calgary, Alberta, Canada
| | - A M Demchuk
- From the Departments of Radiology and Clinical Neurosciences (M.A.A., B.K.M., M.D.H., A.M.D., M.G.), University of Calgary, Calgary, Alberta, Canada
| | - M Goyal
- From the Departments of Radiology and Clinical Neurosciences (M.A.A., B.K.M., M.D.H., A.M.D., M.G.), University of Calgary, Calgary, Alberta, Canada
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Román LS, Menon BK, Blasco J, Hernández-Pérez M, Dávalos A, Majoie CBLM, Campbell BCV, Guillemin F, Lingsma H, Anxionnat R, Epstein J, Saver JL, Marquering H, Wong JH, Lopes D, Reimann G, Desal H, Dippel DWJ, Coutts S, du Mesnil de Rochemont R, Yavagal D, Ferre JC, Roos YBWEM, Liebeskind DS, Lenthall R, Molina C, Al Ajlan FS, Reddy V, Dowlatshahi D, Sourour NA, Oppenheim C, Mitha AP, Davis SM, Weimar C, van Oostenbrugge RJ, Cobo E, Kleinig TJ, Donnan GA, van der Lugt A, Demchuk AM, Berkhemer OA, Boers AMM, Ford GA, Muir KW, Brown BS, Jovin T, van Zwam WH, Mitchell PJ, Hill MD, White P, Bracard S, Goyal M, Berkhemer OA, Fransen PSS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJH, van Walderveen MAA, Staals J, Hofmeijer J, van Oostayen JA, Lycklama à Nijeholt GJ, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk LC, Kappelle J, Lo RH, van Dijk EJ, de Vries J, de Kort PL, van Rooij WJJ, van den Berg JS, van Hasselt BA, Aerden LA, Dallinga RJ, Visser MC, Bot JC, Vroomen PC, Eshghi O, Schreuder TH, Heijboer RJ, Keizer K, Tielbeek AV, den Hertog HM, Gerrits DG, van den Berg-Vos RM, Karas GB, Steyerberg EW, Flach Z, Marquering HA, Sprengers ME, Jenniskens SF, Beenen LF, Zech M, Kowarik M, Seifert C, Schwaiger B, Puri A, Hou S, Wakhloo A, Moonis M, Henniger N, Goddeau R, van den Berg R, Massari F, Minaeian A, Lozano JD, Ramzan M, Stout C, Patel A, Tunguturi A, Onteddu S, Carandang R, Howk M, Koudstaal PJ, Ribó M, Sanjuan E, Rubiera M, Pagola J, Flores A, Muchada M, Meler P, Huerga E, Gelabert S, Coscojuela P, van Zwam WH, Tomasello A, Rodriguez D, Santamarina E, Maisterra O, Boned S, Seró L, Rovira A, Molina CA, Millán M, Muñoz L, Roos YB, Pérez de la Ossa N, Gomis M, Dorado L, López-Cancio E, Palomeras E, Munuera J, García Bermejo P, Remollo S, Castaño C, García-Sort R, van der Lugt A, Cuadras P, Puyalto P, Hernández-Pérez M, Jiménez M, Martínez-Piñeiro A, Lucente G, Dávalos A, Chamorro A, Urra X, Obach V, van Oostenbrugge RJ, Cervera A, Amaro S, Llull L, Codas J, Balasa M, Navarro J, Ariño H, Aceituno A, Rudilosso S, Renu A, Majoie CB, Macho JM, San Roman L, Blasco J, López A, Macías N, Cardona P, Quesada H, Rubio F, Cano L, Lara B, Dippel DW, de Miquel MA, Aja L, Serena J, Cobo E, Albers GW, Lees KR, Arenillas J, Roberts R, Minhas P, Al-Ajlan F, Brown MM, Salluzzi M, Zimmel L, Patel S, Eesa M, Martí-Fàbregas J, Jankowitz B, Serena J, Salvat-Plana M, López-Cancio E, Bracard S, Liebig T, Ducrocq X, Anxionnat R, Baillot PA, Barbier C, Derelle AL, Lacour JC, Richard S, Samson Y, Sourour N, Baronnet-Chauvet F, Stijnen T, Clarencon F, Crozier S, Deltour S, Di Maria F, Le Bouc R, Leger A, Mutlu G, Rosso C, Szatmary Z, Yger M, Andersson T, Zavanone C, Bakchine S, Pierot L, Caucheteux N, Estrade L, Kadziolka K, Leautaud A, Renkes C, Serre I, Desal H, Mattle H, Guillon B, Boutoleau-Bretonniere C, Daumas-Duport B, De Gaalon S, Derkinderen P, Evain S, Herisson F, Laplaud DA, Lebouvier T, Lintia-Gaultier A, Wahlgren N, Pouclet-Courtemanche H, Rouaud T, Rouaud Jaffrenou V, Schunck A, Sevin-Allouet M, Toulgoat F, Wiertlewski S, Gauvrit JY, Ronziere T, Cahagne V, van der Heijden E, Ferre JC, Pinel JF, Raoult H, Mas JL, Meder JF, Al Najjar-Carpentier AA, Birchenall J, Bodiguel E, Calvet D, Domigo V, Ghannouti N, Godon-Hardy S, Guiraud V, Lamy C, Majhadi L, Morin L, Naggara O, Trystram D, Turc G, Berge J, Sibon I, Fleitour N, Menegon P, Barreau X, Rouanet F, Debruxelles S, Kazadi A, Renou P, Fleury O, Pasco-Papon A, Dubas F, Caroff J, Hooijenga I, Godard Ducceschi S, Hamon MA, Lecluse A, Marc G, Giroud M, Ricolfi F, Bejot Y, Chavent A, Gentil A, Kazemi A, Puppels C, Osseby GV, Voguet C, Mahagne MH, Sedat J, Chau Y, Suissa L, Lachaud S, Houdart E, Stapf C, Buffon Porcher F, Pellikaan W, Chabriat H, Guedin P, Herve D, Jouvent E, Mawet J, Saint-Maurice JP, Schneble HM, Turjman F, Nighoghossian N, Berhoune NN, Geerling A, Bouhour F, Cho TH, Derex L, Felix S, Gervais-Bernard H, Gory B, Manera L, Mechtouff L, Ritzenthaler T, Riva R, Lindl-Velema A, Salaris Silvio F, Tilikete C, Blanc R, Obadia M, Bartolini MB, Gueguen A, Piotin M, Pistocchi S, Redjem H, Drouineau J, van Vemde G, Neau JP, Godeneche G, Lamy M, Marsac E, Velasco S, Clavelou P, Chabert E, Bourgois N, Cornut-Chauvinc C, Ferrier A, de Ridder A, Gabrillargues J, Jean B, Marques AR, Vitello N, Detante O, Barbieux M, Boubagra K, Favre Wiki I, Garambois K, Tahon F, Greebe P, Ashok V, Voguet C, Coskun O, Guedin P, Rodesch G, Lapergue B, Bourdain F, Evrard S, Graveleau P, Decroix JP, de Bont-Stikkelbroeck J, Wang A, Sellal F, Ahle G, Carelli G, Dugay MH, Gaultier C, Lebedinsky AP, Lita L, Musacchio RM, Renglewicz-Destuynder C, de Meris J, Tournade A, Vuillemet F, Montoro FM, Mounayer C, Faugeras F, Gimenez L, Labach C, Lautrette G, Denier C, Saliou G, Janssen K, Chassin O, Dussaule C, Melki E, Ozanne A, Puccinelli F, Sachet M, Sarov M, Bonneville JF, Moulin T, Biondi A, Struijk W, De Bustos Medeiros E, Vuillier F, Courtheoux P, Viader F, Apoil-Brissard M, Bataille M, Bonnet AL, Cogez J, Kazemi A, Touze E, Licher S, Leclerc X, Leys D, Aggour M, Aguettaz P, Bodenant M, Cordonnier C, Deplanque D, Girot M, Henon H, Kalsoum E, Boodt N, Lucas C, Pruvo JP, Zuniga P, Bonafé A, Arquizan C, Costalat V, Machi P, Mourand I, Riquelme C, Bounolleau P, Ros A, Arteaga C, Faivre A, Bintner M, Tournebize P, Charlin C, Darcel F, Gauthier-Lasalarie P, Jeremenko M, Mouton S, Zerlauth JB, Venema E, Lamy C, Hervé D, Hassan H, Gaston A, Barral FG, Garnier P, Beaujeux R, Wolff V, Herbreteau D, Debiais S, Slokkers I, Murray A, Ford G, Muir KW, White P, Brown MM, Clifton A, Freeman J, Ford I, Markus H, Wardlaw J, Ganpat RJ, Lees KR, Molyneux A, Robinson T, Lewis S, Norrie J, Robertson F, Perry R, Dixit A, Cloud G, Clifton A, Mulder M, Madigan J, Roffe C, Nayak S, Lobotesis K, Smith C, Herwadkar A, Kandasamy N, Goddard T, Bamford J, Subramanian G, Saiedie N, Lenthall R, Littleton E, Lamin S, Storey K, Ghatala R, Banaras A, Aeron-Thomas J, Hazel B, Maguire H, Veraque E, Heshmatollah A, Harrison L, Keshvara R, Cunningham J, Schipperen S, Vinken S, van Boxtel T, Koets J, Boers M, Santos E, Borst J, Jansen I, Kappelhof M, Lucas M, Geuskens R, Barros RS, Dobbe R, Csizmadia M, Hill MD, Goyal M, Demchuk AM, Menon BK, Eesa M, Ryckborst KJ, Wright MR, Kamal NR, Andersen L, Randhawa PA, Stewart T, Patil S, Minhas P, Almekhlafi M, Mishra S, Clement F, Sajobi T, Shuaib A, Montanera WJ, Roy D, Silver FL, Jovin TG, Frei DF, Sapkota B, Rempel JL, Thornton J, Williams D, Tampieri D, Poppe AY, Dowlatshahi D, Wong JH, Mitha AP, Subramaniam S, Hull G, Lowerison MW, Sajobi T, Salluzzi M, Wright MR, Maxwell M, Lacusta S, Drupals E, Armitage K, Barber PA, Smith EE, Morrish WF, Coutts SB, Derdeyn C, Demaerschalk B, Yavagal D, Martin R, Brant R, Yu Y, Willinsky RA, Montanera WJ, Weill A, Kenney C, Aram H, Stewart T, Stys PK, Watson TW, Klein G, Pearson D, Couillard P, Trivedi A, Singh D, Klourfeld E, Imoukhuede O, Nikneshan D, Blayney S, Reddy R, Choi P, Horton M, Musuka T, Dubuc V, Field TS, Desai J, Adatia S, Alseraya A, Nambiar V, van Dijk R, Wong JH, Mitha AP, Morrish WF, Eesa M, Newcommon NJ, Shuaib A, Schwindt B, Butcher KS, Jeerakathil T, Buck B, Khan K, Naik SS, Emery DJ, Owen RJ, Kotylak TB, Ashforth RA, Yeo TA, McNally D, Siddiqui M, Saqqur M, Hussain D, Kalashyan H, Manosalva A, Kate M, Gioia L, Hasan S, Mohammad A, Muratoglu M, Williams D, Thornton J, Cullen A, Brennan P, O'Hare A, Looby S, Hyland D, Duff S, McCusker M, Hallinan B, Lee S, McCormack J, Moore A, O'Connor M, Donegan C, Brewer L, Martin A, Murphy S, O'Rourke K, Smyth S, Kelly P, Lynch T, Daly T, O'Brien P, O'Driscoll A, Martin M, Daly T, Collins R, Coughlan T, McCabe D, Murphy S, O'Neill D, Mulroy M, Lynch O, Walsh T, O'Donnell M, Galvin T, Harbison J, McElwaine P, Mulpeter K, McLoughlin C, Reardon M, Harkin E, Dolan E, Watts M, Cunningham N, Fallon C, Gallagher S, Cotter P, Crowe M, Doyle R, Noone I, Lapierre M, Coté VA, Lanthier S, Odier C, Durocher A, Raymond J, Weill A, Daneault N, Deschaintre Y, Jankowitz B, Baxendell L, Massaro L, Jackson-Graves C, Decesare S, Porter P, Armbruster K, Adams A, Billigan J, Oakley J, Ducruet A, Jadhav A, Giurgiutiu DV, Aghaebrahim A, Reddy V, Hammer M, Starr M, Totoraitis V, Wechsler L, Streib S, Rangaraju S, Campbell D, Rocha M, Gulati D, Silver FL, Krings T, Kalman L, Cayley A, Williams J, Stewart T, Wiegner R, Casaubon LK, Jaigobin C, del Campo JM, Elamin E, Schaafsma JD, Willinsky RA, Agid R, Farb R, ter Brugge K, Sapkoda BL, Baxter BW, Barton K, Knox A, Porter A, Sirelkhatim A, Devlin T, Dellinger C, Pitiyanuvath N, Patterson J, Nichols J, Quarfordt S, Calvert J, Hawk H, Fanale C, Frei DF, Bitner A, Novak A, Huddle D, Bellon R, Loy D, Wagner J, Chang I, Lampe E, Spencer B, Pratt R, Bartt R, Shine S, Dooley G, Nguyen T, Whaley M, McCarthy K, Teitelbaum J, Tampieri D, Poon W, Campbell N, Cortes M, Dowlatshahi D, Lum C, Shamloul R, Robert S, Stotts G, Shamy M, Steffenhagen N, Blacquiere D, Hogan M, AlHazzaa M, Basir G, Lesiuk H, Iancu D, Santos M, Choe H, Weisman DC, Jonczak K, Blue-Schaller A, Shah Q, MacKenzie L, Klein B, Kulandaivel K, Kozak O, Gzesh DJ, Harris LJ, Khoury JS, Mandzia J, Pelz D, Crann S, Fleming L, Hesser K, Beauchamp B, Amato-Marzialli B, Boulton M, Lopez-Ojeda P, Sharma M, Lownie S, Chan R, Swartz R, Howard P, Golob D, Gladstone D, Boyle K, Boulos M, Hopyan J, Yang V, Da Costa L, Holmstedt CA, Turk AS, Navarro R, Jauch E, Ozark S, Turner R, Phillips S, Shankar J, Jarrett J, Gubitz G, Maloney W, Vandorpe R, Schmidt M, Heidenreich J, Hunter G, Kelly M, Whelan R, Peeling L, Burns PA, Hunter A, Wiggam I, Kerr E, Watt M, Fulton A, Gordon P, Rennie I, Flynn P, Smyth G, O'Leary S, Gentile N, Linares G, McNelis P, Erkmen K, Katz P, Azizi A, Weaver M, Jungreis C, Faro S, Shah P, Reimer H, Kalugdan V, Saposnik G, Bharatha A, Li Y, Kostyrko P, Santos M, Marotta T, Montanera W, Sarma D, Selchen D, Spears J, Heo JH, Jeong K, Kim DJ, Kim BM, Kim YD, Song D, Lee KJ, Yoo J, Bang OY, Rho S, Lee J, Jeon P, Kim KH, Cha J, Kim SJ, Ryoo S, Lee MJ, Sohn SI, Kim CH, Ryu HG, Hong JH, Chang HW, Lee CY, Rha J, Davis SM, Donnan GA, Campbell BCV, Mitchell PJ, Churilov L, Yan B, Dowling R, Yassi N, Oxley TJ, Wu TY, Silver G, McDonald A, McCoy R, Kleinig TJ, Scroop R, Dewey HM, Simpson M, Brooks M, Coulton B, Krause M, Harrington TJ, Steinfort B, Faulder K, Priglinger M, Day S, Phan T, Chong W, Holt M, Chandra RV, Ma H, Young D, Wong K, Wijeratne T, Tu H, Mackay E, Celestino S, Bladin CF, Loh PS, Gilligan A, Ross Z, Coote S, Frost T, Parsons MW, Miteff F, Levi CR, Ang T, Spratt N, Kaauwai L, Badve M, Rice H, de Villiers L, Barber PA, McGuinness B, Hope A, Moriarty M, Bennett P, Wong A, Coulthard A, Lee A, Jannes J, Field D, Sharma G, Salinas S, Cowley E, Snow B, Kolbe J, Stark R, King J, Macdonnell R, Attia J, D'Este C, Saver JL, Goyal M, Diener HC, Levy EI, Bonafé A, Mendes Pereira V, Jahan R, Albers GW, Cognard C, Cohen DJ, Hacke W, Jansen O, Jovin TG, Mattle HP, Nogueira RG, Siddiqui AH, Yavagal DR, von Kummer R, Smith W, Turjman F, Hamilton S, Chiacchierini R, Amar A, Sanossian N, Loh Y, Devlin T, Baxter B, Hawk H, Sapkota B, Quarfordt S, Sirelkhatim A, Dellinger C, Barton K, Reddy VK, Ducruet A, Jadhav A, Horev A, Giurgiutiu DV, Totoraitis V, Hammer M, Jankowitz B, Wechsler L, Rocha M, Gulati D, Campbell D, Star M, Baxendell L, Oakley J, Siddiqui A, Hopkins LN, Snyder K, Sawyer R, Hall S, Costalat V, Riquelme C, Machi P, Omer E, Arquizan C, Mourand I, Charif M, Ayrignac X, Menjot de Champfleur N, Leboucq N, Gascou G, Moynier M, du Mesnil de Rochemont R, Singer O, Berkefeld J, Foerch C, Lorenz M, Pfeilschifer W, Hattingen E, Wagner M, You SJ, Lescher S, Braun H, Dehkharghani S, Belagaje SR, Anderson A, Lima A, Obideen M, Haussen D, Dharia R, Frankel M, Patel V, Owada K, Saad A, Amerson L, Horn C, Doppelheuer S, Schindler K, Lopes DK, Chen M, Moftakhar R, Anton C, Smreczak M, Carpenter JS, Boo S, Rai A, Roberts T, Tarabishy A, Gutmann L, Brooks C, Brick J, Domico J, Reimann G, Hinrichs K, Becker M, Heiss E, Selle C, Witteler A, Al-Boutros S, Danch MJ, Ranft A, Rohde S, Burg K, Weimar C, Zegarac V, Hartmann C, Schlamann M, Göricke S, Ringlestein A, Wanke I, Mönninghoff C, Dietzold M, Budzik R, Davis T, Eubank G, Hicks WJ, Pema P, Vora N, Mejilla J, Taylor M, Clark W, Rontal A, Fields J, Peterson B, Nesbit G, Lutsep H, Bozorgchami H, Priest R, Ologuntoye O, Barnwell S, Dogan A, Herrick K, Takahasi C, Beadell N, Brown B, Jamieson S, Hussain MS, Russman A, Hui F, Wisco D, Uchino K, Khawaja Z, Katzan I, Toth G, Cheng-Ching E, Bain M, Man S, Farrag A, George P, John S, Shankar L, Drofa A, Dahlgren R, Bauer A, Itreat A, Taqui A, Cerejo R, Richmond A, Ringleb P, Bendszus M, Möhlenbruch M, Reiff T, Amiri H, Purrucker J, Herweh C, Pham M, Menn O, Ludwig I, Acosta I, Villar C, Morgan W, Sombutmai C, Hellinger F, Allen E, Bellew M, Gandhi R, Bonwit E, Aly J, Ecker RD, Seder D, Morris J, Skaletsky M, Belden J, Baker C, Connolly LS, Papanagiotou P, Roth C, Kastrup A, Politi M, Brunner F, Alexandrou M, Merdivan H, Ramsey C, Given II C, Renfrow S, Deshmukh V, Sasadeusz K, Vincent F, Thiesing JT, Putnam J, Bhatt A, Kansara A, Caceves D, Lowenkopf T, Yanase L, Zurasky J, Dancer S, Freeman B, Scheibe-Mirek T, Robison J, Rontal A, Roll J, Clark D, Rodriguez M, Fitzsimmons BFM, Zaidat O, Lynch JR, Lazzaro M, Larson T, Padmore L, Das E, Farrow-Schmidt A, Hassan A, Tekle W, Cate C, Jansen O, Cnyrim C, Wodarg F, Wiese C, Binder A, Riedel C, Rohr A, Lang N, Laufs H, Krieter S, Remonda L, Diepers M, Añon J, Nedeltchev K, Kahles T, Biethahn S, Lindner M, Chang V, Gächter C, Esperon C, Guglielmetti M, Arenillas Lara JF, Martínez Galdámez M, Calleja Sanz AI, Cortijo Garcia E, Garcia Bermejo P, Perez S, Mulero Carrillo P, Crespo Vallejo E, Ruiz Piñero M, Lopez Mesonero L, Reyes Muñoz FJ, Brekenfeld C, Buhk JH, Krützelmann A, Thomalla G, Cheng B, Beck C, Hoppe J, Goebell E, Holst B, Grzyska U, Wortmann G, Starkman S, Duckwiler G, Jahan R, Rao N, Sheth S, Ng K, Noorian A, Szeder V, Nour M, McManus M, Huang J, Tarpley J, Tateshima S, Gonzalez N, Ali L, Liebeskind D, Hinman J, Calderon-Arnulphi M, Liang C, Guzy J, Koch S, DeSousa K, Gordon-Perue G, Haussen D, Elhammady M, Peterson E, Pandey V, Dharmadhikari S, Khandelwal P, Malik A, Pafford R, Gonzalez P, Ramdas K, Andersen G, Damgaard D, Von Weitzel-Mudersbach P, Simonsen C, Ruiz de Morales Ayudarte N, Poulsen M, Sørensen L, Karabegovich S, Hjørringgaard M, Hjort N, Harbo T, Sørensen K, Deshaies E, Padalino D, Swarnkar A, Latorre JG, Elnour E, El-Zammar Z, Villwock M, Farid H, Balgude A, Cross L, Hansen K, Holtmannspötter M, Kondziella D, Hoejgaard J, Taudorf S, Soendergaard H, Wagner A, Cronquist M, Stavngaard T, Cortsen M, Krarup LH, Hyldal T, Haring HP, Guggenberger S, Hamberger M, Trenkler J, Sonnberger M, Nussbaumer K, Dominger C, Bach E, Jagadeesan BD, Taylor R, Kim J, Shea K, Tummala R, Zacharatos H, Sandhu D, Ezzeddine M, Grande A, Hildebrandt D, Miller K, Scherber J, Hendrickson A, Jumaa M, Zaidi S, Hendrickson T, Snyder V, Killer-Oberpfalzer M, Mutzenbach J, Weymayr F, Broussalis E, Stadler K, Jedlitschka A, Malek A, Mueller-Kronast N, Beck P, Martin C, Summers D, Day J, Bettinger I, Holloway W, Olds K, Arkin S, Akhtar N, Boutwell C, Crandall S, Schwartzman M, Weinstein C, Brion B, Prothmann S, Kleine J, Kreiser K, Boeckh-Behrens T, Poppert H, Wunderlich S, Koch ML, Biberacher V, Huberle A, Gora-Stahlberg G, Knier B, Meindl T, Utpadel-Fischler D. Imaging features and safety and efficacy of endovascular stroke treatment: a meta-analysis of individual patient-level data. Lancet Neurol 2018; 17:895-904. [DOI: 10.1016/s1474-4422(18)30242-4] [Citation(s) in RCA: 213] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 11/29/2022]
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Leslie-Mazwi T, Chandra RV, Fraser JF, Hoh B, Baxter BW, Albuquerque FC, Hirsch JA. AHA/ASA 2018 AIS guidelines: impact and opportunity for endovascular stroke care. J Neurointerv Surg 2018; 10:813-817. [PMID: 29807886 DOI: 10.1136/neurintsurg-2018-013911] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Thabele Leslie-Mazwi
- Departments of Neurosurgery and Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ronil V Chandra
- Department of Radiology, Monash University, Melbourne, Victoria, Australia
| | - Justin F Fraser
- Departments of Neurological Surgery, Neurology, Radiology, and Neuroscience, University of Kentucky, Lexington, Kentucky, USA
| | - Brian Hoh
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Blaise W Baxter
- Tennessee Interventional & Imaging Associates/Erlanger, Chattanooga, Tennessee, USA
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Joshua A Hirsch
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Mokin M, Chinea A, Primiani CT, Ren Z, Kan P, Srinivasan VM, Hanel R, Aguilar-Salinas P, Turk AS, Turner RD, Chaudry MI, Ringer AJ, Welch BG, Mendes Pereira V, Renieri L, Piano M, Elijovich L, Arthur AS, Cheema A, Lopes DK, Saied A, Baxter BW, Hawk H, Puri AS, Wakhloo AK, Shallwani H, Levy EI, Siddiqui AH, Dabus G, Linfante I. Treatment of blood blister aneurysms of the internal carotid artery with flow diversion. J Neurointerv Surg 2018; 10:1074-1078. [DOI: 10.1136/neurintsurg-2017-013701] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/07/2018] [Accepted: 02/08/2018] [Indexed: 11/03/2022]
Abstract
BackgroundBlood blister aneurysms (BBA) are a rare subset of intracranial aneurysms that represent a therapeutic challenge from both a surgical and endovascular perspective.ObjectiveTo report multicenter experience with flow diversion exclusively for BBA, located at non-branching segments along the anteromedial wall of the supraclinoidal internal carotid artery (ICA).MethodsConsecutive cases of BBA located at non-branching segments along the anteromedial wall of the supraclinoidal ICA treated with flow diversion were included in the final analysis.Results49 patients with 51 BBA of the ICA treated with devices to achieve the flow diversion effect were identified. 43 patients with 45 BBA of the ICA were treated with the pipeline embolization device and were included in the final analysis. Angiographic follow-up data were available for 30 patients (32 aneurysms in total); 87.5% of aneurysms (28/32) showed complete obliteration, 9.4% (3/32) showed reduced filling, and 3.1% (1/32) persistent filling. There was no difference between the size of aneurysm (≤2 mm vs >2 mm) or the use of adjunct coiling and complete occlusion of the aneurysm on follow-up (P=0.354 and P=0.865, respectively). Clinical follow-up data were available for 38 of 43 patients. 68% of patients (26/38) had a good clinical outcome (modified Rankin scale score of 0–2) at 3 months. There were 7 (16%) immediate procedural and 2 (5%) delayed complications, with 1 case of fatal delayed re-rupture after the initial treatment.ConclusionsOur data support the use of a flow diversion technique as a safe and effective therapeutic modality for BBA of the supraclinoid ICA.
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Leslie-Mazwi T, Chandra RV, Baxter BW, Arthur AS, Hussain MS, Singh IP, Frei DF, Klucznik RP, Albuquerque FC, Hirsch JA. ELVO: an operational definition. J Neurointerv Surg 2018; 10:507-509. [DOI: 10.1136/neurintsurg-2018-013792] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2018] [Indexed: 11/04/2022]
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Liebeskind DS, Zhang Y, Scalzo F, Veznedaroglu E, English J, Baxter BW, Budzik RF, Bartolini BM, Krajina A, Malek A, Sarraj A, Gupta R, Nogueira RG. Abstract 63: Collaterals in Thrombectomy for MCA Occlusion: Mapping the Collaterome in the Trevo Retriever Registry. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The delay and dispersion of collateral circulation to the MCA territory is readily available prior to endovascular thrombectomy for acute ischemic stroke (AIS). Factors associated with collateral grade have never been established in such an extensive population, reflecting diverse subjects from around the world. Largescale data from the Trevo Retriever Registry enables mapping of the MCA collaterome for the first time.
Methods:
The Imaging and Angiography Core Lab of the Trevo Retriever Registry independently conducted prospective evaluation of angiography in more than 1,500 subjects. Collaterals were systematically scored using ASITN grade prior to thrombectomy. Descriptive statistics detailed the distribution of collateral grades and analyses with demographic, imaging and clinical variables to explore key associations with routinely acquired registry data.
Results:
890 subjects (68.5 ± 15.1 years; 54.6% women; baseline NIHSS median 15 (10-19)) with AIS due to MCA occlusion had angiography of collateral circulation centrally adjudicated. Proximal M1 MCA occlusion was noted in 671/890 (75.4%). Collateral grade prior to thrombectomy included grade 4 or most robust collaterals in 38/890 (4.3%), 3 in 294/890 (33.0%), 2 in 467/890 (52.5%), 1 in 80/890 (9%) and 0 or none in 11/890 (1.2%). Baseline collaterals at angiography and pre-procedure ASPECTS were closely correlated (r=0.439, p<0.001) with more modest correlation between collateral grade and CTP/DWI (rrCBF<30% or ADC<620) infarct core (r=-0.31, n=391; p<0.001) or CTP/PWI (Tmax>6s) hypoperfusion at-risk (r=-0.10, n=391; p=0.043) volumes. First pass mTICI≥2b occurred in 553/858 (64.5%) with final mTICI≥2b in 824/890 (92.6%). Collateral grade prior to thrombectomy (each 1-point increment, after adjustment for other predictors) was strongly associated (OR 1.38 95%CI (1.12-1.7), p=0.002) with good clinical outcomes (mRS 0-2) at 90 days.
Conclusions:
Largescale mapping of collaterals prior to MCA thrombectomy reveals marked variation in the extent and functional impact of the collaterome. The preponderance of partial perfusion in the downstream ischemic territory prompts the need to investigate and leverage the protective nature of the collaterome in AIS.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ali Malek
- St. Mary’s Med Cntr, West Palm Beach, FL
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Liebeskind DS, Zhang Y, Trieu H, Revanur A, Scalzo F, Veznedaroglu E, English J, Baxter BW, Budzik RF, Bartolini BM, Krajina A, Malek A, Sarraj A, Gupta R, Jadhav AJ, Jovin TG, Nogueira RG. Abstract 114:
Aspects
versus Perfusion in the Trevo Retriever Registry: Defining the Core on the Largest Scale to Date. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Routine use of advanced imaging versus ASPECTS for imaging triage of endovascular thrombectomy candidates has not been evaluated on a large scale to date. Ischemic core may be defined by ASPECTS or perfusion imaging, yet these variable definitions likely reflect different pathophysiology as perfusion may fluctuate and ASPECTS lesions may be time-dependent.
Methods:
The Trevo Retriever Registry was a prospective, open-label, consecutive enrollment, multicenter, international registry with more than 65 enrolling sites worldwide. The Imaging and Angiography Core Lab systematically adjudicated more than 1,500 subjects, scoring ASPECTS and separately processing perfusion imaging. Ischemic core volume on perfusion imaging was defined as rrCBF<30% (CTP) and analyzed with respect to ASPECTS.
Results:
488 subjects (68.3±14.4 years; 53.3% women; baseline NIHSS median 15 (10-19) with anterior circulation occlusions were evaluated with both ASPECTS and perfusion imaging prior to thrombectomy. Arterial occlusions included 87/487 (17.9%) ICA and 296/487 (60.8%) proximal M1 MCA, treated with thrombectomy at median 4.7 (3.3-7.9) hours from time last known well (TLKW). ASPECTS was median 8 (7-9) with ischemic core lesions of median 18 (4.9-39.2) cc. At-risk hypoperfusion (Tmax>6s) lesions were median 109.8 (62-156.9) cc. TLKW was associated with ASPECTS (r=-0.18, p<0.001) yet no time relationship was noted with either ischemic core or at-risk hypoperfusion on perfusion imaging. ASPECTS correlated modestly with perfusion imaging-derived ischemic core (r=-0.35, p<0.001) and at-risk hypoperfusion (r=-0.24, p<0.001). Post-procedure mTICI≥2b occurred in 448/488 (91.8%). Each increment in baseline ASPECTS was associated with an adjusted OR of 1.21 (95%CI (1.05-1.39), p<0.008 for good clinical outcomes (day 90 mRS 0-2), whereas the perfusion lesion volume for ischemic core and at-risk hypoperfusion did not predict outcomes.
Conclusions:
Largescale, systematic evaluation of ASPECTS and perfusion imaging prior to thrombectomy reveals discrepancy in the definition of ischemic core and the prediction of clinical outcomes after revascularization. ASPECTS is time-dependent, yet reliably predicts outcomes in routine clinical practice.
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Affiliation(s)
| | | | - Harry Trieu
- Neurovascular Imaging Rsch Core, Los Angeles, CA
| | | | | | | | | | | | | | | | | | - Ali Malek
- St. Mary’s Med Cntr, West Palm Beach, FL
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Gandhi CD, Al Mufti F, Singh IP, Abruzzo T, Albani B, Ansari SA, Arthur AS, Bain M, Baxter BW, Bulsara KR, Caplan JM, Chen M, Dabus G, Frei D, Hetts SW, Hussain MS, Jayaraman MV, Kayan Y, Klucznik RP, Lee SK, Mack WJ, Leslie-Mazwi T, McTaggart RA, Meyers PM, Mokin M, Patsalides AT, Prestigiacomo CJ, Pride GL, Starke RM, Sunenshine PJ, Fraser JF. Neuroendovascular management of emergent large vessel occlusion: update on the technical aspects and standards of practice by the Standards and Guidelines Committee of the Society of NeuroInterventional Surgery. J Neurointerv Surg 2018; 10:315-320. [DOI: 10.1136/neurintsurg-2017-013554] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 11/16/2017] [Accepted: 11/20/2017] [Indexed: 11/03/2022]
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Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P, Yavagal DR, Ribo M, Cognard C, Hanel RA, Sila CA, Hassan AE, Millan M, Levy EI, Mitchell P, Chen M, English JD, Shah QA, Silver FL, Pereira VM, Mehta BP, Baxter BW, Abraham MG, Cardona P, Veznedaroglu E, Hellinger FR, Feng L, Kirmani JF, Lopes DK, Jankowitz BT, Frankel MR, Costalat V, Vora NA, Yoo AJ, Malik AM, Furlan AJ, Rubiera M, Aghaebrahim A, Olivot JM, Tekle WG, Shields R, Graves T, Lewis RJ, Smith WS, Liebeskind DS, Saver JL, Jovin TG. Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. N Engl J Med 2018; 378:11-21. [PMID: 29129157 DOI: 10.1056/nejmoa1706442] [Citation(s) in RCA: 3278] [Impact Index Per Article: 546.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The effect of endovascular thrombectomy that is performed more than 6 hours after the onset of ischemic stroke is uncertain. Patients with a clinical deficit that is disproportionately severe relative to the infarct volume may benefit from late thrombectomy. METHODS We enrolled patients with occlusion of the intracranial internal carotid artery or proximal middle cerebral artery who had last been known to be well 6 to 24 hours earlier and who had a mismatch between the severity of the clinical deficit and the infarct volume, with mismatch criteria defined according to age (<80 years or ≥80 years). Patients were randomly assigned to thrombectomy plus standard care (the thrombectomy group) or to standard care alone (the control group). The coprimary end points were the mean score for disability on the utility-weighted modified Rankin scale (which ranges from 0 [death] to 10 [no symptoms or disability]) and the rate of functional independence (a score of 0, 1, or 2 on the modified Rankin scale, which ranges from 0 to 6, with higher scores indicating more severe disability) at 90 days. RESULTS A total of 206 patients were enrolled; 107 were assigned to the thrombectomy group and 99 to the control group. At 31 months, enrollment in the trial was stopped because of the results of a prespecified interim analysis. The mean score on the utility-weighted modified Rankin scale at 90 days was 5.5 in the thrombectomy group as compared with 3.4 in the control group (adjusted difference [Bayesian analysis], 2.0 points; 95% credible interval, 1.1 to 3.0; posterior probability of superiority, >0.999), and the rate of functional independence at 90 days was 49% in the thrombectomy group as compared with 13% in the control group (adjusted difference, 33 percentage points; 95% credible interval, 24 to 44; posterior probability of superiority, >0.999). The rate of symptomatic intracranial hemorrhage did not differ significantly between the two groups (6% in the thrombectomy group and 3% in the control group, P=0.50), nor did 90-day mortality (19% and 18%, respectively; P=1.00). CONCLUSIONS Among patients with acute stroke who had last been known to be well 6 to 24 hours earlier and who had a mismatch between clinical deficit and infarct, outcomes for disability at 90 days were better with thrombectomy plus standard care than with standard care alone. (Funded by Stryker Neurovascular; DAWN ClinicalTrials.gov number, NCT02142283 .).
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Affiliation(s)
- Raul G Nogueira
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Ashutosh P Jadhav
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Diogo C Haussen
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Alain Bonafe
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Ronald F Budzik
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Parita Bhuva
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Dileep R Yavagal
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Marc Ribo
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Christophe Cognard
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Ricardo A Hanel
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Cathy A Sila
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Ameer E Hassan
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Monica Millan
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Elad I Levy
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Peter Mitchell
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Michael Chen
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Joey D English
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Qaisar A Shah
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Frank L Silver
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Vitor M Pereira
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Brijesh P Mehta
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Blaise W Baxter
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Michael G Abraham
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Pedro Cardona
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Erol Veznedaroglu
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Frank R Hellinger
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Lei Feng
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Jawad F Kirmani
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Demetrius K Lopes
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Brian T Jankowitz
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Michael R Frankel
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Vincent Costalat
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Nirav A Vora
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Albert J Yoo
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Amer M Malik
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Anthony J Furlan
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Marta Rubiera
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Amin Aghaebrahim
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Jean-Marc Olivot
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Wondwossen G Tekle
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Ryan Shields
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Todd Graves
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Roger J Lewis
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Wade S Smith
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - David S Liebeskind
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Jeffrey L Saver
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
| | - Tudor G Jovin
- From the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N., D.C.H., M.R.F.); the Stroke Institute, Departments of Neurology (A.P.J., T.G.J.) and Neurosurgery (B.T.J.), University of Pittsburgh Medical Center, Pittsburgh, and Abington Health, Abington (Q.A.S.) - both in Pennsylvania; the Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier (A.B., V.C.), and the Department of Diagnostic and Therapeutic Neuroradiology (C.C.) and the Neuroimaging Center and Center for Clinical Investigations (J.-M.O.), University Hospital of Toulouse, Toulouse - both in France; OhioHealth Riverside Methodist Hospital, Columbus (R.F.B., N.A.V.), and University Hospitals of Cleveland, Cleveland (C.A.S., A.J.F.) - both in Ohio; Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.), the Department of Neuroscience, Valley Baptist Medical Center, Harlingen (A.E.H., W.G.T.), and Berry Consultants, Austin (T.G., R.J.L.) - all in Texas; the Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami (D.R.Y., A.M.M.), Baptist Health, Jacksonville (R.A.H., A.A.), Memorial Regional Hospital, Hollywood (B.P.M.), and Florida Hospital, Orlando (F.R.H.) - all in Florida; the Stroke Unit, Hospital Vall d'Hebrón (M. Ribo, M. Rubiera), and Hospital Universitari de Bellvitge (P.C.), Barcelona, and the Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona (M.M.) - all in Spain; the Department of Neurosurgery, State University of New York at Buffalo, Buffalo (E.I.L.); the Department of Interventional Neuroradiology, Royal Melbourne Hospital, Victoria (P.M.); the Departments of Neurology (M.C.) and Neurosurgery (D.K.L.), Rush University Medical Center, Chicago; California Pacific Medical Center (J.D.E.) and the Department of Neurology, University of California, San Francisco (W.S.S.), San Francisco, the Department of Neuroradiology, Kaiser Permanente (L.F.), and the Neurovascular Imaging Research Core, Department of Neurology and Comprehensive Stroke Center (D.S.L.), David Geffen School of Medicine, University of California, Los Angeles (UCLA) (D.S.L., J.L.S.), Los Angeles, Stryker Neurovascular, Fremont (R.S.), and Los Angeles County Harbor-UCLA Medical Center, Torrance (R.J.L.) - all in California; the Departments of Medical Imaging and Surgery (F.L.S., V.M.P.) and Neurology (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Toronto; the Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga (B.W.B.); the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A.); and the Neuroscience Center, Capital Health Hospital, Trenton (E.V.), and the JFK Medical Center, Edison (J.F.K.) - both in New Jersey
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Campbell BCV, van Zwam WH, Goyal M, Menon BK, Dippel DWJ, Demchuk AM, Bracard S, White P, Dávalos A, Majoie CBLM, van der Lugt A, Ford GA, de la Ossa NP, Kelly M, Bourcier R, Donnan GA, Roos YBWEM, Bang OY, Nogueira RG, Devlin TG, van den Berg LA, Clarençon F, Burns P, Carpenter J, Berkhemer OA, Yavagal DR, Pereira VM, Ducrocq X, Dixit A, Quesada H, Epstein J, Davis SM, Jansen O, Rubiera M, Urra X, Micard E, Lingsma HF, Naggara O, Brown S, Guillemin F, Muir KW, van Oostenbrugge RJ, Saver JL, Jovin TG, Hill MD, Mitchell PJ, Berkhemer OA, Fransen PSS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJH, van Walderveen MAA, Staals J, Hofmeijer J, van Oostayen JA, Lycklama à Nijeholt GJ, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk LC, Kappelle J, Lo RH, van Dijk EJ, de Vries J, de Kort PL, van Rooij WJJ, van den Berg JS, van Hasselt BA, Aerden LA, Dallinga RJ, Visser MC, Bot JC, Vroomen PC, Eshghi O, Schreuder TH, Heijboer RJ, Keizer K, Tielbeek AV, den Hertog HM, Gerrits DG, van den Berg-Vos RM, Karas GB, Steyerberg EW, Flach Z, Marquering HA, Sprengers ME, Jenniskens SF, Beenen LF, van den Berg R, Koudstaal PJ, van Zwam WH, Roos YB, van der Lugt A, van Oostenbrugge RJ, Wakhloo A, Moonis M, Henninger N, Goddeau R, Massari F, Minaeian A, Lozano JD, Ramzan M, Stout C, Patel A, Majoie CB, Tunguturi A, Onteddu S, Carandang R, Howk M, Ribó M, Sanjuan E, Rubiera M, Pagola J, Flores A, Muchada M, Dippel DW, Meler P, Huerga E, Gelabert S, Coscojuela P, Tomasello A, Rodriguez D, Santamarina E, Maisterra O, Boned S, Seró L, Brown MM, Rovira A, Molina CA, Millán M, Muñoz L, Pérez de la Ossa N, Gomis M, Dorado L, López-Cancio E, Palomeras E, Munuera J, Liebig T, García Bermejo P, Remollo S, Castaño C, García-Sort R, Cuadras P, Puyalto P, Hernández-Pérez M, Jiménez M, Martínez-Piñeiro A, Lucente G, Stijnen T, Dávalos A, Chamorro A, Urra X, Obach V, Cervera A, Amaro S, Llull L, Codas J, Balasa M, Navarro J, Andersson T, Ariño H, Aceituno A, Rudilosso S, Renu A, Macho JM, San Roman L, Blasco J, López A, Macías N, Cardona P, Mattle H, Quesada H, Rubio F, Cano L, Lara B, de Miquel MA, Aja L, Serena J, Cobo E, Albers GW, Lees KR, Wahlgren N, Arenillas J, Roberts R, Minhas P, Al-Ajlan F, Salluzzi M, Zimmel L, Patel S, Eesa M, Martí-Fàbregas J, Jankowitz B, van der Heijden E, Serena J, Salvat-Plana M, López-Cancio E, Bracard S, Ducrocq X, Anxionnat R, Baillot PA, Barbier C, Derelle AL, Lacour JC, Ghannouti N, Richard S, Samson Y, Sourour N, Baronnet-Chauvet F, Clarencon F, Crozier S, Deltour S, Di Maria F, Le Bouc R, Leger A, Fleitour N, Mutlu G, Rosso C, Szatmary Z, Yger M, Zavanone C, Bakchine S, Pierot L, Caucheteux N, Estrade L, Kadziolka K, Hooijenga I, Leautaud A, Renkes C, Serre I, Desal H, Guillon B, Boutoleau-Bretonniere C, Daumas-Duport B, De Gaalon S, Derkinderen P, Evain S, Puppels C, Herisson F, Laplaud DA, Lebouvier T, Lintia-Gaultier A, Pouclet-Courtemanche H, Rouaud T, Rouaud Jaffrenou V, Schunck A, Sevin-Allouet M, Toulgoat F, Pellikaan W, Wiertlewski S, Gauvrit JY, Ronziere T, Cahagne V, Ferre JC, Pinel JF, Raoult H, Mas JL, Meder JF, Al Najjar-Carpentier AA, Geerling A, Birchenall J, Bodiguel E, Calvet D, Domigo V, Godon-Hardy S, Guiraud V, Lamy C, Majhadi L, Morin L, Naggara O, Lindl-Velema A, Trystram D, Turc G, Berge J, Sibon I, Menegon P, Barreau X, Rouanet F, Debruxelles S, Kazadi A, Renou P, van Vemde G, Fleury O, Pasco-Papon A, Dubas F, Caroff J, Godard Ducceschi S, Hamon MA, Lecluse A, Marc G, Giroud M, Ricolfi F, de Ridder A, Bejot Y, Chavent A, Gentil A, Kazemi A, Osseby GV, Voguet C, Mahagne MH, Sedat J, Chau Y, Suissa L, Greebe P, Lachaud S, Houdart E, Stapf C, Buffon Porcher F, Chabriat H, Guedin P, Herve D, Jouvent E, Mawet J, Saint-Maurice JP, de Bont-Stikkelbroeck J, Schneble HM, Turjman F, Nighoghossian N, Berhoune NN, Bouhour F, Cho TH, Derex L, Felix S, Gervais-Bernard H, Gory B, de Meris J, Manera L, Mechtouff L, Ritzenthaler T, Riva R, Salaris Silvio F, Tilikete C, Blanc R, Obadia M, Bartolini MB, Gueguen A, Janssen K, Piotin M, Pistocchi S, Redjem H, Drouineau J, Neau JP, Godeneche G, Lamy M, Marsac E, Velasco S, Clavelou P, Struijk W, Chabert E, Bourgois N, Cornut-Chauvinc C, Ferrier A, Gabrillargues J, Jean B, Marques AR, Vitello N, Detante O, Barbieux M, Licher S, Boubagra K, Favre Wiki I, Garambois K, Tahon F, Ashok V, Voguet C, Coskun O, Guedin P, Rodesch G, Lapergue B, Boodt N, Bourdain F, Evrard S, Graveleau P, Decroix JP, Wang A, Sellal F, Ahle G, Carelli G, Dugay MH, Gaultier C, Ros A, Lebedinsky AP, Lita L, Musacchio RM, Renglewicz-Destuynder C, Tournade A, Vuillemet F, Montoro FM, Mounayer C, Faugeras F, Gimenez L, Venema E, Labach C, Lautrette G, Denier C, Saliou G, Chassin O, Dussaule C, Melki E, Ozanne A, Puccinelli F, Sachet M, Slokkers I, Sarov M, Bonneville JF, Moulin T, Biondi A, De Bustos Medeiros E, Vuillier F, Courtheoux P, Viader F, Apoil-Brissard M, Bataille M, Ganpat RJ, Bonnet AL, Cogez J, Kazemi A, Touze E, Leclerc X, Leys D, Aggour M, Aguettaz P, Bodenant M, Cordonnier C, Mulder M, Deplanque D, Girot M, Henon H, Kalsoum E, Lucas C, Pruvo JP, Zuniga P, Bonafé A, Arquizan C, Costalat V, Saiedie N, Machi P, Mourand I, Riquelme C, Bounolleau P, Arteaga C, Faivre A, Bintner M, Tournebize P, Charlin C, Darcel F, Heshmatollah A, Gauthier-Lasalarie P, Jeremenko M, Mouton S, Zerlauth JB, Lamy C, Hervé D, Hassan H, Gaston A, Barral FG, Garnier P, Schipperen S, Beaujeux R, Wolff V, Herbreteau D, Debiais S, Murray A, Ford G, Muir KW, White P, Brown MM, Clifton A, Vinken S, Freeman J, Ford I, Markus H, Wardlaw J, Lees KR, Molyneux A, Robinson T, Lewis S, Norrie J, Robertson F, van Boxtel T, Perry R, Dixit A, Cloud G, Clifton A, Madigan J, Roffe C, Nayak S, Lobotesis K, Smith C, Herwadkar A, Koets J, Kandasamy N, Goddard T, Bamford J, Subramanian G, Lenthall R, Littleton E, Lamin S, Storey K, Ghatala R, Banaras A, Boers M, Aeron-Thomas J, Hazel B, Maguire H, Veraque E, Harrison L, Keshvara R, Cunningham J, Santos E, Borst J, Jansen I, Kappelhof M, Lucas M, Geuskens R, Barros RS, Dobbe R, Csizmadia M, Hill MD, Goyal M, Demchuk AM, Menon BK, Eesa M, Ryckborst KJ, Wright MR, Kamal NR, Andersen L, Randhawa PA, Stewart T, Patil S, Minhas P, Almekhlafi M, Mishra S, Clement F, Sajobi T, Shuaib A, Montanera WJ, Roy D, Silver FL, Jovin TG, Frei DF, Sapkota B, Rempel JL, Thornton J, Williams D, Tampieri D, Poppe AY, Dowlatshahi D, Wong JH, Mitha AP, Subramaniam S, Hull G, Lowerison MW, Sajobi T, Salluzzi M, Wright MR, Maxwell M, Lacusta S, Drupals E, Armitage K, Barber PA, Smith EE, Morrish WF, Coutts SB, Derdeyn C, Demaerschalk B, Yavagal D, Martin R, Brant R, Yu Y, Willinsky RA, Montanera WJ, Weill A, Kenney C, Aram H, Stewart T, Stys PK, Watson TW, Klein G, Pearson D, Couillard P, Trivedi A, Singh D, Klourfeld E, Imoukhuede O, Nikneshan D, Blayney S, Reddy R, Choi P, Horton M, Musuka T, Dubuc V, Field TS, Desai J, Adatia S, Alseraya A, Nambiar V, van Dijk R, Wong JH, Mitha AP, Morrish WF, Eesa M, Newcommon NJ, Shuaib A, Schwindt B, Butcher KS, Jeerakathil T, Buck B, Khan K, Naik SS, Emery DJ, Owen RJ, Kotylak TB, Ashforth RA, Yeo TA, McNally D, Siddiqui M, Saqqur M, Hussain D, Kalashyan H, Manosalva A, Kate M, Gioia L, Hasan S, Mohammad A, Muratoglu M, Williams D, Thornton J, Cullen A, Brennan P, O'Hare A, Looby S, Hyland D, Duff S, McCusker M, Hallinan B, Lee S, McCormack J, Moore A, O'Connor M, Donegan C, Brewer L, Martin A, Murphy S, O'Rourke K, Smyth S, Kelly P, Lynch T, Daly T, O'Brien P, O'Driscoll A, Martin M, Daly T, Collins R, Coughlan T, McCabe D, Murphy S, O'Neill D, Mulroy M, Lynch O, Walsh T, O'Donnell M, Galvin T, Harbison J, McElwaine P, Mulpeter K, McLoughlin C, Reardon M, Harkin E, Dolan E, Watts M, Cunningham N, Fallon C, Gallagher S, Cotter P, Crowe M, Doyle R, Noone I, Lapierre M, Coté VA, Lanthier S, Odier C, Durocher A, Raymond J, Weill A, Daneault N, Deschaintre Y, Jankowitz B, Baxendell L, Massaro L, Jackson-Graves C, Decesare S, Porter P, Armbruster K, Adams A, Billigan J, Oakley J, Ducruet A, Jadhav A, Giurgiutiu DV, Aghaebrahim A, Reddy V, Hammer M, Starr M, Totoraitis V, Wechsler L, Streib S, Rangaraju S, Campbell D, Rocha M, Gulati D, Silver FL, Krings T, Kalman L, Cayley A, Williams J, Stewart T, Wiegner R, Casaubon LK, Jaigobin C, del Campo JM, Elamin E, Schaafsma JD, Willinsky RA, Agid R, Farb R, ter Brugge K, Sapkoda BL, Baxter BW, Barton K, Knox A, Porter A, Sirelkhatim A, Devlin T, Dellinger C, Pitiyanuvath N, Patterson J, Nichols J, Quarfordt S, Calvert J, Hawk H, Fanale C, Frei DF, Bitner A, Novak A, Huddle D, Bellon R, Loy D, Wagner J, Chang I, Lampe E, Spencer B, Pratt R, Bartt R, Shine S, Dooley G, Nguyen T, Whaley M, McCarthy K, Teitelbaum J, Tampieri D, Poon W, Campbell N, Cortes M, Dowlatshahi D, Lum C, Shamloul R, Robert S, Stotts G, Shamy M, Steffenhagen N, Blacquiere D, Hogan M, AlHazzaa M, Basir G, Lesiuk H, Iancu D, Santos M, Choe H, Weisman DC, Jonczak K, Blue-Schaller A, Shah Q, MacKenzie L, Klein B, Kulandaivel K, Kozak O, Gzesh DJ, Harris LJ, Khoury JS, Mandzia J, Pelz D, Crann S, Fleming L, Hesser K, Beauchamp B, Amato-Marzialli B, Boulton M, Lopez- Ojeda P, Sharma M, Lownie S, Chan R, Swartz R, Howard P, Golob D, Gladstone D, Boyle K, Boulos M, Hopyan J, Yang V, Da Costa L, Holmstedt CA, Turk AS, Navarro R, Jauch E, Ozark S, Turner R, Phillips S, Shankar J, Jarrett J, Gubitz G, Maloney W, Vandorpe R, Schmidt M, Heidenreich J, Hunter G, Kelly M, Whelan R, Peeling L, Burns PA, Hunter A, Wiggam I, Kerr E, Watt M, Fulton A, Gordon P, Rennie I, Flynn P, Smyth G, O'Leary S, Gentile N, Linares G, McNelis P, Erkmen K, Katz P, Azizi A, Weaver M, Jungreis C, Faro S, Shah P, Reimer H, Kalugdan V, Saposnik G, Bharatha A, Li Y, Kostyrko P, Santos M, Marotta T, Montanera W, Sarma D, Selchen D, Spears J, Heo JH, Jeong K, Kim DJ, Kim BM, Kim YD, Song D, Lee KJ, Yoo J, Bang OY, Rho S, Lee J, Jeon P, Kim KH, Cha J, Kim SJ, Ryoo S, Lee MJ, Sohn SI, Kim CH, Ryu HG, Hong JH, Chang HW, Lee CY, Rha J, Davis SM, Donnan GA, Campbell BCV, Mitchell PJ, Churilov L, Yan B, Dowling R, Yassi N, Oxley TJ, Wu TY, Silver G, McDonald A, McCoy R, Kleinig TJ, Scroop R, Dewey HM, Simpson M, Brooks M, Coulton B, Krause M, Harrington TJ, Steinfort B, Faulder K, Priglinger M, Day S, Phan T, Chong W, Holt M, Chandra RV, Ma H, Young D, Wong K, Wijeratne T, Tu H, Mackay E, Celestino S, Bladin CF, Loh PS, Gilligan A, Ross Z, Coote S, Frost T, Parsons MW, Miteff F, Levi CR, Ang T, Spratt N, Kaauwai L, Badve M, Rice H, de Villiers L, Barber PA, McGuinness B, Hope A, Moriarty M, Bennett P, Wong A, Coulthard A, Lee A, Jannes J, Field D, Sharma G, Salinas S, Cowley E, Snow B, Kolbe J, Stark R, King J, Macdonnell R, Attia J, D'Este C, Saver JL, Goyal M, Diener HC, Levy EI, Bonafé A, Mendes Pereira V, Jahan R, Albers GW, Cognard C, Cohen DJ, Hacke W, Jansen O, Jovin TG, Mattle HP, Nogueira RG, Siddiqui AH, Yavagal DR, von Kummer R, Smith W, Turjman F, Hamilton S, Chiacchierini R, Amar A, Sanossian N, Loh Y, Devlin T, Baxter B, Hawk H, Sapkota B, Quarfordt S, Sirelkhatim A, Dellinger C, Barton K, Reddy VK, Ducruet A, Jadhav A, Horev A, Giurgiutiu DV, Totoraitis V, Hammer M, Jankowitz B, Wechsler L, Rocha M, Gulati D, Campbell D, Star M, Baxendell L, Oakley J, Siddiqui A, Hopkins LN, Snyder K, Sawyer R, Hall S, Costalat V, Riquelme C, Machi P, Omer E, Arquizan C, Mourand I, Charif M, Ayrignac X, Menjot de Champfleur N, Leboucq N, Gascou G, Moynier M, du Mesnil de Rochemont R, Singer O, Berkefeld J, Foerch C, Lorenz M, Pfeilschifer W, Hattingen E, Wagner M, You SJ, Lescher S, Braun H, Dehkharghani S, Belagaje SR, Anderson A, Lima A, Obideen M, Haussen D, Dharia R, Frankel M, Patel V, Owada K, Saad A, Amerson L, Horn C, Doppelheuer S, Schindler K, Lopes DK, Chen M, Moftakhar R, Anton C, Smreczak M, Carpenter JS, Boo S, Rai A, Roberts T, Tarabishy A, Gutmann L, Brooks C, Brick J, Domico J, Reimann G, Hinrichs K, Becker M, Heiss E, Selle C, Witteler A, Al-Boutros S, Danch MJ, Ranft A, Rohde S, Burg K, Weimar C, Zegarac V, Hartmann C, Schlamann M, Göricke S, Ringlestein A, Wanke I, Mönninghoff C, Dietzold M, Budzik R, Davis T, Eubank G, Hicks WJ, Pema P, Vora N, Mejilla J, Taylor M, Clark W, Rontal A, Fields J, Peterson B, Nesbit G, Lutsep H, Bozorgchami H, Priest R, Ologuntoye O, Barnwell S, Dogan A, Herrick K, Takahasi C, Beadell N, Brown B, Jamieson S, Hussain MS, Russman A, Hui F, Wisco D, Uchino K, Khawaja Z, Katzan I, Toth G, Cheng-Ching E, Bain M, Man S, Farrag A, George P, John S, Shankar L, Drofa A, Dahlgren R, Bauer A, Itreat A, Taqui A, Cerejo R, Richmond A, Ringleb P, Bendszus M, Möhlenbruch M, Reiff T, Amiri H, Purrucker J, Herweh C, Pham M, Menn O, Ludwig I, Acosta I, Villar C, Morgan W, Sombutmai C, Hellinger F, Allen E, Bellew M, Gandhi R, Bonwit E, Aly J, Ecker RD, Seder D, Morris J, Skaletsky M, Belden J, Baker C, Connolly LS, Papanagiotou P, Roth C, Kastrup A, Politi M, Brunner F, Alexandrou M, Merdivan H, Ramsey C, Given II C, Renfrow S, Deshmukh V, Sasadeusz K, Vincent F, Thiesing JT, Putnam J, Bhatt A, Kansara A, Caceves D, Lowenkopf T, Yanase L, Zurasky J, Dancer S, Freeman B, Scheibe-Mirek T, Robison J, Rontal A, Roll J, Clark D, Rodriguez M, Fitzsimmons BFM, Zaidat O, Lynch JR, Lazzaro M, Larson T, Padmore L, Das E, Farrow-Schmidt A, Hassan A, Tekle W, Cate C, Jansen O, Cnyrim C, Wodarg F, Wiese C, Binder A, Riedel C, Rohr A, Lang N, Laufs H, Krieter S, Remonda L, Diepers M, Añon J, Nedeltchev K, Kahles T, Biethahn S, Lindner M, Chang V, Gächter C, Esperon C, Guglielmetti M, Arenillas Lara JF, Martínez Galdámez M, Calleja Sanz AI, Cortijo Garcia E, Garcia Bermejo P, Perez S, Mulero Carrillo P, Crespo Vallejo E, Ruiz Piñero M, Lopez Mesonero L, Reyes Muñoz FJ, Brekenfeld C, Buhk JH, Krützelmann A, Thomalla G, Cheng B, Beck C, Hoppe J, Goebell E, Holst B, Grzyska U, Wortmann G, Starkman S, Duckwiler G, Jahan R, Rao N, Sheth S, Ng K, Noorian A, Szeder V, Nour M, McManus M, Huang J, Tarpley J, Tateshima S, Gonzalez N, Ali L, Liebeskind D, Hinman J, Calderon-Arnulphi M, Liang C, Guzy J, Koch S, DeSousa K, Gordon-Perue G, Haussen D, Elhammady M, Peterson E, Pandey V, Dharmadhikari S, Khandelwal P, Malik A, Pafford R, Gonzalez P, Ramdas K, Andersen G, Damgaard D, Von Weitzel-Mudersbach P, Simonsen C, Ruiz de Morales Ayudarte N, Poulsen M, Sørensen L, Karabegovich S, Hjørringgaard M, Hjort N, Harbo T, Sørensen K, Deshaies E, Padalino D, Swarnkar A, Latorre JG, Elnour E, El-Zammar Z, Villwock M, Farid H, Balgude A, Cross L, Hansen K, Holtmannspötter M, Kondziella D, Hoejgaard J, Taudorf S, Soendergaard H, Wagner A, Cronquist M, Stavngaard T, Cortsen M, Krarup LH, Hyldal T, Haring HP, Guggenberger S, Hamberger M, Trenkler J, Sonnberger M, Nussbaumer K, Dominger C, Bach E, Jagadeesan BD, Taylor R, Kim J, Shea K, Tummala R, Zacharatos H, Sandhu D, Ezzeddine M, Grande A, Hildebrandt D, Miller K, Scherber J, Hendrickson A, Jumaa M, Zaidi S, Hendrickson T, Snyder V, Killer-Oberpfalzer M, Mutzenbach J, Weymayr F, Broussalis E, Stadler K, Jedlitschka A, Malek A, Mueller-Kronast N, Beck P, Martin C, Summers D, Day J, Bettinger I, Holloway W, Olds K, Arkin S, Akhtar N, Boutwell C, Crandall S, Schwartzman M, Weinstein C, Brion B, Prothmann S, Kleine J, Kreiser K, Boeckh-Behrens T, Poppert H, Wunderlich S, Koch ML, Biberacher V, Huberle A, Gora-Stahlberg G, Knier B, Meindl T, Utpadel-Fischler D, Zech M, Kowarik M, Seifert C, Schwaiger B, Puri A, Hou S. Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data. Lancet Neurol 2018; 17:47-53. [DOI: 10.1016/s1474-4422(17)30407-6] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/05/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
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Evans JW, Graham BR, Pordeli P, Al-Ajlan FS, Willinsky R, Montanera WJ, Rempel JL, Shuaib A, Brennan P, Williams D, Roy D, Poppe AY, Jovin TG, Devlin T, Baxter BW, Krings T, Silver FL, Frei DF, Fanale C, Tampieri D, Teitelbaum J, Iancu D, Shankar J, Barber PA, Demchuk AM, Goyal M, Hill MD, Menon BK. Time for a Time Window Extension: Insights from Late Presenters in the ESCAPE Trial. AJNR Am J Neuroradiol 2017; 39:102-106. [PMID: 29191873 DOI: 10.3174/ajnr.a5462] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 08/15/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The safety and efficacy of endovascular therapy for large-artery stroke in the extended time window is not yet well-established. We performed a subgroup analysis on subjects enrolled within an extended time window in the Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke (ESCAPE) trial. MATERIALS AND METHODS Fifty-nine of 315 subjects (33 in the intervention group and 26 in the control group) were randomized in the ESCAPE trial between 5.5 and 12 hours after last seen healthy (likely to have groin puncture administered 6 hours after that). Treatment effect sizes for all relevant outcomes (90-day mRS shift, mRS 0-2, mRS 0-1, and 24-hour NIHSS scores and intracerebral hemorrhage) were reported using unadjusted and adjusted analyses. RESULTS There was no evidence of treatment heterogeneity between subjects in the early and late windows. Treatment effect favoring intervention was seen across all clinical outcomes in the extended time window (absolute risk difference of 19.3% for mRS 0-2 at 90 days). There were more asymptomatic intracerebral hemorrhage events within the intervention arm (48.5% versus 11.5%, P = .004) but no difference in symptomatic intracerebral hemorrhage. CONCLUSIONS Patients with an extended time window could potentially benefit from endovascular treatment. Ongoing randomized controlled trials using imaging to identify late presenters with favorable brain physiology will help cement the paradigm of using time windows to select the population for acute imaging and imaging to select individual patients for therapy.
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Affiliation(s)
- J W Evans
- From the Departments of Clinical Neurosciences and Radiology (J.W.E., B.R.G., F.S.A.-A., P.A.B., A.M.D., M.G., M.D.H., B.K.M.)
| | - B R Graham
- From the Departments of Clinical Neurosciences and Radiology (J.W.E., B.R.G., F.S.A.-A., P.A.B., A.M.D., M.G., M.D.H., B.K.M.)
| | - P Pordeli
- Community Health Sciences and Department of Medicine (P.P., M.D.H., B.K.M.), Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - F S Al-Ajlan
- From the Departments of Clinical Neurosciences and Radiology (J.W.E., B.R.G., F.S.A.-A., P.A.B., A.M.D., M.G., M.D.H., B.K.M.)
| | - R Willinsky
- Department of Medical Imaging (R.W., W.J.M.)
| | | | | | - A Shuaib
- Medicine (Neurology) (A.S.), University of Alberta, Edmonton, Alberta, Canada
| | - P Brennan
- Departments of Neuroradiology (P.B.)
| | - D Williams
- Geriatric and Stroke Medicine (D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin, Ireland
| | - D Roy
- Departments of Radiology (D.R.)
| | - A Y Poppe
- Neurosciences (A.Y.P.), Centre hospitalier de l'Université de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - T G Jovin
- Department of Neurology (T.G.J.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - B W Baxter
- Department of Radiology (B.W.B), Erlanger Hospital, University of Tennessee, Chattanooga, Tennessee
| | | | - F L Silver
- Division of Neurology (F.L.S., C.F.), Department of Medicine, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
| | - D F Frei
- Colorado Neurological Institute (D.F.F., D.T.), Engelwood, Colorado
| | - C Fanale
- Division of Neurology (F.L.S., C.F.), Department of Medicine, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
| | - D Tampieri
- Colorado Neurological Institute (D.F.F., D.T.), Engelwood, Colorado
| | - J Teitelbaum
- Montreal Neurological Institute (J.T.), McGill University, Montreal, Quebec, Canada
| | - D Iancu
- Department of Radiology (D.I.), The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - J Shankar
- Department of Neuroradiology (J.S.), Dalhousie University, Halifax, Nova Scotia, Canada
| | - P A Barber
- From the Departments of Clinical Neurosciences and Radiology (J.W.E., B.R.G., F.S.A.-A., P.A.B., A.M.D., M.G., M.D.H., B.K.M.).,Hotchkiss Brain Institute (P.A.B., A.M.D., M.G., M.D.H., B.K.M.), University of Calgary, Calgary, Alberta, Canada
| | - A M Demchuk
- From the Departments of Clinical Neurosciences and Radiology (J.W.E., B.R.G., F.S.A.-A., P.A.B., A.M.D., M.G., M.D.H., B.K.M.).,Hotchkiss Brain Institute (P.A.B., A.M.D., M.G., M.D.H., B.K.M.), University of Calgary, Calgary, Alberta, Canada
| | - M Goyal
- From the Departments of Clinical Neurosciences and Radiology (J.W.E., B.R.G., F.S.A.-A., P.A.B., A.M.D., M.G., M.D.H., B.K.M.).,Hotchkiss Brain Institute (P.A.B., A.M.D., M.G., M.D.H., B.K.M.), University of Calgary, Calgary, Alberta, Canada
| | - M D Hill
- From the Departments of Clinical Neurosciences and Radiology (J.W.E., B.R.G., F.S.A.-A., P.A.B., A.M.D., M.G., M.D.H., B.K.M.).,Community Health Sciences and Department of Medicine (P.P., M.D.H., B.K.M.), Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute (P.A.B., A.M.D., M.G., M.D.H., B.K.M.), University of Calgary, Calgary, Alberta, Canada
| | - B K Menon
- From the Departments of Clinical Neurosciences and Radiology (J.W.E., B.R.G., F.S.A.-A., P.A.B., A.M.D., M.G., M.D.H., B.K.M.) .,Community Health Sciences and Department of Medicine (P.P., M.D.H., B.K.M.), Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute (P.A.B., A.M.D., M.G., M.D.H., B.K.M.), University of Calgary, Calgary, Alberta, Canada.,Foothills Medical Centre (B.K.M.), Calgary, Alberta, Canada
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Jadhav AP, Diener HC, Bonafe A, Pereira VM, Levy EI, Baxter BW, Jovin TG, Nogueira RG, Yavagal DR, Cognard C, Purcell DD, Menon BK, Jahan R, Saver JL, Goyal M. Correlation between Clinical Outcomes and Baseline CT and CT Angiographic Findings in the SWIFT PRIME Trial. AJNR Am J Neuroradiol 2017; 38:2270-2276. [PMID: 29025724 DOI: 10.3174/ajnr.a5406] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 07/19/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Patient selection for endovascular therapy remains a great challenge in clinic practice. We sought to determine the effect of baseline CT and angiography on outcomes in the Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke (SWIFT PRIME) trial and to identify patients who would benefit from endovascular stroke therapy. MATERIALS AND METHODS The primary end point was a 90-day modified Rankin Scale score of 0-2. Subgroup and classification and regression tree analysis was performed on baseline ASPECTS, site of occlusion, clot length, collateral status, and onset-to-treatment time. RESULTS Smaller baseline infarct (n = 145) (ASPECTS 8-10) was associated with better outcomes in patients treated with thrombectomy versus IV tPA alone (66% versus 41%; rate ratio, 1.62) compared with patients with larger baseline infarcts (n = 44) (ASPECTS 6-7) (42% versus 21%; rate ratio, 1.98). The benefit of thrombectomy over IV tPA alone did not differ significantly by ASPECTS. Stratification by occlusion location also showed benefit with thrombectomy across all groups. Improved outcomes after thrombectomy occurred in patients with clot lengths of ≥8 mm (71% versus 43%; rate ratio, 1.67). Outcomes stratified by collateral status had a benefit with thrombectomy across all groups: none-fair collaterals (33% versus 0%), good collaterals (58% versus 44%), and excellent collaterals (82% versus 28%). Using a 3-level classification and regression tree analysis, we observed optimal outcomes in patients with favorable baseline ASPECTS, complete/near-complete recanalization (TICI 2b/3), and early treatment (mean mRS, 1.35 versus 3.73), while univariate and multivariate logistic regression showed significantly better results in patients with higher ASPECTS. CONCLUSIONS While benefit was seen with endovascular therapy across multiple subgroups, the greatest response was observed in patients with a small baseline core infarct, excellent collaterals, and early treatment.
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Affiliation(s)
- A P Jadhav
- From Department of Neurology and Neurological Surgery (A.P.J., T.G.J.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - H-C Diener
- Department of Neurology (H.-C.D,), University Hospital of University Duisburg-Essen, Essen, Germany
| | - A Bonafe
- Department of Neuroradiology (A.B.), Hôpital Gui-de-Chauliac, Montpellier, France
| | - V M Pereira
- Division of Neuroradiology and Division of Neurosurgery (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
| | - E I Levy
- Department of Neurosurgery (E.I.L.), State University of New York at Buffalo, Buffalo, New York
| | - B W Baxter
- Department of Radiology (B.W.B.), Erlanger Hospital at University of Tennessee, Chattanooga, Tennessee
| | - T G Jovin
- From Department of Neurology and Neurological Surgery (A.P.J., T.G.J.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - R G Nogueira
- Department of Neurology (R.G.N.), Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia
| | - D R Yavagal
- Department of Neurology and Neurosurgery (D.R.Y.), University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
| | - C Cognard
- Department of Diagnostic and Therapeutic Neuroradiology (C.C.), University Hospital of Toulouse, Toulouse, France
| | - D D Purcell
- BioClinica (D.D.P.), Newark, California.,Department of Radiology (D.D.P.), California Pacific Medical Center, San Francisco, California.,Division of Neuroradiology (D.D.P.), University of California San Francisco, San Francisco, California
| | - B K Menon
- Neurology and Neurosurgery (B.K.M.), University of Calgary, Calgary, Alberta, Canada
| | - R Jahan
- Division of Interventional Neuroradiology (R.J.)
| | - J L Saver
- Department of Neurology and Comprehensive Stroke Center (J.L.S.), David Geffen School of Medicine at the University of California Los Angeles, University of California, Los Angeles, Los Angeles, California
| | - M Goyal
- Departments of Radiology and Clinical Neurosciences (M.G.)
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Assis Z, Menon BK, Goyal M, Demchuk AM, Shankar J, Rempel JL, Roy D, Poppe AY, Yang V, Lum C, Dowlatshahi D, Thornton J, Choe H, Burns PA, Frei DF, Baxter BW, Hill MD. Acute ischemic stroke with tandem lesions: technical endovascular management and clinical outcomes from the ESCAPE trial. J Neurointerv Surg 2017; 10:429-433. [DOI: 10.1136/neurintsurg-2017-013316] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 11/04/2022]
Abstract
BackgroundTandem occlusions of the extracranial carotid and intracranial carotid or middle cerebral artery have a particularly poor prognosis without treatment. Several management strategies have been used with no clear consensus recommendations. We examined subjects with tandem occlusions enrolled in the ESCAPE trial and their outcomes.MethodsData are from the ESCAPE trial. Additional data were sought on interventions for each subject.ResultsThere were 54 (17%) subjects with tandem extracranial and intracranial occlusions. Patients in the endovascular treatment arm (n=30) were more likely to be younger (median age 66 years, p<0.01), male (66.7%, p=0.03), diabetic, and without atrial fibrillation. Subjects with tandem occlusions were more likely to have intracranial internal carotid artery occlusions than M1 occlusions (p<0.01). Of the 30 intervention-arm subjects, 17 (57%) underwent emergency endovascular treatment of the extracranial disease, 10 subjects before and seven subjects after intracranial thrombectomy. Of the remaining 13 subjects, only four required staged carotid revascularization due to persistent severe carotid stenosis; four had cervical pseudo-occlusions with no residual stenosis after large distal carotid thrombus burden aspiration/retrieval. Outcomes were similar between subjects with and without tandem lesions. The use of antithrombotic agents after acute carotid artery stenting was variable but no symptomatic intracerebral hemorrhage was seen in subjects who underwent emergency endovascular treatment of extracranial carotid artery.ConclusionsTandem occlusions occurred in one-sixth of patients and were treated highly variably within the ESCAPE trial. While outcomes were similar, the best method to treat the carotid artery in patients with tandem occlusion awaits further randomized data.Trial registration numberNCT01778335.
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29
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Mueller-Kronast NH, Zaidat OO, Froehler MT, Jahan R, Aziz-Sultan MA, Klucznik RP, Saver JL, Hellinger FR, Yavagal DR, Yao TL, Liebeskind DS, Jadhav AP, Gupta R, Hassan AE, Martin CO, Bozorgchami H, Kaushal R, Nogueira RG, Gandhi RH, Peterson EC, Dashti SR, Given CA, Mehta BP, Deshmukh V, Starkman S, Linfante I, McPherson SH, Kvamme P, Grobelny TJ, Hussain MS, Thacker I, Vora N, Chen PR, Monteith SJ, Ecker RD, Schirmer CM, Sauvageau E, Abou-Chebl A, Derdeyn CP, Maidan L, Badruddin A, Siddiqui AH, Dumont TM, Alhajeri A, Taqi MA, Asi K, Carpenter J, Boulos A, Jindal G, Puri AS, Chitale R, Deshaies EM, Robinson DH, Kallmes DF, Baxter BW, Jumaa MA, Sunenshine P, Majjhoo A, English JD, Suzuki S, Fessler RD, Delgado Almandoz JE, Martin JC, Haussen DC. Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke. Stroke 2017; 48:2760-2768. [DOI: 10.1161/strokeaha.117.016456] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 06/26/2017] [Accepted: 07/20/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Nils H. Mueller-Kronast
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Osama O. Zaidat
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Michael T. Froehler
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Reza Jahan
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Mohammad Ali Aziz-Sultan
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Richard P. Klucznik
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Jeffrey L. Saver
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Frank R. Hellinger
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Dileep R. Yavagal
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Tom L. Yao
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - David S. Liebeskind
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Ashutosh P. Jadhav
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Rishi Gupta
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Ameer E. Hassan
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Coleman O. Martin
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Hormozd Bozorgchami
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Ritesh Kaushal
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Raul G. Nogueira
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Ravi H. Gandhi
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Eric C. Peterson
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Shervin R. Dashti
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Curtis A. Given
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Brijesh P. Mehta
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Vivek Deshmukh
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Sidney Starkman
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Italo Linfante
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Scott H. McPherson
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Peter Kvamme
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Thomas J. Grobelny
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Muhammad S. Hussain
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Ike Thacker
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Nirav Vora
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Peng Roc Chen
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Stephen J. Monteith
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Robert D. Ecker
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Clemens M. Schirmer
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Eric Sauvageau
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Alex Abou-Chebl
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Colin P. Derdeyn
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Lucian Maidan
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Aamir Badruddin
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Adnan H. Siddiqui
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Travis M. Dumont
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Abdulnasser Alhajeri
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - M. Asif Taqi
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Khaled Asi
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Jeffrey Carpenter
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Alan Boulos
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Gaurav Jindal
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Ajit S. Puri
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Rohan Chitale
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Eric M. Deshaies
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - David H. Robinson
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - David F. Kallmes
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Blaise W. Baxter
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Mouhammad A. Jumaa
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Peter Sunenshine
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Aniel Majjhoo
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Joey D. English
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Shuichi Suzuki
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Richard D. Fessler
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Josser E. Delgado Almandoz
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Jerry C. Martin
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Diogo C. Haussen
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
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Leslie-Mazwi T, Chen M, Yi J, Starke RM, Hussain MS, Meyers PM, McTaggart RA, Pride GL, Ansari AS, Abruzzo T, Albani B, Arthur AS, Baxter BW, Bulsara KR, Delgado Almandoz JE, Gandhi CD, Heck D, Hetts SW, Klucznik RP, Jayaraman MV, Lee SK, Mack WJ, Mocco J, Prestigiacomo C, Patsalides A, Rasmussen P, Sunenshine P, Frei D, Fraser JF. Post-thrombectomy management of the ELVO patient: Guidelines from the Society of NeuroInterventional Surgery. J Neurointerv Surg 2017; 9:1258-1266. [PMID: 28963364 DOI: 10.1136/neurintsurg-2017-013270] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 07/22/2017] [Accepted: 08/06/2017] [Indexed: 01/01/2023]
Affiliation(s)
- Thabele Leslie-Mazwi
- Neurointerventional Service, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael Chen
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Julia Yi
- University Illinois at Chicago, Chicago, Illinois, USA
| | - Robert M Starke
- Department of Neurosurgery and Radiology, University of Miami, Miami, Florida, USA
| | | | | | - Ryan A McTaggart
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - G Lee Pride
- Department of Neuroradiology, University of Texas Southwestern, Dallas, Texas, USA
| | - A Sameer Ansari
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Todd Abruzzo
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Barbara Albani
- Department of Neurointerventional Surgery, Christiana Care Health Systems, Newark, Delaware, USA
| | | | - Blaise W Baxter
- Department of Radiology, Erlanger Medical Center, Chattanooga, Tennessee, USA
| | - Ketan R Bulsara
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Josser E Delgado Almandoz
- Department of Neurointerventional Radiology, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Chirag D Gandhi
- Department of Neurosurgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - Don Heck
- Department of Radiology, Forsyth Medical Center, Winston Salem, North Carolina, USA
| | - Steven W Hetts
- Department of Radiology, University of California in San Francisco, San Francisco, California, USA
| | - Richard P Klucznik
- Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas, USA
| | - Mahesh V Jayaraman
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Seon-Kyu Lee
- The University of Chicago, Chicago, Illinois, USA
| | - William J Mack
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - J Mocco
- Mount Sinai School of Medicine, Mount Sinai Health System, New York, New York, USA
| | | | - Athos Patsalides
- New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York, USA
| | - Peter Rasmussen
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Donald Frei
- Swedish Medical Center, Denver, Colorado, USA
| | - Justin F Fraser
- Department of Neurological Surgery, University of Kentucky, Lexington, Kentucky, USA
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Froehler MT, Saver JL, Zaidat OO, Jahan R, Aziz-Sultan MA, Klucznik RP, Haussen DC, Hellinger FR, Yavagal DR, Yao TL, Liebeskind DS, Jadhav AP, Gupta R, Hassan AE, Martin CO, Bozorgchami H, Kaushal R, Nogueira RG, Gandhi RH, Peterson EC, Dashti SR, Given CA, Mehta BP, Deshmukh V, Starkman S, Linfante I, McPherson SH, Kvamme P, Grobelny TJ, Hussain MS, Thacker I, Vora N, Chen PR, Monteith SJ, Ecker RD, Schirmer CM, Sauvageau E, Abou-Chebl A, Derdeyn CP, Maidan L, Badruddin A, Siddiqui AH, Dumont TM, Alhajeri A, Taqi MA, Asi K, Carpenter J, Boulos A, Jindal G, Puri AS, Chitale R, Deshaies EM, Robinson DH, Kallmes DF, Baxter BW, Jumaa MA, Sunenshine P, Majjhoo A, English JD, Suzuki S, Fessler RD, Delgado Almandoz JE, Martin JC, Mueller-Kronast NH. Interhospital Transfer Before Thrombectomy Is Associated With Delayed Treatment and Worse Outcome in the STRATIS Registry (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke). Circulation 2017; 136:2311-2321. [PMID: 28943516 PMCID: PMC5732640 DOI: 10.1161/circulationaha.117.028920] [Citation(s) in RCA: 280] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 09/08/2017] [Indexed: 11/17/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Endovascular treatment with mechanical thrombectomy (MT) is beneficial for patients with acute stroke suffering a large-vessel occlusion, although treatment efficacy is highly time-dependent. We hypothesized that interhospital transfer to endovascular-capable centers would result in treatment delays and worse clinical outcomes compared with direct presentation. Methods: STRATIS (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke) was a prospective, multicenter, observational, single-arm study of real-world MT for acute stroke because of anterior-circulation large-vessel occlusion performed at 55 sites over 2 years, including 1000 patients with severe stroke and treated within 8 hours. Patients underwent MT with or without intravenous tissue plasminogen activator and were admitted to endovascular-capable centers via either interhospital transfer or direct presentation. The primary clinical outcome was functional independence (modified Rankin Score 0–2) at 90 days. We assessed (1) real-world time metrics of stroke care delivery, (2) outcome differences between direct and transfer patients undergoing MT, and (3) the potential impact of local hospital bypass. Results: A total of 984 patients were analyzed. Median onset-to-revascularization time was 202.0 minutes for direct versus 311.5 minutes for transfer patients (P<0.001). Clinical outcomes were better in the direct group, with 60.0% (299/498) achieving functional independence compared with 52.2% (213/408) in the transfer group (odds ratio, 1.38; 95% confidence interval, 1.06–1.79; P=0.02). Likewise, excellent outcome (modified Rankin Score 0–1) was achieved in 47.4% (236/498) of direct patients versus 38.0% (155/408) of transfer patients (odds ratio, 1.47; 95% confidence interval, 1.13–1.92; P=0.005). Mortality did not differ between the 2 groups (15.1% for direct, 13.7% for transfer; P=0.55). Intravenous tissue plasminogen activator did not impact outcomes. Hypothetical bypass modeling for all transferred patients suggested that intravenous tissue plasminogen activator would be delayed by 12 minutes, but MT would be performed 91 minutes sooner if patients were routed directly to endovascular-capable centers. If bypass is limited to a 20-mile radius from onset, then intravenous tissue plasminogen activator would be delayed by 7 minutes and MT performed 94 minutes earlier. Conclusions: In this large, real-world study, interhospital transfer was associated with significant treatment delays and lower chance of good outcome. Strategies to facilitate more rapid identification of large-vessel occlusion and direct routing to endovascular-capable centers for patients with severe stroke may improve outcomes. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02239640.
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Affiliation(s)
| | - Jeffrey L Saver
- University of California, Los Angeles (J.L.S., R.J., D.S.L., S.S.)
| | | | - Reza Jahan
- University of California, Los Angeles (J.L.S., R.J., D.S.L., S.S.)
| | | | | | - Diogo C Haussen
- Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA (D.C.H., R.G.N.)
| | - Frank R Hellinger
- Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.)
| | - Dileep R Yavagal
- University of Miami Miller School of Medicine/Jackson Memorial Hospital, FL (D.R.Y., E.C.P.)
| | - Tom L Yao
- Norton Neuroscience Institute, Norton Healthcare, Louisville, KY (T.L.Y., S.R.D.)
| | | | | | - Rishi Gupta
- WellStar Neurosciences Network, WellStar Kennestone Regional Medical Center, Marietta, GA (R.G.)
| | | | | | | | - Ritesh Kaushal
- Advanced Neuroscience Network/Tenet South Florida, Delray Beach (R.K., N.H.M.-K.)
| | - Raul G Nogueira
- Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA (D.C.H., R.G.N.)
| | - Ravi H Gandhi
- Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.)
| | - Eric C Peterson
- University of Miami Miller School of Medicine/Jackson Memorial Hospital, FL (D.R.Y., E.C.P.)
| | - Shervin R Dashti
- Norton Neuroscience Institute, Norton Healthcare, Louisville, KY (T.L.Y., S.R.D.)
| | | | | | - Vivek Deshmukh
- Providence St Vincent Medical Center, Portland, OR (V.D.)
| | - Sidney Starkman
- University of California, Los Angeles (J.L.S., R.J., D.S.L., S.S.)
| | | | | | - Peter Kvamme
- University of Tennessee Medical Center, Knoxville (P.K.)
| | | | | | - Ike Thacker
- Baylor University Medical Center, Dallas, TX (I.T.)
| | - Nirav Vora
- OhioHealth Riverside Methodist Hospital, Columbus (N.V.)
| | - Peng Roc Chen
- Memorial Hermann Texas Medical Center, Houston (P.R.C.)
| | | | | | | | | | | | | | - Lucian Maidan
- Mercy San Juan Medical Center and Mercy General, Carmichael, CA (L.M.)
| | | | | | | | | | - M Asif Taqi
- Los Robles Medical Center, Thousand Oaks, CA (M.A.T.)
| | | | | | | | - Gaurav Jindal
- University of Maryland Medical Center, Baltimore (G.J.)
| | - Ajit S Puri
- University of Massachusetts Memorial Medical Center, Worcester (A.S.P.)
| | - Rohan Chitale
- Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.)
| | | | | | | | | | | | | | | | - Joey D English
- California Pacific Medical Center, San Francisco, CA (J.D.E.)
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Sarraj A, Veznedaroglu E, Budzik RF, English JD, Baxter BW, Bartolini BM, Liebeskind DS, Krajina A, Shields RD, Xiang B, Nogueira RG, Gupta R, Dannenbaum M, Farrell CM, McCullough LD, Savitz SI. Abstract WP5: The Transfer Score May Aid Decisions Whether to Transfer Patients with Large Vessel Occlusions for Endovascular Therapy. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.wp5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
While faster reperfusion with EVT leads to better outcomes in acute ischemic stroke due to large vessel occlusion (LVO), most LVO patients present to outside hospitals without EVT capability. Treating physicians are often unsure if EVT would confer benefit upon arrival to tertiary hospitals given inter-facility transfer delays.
Objective:
We evaluated independent predictors of good outcome in transferred patients treated with EVT to devise a score that may assist treating physicians to make transfer and treatment decisions.
Methods:
Transfer patients were analyzed in a multicenter international prospective cohort study of LVO patients treated with stent retriever thrombectomy (TREVO Registry) from 11/2013 to 4/2016. Independent factors correlating with good outcome after EVT were identified using univariate and multivariate analyses. We devised a score to identify patients with LVO at the referral facility who may benefit from EVT.
Results:
Of 1000 patients enrolled, 226 were anterior circulation occlusions, transferred and treated within 0-8 hrs (Table 1). Age, stroke severity, glucose level, M2 occlusion and achieving onset to groin puncture ≤ 5 hr were independent factors associated with good outcome (Table 2). Other clinical variables were analyzed, as in ASPECTS, but were not significant. A 10 point score was devised (Table 3). Patients with a score of 0-4 had 4 times the odds of good outcome compared to a score of 5-9 (aOR 4.3, 95% CI 1.9-9.9;
p
<0.001). These results were maintained after adjustment for mTICI and IV-tPA (aOR 4.0, 95% CI 1.7-9.4;
p
<0.001). Fig 1 shows good outcome rates stratified by score points. ROC curves showed better score performance (AUC= 0.8) compared to THRIVE (AUC=0.74) and HIAT (AUC=0.69) certifying good predictability.
Conclusion:
A simple transfer score may be an effective triage method to identify patients at remote facilities who may benefit from EVT upon transfer. Further validation is necessary to confirm these findings.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Bin Xiang
- Prospect Analytical, Inc., San Jose, CA
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33
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Binning MJ, Budzik RF, Baxter BW, Bartolini BM, Liebeskind DS, Krajina A, English JD, Maxwell C, Veznedaroglu E. Abstract WMP2: Trevo 2000: Real-World Experience in the First 1247 Patients. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.wmp2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:
The Trevo Registry is designed to assess real world outcomes of the Trevo Retriever in patients experiencing ischemic stroke. This is the largest prospective study for acute stroke intervention, with 1247 patients currently enrolled and 90 day outcomes in 1021 patients. The primary endpoint is revascularization status based on post-procedure TICI score and secondary endpoints include 90-day mRS, 90-day mortality, neurological deterioration at 24 hours and device/procedure related adverse events.
Methods:
The study is a prospective, open-label, consecutive enrollment, multi-center, international registry of patients undergoing mechanical thrombectomy for acute stroke using the Trevo stent retriever as the initial device. Enrollment is expected to reach 2000 subjects at up to 100 sites.
Results:
As of August 13, 2016 a total of 1247 patients were enrolled. The median NIHSS at admission was 16 (IQR 11-20). Most patients (66.2%) were treated at >/= 6 hours from last known normal with a median procedure time of 50 minutes (32-77). The occlusion site was M1 or M2 in 74.5%. General anesthesia was employed in 46.6% of procedures. TICI 2b or 3 revascularization was 92.8% with an average of 1.6 passes with the device. Median NIHSS at 24 hours and discharge was 6 and 4 respectively. Fifty-five percent of patients had mRS ≤2 at 3 months and the overall mortality rate was 15.4%. Patients treated after 8 hours of symptom onset had a 94.9% revascularization rate and 52.8% mRS ≤2 at 3 months. The symptomatic ICH rate was 1.2%. Patients who met the revised AHA criteria for thrombectomy were found to have 58.4% mRS 0-2 at 90 days.
Conclusions:
The Trevo Retriever Registry represents the first real world data with stent retriever use in the era of clinical trials showing the overwhelming benefit of stent retrievers to treat acute ischemic stroke. Due to the fact that this data represents real world use of the Trevo Retriever, (e.g. subjects pre-stroke mRS >1 (16.5%) and those treated 6-24 hours after stroke symptoms (33.8%), this data cannot be compared to the results from recent trials with restricted eligibility criteria. Future subgroup analysis of this large cohort will help to identify areas of future research to enhance outcomes further with this treatment modality.
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Affiliation(s)
- Mandy J Binning
- Neurosurgery, Drexel Neurosciences Institute, Philadelphia, PA
| | | | | | | | | | - Antonin Krajina
- Univ Hosp Hradec Kralove, Kralovehracky kraj, Czech Republic
| | - Joey D English
- neurology, California Pacific Med Cntr, San Francisco, CA
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34
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Sarraj A, Veznedaroglu E, Budzik RF, English JD, Baxter BW, Bartolini BM, Krajina A, Shields RD, Nogueira RG, Gupta R, Spiegel GR, Savitz SI, McCullough LD, Farrell CM, Liebeskind DS. Abstract WMP9: Endovascular Thrombectomy Impact in the First Three “Golden” Hours. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.wmp9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Endovascular thrombectomy (EVT) substantially increases the likelihood of good outcome in acute ischemic strokes due to large vessel occlusion (LVO). Expediting EVT to achieve faster reperfusion is an important factor that correlates with good outcome. Ultra-early intervention in the first 3 “golden” hours from onset was not well characterized in recent trials.
Objective:
We sought to assess the impact of early treatment within the first 3 hours on clinical outcomes in large, real life, world-wide practice.
Methods:
We analyzed a multicenter international prospective cohort study of LVO patients treated with stent retriever thrombectomy (TREVO Registry) between11/2013 and 4/2016. We stratified patients based on treatment time, onset to groin puncture (GP), into 3 groups: 0-3, 3-6, >6 hrs. 90 day mRS was the primary outcome (0-2 good outcome). Logistic regression modeling was performed to evaluate the impact of treatment within the golden 3 hours on outcomes and to determine the independent factors associated with EVT initiation within 3 hours.
Results:
In the 905 patients, GP occurred in: 23.1% 0-3 hrs, 44.3% 3-6 hrs and 32.6% >6 hrs. Table 1 shows similar baseline characteristics among the groups. Patient-level predictors of treatment within 3 hrs were age (aOR 1.1 per decade of age ≥18) and good ASPECTS (aOR 1.2 per point). No hospital-level predictors of early treatment were found. Patients treated within 3 hrs have a higher likelihood of good outcome as compared to those treated >3 hrs (aOR 2.0, 95% CI 1.4-2.9;
p
<0.001) after adjustment for age, NIHSS, IV tPA and mTICI ≥2b (Table 2). No differences were found in mortality and sICH. Treatment in the golden hours had the highest impact on excellent outcome rates (mRS 0-1) (Fig 1).
Conclusion:
Early thrombectomy of LVO strokes, within the first three hours provides the highest impact compared with later time windows. Streamlining processes to deliver rapid intervention within 3 hours would improve clinical outcomes.
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35
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Sarraj A, Budzik RF, Veznedaroglu E, English JD, Baxter BW, Bartolini BM, Liebeskind DS, Krajina A, Shields RD, Jin N, Nogueira RG, Gupta R, Chen PR, Farrell CM, Savitz SI, McCullough LD. Abstract TP20: Uncertainties of Endovascular Therapy Outside the AHA Guidelines. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.tp20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The efficacy of endovascular therapy (EVT) in randomized clinical trials (RCTs) for acute strokes due to large vessel occlusion (LVO) led to AHA guidelines recommending EVT as standard of care for selected patients. However, many conditions were under-represented in the RCTs: ASPECTS <6, age ≥80 yo, NIHSS <6, onset to treatment >6 hrs and M2/ distal/ posterior circulation occlusions.
Objective:
We evaluated EVT outcomes in these populations compared to counterparts represented in the RCTs.
Methods:
A large multicenter international prospective cohort study of LVO patients treated with stent retriever thrombectomy (TREVO Registry) between 11/2013 and 4/2016 was analyzed. 90 day mRS was the primary outcome (0-2 good outcome). Multivariate logistic regression modeling was employed to evaluate EVT impact in the different groups.
Results:
Of 1000 patients, 81 had NIHSS <6 and 81.5% of those achieved a good outcome (aOR 3.6, 95% CI 1.9-6.8;
p<
0.001 compared with NIHSS ≥6) (Table 1). Over 80 yo, however, had low odds of independence (aOR 0.3, 95% CI 0.2-0.5;
p
<0.001 compared with <80 yo). Among 212 patients treated >6 hrs, 51% had a good outcome (aOR 0.78, 95% CI 0.55-1.1;
p
=0.17) compared to ≤6 hrs. Nearly half of patients with ASPECTS <6 (3-5) had a good outcome. Fig 1 illustrates mRS distributions stratified by the different subgroups. There were low rates of sICH for treated patients with NIHSS<6, age≥80, ASPECTS <6 or treatment >6 hrs. Fig 2 demonstrates the likelihood of good outcome by clot location. M2 and distal occlusions had the highest good outcome probabilities while proximal ICAs had the lowest (48.1%). More than half of vertebrobasilar patients achieved independence (54.8%).
Conclusion:
While effectiveness cannot be determined in the absence of medically treated controls, our analyses of real world data show several groups outside AHA guidelines may benefit from EVT. In particular, further study is needed to examine EVT benefits for mild stroke and M2 occlusions.
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36
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Gupta R, Veznedaroglu E, Budzik RF, English JD, Baxter BW, Bartolini BM, Krajina A, Sarraj A, Liebeskind DS, Shields RD, Xiang B. Abstract WMP11: Joint Commission Certified Stroke Centers Treat More Severe Strokes with Faster Procedure Times Compared to Non-joint Commission Certified Stroke Centers in the Trevo Registry. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.wmp11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Endovascular stroke therapy has become the gold standard treatment for large vessel occlusion. The Joint Commission has certified hospitals as Comprehensive stroke centers (JCCSC) based on rigorous standards in the hopes of identifying centers of excellence. We sought to determine if JCCSC have faster door to reperfusion times compared to non-JCCSC.
Methods:
The TREVO registry is a multicenter international real world registry assessing angiographic and clinical outcomes with the Trevo device being used in the first pass. We defined a CSC as certified by the Joint Commission as of July 1, 2016. Demographic information, times within the hospital, angiographic results and clinical outcomes were analyzed between the JCCSC and non-JCCSC institutions.
Results:
A total of 507 patients (329 JCCSC, 178 non-JCCSC) have completed data in the Trevo registry to date. There are a higher proportion of patients with ASPECTS < 7 being treated at JCCSC vs. non-JCCSC (8.8% vs. 0.0%, p<0.02). There were no differences in outcomes, reperfusion rates or symptomatic hemorrhage rates between the two groups. Demographics were similar except patients treated at a JCCSC had a higher median NIHSS [17 vs. 15, p<0.003] compared to the non-JCCSC group. Median (IQR) door to puncture times did not differ between the two groups [85(57-132) vs. 91(59-137), p<0.96], but patients treated at a JCCSC had lower mean angiographic procedure times [59 ± 34 minutes vs. 66±44 minutes, p<0.05]. The analysis did not change when we looked at the subset of patients who were not transferred with anterior circulation strokes less than 8 hours from onset.
Conclusions:
Patients treated at a JCCSC had faster procedural times, without faster door to procedure times when compared to non-JCCSC centers. Outcomes were no different, due to imbalances in stroke severity at baseline and a higher proportion of patients with ASPECTS < 7 being treated.
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Affiliation(s)
- Rishi Gupta
- Dept of Wellstar Neurosurgery, Kennestone Hosp, Marietta, GA
| | | | | | | | | | | | | | | | | | | | - Bin Xiang
- Prospect Analytical, Inc., San Jose, CA
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37
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Liebeskind DS, Woolf GW, Xiang B, Shields R, Veznedaroglu E, English J, Baxter BW, Budzik RF, Bartolini BM, Krajina A, Sarraj A, Narata AP, Miller T, Grobelny T, Gupta R, Jadhav A, Nogueira RG. Abstract 37: ASPECTS and Stratified Outcomes After Endovascular Therapy in the Trevo Retriever Registry: Benefit in Low ASPECTS. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Most endovascular stroke therapy studies and subsequent guidelines restrict intervention based on ASPECTS. A wide range of ASPECTS scores may be encountered in practice and individual patient benefit may be realized even at low ASPECTS. We examined large-scale data on outcomes after endovascular therapy, stratified by baseline ASPECTS in the Trevo Retriever Registry.
Methods:
The independent Imaging Core Lab of the Trevo Retriever Registry prospectively determines ASPECTS on baseline imaging acquired immediately prior to endovascular thrombectomy. ASPECTS scores and regional involvement were analyzed with respect to site of arterial occlusion, effect of time from symptom onset, co-morbidities and clinical outcomes, based on ASPECTS strata.
Results:
Baseline ASPECTS data was reviewed by the Imaging Core Lab in 426 subjects with anterior circulation stroke enrolled in the Trevo Retriever Registry, as of July 2016. Mean age was 68.8 ± 13.7 yrs, with 20.9% > 80 years old. Baseline NIHSS was median 15.0 (10.0, 19.0). Onset to CT was median 3.8 (1.5, 9.0) hrs, with median ASPECTS of 8.0 (7.0, 9.0), ranging from 3-10. Baseline ASPECTS 0-7 occurred in 118/426 (27.7%) subjects, including 39.0% of ICA, 27.1% M1 and 16.9% M2/3 arterial occlusions at angiography. Baseline clinical variables predicting ASPECTS included age and NIHSS, whereas the ASPECTS score was mildly associated with final TICI2C reperfusion (r=0.24, p<0.001). Subsequent symptomatic ICH was 1.7% with baseline ASPECTS 0-7 versus 2.0% with ASPECTS 8-10. The distribution of mRS at 90 days based on individual ASPECTS strata from 10 to 3 revealed a trend to worse outcomes with lower ASPECTS, yet good outcomes (mRS 0-2) were 60.7% (ASPECTS 10), 55.3% (9), 60.2% (8), 54.9% (7), 55.1% (3-6).
Conclusions:
Discrete ASPECTS strata may influence outcomes of endovascular therapy conducted in routine practice around the world, yet individuals with low ASPECTS may still achieve reasonable outcomes.
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Affiliation(s)
| | | | - Bin Xiang
- Prospect Analytical, Inc, San Jose, CA
| | | | | | | | | | | | | | | | | | | | - Tim Miller
- Univ of Maryland Med Cntr, Baltimore, MD
| | | | | | | | - Raul G Nogueira
- Emory Univ Sch of Medicine / Grady Memorial Hosp, Atlanta, GA
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38
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Liebeskind DS, Woolf GW, Xiang B, Shields R, Veznedaroglu E, English J, Baxter BW, Budzik RF, Bartolini BM, Krajina A, Sarraj A, Narata AP, Miller T, Grobelny T, Nogueira RG, Gupta R, Jadhav A. Abstract WP6: Real-World Data on Reperfusion: Evidence of Good Outcomes in the International Trevo Retriever Registry. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.wp6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Endovascular thrombectomy trials established efficacy in acute ischemic stroke, yet real-world data on device effectiveness is warranted. Core lab adjudication of angiography is required to validate reperfusion, providing evidence and detailed data beyond randomized, controlled trials. We report the largest endovascular therapy registry data linking independent core lab data on reperfusion with clinical outcomes.
Methods:
The Trevo Retriever Registry is a prospective, open-label, consecutive enrollment, multicenter, international registry with more than 65 enrolling sites worldwide. An independent Imaging Core Lab, blind to all other data, evaluates the angiography with a battery of various TICI scores (mTICI, oTICI, oTICI2C) to define reperfusion. Statistical analyses examined TICI reperfusion and association with clinical outcomes considering expansive data collected in the registry.
Results:
506 enrolled subjects (mean age 68.2 ± 14.2 yrs; 53% female) had core lab adjudicated angiography as of July 2016, including 21.5% > 80 years old. Baseline NIHSS was median 15.0 (9.0, 20.0) with time from onset to CT of median 4.0 (1.7, 9.7) hrs. Core lab adjudicated arterial occlusion sites were: 53% M1, 24% ICA, 16% M2, 4% Basilar and 2% other. Time to reperfusion (oTICI ≥ 2A) was median 30.0 (19.0, 42.0) min. Core lab adjudicated revascularization was mTICI ≥ 2B in 90.4% (95%CI 87.4, 92.9), oTICI ≥ 2B in 82.3% (95%CI 78.6, 85.6) and oTICI2C ≥ 2C in 45.0% (95%CI 40.5, 49.6). mRS of 0-2 at 90 days was achieved in 57.3% (95%CI 52.5, 62.1). Extensive clinical, laboratory and stroke workflow variables were considered, yet only male sex (OR 0.62 (95% CI 0.38, 0.99) was an independent predictor of successful reperfusion (oTICI ≥ 2B) while age (OR 0.96 (95% CI 0.94, 0.97), NIHSS (OR 0.91 (95% CI 0.88, 0.94) and diabetes (OR 0.54 (95% CI 0.33, 0.88) predicted mRS 0-2 at 90 days.
Conclusions:
Proven reperfusion rates after endovascular stroke therapy excel in the real-world translation of thrombectomy devices around the globe, leading to good outcomes after stroke.
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Affiliation(s)
| | | | - Bin Xiang
- Prospect Analytical, Inc, San Jose, CA
| | | | | | | | | | | | | | | | | | | | - Tim Miller
- Univ of Maryland Med Cntr, Baltimore, MD
| | | | - Raul G Nogueira
- Emory Univ Sch of Medicine / Grady Memorial Hosp, Atlanta, GA
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39
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Sarraj A, Veznedaroglu E, Budzik RF, English JD, Baxter BW, Bartolini B, Liebeskind DS, Krajina A, Shields RD, Xiang B, Nogueira RG, Blackburn S, Farrell CM, Savitz SI, McCullough LD, Gupta R. Abstract WP4: Transfer Patients and Patients Presenting Directly to Endovascular Capable Centers Achieve Similar Good Outcome Rates with Endovascular Therapy. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.wp4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
While endovascular therapy (EVT) is effective for large vessel occlusions (LVO), most patients present to hospitals without EVT capability and are transferred for intervention, delaying treatment.
Objective:
We evaluated outcomes in LVO patients treated with thrombectomy who were transferred compared to those presenting directly to EVT facilities.
Methods:
In a large multicenter international prospective cohort study of LVO patients treated with stent retriever thrombectomy (TREVO Registry), patients were stratified by initial presentation into transferred (TNS) vs direct (DIR). 90 day mRS was the primary outcome (0-1 excellent, 0-2 good outcomes); sICH and reperfusion by mTICI were secondary outcomes. Outcomes were compared in the 2 groups (0-8 hrs onset to groin puncture (GP) then in time matched 3-8 hrs subgroups for validation). Logistic regression identified independent predictors of good outcome in TNS patients.
Results:
We identified 540 patients (230 TNS; 310 DIR) (Fig 1). TNS patients were younger and had longer onset to GP times (4.6 vs 3.1 hrs;
p
<0.001) (Table 1). DIR achieved higher excellent outcomes (50.4 vs 38.7%;
p
<0.001) (Table 2). There were no significant differences in good clinical outcomes (61 DIR vs 57.4% TNS, OR 0.90, 95% CI 0.63-1.27;
p
=0.4) (Fig 2) and no difference in the time matched 3-8 hrs subgroups (59.2% DIR vs 56.3% TNS,
p
=0.6). Fig 3 plots good outcome probabilities over time, showing similar confidence interval bands. Younger age (OR 0.95), lower NIHSS (OR 0.90), glucose level < 170 mg/dL (OR 2.4), distal clot location (M2) (OR 1.7), excellent reperfusion (mTICI≥2b) (OR 2) and time to GP <5 hrs (OR 1.6) were independent predictors of good outcome in TNS patients.
Conclusion:
While excellent outcomes were higher in directly-presenting patients, EVT-treated transfers may achieve similar good outcomes. The association between earlier EVT after transfer and better outcomes emphasizes the need to streamline the transfer process.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Bin Xiang
- Prospect Analytical, Inc., San Jose, CA
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40
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Stotts G, Poppe AY, Roy D, Jovin TG, Lum C, Williams D, Thornton J, Baxter BW, Devlin T, Frei DF, Fanale C, Shuaib A, Rempel JL, Menon BK, Demchuk AM, Goyal M, Hill MD. Defining the Role of the Stroke Physician During Endovascular Therapy of Acute Ischemic Stroke. Stroke 2017; 48:805-807. [PMID: 28143924 DOI: 10.1161/strokeaha.116.015385] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 12/05/2016] [Accepted: 12/12/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Grant Stotts
- From the Division of Neurology, Department of Medicine (G.S.) and Department of Medical Imaging (C.L.), Ottawa Hospital, University of Ottawa, Ontario, Canada; Department of Neurosciences (A.Y.P.) and Department of Radiology (D.R.), Université de Montréal, Centre Hospitalier de l'Université de Montréal, Québec, Canada; University of Pittsburgh Medical Centre, PA (T.G.J.); Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin (D.W.); Beaumont Hospital, Dublin, Ireland (D.W., J.T.); Erlanger Medical Centre, Chattanooga, TN (B.W.B., T.D.); Swedish Medical Centre, Englewood, CO (D.F.F., C.F.); Division of Neurology, Department of Medicine (A.S.) and Department of Radiology (J.L.R.), University of Alberta, Edmonton, Canada; and Department of Clinical Neurosciences (B.K.M., A.M.D., M.D.H.), Department of Medicine (A.M.D., M.D.H.), Department of Radiology (A.M.D., M.G., M.D.H.), and Department of Community Health Sciences (A.M.D., M.D.H.), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Alexandre Y Poppe
- From the Division of Neurology, Department of Medicine (G.S.) and Department of Medical Imaging (C.L.), Ottawa Hospital, University of Ottawa, Ontario, Canada; Department of Neurosciences (A.Y.P.) and Department of Radiology (D.R.), Université de Montréal, Centre Hospitalier de l'Université de Montréal, Québec, Canada; University of Pittsburgh Medical Centre, PA (T.G.J.); Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin (D.W.); Beaumont Hospital, Dublin, Ireland (D.W., J.T.); Erlanger Medical Centre, Chattanooga, TN (B.W.B., T.D.); Swedish Medical Centre, Englewood, CO (D.F.F., C.F.); Division of Neurology, Department of Medicine (A.S.) and Department of Radiology (J.L.R.), University of Alberta, Edmonton, Canada; and Department of Clinical Neurosciences (B.K.M., A.M.D., M.D.H.), Department of Medicine (A.M.D., M.D.H.), Department of Radiology (A.M.D., M.G., M.D.H.), and Department of Community Health Sciences (A.M.D., M.D.H.), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada.
| | - Daniel Roy
- From the Division of Neurology, Department of Medicine (G.S.) and Department of Medical Imaging (C.L.), Ottawa Hospital, University of Ottawa, Ontario, Canada; Department of Neurosciences (A.Y.P.) and Department of Radiology (D.R.), Université de Montréal, Centre Hospitalier de l'Université de Montréal, Québec, Canada; University of Pittsburgh Medical Centre, PA (T.G.J.); Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin (D.W.); Beaumont Hospital, Dublin, Ireland (D.W., J.T.); Erlanger Medical Centre, Chattanooga, TN (B.W.B., T.D.); Swedish Medical Centre, Englewood, CO (D.F.F., C.F.); Division of Neurology, Department of Medicine (A.S.) and Department of Radiology (J.L.R.), University of Alberta, Edmonton, Canada; and Department of Clinical Neurosciences (B.K.M., A.M.D., M.D.H.), Department of Medicine (A.M.D., M.D.H.), Department of Radiology (A.M.D., M.G., M.D.H.), and Department of Community Health Sciences (A.M.D., M.D.H.), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Tudor G Jovin
- From the Division of Neurology, Department of Medicine (G.S.) and Department of Medical Imaging (C.L.), Ottawa Hospital, University of Ottawa, Ontario, Canada; Department of Neurosciences (A.Y.P.) and Department of Radiology (D.R.), Université de Montréal, Centre Hospitalier de l'Université de Montréal, Québec, Canada; University of Pittsburgh Medical Centre, PA (T.G.J.); Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin (D.W.); Beaumont Hospital, Dublin, Ireland (D.W., J.T.); Erlanger Medical Centre, Chattanooga, TN (B.W.B., T.D.); Swedish Medical Centre, Englewood, CO (D.F.F., C.F.); Division of Neurology, Department of Medicine (A.S.) and Department of Radiology (J.L.R.), University of Alberta, Edmonton, Canada; and Department of Clinical Neurosciences (B.K.M., A.M.D., M.D.H.), Department of Medicine (A.M.D., M.D.H.), Department of Radiology (A.M.D., M.G., M.D.H.), and Department of Community Health Sciences (A.M.D., M.D.H.), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Cheemun Lum
- From the Division of Neurology, Department of Medicine (G.S.) and Department of Medical Imaging (C.L.), Ottawa Hospital, University of Ottawa, Ontario, Canada; Department of Neurosciences (A.Y.P.) and Department of Radiology (D.R.), Université de Montréal, Centre Hospitalier de l'Université de Montréal, Québec, Canada; University of Pittsburgh Medical Centre, PA (T.G.J.); Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin (D.W.); Beaumont Hospital, Dublin, Ireland (D.W., J.T.); Erlanger Medical Centre, Chattanooga, TN (B.W.B., T.D.); Swedish Medical Centre, Englewood, CO (D.F.F., C.F.); Division of Neurology, Department of Medicine (A.S.) and Department of Radiology (J.L.R.), University of Alberta, Edmonton, Canada; and Department of Clinical Neurosciences (B.K.M., A.M.D., M.D.H.), Department of Medicine (A.M.D., M.D.H.), Department of Radiology (A.M.D., M.G., M.D.H.), and Department of Community Health Sciences (A.M.D., M.D.H.), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - David Williams
- From the Division of Neurology, Department of Medicine (G.S.) and Department of Medical Imaging (C.L.), Ottawa Hospital, University of Ottawa, Ontario, Canada; Department of Neurosciences (A.Y.P.) and Department of Radiology (D.R.), Université de Montréal, Centre Hospitalier de l'Université de Montréal, Québec, Canada; University of Pittsburgh Medical Centre, PA (T.G.J.); Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin (D.W.); Beaumont Hospital, Dublin, Ireland (D.W., J.T.); Erlanger Medical Centre, Chattanooga, TN (B.W.B., T.D.); Swedish Medical Centre, Englewood, CO (D.F.F., C.F.); Division of Neurology, Department of Medicine (A.S.) and Department of Radiology (J.L.R.), University of Alberta, Edmonton, Canada; and Department of Clinical Neurosciences (B.K.M., A.M.D., M.D.H.), Department of Medicine (A.M.D., M.D.H.), Department of Radiology (A.M.D., M.G., M.D.H.), and Department of Community Health Sciences (A.M.D., M.D.H.), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - John Thornton
- From the Division of Neurology, Department of Medicine (G.S.) and Department of Medical Imaging (C.L.), Ottawa Hospital, University of Ottawa, Ontario, Canada; Department of Neurosciences (A.Y.P.) and Department of Radiology (D.R.), Université de Montréal, Centre Hospitalier de l'Université de Montréal, Québec, Canada; University of Pittsburgh Medical Centre, PA (T.G.J.); Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin (D.W.); Beaumont Hospital, Dublin, Ireland (D.W., J.T.); Erlanger Medical Centre, Chattanooga, TN (B.W.B., T.D.); Swedish Medical Centre, Englewood, CO (D.F.F., C.F.); Division of Neurology, Department of Medicine (A.S.) and Department of Radiology (J.L.R.), University of Alberta, Edmonton, Canada; and Department of Clinical Neurosciences (B.K.M., A.M.D., M.D.H.), Department of Medicine (A.M.D., M.D.H.), Department of Radiology (A.M.D., M.G., M.D.H.), and Department of Community Health Sciences (A.M.D., M.D.H.), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Blaise W Baxter
- From the Division of Neurology, Department of Medicine (G.S.) and Department of Medical Imaging (C.L.), Ottawa Hospital, University of Ottawa, Ontario, Canada; Department of Neurosciences (A.Y.P.) and Department of Radiology (D.R.), Université de Montréal, Centre Hospitalier de l'Université de Montréal, Québec, Canada; University of Pittsburgh Medical Centre, PA (T.G.J.); Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin (D.W.); Beaumont Hospital, Dublin, Ireland (D.W., J.T.); Erlanger Medical Centre, Chattanooga, TN (B.W.B., T.D.); Swedish Medical Centre, Englewood, CO (D.F.F., C.F.); Division of Neurology, Department of Medicine (A.S.) and Department of Radiology (J.L.R.), University of Alberta, Edmonton, Canada; and Department of Clinical Neurosciences (B.K.M., A.M.D., M.D.H.), Department of Medicine (A.M.D., M.D.H.), Department of Radiology (A.M.D., M.G., M.D.H.), and Department of Community Health Sciences (A.M.D., M.D.H.), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Thomas Devlin
- From the Division of Neurology, Department of Medicine (G.S.) and Department of Medical Imaging (C.L.), Ottawa Hospital, University of Ottawa, Ontario, Canada; Department of Neurosciences (A.Y.P.) and Department of Radiology (D.R.), Université de Montréal, Centre Hospitalier de l'Université de Montréal, Québec, Canada; University of Pittsburgh Medical Centre, PA (T.G.J.); Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin (D.W.); Beaumont Hospital, Dublin, Ireland (D.W., J.T.); Erlanger Medical Centre, Chattanooga, TN (B.W.B., T.D.); Swedish Medical Centre, Englewood, CO (D.F.F., C.F.); Division of Neurology, Department of Medicine (A.S.) and Department of Radiology (J.L.R.), University of Alberta, Edmonton, Canada; and Department of Clinical Neurosciences (B.K.M., A.M.D., M.D.H.), Department of Medicine (A.M.D., M.D.H.), Department of Radiology (A.M.D., M.G., M.D.H.), and Department of Community Health Sciences (A.M.D., M.D.H.), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Donald F Frei
- From the Division of Neurology, Department of Medicine (G.S.) and Department of Medical Imaging (C.L.), Ottawa Hospital, University of Ottawa, Ontario, Canada; Department of Neurosciences (A.Y.P.) and Department of Radiology (D.R.), Université de Montréal, Centre Hospitalier de l'Université de Montréal, Québec, Canada; University of Pittsburgh Medical Centre, PA (T.G.J.); Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin (D.W.); Beaumont Hospital, Dublin, Ireland (D.W., J.T.); Erlanger Medical Centre, Chattanooga, TN (B.W.B., T.D.); Swedish Medical Centre, Englewood, CO (D.F.F., C.F.); Division of Neurology, Department of Medicine (A.S.) and Department of Radiology (J.L.R.), University of Alberta, Edmonton, Canada; and Department of Clinical Neurosciences (B.K.M., A.M.D., M.D.H.), Department of Medicine (A.M.D., M.D.H.), Department of Radiology (A.M.D., M.G., M.D.H.), and Department of Community Health Sciences (A.M.D., M.D.H.), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Chris Fanale
- From the Division of Neurology, Department of Medicine (G.S.) and Department of Medical Imaging (C.L.), Ottawa Hospital, University of Ottawa, Ontario, Canada; Department of Neurosciences (A.Y.P.) and Department of Radiology (D.R.), Université de Montréal, Centre Hospitalier de l'Université de Montréal, Québec, Canada; University of Pittsburgh Medical Centre, PA (T.G.J.); Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin (D.W.); Beaumont Hospital, Dublin, Ireland (D.W., J.T.); Erlanger Medical Centre, Chattanooga, TN (B.W.B., T.D.); Swedish Medical Centre, Englewood, CO (D.F.F., C.F.); Division of Neurology, Department of Medicine (A.S.) and Department of Radiology (J.L.R.), University of Alberta, Edmonton, Canada; and Department of Clinical Neurosciences (B.K.M., A.M.D., M.D.H.), Department of Medicine (A.M.D., M.D.H.), Department of Radiology (A.M.D., M.G., M.D.H.), and Department of Community Health Sciences (A.M.D., M.D.H.), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Ashfaq Shuaib
- From the Division of Neurology, Department of Medicine (G.S.) and Department of Medical Imaging (C.L.), Ottawa Hospital, University of Ottawa, Ontario, Canada; Department of Neurosciences (A.Y.P.) and Department of Radiology (D.R.), Université de Montréal, Centre Hospitalier de l'Université de Montréal, Québec, Canada; University of Pittsburgh Medical Centre, PA (T.G.J.); Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin (D.W.); Beaumont Hospital, Dublin, Ireland (D.W., J.T.); Erlanger Medical Centre, Chattanooga, TN (B.W.B., T.D.); Swedish Medical Centre, Englewood, CO (D.F.F., C.F.); Division of Neurology, Department of Medicine (A.S.) and Department of Radiology (J.L.R.), University of Alberta, Edmonton, Canada; and Department of Clinical Neurosciences (B.K.M., A.M.D., M.D.H.), Department of Medicine (A.M.D., M.D.H.), Department of Radiology (A.M.D., M.G., M.D.H.), and Department of Community Health Sciences (A.M.D., M.D.H.), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Jeremy L Rempel
- From the Division of Neurology, Department of Medicine (G.S.) and Department of Medical Imaging (C.L.), Ottawa Hospital, University of Ottawa, Ontario, Canada; Department of Neurosciences (A.Y.P.) and Department of Radiology (D.R.), Université de Montréal, Centre Hospitalier de l'Université de Montréal, Québec, Canada; University of Pittsburgh Medical Centre, PA (T.G.J.); Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin (D.W.); Beaumont Hospital, Dublin, Ireland (D.W., J.T.); Erlanger Medical Centre, Chattanooga, TN (B.W.B., T.D.); Swedish Medical Centre, Englewood, CO (D.F.F., C.F.); Division of Neurology, Department of Medicine (A.S.) and Department of Radiology (J.L.R.), University of Alberta, Edmonton, Canada; and Department of Clinical Neurosciences (B.K.M., A.M.D., M.D.H.), Department of Medicine (A.M.D., M.D.H.), Department of Radiology (A.M.D., M.G., M.D.H.), and Department of Community Health Sciences (A.M.D., M.D.H.), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Bijoy K Menon
- From the Division of Neurology, Department of Medicine (G.S.) and Department of Medical Imaging (C.L.), Ottawa Hospital, University of Ottawa, Ontario, Canada; Department of Neurosciences (A.Y.P.) and Department of Radiology (D.R.), Université de Montréal, Centre Hospitalier de l'Université de Montréal, Québec, Canada; University of Pittsburgh Medical Centre, PA (T.G.J.); Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin (D.W.); Beaumont Hospital, Dublin, Ireland (D.W., J.T.); Erlanger Medical Centre, Chattanooga, TN (B.W.B., T.D.); Swedish Medical Centre, Englewood, CO (D.F.F., C.F.); Division of Neurology, Department of Medicine (A.S.) and Department of Radiology (J.L.R.), University of Alberta, Edmonton, Canada; and Department of Clinical Neurosciences (B.K.M., A.M.D., M.D.H.), Department of Medicine (A.M.D., M.D.H.), Department of Radiology (A.M.D., M.G., M.D.H.), and Department of Community Health Sciences (A.M.D., M.D.H.), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Andrew M Demchuk
- From the Division of Neurology, Department of Medicine (G.S.) and Department of Medical Imaging (C.L.), Ottawa Hospital, University of Ottawa, Ontario, Canada; Department of Neurosciences (A.Y.P.) and Department of Radiology (D.R.), Université de Montréal, Centre Hospitalier de l'Université de Montréal, Québec, Canada; University of Pittsburgh Medical Centre, PA (T.G.J.); Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin (D.W.); Beaumont Hospital, Dublin, Ireland (D.W., J.T.); Erlanger Medical Centre, Chattanooga, TN (B.W.B., T.D.); Swedish Medical Centre, Englewood, CO (D.F.F., C.F.); Division of Neurology, Department of Medicine (A.S.) and Department of Radiology (J.L.R.), University of Alberta, Edmonton, Canada; and Department of Clinical Neurosciences (B.K.M., A.M.D., M.D.H.), Department of Medicine (A.M.D., M.D.H.), Department of Radiology (A.M.D., M.G., M.D.H.), and Department of Community Health Sciences (A.M.D., M.D.H.), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Mayank Goyal
- From the Division of Neurology, Department of Medicine (G.S.) and Department of Medical Imaging (C.L.), Ottawa Hospital, University of Ottawa, Ontario, Canada; Department of Neurosciences (A.Y.P.) and Department of Radiology (D.R.), Université de Montréal, Centre Hospitalier de l'Université de Montréal, Québec, Canada; University of Pittsburgh Medical Centre, PA (T.G.J.); Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin (D.W.); Beaumont Hospital, Dublin, Ireland (D.W., J.T.); Erlanger Medical Centre, Chattanooga, TN (B.W.B., T.D.); Swedish Medical Centre, Englewood, CO (D.F.F., C.F.); Division of Neurology, Department of Medicine (A.S.) and Department of Radiology (J.L.R.), University of Alberta, Edmonton, Canada; and Department of Clinical Neurosciences (B.K.M., A.M.D., M.D.H.), Department of Medicine (A.M.D., M.D.H.), Department of Radiology (A.M.D., M.G., M.D.H.), and Department of Community Health Sciences (A.M.D., M.D.H.), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Michael D Hill
- From the Division of Neurology, Department of Medicine (G.S.) and Department of Medical Imaging (C.L.), Ottawa Hospital, University of Ottawa, Ontario, Canada; Department of Neurosciences (A.Y.P.) and Department of Radiology (D.R.), Université de Montréal, Centre Hospitalier de l'Université de Montréal, Québec, Canada; University of Pittsburgh Medical Centre, PA (T.G.J.); Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin (D.W.); Beaumont Hospital, Dublin, Ireland (D.W., J.T.); Erlanger Medical Centre, Chattanooga, TN (B.W.B., T.D.); Swedish Medical Centre, Englewood, CO (D.F.F., C.F.); Division of Neurology, Department of Medicine (A.S.) and Department of Radiology (J.L.R.), University of Alberta, Edmonton, Canada; and Department of Clinical Neurosciences (B.K.M., A.M.D., M.D.H.), Department of Medicine (A.M.D., M.D.H.), Department of Radiology (A.M.D., M.G., M.D.H.), and Department of Community Health Sciences (A.M.D., M.D.H.), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
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41
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Ganesh A, Al-Ajlan FS, Sabiq F, Assis Z, Rempel JL, Butcher K, Thornton J, Kelly P, Roy D, Poppe AY, Jovin TG, Devlin T, Baxter BW, Krings T, Casaubon LK, Frei DF, Choe H, Tampieri D, Teitelbaum J, Lum C, Mandzia J, Phillips SJ, Bang OY, Almekhlafi MA, Coutts SB, Barber PA, Sajobi T, Demchuk AM, Eesa M, Hill MD, Goyal M, Menon BK. Infarct in a New Territory After Treatment Administration in the ESCAPE Randomized Controlled Trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times). Stroke 2016; 47:2993-2998. [DOI: 10.1161/strokeaha.116.014852] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 09/06/2016] [Accepted: 09/30/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Infarct in a new previously unaffected territory (INT) is a potential complication of endovascular treatment. We applied a recently proposed methodology to identify and classify INTs in the ESCAPE randomized controlled trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times).
Methods—
The core laboratory identified INTs on 24-hour follow-up imaging, blinded to treatment allocation, after assessing all baseline imaging. INTs were classified into 3 types (I–III) and 2 subtypes (A/B) based on size and if catheter manipulation was likely performed across the vessel territory ostium. Logistic regression was used to understand the effect of multiple a priori identified variables on INT occurrence. Ordinal logistic regression was used to analyze the effect of INTs on modified Rankin Scale shift at 90 days.
Results—
From 308 patients included, 14 INTs (4.5% overall; 2.8% on follow-up noncontrast computed tomography, 11.7% on follow-up magnetic resonance imaging) were identified (5.0% in endovascular treatment arm versus 4.0% in control arm [
P
=0.7]). The use of intravenous alteplase was associated with a 68% reduction in the odds of INT occurrence (3.0% with versus 9.1% without; odds ratio, 0.32; 95% confidence interval, 0.11–0.96; adjusted for age, sex, and treatment type). No other variables were associated with INTs. INT occurrence was associated with reduced probability of good clinical outcome (common odds ratio, 0.25; 95% confidence interval, 0.09–0.74; adjusted for age, type of treatment, and follow-up scan).
Conclusions—
INTs are uncommon, detected more frequently on follow-up magnetic resonance imaging, and affect clinical outcome. In experienced centers, endovascular treatment is likely not causal, whereas intravenous alteplase may be therapeutic.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01778335.
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Affiliation(s)
- Aravind Ganesh
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Fahad S. Al-Ajlan
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Farahna Sabiq
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Zarina Assis
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Jeremy L. Rempel
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Kenneth Butcher
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - John Thornton
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Peter Kelly
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Daniel Roy
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Alexandre Y. Poppe
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Tudor G. Jovin
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Thomas Devlin
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Blaise W. Baxter
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Timo Krings
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Leanne K. Casaubon
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Donald F. Frei
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Hana Choe
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Donatella Tampieri
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Jeanne Teitelbaum
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Cheemun Lum
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Jennifer Mandzia
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Stephen J. Phillips
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Oh Young Bang
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Mohammed A. Almekhlafi
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Shelagh B. Coutts
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Philip A. Barber
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Tolulope Sajobi
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Andrew M. Demchuk
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Muneer Eesa
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Michael D. Hill
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Mayank Goyal
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Bijoy K. Menon
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
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Al-Ajlan FS, Goyal M, Demchuk AM, Minhas P, Sabiq F, Assis Z, Willinsky R, Montanera WJ, Rempel JL, Shuaib A, Thornton J, Williams D, Roy D, Poppe AY, Jovin TG, Sapkota BL, Baxter BW, Krings T, Silver FL, Frei DF, Fanale C, Tampieri D, Teitelbaum J, Lum C, Dowlatshahi D, Shankar JJ, Barber PA, Hill MD, Menon BK. Intra-Arterial Therapy and Post-Treatment Infarct Volumes: Insights From the ESCAPE Randomized Controlled Trial. Stroke 2016; 47:777-81. [PMID: 26892284 DOI: 10.1161/strokeaha.115.012424] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The goal of reperfusion therapy in acute ischemic stroke is to limit brain infarction. The objective of this study was to investigate whether the beneficial effect of endovascular treatment on functional outcome could be explained by a reduction in post-treatment infarct volume. METHODS The Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times (ESCAPE) trial was a multicenter randomized open-label trial with blinded outcome evaluation. Among 315 enrolled subjects (endovascular treatment n=165; control n=150), 314 subject's infarct volumes at 24 to 48 hours on magnetic resonance imaging (n=254) or computed tomography (n=60) were measured. Post-treatment infarct volumes were compared by treatment assignment and recanalization/reperfusion status. Appropriate statistical models were used to assess relationship between baseline clinical and imaging variables, post-treatment infarct volume, and functional status at 90 days (modified Rankin Scale). RESULTS Median post-treatment infarct volume in all subjects was 21 mL (interquartile range =65 mL), in the intervention arm, 15.5 mL (interquartile range =41.5 mL), and in the control arm, 33.5 mL (interquartile range =84 mL; P<0.01). Baseline National Institute of Health Stroke Scale (P<0.01), site of occlusion (P<0.01), baseline noncontrast computed tomographic scan Alberta Stroke Program Early CT score (ASPECTS) (P<0.01), and recanalization (P<0.01) were independently associated with post-treatment infarct volume, whereas age, sex, treatment type, intravenous alteplase, and time from onset to randomization were not (P>0.05). Post-treatment infarct volume (P<0.01) and delta National Institute of Health Stroke Scale (P<0.01) were independently associated with 90-day modified Rankin Scale, whereas laterality (left versus right) was not. CONCLUSIONS These results support the primary results of the ESCAPE trial and show that the biological underpinning of the success of endovascular therapy is a reduction in infarct volume. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01778335.
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Affiliation(s)
- Fahad S Al-Ajlan
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Mayank Goyal
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Andrew M Demchuk
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Priyanka Minhas
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Farahna Sabiq
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Zarina Assis
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Robert Willinsky
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Walter J Montanera
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Jeremy L Rempel
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Ashfaq Shuaib
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - John Thornton
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - David Williams
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Daniel Roy
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Alexandre Y Poppe
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Tudor G Jovin
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Biggya L Sapkota
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Blaise W Baxter
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Timo Krings
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Frank L Silver
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Donald F Frei
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Christopher Fanale
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Donatella Tampieri
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Jeanne Teitelbaum
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Cheemun Lum
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Dar Dowlatshahi
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Jai J Shankar
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Philip A Barber
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Michael D Hill
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Bijoy K Menon
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.).
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Menon BK, Sajobi TT, Zhang Y, Rempel JL, Shuaib A, Thornton J, Williams D, Roy D, Poppe AY, Jovin TG, Sapkota B, Baxter BW, Krings T, Silver FL, Frei DF, Fanale C, Tampieri D, Teitelbaum J, Lum C, Dowlatshahi D, Eesa M, Lowerison MW, Kamal NR, Demchuk AM, Hill MD, Goyal M. Analysis of Workflow and Time to Treatment on Thrombectomy Outcome in the Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke (ESCAPE) Randomized, Controlled Trial. Circulation 2016; 133:2279-86. [PMID: 27076599 DOI: 10.1161/circulationaha.115.019983] [Citation(s) in RCA: 177] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 04/08/2016] [Indexed: 01/20/2023]
Affiliation(s)
- Bijoy K. Menon
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Tolulope T. Sajobi
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Yukun Zhang
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Jeremy L. Rempel
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Ashfaq Shuaib
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - John Thornton
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - David Williams
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Daniel Roy
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Alexandre Y. Poppe
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Tudor G. Jovin
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Biggya Sapkota
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Blaise W. Baxter
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Timo Krings
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Frank L. Silver
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Donald F. Frei
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Christopher Fanale
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Donatella Tampieri
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Jeanne Teitelbaum
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Cheemun Lum
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Dar Dowlatshahi
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Muneer Eesa
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Mark W. Lowerison
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Noreen R. Kamal
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Andrew M. Demchuk
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Michael D. Hill
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Mayank Goyal
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
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Lavine SD, Cockroft K, Hoh B, Bambakidis N, Khalessi AA, Woo H, Riina H, Siddiqui A, Hirsch JA, Chong W, Rice H, Wenderoth J, Mitchell P, Coulthard A, Signh TJ, Phatorous C, Khangure M, Klurfan P, Ter Brugge K, Iancu D, Gunnarsson T, Jansen O, Muto M, Szikora I, Pierot L, Brouwer P, Gralla J, Renowden S, Andersson T, Fiehler J, Turjman F, White P, Januel AC, Spelle L, Kulcsar Z, Chapot R, Biondi A, Dima S, Taschner C, Szajner M, Krajina A, Sakai N, Matsumaru Y, Yoshimura S, Diaz O, Lylyk P, Jayaraman MV, Patsalides A, Gandhi CD, Lee SK, Abruzzo T, Albani B, Ansari SA, Arthur AS, Baxter BW, Bulsara KR, Chen M, Almandoz JED, Fraser JF, Heck DV, Hetts SW, Hussain MS, Klucznik RP, Leslie-Mawzi TM, Mack WJ, McTaggart RA, Meyers PM, Mocco J, Prestigiacomo CJ, Pride GL, Rasmussen PA, Starke RM, Sunenshine PJ, Tarr RW, Frei DF, Ribo M, Nogueira RG, Zaidat OO, Jovin T, Linfante I, Yavagal D, Liebeskind D, Novakovic R, Pongpech S, Rodesch G, Soderman M, Ter Brugge K, Taylor A, Krings T, Orbach D, Biondi A, Picard L, Suh DC, Tanaka M, Zhang HQ. Training Guidelines for Endovascular Stroke Intervention: An International Multi-Society Consensus Document. Interv Neurol 2016; 5:51-6. [PMID: 27610121 DOI: 10.1159/000444945] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Mokin M, Sonig A, Sivakanthan S, Ren Z, Elijovich L, Arthur A, Goyal N, Kan P, Duckworth E, Veznedaroglu E, Binning MJ, Liebman KM, Rao V, Turner RD, Turk AS, Baxter BW, Dabus G, Linfante I, Snyder KV, Levy EI, Siddiqui AH. Clinical and Procedural Predictors of Outcomes From the Endovascular Treatment of Posterior Circulation Strokes. Stroke 2016; 47:782-8. [DOI: 10.1161/strokeaha.115.011598] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Patients with posterior circulation strokes have been excluded from recent randomized endovascular stroke trials. We reviewed the recent multicenter experience with endovascular treatment of posterior circulation strokes to identify the clinical, radiographic, and procedural predictors of successful recanalization and good neurological outcomes.
Methods—
We performed a multicenter retrospective analysis of consecutive patients with posterior circulation strokes, who underwent thrombectomy with stent retrievers or primary aspiration thrombectomy (including A Direct Aspiration First Pass Technique [ADAPT] approach). We correlated clinical and radiographic outcomes with demographic, clinical, and technical characteristics.
Results—
A total of 100 patients were included in the final analysis (mean age, 63.5±14.2 years; mean admission National Institutes of Health Stroke Scale score, 19.2±8.2). Favorable clinical outcome at 3 months (modified Rankin Scale score ≤2) was achieved in 35% of patients. Successful recanalization and shorter time from stroke onset to the start of the procedure were significant predictors of favorable clinical outcome at 90 days. Stent retriever and aspiration thrombectomy as primary treatment approaches showed comparable procedural and clinical outcomes. None of the baseline advanced imaging modalities (magnetic resonance imaging, computed tomographic perfusion, or computed tomography angiography assessment of collaterals) showed superiority in selecting patients for thrombectomy.
Conclusions—
Time to the start of the procedure is an important predictor of clinical success after thrombectomy in patients with posterior circulation strokes. Both stent retriever and aspiration thrombectomy as primary treatment approaches are effective in achieving successful recanalization.
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Affiliation(s)
- Maxim Mokin
- From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.)
| | - Ashish Sonig
- From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.)
| | - Sananthan Sivakanthan
- From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.)
| | - Zeguang Ren
- From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.)
| | - Lucas Elijovich
- From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.)
| | - Adam Arthur
- From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.)
| | - Nitin Goyal
- From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.)
| | - Peter Kan
- From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.)
| | - Edward Duckworth
- From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.)
| | - Erol Veznedaroglu
- From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.)
| | - Mandy J. Binning
- From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.)
| | - Kenneth M. Liebman
- From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.)
| | - Vikas Rao
- From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.)
| | - Raymond D. Turner
- From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.)
| | - Aquilla S. Turk
- From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.)
| | - Blaise W. Baxter
- From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.)
| | - Guilherme Dabus
- From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.)
| | - Italo Linfante
- From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.)
| | - Kenneth V. Snyder
- From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.)
| | - Elad I. Levy
- From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.)
| | - Adnan H. Siddiqui
- From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.)
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Lavine SD, Cockroft K, Hoh B, Bambakidis N, Khalessi AA, Woo H, Riina H, Siddiqui A, Hirsch JA, Chong W, Rice H, Wenderoth J, Mitchell P, Coulthard A, Signh TJ, Phatorous C, Khangure M, Klurfan P, terBrugge K, Iancu D, Gunnarsson T, Jansen O, Muto M, Szikora I, Pierot L, Brouwer P, Gralla J, Renowden S, Andersson T, Fiehler J, Turjman F, White P, Januel AC, Spelle L, Kulcsar Z, Chapot R, Spelle L, Biondi A, Dima S, Taschner C, Szajner M, Krajina A, Sakai N, Matsumaru Y, Yoshimura S, Ezura M, Fujinaka T, Iihara K, Ishii A, Higashi T, Hirohata M, Hyodo A, Ito Y, Kawanishi M, Kiyosue H, Kobayashi E, Kobayashi S, Kuwayama N, Matsumoto Y, Miyachi S, Murayama Y, Nagata I, Nakahara I, Nemoto S, Niimi Y, Oishi H, Satomi J, Satow T, Sugiu K, Tanaka M, Terada T, Yamagami H, Diaz O, Lylyk P, Jayaraman MV, Patsalides A, Gandhi CD, Lee SK, Abruzzo T, Albani B, Ansari SA, Arthur AS, Baxter BW, Bulsara KR, Chen M, Delgado Almandoz JE, Fraser JF, Heck DV, Hetts SW, Hussain MS, Klucznik RP, Leslie-Mawzi TM, Mack WJ, McTaggart RA, Meyers PM, Mocco J, Prestigiacomo CJ, Pride GL, Rasmussen PA, Starke RM, Sunenshine PJ, Tarr RW, Frei DF, Ribo M, Nogueira RG, Zaidat OO, Jovin T, Linfante I, Yavagal D, Liebeskind D, Novakovic R, Pongpech S, Rodesch G, Soderman M, terBrugge K, Taylor A, Krings T, Orbach D, Biondi A, Picard L, Suh DC, Tanaka M, Zhang HQ. Training Guidelines for Endovascular Ischemic Stroke Intervention: An International Multi-Society Consensus Document. AJNR Am J Neuroradiol 2016; 37:E31-4. [PMID: 26892982 DOI: 10.3174/ajnr.a4766] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Al-ajlan F, Goyal M, Menon BK, Demchuk AM, Eesa M, Rempel JL, Thornton J, Roy D, Roy D, Jovin TG, Willinsky RA, Sapkota B, Lum C, Frei DF, Montanera WJ, Poppe AY, Silver FL, Shuaib A, Tampieri D, Williams D, Bang OY, Baxter BW, Burns PA, Choe H, Heo JH, Holmstedt CA, Jankowitz B, Kelly M, Linares G, Hill MD. Abstract TP14: Final Infarct Volume as an Early Indicator the Clinical Outcome: Insight from ESCAPE Trial. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.tp14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose:
The goal of reperfusion therapy in acute ischemic stroke is to limit the extension of the ischemic core. The objectives of the present study were to assess the relationship between endovascular treatment and final infarct volume.
Methods and Results:
ESCAPE is a multicenter prospective randomized open-label trial with blinded outcome evaluation that enrolled 315 patients (endovascular treatment n=165; control n=150). Of these, 314 patient infarct volumes at 24 hours on CT or MRI were measured blinded to clinical data. Because infarct volumes were non-normally distributed, final infarct volumes were analysed by quartiles. Final infarct volumes were compared by treatment assignment and recanalization/reperfusion status measured by 2-8h CT angiogram in the control group and by formal angiography in the intervention arm.
Results:
Median final infarct volume among all study participants was 21 mL (IQR: 7 to 72). Median final infarct volume in endovascular treatment arm at 15.5 mL (IQR: 5 to 46.5) was significantly lower than median final infarct volume in control arm 33.5 mL (IQR: 11 to 95; P=0.0004). Small infarcts, defined as 1st quartile of infarct volumes were more common in the endovascular group compared to control (relative risk [RR] 1.5, CI95 1.02-2.3). Successful recanalization and reperfusion was highly associated with small infarcts (RR 2.2, CI95 1.4-3.4). The proportion of large hemispheric stroke (defined as an infarct volume in the 4th quartile) was much less frequent in the endovascular treatment arm (RR 0.6, CI95 0.3-0.8).
Conclusions:
This analysis supports the primary results of ESCAPE trial as endovascular treatment was associated with significantly smaller final infarct volumes. Recanalization/reperfusion was associated with smaller final infarct volume.
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Affiliation(s)
- Fahad Al-ajlan
- Clinical Neurosciences, Univ of Calgary, Calgary, Canada
| | | | - Bijoy K Menon
- Clinical Neurosciences, Univ of Calgary, Calgary, Canada
| | | | | | | | | | - Daniel Roy
- Universite de Montreal, Montreal, Canada
| | - Daniel Roy
- Universite de Montreal, Montreal, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Hana Choe
- Abington Memorial Hosp, Abington, PA
| | | | | | | | | | | | - Michael D Hill
- Clinical Neurosciences, Univ of Calgary, Calgary, Canada
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Moore RD, Jackson JC, Venkatesh SL, Quarfordt SD, Baxter BW. Revisiting the NIH Stroke Scale as a screening tool for proximal vessel occlusion: can advanced imaging be targeted in acute stroke? J Neurointerv Surg 2016; 8:1208-1210. [PMID: 26769727 DOI: 10.1136/neurintsurg-2015-012088] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/14/2015] [Accepted: 12/19/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Most patients with stroke-like symptoms screened by advanced imaging for proximal occlusion will not have a thrombus accessible by neurointerventional techniques. Development of a sensitive clinical scoring system for rapidly identifying patients with an emergent large vessel occlusion could help target limited resources and reduce exposure to unnecessary imaging. METHODS This historical cohort study included patients who underwent non-contrast CT and CT angiography in the emergency department for stroke-like symptoms. NIH Stroke Scale (NIHSS) criteria were extended to include resolved symptoms and dichotomized as present or absent. Combinations of NIHSS criteria were considered as tests for proximal occlusion. RESULTS Proximal cerebral vascular occlusion was present in 19.2% (100/522) of the population and, of these, 13% (13/100) had an NIHSS score of 0. The presence on examination or history of diminished consciousness with inability to answer questions, leg weakness, dysarthria, or gaze deviation had 96% sensitivity and 39% specificity for proximal occlusion. If implemented in this population, the use of CT angiography would have been decreased by 32.4% (169/522 patients) while missing 0.76% with proximal occlusions (4/522). Half of those missed (2/4) would have been identified as large vessel infarcts on non-contrast CT, while the remainder (2/4) were transient ischemic attacks associated with carotid stenosis. CONCLUSIONS In this cohort, specific NIHSS criteria were highly sensitive for emergent large vessel occlusion and, if validated, may allow for clinical screening prior to advanced imaging with CT angiography.
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Affiliation(s)
- Ryan D Moore
- Department of Radiology, Erlanger Medical Center, Chattanooga, Tennessee, USA
| | - John C Jackson
- Department of Radiology, Erlanger Medical Center, Chattanooga, Tennessee, USA
| | - Sheila L Venkatesh
- Department of Radiology, Erlanger Medical Center, Chattanooga, Tennessee, USA
| | - Steven D Quarfordt
- Department of Radiology, Erlanger Medical Center, Chattanooga, Tennessee, USA
| | - Blaise W Baxter
- Department of Radiology, Erlanger Medical Center, Chattanooga, Tennessee, USA
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Albers GW, Goyal M, Jahan R, Bonafe A, Diener HC, Levy EI, Pereira VM, Cognard C, Cohen DJ, Hacke W, Jansen O, Jovin TG, Mattle HP, Nogueira RG, Siddiqui AH, Yavagal DR, Baxter BW, Devlin TG, Lopes DK, Reddy VK, de Rochemont RDM, Singer OC, Bammer R, Saver JL. Ischemic core and hypoperfusion volumes predict infarct size in SWIFT PRIME. Ann Neurol 2015; 79:76-89. [PMID: 26476022 DOI: 10.1002/ana.24543] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 10/01/2015] [Accepted: 10/15/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Within the context of a prospective randomized trial (SWIFT PRIME), we assessed whether early imaging of stroke patients, primarily with computed tomography (CT) perfusion, can estimate the size of the irreversibly injured ischemic core and the volume of critically hypoperfused tissue. We also evaluated the accuracy of ischemic core and hypoperfusion volumes for predicting infarct volume in patients with the target mismatch profile. METHODS Baseline ischemic core and hypoperfusion volumes were assessed prior to randomized treatment with intravenous (IV) tissue plasminogen activator (tPA) alone versus IV tPA + endovascular therapy (Solitaire stent-retriever) using RAPID automated postprocessing software. Reperfusion was assessed with angiographic Thrombolysis in Cerebral Infarction scores at the end of the procedure (endovascular group) and Tmax > 6-second volumes at 27 hours (both groups). Infarct volume was assessed at 27 hours on noncontrast CT or magnetic resonance imaging (MRI). RESULTS A total of 151 patients with baseline imaging with CT perfusion (79%) or multimodal MRI (21%) were included. The median baseline ischemic core volume was 6 ml (interquartile range= 0-16). Ischemic core volumes correlated with 27-hour infarct volumes in patients who achieved reperfusion (r = 0.58, p < 0.0001). In patients who did not reperfuse (<10% reperfusion), baseline Tmax > 6-second lesion volumes correlated with 27-hour infarct volume (r = 0.78, p = 0.005). In target mismatch patients, the union of baseline core and early follow-up Tmax > 6-second volume (ie, predicted infarct volume) correlated with the 27-hour infarct volume (r = 0.73, p < 0.0001); the median absolute difference between the observed and predicted volume was 13 ml. INTERPRETATION Ischemic core and hypoperfusion volumes, obtained primarily from CT perfusion scans, predict 27-hour infarct volume in acute stroke patients who were treated with reperfusion therapies.
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Affiliation(s)
- Gregory W Albers
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA
| | - Mayank Goyal
- Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Reza Jahan
- Division of Interventional Neuroradiology, University of California, Los Angeles, Los Angeles, CA
| | - Alain Bonafe
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier, France
| | | | - Elad I Levy
- Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY
| | - Vitor M Pereira
- Division of Neuroradiology and Division of Neurosurgery, Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Christophe Cognard
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Toulouse, Toulouse, France
| | - David J Cohen
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Werner Hacke
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, Christian Albrechts University of Kiel, Kiel, Germany
| | - Tudor G Jovin
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Heinrich P Mattle
- Department of Neurology, Inselspital, University of Bern, Bern, Switzerland
| | - Raul G Nogueira
- Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Department of Neurology, Emory University School of Medicine, Atlanta, GA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Toshiba Stroke and Vascular Research Center, State University of New York at Buffalo, Buffalo, NY
| | - Dileep R Yavagal
- Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL
| | - Blaise W Baxter
- Department of Radiology, Erlanger Hospital at University of Tennessee, Chattanooga, TN
| | - Thomas G Devlin
- Division of Neurology, Erlanger Hospital at University of Tennessee, Chattanooga, TN
| | - Demetrius K Lopes
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL
| | - Vivek K Reddy
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Oliver C Singer
- Department of Neurology, Goethe University Hospital, Frankfurt, Germany
| | - Roland Bammer
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA
| | - Jeffrey L Saver
- Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
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50
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Coutinho JM, Liebeskind DS, Slater LA, Nogueira RG, Baxter BW, Levy EI, Siddiqui AH, Goyal M, Zaidat OO, Davalos A, Bonafé A, Jahan R, Gralla J, Saver JL, Pereira VM. Mechanical Thrombectomy for Isolated M2 Occlusions: A Post Hoc Analysis of the STAR, SWIFT, and SWIFT PRIME Studies. AJNR Am J Neuroradiol 2015; 37:667-72. [PMID: 26564442 DOI: 10.3174/ajnr.a4591] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 08/11/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Mechanical thrombectomy is beneficial for patients with acute ischemic stroke and a proximal anterior occlusion, but it is unclear if these results can be extrapolated to patients with an M2 occlusion. The purpose of this study was to examine the technical aspects, safety, and outcomes of mechanical thrombectomy with a stent retriever in patients with an isolated M2 occlusion who were included in 3 large multicenter prospective studies. MATERIALS AND METHODS We included patients from the Solitaire Flow Restoration Thrombectomy for Acute Revascularization (STAR), Solitaire With the Intention For Thrombectomy (SWIFT), and Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment (SWIFT PRIME) studies, 3 large multicenter prospective studies on thrombectomy for ischemic stroke. We compared outcomes and technical details of patients with an M2 with those with an M1 occlusion. All patients were treated with a stent retriever. Imaging data and outcomes were scored by an independent core laboratory. Successful reperfusion was defined as modified Thrombolysis in Cerebral Infarction score of 2b/3. RESULTS We included 50 patients with an M2 and 249 patients with an M1 occlusion. Patients with an M2 occlusion were older (mean age, 71 versus 67 years; P = .04) and had a lower NIHSS score (median, 13 versus 17; P < .001) compared with those with an M1 occlusion. Procedural time was nonsignificantly shorter in patients with an M2 occlusion (median, 29 versus 35 minutes; P = .41). The average number of passes with a stent retriever was also nonsignificantly lower in patients with an M2 occlusion (mean, 1.4 versus 1.7; P = .07). There were no significant differences in successful reperfusion (85% versus 82%, P = .82), symptomatic intracerebral hemorrhages (2% versus 2%, P = 1.0), device-related serious adverse events (6% versus 4%, P = .46), or modified Rankin Scale score 0-2 at follow-up (60% versus 56%, P = .64). CONCLUSIONS Endovascular reperfusion therapy appears to be feasible in selected patients with ischemic stroke and an M2 occlusion.
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Affiliation(s)
- J M Coutinho
- From the Divisions of Neuroradiology (J.M.C., L.-A.S., V.M.P.)
| | - D S Liebeskind
- Neurovascular Imaging Research Core and the University of California, Los Angeles Stroke Center (D.S.L.), Los Angeles, California
| | - L-A Slater
- From the Divisions of Neuroradiology (J.M.C., L.-A.S., V.M.P.)
| | - R G Nogueira
- Marcus Stroke and Neuroscience Center (R.G.N.), Department of Neurology, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia
| | - B W Baxter
- Department of Radiology (B.W.B.), Erlanger Hospital at University of Tennessee, Chattanooga, Tennessee
| | - E I Levy
- Department of Neurosurgery (E.I.L., A.H.S.)
| | - A H Siddiqui
- Department of Neurosurgery (E.I.L., A.H.S.) Toshiba Stroke and Vascular Research Center (A.H.S.), State University of New York at Buffalo, Buffalo, New York
| | - M Goyal
- Departments of Radiology and Clinical Neurosciences (M.G.), University of Calgary, Calgary, Alberta, Canada
| | - O O Zaidat
- Department of Neurology (O.O.Z.), Medical College of Wisconsin, Milwaukee, Wisconsin
| | - A Davalos
- Department of Neurosciences (A.D.), Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - A Bonafé
- Department of Neuroradiology (A.B.), Hôpital Gui-de-Chauliac, Montpellier, France
| | - R Jahan
- Division of Interventional Neuroradiology (R.J.)
| | - J Gralla
- Departments of Diagnostic and Interventional Neuroradiology (J.G.), Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - J L Saver
- Department of Neurology and Comprehensive Stroke Center (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - V M Pereira
- From the Divisions of Neuroradiology (J.M.C., L.-A.S., V.M.P.) Neurosurgery (V.M.P.), Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
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