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Broderick JP, Silva GS, Selim M, Kasner SE, Aziz Y, Sutherland J, Jauch EC, Adeoye OM, Hill MD, Mistry EA, Lyden PD, Mocco J, Smith EM, Hernandez-Jimenez M, Deljkich E, Kamel H. Enhancing Enrollment in Acute Stroke Trials: Current State and Consensus Recommendations. Stroke 2023; 54:2698-2707. [PMID: 37694403 PMCID: PMC10542906 DOI: 10.1161/strokeaha.123.044149] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
The Stroke Treatment Academic Industry Roundtable (STAIR) convened a session and workshop regarding enrollment in acute stroke trials during the STAIR XII meeting on March 22, 2023. This forum brought together stroke physicians and researchers, members of the National Institute of Neurological Disorders and Stroke, industry representatives, and members of the US Food and Drug Administration to discuss the current status and opportunities for improving enrollment in acute stroke trials. The workshop identified the most relevant issues impacting enrollment in acute stroke trials and addressed potential action items for each. Focus areas included emergency consent in the United States and other countries; careful consideration of eligibility criteria to maximize enrollment and representativeness; investigator, study coordinator, and pharmacist availability outside of business hours; trial enthusiasm/equipoise; site start-up including contractual issues; site champions; incorporation of study procedures into standard workflow as much as possible; centralized enrollment at remote sites by study teams using telemedicine; global trials; and coenrollment in trials when feasible. In conclusion, enrollment of participants is the lifeblood of acute stroke trials and is the rate-limiting step for testing an exciting array of new approaches to improve patient outcomes. In particular, efforts should be undertaken to broaden the medical community's understanding and implementation of emergency consent procedures and to adopt designs and processes that are easily incorporated into standard workflow and that improve trials' efficiencies and execution. Research and actions to improve enrollment in ongoing and future trials will improve stroke outcomes more broadly than any single therapy under consideration.
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Affiliation(s)
- Joseph P. Broderick
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute, Cincinnati, Ohio
| | - Gisele Sampaio Silva
- Federal University of São Paulo, Clinical Trialist/Neurology ,Albert Einstein Hospital, São Paulo, Brazil
| | - Magdy Selim
- Dept. of Neurology, Division of Stroke & Cerebrovascular Disease. Harvard Medical School / Beth Israel Deaconess Med. Ctr
| | - Scott E. Kasner
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Yasmin Aziz
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute, Cincinnati, Ohio
| | | | - Edward C. Jauch
- Chair, Department of Research and Evaluation Sciences, University of North Carolina at MAHEC
| | - Opeolu M. Adeoye
- Department of Emergency Medicine, Washington University School of Medicine, Emergency Physician-in-Chief, Barnes-Jewish Hospital, St. Louis, MO
| | - Michael D. Hill
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, AB, Canada
| | - Eva A. Mistry
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute, Cincinnati, Ohio
| | - Patrick D. Lyden
- Professor of Physiology and Neuroscience, Professor of Neurology, Zilkha Neurogenetic Institute, Keck School of Medicine of USC
| | - J Mocco
- Department of Neurological Surgery, Mount Sinai Health System. Mount Sinai Health System. New York, New York, United States
| | | | - Macarena Hernandez-Jimenez
- Scientific Director, aptaTargets S.L., Av. Cardenal Herrera Oria 298, Madrid, Spain. Pharmacology and Toxicology Department, Complutense University, Av. Complutense s/n, Madrid, Spain
| | | | - Hooman Kamel
- Department of Neurology, Weill Cornell Medicine, New York, NY
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2
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Shams RB, Chari SV, Cui ER, Fernandez AR, Brice JH, Winslow JE, Jauch EC, Patel MD. Community Socioeconomic and Urban-Rural Disparities in Prehospital Notification of Stroke by Emergency Medical Services in North Carolina. South Med J 2023; 116:765-771. [PMID: 37657786 PMCID: PMC10491424 DOI: 10.14423/smj.0000000000001601] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
OBJECTIVES Notification by emergency medical services (EMS) to the destination hospital of an incoming suspected stroke patient is associated with timelier in-hospital evaluation and treatment. Current data on adherence to this evidence-based best practice are limited, however. We examined the frequency of EMS stroke prenotification in North Carolina by community socioeconomic status (SES) and rurality. METHODS Using a statewide database of EMS patient care reports, we selected 9-1-1 responses in 2019 with an EMS provider impression of stroke or documented stroke care protocol use. Eligible patients were 18 years old and older with a completed prehospital stroke screen. Incident street addresses were geocoded to North Carolina census tracts and linked to American Community Survey socioeconomic data and urban-rural commuting area codes. High, medium, and low SES tracts were defined by SES index tertiles. Tracts were classified as urban, suburban, and rural. We used multivariable logistic regression to estimate independent associations between tract-level SES and rurality with EMS prenotification, adjusting for patient age, sex, and race/ethnicity; duration of symptoms; incident day of week and time of day; 9-1-1 dispatch complaint; EMS provider primary impression; and prehospital stroke screen interpretation. RESULTS The cohort of 9527 eligible incidents was mostly at least 65 years old (65%), female (55%), and non-Hispanic White (71%). EMS prenotification occurred in 2783 (29%) patients. Prenotification in low SES tracts (27%) occurred less often than in medium (30%) and high (32%) SES tracts. Rural tracts had the lowest frequency (21%) compared with suburban (28%) and urban (31%) tracts. In adjusted analyses, EMS prenotification was less likely in low SES (vs high SES; odds ratio 0.76, 95% confidence interval 0.67-0.88) and rural (vs urban; odds ratio 0.64, 95% confidence interval 0.52-0.77) tracts. CONCLUSIONS Across a large, diverse population, EMS prenotification occurred in only one-third of suspected stroke patients. Furthermore, low SES and rural tracts were independently associated with a lower likelihood of prehospital notification. These findings suggest the need for education and quality improvement initiatives to increase EMS stroke prenotification, particularly in underserved communities.
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Affiliation(s)
- Rayad B. Shams
- School of Medicine, University of North Carolina at Chapel
Hill, Chapel Hill
| | - Srihari V. Chari
- Department of Emergency Medicine, University of North
Carolina at Chapel Hill, Chapel Hill
| | - Eric R. Cui
- School of Medicine, University of North Carolina at Chapel
Hill, Chapel Hill
| | | | - Jane H. Brice
- Department of Emergency Medicine, University of North
Carolina at Chapel Hill, Chapel Hill
| | - James E. Winslow
- Department of Emergency Medicine, Wake Forest University,
Winston Salem, North Carolina
| | - Edward C. Jauch
- Department of Research, University of North Carolina Health
Sciences at Mountain Area Health Education Center, Asheville, North Carolina
| | - Mehul D. Patel
- Department of Emergency Medicine, University of North
Carolina at Chapel Hill, Chapel Hill
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3
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Stamm B, Royan R, Giurcanu M, Messe SR, Jauch EC, Prabhakaran S. Door-in-Door-out Times for Interhospital Transfer of Patients With Stroke. JAMA 2023; 330:636-649. [PMID: 37581671 PMCID: PMC10427946 DOI: 10.1001/jama.2023.12739] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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] [Received: 03/11/2023] [Accepted: 06/22/2023] [Indexed: 08/16/2023]
Abstract
Importance Treatments for time-sensitive acute stroke are not available at every hospital, often requiring interhospital transfer. Current guidelines recommend hospitals achieve a door-in-door-out time of no more than 120 minutes at the transferring emergency department (ED). Objective To evaluate door-in-door-out times for acute stroke transfers in the American Heart Association Get With The Guidelines-Stroke registry and to identify patient and hospital factors associated with door-in-door-out times. Design, Setting, and Participants US registry-based, retrospective study of patients with ischemic or hemorrhagic stroke from January 2019 through December 2021 who were transferred from the ED at registry-affiliated hospitals to other acute care hospitals. Exposure Patient- and hospital-level characteristics. Main Outcomes and Measures The primary outcome was the door-in-door-out time (time of transfer out minus time of arrival to the transferring ED) as a continuous variable and a categorical variable (≤120 minutes, >120 minutes). Generalized estimating equation (GEE) regression models were used to identify patient and hospital-level characteristics associated with door-in-door-out time overall and in subgroups of patients with hemorrhagic stroke, acute ischemic stroke eligible for endovascular therapy, and acute ischemic stroke transferred for reasons other than endovascular therapy. Results Among 108 913 patients (mean [SD] age, 66.7 [15.2] years; 71.7% non-Hispanic White; 50.6% male) transferred from 1925 hospitals, 67 235 had acute ischemic stroke and 41 678 had hemorrhagic stroke. Overall, the median door-in-door-out time was 174 minutes (IQR, 116-276 minutes): 29 741 patients (27.3%) had a door-in-door-out time of 120 minutes or less. The factors significantly associated with longer median times were age 80 years or older (vs 18-59 years; 14.9 minutes, 95% CI, 12.3 to 17.5 minutes), female sex (5.2 minutes; 95% CI, 3.6 to 6.9 minutes), non-Hispanic Black vs non-Hispanic White (8.2 minutes, 95% CI, 5.7 to 10.8 minutes), and Hispanic ethnicity vs non-Hispanic White (5.4 minutes, 95% CI, 1.8 to 9.0 minutes). The following were significantly associated with shorter median door-in-door-out time: emergency medical services prenotification (-20.1 minutes; 95% CI, -22.1 to -18.1 minutes), National Institutes of Health Stroke Scale (NIHSS) score exceeding 12 vs a score of 0 to 1 (-66.7 minutes; 95% CI, -68.7 to -64.7 minutes), and patients with acute ischemic stroke eligible for endovascular therapy vs the hemorrhagic stroke subgroup (-16.8 minutes; 95% CI, -21.0 to -12.7 minutes). Among patients with acute ischemic stroke eligible for endovascular therapy, female sex, Black race, and Hispanic ethnicity were associated with a significantly higher door-in-door-out time, whereas emergency medical services prenotification, intravenous thrombolysis, and a higher NIHSS score were associated with significantly lower door-in-door-out times. Conclusions and Relevance In this US registry-based study of interhospital transfer for acute stroke, the median door-in-door-out time was 174 minutes, which is longer than current recommendations for acute stroke transfer. Disparities and modifiable health system factors associated with longer door-in-door-out times are suitable targets for quality improvement initiatives.
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Affiliation(s)
- Brian Stamm
- Department of Neurology, University of Michigan, Ann Arbor
- Department of Neurology, Northwestern University, Chicago, Illinois
| | - Regina Royan
- Department of Emergency Medicine, University of Michigan, Ann Arbor
- Department of Emergency Medicine, Northwestern University, Chicago, Illinois
- Assistant Editor, JAMA Network Open
| | - Mihai Giurcanu
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Steven R. Messe
- Department of Neurology, University of Pennsylvania, Philadelphia
| | - Edward C. Jauch
- Department of Research, Mountain Area Health Education Center, Asheville, North Carolina
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4
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Zachrison KS, Nielsen VM, de la Ossa NP, Madsen TE, Cash RE, Crowe RP, Odom EC, Jauch EC, Adeoye OM, Richards CT. Prehospital Stroke Care Part 1: Emergency Medical Services and the Stroke Systems of Care. Stroke 2023; 54:1138-1147. [PMID: 36444720 PMCID: PMC11050637 DOI: 10.1161/strokeaha.122.039586] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Acute stroke care begins before hospital arrival, and several prehospital factors are critical in influencing overall patient care and poststroke outcomes. This topical review provides an overview of the state of the science on prehospital components of stroke systems of care and how emergency medical services systems may interact in the system to support acute stroke care. Topics include layperson recognition of stroke, prehospital transport strategies, networked stroke care, systems for data integration and real-time feedback, and inequities that exist within and among systems.
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Affiliation(s)
- Kori S Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA (K.S.Z., R.E.C.)
| | | | - Natalia Perez de la Ossa
- Department of Neurology, Stroke Unit, Hospital Universitari Germans Trias I Pujol, Badalona, Spain and Stroke Programme, Catalan Health Department, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (N.P.d.l.O)
| | - Tracy E Madsen
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI (T.E.M.)
| | - Rebecca E Cash
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA (K.S.Z., R.E.C.)
| | | | - Erika C Odom
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA (E.C.O.)
| | - Edward C Jauch
- Department of Research, University of North Carolina Health Sciences at Mountain Area Health Education Center, Asheville, NC (E.C.J.)
| | - Opeolu M Adeoye
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO (O.M.A.)
| | - Christopher T Richards
- Division of EMS, Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH (C.T.R.)
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5
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Zachrison KS, Rothenberg C, Adeoye OM, Feeser VR, Ganti L, Goldstein JN, Jauch EC, Lo B, Madsen T, Corral M, Decker-Palmer M, Mendez-Hernandez C, Finch M, Goyal P, Venkatesh A. Abstract WP38: Variation In Performance On Stroke Care Delivery Measures Among Us Community Emergency Departments. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.wp38] [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: 02/05/2023]
Abstract
Introduction:
Many stroke patients initially present to non-stroke center hospitals. However, the delivery of Emergency Department (ED)-based acute stroke care at smaller, non-academic (i.e., community) EDs is less well-described than for larger, academic hospitals.
Hypothesis:
There is wide variation in community EDs’ performance on acute stroke care delivery measures.
Methods:
This is a retrospective analysis of a cohort of stroke patients from EDs participating in the Emergency Quality Network (E-QUAL) stroke collaborative, a national stroke quality improvement project targeted to community EDs. Sites used ICD10 codes to identify ischemic stroke patients and submitted data using a web-based submission portal. EDs with data from at least 20 patients were included. For each site, we calculated median door-to-imaging (DTI), door-to-needle (DTN), and door-in-door-out (DIDO) times among transferred patients and ED length of stay (LOS) among admitted patients. We also determined the proportions of eligible patients arriving with 3.5 hours of last known well who received thrombolysis within 4.5 hours, of patients with documentation of severity assessment performance and of dysphagia screening. We used descriptive statistics to illustrate variation.
Results:
Of the 54 participating EDs, data were available for 45, and 28 included ≥ 20 patients. Of included EDs, median annual ED volume was 34,648 (IQR 21,250-47,120) and 40% were rural. Performance varied on DTI, DIDO among transferred patients, and LOS among admitted patients (Table). Performance was more consistent on documentation of severity assessment and dysphagia screening.
Conclusions:
Performance on stroke care delivery measures varied between these community EDs and data in the literature from larger hospitals that typically participate in national registries. Future efforts to improve emergency stroke care delivery should consider unique factors impacting care at smaller, community EDs.
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Affiliation(s)
| | | | | | | | | | | | | | - Bruce Lo
- Eastern Virginia Med Sch, Norfolk, VA
| | | | | | | | | | - Melissa Finch
- American College of Emergency Physicians, Irving, TX
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6
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Stamm B, Royan R, Giurcanu M, Messe S, Jauch EC, Prabhakaran S. Abstract 72: Association Between Patient And Hospital-level Factors With Door-in-door-out Times In Stroke Transfers: Findings From Get With The Guidelines®. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.72] [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: 02/05/2023]
Abstract
Introduction:
Advanced acute stroke treatments (endovascular therapy (EVT), neurosurgery) are time sensitive and often require emergent interfacility transfer. Thus, Door-in-door-out (DIDO) times at transferring hospitals are an important quality improvement metric. We sought to characterize DIDO times for acute stroke transfers in the Get With The Guidelines® (GWTG)-Stroke registry and identify patient and hospital factors associated with DIDO time.
Methods:
Patients with stroke presenting between January 2019 and December 2021 transferred from the emergency department (ED) at the presenting hospital to another acute care hospital were included. Primary outcome was DIDO time (time of transfer out minus time of arrival to presenting ED). Generalized estimating equation (GEE) regression models were used to identify patient and hospital characteristics associated with DIDO time. Subgroup analyses were performed for hemorrhagic and ischemic stroke patients transferred for EVT.
Results:
Among 153,434 patients (age 67.3+15.0 years, 72.9% White, 51.2% male), 107,897 were ischemic and 41,736 hemorrhagic strokes. Overall, median DIDO time was 216 (25th-75th percentile 131 - 457) minutes. The following were associated with increased DIDO time: age >80 years (+36.18 minute increase in median DIDO time), Black race (+11.23 min), Hispanic ethnicity (+9.65 min), ischemic stroke type (+156.51 min), and urban location (+44.54 min) while the following were associated with decreased DIDO time: EMS prenotification (-49.19 min) and NIHSS >12 (-139.81 min). In the EVT ischemic stroke subgroup, age, sex, race, EMS prenotification, stroke severity, and after-hours timing were strongly associated with median DIDO time.
Conclusions:
Opportunities to reduce DIDO times for acute stroke interhospital transfers require focus on modifiable health system factors such as EMS pre-notification but also persistent race-ethnic and urban-rural disparities.
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Affiliation(s)
| | - Regina Royan
- Emergency Medicine, Northwestern Univ, Chicago, IL
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7
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Zachrison KS, Goldstein JN, Jauch EC, Radecki R, Madsen T, Adeoye OM, Oostema JA, Feeser R, Ganti L, Lo BM, Meurer WJ, Garvin R, Corral M, Rothenberg C, Mendez-Hernandez C, Finch M, Goyal P, Venkatesh A. Abstract WP49: Clinical Performance Measures For Emergency Department Care For Adults With Nontraumatic Intracranial Hemorrhage. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.wp49] [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: 02/05/2023]
Abstract
Study Objective:
Though select inpatient-based performance measures exist for the care of patients with nontraumatic intracranial hemorrhage (ICH), Emergency Departments (EDs) lack measurement instruments designed to support and improve care processes in the hyperacute phase. To address this, we propose a set of measures applying a syndromic (rather than diagnosis-based) approach informed by performance data from a national sample of community EDs participating in the Emergency Quality Network Stroke Initiative (E-QUAL).
Methods:
We convened a workgroup of experts in acute neurologic emergencies. The group considered the appropriate use case for each proposed measure (internal quality improvement [QI], benchmarking, or accountability) and examined data from E-QUAL-participating EDs to consider the validity and feasibility of proposed measures. The initially conceived set included 14 measure concepts of which 7 were selected for inclusion in the measure set after review of data and further deliberation. To inform the process, we collected data from E-QUAL participating EDs. EDs used a web-based portal to submit data from chart reviews on patients with ICH during 2020-2021. Descriptive statistics characterize performance and identify variation.
Results:
Proposed measures include 2 for QI, benchmarking, and accountability, 3 for QI and benchmarking and 2 for QI only (Table). Of the E-QUAL participating EDs, 35 had sufficient case volume (≥25) and were included for review of preliminary performance data. Median annual ED volume was 44,000 (IQR 31,337-67,000) and 16 (48%) reported typically transferring patients with ICH. The Table includes available performance data.
Conclusion:
Application of these measures may identify opportunities for improvement and focus QI resources on evidence-based targets. The proposed measures warrant further development and validation to support broader implementation and advance national healthcare quality goals.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Bruce M Lo
- Sentara Norfolk General/Eastern Virginia Med Sch, Norfolk, VA
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8
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French DM, DuBose-Morris RA, Lee FW, Sulkowski SJ, Samuelson GA, Jauch EC. Telesimulation to Improve Critical Decision-Making in Prehospital Airway Management: A Feasibility Study. South Med J 2022; 115:639-644. [PMID: 35922053 DOI: 10.14423/smj.0000000000001429] [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: 11/23/2022]
Abstract
OBJECTIVES Telesimulation, in which learners and evaluators use technology to connect remotely to simulation-based learning activities, is effective for skills and decision-making review. Historical models in which learners are colocated with the simulation equipment have inherent issues, especially for emergency medical services (EMS) providers. This feasibility study placed the evaluators in the simulation center, whereas the learners were at a distance steering the scenario evolution through telehealth technologies. METHODS Volunteer EMS providers across South Carolina with varying levels of training and experience completed difficult airway management scenarios focused on clinical decision making. The program consisted of pre- and postexperience examinations, a lecture, and increasingly complicated simulations using high-fidelity mannequins that were facilitated by local trainers under the direction of remote trainees. Audio and video content, including vital signs and cardiac monitoring, were live streamed. Participants worked in two-person teams with lead providers on each scenario clinically assessing and managing cases of anaphylaxis. Data were collected from the simulations using Laerdal software, as well as examination and survey results. RESULTS A total of 24 participants completed all of the elements of the training. Trends toward improvement in times to bag-mask ventilation and initial epinephrine administration were noted. Average cognitive test scores increased by 9.6%, and learners reported improved comfort with simulation (75%, P ≥ 0.0001) and videoconferencing (83%, P ≥ 0.0001). They also reported high degrees of comfort with intubation (73.3%) following the training. CONCLUSIONS This method of telesimulation appears to be a viable addition to continuing EMS education and may address access issues for some providers.
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Affiliation(s)
- David M French
- From Charleston County EMS, Charleston, the Center for Telehealth, Medical University of South Carolina, Charleston, Healthcare Simulation Center, Medical University of South Carolina, Charleston, and the Mission Research Institute, Mission Health System, Asheville, North Carolina
| | - Ragan A DuBose-Morris
- From Charleston County EMS, Charleston, the Center for Telehealth, Medical University of South Carolina, Charleston, Healthcare Simulation Center, Medical University of South Carolina, Charleston, and the Mission Research Institute, Mission Health System, Asheville, North Carolina
| | - Frances W Lee
- From Charleston County EMS, Charleston, the Center for Telehealth, Medical University of South Carolina, Charleston, Healthcare Simulation Center, Medical University of South Carolina, Charleston, and the Mission Research Institute, Mission Health System, Asheville, North Carolina
| | - Stanley J Sulkowski
- From Charleston County EMS, Charleston, the Center for Telehealth, Medical University of South Carolina, Charleston, Healthcare Simulation Center, Medical University of South Carolina, Charleston, and the Mission Research Institute, Mission Health System, Asheville, North Carolina
| | - Greig A Samuelson
- From Charleston County EMS, Charleston, the Center for Telehealth, Medical University of South Carolina, Charleston, Healthcare Simulation Center, Medical University of South Carolina, Charleston, and the Mission Research Institute, Mission Health System, Asheville, North Carolina
| | - Edward C Jauch
- From Charleston County EMS, Charleston, the Center for Telehealth, Medical University of South Carolina, Charleston, Healthcare Simulation Center, Medical University of South Carolina, Charleston, and the Mission Research Institute, Mission Health System, Asheville, North Carolina
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9
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Zachrison KS, Ganti L, Sharma D, Goyal P, Decker‐Palmer M, Adeoye O, Goldstein JN, Jauch EC, Lo BM, Madsen TE, Meurer W, Oostema JA, Mendez‐Hernandez C, Venkatesh AK. A survey of stroke-related capabilities among a sample of US community emergency departments. J Am Coll Emerg Physicians Open 2022; 3:e12762. [PMID: 35898236 PMCID: PMC9307290 DOI: 10.1002/emp2.12762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/20/2022] [Accepted: 02/09/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives Most acute stroke research is conducted at academic and larger hospitals, which may differ from many non-academic (ie, community) and smaller hospitals with respect to resources and consultant availability. We describe current emergency department (ED) and hospital-level stroke-related capabilities among a sample of community EDs participating in the Emergency Quality Network (E-QUAL) stroke collaborative. Methods Among E-QUAL-participating EDs, we conducted a survey to collect data on ED and hospital stroke-related structural and process capabilities associated with quality of stroke care delivery and patient outcomes. EDs submitted data using a web-based submission portal. We present descriptive statistics of self-reported capabilities. Results Of 154 participating EDs in 30 states, 97 (63%) completed the survey. Many were rural (33%); most (82%) were not certified stroke centers. Although most reported having stroke protocols (67%), many did not include hemorrhagic stroke or transient ischemic attack (45% and 57%, respectively). Capability to perform emergent head computed tomography and to administer thrombolysis were not universal (absent in 4% and 5%, respectively). Access to neurologic consultants varied; 18% reported no 24/7 availability onsite or remotely. Of those with access, 48% reported access through telemedicine only. Admission capabilities also varied with patient transfer commonly performed (79%). Conclusion Stroke-related capabilities vary substantially between community EDs and are different from capabilities typically found in larger stroke centers. These data may be valuable for identifying areas for future investment. Additionally, the design of stroke quality improvement interventions and metrics to evaluate emergency stroke care delivery should account for these key structural differences.
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Affiliation(s)
- Kori S. Zachrison
- Department of Emergency MedicineMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Latha Ganti
- Department of Emergency MedicineUniversity of Central FloridaOrlandoFloridaUSA
| | - Dhruv Sharma
- American College of Emergency PhysiciansIrvingTexasUSA
| | - Pawan Goyal
- American College of Emergency PhysiciansIrvingTexasUSA
| | | | - Opeolu Adeoye
- Department of Emergency MedicineWashington UniversitySt. LouisMissouriUSA
| | - Joshua N. Goldstein
- Department of Emergency MedicineMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | | | - Bruce M. Lo
- Department of Emergency MedicineEastern Virginia Medical School/Sentara Norfolk General HospitalNorfolkVirginiaUSA
| | - Tracy E. Madsen
- Department of Emergency MedicineWarren Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - William Meurer
- Department of Emergency MedicineUniversity of Michigan School of MedicineAnn ArborMichiganUSA
| | - John A. Oostema
- Department of Emergency MedicineMichigan State UniversityEast LansingMichiganUSA
| | | | - Arjun K. Venkatesh
- Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
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10
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Matuskowitz AJ, Obeid JS, Jennings L, Bayer RR, Ramakrishnan V, Schoepf UJ, Jauch EC. Feasibility and Impact of the Combined Application of Coronary CT Angiography With the HEART Pathway in Patients With Suspected Acute Coronary Syndrome. Crit Pathw Cardiol 2021; 20:185-191. [PMID: 33660627 PMCID: PMC8408286 DOI: 10.1097/hpc.0000000000000258] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/23/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study examines the feasibility and utility of integrating coronary computed tomography angiography and the HEART Pathway into a novel accelerated diagnostic protocol-called HEART-CT-and assesses its impact as an optional interactive decision support tool (smart form) in the electronic health record. METHODS This was a retrospective observational study performed in 2 adult emergency departments (ED) among patients evaluated for suspected acute coronary syndrome. Primary outcomes included the rate of discharge from the ED following HEART-CT Smart Form use, 30-day major adverse cardiac events (MACE), and ED length of stay (LOS). Hypothesis-generating outcomes included the rate of Smart Form use by ED providers and whether adhering to the HEART-CT recommendations was associated with improved outcomes. RESULTS The study included 672 subjects, 78.1% of whom were discharged from the ED. HEART-CT identified 76.7% of patients with increased risk HEAR scores as safe for discharge. No patients identified as low risk by HEART-CT had MACE within 30 days. Total mean ED LOS was 4.6 hours. ED providers used the HEART-CT smart form in 19.7% of eligible patients. ED providers who followed the HEART-CT recommendations had 3.41 times higher odds of ED discharging patients with increased risk HEAR scores than nonadherent providers (95% CI, 2.20-5.27). CONCLUSIONS HEART-CT reclassified a large proportion of patients as safe for discharge, maintained a high sensitivity for detecting 30-day MACE, and had an acceptable ED LOS. Future studies should test the extent to which more automated clinical decision support improves provider adoption and clinical outcomes of HEART-CT.
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Affiliation(s)
- Andrew J. Matuskowitz
- From the Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC
| | - Jihad S. Obeid
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Lindsey Jennings
- From the Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC
| | - Richard R. Bayer
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC
| | | | - U. Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Edward C. Jauch
- From the Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC
- Mission Research Institute, Mission Health, Asheville, NC
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11
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Jacobs AK, Ali MJ, Best PJ, Bieniarz MC, Bufalino VJ, French WJ, Henry TD, Hollowell L, Jauch EC, Kurz MC, Levy M, Patel P, Spier T, Stone RH, Tataris KL, Thomas RJ, Zègre-Hemsey JK. Systems of Care for ST-Segment-Elevation Myocardial Infarction: A Policy Statement From the American Heart Association. Circulation 2021; 144:e310-e327. [PMID: 34641735 DOI: 10.1161/cir.0000000000001025] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The introduction of Mission: Lifeline significantly increased timely access to percutaneous coronary intervention for patients with ST-segment-elevation myocardial infarction (STEMI). In the years since, morbidity and mortality rates have declined, and research has led to significant developments that have broadened our concept of the STEMI system of care. However, significant barriers and opportunities remain. From community education to 9-1-1 activation and emergency medical services triage and from emergency department and interfacility transfer protocols to postacute care, each critical juncture presents unique challenges for the optimal care of patients with STEMI. This policy statement sets forth recommendations for how the ideal STEMI system of care should be designed and implemented to ensure that patients with STEMI receive the best evidence-based care at each stage in their illness.
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12
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Gladstone DJ, Aviv RI, Demchuk AM, Hill MD, Thorpe KE, Khoury JC, Sucharew HJ, Al-Ajlan F, Butcher K, Dowlatshahi D, Gubitz G, De Masi S, Hall J, Gregg D, Mamdani M, Shamy M, Swartz RH, Del Campo CM, Cucchiara B, Panagos P, Goldstein JN, Carrozzella J, Jauch EC, Broderick JP, Flaherty ML. Effect of Recombinant Activated Coagulation Factor VII on Hemorrhage Expansion Among Patients With Spot Sign-Positive Acute Intracerebral Hemorrhage: The SPOTLIGHT and STOP-IT Randomized Clinical Trials. JAMA Neurol 2021; 76:1493-1501. [PMID: 31424491 DOI: 10.1001/jamaneurol.2019.2636] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Importance Intracerebral hemorrhage (ICH) is a devastating stroke type that lacks effective treatments. An imaging biomarker of ICH expansion-the computed tomography (CT) angiography spot sign-may identify a subgroup that could benefit from hemostatic therapy. Objective To investigate whether recombinant activated coagulation factor VII (rFVIIa) reduces hemorrhage expansion among patients with spot sign-positive ICH. Design, Setting, and Participants In parallel investigator-initiated, multicenter, double-blind, placebo-controlled randomized clinical trials in Canada ("Spot Sign" Selection of Intracerebral Hemorrhage to Guide Hemostatic Therapy [SPOTLIGHT]) and the United States (The Spot Sign for Predicting and Treating ICH Growth Study [STOP-IT]) with harmonized protocols and a preplanned individual patient-level pooled analysis, patients presenting to the emergency department with an acute primary spontaneous ICH and a spot sign on CT angiography were recruited. Data were collected from November 2010 to May 2016. Data were analyzed from November 2016 to May 2017. Interventions Eligible patients were randomly assigned 80 μg/kg of intravenous rFVIIa or placebo as soon as possible within 6.5 hours of stroke onset. Main Outcomes and Measures Head CT at 24 hours assessed parenchymal ICH volume expansion from baseline (primary outcome) and total (ie, parenchymal plus intraventricular) hemorrhage volume expansion (secondary outcome). The pooled analysis compared hemorrhage expansion between groups by analyzing 24-hour volumes in a linear regression model adjusted for baseline volumes, time from stroke onset to treatment, and trial. Results Of the 69 included patients, 35 (51%) were male, and the median (interquartile range [IQR]) age was 70 (59-80) years. Baseline median (IQR) ICH volumes were 16.3 (9.6-39.2) mL in the rFVIIa group and 20.4 (8.6-32.6) mL in the placebo group. Median (IQR) time from CT to treatment was 71 (57-96) minutes, and the median (IQR) time from stroke onset to treatment was 178 (138-197) minutes. The median (IQR) increase in ICH volume from baseline to 24 hours was small in both the rFVIIa group (2.5 [0-10.2] mL) and placebo group (2.6 [0-6.6] mL). After adjustment, there was no difference between groups on measures of ICH or total hemorrhage expansion. At 90 days, 9 of 30 patients in the rFVIIa group and 13 of 34 in the placebo group had died or were severely disabled (P = .60). Conclusions and Relevance Among patients with spot sign-positive ICH treated a median of about 3 hours from stroke onset, rFVIIa did not significantly improve radiographic or clinical outcomes. Trial Registration ClinicalTrials.gov identifier: NCT01359202 and NCT00810888.
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Affiliation(s)
- David J Gladstone
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Richard I Aviv
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Andrew M Demchuk
- Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences and Medicine, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kevin E Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - Jane C Khoury
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Heidi J Sucharew
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Fahad Al-Ajlan
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ken Butcher
- University of New South Wales, Prince of Wales Clinical School, Sydney, New South Wales, Australia
| | - Dar Dowlatshahi
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Gord Gubitz
- Division of Neurology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stephanie De Masi
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - Judith Hall
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - David Gregg
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston
| | - Muhammad Mamdani
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | | | - Richard H Swartz
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - C Martin Del Campo
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Brett Cucchiara
- Department of Neurology, University of Pennsylvania, Philadelphia
| | - Peter Panagos
- Department of Emergency Medicine, Washington University in St Louis, St Louis, Missouri
| | - Joshua N Goldstein
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
| | - Janice Carrozzella
- Department of Radiology, University of Cincinnati Academic Health Center, Cincinnati, Ohio
| | - Edward C Jauch
- Mission Research Institute, Mission Health System, Asheville, North Carolina
| | - Joseph P Broderick
- Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, Ohio
| | - Matthew L Flaherty
- Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, Ohio
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13
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Jauch EC, Schwamm LH, Panagos PD, Barbazzeni J, Dickson R, Dunne R, Foley J, Fraser JF, Lassers G, Martin-Gill C, O'Brien S, Pinchalk M, Prabhakaran S, Richards CT, Taillac P, Tsai AW, Yallapragada A. Recommendations for Regional Stroke Destination Plans in Rural, Suburban, and Urban Communities From the Prehospital Stroke System of Care Consensus Conference: A Consensus Statement From the American Academy of Neurology, American Heart Association/American Stroke Association, American Society of Neuroradiology, National Association of EMS Physicians, National Association of State EMS Officials, Society of NeuroInterventional Surgery, and Society of Vascular and Interventional Neurology: Endorsed by the Neurocritical Care Society. Stroke 2021; 52:e133-e152. [PMID: 33691507 DOI: 10.1161/strokeaha.120.033228] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | | | | | - Robert Dunne
- Detroit East Medical Control Authority, MI (R. Dunne).,National Association of EMS Physicians (R. Dunne, C.M.-G.)
| | | | - Justin F Fraser
- University of Kentucky, Lexington (J.F.F.).,American Association of Neurological Surgeons, Society of NeuroInterventional Surgery (J.F.F.)
| | | | | | | | - Mark Pinchalk
- City of Pittsburgh Emergency Medical Services, PA (M.P.)
| | - Shyam Prabhakaran
- University of Chicago, IL (S.P.).,American Academy of Neurology (S.P.)
| | | | - Peter Taillac
- University of Utah, Salt Lake City (P.T.).,National Association of State EMS Officials (P.T.)
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14
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Baker DW, Tschurtz BA, Aliaga AE, Williams SC, Jauch EC, Schwamm LH. Determining the Need for Thrombectomy-Capable Stroke Centers Based on Travel Time to the Nearest Comprehensive Stroke Center. Jt Comm J Qual Patient Saf 2020; 46:501-505. [PMID: 32736996 DOI: 10.1016/j.jcjq.2020.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 06/12/2020] [Accepted: 06/12/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND In January 2018 The Joint Commission introduced its Thrombectomy-Capable Stroke Center (TSC) certification program to recognize hospitals capable of performing endovascular thrombectomy for patients with ischemic strokes due to large vessel occlusions, intended for hospitals not in close geographic proximity to Comprehensive Stroke Centers (CSCs). This study was conducted to determine (1) the travel times between current and potential TSCs and the nearest CSC and (2) the proportion of TSCs that were in areas of high need. METHODS The locations of current and applicant TSCs (N = 44) were mapped and paired with the closest CSCs. Google Maps estimated travel times for each pair at 8:00 a.m., 12:00 a.m., and 5:00 p.m. on Wednesdays, providing the minimum, maximum, and midpoint for each period. The area served by each TSC was classified based on the number of time periods with drive times > 30 or > 60 minutes to the closest CSC ("very low need" [0 of 3], "low need" [1 of 3], "high need" [2 of 3], or "very high need" [3 of 3]). RESULTS Using minimum drive times and the > 30 minute to the nearest CSC threshold, 68.2% of the 44 TSCs were in very low need areas, and 29.5% were in very high need areas. Using maximum drive times, 31.8% were in high need areas, and 31.8% were in very high need areas. With a 60-minute threshold, 25.0% were still in very high need areas. CONCLUSION Many TSCs were in very low need areas using a 30-minute threshold. This methodology may help regional authorities determine how a TSC should be included in stroke systems of care prehospital destination protocols.
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15
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Rudd AG, Bladin C, Carli P, De Silva DA, Field TS, Jauch EC, Kudenchuk P, Kurz MW, Lærdal T, Ong M, Panagos P, Ranta A, Rutan C, Sayre MR, Schonau L, Shin SD, Waters D, Lippert F. Utstein recommendation for emergency stroke care. Int J Stroke 2020; 15:555-564. [PMID: 32223543 PMCID: PMC7672780 DOI: 10.1177/1747493020915135] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Recent advances in treatment for stroke give new possibilities for optimizing
outcomes. To deliver these prehospital care needs to become more
efficient. Aim To develop a framework to support improved delivery of prehospital care. The
recommendations are aimed at clinicians involved in prehospital and
emergency health systems who will often not be stroke specialists but need
clear guidance as to how to develop and deliver safe and effective care for
acute stroke patients. Methods Building on the successful implementation program from the Global
Resuscitation Alliance and the Resuscitation Academy, the Utstein
methodology was used to define a generic chain of survival for Emergency
Stroke Care by assembling international expertise in Stroke and Emergency
Medical Services (EMS). Ten programs were identified for Acute Stroke Care
to improve survival and outcomes, with recommendations for implementation of
best practice. Conclusions Efficient prehospital systems for acute stroke will be improved through
public awareness, optimized prehospital triage and timely diagnostics, and
quick and equitable access to acute treatments. Documentation, use of
metrics and transparency will help to build a culture of excellence and
accountability.
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Affiliation(s)
- A G Rudd
- NHS England and King's College, London, England
| | - C Bladin
- Eastern Health Monash University, Melbourne, Australia
| | - P Carli
- Emergency Medical Services, Paris, France
| | - D A De Silva
- National Neuroscience Institute, Singapore General Hospital, Singapore
| | - T S Field
- University of British Columbia, Vancouver, Canada
| | - E C Jauch
- Mission Health System, Asheville, USA
| | - P Kudenchuk
- University of Washington School of Medicine, Seattle, WA, USA
| | - M W Kurz
- Stavanger University Hospital, Stavanger, Norway
| | - T Lærdal
- The Laerdal Foundation, Stavanger, Norway
| | - Meh Ong
- Singapore General Hospital and Duke-NUS Medical School, Singapore, Singapore
| | - P Panagos
- Washington University School of Medicine, St. Louis, MO, USA
| | - A Ranta
- University of Otago, Dunedin, New Zealand
| | - C Rutan
- American Heart Association, Dallas, TX, USA
| | | | - L Schonau
- Danish Resuscitation Council, Copenhagen, Denmark
| | - S D Shin
- Seoul National University College of Medicine, Seoul, South Korea
| | - D Waters
- Ambulance New Zealand, Wellington, New Zealand
| | - F Lippert
- Copenhagen Emergency Medical Services, Copenhagen, Denmark
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16
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Jauch EC, Bhuva P, Schneider AT, Thurman J, Tooley A, Lewis J, McCarthy K, Philpot D, Jones R, Yoo A, Frei D. Abstract TP254: A Comparison of Models for Evaluation and Transfer of Patients With Suspected Large Vessel Occlusions. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.tp254] [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:
Mechanisms for the hospital identification of patients with suspected large vessel occlusions (LVO) vary widely based on referring and receiving stroke center resources. We compared processes for identifying patients with suspected LVO who may be candidates for endovascular therapy (EVT) at non-EVT hospitals and the criteria for interfacility transport to Comprehensive Stroke Centers (CSC) for potential EVT.
Methods:
Data were obtained from 4 CSC which serve distinct geographic regions, ranging from rural to urban environments, over a continuous 12 month period of time beginning year 2018. Patients transferred from all referring hospitals to these facilities were considered regardless of hospital affiliations (n=2213). Geographic description, imaging modalities and form of emergent neurologic consultation available and utilized, rates of stroke transfers for EVT, and rates of final EVT were recorded.
Results:
The process for identifying a patient with a likely LVO appropriate for interfacility transfer varied greatly by referring and receiving hospital (table). The intensity of referring hospital evaluation ranged from complete multimodal CT imaging and either onsite or video telestroke consultation with access to neuroimaging to simple noncontrast CT and telephone consultation. Rates of transfer and eventual EVT varied across the centers. Further details of the form of stroke expertise, penumbral imaging criteria, unique geographic variances, criteria for transfer, and final utilization of EVT will be presented.
Conclusions:
Optimal interfacility transfer procedures are essential to ensure patients with LVO are considered in a timely fashion, and that over triage does not overwhelm receiving CSC. We found significant process variations in identifying EVT candidates for interfacility transfer. Providing examples of multiple best practices allows for other centers to identify potential solutions for their unique circumstances.
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17
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Jauch EC. Abstract 50: RNA Expression for Diagnosis of Stroke Etiology Differentiating Large Artery and Cardioembolic Stroke: Analytical Validation of Testing From the BASE Clinical Trial. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.50] [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:
An accurate test to differentiate large artery stroke (LAS) patients from those with cardioembolic stroke (CES) would be of significant clinical utility. Using the Biomarkers of Acute Stroke Etiology (BASE) trial (NCT02014896) dataset, our purpose was to utilize blood gene expression signatures for accurately differentiating LAS from CES acute stroke etiologies.
Methods:
The BASE trial enrolled suspected stroke patients presenting to 20 hospitals within 24 hrs of symptom onset. Final gold standard diagnosis and stroke etiology were determined by an adjudication committee using all hospital data but blinded to RNA test results. Whole blood, obtained in PAX tubes, was frozen at -20C within 72 hrs and analyzed at a core lab (Ischemia Care, Dayton, OH) using Affymetrix HTA microarrays. Genes on the HTA microarray were filtered to eliminate genes with low expression or high CV (> 10%) when run on replicate samples leaving 9,513 potential signature genes. A two-way random forest classifier was built through cross validation of the training data resulting in a 45 gene diagnostic signature.
Results:
This is a planned interim cohort study of the 1700 patients enrolled in the BASE trial that does not include lacunar strokes, TIA, or stroke mimics. Overall, 222 patients were enrolled with NIHSS>5, 70 (32%) with LAS and 152 (68%) with CES; 59% were male, and median (IQR) age was 70.7 yrs (62.0, 80.2). Median (IQR) time from symptom onset to blood collection was 1200 (448, 1568) minutes. Coexistent pathology at presentation included atrial fibrillation 90 (48%), hypertension 153 (82%), hyperlipidemia 87 (47%), diabetes 60 (32%), and coronary artery disease 70 (37%). Patients were randomly divided into training (148), early symptom onset (<18hrs) validation (39) and a late symptom onset (>18 hrs) validation (35). The diagnostic gene signature results in the early validation cohort distinguished LAS from CES; C-statistic 0.78 (0.50-1.0, 95% CI), sensitivity 0.90 (0.55-1.0, 95% CI) and specificity of 0.70 (0.43-1.0, 95%
CI).
Conclusion:
Early RNA expression differentiates large artery stroke patients from those with cardioembolic stroke, and may have therapeutic and secondary prevention implications.
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18
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Damani R, Mayer S, Dhar R, Martin RH, Nyquist P, Olson DM, Mejia-Mantilla JH, Muehlschlegel S, Jauch EC, Mocco J, Mutoh T, Suarez JI. Common Data Element for Unruptured Intracranial Aneurysm and Subarachnoid Hemorrhage: Recommendations from Assessments and Clinical Examination Workgroup/Subcommittee. Neurocrit Care 2020; 30:28-35. [PMID: 31090013 DOI: 10.1007/s12028-019-00736-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Clinical studies of subarachnoid hemorrhage (SAH) and unruptured cerebral aneurysms lack uniformity in terms of variables used for assessments and clinical examination of patients which has led to difficulty in comparing studies and performing meta-analyses. The overall goal of the National Institute of Health/National Institute of Neurological Disorders and Stroke Unruptured Intracranial Aneurysms (UIA) and subarachnoid hemorrhage (SAH) Common Data Elements (CDE) Project was to provide common definitions and terminology for future unruptured intracranial aneurysm and SAH research. METHODS This paper summarizes the recommendations of the subcommittee on SAH Assessments and Clinical Examination. The subcommittee consisted of an international and multidisciplinary panel of experts in UIA and SAH. Consensus recommendations were developed by reviewing previously published CDEs for other neurological diseases including traumatic brain injury, epilepsy and stroke, and the SAH literature. Recommendations for CDEs were classified by priority into "core," "supplemental-highly recommended," "supplemental" and "exploratory." RESULTS We identified 248 variables for Assessments and Clinical Examination. Only the World Federation of Neurological Societies grading scale was classified as "Core." The Glasgow Coma Scale was classified as "Supplemental-Highly Recommended." All other Assessments and Clinical Examination variables were categorized as "Supplemental." CONCLUSION The recommended Assessments and Clinical Examination variables have been collated from a large number of potentially useful scales, history, clinical presentation, laboratory, and other tests. We hope that adherence to these recommendations will facilitate the comparison of results across studies and meta-analyses of individual patient data.
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Affiliation(s)
- Rahul Damani
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Stephan Mayer
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
| | - Raj Dhar
- Department of Neurology, Washington University School of Medicine, St Louis, MO, USA
| | - Renee H Martin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Paul Nyquist
- Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Zayed 3014C, Baltimore, MD, 21287, USA
| | - DaiWai M Olson
- Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Susanne Muehlschlegel
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Edward C Jauch
- Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - J Mocco
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tatsushi Mutoh
- Department of Surgical Neurology, Research Institute for Brain and Blood Vessels, Akita, Japan
| | - Jose I Suarez
- Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Zayed 3014C, Baltimore, MD, 21287, USA.
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19
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Xirasagar S, Tsai MH, Heidari K, Hardin JW, Wu Y, Wronski R, Hurley D, Jauch EC, Sen S. Why acute ischemic stroke patients in the United States use or do not use emergency medical services transport? Findings of an inpatient survey. BMC Health Serv Res 2019; 19:929. [PMID: 31796059 PMCID: PMC6892139 DOI: 10.1186/s12913-019-4741-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 11/13/2019] [Indexed: 01/01/2023] Open
Abstract
Background Patients with acute ischemic stroke (AIS) who use emergency medical services (EMS) receive quicker reperfusion treatment which, in turn, mitigates post-stroke disability. However, nationally only 59% use EMS. We examined why AIS patients use or do not use EMS. Methods During 2016–2018, a convenience sample of AIS patients admitted to a primary stroke center in South Carolina were surveyed during hospitalization if they were medically fit, available for survey when contacted, and consented to participate. The survey was programed into EpiInfo with skip patterns to minimize survey burden and self-administered on a touchscreen computer. Survey questions covered symptom characteristics, knowledge of stroke and EMS importance, subjective reactions, role of bystanders and financial factors. Descriptive and multiple regression analyses were performed. Results Of 108 inpatients surveyed (out of 1179 AIS admissions), 49% were male, 44% African American, mean age 63.5 years, 59% mild strokes, 75 (69%) arrived by EMS, 33% were unaware of any stroke symptom prior to stroke, and 75% were unaware of the importance of EMS use for good outcome. Significant factors that influenced EMS use decisions (identified by regression analysis adjusting for stroke severity) were: prior familiarity with stroke (self or family/friend with stroke) adjusted odds ratio, 5.0 (95% confidence interval, 1.6, 15.1), perceiving symptoms as relevant for self and indicating possible stroke, 26.3 (7.6, 91.1), and bystander discouragement to call 911, 0.1 (0.01,0.7). Further, all 27 patients who knew the importance of EMS had used EMS. All patients whose physician office advised actions other than calling EMS at symptom onset, did not use EMS. Conclusion Systematic stroke education of patients with stroke-relevant comorbidities and life-style risk factors, and public health educational programs may increase EMS use and mitigate post-stroke disability.
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Affiliation(s)
- Sudha Xirasagar
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA.
| | - Meng-Han Tsai
- Department of Health, Human Services and Public Policy, California State University-Monterey Bay, Seaside, CA, USA
| | | | - James W Hardin
- Arnold School of Public Health, Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC,, USA
| | - Yuqi Wu
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Robert Wronski
- Bureau of Emergency Medical Services, South Carolina Department of Health and Environmental Control, Columbia, SC, USA
| | - Dana Hurley
- Genentech, Inc., South San Francisco, CA, USA
| | - Edward C Jauch
- Department of Emergency Medicine, Department of Neurosciences, Mission Research Institute, Mission Health, Asheville, NC, USA
| | - Souvik Sen
- University of South Carolina School of Medicine and Prisma Health Midlands Richland Stroke Unit, Columbia, SC, USA
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Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, Jauch EC, Kidwell CS, Leslie-Mazwi TM, Ovbiagele B, Scott PA, Sheth KN, Southerland AM, Summers DV, Tirschwell DL. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2019; 50:e344-e418. [PMID: 31662037 DOI: 10.1161/str.0000000000000211] [Citation(s) in RCA: 3064] [Impact Index Per Article: 612.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background and Purpose- The purpose of these guidelines is to provide an up-to-date comprehensive set of recommendations in a single document for clinicians caring for adult patients with acute arterial ischemic stroke. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators. These guidelines supersede the 2013 Acute Ischemic Stroke (AIS) Guidelines and are an update of the 2018 AIS Guidelines. Methods- Members of the writing group were appointed by the American Heart Association (AHA) Stroke Council's Scientific Statements Oversight Committee, representing various areas of medical expertise. Members were not allowed to participate in discussions or to vote on topics relevant to their relations with industry. An update of the 2013 AIS Guidelines was originally published in January 2018. This guideline was approved by the AHA Science Advisory and Coordinating Committee and the AHA Executive Committee. In April 2018, a revision to these guidelines, deleting some recommendations, was published online by the AHA. The writing group was asked review the original document and revise if appropriate. In June 2018, the writing group submitted a document with minor changes and with inclusion of important newly published randomized controlled trials with >100 participants and clinical outcomes at least 90 days after AIS. The document was sent to 14 peer reviewers. The writing group evaluated the peer reviewers' comments and revised when appropriate. The current final document was approved by all members of the writing group except when relationships with industry precluded members from voting and by the governing bodies of the AHA. These guidelines use the American College of Cardiology/AHA 2015 Class of Recommendations and Level of Evidence and the new AHA guidelines format. Results- These guidelines detail prehospital care, urgent and emergency evaluation and treatment with intravenous and intra-arterial therapies, and in-hospital management, including secondary prevention measures that are appropriately instituted within the first 2 weeks. The guidelines support the overarching concept of stroke systems of care in both the prehospital and hospital settings. Conclusions- These guidelines provide general recommendations based on the currently available evidence to guide clinicians caring for adult patients with acute arterial ischemic stroke. In many instances, however, only limited data exist demonstrating the urgent need for continued research on treatment of acute ischemic stroke.
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Affiliation(s)
- David S. Liebeskind
- From the Department of Neurology, Neurovascular Imaging Research Core and UCLA Stroke Center, University of California Los Angeles (D.S.L.)
| | - Eric Jüttler
- Department of Neurology, University of Heidelberg, Germany (E.J.)
- Department of Neurology, University of Ulm, University and Rehabilitation Hospitals, Ulm, and the Center for Stroke Research Berlin, Germany (E.J.)
| | | | | | | | - Edward C. Jauch
- Mission Research Institute, Mission Health System, Asheville, NC (E.C.J.)
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Adeoye O, Nyström KV, Yavagal DR, Luciano J, Nogueira RG, Zorowitz RD, Khalessi AA, Bushnell C, Barsan WG, Panagos P, Alberts MJ, Tiner AC, Schwamm LH, Jauch EC. Recommendations for the Establishment of Stroke Systems of Care: A 2019 Update. Stroke 2019; 50:e187-e210. [PMID: 31104615 DOI: 10.1161/str.0000000000000173] [Citation(s) in RCA: 212] [Impact Index Per Article: 42.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In 2005, the American Stroke Association published recommendations for the establishment of stroke systems of care and in 2013 expanded on them with a statement on interactions within stroke systems of care. The aim of this policy statement is to provide a comprehensive review of the scientific evidence evaluating stroke systems of care to date and to update the American Stroke Association recommendations on the basis of improvements in stroke systems of care. Over the past decade, stroke systems of care have seen vast improvements in endovascular therapy, neurocritical care, and stroke center certification, in addition to the advent of innovations, such as telestroke and mobile stroke units, in the context of significant changes in the organization of healthcare policy in the United States. This statement provides an update to prior publications to help guide policymakers and public healthcare agencies in continually updating their stroke systems of care in light of these changes. This statement and its recommendations span primordial and primary prevention, acute stroke recognition and activation of emergency medical services, triage to appropriate facilities, designation of and treatment at stroke centers, secondary prevention at hospital discharge, and rehabilitation and recovery.
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Wira CR, Madsen TE, Chang BP, Nomura JT, Marcolini E, Gentile NT, Schreyer KE, Merck LH, Siket M, Greenberg K, Zammit CG, Jauch EC, Fernanda Bellolio M. Is There a Neurologist in the House? A Summary of the Current State of Neurovascular Rotations for Emergency Medicine Residents. AEM Educ Train 2018; 2:S56-S67. [PMID: 30607380 PMCID: PMC6304277 DOI: 10.1002/aet2.10200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/20/2018] [Accepted: 09/25/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Neurovascular and neurocritical care emergencies constitute a leading cause of morbidity/mortality. There has been great evolution in this field, including but not limited to extended time-window therapeutic interventions for acute ischemic stroke. The intent of this article is to evaluate the goals and future direction of clinical rotations in neurovascular and neurocritical care for emergency medicine (EM) residents. METHODS A panel of 13 board-certified emergency physicians from the Society for Academic Emergency Medicine (SAEM) neurologic emergencies interest group (IG) convened in response to a call for publications-three with fellowship training/board certification in stroke and/or neurocritical care; five with advanced research degrees; three who have been authors on national practice guidelines; and six who have held clinical duties within neurology, neurosurgery, or neurocritical care. A mixed-methods analysis was performed including a review of the literature, a survey of Council of Emergency Medicine Residency Directors (CORD) residency leaders/faculty and SAEM neuro-IG members, and a consensus review by this panel of select neurology rotations provided by IG faculty. RESULTS Thirteen articles for residency neurovascular education were identified: three studies on curriculum, three studies evaluating knowledge, and seven studies evaluating knowledge after an educational intervention. Intervention outcomes included the ability to recognize and manage acute strokes, manage intracerebral hemorrhage, calculate National Institutes of Health Stroke Scale (NIHSS), and interpret images. In the survey sent to CORD residency leaders and neuro-IG faculty, response was obtained from 48 programs. A total of 52.1% indicated having a required rotation (6.2% general neurology, 2% stroke service, 18.8% neurologic intensive care unit, 2% neurosurgery, 22.9% on a combination of services). The majority of programs with required rotations have a combination rotation (residents rotate through multiple services) and evaluations were positive. CONCLUSIONS Variability exists in the availability of neurovascular/neurocritical care rotations for EM trainees. Dedicated clinical time in neurologic education was beneficial to participants. Given recent advancements in the field, augmentation of EM residency training in this area merits strong consideration.
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Affiliation(s)
- Charles R. Wira
- Yale Department of Emergency MedicineYale Division of Cerebrovascular DiseasesDepartment of NeurologyYale School of MedicineNew HavenCT
| | - Tracy E. Madsen
- Department of Emergency MedicineThe Warren Alpert Medical School of Brown UniversityProvidenceRI
| | - Bernard P. Chang
- Department of Emergency MedicineColumbia University Medical CenterNew YorkNY
| | - Jason T. Nomura
- Christiana Care Health SystemNeurosciences Service LineNewarkDE
| | - Evie Marcolini
- Departments of Surgery and NeurologyUniversity of Vermont College of MedicineBurlingtonVT
| | - Nina T. Gentile
- Department of Emergency MedicineTemple University HospitalPhiladelphiaPA
| | | | - Lisa H. Merck
- Division of Emergency Neurosciences and Critical Care ResearchDepartment of Emergency Medicine and Diagnostic ImagingThe Warren Alpert Medical School of Brown UniversityProvidenceRI
| | - Matthew Siket
- Department of Emergency MedicineThe Warren Alpert Medical School of Brown UniversityProvidenceRI
| | - Karen Greenberg
- Global Neurosciences InstituteCrozer Neurologic Emergency DepartmentCrozer Chester Medical CenterUplandPA
| | - Christopher G. Zammit
- Departments of Emergency MedicineNeurology& NeurosurgeryUniversity of Rochester Medical CenterRochesterNY
| | - Edward C. Jauch
- Mission Research Institute/Mission HealthAshevilleNC
- Department of Emergency MedicineMedical University of South CarolinaCharlestonSC
- Departments of Emergency Medicine and NeurologyUniversity of North Carolina– Chapel HillChapel HillNC
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Jauch EC, Holmstedt CA. Fast Protocol for Treating Acute Ischemic Stroke by Emergency Physicians: What Took So Long? Ann Emerg Med 2018; 73:113-115. [PMID: 30420233 DOI: 10.1016/j.annemergmed.2018.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Edward C Jauch
- Mission Research Institute/Mission Health System, Asheville, NC.
| | - Christine A Holmstedt
- Departments of Neurology and Emergency Medicine, MUSC Health Comprehensive Stroke Program, and MUSC Health Teleneuroscience Program, Medical University of South Carolina, Charleston, SC
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Yeatts SD, Broderick JP, Chatterjee A, Jauch EC, Levine SR, Romano JG, Saver JL, Vagal A, Purdon B, Devenport J, Khatri P. Alteplase for the treatment of acute ischemic stroke in patients with low National Institutes of Health Stroke Scale and not clearly disabling deficits (Potential of rtPA for Ischemic Strokes with Mild Symptoms PRISMS): Rationale and design. Int J Stroke 2018; 13:654-661. [PMID: 29570044 DOI: 10.1177/1747493018765269] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 11/16/2022]
Abstract
Rationale Over half of acute ischemic stroke patients have a low National Institutes of Health Stroke Scale of 0-5 and up to two-thirds may not appear clearly disabled at presentation. The efficacy of intravenous alteplase for the latter group is not known. Aim Potential of rtPA for Ischemic Strokes with Mild Symptoms (PRISMS) was designed to evaluate the safety and efficacy of intravenous alteplase for the treatment of acute ischemic stroke with National Institutes of Health Stroke Scale 0-5 and without clearly disabling deficits. Sample size estimates A maximum of 948 subjects were required to test the superiority hypothesis with 80% power, according to a one-sided 0.025 level of significance. Methods and design PRISMS was a multicenter, randomized, double-blind, placebo-controlled phase 3b clinical trial. Patients were randomized to the active arm (intravenous alteplase standard dose of 0.9 mg/kg, up to a maximum of 90 mg, plus oral aspirin placebo) or the control arm (intravenous alteplase placebo plus active oral aspirin dose of 325 mg). Study outcome The primary efficacy endpoint was favorable functional outcome, defined as a modified Rankin Scale score 0 or 1 assessed at 90-day postrandomization.
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Affiliation(s)
| | | | - Anjan Chatterjee
- 3 Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | | | - Steven R Levine
- 4 The State University of New York - Downstate Medical Center, Kings County Hospital Cente, Brooklyn, USA
| | - Jose G Romano
- 5 Miller School of Medicine, University of Miami, Miami, USA
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Chartrain AG, Shoirah H, Jauch EC, Mocco J. A review of acute ischemic stroke triage protocol evidence: a context for discussion. J Neurointerv Surg 2018; 10:1047-1052. [PMID: 30002087 DOI: 10.1136/neurintsurg-2018-013951] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 03/20/2018] [Revised: 05/08/2018] [Accepted: 05/10/2018] [Indexed: 11/03/2022]
Abstract
Endovascular thrombectomy (EVT) is now the standard of care for eligible patients with acute ischemic stroke (AIS) secondary to emergent large vessel occlusion (ELVO). However, there remains uncertainty in how hospital systems can most efficiently route patients with suspected ELVO for EVT treatment. Given the relative geographic distribution of centers with and without endovascular capabilities, the value of prehospital triage directly to centers with the ability to provide EVT remains debated. While there are no randomized trial data available to date, there is substantial evidence in the literature that may offer guidance on the subject. In this review we examine the available data in the context of improving the existing AIS triage systems and discuss how prehospital triage directly to endovascular-capable centers may confer clinical benefits for patients with suspected ELVO.
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Affiliation(s)
| | - Hazem Shoirah
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Edward C Jauch
- Departments of Emergency Medicine and Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - J Mocco
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
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Khatri P, Kleindorfer DO, Devlin T, Sawyer RN, Starr M, Mejilla J, Broderick J, Chatterjee A, Jauch EC, Levine SR, Romano JG, Saver JL, Vagal A, Purdon B, Devenport J, Pavlov A, Yeatts SD. Effect of Alteplase vs Aspirin on Functional Outcome for Patients With Acute Ischemic Stroke and Minor Nondisabling Neurologic Deficits: The PRISMS Randomized Clinical Trial. JAMA 2018; 320:156-166. [PMID: 29998337 PMCID: PMC6583516 DOI: 10.1001/jama.2018.8496] [Citation(s) in RCA: 188] [Impact Index Per Article: 31.3] [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: 12/18/2022]
Abstract
IMPORTANCE More than half of patients with acute ischemic stroke have minor neurologic deficits (National Institutes of Health Stroke Scale [NIHSS] score of 0-5) at presentation. Although prior major trials of alteplase included patients with low NIHSS scores, few without clearly disabling deficits were enrolled. OBJECTIVE To evaluate the efficacy and safety of alteplase in patients with NIHSS scores of 0 to 5 whose deficits are not clearly disabling. DESIGN, SETTING, AND PARTICIPANTS The PRISMS trial was designed as a 948-patient, phase 3b, double-blind, double-placebo, multicenter randomized clinical trial of alteplase compared with aspirin for emergent stroke at 75 stroke hospital networks in the United States. Patients with acute ischemic stroke whose deficits were scored as 0 to 5 on the NIHSS and judged not clearly disabling and in whom study treatment could be initiated within 3 hours of onset were eligible and enrolled from May 30, 2014, to December 20, 2016, with final follow-up on March 22, 2017. INTERVENTIONS Participants were randomized to receive intravenous alteplase at the standard dose (0.9 mg/kg) with oral placebo (n = 156) or oral aspirin, 325 mg, with intravenous placebo (n = 157). MAIN OUTCOMES AND MEASURES The primary outcome was the difference in favorable functional outcome, defined as a modified Rankin Scale score of 0 or 1 at 90 days via Cochran-Mantel-Haenszel test stratified by pretreatment NIHSS score, age, and time from onset to treatment. Because of early termination of the trial, prior to unblinding or interim analyses, the plan was revised to examine the risk difference of the primary outcome by a linear model adjusted for the same factors. The primary safety end point was symptomatic intracranial hemorrhage (sICH) within 36 hours of intravenous study treatment. RESULTS Among 313 patients enrolled at 53 stroke networks (mean age, 62 [SD, 13] years; 144 [46%] women; median NIHSS score, 2 [interquartile range {IQR}, 1-3]; median time to treatment, 2.7 hours [IQR, 2.1-2.9]), 281 (89.8%) completed the trial. At 90 days, 122 patients (78.2%) in the alteplase group vs 128 (81.5%) in the aspirin group achieved a favorable outcome (adjusted risk difference, -1.1%; 95% CI, -9.4% to 7.3%). Five alteplase-treated patients (3.2%) vs 0 aspirin-treated patients had sICH (risk difference, 3.3%; 95% CI, 0.8%-7.4%). CONCLUSIONS AND RELEVANCE Among patients with minor nondisabling acute ischemic stroke, treatment with alteplase vs aspirin did not increase the likelihood of favorable functional outcome at 90 days. However, the very early study termination precludes any definitive conclusions, and additional research may be warranted. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02072226.
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Affiliation(s)
| | | | - Thomas Devlin
- University of Tennessee College of Medicine, Chattanooga
| | | | - Matthew Starr
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jennifer Mejilla
- Dayton Medical Center, Department of Veterans Affairs, Dayton, Ohio
| | | | | | | | - Steven R. Levine
- SUNY Downstate Medical Center, Brooklyn, New York
- Kings County Hospital Center, Brooklyn, New York
| | - Jose G. Romano
- University of Miami Miller School of Medicine, Miami, Florida
| | - Jeffrey L. Saver
- Comprehensive Stroke Center and Department of Neurology, University of California, Los Angeles
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Abstract
OBJECTIVES Sudden cardiac arrest (SCA) remains a significant cause of morbidity and mortality, and the key to increased survival is emergent bystander intervention. A growing body of evidence has shown that timely bystander-initiated cardiopulmonary resuscitation (CPR) and defibrillation are significantly correlated with an increased likelihood of survival. Despite these demonstrated benefits, bystanders perform these interventions in less than half of witnessed SCA cases. We hypothesized that the level of public CPR and automated external defibrillator (AED) knowledge may be limited and may play a role in the likelihood of intervening. METHODS A convenience survey of potential bystanders to SCA was conducted in a high-traffic shopping center to estimate the overall knowledge level of CPR and AED usage and determine general attitudes toward intervening in the setting of SCA. Concurrently with the survey, professional emergency responders offered free bystander compression-only CPR and AED training on location. RESULTS The majority of survey respondents expressed a willingness to perform the aforementioned interventions when asked directly. Results, however, indicate that although 69% of respondents consider themselves to have a general knowledge of CPR, only 18% spontaneously mentioned CPR when presented with a hypothetical SCA scenario. In addition, only 2.2% mentioned defibrillation, and 63% indicated that they would not know how to locate a public access AED when needed. Of the individuals who participated in both the survey and the training, all of them indicated that they were more likely to intervene in an SCA after receiving the training. CONCLUSIONS Our findings suggest that future public outreach efforts should target the current CPR and AED knowledge gap. They also indicate that free, brief trainings offered at public events are a feasible way to increase the knowledge and skills of potential bystanders to SCA.
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Affiliation(s)
- Lisa M Petruncio
- From the College of Medicine and the Department of Emergency Medicine, Medical University of South Carolina, Charleston
| | - David M French
- From the College of Medicine and the Department of Emergency Medicine, Medical University of South Carolina, Charleston
| | - Edward C Jauch
- From the College of Medicine and the Department of Emergency Medicine, Medical University of South Carolina, Charleston
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Jauch EC, Huang DY, Gardner AJ, Blum JL. Strategies for improving outcomes in the acute management of ischemic stroke in rural emergency departments: a quality improvement initiative in the Stroke Belt. Open Access Emerg Med 2018; 10:53-59. [PMID: 29805271 PMCID: PMC5960248 DOI: 10.2147/oaem.s160269] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The timely evaluation and initiation of treatment for acute ischemic stroke (AIS) is critical to optimal patient outcomes. However, clinical practice often falls short of guideline-established goals. Hospitals in rural regions of the USA, and notably those in the Stroke Belt, are particularly challenged to meet timing goals since the vast majority of primary stroke centers (PSCs) are concentrated in urban academic institutions. Methods Between May 2015 and May 2017, emergency department (ED) teams from 5 non-PSC hospitals in the Stroke Belt participated in a quality improvement (QI) initiative. The intervention included a baseline practice assessment survey, repeat audit-and-feedback cycles with patient data on AIS treatment timing, personalized Continuing Medical Education/Continuing Education-certified grand rounds sessions at each participating site with expert study faculty, targeted reinforcement of best practices, and follow-up to evaluate the benefits and limitations of the intervention. Results At the start of the initiative, clinical staff from participating EDs overestimated the proportion of patients with AIS who received alteplase within the guideline-recommended 60-minute door-to-needle window at their facility. At the end of the 6-month intervention period, significantly more patients were treated with alteplase within 60 minutes of ED arrival compared to baseline across the entire sample (1.9% of patients at baseline vs. 5.2% at 6 months; P < 0.01). Similarly, there was a trend toward a decrease in the percentage of patients whose alteplase treatment was initiated more than 60 minutes after their arrival at the ED (67.3% at baseline vs. 22.2% at 6 months). Conclusion Structured QI interventions that engage ED care teams to reflect on processes related to AIS diagnosis and treatment and deploy repeat audit-and-feedback cycles with real-time patient data have the potential to support an increase in the number of patients who receive alteplase within the guideline-recommended timeframe of 60 minutes from hospital arrival.
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Affiliation(s)
- Edward C Jauch
- Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - David Y Huang
- Department of Neurology, Division of Stroke and Vascular Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, Jauch EC, Kidwell CS, Leslie-Mazwi TM, Ovbiagele B, Scott PA, Sheth KN, Southerland AM, Summers DV, Tirschwell DL. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2018; 49:e46-e110. [PMID: 29367334 DOI: 10.1161/str.0000000000000158] [Citation(s) in RCA: 3408] [Impact Index Per Article: 568.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of these guidelines is to provide an up-to-date comprehensive set of recommendations for clinicians caring for adult patients with acute arterial ischemic stroke in a single document. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators. These guidelines supersede the 2013 guidelines and subsequent updates. METHODS Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statements Oversight Committee, representing various areas of medical expertise. Strict adherence to the American Heart Association conflict of interest policy was maintained. Members were not allowed to participate in discussions or to vote on topics relevant to their relations with industry. The members of the writing group unanimously approved all recommendations except when relations with industry precluded members voting. Prerelease review of the draft guideline was performed by 4 expert peer reviewers and by the members of the Stroke Council's Scientific Statements Oversight Committee and Stroke Council Leadership Committee. These guidelines use the American College of Cardiology/American Heart Association 2015 Class of Recommendations and Levels of Evidence and the new American Heart Association guidelines format. RESULTS These guidelines detail prehospital care, urgent and emergency evaluation and treatment with intravenous and intra-arterial therapies, and in-hospital management, including secondary prevention measures that are appropriately instituted within the first 2 weeks. The guidelines support the overarching concept of stroke systems of care in both the prehospital and hospital settings. CONCLUSIONS These guidelines are based on the best evidence currently available. In many instances, however, only limited data exist demonstrating the urgent need for continued research on treatment of acute ischemic stroke.
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Dvoren-Baker TM, Holmstedt CA, Hegedus MA, Kerrigone JT, Matuskowitz AJ, Jauch EC, Ovbiagele BI, Turan TN. Abstract NS2: A Rapid Care Evaluation Transient Ischemic Attack Clinic by Nurse Practitioners. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.ns2] [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:
Prompt evaluation and management of patients having a transient ischemic attack (TIA) with the ABCD2 triage score has been shown to decrease the risk of stroke and potentially life-long disability. However, creating an organized, well-coordinated approach that provides rapid access for patients is a challenge at many high-volume stroke centers.
Purpose:
We sought to determine the feasibility of a nurse practitioner (NP)-led Rapid Access Care Execution for Transient Ischemic Attack (RACE-TIA) Clinic as part of an Outpatient Stroke Nurse Practitioner Clinic.
Methods:
Our RACE-TIA Clinic Algorithm uses ABCD2 score triaging, and outlines the care process for TIA patients who present either through the Emergency Department (ED), Outpatient Clinic or via telephone triage. Patients with possible TIA are triaged using the ABCD2 tool. Those who present to the ED are evaluated by a member of the Acute Stroke Team and patients with a score ≥ 3 remain in the ED Clinical Decision Unit (CDU) for evaluation. Patients with a score < 3 are scheduled in the RACE-TIA Clinic staffed by two stroke-trained NPs. Referrals to the RACE-TIA clinic from the electronic medical record (EMR) referral or the dedicated phone line are triaged by a registered nurse who was trained to complete the ABCD2 scoring. All appointments are scheduled within 24-48 hours of receiving a referral.
Results:
Since initiating the RACE-TIA Clinic Algorithm in January 2017 a total of 20 patients were seen as outpatients for TIA evaluation. Six patients were directly referred to the RACE-TIA Clinic for acute TIA evaluation and of those, 5 were referred from the ED and 1 from a primary care office. Another 14 patients were scheduled for follow-up after having an initial TIA evaluation at either an outside hospital (3), the ED (2), ED CDU (3) or after inpatient hospitalization (6). The average time from referral to clinic visit was 34 hours.
Conclusion:
Our NP-led RACE-TIA Clinic has successfully evaluated patients with low risk TIA in the outpatient setting in a timely way and also provided close follow-up for high risk TIA patients after the acute evaluation without expanding or duplicating existing resources.
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Tsai MH, Xirasagar S, Carroll S, Bryan CS, Gallagher PJ, Davis K, Jauch EC. Reducing High-Users' Visits to the Emergency Department by a Primary Care Intervention for the Uninsured: A Retrospective Study. Inquiry 2018; 55:46958018763917. [PMID: 29591539 PMCID: PMC5888802 DOI: 10.1177/0046958018763917] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Reducing avoidable emergency department (ED) visits is an important health system goal. This is a retrospective cohort study of the impact of a primary care intervention including an in-hospital, free, adult clinic for poor uninsured patients on ED visit rates and emergency severity at a nonprofit hospital. We studied adult ED visits during August 16, 2009-August 15, 2011 (preintervention) and August 16, 2011-August 15, 2014 (postintervention). We compared pre- versus post-mean annual visit rates and discharge emergency severity index (ESI; triage and resource use-based, calculated Agency for Healthcare Research and Quality categories) among high-users (≥3 ED visits in 12 months) and occasional users. Annual adult ED visit volumes were 16 372 preintervention (47.5% by high-users), versus 18 496 postintervention. High-users' mean annual visit rates were 5.43 (top quartile) and 0.94 (bottom quartile) preintervention, versus 3.21 and 1.11, respectively, for returning high-users, postintervention (all P < .001). Postintervention, the visit rates of new high-users were lower (lowest and top quartile rates, 0.6 and 3.23) than preintervention high-users' rates in the preintervention period. Visit rates of the top quartile of occasional users also declined. Subgroup analysis of medically uninsured high-users showed similar results. Upon classifying preintervention high-users by emergency severity, postintervention mean ESI increased 24.5% among the lowest ESI quartile, and decreased 12.2% among the top quartile. Pre- and post-intervention sample demographics and comorbidities were similar. The observed reductions in overall ED visit rates, particularly low-severity visits; highest reductions observed among high-users and the top quartile of occasional users; and the pattern of changes in emergency severity support a positive impact of the primary care intervention.
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Affiliation(s)
| | | | | | | | | | - Kim Davis
- Providence Health, Columbia, SC, USA
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Simpson AN, Wilmskoetter J, Hong I, Li CY, Jauch EC, Bonilha HS, Anderson K, Harvey J, Simpson KN. Stroke Administrative Severity Index: using administrative data for 30-day poststroke outcomes prediction. J Comp Eff Res 2017; 7:293-304. [PMID: 29057660 PMCID: PMC6615407 DOI: 10.2217/cer-2017-0058] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim: Current stroke severity scales cannot be used for archival data. We develop and validate a measure of stroke severity at hospital discharge (Stroke Administrative Severity Index [SASI]) for use in billing data. Methods: We used the NIH Stroke Scale (NIHSS) as the theoretical framework and identified 285 relevant International Classification of Diseases, 9th Revision diagnosis and procedure codes, grouping them into 23 indicator variables using cluster analysis. A 60% sample of stroke patients in Medicare data were used for modeling risk of 30-day postdischarge mortality or discharge to hospice, with validation performed on the remaining 40% and on data with NIHSS scores. Results: Model fit was good (p > 0.05) and concordance was strong (C-statistic = 0.76–0.83). The SASI predicted NIHSS at discharge (C = 0.83). Conclusion: The SASI model and score provide important tools to control for stroke severity at time of hospital discharge. It can be used as a risk-adjustment variable in administrative data analyses to measure postdischarge outcomes.
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Affiliation(s)
- Annie N Simpson
- Department of Healthcare Leadership & Management, College of Health Professions, Medical University of South Carolina, 151B Rutledge Ave, MSC 962, Charleston, SC 29425, USA.,Department of Otolaryngology - Head & Neck Surgery, Medical University of South Carolina, 135 Rutledge Ave, MSC 550, Charleston, SC 29425, USA
| | - Janina Wilmskoetter
- Department of Health Sciences & Research, College of Health Professions, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC 29425, USA
| | - Ickpyo Hong
- Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA
| | - Chih-Ying Li
- Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA
| | - Edward C Jauch
- Division of Emergency Medicine, Department of Medicine, College of Medicine, Medical University of South Carolina, 169 Ashley Avenue, MSC 300, Charleston, SC 29425, USA
| | - Heather S Bonilha
- Department of Otolaryngology - Head & Neck Surgery, Medical University of South Carolina, 135 Rutledge Ave, MSC 550, Charleston, SC 29425, USA.,Department of Health Sciences & Research, College of Health Professions, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC 29425, USA
| | - Kelly Anderson
- Department of Healthcare Leadership & Management, College of Health Professions, Medical University of South Carolina, 151B Rutledge Ave, MSC 962, Charleston, SC 29425, USA.,Department of Health Sciences & Research, College of Health Professions, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC 29425, USA
| | - Jillian Harvey
- Department of Healthcare Leadership & Management, College of Health Professions, Medical University of South Carolina, 151B Rutledge Ave, MSC 962, Charleston, SC 29425, USA
| | - Kit N Simpson
- Department of Healthcare Leadership & Management, College of Health Professions, Medical University of South Carolina, 151B Rutledge Ave, MSC 962, Charleston, SC 29425, USA
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Bosetti F, Koenig JI, Ayata C, Back SA, Becker K, Broderick JP, Carmichael ST, Cho S, Cipolla MJ, Corbett D, Corriveau RA, Cramer SC, Ferguson AR, Finklestein SP, Ford BD, Furie KL, Hemmen TM, Iadecola C, Jakeman LB, Janis S, Jauch EC, Johnston KC, Kochanek PM, Kohn H, Lo EH, Lyden PD, Mallard C, McCullough LD, McGavern LM, Meschia JF, Moy CS, Perez-Pinzon MA, Ramadan I, Savitz SI, Schwamm LH, Steinberg GK, Stenzel-Poore MP, Tymianski M, Warach S, Wechsler LR, Zhang JH, Koroshetz W. Translational Stroke Research: Vision and Opportunities. Stroke 2017; 48:2632-2637. [PMID: 28751554 DOI: 10.1161/strokeaha.117.017112] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/20/2017] [Accepted: 05/01/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Francesca Bosetti
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.).
| | - James I Koenig
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - Cenk Ayata
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - Stephen A Back
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - Kyra Becker
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - Joseph P Broderick
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - S Thomas Carmichael
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - Sunghee Cho
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - Marilyn J Cipolla
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - Dale Corbett
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - Roderick A Corriveau
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - Steven C Cramer
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - Adam R Ferguson
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - Seth P Finklestein
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - Byron D Ford
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - Karen L Furie
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - Thomas M Hemmen
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - Costantino Iadecola
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - Lyn B Jakeman
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - Scott Janis
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - Edward C Jauch
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - Karen C Johnston
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - Patrick M Kochanek
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - Harold Kohn
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - Eng H Lo
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - Patrick D Lyden
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - Carina Mallard
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - Louise D McCullough
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - Linda M McGavern
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - James F Meschia
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - Claudia S Moy
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - Miguel A Perez-Pinzon
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - Ipolia Ramadan
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - Sean I Savitz
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - Lee H Schwamm
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - Gary K Steinberg
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - Mary P Stenzel-Poore
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - Michael Tymianski
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - Steven Warach
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - Lawrence R Wechsler
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - John H Zhang
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
| | - Walter Koroshetz
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health (F.B., J.I.K., R.A.C., L.B.J., S.J., L.M.M., C.S.M., I.R., W.K.); Department of Neurology, Massachusetts General Hospital, Boston (C.A., E.H.L., L.H.S.); Oregon Health & Science University, Portland (S.A.B., M.P.S.-P.); Department of Neurology and Neurological Surgery, University of Washington, Seattle (K.B.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (J.P.B.); Department of Neurology, University of California, Los Angeles (S.T.C.); Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C., C.I.); Department of Neurological Sciences, University of Vermont, Burlington (M.J. C.); Brain and Mind Research Institute, University of Ottawa, Ontario (D.C.); Department of Neurology, University of California, Irvine, Orange (S.C.C.); Department of Neurological Surgery, University of California, San Francisco (A.R.F.); Stemetix, Inc, Needham, MA (S.F.); Division of Biomedical Sciences, University of California, Riverside (B.D.F.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Department of Neurology, University of California, San Diego (T.M.H.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); Department of Neurology, University of Virginia, Charlottesville (K.C.J.); Department of Critical Care Medicine (P.M.K.) and Department of Neurology (L.R.W.), University of Pittsburgh, PA; School of Pharmacy, University of North Carolina, Chapel Hill (H.K.); Cedars-Sinai Medical Center, Los Angeles, CA (P.D.L.); University of Gothenburg, Sweden (C.M.); Department of Neurology, University of Texas Health Science Center, Houston (L.D.M., S.I.S.); Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Miami Miller School, FL (M.A.P.-P.); Department of Neurosurgery, Stanford University, CA (G.K.S.); Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, ON (M.T.); Department of Neurology, University of Texas, Austin (S.W.); and Department of Neurosurgery and Anesthesiology, Loma Linda University, CA (J.H.Z.)
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35
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Simpson KN, Simpson AN, Mauldin PD, Palesch YY, Yeatts SD, Kleindorfer D, Tomsick TA, Foster LD, Demchuk AM, Khatri P, Hill MD, Jauch EC, Jovin TG, Yan B, von Kummer R, Molina CA, Goyal M, Schonewille WJ, Mazighi M, Engelter ST, Anderson C, Spilker J, Carrozzella J, Ryckborst KJ, Janis LS, Broderick JP. Observed Cost and Variations in Short Term Cost-Effectiveness of Therapy for Ischemic Stroke in Interventional Management of Stroke (IMS) III. J Am Heart Assoc 2017; 6:JAHA.116.004513. [PMID: 28483774 PMCID: PMC5524059 DOI: 10.1161/jaha.116.004513] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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] [Indexed: 12/03/2022]
Abstract
Background Examination of linked data on patient outcomes and cost of care may help identify areas where stroke care can be improved. We report on the association between variations in stroke severity, patient outcomes, cost, and treatment patterns observed over the acute hospital stay and through the 12‐month follow‐up for subjects receiving endovascular therapy compared to intravenous tissue plasminogen activator alone in the IMS (Interventional Management of Stroke) III Trial. Methods and Results Prospective data collected for a prespecified economic analysis of the trial were used. Data included hospital billing records for the initial stroke admission and subsequent detailed resource use after the acute hospitalization collected at 3, 6, 9, and 12 months. Cost of follow‐up care varied 6‐fold for patients in the lowest (0–1) and highest (20+) National Institutes of Health Stroke Scale category at 5 days, and by modified Rankin Scale at 3 months. The kind of resources used postdischarge also varied between treatment groups. Incremental short‐term cost‐effectiveness ratios varied greatly when treatments were compared for patient subgroups. Patient subgroups predefined by stroke severity had incremental cost‐effectiveness ratios of $97 303/quality‐adjusted life year (severe stroke) and $3 187 805/quality‐adjusted life year (moderately severe stroke). Conclusions Detailed economic and resource utilization data from IMS III provide powerful evidence for the large effect that patient outcome has on the economic value of medical and endovascular reperfusion therapies. These data can be used to inform process improvements for stroke care and to estimate the cost‐effectiveness of endovascular therapy in the US health system for stroke intervention trials. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Registration number: NCT00359424.
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Affiliation(s)
- Kit N Simpson
- Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, SC
| | - Annie N Simpson
- Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, SC
| | - Patrick D Mauldin
- Department of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, SC
| | - Yuko Y Palesch
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Sharon D Yeatts
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Dawn Kleindorfer
- Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Gardner Neuroscience Institute University of Cincinnati Academic Health Center, Cincinnati, OH
| | - Thomas A Tomsick
- Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Gardner Neuroscience Institute University of Cincinnati Academic Health Center, Cincinnati, OH
| | - Lydia D Foster
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Andrew M Demchuk
- Calgary Stroke Program, Departments of Clinical Neurosciences and Radiology, Seaman Family MR Research Centre, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Pooja Khatri
- Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Gardner Neuroscience Institute University of Cincinnati Academic Health Center, Cincinnati, OH
| | - Michael D Hill
- Calgary Stroke Program, Departments of Clinical Neurosciences and Radiology, Seaman Family MR Research Centre, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Edward C Jauch
- Division of Emergency Medicine, Medical University of South Carolina, Charleston, SC
| | - Tudor G Jovin
- Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Bernard Yan
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Rüdiger von Kummer
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Dresden, Dresden, Germany
| | - Carlos A Molina
- Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Mayank Goyal
- Calgary Stroke Program, Departments of Clinical Neurosciences and Radiology, Seaman Family MR Research Centre, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Wouter J Schonewille
- Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, The Netherlands.,St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Mikael Mazighi
- Department of Neurology and Stroke Center, Lariboisière Hospital, DHU NeuroVasc, Paris, France
| | - Stefan T Engelter
- Neurorehabilitation Unit, Department of Neurology, Basel University Hospital, University of Basel, Basel, Switzerland.,University Center for Medicine of Aging, Felix Platter Hospital, Basel, Switzerland
| | - Craig Anderson
- George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - Judith Spilker
- Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Gardner Neuroscience Institute University of Cincinnati Academic Health Center, Cincinnati, OH
| | - Janice Carrozzella
- Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Gardner Neuroscience Institute University of Cincinnati Academic Health Center, Cincinnati, OH
| | - Karla J Ryckborst
- Calgary Stroke Program, Departments of Clinical Neurosciences and Radiology, Seaman Family MR Research Centre, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - L Scott Janis
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Joseph P Broderick
- Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Gardner Neuroscience Institute University of Cincinnati Academic Health Center, Cincinnati, OH
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36
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Jauch EC, Barreto AD, Broderick JP, Char DM, Cucchiara BL, Devlin TG, Haddock AJ, Hicks WJ, Hiestand BC, Jickling GC, June J, Liebeskind DS, Lowenkopf TJ, Miller JB, O'Neill J, Schoonover TL, Sharp FR, Peacock WF. Biomarkers of Acute Stroke Etiology (BASE) Study Methodology. Transl Stroke Res 2017; 8:10.1007/s12975-017-0537-3. [PMID: 28477280 PMCID: PMC5590025 DOI: 10.1007/s12975-017-0537-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/02/2017] [Accepted: 04/27/2017] [Indexed: 11/25/2022]
Abstract
Acute ischemic stroke affects over 800,000 US adults annually, with hundreds of thousands more experiencing a transient ischemic attack. Emergent evaluation, prompt acute treatment, and identification of stroke or TIA (transient ischemic attack) etiology for specific secondary prevention are critical for decreasing further morbidity and mortality of cerebrovascular disease. The Biomarkers of Acute Stroke Etiology (BASE) study is a multicenter observational study to identify serum markers defining the etiology of acute ischemic stroke. Observational trial of patients presenting to the hospital within 24 h of stroke onset. Blood samples are collected at arrival, 24, and 48 h later, and RNA gene expression is utilized to identify stroke etiology marker candidates. The BASE study began January 2014. At the time of writing, there are 22 recruiting sites. Enrollment is ongoing, expected to hit 1000 patients by March 2017. The BASE study could potentially aid in focusing the initial diagnostic evaluation to determine stroke etiology, with more rapidly initiated targeted evaluations and secondary prevention strategies.Clinical Trial Registration Clinicaltrials.gov NCT02014896 https://clinicaltrials.gov/ct2/show/NCT02014896?term=biomarkers+of+acute+stroke+etiology&rank=1.
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Affiliation(s)
- Edward C Jauch
- Medical University of South Carolina, Charleston, SC, USA
| | | | | | | | | | | | - Alison J Haddock
- Baylor College of Medicine, 3302 S. Macgregor Way, Houston, TX, 77021, USA
| | | | | | | | - Jeff June
- Ischemia Care, LLC, Cincinnati, OH, USA
| | | | | | | | | | | | - Frank R Sharp
- University of California, Davis, Sacramento, CA, USA
| | - W Frank Peacock
- Baylor College of Medicine, 3302 S. Macgregor Way, Houston, TX, 77021, USA.
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37
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Xian Y, Xu H, Lytle B, Blevins J, Peterson ED, Hernandez AF, Smith EE, Saver JL, Messé SR, Paulsen M, Suter RE, Reeves MJ, Jauch EC, Schwamm LH, Fonarow GC. Use of Strategies to Improve Door-to-Needle Times With Tissue-Type Plasminogen Activator in Acute Ischemic Stroke in Clinical Practice. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.116.003227. [DOI: 10.1161/circoutcomes.116.003227] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 11/11/2016] [Indexed: 11/16/2022]
Abstract
Background—
The implementation of Target: Stroke Phase I, the first stage of the American Heart Association’s national quality improvement initiative to accelerate door-to-needle (DTN) times, was associated with an average 15-minute reduction in DTN times. Target: Stroke phase II was launched in April 2014 with a goal of promoting further reduction in treatment times for tissue-type plasminogen activator (tPA) administration.
Methods and Results—
We conducted a second survey of Get With The Guidelines-Stroke hospitals regarding strategies used to reduce delays after Target: Stroke and quantify their association with DTN times. A total of 16 901 ischemic stroke patients were treated with intravenous tPA within 4.5 hours of symptom onset from 888 surveyed hospitals between June 2014 and April 2015. The patient-level median DTN time was 56 minutes (interquartile range, 42–75), with 59.3% of patients receiving intravenous tPA within 60 minutes and 30.4% within 45 minutes after hospital arrival. Most hospitals reported routinely using a majority of Target: Stroke key practice strategies, although direct transport of patients to computed tomographic/magenetic resonance imaging scanner, premix of tPA ahead of time, initiation of tPA in brain imaging suite, and prompt data feedback to emergency medical services providers were used less frequently. Overall, we identified 16 strategies associated with significant reductions in DTN times. Combined, a total of 20 minutes (95% confidence intervals 15–25 minutes) could be saved if all strategies were implemented.
Conclusions—
Get With The Guidelines-Stroke hospitals have initiated a majority of Target: Stroke–recommended strategies to reduce DTN times in acute ischemic stroke. Nevertheless, certain strategies were infrequently practiced and represent a potential immediate target for further improvements.
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Affiliation(s)
- Ying Xian
- From the Duke Clinical Research Institute, Durham, NC (Y.X., H.X., B.L., J.B., E.D.P., A.F.H.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; University of Pennsylvania, Philadelphia (S.R.M.); American Heart Association, Dallas, TX (M.P.)
| | - Haolin Xu
- From the Duke Clinical Research Institute, Durham, NC (Y.X., H.X., B.L., J.B., E.D.P., A.F.H.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; University of Pennsylvania, Philadelphia (S.R.M.); American Heart Association, Dallas, TX (M.P.)
| | - Barbara Lytle
- From the Duke Clinical Research Institute, Durham, NC (Y.X., H.X., B.L., J.B., E.D.P., A.F.H.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; University of Pennsylvania, Philadelphia (S.R.M.); American Heart Association, Dallas, TX (M.P.)
| | - Jason Blevins
- From the Duke Clinical Research Institute, Durham, NC (Y.X., H.X., B.L., J.B., E.D.P., A.F.H.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; University of Pennsylvania, Philadelphia (S.R.M.); American Heart Association, Dallas, TX (M.P.)
| | - Eric D. Peterson
- From the Duke Clinical Research Institute, Durham, NC (Y.X., H.X., B.L., J.B., E.D.P., A.F.H.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; University of Pennsylvania, Philadelphia (S.R.M.); American Heart Association, Dallas, TX (M.P.)
| | - Adrian F. Hernandez
- From the Duke Clinical Research Institute, Durham, NC (Y.X., H.X., B.L., J.B., E.D.P., A.F.H.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; University of Pennsylvania, Philadelphia (S.R.M.); American Heart Association, Dallas, TX (M.P.)
| | - Eric E. Smith
- From the Duke Clinical Research Institute, Durham, NC (Y.X., H.X., B.L., J.B., E.D.P., A.F.H.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; University of Pennsylvania, Philadelphia (S.R.M.); American Heart Association, Dallas, TX (M.P.)
| | - Jeffrey L. Saver
- From the Duke Clinical Research Institute, Durham, NC (Y.X., H.X., B.L., J.B., E.D.P., A.F.H.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; University of Pennsylvania, Philadelphia (S.R.M.); American Heart Association, Dallas, TX (M.P.)
| | - Steven R. Messé
- From the Duke Clinical Research Institute, Durham, NC (Y.X., H.X., B.L., J.B., E.D.P., A.F.H.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; University of Pennsylvania, Philadelphia (S.R.M.); American Heart Association, Dallas, TX (M.P.)
| | - Mary Paulsen
- From the Duke Clinical Research Institute, Durham, NC (Y.X., H.X., B.L., J.B., E.D.P., A.F.H.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; University of Pennsylvania, Philadelphia (S.R.M.); American Heart Association, Dallas, TX (M.P.)
| | - Robert E. Suter
- From the Duke Clinical Research Institute, Durham, NC (Y.X., H.X., B.L., J.B., E.D.P., A.F.H.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; University of Pennsylvania, Philadelphia (S.R.M.); American Heart Association, Dallas, TX (M.P.)
| | - Mathew J. Reeves
- From the Duke Clinical Research Institute, Durham, NC (Y.X., H.X., B.L., J.B., E.D.P., A.F.H.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; University of Pennsylvania, Philadelphia (S.R.M.); American Heart Association, Dallas, TX (M.P.)
| | - Edward C. Jauch
- From the Duke Clinical Research Institute, Durham, NC (Y.X., H.X., B.L., J.B., E.D.P., A.F.H.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; University of Pennsylvania, Philadelphia (S.R.M.); American Heart Association, Dallas, TX (M.P.)
| | - Lee H. Schwamm
- From the Duke Clinical Research Institute, Durham, NC (Y.X., H.X., B.L., J.B., E.D.P., A.F.H.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; University of Pennsylvania, Philadelphia (S.R.M.); American Heart Association, Dallas, TX (M.P.)
| | - Gregg C. Fonarow
- From the Duke Clinical Research Institute, Durham, NC (Y.X., H.X., B.L., J.B., E.D.P., A.F.H.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; University of Pennsylvania, Philadelphia (S.R.M.); American Heart Association, Dallas, TX (M.P.)
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Abstract
Intracerebral hemorrhage (ICH) is a subset of stroke due to bleeding within the parenchyma of the brain. It is potentially lethal, and survival depends on ensuring an adequate airway, reversal of coagulopathy, and proper diagnosis. ICH was chosen as an Emergency Neurological Life Support protocol because intervention within the first critical hour may improve outcome, and it is critical to have site-specific protocols to drive care quickly and efficiently.
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Affiliation(s)
- Edward C Jauch
- Division of Emergency Medicine and Department of Neurosciences, Medical University of South Carolina, Charleston, USA.
| | - Jose A Pineda
- Department of Pediatrics and Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - J Claude Hemphill
- Department of Neurology, University of California, San Francisco, USA
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Nemeth LS, Jenkins C, Jauch EC, Conway S, Pearlman A, Spruill IJ, Brown LJ, Linnen J, Linnen F, Andrews JO. A Community-Engaged Assessment of Barriers and Facilitators to Rapid Stroke Treatment. Res Nurs Health 2016; 39:438-448. [PMID: 27545591 DOI: 10.1002/nur.21749] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2016] [Indexed: 11/08/2022]
Abstract
Treatment for acute ischemic stroke must be initiated within hours of stroke symptom onset, and the sooner it is administered, the better. In South Carolina, 76% of the population can access expert stroke care, and rural hospitals may provide specialized treatment using telemedicine, but many stroke sufferers seek care too late to achieve full benefit. Using a community-engaged approach in a southern rural community, we explored barriers and facilitators to early stroke care and implications for improvement. The Community-Engaged Assessment to facilitate Stroke Elimination (CEASE) study was guided by a community advisory group to ensure community centeredness and local relevance. In a qualitative descriptive study, eight focus groups were conducted including 52 individuals: recent stroke survivors, family members, emergency medical personnel, hospital emergency department staff, primary care providers, and community leaders. From analysis of focus group transcripts came six themes: lack of trust in healthcare system and providers; weak relationships fueled by poor communication; low health literacy; financial limitations related to health care; community-based education; and faith as a message of hope. A hierarchy model for improving early community-based stroke care was developed through consensus dialogue by community representatives and the research team. This model can be used to inform a community-partnered, stakeholder-informed intervention to improve stroke care in a rural southern community with the goal of improving stroke education, care, and outcome. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Lynne S Nemeth
- Professor, College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas, MSC 160, Charleston, SC 29425
| | - Carolyn Jenkins
- Professor and Ann Darlington Edwards Endowed Chair, College of Nursing, Medical University of South Carolina, Charleston, SC
| | - Edward C Jauch
- Professor, Division of Emergency Medicine, Medical University of South Carolina, Charleston, SC
| | - Sharon Conway
- Research Associate and Health Research Board Clinical Research Facility, National University of Ireland, Galway, Galway, Ireland
| | - Adam Pearlman
- Medical Student (Former), Medical University of South Carolina, Charleston, SC
| | - Ida J Spruill
- Associate Professor, College of Nursing, Medical University of South Carolina, Charleston, SC
| | - Lynette J Brown
- Neurosciences Program Coordinator, Medical University of South Carolina, Charleston, SC
| | - Joyce Linnen
- Community Outreach Coordinator, Georgetown Diabetes Community Outreach Resources and Education (CORE) Group, Georgetown, SC
| | - Florene Linnen
- Community Member, Georgetown Diabetes Community Outreach Resources and Education (CORE) Group, Georgetown, SC
| | - Jeannette O Andrews
- Dean and Professor, College of Nursing, University of South Carolina, Columbia, SC
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40
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Simpson KN, Simpson AN, Hill MD, Palesh YY, Jauch EC, Khatri P, Kleindorfer D, Foster LD, Mauldin PD, Broderick JP. Abstract 185: Residual Stroke Morbidity and Post-acute Care Cost: the IMS III Economic Data Cohort. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.185] [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:
The IMS III trial included 1-year follow-up with prospectively collected data on resource use after stroke. While the trial showed no difference in 90-day clinical outcomes by treatment group, this cohort provides invaluable information on cost variations associated with post-stroke morbidity. We report the effect of residual stroke morbidity on cost of stroke care after discharge at 12 months post stroke.
Methods:
Among 470 subjects with moderate to severe stroke for whom economic data were collected (316 randomized to IV t-PA and endovascular therapy, 154 to IV t-PA alone), we estimated cumulative cost post discharge using cost weights derived from a 5% sample of US Medicare patients in 2012 with an admission for acute ischemic stroke with IV t-PA treatment. Cost weights included post-stroke rehabilitation hospital days, emergency care visits, hospital readmissions, medical office visits, rehabilitation therapy visits and nursing home days. Costs were summed at the level of the subject and estimated for the subset defined by NIH Stroke Scale Score (NIHSS) at day 5, and Modified Rankin Score (mRS) and Barthel Index (BI) at 3 months post stroke. Subjects who died during the initial hospital admission or who had no score at day 5 or at 3 months were not included in our analysis. Age-adjusted, log-transformed costs were compared.
Results:
There was a 6 fold difference in the cost of follow-up care by lowest and highest NIHSS at day 5 (p<.0001). Similarly large differences by outcome category were observed for both the mRS (p<.0001) groups and subjects defined by the BI (p<.0001) at 3 months (see Figure).
Conclusion:
Residual stroke morbidity has a large effect on the long-term cost of stroke care, with an effect size of over 600%. Interventions that improve the residual morbidity after stroke as early as day 5 may be expected to result in substantial post discharge cost savings.
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Affiliation(s)
| | | | - Michael D Hill
- Hotchkiss Brain Institute, Univ of Calgary, Calgary, Canada
| | | | | | - Pooja Khatri
- Neurology and Rehabilitation Medicine, Univ of Cincinnati, Cincinnati, OH
| | - Dawn Kleindorfer
- Neurology and Rehabilitation Medicine, Univ of Cincinnati, Cincinnati, OH
| | | | | | - Joseph P Broderick
- Neurology and Rehabilitation Medicine, Univ of Cincinnati, Cincinnati, OH
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Khatri P, Devlin T, Sapkota B, Sethi P, Mejilla J, Lopez JI, Jauch EC, Broderick J, Chatterjee A, Levine S, Romano JG, Saver JI, Yeatts S, Mu Y, Tayama D. Abstract TP72: The PRISMS Trial: Baseline Characteristics of the First 100 Subjects. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.tp72] [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:
Ischemic stroke patients with mild deficits were largely excluded from pivotal trials of IV rt-PA. The balance of benefit versus risk of intravenous thrombolysis for this large, understudied patient cohort is uncertain. The PRISMS trial is underway to test the benefit of IV rt-PA for treatment of mild stroke.
Objective:
To characterize baseline features of the first 100 patients enrolled in this prospective cohort of exclusively mild stroke.
Methods:
The PRISMS trial is a Phase 3b, double-blind, 75-center, 948-subject study evaluating IV rt-PA administered within three hours of mild stroke onset to improve 90-day functional outcome (modified Rankin Scale 0 or 1). Mild stroke is defined as NIHSS ≤5 and not “clearly disabling” (i.e., inability to return to work or perform basic activities of daily living based on current deficits). Patients are randomized 1:1 to IV rt-PA 0.9 mg/kg with aspirin placebo or IV rt-PA placebo with aspirin 325 mg. Here we describe baseline characteristics, including clinical presentations by NIHSS item, of the first 100 enrolled patients. The study team remains fully blinded to patient treatment assignment and outcomes.
Results:
The 100th subject was enrolled on June 15, 2015. Baseline characteristics are presented in the Table. Median NIHSS was 2 (IQR 1-3). Clinical presentations of each patient by abnormal NIHSS items are shown in the Figure. Dysarthria, facial palsy, and sensory loss were the most common deficits.
Conclusions:
This initial 100-patient PRISMS cohort is consistent with expectations. Upon completion, the PRISMS trial will determine the benefit of IV rt-PA for mild stroke.
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Affiliation(s)
- Pooja Khatri
- Univ of Cincinnati Academic Health Cntr, Cincinnati, OH
| | - Thomas Devlin
- Erlanger Southeast Regional Stroke Cntr, Chattanooga, TN
| | | | | | | | - J I Lopez
- Dept of Neurology, Renown Health, Reno, NV
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Xian Y, Lytle B, Blevins J, Hernandez AF, Peterson ED, Smith EE, Saver JL, Messe SR, Paulsen M, Suter R, Reeves MJ, Jauch EC, Schwamm LH, Fonarow GC. Abstract TP314: Current Use of Strategies to Improve Door-to-Needle Times With Tissue Plasminogen Activator in Acute Ischemic Stroke: Findings From the Target: Stroke Phase II Survey. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.tp314] [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 benefits of intravenous tissue plasminogen activator (IV tPA) in acute ischemic stroke are time-dependent. The implementation of Target: Stroke Phase I, the first stage of the American Heart Association’s national quality improvement initiative to accelerate door-to-need (DTN) times, was associated with an average 15 minutes reduction in DTN times. To further reduce DTN delays, Target: Stroke Phase II was launched in 2014 and disseminated additional new best practice strategies.
Methods:
All active Get With The Guidelines-Stroke hospitals (n=1701) were invited to participate in Target: Stroke Phase II and completed an online survey regarding their use of DTN strategies. Hospital respondents reported the use of specific strategies in the 6 months preceding the survey as a binary yes/no or a continuous 0 to 100% of the time scale.
Results:
A total of 1034 hospitals (61% response rate) completed the survey between Dec 2014 and Apr 2015. The majority of participating hospitals reported routine use of Target: Stroke key practice strategies, although direct transfer to CT scanner, point of care testing, pre-mix of tPA ahead of time, tPA stored in Emergency Department (ED), or initiation of tPA bolus in the imaging suite were used less frequently (Table). Brain imaging located within the ED was reported by 44% of hospitals and 78% had access to an in-house stroke expert 24/7. Among those who did not have stroke expertise at all times, a majority of hospitals used telestroke systems for imaging interpretation (78%) or clinical evaluation (58%).
Conclusions:
GWTG-Stroke hospitals reported moderate to extensive use of most Target: Stroke key practice strategies to evaluate acute stroke cases for tPA eligibility and reduce DTN times. Nevertheless, use of point of care testing, pre-mixing of tPA, ED storage of tPA, initiation of tPA in the imaging suite, and direct transfer to CT scanner remained low, representing potential targets for additional improvements.
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Affiliation(s)
- Ying Xian
- Duke Clinical Rsch Institute, Duke Univ, Durham, NC
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43
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Broderick JP, Berkhemer OA, Palesch YY, Dippel DWJ, Foster LD, Roos YBWEM, van der Lugt A, Tomsick TA, Majoie CBLM, van Zwam WH, Demchuk AM, van Oostenbrugge RJ, Khatri P, Lingsma HF, Hill MD, Roozenbeek B, Jauch EC, Jovin TG, Yan B, von Kummer R, Molina CA, Goyal M, Schonewille WJ, Mazighi M, Engelter ST, Anderson CS, Spilker J, Carrozzella J, Ryckborst KJ, Janis LS, Simpson KN. Endovascular Therapy Is Effective and Safe for Patients With Severe Ischemic Stroke: Pooled Analysis of Interventional Management of Stroke III and Multicenter Randomized Clinical Trial of Endovascular Therapy for Acute Ischemic Stroke in the Netherlands Data. Stroke 2015; 46:3416-22. [PMID: 26486865 DOI: 10.1161/strokeaha.115.011397] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [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: 09/02/2015] [Accepted: 09/08/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We assessed the effect of endovascular treatment in acute ischemic stroke patients with severe neurological deficit (National Institutes of Health Stroke Scale score, ≥20) after a prespecified analysis plan. METHODS The pooled analysis of the Interventional Management of Stroke III (IMS III) and Multicenter Randomized Clinical Trial of Endovascular Therapy for Acute Ischemic Stroke in the Netherlands (MR CLEAN) trials included participants with an National Institutes of Health Stroke Scale score of ≥20 before intravenous tissue-type plasminogen activator (tPA) treatment (IMS III) or randomization (MR CLEAN) who were treated with intravenous tPA ≤3 hours of stroke onset. Our hypothesis was that participants with severe stroke randomized to endovascular therapy after intravenous tPA would have improved 90-day outcome (distribution of modified Rankin Scale scores), when compared with those who received intravenous tPA alone. RESULTS Among 342 participants in the pooled analysis (194 from IMS III and 148 from MR CLEAN), an ordinal logistic regression model showed that the endovascular group had superior 90-day outcome compared with the intravenous tPA group (adjusted odds ratio, 1.78; 95% confidence interval, 1.20-2.66). In the logistic regression model of the dichotomous outcome (modified Rankin Scale score, 0-2, or functional independence), the endovascular group had superior outcomes (adjusted odds ratio, 1.97; 95% confidence interval, 1.09-3.56). Functional independence (modified Rankin Scale score, ≤2) at 90 days was 25% in the endovascular group when compared with 14% in the intravenous tPA group. CONCLUSIONS Endovascular therapy after intravenous tPA within 3 hours of symptom onset improves functional outcome at 90 days after severe ischemic stroke. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00359424 (IMS III) and ISRCTN10888758 (MR CLEAN).
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Affiliation(s)
- Joseph P Broderick
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati, OH (J.P.B., P.K., J.S., J.C., T.A.T.); Division of Emergency Medicine (E.C.J.), Department of Public Health Sciences (Y.Y.P., L.D.F.), and Department of Healthcare Management and Leadership (K.N.S.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H., M.G., K.J.R.); the Stroke Institute, University of Pittsburgh Medical Center, PA (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands (W.J.S.); St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris, France (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.S.A.); and the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.); the Department of Radiology (O.A.B., C.B.L.M.M.) and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.W.J.D., B.R.), Radiology (A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, Netherlands; and Department of Radiology (W.H.v.Z.) and N
| | - Olvert A Berkhemer
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati, OH (J.P.B., P.K., J.S., J.C., T.A.T.); Division of Emergency Medicine (E.C.J.), Department of Public Health Sciences (Y.Y.P., L.D.F.), and Department of Healthcare Management and Leadership (K.N.S.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H., M.G., K.J.R.); the Stroke Institute, University of Pittsburgh Medical Center, PA (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands (W.J.S.); St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris, France (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.S.A.); and the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.); the Department of Radiology (O.A.B., C.B.L.M.M.) and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.W.J.D., B.R.), Radiology (A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, Netherlands; and Department of Radiology (W.H.v.Z.) and N
| | - Yuko Y Palesch
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati, OH (J.P.B., P.K., J.S., J.C., T.A.T.); Division of Emergency Medicine (E.C.J.), Department of Public Health Sciences (Y.Y.P., L.D.F.), and Department of Healthcare Management and Leadership (K.N.S.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H., M.G., K.J.R.); the Stroke Institute, University of Pittsburgh Medical Center, PA (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands (W.J.S.); St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris, France (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.S.A.); and the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.); the Department of Radiology (O.A.B., C.B.L.M.M.) and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.W.J.D., B.R.), Radiology (A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, Netherlands; and Department of Radiology (W.H.v.Z.) and N
| | - Diederik W J Dippel
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati, OH (J.P.B., P.K., J.S., J.C., T.A.T.); Division of Emergency Medicine (E.C.J.), Department of Public Health Sciences (Y.Y.P., L.D.F.), and Department of Healthcare Management and Leadership (K.N.S.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H., M.G., K.J.R.); the Stroke Institute, University of Pittsburgh Medical Center, PA (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands (W.J.S.); St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris, France (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.S.A.); and the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.); the Department of Radiology (O.A.B., C.B.L.M.M.) and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.W.J.D., B.R.), Radiology (A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, Netherlands; and Department of Radiology (W.H.v.Z.) and N
| | - Lydia D Foster
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati, OH (J.P.B., P.K., J.S., J.C., T.A.T.); Division of Emergency Medicine (E.C.J.), Department of Public Health Sciences (Y.Y.P., L.D.F.), and Department of Healthcare Management and Leadership (K.N.S.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H., M.G., K.J.R.); the Stroke Institute, University of Pittsburgh Medical Center, PA (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands (W.J.S.); St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris, France (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.S.A.); and the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.); the Department of Radiology (O.A.B., C.B.L.M.M.) and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.W.J.D., B.R.), Radiology (A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, Netherlands; and Department of Radiology (W.H.v.Z.) and N
| | - Yvo B W E M Roos
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati, OH (J.P.B., P.K., J.S., J.C., T.A.T.); Division of Emergency Medicine (E.C.J.), Department of Public Health Sciences (Y.Y.P., L.D.F.), and Department of Healthcare Management and Leadership (K.N.S.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H., M.G., K.J.R.); the Stroke Institute, University of Pittsburgh Medical Center, PA (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands (W.J.S.); St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris, France (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.S.A.); and the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.); the Department of Radiology (O.A.B., C.B.L.M.M.) and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.W.J.D., B.R.), Radiology (A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, Netherlands; and Department of Radiology (W.H.v.Z.) and N
| | - Aad van der Lugt
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati, OH (J.P.B., P.K., J.S., J.C., T.A.T.); Division of Emergency Medicine (E.C.J.), Department of Public Health Sciences (Y.Y.P., L.D.F.), and Department of Healthcare Management and Leadership (K.N.S.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H., M.G., K.J.R.); the Stroke Institute, University of Pittsburgh Medical Center, PA (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands (W.J.S.); St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris, France (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.S.A.); and the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.); the Department of Radiology (O.A.B., C.B.L.M.M.) and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.W.J.D., B.R.), Radiology (A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, Netherlands; and Department of Radiology (W.H.v.Z.) and N
| | - Thomas A Tomsick
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati, OH (J.P.B., P.K., J.S., J.C., T.A.T.); Division of Emergency Medicine (E.C.J.), Department of Public Health Sciences (Y.Y.P., L.D.F.), and Department of Healthcare Management and Leadership (K.N.S.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H., M.G., K.J.R.); the Stroke Institute, University of Pittsburgh Medical Center, PA (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands (W.J.S.); St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris, France (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.S.A.); and the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.); the Department of Radiology (O.A.B., C.B.L.M.M.) and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.W.J.D., B.R.), Radiology (A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, Netherlands; and Department of Radiology (W.H.v.Z.) and N
| | - Charles B L M Majoie
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati, OH (J.P.B., P.K., J.S., J.C., T.A.T.); Division of Emergency Medicine (E.C.J.), Department of Public Health Sciences (Y.Y.P., L.D.F.), and Department of Healthcare Management and Leadership (K.N.S.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H., M.G., K.J.R.); the Stroke Institute, University of Pittsburgh Medical Center, PA (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands (W.J.S.); St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris, France (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.S.A.); and the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.); the Department of Radiology (O.A.B., C.B.L.M.M.) and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.W.J.D., B.R.), Radiology (A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, Netherlands; and Department of Radiology (W.H.v.Z.) and N
| | - Wim H van Zwam
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati, OH (J.P.B., P.K., J.S., J.C., T.A.T.); Division of Emergency Medicine (E.C.J.), Department of Public Health Sciences (Y.Y.P., L.D.F.), and Department of Healthcare Management and Leadership (K.N.S.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H., M.G., K.J.R.); the Stroke Institute, University of Pittsburgh Medical Center, PA (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands (W.J.S.); St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris, France (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.S.A.); and the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.); the Department of Radiology (O.A.B., C.B.L.M.M.) and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.W.J.D., B.R.), Radiology (A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, Netherlands; and Department of Radiology (W.H.v.Z.) and N
| | - Andrew M Demchuk
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati, OH (J.P.B., P.K., J.S., J.C., T.A.T.); Division of Emergency Medicine (E.C.J.), Department of Public Health Sciences (Y.Y.P., L.D.F.), and Department of Healthcare Management and Leadership (K.N.S.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H., M.G., K.J.R.); the Stroke Institute, University of Pittsburgh Medical Center, PA (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands (W.J.S.); St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris, France (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.S.A.); and the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.); the Department of Radiology (O.A.B., C.B.L.M.M.) and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.W.J.D., B.R.), Radiology (A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, Netherlands; and Department of Radiology (W.H.v.Z.) and N
| | - Robert J van Oostenbrugge
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati, OH (J.P.B., P.K., J.S., J.C., T.A.T.); Division of Emergency Medicine (E.C.J.), Department of Public Health Sciences (Y.Y.P., L.D.F.), and Department of Healthcare Management and Leadership (K.N.S.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H., M.G., K.J.R.); the Stroke Institute, University of Pittsburgh Medical Center, PA (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands (W.J.S.); St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris, France (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.S.A.); and the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.); the Department of Radiology (O.A.B., C.B.L.M.M.) and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.W.J.D., B.R.), Radiology (A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, Netherlands; and Department of Radiology (W.H.v.Z.) and N
| | - Pooja Khatri
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati, OH (J.P.B., P.K., J.S., J.C., T.A.T.); Division of Emergency Medicine (E.C.J.), Department of Public Health Sciences (Y.Y.P., L.D.F.), and Department of Healthcare Management and Leadership (K.N.S.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H., M.G., K.J.R.); the Stroke Institute, University of Pittsburgh Medical Center, PA (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands (W.J.S.); St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris, France (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.S.A.); and the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.); the Department of Radiology (O.A.B., C.B.L.M.M.) and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.W.J.D., B.R.), Radiology (A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, Netherlands; and Department of Radiology (W.H.v.Z.) and N
| | - Hester F Lingsma
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati, OH (J.P.B., P.K., J.S., J.C., T.A.T.); Division of Emergency Medicine (E.C.J.), Department of Public Health Sciences (Y.Y.P., L.D.F.), and Department of Healthcare Management and Leadership (K.N.S.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H., M.G., K.J.R.); the Stroke Institute, University of Pittsburgh Medical Center, PA (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands (W.J.S.); St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris, France (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.S.A.); and the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.); the Department of Radiology (O.A.B., C.B.L.M.M.) and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.W.J.D., B.R.), Radiology (A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, Netherlands; and Department of Radiology (W.H.v.Z.) and N
| | - Michael D Hill
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati, OH (J.P.B., P.K., J.S., J.C., T.A.T.); Division of Emergency Medicine (E.C.J.), Department of Public Health Sciences (Y.Y.P., L.D.F.), and Department of Healthcare Management and Leadership (K.N.S.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H., M.G., K.J.R.); the Stroke Institute, University of Pittsburgh Medical Center, PA (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands (W.J.S.); St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris, France (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.S.A.); and the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.); the Department of Radiology (O.A.B., C.B.L.M.M.) and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.W.J.D., B.R.), Radiology (A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, Netherlands; and Department of Radiology (W.H.v.Z.) and N
| | - Bob Roozenbeek
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati, OH (J.P.B., P.K., J.S., J.C., T.A.T.); Division of Emergency Medicine (E.C.J.), Department of Public Health Sciences (Y.Y.P., L.D.F.), and Department of Healthcare Management and Leadership (K.N.S.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H., M.G., K.J.R.); the Stroke Institute, University of Pittsburgh Medical Center, PA (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands (W.J.S.); St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris, France (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.S.A.); and the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.); the Department of Radiology (O.A.B., C.B.L.M.M.) and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.W.J.D., B.R.), Radiology (A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, Netherlands; and Department of Radiology (W.H.v.Z.) and N
| | - Edward C Jauch
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati, OH (J.P.B., P.K., J.S., J.C., T.A.T.); Division of Emergency Medicine (E.C.J.), Department of Public Health Sciences (Y.Y.P., L.D.F.), and Department of Healthcare Management and Leadership (K.N.S.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H., M.G., K.J.R.); the Stroke Institute, University of Pittsburgh Medical Center, PA (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands (W.J.S.); St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris, France (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.S.A.); and the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.); the Department of Radiology (O.A.B., C.B.L.M.M.) and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.W.J.D., B.R.), Radiology (A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, Netherlands; and Department of Radiology (W.H.v.Z.) and N
| | - Tudor G Jovin
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati, OH (J.P.B., P.K., J.S., J.C., T.A.T.); Division of Emergency Medicine (E.C.J.), Department of Public Health Sciences (Y.Y.P., L.D.F.), and Department of Healthcare Management and Leadership (K.N.S.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H., M.G., K.J.R.); the Stroke Institute, University of Pittsburgh Medical Center, PA (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands (W.J.S.); St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris, France (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.S.A.); and the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.); the Department of Radiology (O.A.B., C.B.L.M.M.) and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.W.J.D., B.R.), Radiology (A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, Netherlands; and Department of Radiology (W.H.v.Z.) and N
| | - Bernard Yan
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati, OH (J.P.B., P.K., J.S., J.C., T.A.T.); Division of Emergency Medicine (E.C.J.), Department of Public Health Sciences (Y.Y.P., L.D.F.), and Department of Healthcare Management and Leadership (K.N.S.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H., M.G., K.J.R.); the Stroke Institute, University of Pittsburgh Medical Center, PA (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands (W.J.S.); St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris, France (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.S.A.); and the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.); the Department of Radiology (O.A.B., C.B.L.M.M.) and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.W.J.D., B.R.), Radiology (A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, Netherlands; and Department of Radiology (W.H.v.Z.) and N
| | - Rüdiger von Kummer
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati, OH (J.P.B., P.K., J.S., J.C., T.A.T.); Division of Emergency Medicine (E.C.J.), Department of Public Health Sciences (Y.Y.P., L.D.F.), and Department of Healthcare Management and Leadership (K.N.S.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H., M.G., K.J.R.); the Stroke Institute, University of Pittsburgh Medical Center, PA (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands (W.J.S.); St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris, France (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.S.A.); and the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.); the Department of Radiology (O.A.B., C.B.L.M.M.) and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.W.J.D., B.R.), Radiology (A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, Netherlands; and Department of Radiology (W.H.v.Z.) and N
| | - Carlos A Molina
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati, OH (J.P.B., P.K., J.S., J.C., T.A.T.); Division of Emergency Medicine (E.C.J.), Department of Public Health Sciences (Y.Y.P., L.D.F.), and Department of Healthcare Management and Leadership (K.N.S.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H., M.G., K.J.R.); the Stroke Institute, University of Pittsburgh Medical Center, PA (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands (W.J.S.); St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris, France (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.S.A.); and the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.); the Department of Radiology (O.A.B., C.B.L.M.M.) and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.W.J.D., B.R.), Radiology (A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, Netherlands; and Department of Radiology (W.H.v.Z.) and N
| | - Mayank Goyal
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati, OH (J.P.B., P.K., J.S., J.C., T.A.T.); Division of Emergency Medicine (E.C.J.), Department of Public Health Sciences (Y.Y.P., L.D.F.), and Department of Healthcare Management and Leadership (K.N.S.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H., M.G., K.J.R.); the Stroke Institute, University of Pittsburgh Medical Center, PA (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands (W.J.S.); St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris, France (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.S.A.); and the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.); the Department of Radiology (O.A.B., C.B.L.M.M.) and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.W.J.D., B.R.), Radiology (A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, Netherlands; and Department of Radiology (W.H.v.Z.) and N
| | - Wouter J Schonewille
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati, OH (J.P.B., P.K., J.S., J.C., T.A.T.); Division of Emergency Medicine (E.C.J.), Department of Public Health Sciences (Y.Y.P., L.D.F.), and Department of Healthcare Management and Leadership (K.N.S.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H., M.G., K.J.R.); the Stroke Institute, University of Pittsburgh Medical Center, PA (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands (W.J.S.); St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris, France (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.S.A.); and the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.); the Department of Radiology (O.A.B., C.B.L.M.M.) and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.W.J.D., B.R.), Radiology (A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, Netherlands; and Department of Radiology (W.H.v.Z.) and N
| | - Mikael Mazighi
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati, OH (J.P.B., P.K., J.S., J.C., T.A.T.); Division of Emergency Medicine (E.C.J.), Department of Public Health Sciences (Y.Y.P., L.D.F.), and Department of Healthcare Management and Leadership (K.N.S.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H., M.G., K.J.R.); the Stroke Institute, University of Pittsburgh Medical Center, PA (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands (W.J.S.); St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris, France (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.S.A.); and the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.); the Department of Radiology (O.A.B., C.B.L.M.M.) and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.W.J.D., B.R.), Radiology (A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, Netherlands; and Department of Radiology (W.H.v.Z.) and N
| | - Stefan T Engelter
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati, OH (J.P.B., P.K., J.S., J.C., T.A.T.); Division of Emergency Medicine (E.C.J.), Department of Public Health Sciences (Y.Y.P., L.D.F.), and Department of Healthcare Management and Leadership (K.N.S.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H., M.G., K.J.R.); the Stroke Institute, University of Pittsburgh Medical Center, PA (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands (W.J.S.); St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris, France (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.S.A.); and the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.); the Department of Radiology (O.A.B., C.B.L.M.M.) and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.W.J.D., B.R.), Radiology (A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, Netherlands; and Department of Radiology (W.H.v.Z.) and N
| | - Craig S Anderson
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati, OH (J.P.B., P.K., J.S., J.C., T.A.T.); Division of Emergency Medicine (E.C.J.), Department of Public Health Sciences (Y.Y.P., L.D.F.), and Department of Healthcare Management and Leadership (K.N.S.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H., M.G., K.J.R.); the Stroke Institute, University of Pittsburgh Medical Center, PA (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands (W.J.S.); St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris, France (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.S.A.); and the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.); the Department of Radiology (O.A.B., C.B.L.M.M.) and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.W.J.D., B.R.), Radiology (A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, Netherlands; and Department of Radiology (W.H.v.Z.) and N
| | - Judith Spilker
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati, OH (J.P.B., P.K., J.S., J.C., T.A.T.); Division of Emergency Medicine (E.C.J.), Department of Public Health Sciences (Y.Y.P., L.D.F.), and Department of Healthcare Management and Leadership (K.N.S.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H., M.G., K.J.R.); the Stroke Institute, University of Pittsburgh Medical Center, PA (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands (W.J.S.); St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris, France (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.S.A.); and the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.); the Department of Radiology (O.A.B., C.B.L.M.M.) and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.W.J.D., B.R.), Radiology (A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, Netherlands; and Department of Radiology (W.H.v.Z.) and N
| | - Janice Carrozzella
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati, OH (J.P.B., P.K., J.S., J.C., T.A.T.); Division of Emergency Medicine (E.C.J.), Department of Public Health Sciences (Y.Y.P., L.D.F.), and Department of Healthcare Management and Leadership (K.N.S.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H., M.G., K.J.R.); the Stroke Institute, University of Pittsburgh Medical Center, PA (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands (W.J.S.); St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris, France (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.S.A.); and the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.); the Department of Radiology (O.A.B., C.B.L.M.M.) and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.W.J.D., B.R.), Radiology (A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, Netherlands; and Department of Radiology (W.H.v.Z.) and N
| | - Karla J Ryckborst
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati, OH (J.P.B., P.K., J.S., J.C., T.A.T.); Division of Emergency Medicine (E.C.J.), Department of Public Health Sciences (Y.Y.P., L.D.F.), and Department of Healthcare Management and Leadership (K.N.S.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H., M.G., K.J.R.); the Stroke Institute, University of Pittsburgh Medical Center, PA (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands (W.J.S.); St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris, France (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.S.A.); and the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.); the Department of Radiology (O.A.B., C.B.L.M.M.) and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.W.J.D., B.R.), Radiology (A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, Netherlands; and Department of Radiology (W.H.v.Z.) and N
| | - L Scott Janis
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati, OH (J.P.B., P.K., J.S., J.C., T.A.T.); Division of Emergency Medicine (E.C.J.), Department of Public Health Sciences (Y.Y.P., L.D.F.), and Department of Healthcare Management and Leadership (K.N.S.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H., M.G., K.J.R.); the Stroke Institute, University of Pittsburgh Medical Center, PA (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands (W.J.S.); St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris, France (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.S.A.); and the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.); the Department of Radiology (O.A.B., C.B.L.M.M.) and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.W.J.D., B.R.), Radiology (A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, Netherlands; and Department of Radiology (W.H.v.Z.) and N
| | - Kit N Simpson
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati, OH (J.P.B., P.K., J.S., J.C., T.A.T.); Division of Emergency Medicine (E.C.J.), Department of Public Health Sciences (Y.Y.P., L.D.F.), and Department of Healthcare Management and Leadership (K.N.S.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H., M.G., K.J.R.); the Stroke Institute, University of Pittsburgh Medical Center, PA (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands (W.J.S.); St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris, France (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.S.A.); and the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.); the Department of Radiology (O.A.B., C.B.L.M.M.) and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.W.J.D., B.R.), Radiology (A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, Netherlands; and Department of Radiology (W.H.v.Z.) and N
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Powers WJ, Derdeyn CP, Biller J, Coffey CS, Hoh BL, Jauch EC, Johnston KC, Johnston SC, Khalessi AA, Kidwell CS, Meschia JF, Ovbiagele B, Yavagal DR. 2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2015; 46:3020-35. [PMID: 26123479 DOI: 10.1161/str.0000000000000074] [Citation(s) in RCA: 1482] [Impact Index Per Article: 164.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE The aim of this guideline is to provide a focused update of the current recommendations for the endovascular treatment of acute ischemic stroke. When there is overlap, the recommendations made here supersede those of previous guidelines. METHODS This focused update analyzes results from 8 randomized, clinical trials of endovascular treatment and other relevant data published since 2013. It is not intended to be a complete literature review from the date of the previous guideline publication but rather to include pivotal new evidence that justifies changes in current recommendations. Members of the writing committee were appointed by the American Heart Association/American Stroke Association Stroke Council's Scientific Statement Oversight Committee and the American Heart Association/American Stroke Association Manuscript Oversight Committee. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Recommendations follow the American Heart Association/American Stroke Association methods of classifying the level of certainty of the treatment effect and the class of evidence. Prerelease review of the draft guideline was performed by 6 expert peer reviewers and by the members of the Stroke Council Scientific Statement Oversight Committee and Stroke Council Leadership Committee. RESULTS Evidence-based guidelines are presented for the selection of patients with acute ischemic stroke for endovascular treatment, for the endovascular procedure, and for systems of care to facilitate endovascular treatment. CONCLUSIONS Certain endovascular procedures have been demonstrated to provide clinical benefit in selected patients with acute ischemic stroke. Systems of care should be organized to facilitate the delivery of this care.
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Affiliation(s)
- Joseph P. Broderick
- From the Department of Neurology and Rehabilitation Medicine, University of Cincinnati Neuroscience Institute, OH (J.P.B.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); and Department of Radiology, Washington University School of Medicine, St. Louis, MO (C.P.D.)
| | - Edward C. Jauch
- From the Department of Neurology and Rehabilitation Medicine, University of Cincinnati Neuroscience Institute, OH (J.P.B.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); and Department of Radiology, Washington University School of Medicine, St. Louis, MO (C.P.D.)
| | - Colin P. Derdeyn
- From the Department of Neurology and Rehabilitation Medicine, University of Cincinnati Neuroscience Institute, OH (J.P.B.); Department of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); and Department of Radiology, Washington University School of Medicine, St. Louis, MO (C.P.D.)
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Khatri P, Hacke W, Fiehler J, Saver JL, Diener HC, Bendszus M, Bracard S, Broderick J, Campbell B, Ciccone A, Dávalos A, Davis S, Demchuk AM, Dippel D, Donnan G, Fiorella D, Goyal M, Hill MD, Jauch EC, Jovin TG, Kidwell CS, Majoie C, Martins SCO, Mitchell P, Mocco J, Muir K, Nogueira RG, Schonewille WJ, Siddiqui AH, Thomalla G, Tomsick TA, Turk AS, White PM, Zaidat OO, Liebeskind DS, Fulton R, Lees KR. State of acute endovascular therapy: report from the 12th thrombolysis, thrombectomy, and acute stroke therapy conference. Stroke 2015; 46:1727-34. [PMID: 25944325 DOI: 10.1161/strokeaha.115.008782] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 03/19/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Pooja Khatri
- From the Department of Neurology and Rehabilitation Medicine (P.K., J.B.), Department of Radiology (T.A.T.), University of Cincinnati, OH; Department of Neurology (W.H.), Department of Neuroradiology (M.B.), University of Heidelberg, Heidelberg, Germany; Diagnostic and Interventional Neuroradiology (J.F.), Department of Neurology (G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Comprehensive Stroke Center (J.L.S.), Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles; Department of Neurology, University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Medicine and Neurology (B.C., S.D.), The Florey Institute of Neuroscience and Mental Health (G.D.), Department of Radiology (P.M.), University of Melbourne, Melbourne, Victoria; Stroke Unit, Department of Neurosciences, Carlo Poma Hospital, Mantua, Italy (A.C.); Erasmus MC University Medical Center, Rotterdam, The Netherlands (D.D.); Departent of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (S.C.O.M.); Department of Neurological Surgery, Mount Sinai Health System, New York, NY (J.M.); Institute of Neurological Sciences (K.M.), Institute of Cardiovascular and Medical Sciences (R.F.), Cerebrovascular Medicine, European Stroke Organization (K.R.L.), University of Glasgow, Glasgow, United Kingdom; Department of Neurology, Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands (W.J.S.); Department of Neurosurgery, Stony Brook University Medical Center, NY (D.F.); Department of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain (A.D.); Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, Nancy
| | - Werner Hacke
- From the Department of Neurology and Rehabilitation Medicine (P.K., J.B.), Department of Radiology (T.A.T.), University of Cincinnati, OH; Department of Neurology (W.H.), Department of Neuroradiology (M.B.), University of Heidelberg, Heidelberg, Germany; Diagnostic and Interventional Neuroradiology (J.F.), Department of Neurology (G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Comprehensive Stroke Center (J.L.S.), Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles; Department of Neurology, University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Medicine and Neurology (B.C., S.D.), The Florey Institute of Neuroscience and Mental Health (G.D.), Department of Radiology (P.M.), University of Melbourne, Melbourne, Victoria; Stroke Unit, Department of Neurosciences, Carlo Poma Hospital, Mantua, Italy (A.C.); Erasmus MC University Medical Center, Rotterdam, The Netherlands (D.D.); Departent of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (S.C.O.M.); Department of Neurological Surgery, Mount Sinai Health System, New York, NY (J.M.); Institute of Neurological Sciences (K.M.), Institute of Cardiovascular and Medical Sciences (R.F.), Cerebrovascular Medicine, European Stroke Organization (K.R.L.), University of Glasgow, Glasgow, United Kingdom; Department of Neurology, Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands (W.J.S.); Department of Neurosurgery, Stony Brook University Medical Center, NY (D.F.); Department of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain (A.D.); Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, Nancy
| | - Jens Fiehler
- From the Department of Neurology and Rehabilitation Medicine (P.K., J.B.), Department of Radiology (T.A.T.), University of Cincinnati, OH; Department of Neurology (W.H.), Department of Neuroradiology (M.B.), University of Heidelberg, Heidelberg, Germany; Diagnostic and Interventional Neuroradiology (J.F.), Department of Neurology (G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Comprehensive Stroke Center (J.L.S.), Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles; Department of Neurology, University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Medicine and Neurology (B.C., S.D.), The Florey Institute of Neuroscience and Mental Health (G.D.), Department of Radiology (P.M.), University of Melbourne, Melbourne, Victoria; Stroke Unit, Department of Neurosciences, Carlo Poma Hospital, Mantua, Italy (A.C.); Erasmus MC University Medical Center, Rotterdam, The Netherlands (D.D.); Departent of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (S.C.O.M.); Department of Neurological Surgery, Mount Sinai Health System, New York, NY (J.M.); Institute of Neurological Sciences (K.M.), Institute of Cardiovascular and Medical Sciences (R.F.), Cerebrovascular Medicine, European Stroke Organization (K.R.L.), University of Glasgow, Glasgow, United Kingdom; Department of Neurology, Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands (W.J.S.); Department of Neurosurgery, Stony Brook University Medical Center, NY (D.F.); Department of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain (A.D.); Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, Nancy
| | - Jeffrey L Saver
- From the Department of Neurology and Rehabilitation Medicine (P.K., J.B.), Department of Radiology (T.A.T.), University of Cincinnati, OH; Department of Neurology (W.H.), Department of Neuroradiology (M.B.), University of Heidelberg, Heidelberg, Germany; Diagnostic and Interventional Neuroradiology (J.F.), Department of Neurology (G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Comprehensive Stroke Center (J.L.S.), Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles; Department of Neurology, University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Medicine and Neurology (B.C., S.D.), The Florey Institute of Neuroscience and Mental Health (G.D.), Department of Radiology (P.M.), University of Melbourne, Melbourne, Victoria; Stroke Unit, Department of Neurosciences, Carlo Poma Hospital, Mantua, Italy (A.C.); Erasmus MC University Medical Center, Rotterdam, The Netherlands (D.D.); Departent of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (S.C.O.M.); Department of Neurological Surgery, Mount Sinai Health System, New York, NY (J.M.); Institute of Neurological Sciences (K.M.), Institute of Cardiovascular and Medical Sciences (R.F.), Cerebrovascular Medicine, European Stroke Organization (K.R.L.), University of Glasgow, Glasgow, United Kingdom; Department of Neurology, Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands (W.J.S.); Department of Neurosurgery, Stony Brook University Medical Center, NY (D.F.); Department of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain (A.D.); Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, Nancy
| | - Hans-Christoph Diener
- From the Department of Neurology and Rehabilitation Medicine (P.K., J.B.), Department of Radiology (T.A.T.), University of Cincinnati, OH; Department of Neurology (W.H.), Department of Neuroradiology (M.B.), University of Heidelberg, Heidelberg, Germany; Diagnostic and Interventional Neuroradiology (J.F.), Department of Neurology (G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Comprehensive Stroke Center (J.L.S.), Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles; Department of Neurology, University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Medicine and Neurology (B.C., S.D.), The Florey Institute of Neuroscience and Mental Health (G.D.), Department of Radiology (P.M.), University of Melbourne, Melbourne, Victoria; Stroke Unit, Department of Neurosciences, Carlo Poma Hospital, Mantua, Italy (A.C.); Erasmus MC University Medical Center, Rotterdam, The Netherlands (D.D.); Departent of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (S.C.O.M.); Department of Neurological Surgery, Mount Sinai Health System, New York, NY (J.M.); Institute of Neurological Sciences (K.M.), Institute of Cardiovascular and Medical Sciences (R.F.), Cerebrovascular Medicine, European Stroke Organization (K.R.L.), University of Glasgow, Glasgow, United Kingdom; Department of Neurology, Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands (W.J.S.); Department of Neurosurgery, Stony Brook University Medical Center, NY (D.F.); Department of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain (A.D.); Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, Nancy
| | - Martin Bendszus
- From the Department of Neurology and Rehabilitation Medicine (P.K., J.B.), Department of Radiology (T.A.T.), University of Cincinnati, OH; Department of Neurology (W.H.), Department of Neuroradiology (M.B.), University of Heidelberg, Heidelberg, Germany; Diagnostic and Interventional Neuroradiology (J.F.), Department of Neurology (G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Comprehensive Stroke Center (J.L.S.), Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles; Department of Neurology, University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Medicine and Neurology (B.C., S.D.), The Florey Institute of Neuroscience and Mental Health (G.D.), Department of Radiology (P.M.), University of Melbourne, Melbourne, Victoria; Stroke Unit, Department of Neurosciences, Carlo Poma Hospital, Mantua, Italy (A.C.); Erasmus MC University Medical Center, Rotterdam, The Netherlands (D.D.); Departent of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (S.C.O.M.); Department of Neurological Surgery, Mount Sinai Health System, New York, NY (J.M.); Institute of Neurological Sciences (K.M.), Institute of Cardiovascular and Medical Sciences (R.F.), Cerebrovascular Medicine, European Stroke Organization (K.R.L.), University of Glasgow, Glasgow, United Kingdom; Department of Neurology, Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands (W.J.S.); Department of Neurosurgery, Stony Brook University Medical Center, NY (D.F.); Department of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain (A.D.); Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, Nancy
| | - Serge Bracard
- From the Department of Neurology and Rehabilitation Medicine (P.K., J.B.), Department of Radiology (T.A.T.), University of Cincinnati, OH; Department of Neurology (W.H.), Department of Neuroradiology (M.B.), University of Heidelberg, Heidelberg, Germany; Diagnostic and Interventional Neuroradiology (J.F.), Department of Neurology (G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Comprehensive Stroke Center (J.L.S.), Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles; Department of Neurology, University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Medicine and Neurology (B.C., S.D.), The Florey Institute of Neuroscience and Mental Health (G.D.), Department of Radiology (P.M.), University of Melbourne, Melbourne, Victoria; Stroke Unit, Department of Neurosciences, Carlo Poma Hospital, Mantua, Italy (A.C.); Erasmus MC University Medical Center, Rotterdam, The Netherlands (D.D.); Departent of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (S.C.O.M.); Department of Neurological Surgery, Mount Sinai Health System, New York, NY (J.M.); Institute of Neurological Sciences (K.M.), Institute of Cardiovascular and Medical Sciences (R.F.), Cerebrovascular Medicine, European Stroke Organization (K.R.L.), University of Glasgow, Glasgow, United Kingdom; Department of Neurology, Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands (W.J.S.); Department of Neurosurgery, Stony Brook University Medical Center, NY (D.F.); Department of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain (A.D.); Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, Nancy
| | - Joseph Broderick
- From the Department of Neurology and Rehabilitation Medicine (P.K., J.B.), Department of Radiology (T.A.T.), University of Cincinnati, OH; Department of Neurology (W.H.), Department of Neuroradiology (M.B.), University of Heidelberg, Heidelberg, Germany; Diagnostic and Interventional Neuroradiology (J.F.), Department of Neurology (G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Comprehensive Stroke Center (J.L.S.), Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles; Department of Neurology, University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Medicine and Neurology (B.C., S.D.), The Florey Institute of Neuroscience and Mental Health (G.D.), Department of Radiology (P.M.), University of Melbourne, Melbourne, Victoria; Stroke Unit, Department of Neurosciences, Carlo Poma Hospital, Mantua, Italy (A.C.); Erasmus MC University Medical Center, Rotterdam, The Netherlands (D.D.); Departent of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (S.C.O.M.); Department of Neurological Surgery, Mount Sinai Health System, New York, NY (J.M.); Institute of Neurological Sciences (K.M.), Institute of Cardiovascular and Medical Sciences (R.F.), Cerebrovascular Medicine, European Stroke Organization (K.R.L.), University of Glasgow, Glasgow, United Kingdom; Department of Neurology, Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands (W.J.S.); Department of Neurosurgery, Stony Brook University Medical Center, NY (D.F.); Department of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain (A.D.); Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, Nancy
| | - Bruce Campbell
- From the Department of Neurology and Rehabilitation Medicine (P.K., J.B.), Department of Radiology (T.A.T.), University of Cincinnati, OH; Department of Neurology (W.H.), Department of Neuroradiology (M.B.), University of Heidelberg, Heidelberg, Germany; Diagnostic and Interventional Neuroradiology (J.F.), Department of Neurology (G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Comprehensive Stroke Center (J.L.S.), Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles; Department of Neurology, University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Medicine and Neurology (B.C., S.D.), The Florey Institute of Neuroscience and Mental Health (G.D.), Department of Radiology (P.M.), University of Melbourne, Melbourne, Victoria; Stroke Unit, Department of Neurosciences, Carlo Poma Hospital, Mantua, Italy (A.C.); Erasmus MC University Medical Center, Rotterdam, The Netherlands (D.D.); Departent of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (S.C.O.M.); Department of Neurological Surgery, Mount Sinai Health System, New York, NY (J.M.); Institute of Neurological Sciences (K.M.), Institute of Cardiovascular and Medical Sciences (R.F.), Cerebrovascular Medicine, European Stroke Organization (K.R.L.), University of Glasgow, Glasgow, United Kingdom; Department of Neurology, Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands (W.J.S.); Department of Neurosurgery, Stony Brook University Medical Center, NY (D.F.); Department of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain (A.D.); Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, Nancy
| | - Alfonso Ciccone
- From the Department of Neurology and Rehabilitation Medicine (P.K., J.B.), Department of Radiology (T.A.T.), University of Cincinnati, OH; Department of Neurology (W.H.), Department of Neuroradiology (M.B.), University of Heidelberg, Heidelberg, Germany; Diagnostic and Interventional Neuroradiology (J.F.), Department of Neurology (G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Comprehensive Stroke Center (J.L.S.), Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles; Department of Neurology, University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Medicine and Neurology (B.C., S.D.), The Florey Institute of Neuroscience and Mental Health (G.D.), Department of Radiology (P.M.), University of Melbourne, Melbourne, Victoria; Stroke Unit, Department of Neurosciences, Carlo Poma Hospital, Mantua, Italy (A.C.); Erasmus MC University Medical Center, Rotterdam, The Netherlands (D.D.); Departent of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (S.C.O.M.); Department of Neurological Surgery, Mount Sinai Health System, New York, NY (J.M.); Institute of Neurological Sciences (K.M.), Institute of Cardiovascular and Medical Sciences (R.F.), Cerebrovascular Medicine, European Stroke Organization (K.R.L.), University of Glasgow, Glasgow, United Kingdom; Department of Neurology, Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands (W.J.S.); Department of Neurosurgery, Stony Brook University Medical Center, NY (D.F.); Department of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain (A.D.); Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, Nancy
| | - Antoni Dávalos
- From the Department of Neurology and Rehabilitation Medicine (P.K., J.B.), Department of Radiology (T.A.T.), University of Cincinnati, OH; Department of Neurology (W.H.), Department of Neuroradiology (M.B.), University of Heidelberg, Heidelberg, Germany; Diagnostic and Interventional Neuroradiology (J.F.), Department of Neurology (G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Comprehensive Stroke Center (J.L.S.), Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles; Department of Neurology, University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Medicine and Neurology (B.C., S.D.), The Florey Institute of Neuroscience and Mental Health (G.D.), Department of Radiology (P.M.), University of Melbourne, Melbourne, Victoria; Stroke Unit, Department of Neurosciences, Carlo Poma Hospital, Mantua, Italy (A.C.); Erasmus MC University Medical Center, Rotterdam, The Netherlands (D.D.); Departent of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (S.C.O.M.); Department of Neurological Surgery, Mount Sinai Health System, New York, NY (J.M.); Institute of Neurological Sciences (K.M.), Institute of Cardiovascular and Medical Sciences (R.F.), Cerebrovascular Medicine, European Stroke Organization (K.R.L.), University of Glasgow, Glasgow, United Kingdom; Department of Neurology, Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands (W.J.S.); Department of Neurosurgery, Stony Brook University Medical Center, NY (D.F.); Department of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain (A.D.); Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, Nancy
| | - Stephen Davis
- From the Department of Neurology and Rehabilitation Medicine (P.K., J.B.), Department of Radiology (T.A.T.), University of Cincinnati, OH; Department of Neurology (W.H.), Department of Neuroradiology (M.B.), University of Heidelberg, Heidelberg, Germany; Diagnostic and Interventional Neuroradiology (J.F.), Department of Neurology (G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Comprehensive Stroke Center (J.L.S.), Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles; Department of Neurology, University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Medicine and Neurology (B.C., S.D.), The Florey Institute of Neuroscience and Mental Health (G.D.), Department of Radiology (P.M.), University of Melbourne, Melbourne, Victoria; Stroke Unit, Department of Neurosciences, Carlo Poma Hospital, Mantua, Italy (A.C.); Erasmus MC University Medical Center, Rotterdam, The Netherlands (D.D.); Departent of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (S.C.O.M.); Department of Neurological Surgery, Mount Sinai Health System, New York, NY (J.M.); Institute of Neurological Sciences (K.M.), Institute of Cardiovascular and Medical Sciences (R.F.), Cerebrovascular Medicine, European Stroke Organization (K.R.L.), University of Glasgow, Glasgow, United Kingdom; Department of Neurology, Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands (W.J.S.); Department of Neurosurgery, Stony Brook University Medical Center, NY (D.F.); Department of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain (A.D.); Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, Nancy
| | - Andrew M Demchuk
- From the Department of Neurology and Rehabilitation Medicine (P.K., J.B.), Department of Radiology (T.A.T.), University of Cincinnati, OH; Department of Neurology (W.H.), Department of Neuroradiology (M.B.), University of Heidelberg, Heidelberg, Germany; Diagnostic and Interventional Neuroradiology (J.F.), Department of Neurology (G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Comprehensive Stroke Center (J.L.S.), Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles; Department of Neurology, University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Medicine and Neurology (B.C., S.D.), The Florey Institute of Neuroscience and Mental Health (G.D.), Department of Radiology (P.M.), University of Melbourne, Melbourne, Victoria; Stroke Unit, Department of Neurosciences, Carlo Poma Hospital, Mantua, Italy (A.C.); Erasmus MC University Medical Center, Rotterdam, The Netherlands (D.D.); Departent of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (S.C.O.M.); Department of Neurological Surgery, Mount Sinai Health System, New York, NY (J.M.); Institute of Neurological Sciences (K.M.), Institute of Cardiovascular and Medical Sciences (R.F.), Cerebrovascular Medicine, European Stroke Organization (K.R.L.), University of Glasgow, Glasgow, United Kingdom; Department of Neurology, Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands (W.J.S.); Department of Neurosurgery, Stony Brook University Medical Center, NY (D.F.); Department of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain (A.D.); Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, Nancy
| | - Diederik Dippel
- From the Department of Neurology and Rehabilitation Medicine (P.K., J.B.), Department of Radiology (T.A.T.), University of Cincinnati, OH; Department of Neurology (W.H.), Department of Neuroradiology (M.B.), University of Heidelberg, Heidelberg, Germany; Diagnostic and Interventional Neuroradiology (J.F.), Department of Neurology (G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Comprehensive Stroke Center (J.L.S.), Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles; Department of Neurology, University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Medicine and Neurology (B.C., S.D.), The Florey Institute of Neuroscience and Mental Health (G.D.), Department of Radiology (P.M.), University of Melbourne, Melbourne, Victoria; Stroke Unit, Department of Neurosciences, Carlo Poma Hospital, Mantua, Italy (A.C.); Erasmus MC University Medical Center, Rotterdam, The Netherlands (D.D.); Departent of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (S.C.O.M.); Department of Neurological Surgery, Mount Sinai Health System, New York, NY (J.M.); Institute of Neurological Sciences (K.M.), Institute of Cardiovascular and Medical Sciences (R.F.), Cerebrovascular Medicine, European Stroke Organization (K.R.L.), University of Glasgow, Glasgow, United Kingdom; Department of Neurology, Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands (W.J.S.); Department of Neurosurgery, Stony Brook University Medical Center, NY (D.F.); Department of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain (A.D.); Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, Nancy
| | - Geoffrey Donnan
- From the Department of Neurology and Rehabilitation Medicine (P.K., J.B.), Department of Radiology (T.A.T.), University of Cincinnati, OH; Department of Neurology (W.H.), Department of Neuroradiology (M.B.), University of Heidelberg, Heidelberg, Germany; Diagnostic and Interventional Neuroradiology (J.F.), Department of Neurology (G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Comprehensive Stroke Center (J.L.S.), Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles; Department of Neurology, University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Medicine and Neurology (B.C., S.D.), The Florey Institute of Neuroscience and Mental Health (G.D.), Department of Radiology (P.M.), University of Melbourne, Melbourne, Victoria; Stroke Unit, Department of Neurosciences, Carlo Poma Hospital, Mantua, Italy (A.C.); Erasmus MC University Medical Center, Rotterdam, The Netherlands (D.D.); Departent of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (S.C.O.M.); Department of Neurological Surgery, Mount Sinai Health System, New York, NY (J.M.); Institute of Neurological Sciences (K.M.), Institute of Cardiovascular and Medical Sciences (R.F.), Cerebrovascular Medicine, European Stroke Organization (K.R.L.), University of Glasgow, Glasgow, United Kingdom; Department of Neurology, Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands (W.J.S.); Department of Neurosurgery, Stony Brook University Medical Center, NY (D.F.); Department of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain (A.D.); Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, Nancy
| | - David Fiorella
- From the Department of Neurology and Rehabilitation Medicine (P.K., J.B.), Department of Radiology (T.A.T.), University of Cincinnati, OH; Department of Neurology (W.H.), Department of Neuroradiology (M.B.), University of Heidelberg, Heidelberg, Germany; Diagnostic and Interventional Neuroradiology (J.F.), Department of Neurology (G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Comprehensive Stroke Center (J.L.S.), Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles; Department of Neurology, University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Medicine and Neurology (B.C., S.D.), The Florey Institute of Neuroscience and Mental Health (G.D.), Department of Radiology (P.M.), University of Melbourne, Melbourne, Victoria; Stroke Unit, Department of Neurosciences, Carlo Poma Hospital, Mantua, Italy (A.C.); Erasmus MC University Medical Center, Rotterdam, The Netherlands (D.D.); Departent of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (S.C.O.M.); Department of Neurological Surgery, Mount Sinai Health System, New York, NY (J.M.); Institute of Neurological Sciences (K.M.), Institute of Cardiovascular and Medical Sciences (R.F.), Cerebrovascular Medicine, European Stroke Organization (K.R.L.), University of Glasgow, Glasgow, United Kingdom; Department of Neurology, Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands (W.J.S.); Department of Neurosurgery, Stony Brook University Medical Center, NY (D.F.); Department of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain (A.D.); Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, Nancy
| | - Mayank Goyal
- From the Department of Neurology and Rehabilitation Medicine (P.K., J.B.), Department of Radiology (T.A.T.), University of Cincinnati, OH; Department of Neurology (W.H.), Department of Neuroradiology (M.B.), University of Heidelberg, Heidelberg, Germany; Diagnostic and Interventional Neuroradiology (J.F.), Department of Neurology (G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Comprehensive Stroke Center (J.L.S.), Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles; Department of Neurology, University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Medicine and Neurology (B.C., S.D.), The Florey Institute of Neuroscience and Mental Health (G.D.), Department of Radiology (P.M.), University of Melbourne, Melbourne, Victoria; Stroke Unit, Department of Neurosciences, Carlo Poma Hospital, Mantua, Italy (A.C.); Erasmus MC University Medical Center, Rotterdam, The Netherlands (D.D.); Departent of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (S.C.O.M.); Department of Neurological Surgery, Mount Sinai Health System, New York, NY (J.M.); Institute of Neurological Sciences (K.M.), Institute of Cardiovascular and Medical Sciences (R.F.), Cerebrovascular Medicine, European Stroke Organization (K.R.L.), University of Glasgow, Glasgow, United Kingdom; Department of Neurology, Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands (W.J.S.); Department of Neurosurgery, Stony Brook University Medical Center, NY (D.F.); Department of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain (A.D.); Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, Nancy
| | - Michael D Hill
- From the Department of Neurology and Rehabilitation Medicine (P.K., J.B.), Department of Radiology (T.A.T.), University of Cincinnati, OH; Department of Neurology (W.H.), Department of Neuroradiology (M.B.), University of Heidelberg, Heidelberg, Germany; Diagnostic and Interventional Neuroradiology (J.F.), Department of Neurology (G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Comprehensive Stroke Center (J.L.S.), Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles; Department of Neurology, University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Medicine and Neurology (B.C., S.D.), The Florey Institute of Neuroscience and Mental Health (G.D.), Department of Radiology (P.M.), University of Melbourne, Melbourne, Victoria; Stroke Unit, Department of Neurosciences, Carlo Poma Hospital, Mantua, Italy (A.C.); Erasmus MC University Medical Center, Rotterdam, The Netherlands (D.D.); Departent of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (S.C.O.M.); Department of Neurological Surgery, Mount Sinai Health System, New York, NY (J.M.); Institute of Neurological Sciences (K.M.), Institute of Cardiovascular and Medical Sciences (R.F.), Cerebrovascular Medicine, European Stroke Organization (K.R.L.), University of Glasgow, Glasgow, United Kingdom; Department of Neurology, Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands (W.J.S.); Department of Neurosurgery, Stony Brook University Medical Center, NY (D.F.); Department of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain (A.D.); Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, Nancy
| | - Edward C Jauch
- From the Department of Neurology and Rehabilitation Medicine (P.K., J.B.), Department of Radiology (T.A.T.), University of Cincinnati, OH; Department of Neurology (W.H.), Department of Neuroradiology (M.B.), University of Heidelberg, Heidelberg, Germany; Diagnostic and Interventional Neuroradiology (J.F.), Department of Neurology (G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Comprehensive Stroke Center (J.L.S.), Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles; Department of Neurology, University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Medicine and Neurology (B.C., S.D.), The Florey Institute of Neuroscience and Mental Health (G.D.), Department of Radiology (P.M.), University of Melbourne, Melbourne, Victoria; Stroke Unit, Department of Neurosciences, Carlo Poma Hospital, Mantua, Italy (A.C.); Erasmus MC University Medical Center, Rotterdam, The Netherlands (D.D.); Departent of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (S.C.O.M.); Department of Neurological Surgery, Mount Sinai Health System, New York, NY (J.M.); Institute of Neurological Sciences (K.M.), Institute of Cardiovascular and Medical Sciences (R.F.), Cerebrovascular Medicine, European Stroke Organization (K.R.L.), University of Glasgow, Glasgow, United Kingdom; Department of Neurology, Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands (W.J.S.); Department of Neurosurgery, Stony Brook University Medical Center, NY (D.F.); Department of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain (A.D.); Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, Nancy
| | - Tudor G Jovin
- From the Department of Neurology and Rehabilitation Medicine (P.K., J.B.), Department of Radiology (T.A.T.), University of Cincinnati, OH; Department of Neurology (W.H.), Department of Neuroradiology (M.B.), University of Heidelberg, Heidelberg, Germany; Diagnostic and Interventional Neuroradiology (J.F.), Department of Neurology (G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Comprehensive Stroke Center (J.L.S.), Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles; Department of Neurology, University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Medicine and Neurology (B.C., S.D.), The Florey Institute of Neuroscience and Mental Health (G.D.), Department of Radiology (P.M.), University of Melbourne, Melbourne, Victoria; Stroke Unit, Department of Neurosciences, Carlo Poma Hospital, Mantua, Italy (A.C.); Erasmus MC University Medical Center, Rotterdam, The Netherlands (D.D.); Departent of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (S.C.O.M.); Department of Neurological Surgery, Mount Sinai Health System, New York, NY (J.M.); Institute of Neurological Sciences (K.M.), Institute of Cardiovascular and Medical Sciences (R.F.), Cerebrovascular Medicine, European Stroke Organization (K.R.L.), University of Glasgow, Glasgow, United Kingdom; Department of Neurology, Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands (W.J.S.); Department of Neurosurgery, Stony Brook University Medical Center, NY (D.F.); Department of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain (A.D.); Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, Nancy
| | - Chelsea S Kidwell
- From the Department of Neurology and Rehabilitation Medicine (P.K., J.B.), Department of Radiology (T.A.T.), University of Cincinnati, OH; Department of Neurology (W.H.), Department of Neuroradiology (M.B.), University of Heidelberg, Heidelberg, Germany; Diagnostic and Interventional Neuroradiology (J.F.), Department of Neurology (G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Comprehensive Stroke Center (J.L.S.), Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles; Department of Neurology, University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Medicine and Neurology (B.C., S.D.), The Florey Institute of Neuroscience and Mental Health (G.D.), Department of Radiology (P.M.), University of Melbourne, Melbourne, Victoria; Stroke Unit, Department of Neurosciences, Carlo Poma Hospital, Mantua, Italy (A.C.); Erasmus MC University Medical Center, Rotterdam, The Netherlands (D.D.); Departent of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (S.C.O.M.); Department of Neurological Surgery, Mount Sinai Health System, New York, NY (J.M.); Institute of Neurological Sciences (K.M.), Institute of Cardiovascular and Medical Sciences (R.F.), Cerebrovascular Medicine, European Stroke Organization (K.R.L.), University of Glasgow, Glasgow, United Kingdom; Department of Neurology, Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands (W.J.S.); Department of Neurosurgery, Stony Brook University Medical Center, NY (D.F.); Department of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain (A.D.); Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, Nancy
| | - Charles Majoie
- From the Department of Neurology and Rehabilitation Medicine (P.K., J.B.), Department of Radiology (T.A.T.), University of Cincinnati, OH; Department of Neurology (W.H.), Department of Neuroradiology (M.B.), University of Heidelberg, Heidelberg, Germany; Diagnostic and Interventional Neuroradiology (J.F.), Department of Neurology (G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Comprehensive Stroke Center (J.L.S.), Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles; Department of Neurology, University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Medicine and Neurology (B.C., S.D.), The Florey Institute of Neuroscience and Mental Health (G.D.), Department of Radiology (P.M.), University of Melbourne, Melbourne, Victoria; Stroke Unit, Department of Neurosciences, Carlo Poma Hospital, Mantua, Italy (A.C.); Erasmus MC University Medical Center, Rotterdam, The Netherlands (D.D.); Departent of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (S.C.O.M.); Department of Neurological Surgery, Mount Sinai Health System, New York, NY (J.M.); Institute of Neurological Sciences (K.M.), Institute of Cardiovascular and Medical Sciences (R.F.), Cerebrovascular Medicine, European Stroke Organization (K.R.L.), University of Glasgow, Glasgow, United Kingdom; Department of Neurology, Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands (W.J.S.); Department of Neurosurgery, Stony Brook University Medical Center, NY (D.F.); Department of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain (A.D.); Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, Nancy
| | - Sheila Cristina Ouriques Martins
- From the Department of Neurology and Rehabilitation Medicine (P.K., J.B.), Department of Radiology (T.A.T.), University of Cincinnati, OH; Department of Neurology (W.H.), Department of Neuroradiology (M.B.), University of Heidelberg, Heidelberg, Germany; Diagnostic and Interventional Neuroradiology (J.F.), Department of Neurology (G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Comprehensive Stroke Center (J.L.S.), Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles; Department of Neurology, University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Medicine and Neurology (B.C., S.D.), The Florey Institute of Neuroscience and Mental Health (G.D.), Department of Radiology (P.M.), University of Melbourne, Melbourne, Victoria; Stroke Unit, Department of Neurosciences, Carlo Poma Hospital, Mantua, Italy (A.C.); Erasmus MC University Medical Center, Rotterdam, The Netherlands (D.D.); Departent of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (S.C.O.M.); Department of Neurological Surgery, Mount Sinai Health System, New York, NY (J.M.); Institute of Neurological Sciences (K.M.), Institute of Cardiovascular and Medical Sciences (R.F.), Cerebrovascular Medicine, European Stroke Organization (K.R.L.), University of Glasgow, Glasgow, United Kingdom; Department of Neurology, Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands (W.J.S.); Department of Neurosurgery, Stony Brook University Medical Center, NY (D.F.); Department of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain (A.D.); Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, Nancy
| | - Peter Mitchell
- From the Department of Neurology and Rehabilitation Medicine (P.K., J.B.), Department of Radiology (T.A.T.), University of Cincinnati, OH; Department of Neurology (W.H.), Department of Neuroradiology (M.B.), University of Heidelberg, Heidelberg, Germany; Diagnostic and Interventional Neuroradiology (J.F.), Department of Neurology (G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Comprehensive Stroke Center (J.L.S.), Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles; Department of Neurology, University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Medicine and Neurology (B.C., S.D.), The Florey Institute of Neuroscience and Mental Health (G.D.), Department of Radiology (P.M.), University of Melbourne, Melbourne, Victoria; Stroke Unit, Department of Neurosciences, Carlo Poma Hospital, Mantua, Italy (A.C.); Erasmus MC University Medical Center, Rotterdam, The Netherlands (D.D.); Departent of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (S.C.O.M.); Department of Neurological Surgery, Mount Sinai Health System, New York, NY (J.M.); Institute of Neurological Sciences (K.M.), Institute of Cardiovascular and Medical Sciences (R.F.), Cerebrovascular Medicine, European Stroke Organization (K.R.L.), University of Glasgow, Glasgow, United Kingdom; Department of Neurology, Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands (W.J.S.); Department of Neurosurgery, Stony Brook University Medical Center, NY (D.F.); Department of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain (A.D.); Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, Nancy
| | - J Mocco
- From the Department of Neurology and Rehabilitation Medicine (P.K., J.B.), Department of Radiology (T.A.T.), University of Cincinnati, OH; Department of Neurology (W.H.), Department of Neuroradiology (M.B.), University of Heidelberg, Heidelberg, Germany; Diagnostic and Interventional Neuroradiology (J.F.), Department of Neurology (G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Comprehensive Stroke Center (J.L.S.), Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles; Department of Neurology, University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Medicine and Neurology (B.C., S.D.), The Florey Institute of Neuroscience and Mental Health (G.D.), Department of Radiology (P.M.), University of Melbourne, Melbourne, Victoria; Stroke Unit, Department of Neurosciences, Carlo Poma Hospital, Mantua, Italy (A.C.); Erasmus MC University Medical Center, Rotterdam, The Netherlands (D.D.); Departent of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (S.C.O.M.); Department of Neurological Surgery, Mount Sinai Health System, New York, NY (J.M.); Institute of Neurological Sciences (K.M.), Institute of Cardiovascular and Medical Sciences (R.F.), Cerebrovascular Medicine, European Stroke Organization (K.R.L.), University of Glasgow, Glasgow, United Kingdom; Department of Neurology, Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands (W.J.S.); Department of Neurosurgery, Stony Brook University Medical Center, NY (D.F.); Department of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain (A.D.); Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, Nancy
| | - Keith Muir
- From the Department of Neurology and Rehabilitation Medicine (P.K., J.B.), Department of Radiology (T.A.T.), University of Cincinnati, OH; Department of Neurology (W.H.), Department of Neuroradiology (M.B.), University of Heidelberg, Heidelberg, Germany; Diagnostic and Interventional Neuroradiology (J.F.), Department of Neurology (G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Comprehensive Stroke Center (J.L.S.), Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles; Department of Neurology, University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Medicine and Neurology (B.C., S.D.), The Florey Institute of Neuroscience and Mental Health (G.D.), Department of Radiology (P.M.), University of Melbourne, Melbourne, Victoria; Stroke Unit, Department of Neurosciences, Carlo Poma Hospital, Mantua, Italy (A.C.); Erasmus MC University Medical Center, Rotterdam, The Netherlands (D.D.); Departent of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (S.C.O.M.); Department of Neurological Surgery, Mount Sinai Health System, New York, NY (J.M.); Institute of Neurological Sciences (K.M.), Institute of Cardiovascular and Medical Sciences (R.F.), Cerebrovascular Medicine, European Stroke Organization (K.R.L.), University of Glasgow, Glasgow, United Kingdom; Department of Neurology, Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands (W.J.S.); Department of Neurosurgery, Stony Brook University Medical Center, NY (D.F.); Department of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain (A.D.); Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, Nancy
| | - Raul G Nogueira
- From the Department of Neurology and Rehabilitation Medicine (P.K., J.B.), Department of Radiology (T.A.T.), University of Cincinnati, OH; Department of Neurology (W.H.), Department of Neuroradiology (M.B.), University of Heidelberg, Heidelberg, Germany; Diagnostic and Interventional Neuroradiology (J.F.), Department of Neurology (G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Comprehensive Stroke Center (J.L.S.), Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles; Department of Neurology, University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Medicine and Neurology (B.C., S.D.), The Florey Institute of Neuroscience and Mental Health (G.D.), Department of Radiology (P.M.), University of Melbourne, Melbourne, Victoria; Stroke Unit, Department of Neurosciences, Carlo Poma Hospital, Mantua, Italy (A.C.); Erasmus MC University Medical Center, Rotterdam, The Netherlands (D.D.); Departent of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (S.C.O.M.); Department of Neurological Surgery, Mount Sinai Health System, New York, NY (J.M.); Institute of Neurological Sciences (K.M.), Institute of Cardiovascular and Medical Sciences (R.F.), Cerebrovascular Medicine, European Stroke Organization (K.R.L.), University of Glasgow, Glasgow, United Kingdom; Department of Neurology, Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands (W.J.S.); Department of Neurosurgery, Stony Brook University Medical Center, NY (D.F.); Department of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain (A.D.); Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, Nancy
| | - Wouter J Schonewille
- From the Department of Neurology and Rehabilitation Medicine (P.K., J.B.), Department of Radiology (T.A.T.), University of Cincinnati, OH; Department of Neurology (W.H.), Department of Neuroradiology (M.B.), University of Heidelberg, Heidelberg, Germany; Diagnostic and Interventional Neuroradiology (J.F.), Department of Neurology (G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Comprehensive Stroke Center (J.L.S.), Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles; Department of Neurology, University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Medicine and Neurology (B.C., S.D.), The Florey Institute of Neuroscience and Mental Health (G.D.), Department of Radiology (P.M.), University of Melbourne, Melbourne, Victoria; Stroke Unit, Department of Neurosciences, Carlo Poma Hospital, Mantua, Italy (A.C.); Erasmus MC University Medical Center, Rotterdam, The Netherlands (D.D.); Departent of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (S.C.O.M.); Department of Neurological Surgery, Mount Sinai Health System, New York, NY (J.M.); Institute of Neurological Sciences (K.M.), Institute of Cardiovascular and Medical Sciences (R.F.), Cerebrovascular Medicine, European Stroke Organization (K.R.L.), University of Glasgow, Glasgow, United Kingdom; Department of Neurology, Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands (W.J.S.); Department of Neurosurgery, Stony Brook University Medical Center, NY (D.F.); Department of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain (A.D.); Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, Nancy
| | - Adnan H Siddiqui
- From the Department of Neurology and Rehabilitation Medicine (P.K., J.B.), Department of Radiology (T.A.T.), University of Cincinnati, OH; Department of Neurology (W.H.), Department of Neuroradiology (M.B.), University of Heidelberg, Heidelberg, Germany; Diagnostic and Interventional Neuroradiology (J.F.), Department of Neurology (G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Comprehensive Stroke Center (J.L.S.), Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles; Department of Neurology, University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Medicine and Neurology (B.C., S.D.), The Florey Institute of Neuroscience and Mental Health (G.D.), Department of Radiology (P.M.), University of Melbourne, Melbourne, Victoria; Stroke Unit, Department of Neurosciences, Carlo Poma Hospital, Mantua, Italy (A.C.); Erasmus MC University Medical Center, Rotterdam, The Netherlands (D.D.); Departent of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (S.C.O.M.); Department of Neurological Surgery, Mount Sinai Health System, New York, NY (J.M.); Institute of Neurological Sciences (K.M.), Institute of Cardiovascular and Medical Sciences (R.F.), Cerebrovascular Medicine, European Stroke Organization (K.R.L.), University of Glasgow, Glasgow, United Kingdom; Department of Neurology, Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands (W.J.S.); Department of Neurosurgery, Stony Brook University Medical Center, NY (D.F.); Department of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain (A.D.); Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, Nancy
| | - Götz Thomalla
- From the Department of Neurology and Rehabilitation Medicine (P.K., J.B.), Department of Radiology (T.A.T.), University of Cincinnati, OH; Department of Neurology (W.H.), Department of Neuroradiology (M.B.), University of Heidelberg, Heidelberg, Germany; Diagnostic and Interventional Neuroradiology (J.F.), Department of Neurology (G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Comprehensive Stroke Center (J.L.S.), Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles; Department of Neurology, University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Medicine and Neurology (B.C., S.D.), The Florey Institute of Neuroscience and Mental Health (G.D.), Department of Radiology (P.M.), University of Melbourne, Melbourne, Victoria; Stroke Unit, Department of Neurosciences, Carlo Poma Hospital, Mantua, Italy (A.C.); Erasmus MC University Medical Center, Rotterdam, The Netherlands (D.D.); Departent of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (S.C.O.M.); Department of Neurological Surgery, Mount Sinai Health System, New York, NY (J.M.); Institute of Neurological Sciences (K.M.), Institute of Cardiovascular and Medical Sciences (R.F.), Cerebrovascular Medicine, European Stroke Organization (K.R.L.), University of Glasgow, Glasgow, United Kingdom; Department of Neurology, Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands (W.J.S.); Department of Neurosurgery, Stony Brook University Medical Center, NY (D.F.); Department of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain (A.D.); Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, Nancy
| | - Thomas A Tomsick
- From the Department of Neurology and Rehabilitation Medicine (P.K., J.B.), Department of Radiology (T.A.T.), University of Cincinnati, OH; Department of Neurology (W.H.), Department of Neuroradiology (M.B.), University of Heidelberg, Heidelberg, Germany; Diagnostic and Interventional Neuroradiology (J.F.), Department of Neurology (G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Comprehensive Stroke Center (J.L.S.), Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles; Department of Neurology, University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Medicine and Neurology (B.C., S.D.), The Florey Institute of Neuroscience and Mental Health (G.D.), Department of Radiology (P.M.), University of Melbourne, Melbourne, Victoria; Stroke Unit, Department of Neurosciences, Carlo Poma Hospital, Mantua, Italy (A.C.); Erasmus MC University Medical Center, Rotterdam, The Netherlands (D.D.); Departent of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (S.C.O.M.); Department of Neurological Surgery, Mount Sinai Health System, New York, NY (J.M.); Institute of Neurological Sciences (K.M.), Institute of Cardiovascular and Medical Sciences (R.F.), Cerebrovascular Medicine, European Stroke Organization (K.R.L.), University of Glasgow, Glasgow, United Kingdom; Department of Neurology, Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands (W.J.S.); Department of Neurosurgery, Stony Brook University Medical Center, NY (D.F.); Department of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain (A.D.); Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, Nancy
| | - Aquilla S Turk
- From the Department of Neurology and Rehabilitation Medicine (P.K., J.B.), Department of Radiology (T.A.T.), University of Cincinnati, OH; Department of Neurology (W.H.), Department of Neuroradiology (M.B.), University of Heidelberg, Heidelberg, Germany; Diagnostic and Interventional Neuroradiology (J.F.), Department of Neurology (G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Comprehensive Stroke Center (J.L.S.), Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles; Department of Neurology, University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Medicine and Neurology (B.C., S.D.), The Florey Institute of Neuroscience and Mental Health (G.D.), Department of Radiology (P.M.), University of Melbourne, Melbourne, Victoria; Stroke Unit, Department of Neurosciences, Carlo Poma Hospital, Mantua, Italy (A.C.); Erasmus MC University Medical Center, Rotterdam, The Netherlands (D.D.); Departent of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (S.C.O.M.); Department of Neurological Surgery, Mount Sinai Health System, New York, NY (J.M.); Institute of Neurological Sciences (K.M.), Institute of Cardiovascular and Medical Sciences (R.F.), Cerebrovascular Medicine, European Stroke Organization (K.R.L.), University of Glasgow, Glasgow, United Kingdom; Department of Neurology, Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands (W.J.S.); Department of Neurosurgery, Stony Brook University Medical Center, NY (D.F.); Department of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain (A.D.); Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, Nancy
| | - Philip M White
- From the Department of Neurology and Rehabilitation Medicine (P.K., J.B.), Department of Radiology (T.A.T.), University of Cincinnati, OH; Department of Neurology (W.H.), Department of Neuroradiology (M.B.), University of Heidelberg, Heidelberg, Germany; Diagnostic and Interventional Neuroradiology (J.F.), Department of Neurology (G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Comprehensive Stroke Center (J.L.S.), Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles; Department of Neurology, University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Medicine and Neurology (B.C., S.D.), The Florey Institute of Neuroscience and Mental Health (G.D.), Department of Radiology (P.M.), University of Melbourne, Melbourne, Victoria; Stroke Unit, Department of Neurosciences, Carlo Poma Hospital, Mantua, Italy (A.C.); Erasmus MC University Medical Center, Rotterdam, The Netherlands (D.D.); Departent of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (S.C.O.M.); Department of Neurological Surgery, Mount Sinai Health System, New York, NY (J.M.); Institute of Neurological Sciences (K.M.), Institute of Cardiovascular and Medical Sciences (R.F.), Cerebrovascular Medicine, European Stroke Organization (K.R.L.), University of Glasgow, Glasgow, United Kingdom; Department of Neurology, Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands (W.J.S.); Department of Neurosurgery, Stony Brook University Medical Center, NY (D.F.); Department of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain (A.D.); Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, Nancy
| | - Osama O Zaidat
- From the Department of Neurology and Rehabilitation Medicine (P.K., J.B.), Department of Radiology (T.A.T.), University of Cincinnati, OH; Department of Neurology (W.H.), Department of Neuroradiology (M.B.), University of Heidelberg, Heidelberg, Germany; Diagnostic and Interventional Neuroradiology (J.F.), Department of Neurology (G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Comprehensive Stroke Center (J.L.S.), Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles; Department of Neurology, University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Medicine and Neurology (B.C., S.D.), The Florey Institute of Neuroscience and Mental Health (G.D.), Department of Radiology (P.M.), University of Melbourne, Melbourne, Victoria; Stroke Unit, Department of Neurosciences, Carlo Poma Hospital, Mantua, Italy (A.C.); Erasmus MC University Medical Center, Rotterdam, The Netherlands (D.D.); Departent of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (S.C.O.M.); Department of Neurological Surgery, Mount Sinai Health System, New York, NY (J.M.); Institute of Neurological Sciences (K.M.), Institute of Cardiovascular and Medical Sciences (R.F.), Cerebrovascular Medicine, European Stroke Organization (K.R.L.), University of Glasgow, Glasgow, United Kingdom; Department of Neurology, Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands (W.J.S.); Department of Neurosurgery, Stony Brook University Medical Center, NY (D.F.); Department of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain (A.D.); Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, Nancy
| | - David S Liebeskind
- From the Department of Neurology and Rehabilitation Medicine (P.K., J.B.), Department of Radiology (T.A.T.), University of Cincinnati, OH; Department of Neurology (W.H.), Department of Neuroradiology (M.B.), University of Heidelberg, Heidelberg, Germany; Diagnostic and Interventional Neuroradiology (J.F.), Department of Neurology (G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Comprehensive Stroke Center (J.L.S.), Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles; Department of Neurology, University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Medicine and Neurology (B.C., S.D.), The Florey Institute of Neuroscience and Mental Health (G.D.), Department of Radiology (P.M.), University of Melbourne, Melbourne, Victoria; Stroke Unit, Department of Neurosciences, Carlo Poma Hospital, Mantua, Italy (A.C.); Erasmus MC University Medical Center, Rotterdam, The Netherlands (D.D.); Departent of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (S.C.O.M.); Department of Neurological Surgery, Mount Sinai Health System, New York, NY (J.M.); Institute of Neurological Sciences (K.M.), Institute of Cardiovascular and Medical Sciences (R.F.), Cerebrovascular Medicine, European Stroke Organization (K.R.L.), University of Glasgow, Glasgow, United Kingdom; Department of Neurology, Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands (W.J.S.); Department of Neurosurgery, Stony Brook University Medical Center, NY (D.F.); Department of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain (A.D.); Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, Nancy
| | - Rachel Fulton
- From the Department of Neurology and Rehabilitation Medicine (P.K., J.B.), Department of Radiology (T.A.T.), University of Cincinnati, OH; Department of Neurology (W.H.), Department of Neuroradiology (M.B.), University of Heidelberg, Heidelberg, Germany; Diagnostic and Interventional Neuroradiology (J.F.), Department of Neurology (G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Comprehensive Stroke Center (J.L.S.), Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles; Department of Neurology, University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Medicine and Neurology (B.C., S.D.), The Florey Institute of Neuroscience and Mental Health (G.D.), Department of Radiology (P.M.), University of Melbourne, Melbourne, Victoria; Stroke Unit, Department of Neurosciences, Carlo Poma Hospital, Mantua, Italy (A.C.); Erasmus MC University Medical Center, Rotterdam, The Netherlands (D.D.); Departent of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (S.C.O.M.); Department of Neurological Surgery, Mount Sinai Health System, New York, NY (J.M.); Institute of Neurological Sciences (K.M.), Institute of Cardiovascular and Medical Sciences (R.F.), Cerebrovascular Medicine, European Stroke Organization (K.R.L.), University of Glasgow, Glasgow, United Kingdom; Department of Neurology, Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands (W.J.S.); Department of Neurosurgery, Stony Brook University Medical Center, NY (D.F.); Department of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain (A.D.); Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, Nancy
| | - Kennedy R Lees
- From the Department of Neurology and Rehabilitation Medicine (P.K., J.B.), Department of Radiology (T.A.T.), University of Cincinnati, OH; Department of Neurology (W.H.), Department of Neuroradiology (M.B.), University of Heidelberg, Heidelberg, Germany; Diagnostic and Interventional Neuroradiology (J.F.), Department of Neurology (G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Comprehensive Stroke Center (J.L.S.), Department of Neurology (J.L.S., D.S.L.), University of California, Los Angeles; Department of Neurology, University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Medicine and Neurology (B.C., S.D.), The Florey Institute of Neuroscience and Mental Health (G.D.), Department of Radiology (P.M.), University of Melbourne, Melbourne, Victoria; Stroke Unit, Department of Neurosciences, Carlo Poma Hospital, Mantua, Italy (A.C.); Erasmus MC University Medical Center, Rotterdam, The Netherlands (D.D.); Departent of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (S.C.O.M.); Department of Neurological Surgery, Mount Sinai Health System, New York, NY (J.M.); Institute of Neurological Sciences (K.M.), Institute of Cardiovascular and Medical Sciences (R.F.), Cerebrovascular Medicine, European Stroke Organization (K.R.L.), University of Glasgow, Glasgow, United Kingdom; Department of Neurology, Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands (W.J.S.); Department of Neurosurgery, Stony Brook University Medical Center, NY (D.F.); Department of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain (A.D.); Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, Nancy
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Palesch YY, Yeatts SD, Tomsick TA, Foster LD, Demchuk AM, Khatri P, Hill MD, Jauch EC, Jovin TG, Yan B, von Kummer R, Molina CA, Goyal M, Schonewille WJ, Mazighi M, Engelter ST, Anderson C, Spilker J, Carrozzella J, Ryckborst KJ, Janis LS, Simpson A, Simpson KN, Broderick JP. Twelve-Month Clinical and Quality-of-Life Outcomes in the Interventional Management of Stroke III Trial. Stroke 2015; 46:1321-7. [PMID: 25858239 DOI: 10.1161/strokeaha.115.009180] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 02/26/2015] [Accepted: 03/04/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Randomized trials have indicated a benefit for endovascular therapy in appropriately selected stroke patients at 3 months, but data regarding outcomes at 12 months are currently lacking. METHODS We compared functional and quality-of-life outcomes at 12 months overall and by stroke severity in stroke patients treated with intravenous tissue-type plasminogen activator followed by endovascular treatment as compared with intravenous tissue-type plasminogen activator alone in the Interventional Management of Stroke III Trial. The key outcome measures were a modified Rankin Scale score ≤2 (functional independence) and the Euro-QoL EQ-5D, a health-related quality-of-life measure. RESULTS 656 subjects with moderate-to-severe stroke (National Institutes of Health Stroke Scale ≥8) were enrolled at 58 centers in the United States (41 sites), Canada (7), Australia (4), and Europe (6). There was an interaction between treatment group and stroke severity in the repeated measures analysis of modified Rankin Scale ≤2 outcome (P=0.039). In the 204 participants with severe stroke (National Institutes of Health Stroke Scale ≥20), a greater proportion of the endovascular group had a modified Rankin Scale ≤2 (32.5%) at 12 months as compared with the intravenous tissue-type plasminogen activator group (18.6%, P=0.037); no difference was seen for the 452 participants with moderately severe strokes (55.6% versus 57.7%). In participants with severe stroke, the endovascular group had 35.2 (95% confidence interval: 2.1, 73.3) more quality-adjusted-days over 12 months as compared with intravenous tissue-type plasminogen activator alone. CONCLUSIONS Endovascular therapy improves functional outcome and health-related quality-of-life at 12 months after severe ischemic stroke. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00359424.
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Affiliation(s)
- Yuko Y Palesch
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P., S.D.Y., L.D.F., A.S., K.N.S.) and Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G., K.J.R.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Sharon D Yeatts
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P., S.D.Y., L.D.F., A.S., K.N.S.) and Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G., K.J.R.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Thomas A Tomsick
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P., S.D.Y., L.D.F., A.S., K.N.S.) and Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G., K.J.R.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Lydia D Foster
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P., S.D.Y., L.D.F., A.S., K.N.S.) and Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G., K.J.R.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Andrew M Demchuk
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P., S.D.Y., L.D.F., A.S., K.N.S.) and Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G., K.J.R.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Pooja Khatri
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P., S.D.Y., L.D.F., A.S., K.N.S.) and Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G., K.J.R.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Michael D Hill
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P., S.D.Y., L.D.F., A.S., K.N.S.) and Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G., K.J.R.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Edward C Jauch
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P., S.D.Y., L.D.F., A.S., K.N.S.) and Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G., K.J.R.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Tudor G Jovin
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P., S.D.Y., L.D.F., A.S., K.N.S.) and Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G., K.J.R.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Bernard Yan
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P., S.D.Y., L.D.F., A.S., K.N.S.) and Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G., K.J.R.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Rüdiger von Kummer
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P., S.D.Y., L.D.F., A.S., K.N.S.) and Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G., K.J.R.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Carlos A Molina
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P., S.D.Y., L.D.F., A.S., K.N.S.) and Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G., K.J.R.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Mayank Goyal
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P., S.D.Y., L.D.F., A.S., K.N.S.) and Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G., K.J.R.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Wouter J Schonewille
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P., S.D.Y., L.D.F., A.S., K.N.S.) and Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G., K.J.R.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Mikael Mazighi
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P., S.D.Y., L.D.F., A.S., K.N.S.) and Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G., K.J.R.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Stefan T Engelter
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P., S.D.Y., L.D.F., A.S., K.N.S.) and Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G., K.J.R.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Craig Anderson
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P., S.D.Y., L.D.F., A.S., K.N.S.) and Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G., K.J.R.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Judith Spilker
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P., S.D.Y., L.D.F., A.S., K.N.S.) and Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G., K.J.R.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Janice Carrozzella
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P., S.D.Y., L.D.F., A.S., K.N.S.) and Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G., K.J.R.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Karla J Ryckborst
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P., S.D.Y., L.D.F., A.S., K.N.S.) and Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G., K.J.R.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - L Scott Janis
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P., S.D.Y., L.D.F., A.S., K.N.S.) and Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G., K.J.R.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Annie Simpson
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P., S.D.Y., L.D.F., A.S., K.N.S.) and Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G., K.J.R.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Kit N Simpson
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P., S.D.Y., L.D.F., A.S., K.N.S.) and Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G., K.J.R.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Joseph P Broderick
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P., S.D.Y., L.D.F., A.S., K.N.S.) and Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G., K.J.R.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.).
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Karcher R, Berman AE, Gross H, Hess DC, Jauch EC, Viser PE, Solenski NJ, Wolf AMD. Addressing Disparities in Stroke Prevention for Atrial Fibrillation: Educational Opportunities. Am J Med Qual 2015; 31:337-48. [PMID: 25788477 DOI: 10.1177/1062860615577971] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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
Disparities in atrial fibrillation (AF)-related stroke and mortality persist, especially racial disparities, within the US "Stroke Belt." This study identified barriers to optimal stroke prevention to develop a framework for clinician education. A comprehensive educational needs assessment was developed focusing on clinicians within the Stroke Belt. The mixed qualitative-quantitative approach included regional surveys and one-on-one clinician interviews. Identified contributors to disparities included implicit racial biases, lack of awareness of racial disparities in AF stroke risk, and lack of effective multicultural awareness and training. Additional barriers affecting disparities included patient medical mistrust and clinician-patient communication challenges. General barriers included lack of consistency in assessing stroke and anticoagulant-related bleeding risk, underuse of standardized risk assessment tools, discomfort with novel anticoagulants, and patient education deficiencies. Effective cultural competency training is one strategy to reduce disparities in AF-related stroke and mortality by improving implicit clinician bias, addressing medical mistrust, and improving clinician-patient communication.
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Affiliation(s)
| | - Adam E Berman
- Medical College of Georgia at Georgia Regents University, Augusta, GA
| | - Hartmut Gross
- Medical College of Georgia at Georgia Regents University, Augusta, GA
| | - David C Hess
- Medical College of Georgia at Georgia Regents University, Augusta, GA
| | | | | | - Nina J Solenski
- University of Virginia School of Medicine, Charlottesville, VA
| | - Andrew M D Wolf
- University of Virginia School of Medicine, Charlottesville, VA
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49
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Meschia JF, Bushnell C, Boden-Albala B, Braun LT, Bravata DM, Chaturvedi S, Creager MA, Eckel RH, Elkind MSV, Fornage M, Goldstein LB, Greenberg SM, Horvath SE, Iadecola C, Jauch EC, Moore WS, Wilson JA. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45:3754-832. [PMID: 25355838 PMCID: PMC5020564 DOI: 10.1161/str.0000000000000046] [Citation(s) in RCA: 973] [Impact Index Per Article: 97.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this updated statement is to provide comprehensive and timely evidence-based recommendations on the prevention of stroke among individuals who have not previously experienced a stroke or transient ischemic attack. Evidence-based recommendations are included for the control of risk factors, interventional approaches to atherosclerotic disease of the cervicocephalic circulation, and antithrombotic treatments for preventing thrombotic and thromboembolic stroke. Further recommendations are provided for genetic and pharmacogenetic testing and for the prevention of stroke in a variety of other specific circumstances, including sickle cell disease and patent foramen ovale.
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50
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Broderick JP, Palesch YY, Demchuk AM, Yeatts SD, Khatri P, Hill MD, Jauch EC, Jovin TG, Yan B, von Kummer R, Molina CA, Goyal M, Mazighi M, Schonewille WJ, Engelter ST, Anderson C, Spilker J, Carrozzella J, Janis LS, Foster LD, Tomsick TA. Evolution of practice during the Interventional Management of Stroke III Trial and implications for ongoing trials. Stroke 2014; 45:3606-11. [PMID: 25325911 DOI: 10.1161/strokeaha.114.005952] [Citation(s) in RCA: 10] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We explored changes in the patient population and practice of endovascular therapy during the course of the Interventional Management of Stroke (IMS) III Trial. METHODS Changes in baseline characteristics, use of baseline CT angiography, treatment times and specifics, and outcomes were compared between the first 4 protocols and the fifth and final protocol. RESULTS Compared with subjects treated in the first 4 protocol versions (n=610), subjects treated in fifth and final protocol (n=46) were older (75 versus 68 years, P<0.0002) and less likely to have a pretreatment Rankin of 0 (76% versus 89%, P=0.01), were more likely to have a pretreatment CT angiography (65% versus 45%, P=0.009), had quicker median times in the endovascular arm from onset to start of intra-arterial therapy (209 versus 250 minutes, P=0.002) and to reperfusion (269 versus 344 minutes, P<0.0001), had a higher mean dose of total tissue-type plasminogen activator in the endovascular arm (74.0 versus 63.7 mg, P<0.0001), and were less likely to receive intra-arterial tissue-type plasminogen activator as part of the endovascular procedure (16% versus 44%, P=0.015). There were no significant differences in functional and safety outcomes between subjects treated in the 2 treatments arms in either the first 4 protocols or fifth protocol although the small sample size in the fifth protocol provided limited power. CONCLUSIONS Endovascular technology and diagnostic approaches to acute stroke patients changed substantially during the IMS III Trial. Efforts to decrease the time to delivery of endovascular therapy were successful.
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Affiliation(s)
- Joseph P Broderick
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P, S.D.Y., L.D.F.) and the Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.).
| | - Yuko Y Palesch
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P, S.D.Y., L.D.F.) and the Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Andrew M Demchuk
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P, S.D.Y., L.D.F.) and the Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Sharon D Yeatts
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P, S.D.Y., L.D.F.) and the Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Pooja Khatri
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P, S.D.Y., L.D.F.) and the Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Michael D Hill
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P, S.D.Y., L.D.F.) and the Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Edward C Jauch
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P, S.D.Y., L.D.F.) and the Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Tudor G Jovin
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P, S.D.Y., L.D.F.) and the Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Bernard Yan
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P, S.D.Y., L.D.F.) and the Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Rüdiger von Kummer
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P, S.D.Y., L.D.F.) and the Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Carlos A Molina
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P, S.D.Y., L.D.F.) and the Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Mayank Goyal
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P, S.D.Y., L.D.F.) and the Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Mikael Mazighi
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P, S.D.Y., L.D.F.) and the Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Wouter J Schonewille
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P, S.D.Y., L.D.F.) and the Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Stefan T Engelter
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P, S.D.Y., L.D.F.) and the Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Craig Anderson
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P, S.D.Y., L.D.F.) and the Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Judith Spilker
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P, S.D.Y., L.D.F.) and the Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Janice Carrozzella
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P, S.D.Y., L.D.F.) and the Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - L Scott Janis
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P, S.D.Y., L.D.F.) and the Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Lydia D Foster
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P, S.D.Y., L.D.F.) and the Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
| | - Thomas A Tomsick
- From the Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati (J.P.B., P.K., J.S., J.C., T.A.T.); Department of Public Health Sciences (Y.Y.P, S.D.Y., L.D.F.) and the Division of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston; Calgary Stroke Program, Seaman Family MR Research Centre, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.D.H., M.G.); Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (B.Y.); Department of Neuroradiology, Dresden University Stroke Center, University Hospital, Dresden, Germany (R.v.K.); Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (C.A.M.); Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, the Netherlands, and the St. Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); Department of Neurology and Stroke Center, Lariboisière Hospital, Paris (M.M.); Department of Neurology, Basel University Hospital, Basel, Switzerland (S.T.E.); George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney (C.A.); and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (L.S.J.)
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