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Marei O, Podlasek A, Soo E, Butt W, Gory B, Nguyen TN, Appleton JP, Richard S, Rice H, de Villiers L, Carraro do Nascimento V, Domitrovic L, McConachie N, Lenthall R, Nair S, Malik L, Panesar J, Krishnan K, Bhogal P, Dineen RA, England TJ, Campbell BCV, Dhillon PS. Safety and efficacy of adjunctive intra-arterial antithrombotic therapy during endovascular thrombectomy for acute ischemic stroke: a systematic review and meta-analysis. J Neurointerv Surg 2024:jnis-2023-021244. [PMID: 38253378 DOI: 10.1136/jnis-2023-021244] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/06/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Half of patients who achieve successful recanalization following endovascular thrombectomy (EVT) for acute ischemic stroke experience poor functional outcome. We aim to investigate whether the use of adjunctive intra-arterial antithrombotic therapy (AAT) during EVT is safe and efficacious compared with standard therapy (ST) of EVT with or without prior intravenous thrombolysis. METHODS Electronic databases were searched (PubMed/MEDLINE, Embase, Cochrane Library) from 2010 until October 2023. Data were pooled using a random-effects model and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Risk of bias was assessed using ROBINS-I and ROB-2. The primary outcome was functional independence (modified Rankin Scale (mRS) 0-2) at 3 months. Secondary outcomes were successful recanalization (modified Thrombolysis In Cerebral Infarction (TICI) 2b-3), symptomatic intracranial hemorrhage (sICH), and 90-day mortality. RESULTS 41 randomized and non-randomized studies met the eligibility criteria. Overall, 15 316 patients were included; 3296 patients were treated with AAT during EVT and 12 020 were treated with ST alone. Compared with ST, patients treated with AAT demonstrated higher odds of functional independence (46.5% AAT vs 42.6% ST; OR 1.22, 95% CI 1.07 to 1.40, P=0.004, I2=48%) and a lower likelihood of 90-day mortality (OR 0.71, 95% CI 0.61 to 0.83, P<0.0001, I2=20%). The rates of sICH (OR 1.00, 95% CI 0.82 to 1.22,P=0.97, I2=13%) and successful recanalization (OR 1.09, 95% CI 0.84 to 1.42, P=0.52, I2=76%) were not significantly different. CONCLUSION The use of AAT during EVT may improve functional outcomes and reduce mortality rates compared with ST alone, without an increased risk of sICH. These findings should be interpreted with caution pending the results from ongoing phase III trials to establish the efficacy and safety of AAT during EVT.
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Affiliation(s)
- Omar Marei
- Radiological Sciences, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Anna Podlasek
- Tayside Innovation Medtech Ecosystem (TIME), University of Dundee, Dundee, UK
| | - Emma Soo
- Radiological Sciences, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Waleed Butt
- Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, CHRU de Nancy, Nancy, Lorraine, France
| | - Thanh N Nguyen
- Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
- Radiology, Boston Medical Center Department of Radiology, Boston, Massachusetts, USA
| | - Jason P Appleton
- Stroke Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Stroke Trials Unit, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | | | - Hal Rice
- Department of Interventional Neuroradiology, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Laetitia de Villiers
- Department of Interventional Neuroradiology, Gold Coast University Hospital, Southport, Queensland, Australia
| | | | - Luis Domitrovic
- Department of Interventional Neuroradiology, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Norman McConachie
- Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Robert Lenthall
- Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Sujit Nair
- Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Luqman Malik
- Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jasmin Panesar
- Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Kailash Krishnan
- Stroke Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Stroke Trials Unit, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Pervinder Bhogal
- Interventional Neuroradiology, Royal London Hospital, London, UK
| | - Robert A Dineen
- Radiological Sciences, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Timothy J England
- Stroke Trials Unit, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
- Stroke Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Bruce C V Campbell
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
- Department of Medicine and Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Permesh Singh Dhillon
- Radiological Sciences, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
- Department of Interventional Neuroradiology, Gold Coast University Hospital, Southport, Queensland, Australia
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2
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Dhillon PS, Butt W, Podlasek A, Bhogal P, McConachie N, Lenthall R, Nair S, Malik L, Lynch J, Goddard T, Barrett E, Krishnan K, Dineen RA, England TJ. Effect of proximal blood flow arrest during endovascular thrombectomy (ProFATE): Study protocol for a multicentre randomised controlled trial. Eur Stroke J 2023; 8:581-590. [PMID: 37231682 DOI: 10.1177/23969873231166194] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/27/2023] Open
Abstract
BACKGROUND Observational studies have demonstrated improved outcomes with the adjunctive use of balloon guide catheters (BGC) during endovascular thrombectomy (EVT) for anterior circulation acute ischaemic stroke (AIS). However, the lack of high-level evidence and global practice heterogeneity justifies a randomised controlled trial (RCT) to investigate the effect of transient proximal blood flow arrest on the procedural and clinical outcomes of patients with AIS following EVT. HYPOTHESIS Proximal blood flow arrest in the cervical internal carotid artery during EVT for proximal large vessel occlusion is superior to no flow arrest in achieving complete vessel recanalisation. METHODS ProFATE is an investigator-initiated, pragmatic, multicentre RCT with blinding of participants and outcome assessment. An estimated 124 participants with an anterior circulation AIS due to large vessel occlusion, an NIHSS of ⩾2, ASPECTS ⩾ 5 and eligible for EVT using a first-line combined technique (contact aspiration and stent retriever) or contact aspiration only will be randomised (1:1) to receive BGC balloon inflation or no inflation during EVT. OUTCOMES The primary outcome is the proportion of patients achieving near-complete/complete vessel recanalisation (eTICI 2c-3) at the end of the EVT procedure. Secondary outcomes include the functional outcome (modified Rankin Scale at 90 days), new or distal vascular territory clot embolisation rate, near-complete/complete recanalisation after the first pass, symptomatic intracranial haemorrhage, procedure-related complications and death at 90 days. DISCUSSION This is the first RCT to investigate the effect of proximal blood flow arrest during EVT using a BGC on the procedural and clinical outcomes of patients with AIS due to large vessel occlusion.
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Affiliation(s)
- Permesh Singh Dhillon
- Interventional Neuroradiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Radiological Sciences, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Waleed Butt
- Interventional Neuroradiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Anna Podlasek
- Radiological Sciences, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
- Tayside Innovation Medtech Ecosystem (TIME), University of Dundee, Dundee, UK
| | - Pervinder Bhogal
- Interventional Neuroradiology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Norman McConachie
- Interventional Neuroradiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Robert Lenthall
- Interventional Neuroradiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Sujit Nair
- Interventional Neuroradiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Luqman Malik
- Interventional Neuroradiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jeremy Lynch
- Interventional Neuroradiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Tony Goddard
- Interventional Neuroradiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Emma Barrett
- Department of Research and Innovation (Medical Statistics), Manchester University NHS Foundation Trust, Manchester, UK
- Centre for Biostatistics, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Kailash Krishnan
- Stroke, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Stroke Trials Unit, Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Derby, UK
| | - Robert A Dineen
- Radiological Sciences, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Timothy J England
- Stroke Trials Unit, Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Derby, UK
- Stroke, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
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3
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Dhillon PS, Butt W, Podlasek A, McConachie N, Lenthall R, Nair S, Malik L, Bhogal P, Makalanda HLD, Spooner O, Krishnan K, Sprigg N, Mortimer A, Booth TC, Lobotesis K, White P, James MA, Bath P, Dineen RA, England TJ. Association between time to treatment and clinical outcomes in endovascular thrombectomy beyond 6 hours without advanced imaging selection. J Neurointerv Surg 2023; 15:336-342. [PMID: 35296526 DOI: 10.1136/neurintsurg-2021-018564] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/24/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND The effectiveness and safety of endovascular thrombectomy (EVT) in the late window (6-24 hours) for acute ischemic stroke (AIS) patients selected without advanced imaging is undetermined. We aimed to assess clinical outcomes and the relationship with time-to-EVT treatment beyond 6 hours of stroke onset without advanced neuroimaging. METHODS Patients who underwent EVT selected with non-contrast CT/CT angiography (without CT perfusion or MR imaging), between October 2015 and March 2020, were included from a national stroke registry. Functional and safety outcomes were assessed in both early (<6 hours) and late windows with time analyzed as a continuous variable. RESULTS Among 3278 patients, 2610 (79.6%) and 668 (20.4%) patients were included in the early and late windows, respectively. In the late window, for every hour delay, there was no significant association with shift towards poorer functional outcome (modified Rankin Scale (mRS)) at discharge (adjusted common OR 0.98, 95% CI 0.94 to 1.01, p=0.27) or change in predicted functional independence (mRS ≤2) (24.5% to 23.3% from 6 to 24 hours; aOR 0.99, 95% CI0.94 to 1.04, p=0.85). In contrast, predicted functional independence was time sensitive in the early window: 5.2% reduction per-hour delay (49.4% to 23.5% from 1 to 6 hours, p=0.0001). There were similar rates of symptomatic intracranial hemorrhage (sICH) (3.4% vs 4.6%, p=0.54) and in-hospital mortality (12.9% vs 14.6%, p=0.33) in the early and late windows, respectively, without a significant association with time. CONCLUSION In this real-world study, there was minimal change in functional disability, sICH and in-hospital mortality within and across the late window. While confirmatory randomized trials are needed, these findings suggest that EVT remains feasible and safe when performed in AIS patients selected without advanced neuroimaging between 6-24 hours from stroke onset.
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Affiliation(s)
- Permesh Singh Dhillon
- Interventional Neuroradiology, Queens Medical Centre Nottingham University Hospitals NHS Trust, Nottingham, UK .,NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Waleed Butt
- Interventional Neuroradiology, Queen Elizabeth Hospital University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Anna Podlasek
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Norman McConachie
- Interventional Neuroradiology, Queens Medical Centre Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Robert Lenthall
- Interventional Neuroradiology, Queens Medical Centre Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Sujit Nair
- Interventional Neuroradiology, Queens Medical Centre Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Luqman Malik
- Interventional Neuroradiology, Queens Medical Centre Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Pervinder Bhogal
- Interventional Neuroradiology, The Royal London Hospital Barts Health NHS Trust, London, UK
| | | | - Oliver Spooner
- Stroke Medicine, The Royal London Hospital Barts Health NHS Trust, London, UK
| | - Kailash Krishnan
- Stroke Medicine, Queen's Medical Centre Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Nikola Sprigg
- Stroke Medicine, Queen's Medical Centre Nottingham University Hospital NHS Trust, Nottingham, UK.,Strokes Trial Unit, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Alex Mortimer
- Interventional Neuroradiology, Southmead Hospital North Bristol NHS Trust, Bristol, Bristol, UK
| | - Thomas Calvert Booth
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, London, UK.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, London, UK
| | - Kyriakos Lobotesis
- Interventional Neuroradiology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, London, UK
| | - Philip White
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Martin A James
- University of Exeter Medical School, Exeter, UK.,Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.,Sentinel Stroke National Audit Programme, King's College London, London, UK
| | - Philip Bath
- Stroke Medicine, Queen's Medical Centre Nottingham University Hospital NHS Trust, Nottingham, UK.,Strokes Trial Unit, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Robert A Dineen
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK.,Radiological Sciences, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Timothy J England
- Strokes Trial Unit, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK.,Stroke, Mental Health and Clinical Neuroscience, School of Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Stroke, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
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4
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Dhillon PS, Butt W, Marei O, Podlasek A, McConachie N, Lenthall R, Nair S, Malik L, Bhogal P, Makalanda HLD, Dineen RA, England TJ. Incidence and predictors of poor functional outcome despite complete recanalisation following endovascular thrombectomy for acute ischaemic stroke. J Stroke Cerebrovasc Dis 2023; 32:107083. [PMID: 36931092 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107083] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Numerous ischaemic stroke patients experience poor functional outcome despite successful recanalisation following endovascular thrombectomy (EVT). We aimed to identify the incidence and predictors of futile complete recanalisation (FCR) in a national stroke registry. METHODS Patients who achieved complete recanalisation (mTICI 3) following EVT, between October 2015 and March 2020, were included from a United Kingdom national stroke registry. Modified Rankin Scale of 4-6 at discharge was defined as a 'poor/futile outcome'. Backward stepwise multivariable logistic regression analysis was performed with FCR as the dependent variable, incorporating all baseline characteristics, procedural time metrics and post-procedural events. RESULTS We included 2132 of 4383 patients (48.8%) with complete recanalisation post-EVT, of which 948 patients (44.4%) developed FCR. Following multivariable regression analysis adjusted for potential confounders, patients with FCR were associated with multiple baseline patient, imaging and procedural factors: age (p=0.0001), admission NIHSS scores (p=0.0001), pre-stroke disability (p=0.007), onset-to-puncture (p=0.0001) and procedural times (p=0.0001), presence of diabetes (p=0.005), and use of general anaesthesia (p=0.0001). Although not predictive of outcome, post-procedural events including development of any intracranial haemorrhage (ICH) (p=0.0001), symptomatic ICH (sICH) (p=0.0001) and early neurological deterioration (END) (p=0.007) were associated with FCR. CONCLUSION Nearly half of patients in this national registry experienced FCR following EVT. Significant predictors of FCR included increasing age, admission NIHSS scores, pre-stroke disability, onset-to-puncture and procedural times, presence of diabetes, atrial fibrillation, and use of general anaesthesia. Post procedural development of any ICH, sICH, and END were associated with FCR.
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Affiliation(s)
- Permesh Singh Dhillon
- Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, UK; NIHR Nottingham Biomedical Research Centre, Nottingham, UK; Radiological Sciences, Mental Health & Clinical Neuroscience, School of Medicine, University of Nottingham, UK.
| | - Waleed Butt
- Interventional Neuroradiology, University Hospitals Birmingham NHS Trust, UK
| | - Omar Marei
- Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, UK; Radiological Sciences, Mental Health & Clinical Neuroscience, School of Medicine, University of Nottingham, UK
| | - Anna Podlasek
- Tayside Innovation Medtech Ecosystem (TIME), University of Dundee, UK
| | - Norman McConachie
- Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, UK
| | - Robert Lenthall
- Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, UK
| | - Sujit Nair
- Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, UK
| | - Luqman Malik
- Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, UK
| | - Pervinder Bhogal
- Interventional Neuroradiology, Barts Health NHS Trust, London, UK
| | | | - Robert A Dineen
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK; Radiological Sciences, Mental Health & Clinical Neuroscience, School of Medicine, University of Nottingham, UK
| | - Timothy J England
- Stroke Trials Unit, Mental Health & Clinical Neuroscience, School of Medicine, University of Nottingham, UK; Stroke, University Hospitals of Derby and Burton NHS Foundation Trust, UK
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5
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Dhillon PS, Butt W, Podlasek A, Barrett E, McConachie N, Lenthall R, Nair S, Malik L, James MA, Dineen RA, England TJ. Endovascular thrombectomy beyond 24 hours from ischemic stroke onset: a propensity score matched cohort study. J Neurointerv Surg 2023; 15:233-237. [PMID: 35169031 DOI: 10.1136/neurintsurg-2021-018591] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/30/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND The safety and functional outcome of endovascular thrombectomy (EVT) in the very late (VL; >24 hours) time window from ischemic stroke onset remains undetermined. METHODS Using data from a national stroke registry, we used propensity score matched (PSM) individual level data of patients who underwent EVT, selected with CT perfusion or non-contrast CT/CT angiography, between October 2015 and March 2020. Functional and safety outcomes were assessed in both late (6-24 hours) and VL time windows. Subgroup analysis was performed of imaging selection modality in the VL time window. RESULTS We included 1150 patients (late window: 1046 (208 after PSM); VL window: 104 (104 after PSM)). Compared with EVT treatment initiation between 6 and 24 hours, patients treated in the VL window had similar modified Rankin Scale (mRS) scores at discharge (ordinal shift; common OR=1.08, 95% CI 0.69 to 1.47, p=0.70). No significant differences in achieving good functional outcome (mRS ≤2 at discharge; 28.8% (VL) vs 29.3% (late), OR=0.97, 95% CI 0.58 to 1.64, p=0.93), successful reperfusion (modified Thrombolysis in Cerebral Infarction score of 2b-3) (p=0.77), or safety outcomes of symptomatic intracranial hemorrhage (p=0.43) and inhospital mortality (p=0.23) were demonstrated. In the VL window, there was no significant difference in functional outcome among patients selected with perfusion versus those selected without perfusion imaging (common OR=1.38, 95% CI 0.81 to 1.76, p=0.18). CONCLUSION In this real world study, EVT beyond 24 hours from stroke onset or last known well appeared to be feasible, with comparable safety and functional outcomes to EVT initiation between 6 and 24 hours. Randomized trials assessing the efficacy of EVT in the VL window are warranted, but may only be feasible with a large international collaborative approach.
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Affiliation(s)
- Permesh Singh Dhillon
- Interventional Neuroradiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK .,NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Waleed Butt
- Interventional Neuroradiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Anna Podlasek
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Emma Barrett
- Department of Research and Innovation (Medical Statistics), Manchester University NHS Foundation Trust, Manchester, UK.,Centre for Biostatistics, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Norman McConachie
- Interventional Neuroradiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Robert Lenthall
- Interventional Neuroradiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Sujit Nair
- Interventional Neuroradiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Luqman Malik
- Interventional Neuroradiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Martin A James
- Exeter Medical School, University of Exeter, Exeter, UK.,Stroke, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.,Sentinel Stroke National Audit Programme, King's College London, London, UK
| | - Robert A Dineen
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK.,Radiological Sciences, Mental Health and Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Timothy J England
- Stroke Trials Unit, Mental Health & Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK.,Stroke, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
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6
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Dhillon PS, Butt W, Podlasek A, McConachie N, Lenthall R, Nair S, Malik L, Booth TC, Bhogal P, Makalanda HLD, Spooner O, Mortimer A, Lamin S, Chavda S, Chew HS, Nader K, Al-Ali S, Butler B, Rajapakse D, Appleton JP, Krishnan K, Sprigg N, Smith A, Lobotesis K, White P, James MA, Bath PM, Dineen RA, England TJ. Perfusion Imaging for Endovascular Thrombectomy in Acute Ischemic Stroke Is Associated With Improved Functional Outcomes in the Early and Late Time Windows. Stroke 2022; 53:2770-2778. [PMID: 35506384 PMCID: PMC9389941 DOI: 10.1161/strokeaha.121.038010] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 11/16/2022]
Abstract
The impact on clinical outcomes of patient selection using perfusion imaging for endovascular thrombectomy (EVT) in patients with acute ischemic stroke presenting beyond 6 hours from onset remains undetermined in routine clinical practice.
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Affiliation(s)
- Permesh Singh Dhillon
- Interventional Neuroradiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, United Kingdom. (P.S.D., N.M., R.L., S.N., L.M.).,National Institute for Health and Care Research Nottingham Biomedical Research Centre, University of Nottingham, United Kingdom. (P.S.D., A.P., R.A.D.)
| | - Waleed Butt
- Interventional Neuroradiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Trust, United Kingdom (W.B., S.L., S.C., H.S.C., K.N., S.A.-A., B.B., D.R.)
| | - Anna Podlasek
- National Institute for Health and Care Research Nottingham Biomedical Research Centre, University of Nottingham, United Kingdom. (P.S.D., A.P., R.A.D.)
| | - Norman McConachie
- Interventional Neuroradiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, United Kingdom. (P.S.D., N.M., R.L., S.N., L.M.)
| | - Robert Lenthall
- Interventional Neuroradiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, United Kingdom. (P.S.D., N.M., R.L., S.N., L.M.)
| | - Sujit Nair
- Interventional Neuroradiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, United Kingdom. (P.S.D., N.M., R.L., S.N., L.M.)
| | - Luqman Malik
- Interventional Neuroradiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, United Kingdom. (P.S.D., N.M., R.L., S.N., L.M.)
| | - Thomas C Booth
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, United Kingdom (T.C.B.).,School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom (T.C.B.)
| | - Pervinder Bhogal
- Interventional Neuroradiology, The Royal London Hospital, Barts Health NHS Trust, United Kingdom. (P.B., H.L.D.M.)
| | | | - Oliver Spooner
- Stroke, The Royal London Hospital, Barts Health NHS Trust, United Kingdom. (O.S.)
| | - Alex Mortimer
- Interventional Neuroradiology, Southmead Hospital, North Bristol NHS Trust, United Kingdom (A.M.)
| | - Saleh Lamin
- Interventional Neuroradiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Trust, United Kingdom (W.B., S.L., S.C., H.S.C., K.N., S.A.-A., B.B., D.R.)
| | - Swarupsinh Chavda
- Interventional Neuroradiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Trust, United Kingdom (W.B., S.L., S.C., H.S.C., K.N., S.A.-A., B.B., D.R.)
| | - Han Seng Chew
- Interventional Neuroradiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Trust, United Kingdom (W.B., S.L., S.C., H.S.C., K.N., S.A.-A., B.B., D.R.)
| | - Kurdow Nader
- Interventional Neuroradiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Trust, United Kingdom (W.B., S.L., S.C., H.S.C., K.N., S.A.-A., B.B., D.R.)
| | - Samer Al-Ali
- Interventional Neuroradiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Trust, United Kingdom (W.B., S.L., S.C., H.S.C., K.N., S.A.-A., B.B., D.R.)
| | - Benjamin Butler
- Interventional Neuroradiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Trust, United Kingdom (W.B., S.L., S.C., H.S.C., K.N., S.A.-A., B.B., D.R.)
| | - Dilina Rajapakse
- Interventional Neuroradiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Trust, United Kingdom (W.B., S.L., S.C., H.S.C., K.N., S.A.-A., B.B., D.R.)
| | - Jason P Appleton
- Stroke, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, United Kingdom (J.P.A.).,Institute of Applied Health Research, College of Dental and Medical Sciences, University of Birmingham, United Kingdom (J.P.A.)
| | - Kailash Krishnan
- Stroke, Queens Medical Centre, Nottingham University Hospitals NHS Trust, United Kingdom. (K.K., N.S., P.M.B.)
| | - Nikola Sprigg
- Stroke, Queens Medical Centre, Nottingham University Hospitals NHS Trust, United Kingdom. (K.K., N.S., P.M.B.).,Stroke Trials Unit, Mental Health and Clinical Neuroscience, University of Nottingham, United Kingdom. (N.S., P.M.B., T.J.E.)
| | - Aubrey Smith
- Interventional Neuroradiology, Hull Royal Infirmary, Hull and East Yorkshire Hospitals NHS Trust, United Kingdom (A.S.)
| | - Kyriakos Lobotesis
- Interventional Neuroradiology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (K.L.)
| | - Phil White
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom (P.W.)
| | - Martin A James
- University of Exeter Medical School, United Kingdom (M.A.J.).,Royal Devon and Exeter NHS Foundation Trust, United Kingdom (M.A.J.).,Sentinel Stroke National Audit Programme, King's College London, United Kingdom (M.A.J.)
| | - Philip M Bath
- Stroke, Queens Medical Centre, Nottingham University Hospitals NHS Trust, United Kingdom. (K.K., N.S., P.M.B.).,Stroke Trials Unit, Mental Health and Clinical Neuroscience, University of Nottingham, United Kingdom. (N.S., P.M.B., T.J.E.)
| | - Robert A Dineen
- National Institute for Health and Care Research Nottingham Biomedical Research Centre, University of Nottingham, United Kingdom. (P.S.D., A.P., R.A.D.).,Radiological Sciences, Mental Health and Clinical Neuroscience, University of Nottingham, United Kingdom. (R.A.D.)
| | - Timothy J England
- Stroke Trials Unit, Mental Health and Clinical Neuroscience, University of Nottingham, United Kingdom. (N.S., P.M.B., T.J.E.).,Stroke, University Hospitals of Derby and Burton NHS Foundation Trust, United Kingdom (T.J.E.)
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7
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Dhillon PS, Butt W, Podlasek A, McConachie N, Lenthall R, Nair S, Malik L, Hewson DW, Bhogal P, Makalanda HLD, James MA, Dineen RA, England TJ. Association between anesthesia modality and clinical outcomes following endovascular stroke treatment in the extended time window. J Neurointerv Surg 2022; 15:478-482. [PMID: 35450928 DOI: 10.1136/neurintsurg-2022-018846] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/08/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND There is a paucity of data on anesthesia-related outcomes for endovascular treatment (EVT) in the extended window (>6 hours from ischemic stroke onset). We compared functional and safety outcomes between local anesthesia (LA) without sedation, conscious sedation (CS) and general anesthesia (GA). METHODS Patients who underwent EVT in the early (<6 hours) and extended time windows using LA, CS, or GA between October 2015 and March 2020 were included from a UK national stroke registry. Multivariable analyses were performed, adjusted for age, sex, baseline stroke severity, pre-stroke disability, EVT technique, center, procedural time and IV thrombolysis. RESULTS A total of 4337 patients were included, 3193 in the early window (1135 LA, 446 CS, 1612 GA) and 1144 in the extended window (357 LA, 134 CS, 653 GA). Compared with GA, patients treated under LA alone had increased odds of an improved modified Rankin Scale (mRS) score at discharge (early: adjusted common (ac) OR=1.50, 95% CI 1.29 to 1.74, p=0.001; extended: acOR=1.29, 95% CI 1.01 to 1.66, p=0.043). Similar mRS scores at discharge were found in the LA and CS cohorts in the early and extended windows (p=0.21). Compared with CS, use of GA was associated with a worse mRS score at discharge in the early window (acOR=0.73, 95% CI 0.45 to 0.96, p=0.017) but not in the extended window (p=0.55). There were no significant differences in the rates of symptomatic intracranial hemorrhage or in-hospital mortality across the anesthesia modalities in the extended window. CONCLUSION LA without sedation during EVT was associated with improved functional outcomes compared with GA, but not CS, within and beyond 6 hours from stroke onset. Prospective studies assessing anesthesia-related outcomes in the extended time window are warranted.
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Affiliation(s)
- Permesh Singh Dhillon
- Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, Nottingham, UK .,NIHR Nottingham Biomedical Research Centre, Nottingham, UK.,Stroke Trials Unit, Mental Health & Clinical Neuroscience, University of Nottingham School of Medicine, Nottingham, UK
| | - Waleed Butt
- Interventional Neuroradiology, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Anna Podlasek
- Tayside Innovation Medtech Ecosystem (TIME), University of Dundee, Dundee, UK
| | - Norman McConachie
- Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Robert Lenthall
- Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Sujit Nair
- Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Luqman Malik
- Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - David W Hewson
- Anaesthesia and Critical Care Research Group, Academic Unit of Injury Inflammation and Recovery Sciences, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Pervinder Bhogal
- Interventional Neuroradiology, Barts Health NHS Trust, London, UK
| | | | - Martin A James
- Exeter Medical School, University of Exeter Medical School, Exeter, UK.,Stroke, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.,Sentinel Stroke National Audit Programme, King's College London, London, UK
| | - Robert A Dineen
- Radiological Sciences, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Timothy J England
- Stroke Trials Unit, Mental Health & Clinical Neuroscience, University of Nottingham School of Medicine, Nottingham, UK.,Stroke, University Hospitals of Derby and Burton NHS Foundation Trust, Nottingham, UK
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8
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Malik L, Nath A, Nandy S, Laurell T, Sen AK. Acoustic particle trapping driven by axial primary radiation force in shaped traps. Phys Rev E 2022; 105:035103. [PMID: 35428152 DOI: 10.1103/physreve.105.035103] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 02/17/2022] [Indexed: 06/14/2023]
Abstract
We study particle trapping driven by the axial primary radiation force (A-PRF) in shaped traps exposed to standing bulk acoustic waves (S-BAW) using numerical simulations and experiments. The utilization of the stronger A-PRF as the main retention force is a consequence of standing-wave formation along the flow direction, instead of the orthogonal direction as in the case of traditionally used lateral-PRF S-BAW trapping setups. The study of particle dynamics reveals that the competition between A-PRF and viscous drag force governs particle trajectory. The ratio of the acoustic energy to the viscous work (β) provides a general criterion for particle trapping at a distinctive off-node site that is spatially controllable. Particles get trapped for β≥β_{cr} at some distance away from the nodal plane and the distance varies as β^{-c} (c=0.6-1.0). The use of A-PRF as the retention force could potentially allow traditional S-BAW trapping systems to envisage high-throughput advancements surpassing the current standards in cell-handling unit operations.
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Affiliation(s)
- L Malik
- Fluid Systems Lab, Dept. of Mechanical Engineering, Indian Institute of Technology Madras, Chennai-600036, India
| | - A Nath
- Fluid Systems Lab, Dept. of Mechanical Engineering, Indian Institute of Technology Madras, Chennai-600036, India
| | - S Nandy
- Fluid Systems Lab, Dept. of Mechanical Engineering, Indian Institute of Technology Madras, Chennai-600036, India
| | - T Laurell
- Division of Nanobiotechnology, Department of Biomedical Engineering, Lund University, Lund University, 221 84 Lund, Sweden
| | - A K Sen
- Fluid Systems Lab, Dept. of Mechanical Engineering, Indian Institute of Technology Madras, Chennai-600036, India
- Micro Nano Bio -Fluidics Group, Indian Institute of Technology Madras, Chennai-600036, India
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9
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Malik L, Butt W, Dhillon PS, Lenthall R. Isolated clival subdural haemorrhage from a dolicoectactic vertebrobasilar aneurysm: Case report and overview of endovascular treatment strategies. J Cerebrovasc Endovasc Neurosurg 2021; 23:365-371. [PMID: 34963259 PMCID: PMC8743819 DOI: 10.7461/jcen.2021.e2020.12.004] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 07/17/2021] [Indexed: 11/23/2022] Open
Abstract
Posterior fossa aneurysms presenting with isolated subdural haemorrhage (SDH) have scarcely been described with no cases attributed to a vertebrobasilar (VB) location. Non-saccular VB aneurysms are a distinct sub-group and in this report we also discuss the pathophysiology and treatment options for these difficult-to-manage lesions. We present a case of a 49 year-old man who presented with a 7-day history of severe headaches who was found to have an isolated acute clival SDH. Vascular imaging revealed a VB dolicoectatic segment with superimposed fusiform dilatations that contacted the dura adjacent to the SDH. A staged treatment was performed with initial parental vessel occlusion of the ruptured vertebral artery segment and subsequent insertion of a braided stent (LEO) with flow diverting properties into the progressively dilating basilar artery. A third procedure was performed to occlude a recurrent pouch at the lower basilar dilatation. Complete angiographic occlusion was achieved and the patient is under continued surveillance. To our knowledge, this is the first case of a ruptured non-saccular VB aneurysm presenting with radiologically isolated clival SDH. Clinical history will often inform the need for vascular imaging in such atypical presentations. Managing these lesions remains an endovascular challenge and requires a specialist multi-disciplinary approach.
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Affiliation(s)
- Luqman Malik
- Interventional Neuroradiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Waleed Butt
- Interventional Neuroradiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Permesh Singh Dhillon
- Interventional Neuroradiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Robert Lenthall
- Interventional Neuroradiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
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10
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Butt W, Dhillon PS, Lenthall R, Malik L, Izzath W, Krishnan K, George B, Pointon K. Left Atrial Enlargement on Non-Gated CT Is Associated with Large Vessel Occlusion in Acute Ischaemic Stroke. Cerebrovasc Dis Extra 2021; 11:87-91. [PMID: 34551410 PMCID: PMC8543283 DOI: 10.1159/000519121] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/17/2021] [Indexed: 11/29/2022] Open
Abstract
Background Recent reports have suggested that atrial fibrillation (AF) is more prevalent in the large vessel occlusion (LVO) subgroup of acute ischaemic stroke patients. Given the association between left atrial enlargement (LAE) and AF, we sought to evaluate the feasibility of assessing LAE on non-gated CT and its association with LVO in the hyperacute stroke setting. Methods We analysed our prospectively collected database that included all stroke patients referred for consideration of endovascular treatment between April 14, 2020, and May 21, 2020. During this period, a CT chest was included in our regional stroke protocol to aid triage of patients suspected for COVID-19 from which cardiac measurements were obtained. Patients were dichotomized into LVO and no-LVO groups, and LA measurements were trichotomized into normal, borderline, and enlarged. Univariate analyses were performed between groups. Results Of the included 38 patients, 21 were categorized as LVO and 17 as no LVO. There was a statistically significant association between LAE and LVO (p = 0.028). No significant difference was demonstrated between groups for the baseline AF and other clinical characteristics, except for baseline NIHSS (p = 0.0005). There was excellent inter- and intra-rater reliability (ICC = 0.969) for LA measurements. Conclusion Our study provides preliminary data to suggest LAE is more prevalent in the LVO stroke subgroup at presentation and can be reliably assessed on non-gated CT in the hyperacute setting. These findings have potential implications for stratifying secondary management and may prompt a more rigorous pursuit of occult AF or other cardiac causes of stroke.
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Affiliation(s)
- Waleed Butt
- Interventional Neuroradiology Department, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Permesh Singh Dhillon
- Interventional Neuroradiology Department, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Robert Lenthall
- Interventional Neuroradiology Department, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Luqman Malik
- Interventional Neuroradiology Department, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Wazim Izzath
- Interventional Neuroradiology Department, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Kailash Krishnan
- Stroke Medicine, Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Bindu George
- Cardiothoracic Radiology Department, Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Kate Pointon
- Cardiothoracic Radiology Department, Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
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11
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Butt W, Dhillon PS, Podlasek A, Malik L, Nair S, Hewson D, England TJ, Lenthall R, McConachie N. Local anesthesia as a distinct comparator versus conscious sedation and general anesthesia in endovascular stroke treatment: a systematic review and meta-analysis. J Neurointerv Surg 2021; 14:221-226. [PMID: 33758063 DOI: 10.1136/neurintsurg-2021-017360] [Citation(s) in RCA: 11] [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: 01/22/2021] [Revised: 03/05/2021] [Accepted: 03/05/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The optimal anesthetic modality for endovascular treatment (EVT) in acute ischemic stroke (AIS) is undetermined. Comparisons of general anesthesia (GA) with composite non-GA cohorts of conscious sedation (CS) and local anesthesia (LA) without sedation have provided conflicting results. There has been emerging interest in assessing whether LA alone may be associated with improved outcomes. We conducted a systematic review and meta-analysis to evaluate clinical and procedural outcomes comparing LA with CS and GA. METHODS We reviewed the literature for studies reporting outcome variables in LA versus CS and LA versus GA comparisons. The primary outcome was 90 day good functional outcome (modified Rankin Scale (mRS) score of ≤2). Secondary outcomes included mortality, symptomatic intracerebral hemorrhage, excellent functional outcome (mRS score ≤1), successful reperfusion (Thrombolysis in Cerebral Infarction (TICI) >2b), procedural time metrics, and procedural complications. Random effects meta-analysis was performed on unadjusted and adjusted data. RESULTS Eight non-randomized studies of 7797 patients (2797 LA, 2218 CS, and 2782 GA) were identified. In the LA versus GA comparison, no statistically significant differences were found in unadjusted analyses for 90 day good functional outcome or mortality (OR=1.22, 95% CI 0.84 to 1.76, p=0.3 and OR=0.83, 95% CI 0.64 to 1.07, p=0.15, respectively) or in the LA versus CS comparison (OR=1.14, 95% CI 0.76 to 1.71, p=0.53 and OR=0.88, 95% CI 0.62 to 1.24, p=0.47, respectively). There was a tendency towards achieving excellent functional outcome (mRS ≤1) in the LA group versus the GA group (OR=1.44, 95% CI 1.00 to 2.08, p=0.05, I2=70%). Analysis of adjusted data demonstrated a tendency towards higher odds of death at 90 days in the GA versus the LA group (OR=1.24, 95% CI 1.00 to 1.54, p=0.05, I2=0%). CONCLUSION LA without sedation was not significantly superior to CS or GA in improving outcomes when performing EVT for AIS. However, the quality of the included studies impaired interpretation, and inclusion of an LA arm in future well designed multicenter, randomized controlled trials is warranted.
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Affiliation(s)
- Waleed Butt
- Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Permesh Singh Dhillon
- Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, Nottingham, Nottinghamshire, UK
| | - Anna Podlasek
- NIHR Nottingham Biomedical Research Centre, Nottingham, Nottinghamshire, UK
| | - Luqman Malik
- Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Sujit Nair
- Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - David Hewson
- Anaesthesia and Critical Care Research Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Timothy J England
- Vascular Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK.,Vascular Medicine, Division of Medical Sciences and GEM, School of Medicine, University of Nottingham, Nottingham, UK
| | - Robert Lenthall
- Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Norman McConachie
- Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
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12
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Butt W, Malik L, Dhillon PS, McConachie N. Flow-related posterior cerebral artery aneurysms with internal carotid artery occlusions: An institutional series. Interv Neuroradiol 2021; 27:631-637. [PMID: 33673757 DOI: 10.1177/15910199211001702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Aneurysm formation after internal carotid artery (ICA) occlusion has been described in animal models and human case series with alteration of cerebral blood flow dynamics considered an aetiological risk factor. Such de novo aneurysms have seldom been described in the posterior cerebral artery (PCA) with the majority observed in the anterior circulation collateral pathways. METHODS We retrospectively reviewed our institutional database of posterior circulation aneurysms in patients with iatrogenic, atherosclerotic or congenital ICA occlusions. A comprehensive review of the online literature using the PubMed and Medline databases was performed to identify previous cases of PCA aneurysms that were considered 'flow-related'. RESULTS We present five patients with symptomatic or ruptured PCA aneurysms with ICA occlusions. Age at presentation ranged from 21-58 and aneurysm size from 3-12 mm. All cases had angiographic evidence of posterior-anterior flow via the ipsilateral posterior communicating artery (PComA). The clinical presentation, diagnostic imaging and management strategies are further discussed. A literature review identified only two previous reported cases. CONCLUSION To our knowledge this is the first single centre series of posterior circulation aneurysms in patients with ICA occlusions that are considered to be 'flow-related.' The natural history of these rare lesions is unclear and the best management and surveillance strategy requires a patient-tailored approach by an experienced neurovascular team.
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Affiliation(s)
- Waleed Butt
- Interventional Neuroradiology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Luqman Malik
- Interventional Neuroradiology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Permesh Singh Dhillon
- Interventional Neuroradiology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Norman McConachie
- Interventional Neuroradiology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
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13
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Evans N, Anton A, Wong R, Lok S, De Boer R, Malik L, Greenberg S, Yeo B, Nott L, Richardson G, Collins I, Torres J, Barnett F, Gibbs P, Devitt B. 51P Real world outcomes in elderly women with HER2-positive advanced breast cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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14
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Conduit C, Boer RH, Lok S, Gibbs P, Malik L, Loh Z, Yeo B, Greenberg S, Devitt B, Lombard J, Nottage M, Collins I, Torres J, Nolan M, Nott L. Real‐world impact of anti‐HER2 therapy‐related cardiotoxicity in patients with advanced HER2‐positive breast cancer. Asia Pac J Clin Oncol 2020; 16:356-362. [DOI: 10.1111/ajco.13381] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 05/07/2020] [Indexed: 11/26/2022]
Affiliation(s)
- C. Conduit
- Medical Oncology Peter MacCallum Cancer Centre Melbourne Australia
- Medical Oncology Royal Hobart Hospital Hobart Australia
| | - R. H Boer
- Medical Oncology Western Health Melbourne Australia
| | - S. Lok
- Medical Oncology Peter MacCallum Cancer Centre Melbourne Australia
| | - P. Gibbs
- Walter and Eliza Hall Institute of Medical Research andMedical Oncology Melbourne Health Melbourne Australia
| | - L. Malik
- Medical Oncology Canberra Hospital Canberra Australia
| | - Z. Loh
- Medical Oncology Austin Health Melbourne Australia
| | - B. Yeo
- Medical Oncology Austin Health Melbourne Australia
- Medical Oncology Olivia Newton‐John Cancer Research Institute Melbourne Australia
| | - S. Greenberg
- Medical Oncology Western Health Melbourne Australia
| | - B. Devitt
- Medical Oncology Eastern Health Clinical School Melbourne Australia
| | - J. Lombard
- Medical Oncology Calvary Mater Newcastle Australia
| | - M. Nottage
- Medical Oncology Royal Brisbane Hospital Brisbane Australia
| | - I. Collins
- Deakin University Geelong Australia
- Medical Oncology South West Healthcare Warrnambool Australia
| | - J. Torres
- Medical Oncology Goulburn Valley Health Shepparton Australia
| | - M. Nolan
- Cardiology Western Health Melbourne Australia
| | - L. Nott
- Medical Oncology Royal Hobart Hospital Hobart Australia
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15
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Semenenko S, Semenenko A, Malik S, Semenenko N, Malik L. EVALUATION OF THE EFFECT OF ADEMOL ON THE DYNAMICS OF NEURON-SPECIFIC ENOLASE IN TRAUMATIC BRAIN INJURY IN RATS. Georgian Med News 2020:123-126. [PMID: 32672703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The great hopes of modern medicine for neuroprotective therapy have stimulated scientists around the world to actively search for new effective means of influencing the pathophysiological cascades of the development of neuronal damage. Aim. To evaluate the effect of the use of the adamantane derivative 1-adamantylethyloxa-3-morpholino-2-propanol hydrochloride (ademol) compared with amantadine sulfate and 0.9% NaCl solution on the activity dynamics of neuron-specific enolase in rats with acute traumatic brain injury (TBI) . The therapeutic effect of ademol in experimental traumatic brain injury was evaluated using a dose of 2 mg/kg (i/v) every 12 hours for 8 days. The pseudo-operated animals and the control group received a 0.9% NaCl solution at a dose of 2 ml/kg i/v, and the comparison group received amantadine sulfate at a dose of 5 mg/kg in the same mode. To determine the effectiveness of the studied drugs in brain injury, the level of neuron-specific enolase (NSE) was used. The course infusion in rats with TBI of solutions of ademol (2 mg/kg) and amantadine sulfate (5 mg/kg) during the 8 days of the TBI model, significantly reduced the increase in the NSE level in animals of the control pathology group by an average of 52.1 and 38.2%. Thus, the results obtained indicate that when using ademol at a dose of 2 mg/kg i/v and amantadine sulfate (5 mg/kg i/v), powerful neurocytoprotective properties appear against the background of a model head injury. Moreover, the neuroprotective effect of ademol manifested itself more clearly, since in terms of the ability to prevent the increase in NSE levels, it significantly dominated the reference drug by an average of 22.5%.
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Affiliation(s)
- S Semenenko
- National Pirogov Memorial Medical University, Vinnytsya, Ukraine
| | - A Semenenko
- National Pirogov Memorial Medical University, Vinnytsya, Ukraine
| | - S Malik
- National Pirogov Memorial Medical University, Vinnytsya, Ukraine
| | - N Semenenko
- National Pirogov Memorial Medical University, Vinnytsya, Ukraine
| | - L Malik
- National Pirogov Memorial Medical University, Vinnytsya, Ukraine
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16
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Malik L. Treating breast cancer with trabectedin: a new arsenal. Ann Oncol 2014; 25:2094-2095. [PMID: 25057176 DOI: 10.1093/annonc/mdu262] [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] [Indexed: 11/13/2022] Open
Affiliation(s)
- L Malik
- Institute for Drug Development, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, USA.
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Affiliation(s)
- L Malik
- Institute for Drug Development, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio,USA
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Legutko J, Hartwich A, Szpakowicz J, Kedra B, Haxhijaha S, Malik L. [Hormonal islet cell tumors. Proposition of a diagnostic-therapeutic model]. Przegl Lek 1999; 55:463-8. [PMID: 10085725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Islet cell tumors make a serious therapeutic problem due to their specific clinical presentation and the necessity of applying a variety of multidisciplinary diagnostic and therapeutic methods. The authors present their own algorithm for diagnosing and treatment of islet-cell tumors worked out basing on many-year experience.
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Affiliation(s)
- J Legutko
- I Katedry Chirurgii Ogólnej i Kliniki Chirurgii Gastroenterologicznej, Collegium Medicum, Uniwersytetu Jagiellońskiego w Krakowie
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Staško A, Malik L, Tkač A, Pelikán P. Bildung paramagnetischer Produkte bei Reaktionen metallorganischer Verbindungen. Z PHYS CHEM 1980. [DOI: 10.1515/zpch-1980-261143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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20
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Sawyer PN, Adamson R, Butt K, Fitzgerald J, Haque S, Landi J, Malik L, Mistry F, Ramasamy N, Reddy K, Stanczewski B, Kirschenbaum D. Long-term function of NCGT vascular conduits in a multicenter trial: evaluation of physical chemical parameters. Biomater Med Devices Artif Organs 1980; 8:345-67. [PMID: 7023557 DOI: 10.3109/10731198009118989] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Our experience with the NCGT graft has now encompassed 12 years in experimental animals and 4.5 years clinical experience with 134 grafts in man. It has previously been suggested that vessel wall structure, interface-charge, electric potential, and polarity of the blood intimal interface appear critical in the prevention of intravascular thrombosis in all vascular prosthetic bypass grafts. This concept has now been confirmed using ferritin, colloidal iron and fluorescamine intimal labelling. These provide a quantitative special characterization of the surface charges of several grafts, including the NCGT graft. Study indicates that each step in the production of the NCGT graft results in a cumulative increase in the structured negative charge of the vascular interface. The more dense the structured negative charge of the prosthesis, the more resistant is the graft to short and long-term thrombosis in experimental animals and man. The experience has been confirmed with a comparative analysis of implantation results in 105 patients up to 4.5 years with 65 to 70% patency rate over that time interval. Statistical analysis of parameters confirm again that the polarity and structure of the vascular interface is important in the effective function and patency rate of the grafts.
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Dass A, Malik L. Prediabetes and pregnancy. J Indian Med Assoc 1969; 53:6-10. [PMID: 5343450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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