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Article ; Online: Initial experience of using a large-bore (0.096″ inner diameter) access catheter in neurovascular interventions.

Starke, Robert M / Abecassis, Isaac Josh / Saini, Vasu / Matouk, Charles C / Hassan, Ameer E / Siddiqui, Adnan H / Frei, Donald F

Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences

2022 , Page(s) 15910199221127074

Abstract: Introduction: The purpose of this study was to report our initial experience of using a large-bore (0.096″ inner diameter) access catheter in neurovascular interventions.: Methods: Data were retrospectively collected from 5 sites in the US for ... ...

Abstract	Introduction: The purpose of this study was to report our initial experience of using a large-bore (0.096″ inner diameter) access catheter in neurovascular interventions. Methods: Data were retrospectively collected from 5 sites in the US for neurovascular procedures performed using a large-bore access catheter. The effectiveness outcome was technical success, defined as the access catheter's successfully reaching its target vessel without conversion to direct carotid puncture or to a smaller-bore access catheter and successfully completing the intended neurointervention. Results: One hundred and thirteen procedures performed in 112 patients were included in this study. The mean age of the patients was 67.5 years (SD 16.2), and about half (49.1%) were female. The most common primary access sites were the femoral (64.6%) or radial (32.7%) artery. Challenging anatomic variations included severe vessel tortuosity (26/81, 32.1%), type II aortic arch (17/88, 19.3%), type III aortic arch (14/88, 15.9%), bovine arch (16/104, 15.4%), severe angle (<30°) between the subclavian and target vessel (11/74, 14.9%), and subclavian loop (7/79, 8.9%). The median access time to branch view was 18 min (IQR 11-28, N = 75). The technical success rate was 94.7%. Two dissections (1.8%) were related to the large-bore access catheter. Access site complications occurred in 2 patients (1.8%). Four additional symptomatic periprocedural complications not related to the large-bore access catheter occurred (7.1%). Conclusion: For neurovascular interventions, a 0.096″ inner diameter access catheter could be used with both femoral and radial arterial approaches, had a high technical success rate, and had a low rate of periprocedural complications.
Language	English
Publishing date	2022-09-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	1354913-3
ISSN	2385-2011 ; 1591-0199 ; 1123-9344
ISSN (online)	2385-2011
ISSN	1591-0199 ; 1123-9344
DOI	10.1177/15910199221127074
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Article: Cost-Effectiveness of Late Endovascular Thrombectomy vs. Best Medical Management in a Clinical Trial Setting and Real-World Setting.

Ospel, Johanna Maria / Zerna, Charlotte / Harrison, Emma / Kleinig, Timothy J / Puetz, Volker / Kaiser, Daniel P O / Graham, Brett / Yu, Amy Y X / van Adel, Brian / Shankar, Jai J / McTaggart, Ryan A / Pereira, Vitor / Frei, Donald F / Kunz, Wolfgang G / Goyal, Mayank / Hill, Michael D

The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques

2024 , Page(s) 1–8

Abstract: Background and purpose: To assess cost-effectiveness of late time-window endovascular treatment (EVT) in a clinical trial setting and a "real-world" setting.: Methods: Data are from the randomized ESCAPE trial and a prospective cohort study (ESCAPE- ... ...

Abstract	Background and purpose: To assess cost-effectiveness of late time-window endovascular treatment (EVT) in a clinical trial setting and a "real-world" setting. Methods: Data are from the randomized ESCAPE trial and a prospective cohort study (ESCAPE-LATE). Anterior circulation large vessel occlusion patients presenting > 6 hours from last-known-well were included, whereby collateral status was an inclusion criterion for ESCAPE but not ESCAPE-LATE. A Markov state transition model was built to estimate lifetime costs and quality-adjusted life-years (QALYs) for EVT in addition to best medical care vs. best medical care only in a clinical trial setting (comparing ESCAPE-EVT to ESCAPE control arm patients) and a "real-world" setting (comparing ESCAPE-LATE to ESCAPE control arm patients). We performed an unadjusted analysis, using 90-day modified Rankin Scale(mRS) scores as model input and analysis adjusted for baseline factors. Acceptability of EVT was calculated using upper/lower willingness-to-pay thresholds of 100,000 USD/50,000 USD/QALY. Results: Two-hundred and forty-nine patients were included (ESCAPE-LATE: Conclusion: EVT for LVO-patients presenting beyond 6 hours was cost effective in the clinical trial setting and "real-world" setting, although this was largely related to baseline patient differences favoring the "real-world" EVT group. After adjusting for these, EVT benefit was reduced in the trial setting, and absent in the real-world setting.
Language	English
Publishing date	2024-02-26
Publishing country	England
Document type	Journal Article
ZDB-ID	197622-9
ISSN	0317-1671
ISSN	0317-1671
DOI	10.1017/cjn.2024.19
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Article ; Online: Timing of Anticoagulation in Patients with Cerebral Venous Thrombosis Requiring Decompressive Surgery: Systematic Review of the Literature and Case Series.

Salottolo, Kristin / Bartt, Russell / Frei, Donald F / Bellon, Richard J / Atchie, Benjamin / McCarthy, Kathryn / Bar-Or, David

World neurosurgery

2020 Volume 137, Page(s) 408–414

Abstract: Objective: Cerebral venous thrombosis (CVT) is a rare type of stroke whose pathophysiology differs from arterial stroke. CVT is treated with systemic anticoagulant therapy even in the setting of intracerebral hemorrhage. Patients who do not respond ... ...

Abstract	Objective: Cerebral venous thrombosis (CVT) is a rare type of stroke whose pathophysiology differs from arterial stroke. CVT is treated with systemic anticoagulant therapy even in the setting of intracerebral hemorrhage. Patients who do not respond adequately may require decompressive surgery. The study objective was to examine the timing of anticoagulation in patients with CVT who require decompressive surgery through systematic literature review and consecutive case series. Methods: A review of the literature was performed through PubMed using key word search to identify case series and cohort studies examining timing of anticoagulation following decompressive surgery. Our case series included 4 patients who had decompressive surgery for hemorrhagic CVT between 1 January, 2015 and 31 December, 2016 at our comprehensive stroke center. Results: The literature review summarizes 243 patients from 15 studies whose timing of anticoagulation varied. The review suggests anticoagulation can be safely resumed at 48 hours postoperatively based on larger series and as early as 12 hours in smaller series, especially when delivered as a half or prophylactic dose. In our case series, timing of anticoagulation varied slightly but was started or resumed within 38-44 hours postoperatively in 3 patients and was started at the time of decompressive surgery without interruption in 1 patient. No patient had worsening hemorrhage or new hemorrhage while 2 patients rethrombosed. Conclusions: Despite the lack of high-quality studies, this systematic review of patients with CVT requiring decompressive surgery indicates that anticoagulation can be safely initiated or resumed around 24-48 hours postoperatively; our series supports the existing literature.
MeSH term(s)	Adult ; Anticoagulants/administration & dosage ; Anticoagulants/adverse effects ; Cerebral Angiography ; Cerebral Hemorrhage/chemically induced ; Decompressive Craniectomy/methods ; Endovascular Procedures ; Female ; Heparin/administration & dosage ; Heparin/adverse effects ; Heparin Antagonists/therapeutic use ; Humans ; Male ; Middle Aged ; Postoperative Hemorrhage/chemically induced ; Postoperative Period ; Protamines/therapeutic use ; Sinus Thrombosis, Intracranial/therapy ; Thrombectomy ; Thrombolytic Therapy ; Time Factors
Chemical Substances	Anticoagulants ; Heparin Antagonists ; Protamines ; Heparin (9005-49-6)
Language	English
Publishing date	2020-02-24
Publishing country	United States
Document type	Journal Article ; Systematic Review
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2020.02.084
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Article ; Online: Effect of Endovascular Thrombectomy for Acute Ischemic Stroke on Cognitive Outcomes: A Secondary Analysis of the ESCAPE Trial.

Joundi, Raed A / Smith, Eric E / Mandzia, Jennifer / Ganesh, Aravind / Menon, Bijoy K / Rempel, Jeremy L / Thornton, John / Roy, Daniel / Jovin, Tudor G / Dowlatshahi, Dar / Frei, Donald F / Bharatha, Aditya / Poppe, Alexandre / Silver, Frank L / Shuaib, Ashfaq / Teitelbaum, Jeanne S / Williams, David / Bang, Oh Young / Sapkota, Biggya L /

Burns, Paul / Choe, Hana / Heo, Jie-Hoe / Kelly, Michael E / Linares, Guillermo / Shankar, Jai J / Sohn, Sung-Il / Swartz, Richard H / Barber, Philip / Coutts, Shelagh B / Demchuk, Andrew / Goyal, Mayank / Hill, Michael D

Neurology

2024 Volume 102, Issue 10, Page(s) e209270

Abstract: Background and objectives: The effect of endovascular therapy (EVT) for large vessel occlusion stroke on cognitive outcomes is not well understood. We evaluated the effect of EVT on cognitive function in the Endovascular Treatment for Small Core and ... ...

Abstract	Background and objectives: The effect of endovascular therapy (EVT) for large vessel occlusion stroke on cognitive outcomes is not well understood. We evaluated the effect of EVT on cognitive function in the Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times (ESCAPE) trial. Methods: Patient data from the ESCAPE randomized trial were analyzed. Cognitive assessments completed at 90 days after stroke were the Montreal Cognitive Assessment (MoCA), the Sunnybrook Neglect Assessment Procedure (SNAP), the Boston Naming Test (BNT), Trail-making test A (Trails A), and Trail-making test B (Trails B). We used logistic regression to evaluate the association between EVT and favorable cognitive outcome on the 5 separate tests, adjusting for demographic and clinical factors. We used generalized estimating equations and ordinal regression to determine the odds of favorable outcome with EVT on global cognition incorporating the 5 tests. We added final infarct volume (FIV) to the models to assess the relationship of FIV with cognitive outcome. Results: The ESCAPE trial included 315 patients, 165 randomized to EVT and 150 randomized to control. There was higher odds of favorable outcome with EVT for MoCA (adjusted odds ratio [aOR] 2.32, 95% CI 1.30-4.16), SNAP (aOR 3.85, 95% CI 2.00-7.45), BNT (aOR 2.33, 95% CI 1.30-4.17), trails A (aOR 3.50, 95% CI 1.93-6.36), and trails B (aOR 2.56, 95% CI 1.46-4.48). There was higher odds of favorable outcome with EVT on global binary (aOR 2.57, 95% CI 1.67-3.94) and ordinal analyses (aOR 2.83, 95% CI 1.68-4.76) of cognitive function. After adding FIV to the models, both FIV and EVT were significantly associated with cognitive outcome. There was a significant correlation between global cognitive performance and mRS at day 90 ( Discussion: In this secondary analysis of the ESCAPE trial, EVT was associated with favorable outcome on 5 separate cognitive tests and in global analyses of cognitive benefit. These results provide novel evidence for the effect of EVT on cognition and support the global benefit of treatment with EVT. Classification of evidence: This study provides Class II evidence that in patients with acute ischemic stroke due to intracranial internal carotid artery (ICA) or M1 segment MCA occlusion, including tandem extracranial ICA occlusions, EVT compared with best medical therapy increased odds of favorable cognitive outcome.
MeSH term(s)	Humans ; Male ; Female ; Ischemic Stroke/surgery ; Ischemic Stroke/therapy ; Endovascular Procedures/methods ; Aged ; Thrombectomy/methods ; Middle Aged ; Treatment Outcome ; Cognition/physiology ; Neuropsychological Tests ; Aged, 80 and over
Language	English
Publishing date	2024-05-13
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	207147-2
ISSN	1526-632X ; 0028-3878
ISSN (online)	1526-632X
ISSN	0028-3878
DOI	10.1212/WNL.0000000000209270
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Article ; Online: 'Time' for success.

Zaidat, Osama O / Lazzaro, Marc A / Gupta, Rishi / Rasmussen, Peter A / Frei, Donald F / Goyal, Mayank

Journal of neurointerventional surgery

2013 Volume 5, Issue 5, Page(s) 391–392

MeSH term(s)	Brain Ischemia/surgery ; Emergency Medical Services ; Endovascular Procedures/methods ; Humans ; Stroke/surgery ; Thrombectomy ; Thrombolytic Therapy ; Treatment Outcome ; Triage
Language	English
Publishing date	2013-09-01
Publishing country	England
Document type	Editorial
ZDB-ID	2514982-9
ISSN	1759-8486 ; 1759-8478
ISSN (online)	1759-8486
ISSN	1759-8478
DOI	10.1136/neurintsurg-2013-010868
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Article ; Online: Epidemiology, Endovascular Treatment, and Prognosis of Cerebral Venous Thrombosis: US Center Study of 152 Patients.

Salottolo, Kristin / Wagner, Jeffrey / Frei, Donald F / Loy, David / Bellon, Richard J / McCarthy, Kathryn / Jensen, Judd / Fanale, Christopher / Bar-Or, David

Journal of the American Heart Association

2017 Volume 6, Issue 6

Abstract: Background: Cerebral venous thrombosis is a rare cause of stroke that poses diagnostic, therapeutic, and prognostic challenges. Mainstay treatment is systemic anticoagulation, but endovascular treatment is increasingly advocated. Our objectives were to ... ...

Abstract	Background: Cerebral venous thrombosis is a rare cause of stroke that poses diagnostic, therapeutic, and prognostic challenges. Mainstay treatment is systemic anticoagulation, but endovascular treatment is increasingly advocated. Our objectives were to describe the epidemiology, treatment, and prognosis of 152 patients with cerebral venous thrombosis. Methods and results: This was a retrospective study of consecutive cerebral venous thrombosis cases from 2006 to 2013 at a comprehensive stroke center through hospital discharge. Predictors of full recovery (modified Rankin Scale scores 0-1) were analyzed with multiple logistic regression and presented as adjusted odds ratios (AORs) with 95% confidence intervals (CIs). The population was young (average age: 42 years), majority female (69%), and commonly presenting with cerebral edema (63%), and 72% were transferred in. All patients received systemic anticoagulation; 49% (n=73) required endovascular treatment. Reasons for requiring endovascular treatment included cerebral edema, herniation, or hemorrhagic infarct (n=38); neurologic decline (n=17); rethrombosis, persistent occlusion, or clot propagation (n=10); extensive clot burden (n=7); and persistent headache despite anticoagulation (n=1). There were 7 (10%) procedural complications. Recanalization was successful (61%), partial (30%), and unsuccessful (9%). Overall, 60% fully recovered. Positive predictors of full recovery included hormonal etiology, particularly for patients who were transferred in (AOR: 7.06 [95% CI, 2.27-21.96], interaction Conclusions: As one of the largest cohort studies, our findings suggest that cerebral edema, history of migraine, and hormonal etiology were prognostic and that endovascular treatment might be a safe and effective treatment for cerebral venous thrombosis when conventional management is inadequate.
Language	English
Publishing date	2017-06-13
Publishing country	England
Document type	Journal Article
ZDB-ID	2653953-6
ISSN	2047-9980 ; 2047-9980
ISSN (online)	2047-9980
ISSN	2047-9980
DOI	10.1161/JAHA.117.005480
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Article ; Online: Acute ischemic stroke with tandem lesions: technical endovascular management and clinical outcomes from the ESCAPE trial.

Assis, Zarina / Menon, Bijoy K / Goyal, Mayank / Demchuk, Andrew M / Shankar, Jai / Rempel, Jeremy L / Roy, Daniel / Poppe, Alexander Y / Yang, Victor / Lum, Cheemun / Dowlatshahi, Dar / Thornton, John / Choe, Hana / Burns, Paul A / Frei, Donald F / Baxter, Blaise W / Hill, Michael D

Journal of neurointerventional surgery

2018 Volume 10, Issue 5, Page(s) 429–433

Abstract: Background: Tandem occlusions of the extracranial carotid and intracranial carotid or middle cerebral artery have a particularly poor prognosis without treatment. Several management strategies have been used with no clear consensus recommendations. We ... ...

Abstract	Background: Tandem occlusions of the extracranial carotid and intracranial carotid or middle cerebral artery have a particularly poor prognosis without treatment. Several management strategies have been used with no clear consensus recommendations. We examined subjects with tandem occlusions enrolled in the ESCAPE trial and their outcomes. Methods: Data are from the ESCAPE trial. Additional data were sought on interventions for each subject. Results: There were 54 (17%) subjects with tandem extracranial and intracranial occlusions. Patients in the endovascular treatment arm (n=30) were more likely to be younger (median age 66 years, p<0.01), male (66.7%, p=0.03), diabetic, and without atrial fibrillation. Subjects with tandem occlusions were more likely to have intracranial internal carotid artery occlusions than M1 occlusions (p<0.01). Of the 30 intervention-arm subjects, 17 (57%) underwent emergency endovascular treatment of the extracranial disease, 10 subjects before and seven subjects after intracranial thrombectomy. Of the remaining 13 subjects, only four required staged carotid revascularization due to persistent severe carotid stenosis; four had cervical pseudo-occlusions with no residual stenosis after large distal carotid thrombus burden aspiration/retrieval. Outcomes were similar between subjects with and without tandem lesions. The use of antithrombotic agents after acute carotid artery stenting was variable but no symptomatic intracerebral hemorrhage was seen in subjects who underwent emergency endovascular treatment of extracranial carotid artery. Conclusions: Tandem occlusions occurred in one-sixth of patients and were treated highly variably within the ESCAPE trial. While outcomes were similar, the best method to treat the carotid artery in patients with tandem occlusion awaits further randomized data. Trial registration number: NCT01778335.
MeSH term(s)	Aged ; Aged, 80 and over ; Brain Ischemia/diagnostic imaging ; Brain Ischemia/epidemiology ; Brain Ischemia/therapy ; Carotid Arteries/diagnostic imaging ; Carotid Stenosis/diagnostic imaging ; Carotid Stenosis/epidemiology ; Carotid Stenosis/therapy ; Endovascular Procedures/methods ; Female ; Fibrinolytic Agents/administration & dosage ; Humans ; Male ; Middle Aged ; Middle Cerebral Artery/diagnostic imaging ; Retrospective Studies ; Stents/adverse effects ; Stroke/diagnostic imaging ; Stroke/epidemiology ; Stroke/therapy ; Thrombectomy/methods ; Treatment Outcome
Chemical Substances	Fibrinolytic Agents
Keywords	covid19
Language	English
Publishing date	2018-05
Publishing country	England
Document type	Journal Article ; Multicenter Study ; Randomized Controlled Trial
ZDB-ID	2514982-9
ISSN	1759-8486 ; 1759-8478
ISSN (online)	1759-8486
ISSN	1759-8478
DOI	10.1136/neurintsurg-2017-013316
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Article ; Online: Defining the Role of the Stroke Physician During Endovascular Therapy of Acute Ischemic Stroke.

Stotts, Grant / Poppe, Alexandre Y / Roy, Daniel / Jovin, Tudor G / Lum, Cheemun / Williams, David / Thornton, John / Baxter, Blaise W / Devlin, Thomas / Frei, Donald F / Fanale, Chris / Shuaib, Ashfaq / Rempel, Jeremy L / Menon, Bijoy K / Demchuk, Andrew M / Goyal, Mayank / Hill, Michael D

Stroke

2017 Volume 48, Issue 3, Page(s) 805–807

Language	English
Publishing date	2017-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	80381-9
ISSN	1524-4628 ; 0039-2499 ; 0749-7954
ISSN (online)	1524-4628
ISSN	0039-2499 ; 0749-7954
DOI	10.1161/STROKEAHA.116.015385
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Article ; Online: Analysis of Workflow and Time to Treatment on Thrombectomy Outcome in the Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke (ESCAPE) Randomized, Controlled Trial.

Menon, Bijoy K / Sajobi, Tolulope T / Zhang, Yukun / Rempel, Jeremy L / Shuaib, Ashfaq / Thornton, John / Williams, David / Roy, Daniel / Poppe, Alexandre Y / Jovin, Tudor G / Sapkota, Biggya / Baxter, Blaise W / Krings, Timo / Silver, Frank L / Frei, Donald F / Fanale, Christopher / Tampieri, Donatella / Teitelbaum, Jeanne / Lum, Cheemun /

Dowlatshahi, Dar / Eesa, Muneer / Lowerison, Mark W / Kamal, Noreen R / Demchuk, Andrew M / Hill, Michael D / Goyal, Mayank

Circulation

2016 Volume 133, Issue 23, Page(s) 2279–2286

Abstract: Background: The Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke (ESCAPE) trial used innovative imaging and aggressive target time metrics to demonstrate the benefit of endovascular treatment in patients with acute ischemic ... ...

Abstract	Background: The Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke (ESCAPE) trial used innovative imaging and aggressive target time metrics to demonstrate the benefit of endovascular treatment in patients with acute ischemic stroke. We analyze the impact of time on clinical outcome and the effect of patient, hospital, and health system characteristics on workflow within the trial. Methods and results: Relationship between outcome (modified Rankin Scale) and interval times was modeled by using logistic regression. Association between time intervals (stroke onset to arrival in endovascular-capable hospital, to qualifying computed tomography, to groin puncture, and to reperfusion) and patient, hospital, and health system characteristics were modeled by using negative binomial regression. Every 30-minute increase in computed tomography-to-reperfusion time reduced the probability of achieving a functionally independent outcome (90-day modified Rankin Scale 0-2) by 8.3% (P=0.006). Symptom onset-to-imaging time was not associated with outcome (P>0.05). Onset-to-endovascular hospital arrival time was 42% (34 minutes) longer among patients receiving intravenous alteplase at the referring hospital (drip and ship) versus direct transfer (mothership). Computed tomography-to-groin puncture time was 15% (8 minutes) shorter among patients presenting during work hours versus off hours, 41% (24 minutes) shorter in drip-ship patients versus mothership, and 43% (22 minutes) longer when general anesthesia was administered. The use of a balloon guide catheter during endovascular procedures shortened puncture-to-reperfusion time by 21% (8 minutes). Conclusions: Imaging-to-reperfusion time is a significant predictor of outcome in the ESCAPE trial. Inefficiencies in triaging, off-hour presentation, intravenous alteplase administration, use of general anesthesia, and endovascular techniques offer major opportunities for improvement in workflow. Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01778335.
MeSH term(s)	Administration, Intravenous ; After-Hours Care ; Anesthesia, General ; Brain Ischemia/diagnostic imaging ; Brain Ischemia/mortality ; Brain Ischemia/therapy ; Cerebral Angiography/methods ; Computed Tomography Angiography ; Disability Evaluation ; Endovascular Procedures/adverse effects ; Endovascular Procedures/mortality ; Fibrinolytic Agents/administration & dosage ; Humans ; Predictive Value of Tests ; Punctures ; Risk Factors ; Stroke/diagnostic imaging ; Stroke/mortality ; Stroke/therapy ; Thrombectomy/adverse effects ; Thrombectomy/mortality ; Thrombolytic Therapy/adverse effects ; Thrombolytic Therapy/mortality ; Time Factors ; Time and Motion Studies ; Time-to-Treatment ; Tissue Plasminogen Activator/administration & dosage ; Treatment Outcome ; Triage ; Workflow
Chemical Substances	Fibrinolytic Agents ; Tissue Plasminogen Activator (EC 3.4.21.68)
Keywords	covid19
Language	English
Publishing date	2016-06-07
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	80099-5
ISSN	1524-4539 ; 0009-7322 ; 0069-4193 ; 0065-8499
ISSN (online)	1524-4539
ISSN	0009-7322 ; 0069-4193 ; 0065-8499
DOI	10.1161/CIRCULATIONAHA.115.019983
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Article ; Online: Intra-Arterial Therapy and Post-Treatment Infarct Volumes: Insights From the ESCAPE Randomized Controlled Trial.

Al-Ajlan, Fahad S / Goyal, Mayank / Demchuk, Andrew M / Minhas, Priyanka / Sabiq, Farahna / Assis, Zarina / Willinsky, Robert / Montanera, Walter J / Rempel, Jeremy L / Shuaib, Ashfaq / Thornton, John / Williams, David / Roy, Daniel / Poppe, Alexandre Y / Jovin, Tudor G / Sapkota, Biggya L / Baxter, Blaise W / Krings, Timo / Silver, Frank L /

Frei, Donald F / Fanale, Christopher / Tampieri, Donatella / Teitelbaum, Jeanne / Lum, Cheemun / Dowlatshahi, Dar / Shankar, Jai J / Barber, Philip A / Hill, Michael D / Menon, Bijoy K

Stroke

2016 Volume 47, Issue 3, Page(s) 777–781

Abstract: Background and purpose: The goal of reperfusion therapy in acute ischemic stroke is to limit brain infarction. The objective of this study was to investigate whether the beneficial effect of endovascular treatment on functional outcome could be ... ...

Abstract	Background and purpose: The goal of reperfusion therapy in acute ischemic stroke is to limit brain infarction. The objective of this study was to investigate whether the beneficial effect of endovascular treatment on functional outcome could be explained by a reduction in post-treatment infarct volume. Methods: The Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times (ESCAPE) trial was a multicenter randomized open-label trial with blinded outcome evaluation. Among 315 enrolled subjects (endovascular treatment n=165; control n=150), 314 subject's infarct volumes at 24 to 48 hours on magnetic resonance imaging (n=254) or computed tomography (n=60) were measured. Post-treatment infarct volumes were compared by treatment assignment and recanalization/reperfusion status. Appropriate statistical models were used to assess relationship between baseline clinical and imaging variables, post-treatment infarct volume, and functional status at 90 days (modified Rankin Scale). Results: Median post-treatment infarct volume in all subjects was 21 mL (interquartile range =65 mL), in the intervention arm, 15.5 mL (interquartile range =41.5 mL), and in the control arm, 33.5 mL (interquartile range =84 mL; P<0.01). Baseline National Institute of Health Stroke Scale (P<0.01), site of occlusion (P<0.01), baseline noncontrast computed tomographic scan Alberta Stroke Program Early CT score (ASPECTS) (P<0.01), and recanalization (P<0.01) were independently associated with post-treatment infarct volume, whereas age, sex, treatment type, intravenous alteplase, and time from onset to randomization were not (P>0.05). Post-treatment infarct volume (P<0.01) and delta National Institute of Health Stroke Scale (P<0.01) were independently associated with 90-day modified Rankin Scale, whereas laterality (left versus right) was not. Conclusions: These results support the primary results of the ESCAPE trial and show that the biological underpinning of the success of endovascular therapy is a reduction in infarct volume. Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01778335.
MeSH term(s)	Cerebral Infarction/diagnosis ; Cerebral Infarction/drug therapy ; Endovascular Procedures/methods ; Endovascular Procedures/trends ; Female ; Follow-Up Studies ; Humans ; Infusions, Intra-Arterial/methods ; Infusions, Intra-Arterial/trends ; Male ; Single-Blind Method ; Stroke/diagnosis ; Stroke/drug therapy ; Thrombolytic Therapy/methods ; Thrombolytic Therapy/trends ; Tissue Plasminogen Activator/administration & dosage ; Treatment Outcome
Chemical Substances	Tissue Plasminogen Activator (EC 3.4.21.68)
Keywords	covid19
Language	English
Publishing date	2016-03
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	80381-9
ISSN	1524-4628 ; 0039-2499 ; 0749-7954
ISSN (online)	1524-4628
ISSN	0039-2499 ; 0749-7954
DOI	10.1161/STROKEAHA.115.012424
Database	MEDical Literature Analysis and Retrieval System OnLINE

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