https://nova.newcastle.edu.au/vital/access/ /manager/Index ${session.getAttribute("locale")} 5 https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:43675 P = 0.005), whereas there was no such association between reperfusion and an excellent outcome with any of the CCM criteria (all p > 0.05). Notably, in IVT-LVO cohort, 58.2% of the PIM-DT positive patients achieved an excellent outcome compared with 31.0% in non-mismatch patients following successful recanalization (P = 0.006).]]> Wed 28 Sep 2022 14:35:18 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:52831 Wed 28 Feb 2024 16:31:25 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:53333 1 s and MTT>145%. Delay time (DT) best estimated the infarct core (AUC = 0.74). The optimal core threshold was a DT >1.5 s. The voxel-based analyses indicated CTP was most accurate in the calcarine (Penumbra-AUC = 0.75, Core-AUC = 0.79) and cerebellar regions (Penumbra-AUC = 0.65, Core-AUC = 0.79). For the volume-based analyses, MTT >160% demonstrated best correlation and smallest mean-volume difference between the penumbral estimate and follow-up MRI (R2 = 0.71). MTT >170% resulted in the smallest mean-volume difference between the core estimate and follow-up MRI, but with poor correlation (R2 = 0.11). Conclusion: CTP has promising diagnostic utility in POCI. Accuracy of CTP varies by brain region. Optimal thresholds to define penumbra were DT >1 s and MTT >145%. The optimal threshold for core was a DT >1.5 s. However, CTP core volume estimates should be interpreted with caution.]]> Wed 28 Feb 2024 16:20:57 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:51451 3 seconds on CTP. Regression analyses were used to identify clinical and imaging variables that predicted poor functional outcome. Results: A total of 139 patients with mild stroke were included, of whom 27 (19%) had poor functional outcome. Patients with poor outcome, compared with those with good outcome, had much larger perfusion lesion volume (median 80 mL vs 41 mL, p < 0.001). Perfusion lesion was a significant predictor of poor outcome in either univariable regression (crude OR = 1.02, 95% CI = [1.01-1.03]) or multivariable regression model (adjusted OR = 1.01, 95% CI = [1.01-1.02]), adjusting for occlusion site, good collaterals, baseline stroke severity, age, IV thrombolysis (IVT), and onset to scan time. A perfusion lesion of 65 mL was the optimal cutpoint to identify poor functional outcome (sensitivity = 59%, specificity = 77%). Patients with perfusion lesion ≥65 mL, compared with patients with perfusion lesion <65 mL, showed a much higher rate of poor functional outcome (38% vs 11%, p < 0.001). Of the 139 patients in this study, 95 received IVT. Patients treated with or without IVT did not influence their outcomes (crude OR = 0.74, 95% CI = [0.31-1.78]). Discussion: A perfusion lesion of ≥65 mL predicted poor functional outcome in mild stroke patients with LVO.]]> Wed 28 Feb 2024 15:56:25 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:45222 Wed 26 Oct 2022 15:50:17 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:35816 Wed 24 Nov 2021 15:51:02 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:30085 Wed 24 Nov 2021 15:50:06 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:35721 Wed 24 May 2023 12:21:56 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:33724 Wed 24 May 2023 12:09:06 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:33190 6 s region resulted in higher prognostic value than recanalization at predicting good clinical outcome (area under the curve = 0.88 and 0.74, respectively, p = 0.002). Successful reperfusion of the Tmax>6 s region (≥60%) had 89% sensitivity and 78% specificity in predicting good clinical outcome. A reperfusion index defined by Tmax>2 s or by mean transit time>145% had much lower area under the curve in comparison to Tmax>6 s measurement (p < 0.001 and p = 0.003, respectively), and had no significant difference to recanalization at predicting clinical outcome (p = 0.58 and 0.63, respectively). In conclusion, reperfusion index calculated by Tmax>6 s is a stronger predictor of clinical outcome than recanalization or other reperfusion measures.]]> Wed 23 Feb 2022 16:03:42 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:43520 Wed 21 Sep 2022 11:25:48 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:32659 Wed 19 Jan 2022 15:19:53 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:33102 15 mL, mismatch ratio > 1.8, baseline ischemic core < 70 mL, and volume of severely hypoperfused tissue < 100 mL). Patients meeting target mismatch criteria were analyzed as a subgroup to identify whether they had different treatment responses from the pooled group. Results: Of 146 pooled patients, 71 received alteplase and 75 received tenecteplase. Tenecteplase-Treated patients had greater early clinical improvement (median National Institutes of Health Stroke Scale score change: Tenecteplase, 7; alteplase, 2; P=0.018) and less parenchymal hematoma (2 of 75 versus 10 of 71; P=0.02). The pooled group did not show improved patient outcomes when treated with tenecteplase (modified Rankin scale score 0-1: odds ratio, 1.77; 95% confidence interval, 0.89-3.51; P=0.102) compared with alteplase therapy. However, in patients with target mismatch (33 tenecteplase, 35 alteplase), treatment with tenecteplase was associated with greater early clinical improvement (median National Institutes of Health Stroke Scale score change: Tenecteplase, 6; alteplase, 1; P < 0.001) and better late independent recovery (modified Rankin scale score 0-1: odds ratio, 2.33; 95% confidence interval, 1.13-5.94; P=0.032) than those treated with alteplase. Conclusions: Tenecteplase may offer an improved efficacy and safety profile compared with alteplase, benefits possibly exaggerated in patients with baseline computed tomography perfusion-defined target mismatch. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01472926. URL: https://www.anzctr.org.au. Unique identifier: ACTRN12608000466347.]]> Wed 19 Jan 2022 15:18:46 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:30082 versus 25% of acute ischaemic stroke patients, p = 0.0016). In both hospitals, reasons for exclusion from IV-tPA treatment were intracerebral haemorrhage, mild symptoms, and stroke mimic. Patients with baseline National Institutes of Health Stroke Scale score =5 were more likely to be excluded from IV-tPA in the Japanese hospital. Of patients treated with IV-tPA, the door-to-needle time (median, 63 versus 54 minutes, p = 0.0355) and imaging-to-needle time (34 versus 27 minutes, p = 0.0220) were longer in the Australian hospital. Through international benchmarking using cohorts captured under ASC, significant differences were noted in rates of IV-tPA treatment and workflow speed. This variation highlights opportunity to improve and areas to focus targeted practice improvement strategies.]]> Wed 19 Jan 2022 15:15:36 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:47414 Wed 18 Jan 2023 13:01:29 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:35040 Wed 17 Nov 2021 16:32:15 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:37886 3 seconds and with clinical outcome measured using 3-month modified Rankin Scale. Results: A total of 732 ischemic stroke patients underwent computed tomography, 231 with transthoracic echocardiogram were included in part (1), 393 with outcome data were included in part (2). In part (1), 193/231 (83.5%) had normal LVEF (median 61%) and 38/231 (16.5%) decreased LVEF (median 39%). The low-LVEF group had significantly prolonged SO-EndAIF compared with normal-LVEF group (mean of 39.7 versus 26 second; P<0.001), and larger hypoperfusion lesions (94.9 versus 37.6 mL; P<0.001). SO-EndAIF time was strongly associated with EF, with an area under the curve of 0.86. Twenty nine seconds was the best threshold to distinguish between normal and impaired EF (area under the curve, 0.77). In part (2), the SO-EndAIF ≥29 second group had larger hypoperfusion volumes (21.8 versus 89.7 mL; P<0.001) and infarct core (12.2 versus 2.3 mL; P<0.0001) and patients with SO-EndAIF ≥29 seconds had fewer excellent or good clinical outcomes (modified Rankin Scale score 0–1; 40% versus 22%; OR, 2.79; P<0.001, modified Rankin Scale score 0–2; 65% versus 35%; OR, 1.41; P=0.033). Conclusions: AIF width correlates with ejection fraction in acute ischemic stroke. A 29-second threshold from scan onset to end of AIF accurately predicts reduced LVEF and identifies patients more likely to have worse outcomes after stroke.]]> Wed 17 Nov 2021 16:29:40 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:38851  15 mL, mismatch ratio > 1.8 and ischemic core < 70 mL). We then investigated whether tenecteplase-treated patients had favorable odds of less disability (on modified Rankin scale, mRS) compared to those treated with alteplase, for clinical and imaging mismatch, respectively. Results: From 146 pooled patients, 71 received alteplase and 75 received tenecteplase. The overall pooled group did not show improved patient outcomes when treated with tenecteplase (mRS 0-1 OR 1.77, 95% CI 0.89–3.51, p = 0.102) compared with alteplase. A total of 39 (27%) patients met both clinical and imaging mismatch criteria, 25 (17%) patients met only imaging criteria, 36 (25%) met only clinical mismatch criteria and, finally, 46 (31%) did not meet either of imaging or mismatch criteria. Patients treated with tenecteplase had more favorable outcomes when they met either imaging mismatch (mRS 0–1, OR 2.33, 95% CI 1.13–5.94, p = 0.032) or clinical mismatch criteria (mRS 0–1, OR 2.15, 95% CI 1.142, 8.732, p = 0.027) but with differing proportions. Conclusion: Target mismatch selection was more inclusive and exhibited in a larger treatment effect between tenecteplase and alteplase.]]> Wed 16 Feb 2022 15:17:26 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:47147 post hoc cost-effectiveness analysis was undertaken. Part A: patient-level cost and health effect data (Multidimensional Fatigue Inventory (MFI) scores) were derived from the MIDAS trial and analysis undertaken from a health-system perspective. Part B: a secondary analysis simulated the societal impact of modafinil therapy in terms of national productivity costs. Results: Part A: Mean cost of modafinil treatment was AUD$3.60/day/patient for a minimally clinically important change (10 points) in total MFI fatigue score, i.e., AUD$0.36/day/unit change in fatigue score per patient. For the base case scenario, the ICER of using modafinil (versus placebo) was AUD$131.73 ($90.17 - 248.15, for minimum and maximum costs, respectively). Part B: The potential productivity cost-savings to society were calculated as nearly AUD$467 million over 1 year, and up to $383,471,991,248 over 10 years, from the widespread use of modafinil treatment in the Australian population of working-age stroke-survivors, representing a significant societal benefit. Conclusions: Modafinil is a highly cost-effective treatment for post-stroke fatigue, offering significant productivity gains and potential cost-savings to society from the widespread use of modafinil treatment in the Australian population of working-age stroke-survivors.]]> Wed 14 Dec 2022 15:27:36 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:39768 Wed 13 Mar 2024 08:58:17 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:47959 Wed 13 Mar 2024 07:52:44 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:46485 70 ml (n = 9), and no perfusion lesion/lack of penumbral tissue (n = 20). The revised perfusion lesion volumes were significantly smaller compared to the original RAPID volumes (median 68 ml IQR 34–102 ml vs. 42 ml 16–92 ml, p = 0.036). Of the patients who met the revised mismatch criteria, 40% receiving alteplase had modified Rankin Scale (mRS) 0–1 at 3-month compared to 28% with placebo (Adjusted Odds Ratio (OR) = 2.23, CI 1.08–4.58, p = 0.028). In contrast, in the original mismatch cohort, 35% receiving alteplase had mRS 0–1 at 3-month compared to 30% with placebo (adjusted OR = 1.88, p = 0.056). Conclusions: These data reinforce the benefit of alteplase in the later time window, and suggest that differences in automated perfusion imaging software outputs may be clinically relevant.]]> Wed 13 Mar 2024 07:51:52 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:44396 Wed 12 Oct 2022 12:58:24 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:29819 p = 0.017). All CTP core volume estimations showed robust correlation with DWI (Pearson p-value < 0.001). As core volume increased, CTP demonstrated increased deviation from DWI. At the critical cut-offs of 25 mL and 70 mL, relative CBF demonstrated the best agreement with DWI for infarct core compared to the other CTP-derived measures of infarct core. Conclusion: Our study demonstrates close approximation between multiple CTP-derived measures of infarct core and DWI infarct volume, Especially relative CBF.]]> Wed 11 Apr 2018 17:03:23 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:32689 Wed 10 Nov 2021 15:04:19 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:50365 Wed 10 Apr 2024 15:51:53 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:32712 Wed 09 Mar 2022 16:01:42 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:38703 Wed 06 Jul 2022 10:42:43 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:33108 Wed 06 Apr 2022 14:05:06 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:33933 Wed 06 Apr 2022 14:02:47 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:29863 n = 296) who underwent 320-detector CT perfusion within 6 hours of the onset of ischemic stroke were studied. First, the ischemic volume at CT perfusion was compared with the penumbra and core reference values at magnetic resonance (MR) imaging to derive CT perfusion penumbra and core thresholds. Second, the thresholds were tested in a different group of patients to predict the final infarction at diffusion-weighted imaging 24 hours after CT perfusion. Third, the change in ischemic volume delineated by the optimal penumbra and core threshold was determined as the brain coverage was gradually reduced from 160 mm to 20 mm. The Wilcoxon signed-rank test, concordance correlation coefficient (CCC), and analysis of variance were used for the first, second, and third steps, respectively. Results: CT perfusion at penumbra and core thresholds resulted in the least volumetric difference from MR imaging reference values with delay times greater than 3 seconds and delay-corrected cerebral blood flow of less than 30% (P = .34 and .33, respectively). When the thresholds were applied to the new group of patients, prediction of the final infarction was allowed with delay times greater than 3 seconds in patients with no recanalization of the occluded artery (CCC, 0.96 [95% confidence interval: 0.92, 0.98]) and with delay-corrected cerebral blood flow less than 30% in patients with complete recanalization (CCC, 0.91 [95% confidence interval: 0.83, 0.95]). However, the ischemic volume with a delay time greater than 3 seconds was underestimated when the brain coverage was reduced to 80 mm (P = .04) and the core volume measured as cerebral blood flow less than 30% was underestimated when brain coverage was 40 mm or less (P < .0001). Conclusion: Correct threshold setting and whole-brain coverage CT perfusion allowed differentiation of the penumbra from the ischemic core in patients with acute ischemic stroke.]]> Wed 06 Apr 2022 14:00:29 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:35216 .05). Conclusion: White matter changes after stroke may be localized rather than a global phenomenon.]]> Wed 06 Apr 2022 13:57:07 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:33107 Wed 04 Sep 2019 09:55:36 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:29354 Wed 02 Mar 2022 14:26:36 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:47058 Tue 30 Apr 2024 09:50:06 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:47197 χ² analysis. Results: From 5 centers, 1,407 patients were included in this study; of these, 282 had HT. The cohort was split into a derivation cohort (1,025, 70% patients) and a validation cohort (382 patients or 30%). The extraction fraction (E) permeability map at a threshold of 30% relative to contralateral had the highest AUC at predicting any HT (derivation AUC 0.85, 95% confidence interval [CI], 0.79–0.91; validation AUC 0.84, 95% CI 0.77–0.91). The AUC improved when permeability was assessed within the acute perfusion lesion for the E maps at a threshold of 30% (derivation AUC 0.91, 95% CI 0.86–0.95; validation AUC 0.89, 95% CI 0.86–0.95). Previously proposed associations with HT and parenchymal hematoma showed lower AUC values than the permeability measure. Interpretation: In this large multicenter study, we have validated a highly accurate measure of HT prediction. This measure might be useful in clinical practice to predict hemorrhagic transformation in ischemic stroke patients before receiving alteplase alone.]]> Tue 28 Mar 2023 08:14:38 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:39183 Tue 24 May 2022 13:58:20 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:41993 6 s (sensitivity, 88%; specificity, 92%). The computed tomographic perfusion collateral index, defined by the ratio of delay time >6 s/delay time >2 s volume, showed a significant correlation with dynamic computed tomographic angiography collateral scores (correlation coefficient, 0.62; P<0.001), with an optimal cut point of 31.8% in predicting good collateral status (sensitivity of 83% and specificity of 86%). When predicting good clinical outcome, the delay time collateral index showed a similar predictive power to dynamic computed tomographic angiography collaterals (area under the curve, 0.78 [0.67–0.83] and 0.77 [0.69–0.84], respectively; P<0.001). Conclusions—Computed tomographic perfusion can accurately quantify collateral flow after acute ischemic stroke.]]> Tue 16 Aug 2022 16:37:23 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:51004 Tue 15 Aug 2023 12:55:22 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:42696 Tue 14 Nov 2023 14:44:08 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:43104 15 mL, and a total hypoperfused volume:core volume ratio of >1.8. The primary outcome was good functional outcome at 90 days (modified Rankin Scale score, 0-2).CTP was acquired in 138 of 316 ESCAPE patients. Penumbral patterns were present in 116 of 128 (90.6%) of patients with interpretable CTP data. The rate of good functional outcome in penumbral pattern patients (53 of 114; 46%) was higher than that in nonpenumbral patients (2 of 12; 17%; P=0.041). In penumbral patients, endovascular therapy increased the likelihood of a good clinical outcome (34 of 58; 57%) compared with those in the control group (19 of 58; 33%; odds ratio, 2.68; 95% confidence interval, 1.25-5.76; P=0.011). Only 3 of 12 nonpenumbral patients were randomized to the endovascular group, preventing an analysis of treatment effect.The majority of patients with CTP imaging in the ESCAPE trial had penumbral patterns, which were associated with better outcomes overall. Patients with penumbra treated with endovascular therapy had the greatest odds of good functional outcome. Nonpenumbral patients were much less likely to achieve good outcomes.]]> Tue 13 Sep 2022 12:47:32 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:49891 25 mL/h, EVT treatment (compared with IVT only) increased the odds of good clinical outcome (adjusted odds ratio=3.62 [1.21–10.76], P=0.021) and resulted in smaller final infarction volume (37.5 versus 73.9 mL, P=0.012). For patients with slow core growth of <15 mL/h, there were no significant differences between the EVT and the IVT only group in either good clinical outcome (adjusted odds ratio=1.44 [0.97–2.14], P=0.070) or final infarction volume (22.6 versus 21.9 mL, P=0.551). Conclusions: Fast core growth was associated with greater benefit from EVT compared with IVT in the early <4.5-hour time window.]]> Tue 13 Jun 2023 14:32:39 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:31178 Tue 11 Sep 2018 12:07:51 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:44350 Tue 11 Oct 2022 19:35:43 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:44277 5 s (AUC: 0.80) in GM and T max > 7 s (AUC: 0.75) in WM. With sSVD, a delay time (DT) > 3 s from ddSVD was the optimal for both GM (AUC: 0.78) and WM (AUC: 0.75). Using tissue-specific thresholds for GM/WM provides more accurate estimation of acute ischemic core.]]> Tue 11 Oct 2022 14:27:33 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:25015 Thu 28 Oct 2021 13:02:55 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:23095 Thu 28 Oct 2021 12:36:41 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:33726 Thu 28 Oct 2021 12:36:19 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:33103 0.05). Despite similar baseline CTP ischemic core volumes using the previously validated measure (relative cerebral blood flow [rCBF], <30%), thrombectomy patients had a smaller median 24-hour infarct core of 17.3ml (IQR, 11.3-32.8) versus 24.3ml (IQR, 16.7-42.2; p = 0.011) in alteplase-treated controls. As a result, the optimal threshold to define the ischemic core in thrombectomy patients was rCBF <20% (area under the curve [AUC], 0.89; 95% CI, 0.84, 0.94), whereas in alteplase controls the optimal ischemic core threshold remained rCBF <30% (AUC, 0.83; 95% CI, 0.77, 0.85). Interpretation: Thrombectomy salvaged tissue with lower CBF, likely attributed to earlier reperfusion. For patients who achieve rapid reperfusion, a stricter rCBF threshold to estimate the ischemic core should be considered.]]> Thu 27 Jan 2022 15:58:26 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:36439 Thu 27 Jan 2022 15:55:31 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:42159 p = 0.0001). No association was shown between sCTA weighting, collateral grade, and clinical outcome. Conclusion: sCTA weighting did not significantly impact collateral grade using three common collateral scores or their ability to predict final infarct.]]> Thu 25 Aug 2022 16:42:47 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:42116 p < 0.001). The group with a baseline core <30 mL contained mostly patients with distal M1 or M2 occlusions, and good collaterals ( p = 0.01). In patients with a baseline ischemic core volume >30 mL (internal carotid artery and mostly proximal M1 occlusions), EVT-R increased the odds of patients achieving an excellent clinical outcome (day 90 mRS 0–1 odds ratio 1.61, p < 0.001) and there was increased symptomatic intracranial hemorrhage in the IVT-R group with core >30 mL (20% vs 3% in EVT-R, p = 0.008). Conclusion: From this observational cohort, LVO patients with larger baseline ischemic cores and proximal LVO, with poorer collaterals, clearly benefited from EVT-R compared to IVT-R alone. However, for distal LVO patients, with smaller ischemic cores and better collaterals, EVT-R was associated with a lower odds of favorable outcome compared to IVT-R alone.]]> Thu 25 Aug 2022 11:08:38 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:38979 4.5 h time window between patient groups who met and did not meet the perfusion imaging trial criteria. Methods: A discrete event simulation (DES) model was developed to simulate the long-term outcome post EVT in patients meeting or not meeting the extended time window clinical trial perfusion imaging criteria at presentation, vs. medical treatment alone (including intravenous thrombolysis). The effectiveness of thrombectomy in patients meeting the landmark trial criteria (DEFUSE 3 and DAWN) was derived from a prospective cohort study of Australian patients who received EVT for ischemic stroke, between 2015 and 2019, in the extended time window (>4.5 h). Results: Endovascular thrombectomy was shown to be a cost-effective treatment for patients satisfying the clinical trial criteria in our prospective cohort [incremental cost-effectiveness ratio (ICER) of $11,608/quality-adjusted life year (QALY) for DEFUSE 3-postive or $34,416/QALY for DAWN-positive]. However, offering EVT to patients outside of clinical trial criteria was associated with reduced benefit (−1.02 QALY for DEFUSE 3; −1.43 QALY for DAWN) and higher long-term patient costs ($8,955 for DEFUSE 3; $9,271 for DAWN), thereby making it unlikely to be cost-effective in Australia. Conclusions: Treating patients not meeting the DAWN or DEFUSE 3 clinical trial criteria in the extended time window for EVT was associated with less gain in QALYs and higher cost. Caution should be exercised when considering this procedure for patients not satisfying the trial perfusion imaging criteria for EVT.]]> Thu 24 Mar 2022 08:55:17 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:52638 Thu 19 Oct 2023 15:12:05 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:38503 Thu 18 Nov 2021 09:53:11 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:33105 Thu 17 Mar 2022 14:41:28 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:31826 P=0.01), in validation cohort (odds ratio, 6.9; 95% CI, 1.4–33; P=0.01), and in endovascular patients, after adjustment for recanalization and time to treatment (odds ratio, 4.8; 95% CI, 1.2–18; P=0.01). BATMAN score of <7 was not associated with recanalization. Interrater agreement was substantial (intraclass coefficient correlation, 0.85; 95% CI, 0.8–0.9). BATMAN score had greater accuracy compared with Posterior Circulation Collateral score (P=0.04). Conclusions: The addition of collateral quality to clot burden in BATMAN score seems to improve prognostic accuracy in basilar artery occlusion patients.]]> Thu 17 Mar 2022 14:35:06 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:31435 P < 0.001). For every millilitre of penumbra salvaged, 7.2 days of disability-adjusted life-year days were saved (ß = -7.2, 95% confidence interval, -10.4 to -4.1 days, P < 0.001). Each minute of earlier onset-to-treatment time resulted in a saving of 4.4 disability-free days after stroke (1.3-7.5 days, P = 0.006). However, after adjustment for imaging variables, onset-to-treatment time was not significantly associated with savings in disability-adjusted life-year days. Pretreatment perfusion computed tomography can (independently of clinical variables) predict significant gains, or loss, of disability-free life in patients undergoing reperfusion therapy for stroke. The effect of earlier treatment on disability-free life appears explained by salvage of penumbra, particularly when the ischaemic core is not too large.]]> Thu 17 Feb 2022 09:30:10 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:26559 Thu 17 Feb 2022 09:28:21 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:31275 Thu 13 Jan 2022 10:30:36 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:33090 Thu 13 Jan 2022 10:30:28 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:33725 Thu 13 Jan 2022 10:30:08 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:30014 14 second R2 = 0.372, P = 0.011). Patients with WMHP also had larger acute infarcts and increased infarct growth compared to those without WMHP (mean 28 mL vs. 13 mL P < 0.001). Conclusion: White matter hypoperfusion remote to the acutely ischemic region on CTP is a marker of small vessel disease and was associated with increased HT, larger acute infarct cores, and greater infarct growth.]]> Thu 13 Jan 2022 10:29:30 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:46050 Thu 10 Nov 2022 10:14:44 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:34090 Thu 09 Dec 2021 11:02:37 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:34103 Thu 07 Feb 2019 14:26:26 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:34105 Thu 07 Feb 2019 14:26:15 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:44094 3 seconds perfusion lesion with severely delayed contrast transit (delay time >3 seconds/delay time >6 seconds). Results: There were 306 patients included in this study. With every increase of 10 mmHg in baseline systolic blood pressure, the odds of achieving an excellent functional outcome decreased by 12% in multivariate analysis (odds ratio = 0.88, p = 0.048). Conversely, increased baseline blood pressure was associated with better collateral flow. In subgroup analysis of patients with major reperfusion, higher blood pressure was associated with decreased infarct growth and a better clinical outcome, and vice versa in patients without reperfusion. Interpretation: Higher baseline blood pressure in acute ischemic stroke patients with large vessel occlusion/stenosis was associated with better collateral flow. However, for patients without reperfusion, higher baseline blood pressure was associated with increased infarct growth, leading to an unfavorable clinical outcome. The relationship between blood pressure and outcomes is highly dependent on reperfusion, and active blood pressure–lowering treatment may be inappropriate in acute ischemic stroke patients prior to reperfusion treatment.]]> Thu 06 Oct 2022 16:16:26 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:47376  1.2, and mismatch volume > 10 mL on follow-up imaging. Patients were divided into PTM or non-PTM groups. Ischemic core and penumbral volumes were compared between baseline and follow-up imaging between the two groups, and collateral flow status assessed using CT perfusion collateral index. Results: A total of 25 patients (14 PTM and 11 non-PTM) were enrolled in the study. Median core volumes increased slightly in the PTM group, from 22 to 36 ml. There was a much greater increase in the non-PTM group, from 57 to 190 ml. Penumbral volumes were stable in the PTM group from a median of 79 ml at baseline to 88 ml at follow-up, whereas penumbra was reduced in the non-PTM group, from 120 to 0 ml. Collateral flow status was also better in the PTM group and the median collateral index was 33% compared with 44% in the non-PTM group (p = 0.043). Conclusion: Multiple patients were identified with limited core growth and large penumbra (persistent target mismatch) > 16 h after stroke onset, likely due to more favorable collateral flow.]]> Thu 06 Jul 2023 13:43:31 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:29940 Thu 04 Nov 2021 10:39:20 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:24016 Thu 04 Nov 2021 10:39:04 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:38704 Thu 03 Feb 2022 15:47:23 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:33106 0.05). Conclusions: Stroke survivors with nonresolving fatigue reported reduced fatigue and improved quality of life after taking 200 mg daily treatment with modafinil.]]> Thu 03 Feb 2022 12:21:55 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:35835 Thu 03 Feb 2022 12:21:17 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:42680 Thu 01 Sep 2022 08:38:24 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:27975 Sat 24 Mar 2018 07:38:43 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:46655 Mon 28 Nov 2022 17:43:31 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:32690 Mon 23 Sep 2019 13:22:20 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:53277 Mon 20 Nov 2023 13:02:57 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:48518 p < 0.001). Vessel occlusion location was not a strong predictor of outcomes compared to baseline ischemic core (area under the curve, mRS 0-1, 0.64 vs 0.83; mRS 0-2, 0.70 vs 0.86, p < 0.001). There was no interaction between occlusion location and ischemic core (interaction coefficient 1.00, p = 0.798). Conclusions: Ischemic stroke patients with a distal occlusion have higher rate of excellent and favorable outcome than patients with an M1 occlusion. The baseline ischemic core was shown to be a more powerful predictor of functional outcome than the occlusion location, but the relationship between ischemic core and outcome does not different by occlusion locations.]]> Mon 20 Mar 2023 17:06:46 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:38706 Mon 17 Jan 2022 15:59:07 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:48932 Mon 17 Apr 2023 15:37:11 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:41051 p < 0.001). The relationship of core growth and CTP collateral index was validated in cohort 2. An increment in collateral index by 1% resulted in an increase of core growth by 0.59 mL/h (coefficient 0.59 [0.48–0.71], p < 0.001) in cohort 2. Conclusion: Collateral status is a major determinant of ischemic core growth.]]> Mon 08 Aug 2022 14:50:17 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:40206 Mon 08 Aug 2022 13:40:29 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:46879 Mon 05 Dec 2022 14:09:44 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:51230 15 mL/h) and slow (≤15 mL/h), based on its interaction with bridging IVT in predicting the primary outcome. The primary outcome was modified Rankin scale of 0-2 at 3 months. The secondary outcomes included successful thrombectomy reperfusion defined by modified Thrombolysis in Cerebral Infarction score of 2b-3 and time from groin puncture to reperfusion. Results: Of the 1,221 EVT patients in the INSPIRE, 323 patients were selected, of which 82 patients received direct EVT and 241 patients received bridging IVT. Bridging IVT was associated with a higher rate of good clinical outcome among patients with fast core growth (39% vs 7% for direct EVT, odds ratio [OR] 8.75 [1.96-39.1], p = 0.005), but the difference was not notable for patients with slow core growth (55% vs 55% for direct EVT, OR 1.00 [0.53-1.87], p = 0.989). In patients with fast core growth, the bridging and direct EVT patients showed no difference in the reperfusion rate (80% vs 76%, p = 0.616). However, patients who received bridging IVT were more likely to achieve reperfusion earlier (the median groin to reperfusion time of 63.0 vs 94.0 minutes, p = 0.005). Discussion: Patients with fast core growth were more likely to benefit from bridging IVT. This is likely because prior IVT facilitates clot removal and thus reduces time to reperfusion.]]> Fri 25 Aug 2023 13:18:37 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:51943 Fri 22 Sep 2023 16:57:08 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:41084 Fri 22 Jul 2022 17:11:20 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:41073 Fri 22 Jul 2022 16:57:34 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:38827 p < 0.047), whereas the measure of executive functioning was uniquely accounted for by the presence of hypertension and angina (all p < 0.032). Increased stroke risk also predicted performance on the cognitive screening test and the measure of executive functioning (all p < 0.002). Conclusions: Our findings indicate that cognitive impairment following a minor stroke or TIA may be attributed to the high prevalence of chronic vascular risk factors in these patients. This highlights the importance of long-term management of vascular risk factors beyond event recovery to reduce the risk of cognitive impairment. Increased stroke risk (i.e., ABCD2 score) was also associated with reduced cognition, suggesting that it may be helpful in signaling the need for further cognitive evaluation and intervention post-event.]]> Fri 20 May 2022 12:40:50 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:42288 Fri 19 Aug 2022 14:58:34 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:47319 70mL. We aimed to compare outcomes of EVT and non-EVT patients with an ischemic core≥70mL, hypothesizing that there would be a benefit from EVT for fair outcome (three-month modified Rankin Scale, mRS, 0-3) after stroke. METHODS: Retrospective analysis of patients enrolled into a multi-center (Australia, China and Canada) registry (2012-2020) who underwent CTP within 24 hours of stroke onset and had a baseline ischemic core≥70mL. Primary outcome was the estimation of the association of EVT in patients with core volume ≥70mL, as well as within 70-100mL and ≥100mL subgroups with fair outcome. RESULTS: Of the 3283 patients in the registry, 299 had CTP core≥70 mL and 269 complete data (135 had core volume between 70-100mL and 134≥100mL). EVT was performed in 121(45%) patients. EVT-treated patients were younger (median 69 versus 75 years; p=0.011), had lower pre-stroke mRS, and smaller median core volumes, 92[79-116.5]mL versus 105.5[85.75-138]mL, (p=0.004). EVT-treated patients had higher odds of achieving fair outcome in adjusted analysis (30% versus 13.9% in the non-EVT group; aOR 2.1(95% CI 1, 4.2), p=0.038). The benefit was seen predominantly in those with 70-100mL core (71 /135 (52.6%) EVT-treated), with 54.3% in EVT-treated versus 21% in non-EVT group achieving a fair outcome (aOR 2.5 (95% CI 1, 6.2), p=0.005). Of those with a core≥100mL, 50 /134(37.3%) underwent EVT. Proportions of fair outcome were very low in both groups (8.1% versus 8.7%; p=0.908). DISCUSSION: We found a positive association of EVT with 3-month outcome after stroke in patients with a baseline CTP ischemic core volume 70-100 mL but not in those with ≥100 mL. Randomized data to confirm these findings is required. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that EVT is associated with better motor outcomes 3 months following CTP-defined ischemic stroke with core of 70-100 mL.]]> Fri 13 Jan 2023 11:06:45 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:41805 Fri 12 Aug 2022 12:31:27 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:41797 5 mL, the AUC was 0.87, 0.81, and 0.66, respectively. Conclusion: Comprehensive CTP analysis increases the detection of posterior fossa lesions compared to NCCT and should be implemented as part of the routine imaging assessment in posterior fossa strokes.]]> Fri 12 Aug 2022 12:24:26 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:48724 Fri 10 Nov 2023 07:23:45 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:40334 Fri 08 Jul 2022 09:51:43 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:44114 Fri 07 Oct 2022 14:05:24 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:41585 Fri 05 Aug 2022 14:51:26 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:33104 Fri 01 Apr 2022 09:29:07 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:30100 p = 0.022) and did not have different rates of mRS 0 to 2 (72% treated patients vs 77% untreated; RR, 0.93; 95% CI, 0.82-1.95; p = 0.23). Interpretation: This large observational cohort suggests that a portion of ischemic stroke patients clinically eligible for alteplase therapy with a small perfusion lesion have a good natural history and may not benefit from treatment.]]> Fri 01 Apr 2022 09:25:36 AEDT ]]>