https://nova.newcastle.edu.au/vital/access/ /manager/Index ${session.getAttribute("locale")} 5 https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:52719 Wed 28 Feb 2024 16:25:42 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:54204 Wed 28 Feb 2024 15:18:26 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:47703 Wed 25 Jan 2023 10:34:30 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: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: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:44396 Wed 12 Oct 2022 12:58:24 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:52454 Wed 11 Oct 2023 15:03:16 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:54640 Wed 06 Mar 2024 15:11:40 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:47058 Tue 30 Apr 2024 09:50:06 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:50318 300 miles would benefit from EVT, achieving rates of functional independence (modified Rankin Scale [mRS] score of 0-2) at 3 months similar to those patients treated at the comprehensive stroke center in the randomized EVT extended window trials and that the selection of patients with computed tomography perfusion (CTP) at the referring site would be associated with ordinal shift toward better outcomes on the mRS. Methods: This is a retrospective analysis of patients transferred from 31 referring hospitals >300 miles (measured by the most direct road distance) to 9 comprehensive stroke centers in Australia and New Zealand for EVT consideration (April 2016 through May 2021). Results: There were 131 patients; the median age was 64 [53-74] years and the median baseline National Institutes of Health Stroke Scale score was 16 [12-22]. At baseline, 79 patients (60.3%) had noncontrast CT+CT angiography, 52 (39.7%) also had CTP. At the comprehensive stroke center, 114 (87%) patients underwent cerebral angiography, and 96 (73.3%) proceeded to EVT. At 3 months, 62 patients (48.4%) had an mRS score of 0 to 2 and 81 (63.3%) mRS score of 0 to 3. CTP selection at the referring site was not associated with better ordinal scores on the mRS at 3 months (mRS median of 2 [1-3] versus 3 [1-6] in the patients selected with noncontrast CT+CT angiography, P=0.1). Nevertheless, patients selected with CTP were less likely to have an mRS score of 5 to 6 (odds ratio 0.03 [0.01-0.19]; P<0.01). Conclusions: In selected patients transferred >300 miles, there was a benefit for EVT, with outcomes similar to those treated in the comprehensive stroke center in the EVT extended window trials. Remote hospital CTP selection was not associated with ordinal mRS improvement, but was associated with fewer very poor 3-month outcomes.]]> Tue 18 Jul 2023 14:30:07 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:52537 Tue 17 Oct 2023 10:04:45 AEDT ]]> 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:47048 30 days: 39% vs. 7%; p < 0.001) and sigmoid sinus thrombosis (86% vs. 51%; p < 0.001), and less frequently had parenchymal lesions (31% vs. 55%; p = 0.013) at baseline imaging. Clinical outcome at last follow-up did not differ between patients with and without dAVF. Additionally, five patients were confirmed with dAVF from non-consecutive CVT cohorts. Among all patients with CVT and dAVF, 17/34 (50%) had multiple fistulas and 23/34 (68%) had cortical venous drainage. Of 34 patients with dAVF with 36 separate CVT events, 3/36 fistulas (8%) were diagnosed prior to, 20/36 (56%) simultaneously and 13/36 after (36%, median 115 [IQR 38–337] days) diagnosis of CVT. Conclusions: Dural arteriovenous fistulas occur in at least 2% of CVT patients and are associated with chronic CVT onset, older age and male sex. Most CVT-related dAVFs are detected simultaneously or subsequently to diagnosis of CVT.]]> Tue 13 Dec 2022 14:44:16 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:47020 Tue 13 Dec 2022 12:44:23 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:46988 Tue 13 Dec 2022 09:28:29 AEDT ]]> 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:55267 Tue 07 May 2024 10:59:54 AEST ]]> 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:38701 Thu 14 Mar 2024 12:20:13 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:40631 Thu 11 Aug 2022 09:02:28 AEST ]]> 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: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:38704 Thu 03 Feb 2022 15:47:23 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:38706 Mon 17 Jan 2022 15:59:07 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:46980 Mon 12 Dec 2022 17:01:27 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:46977 50-year-old were more often hospitalized in the COVID-19 period (P = 0.042). SARS-CoV-2 PCR test was done in 49.3% out of all COVID-19 period patients, which were positive in 6.5%. Modified Rankin Scale (mRS) score ≥3 at three-month follow-up was associated with age (P = 0.015) and malignancy (P = 0.014) in pre-COVID period; and was associated with age (P = 0.025), altered mental status on admission time (P<0.001), malignancy (P = 0.041) and COVID-19 infection (P = 0.008) in COVID-19 period. Conclusion: Since there was a more dismal outcome in COVID-19 associated CVST, a high index of suspicion for CVST among COVID-19 positive is recommended.]]> Mon 12 Dec 2022 17:01:24 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:39528 Mon 08 Aug 2022 11:13:05 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:38990 Fri 25 Mar 2022 14:35:33 AEDT ]]> 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:52659 Fri 20 Oct 2023 09:09:41 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:50542 Fri 18 Aug 2023 12:00:25 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:46168 Fri 11 Nov 2022 19:54:47 AEDT ]]>