https://nova.newcastle.edu.au/vital/access/ /manager/Index en-au 5 https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:54324 Wed 28 Feb 2024 15:22:19 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:47414 Wed 18 Jan 2023 13:01:29 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:44530 Wed 09 Nov 2022 10:25:52 AEDT ]]> 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: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: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:38503 Thu 18 Nov 2021 09:53:11 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:56066 3 at the 90-day follow-up. Results: A total of 90 patients were enrolled in the study, with a median Glasgow Coma Scale of 6, 46 (51.1%) showed ADCV filling, 59 (65.6%) had a poor prognosis, and 27 (30.7%) had malignant cerebellar edema (MCE). Multivariate adjusted analysis revealed significant associations between asymmetric TSV and poor prognosis (odds ratio, 9.091, p = 0.006); asymmetric BVR (OR, 9.232, p = 0.001) and asymmetric ICV (OR, 4.028, p = 0.041) were significantly associated with MCE. Conclusion: Preoperative ADCV filling is an independent influencing factor for the poor outcome after EVT in ABAO patients.]]> Mon 29 Jul 2024 13:38:00 AEST ]]> 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:51943 Fri 22 Sep 2023 16:57:08 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:35602 Fri 13 Sep 2019 15:57:13 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:41585 Fri 05 Aug 2022 14:51:26 AEST ]]>