https://ogma.newcastle.edu.au/vital/access/ /manager/Index ${session.getAttribute("locale")} 5 https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:54324 Wed 28 Feb 2024 15:22:19 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:34583 Wed 23 Feb 2022 16:04:47 AEDT ]]> https://ogma.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://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:22216 Wed 11 Apr 2018 14:00:50 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:41666 Wed 10 Aug 2022 12:13:25 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:33105 Thu 17 Mar 2022 14:41:28 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:31270 Thu 09 Dec 2021 11:04:26 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:7458 1.2 and perfusion deficit at least 10 mL>DWI volume) and CDM (NIHSS ≥8 and DWI volume ≤25 mL) was determined for each patient. We assessed lesion growth and neurological improvement (decrease in NIHSS ≥8 points between baseline and 90 days, or a 90-day NIHSS ≤1). Results: 86% of the patients had PDM, but only 41% had CDM. CDM detected PDM with a sensitivity of 46% and a specificity of 86%. We found statistically significant effects of reperfusion on the rate of neurological improvement (OR 9.92, 95% CI 1.91 to 51.64; P<0.01) and on absolute growth (difference: –59.60 mL, 95% CI –95.40 mL to –23.81 mL; P<0.01). Neither treatment with tPA nor reperfusion had a significantly different impact on lesion growth or clinical course in CDM patients compared to patients without CDM. Conclusions: There was no increased benefit from tPA in patients with CDM. The beneficial effects of reperfusion were similar in patients with and without CDM.]]> Sat 24 Mar 2018 10:46:49 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:6925 Sat 24 Mar 2018 08:40:25 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:9613 Sat 24 Mar 2018 08:39:38 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:9555 1.2, was independently scored by 1 expert and 2 inexperienced raters blinded to calculated volumes and clinical information. Visual mismatch was compared with region-of-interest-based volumetric calculation, which was used as the gold standard. Results: Volumetric calculation demonstrated perfusion-diffusion mismatch in 85/99 patients. Visual TTP-DWI mismatch was correctly classified by the experienced rater in 82% of the cases (sensitivity: 0.86; specificity: 0.54) compared to 73% for the inexperienced raters (sensitivity: 0.75; specificity: 0.57). The interrater reliability for TTP-DWI mismatch was moderate (к= 0.50). Visual T max -DWI mismatch performed better (agreement – 93 and 87%, sensitivity – 95 and 88%, specificity – 77 and 82% for the experienced and inexperienced raters, respectively). Conclusions: The assessment of visual TTP-DWI mismatch at the MRI console is insufficiently reliable for use in clinical trials. Differences in perfusion analysis technique and visual inaccuracies combine to make visual TTP-DWI mismatch substantially different to volumetric T max -DWI mismatch. Automated software that applies perfusion thresholds may improve the reproducibility of real-time mismatch assessment.]]> Sat 24 Mar 2018 08:34:38 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:10952 Sat 24 Mar 2018 08:14:15 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:10752 Sat 24 Mar 2018 08:08:22 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:10749 Sat 24 Mar 2018 08:08:20 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:21405 P=0·03) and a trend to lower absolute growth (-0·17ml versus 9·6ml, P=0·07). Reperfusion was increased in the tissue plasminogen activator group (58% versus 25%, P=0·03) and was associated with increased rates of good neurological (86% versus 28% P<0·001) and functional (modified Rankin scale 0-2 73% versus 34%, P=0·01) outcomes. Reperfusion was strongly associated with lower relative (80% versus 189%, P<0·001) and absolute (-2·5ml versus 40ml, P<0·001) infarct growth. Conclusions: Thrombolysis 4·5-6h after stroke onset reduced infarct growth and increased the rate of reperfusion, which was associated with good neurological and functional outcome.]]> Sat 24 Mar 2018 08:05:00 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:17780 1.2 and total coregistered mismatch volume was ≥10 mL. The primary outcome was a comparison of infarct growth in alteplase vs placebo patients with coregistered mismatch. Of 99 patients with baseline diffusion-weighted imaging and perfusion-weighted imaging, coregistration of both images was possible in 95 patients. Coregistered mismatch was present in 93% (88/95) compared to 85% (81/95) with standard volumetric mismatch. In the coregistered mismatch patients, of whom 45 received alteplase and 43 received placebo, the primary outcome measure of geometric mean infarct growth was significantly attenuated by a ratio of 0.58 with alteplase compared to placebo (1.02 vs 1.77; 95% CI, 0.33–0.99; P=0.0459). When using coregistration techniques to determine the presence of mismatch at study entry, alteplase significantly attenuated infarct growth. This highlights the necessity for a randomized, placebo-controlled, phase III clinical trial of alteplase using penumbral selection beyond 3 hours.]]> Sat 24 Mar 2018 07:57:41 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:16768 Mon 26 Nov 2018 15:27:36 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:38822 4.0% to ≤10.0%); and moderate rates (>10.0%). Hospitals were randomized to an implementation package (experimental group) or usual care (control group) using a 1:1 ratio. The 16‐month intervention was based on behavioral theory and analysis of the steps, roles, and barriers to rapid assessment for thrombolysis eligibility and involved comprehensive strategies addressing individual and system‐level change. The primary outcome was the difference in tissue plasminogen activator proportions between the 2 groups postintervention. The absolute difference in postintervention IVT rates between intervention and control hospitals adjusted for baseline IVT rate and stratum was not significant (primary outcome rate difference=1.1% (95% CI −1.5% to 3.7%; P=0.38). Rates of intracranial hemorrhage remained below international benchmarks. Conclusions: The implementation package resulted in no significant change in tissue plasminogen activator implementation, suggesting that ongoing support is needed to sustain initial modifications in behavior.]]> Mon 14 Feb 2022 14:40:13 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:41084 Fri 22 Jul 2022 17:11:20 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:41586 Fri 05 Aug 2022 14:51:46 AEST ]]>