https://ogma.newcastle.edu.au/vital/access/ /manager/Index ${session.getAttribute("locale")} 5 https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:39452 Wed 29 Mar 2023 14:38:36 AEDT ]]> https://ogma.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://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:43520 Wed 21 Sep 2022 11:25:48 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:32659 Wed 19 Jan 2022 15:19:53 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:47414 Wed 18 Jan 2023 13:01:29 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:47149 P<0.05). Rapamycin dilated leptomeningeal anastomoses by 80±9%, which was abolished by nitric oxide synthase inhibition. In spontaneously hypertensive rats, rapamycin increased collateral perfusion by 32±25%, reperfusion cerebral blood flow by 44±16%, without reducing acute infarct volume 2 hours postreperfusion. Reperfusion cerebral blood flow was a stronger predictor of brain damage than collateral perfusion in both Wistar and spontaneously hypertensive rats. Conclusions: Rapamycin increased collateral perfusion and reperfusion cerebral blood flow in both Wistar and comorbid spontaneously hypertensive rats that appeared to be mediated by enhancing eNOS activation. These findings suggest that rapamycin may be an effective acute therapy for increasing collateral flow and as an adjunct therapy to thrombolysis or thrombectomy to improve reperfusion blood flow.]]> Wed 14 Dec 2022 15:27:41 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:22033 Wed 11 Apr 2018 13:40:02 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:22364 Wed 11 Apr 2018 12:37:43 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:44000 Z = 2.451, P = 0.014). Conclusion: In acute LAO patients, the presence of SMCV– was a sensitive and specific imaging marker for midline shift. SMCV– had supplementary value to baseline ischemic core volume in predicting midline shift.]]> Wed 05 Oct 2022 15:04:56 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:39183 Tue 24 May 2022 13:58:20 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:16806 Tue 24 Aug 2021 14:40:46 AEST ]]> https://ogma.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://ogma.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://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:30493 2; odds ratio, 2.710; P=0.040). No difference was found in reperfusion rate after treatment between patients with and without SMCV-(P > 0.05). In patients achieving major reperfusion (=80%), there was no difference in 24-hour infarct volume, or rate of poor outcome between patients with and without SMCV-(P > 0.05). However, in those without major reperfusion, patients with SMCV-had larger 24-hour infarct volume (P=0.011), higher rate of poor outcome (P=0.012), and death (P=0.032) compared with those with SMCV filling. SMCV-was significantly associated with brain edema at 24 hours (P=0.037), which, in turn, was associated with poor 3-month outcome (P=0.002). Conclusions: Lack of SMCV filling contributed to poor outcome after thrombolysis, especially when reperfusion was not achieved. The main deleterious effect of poor venous filling appears related to the development of brain edema.]]> Thu 28 Oct 2021 13:03:14 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:25015 Thu 28 Oct 2021 13:02:55 AEDT ]]> https://ogma.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://ogma.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://ogma.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://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:36740 hypo-i), non-hypoperfused region of ischaemic hemisphere (rPS_nonhypo-i) and their contralateral mirror regions (rPS_hypo-c and rPS_nonhypo-c). The changes of rPS were analysed using analysis of variance (ANOVA) with repeated measures. Logistic regression was used to identify independent predictors of unfavourable outcome. Results: Fifty-six patients were included in the analysis, median age was 76 (IQR 62-81) years and 28 (50%) were female. From baseline to 24 h after treatment, rPS_hypo-i, rPS_nonhypo-i and rPS_hypo-c all decreased significantly. The decreases in rPS_hypo-i and rPS_hypo-c were larger in the reperfusion group than non-reperfusion group. The rPS_hypo-i at follow-up was a predictor for unfavourable outcome (OR 1.131; 95% CI 1.018-1.256; P = 0.022). Conclusion: Early disruption of BBB in AIS is reversible, particularly when greater reperfusion is achieved. Elevated BBBP at 24 h after treatment, not the pretreatment BBBP, predicts unfavourable outcome. Key points: Early disruption of blood-brain barrier (BBB) in stroke is reversible after treatment; The reversibility of BBB permeability is associated with reperfusion; Unfavourable outcome is associated with BBB permeability at 24 h after treatment; Contralateral non-ischaemic hemisphere is not 'normal' during an acute stroke.]]> Thu 02 Jul 2020 16:31:45 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:8112 90% reduction in magnetic resonance perfusion-weighted imaging lesion volume and recanalization as improvement of MR angiographic Thrombolysis In Myocardial Infarction grading by ≥2 points from baseline to Day 3 to 5. At Day 3 to 5, reperfusion and recanalization with intravenous tissue plasminogen activator were strongly correlated. Reperfusion was associated with improved clinical outcome independent of whether recanalization occurred. In contrast, recanalization was not associated with clinical outcome when reperfusion was included as a covariate in regression analyses. Reperfusion is a surrogate marker of clinical outcomes independent of recanalization based on the criteria applied in EPITHET. The impact of recanalization on clinical outcomes was attributable to reperfusion.]]> Sat 24 Mar 2018 08:40:01 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:20363 Sat 24 Mar 2018 07:58:13 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:20613 max) was the only one with a nonsignificant difference between CTP and MRP in delineating perfusion defects. This was validated on whole-brain perfusion data, showing high concordance of T_max between the 2 modalities (concordance correlation coefficient of Lin, >0.91); the best concordance was at 6 s. At T max>6 s threshold, MRP and CTP reached substantial agreement in mismatch classification (κ >0.61). Cross-modality reperfusion calculated by T_max>6 s strongly predicted good functional outcome at 3 months (area under the curve, 0.979; P<0.05). Conclusions: MRP and CTP can be used interchangeably if one uses T_max measurement.]]> Sat 24 Mar 2018 07:55:49 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:21327 Sat 24 Mar 2018 07:52:51 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:26920 70% reperfusion at 24 h) were enrolled to investigate the ischemic penumbra and infarct core, respectively. The final infarct was assessed on 24-h diffusion-weighted imaging (DWI), which was retrospectively matched to the baseline perfusion-weighted imaging (PWI) images by volume or voxel-based analysis. The optimal thresholds that determined by each approach were compared. Results: From June 2009 to Jan 2014, of 50 patients enrolled, 19 patients achieved no reperfusion, and 20 patients reperfused at 24 h. In patients with no reperfusion, Tmax > 6 seconds was proved of the best agreement with the final infarct in both volumetric analysis (ratio: 1.05, 95% limits of agreement:-0.23 to 2.33, P < 0.001) and voxel-by-voxel analysis (sensitivity: 72.3%, specificity: 74.3%). In patients with reperfusion, rMTT>225% (ratio:2.4, 95% limits of agreement: -6.5 to 11.4, P < 0.001) was found of the best volumetric agreement with the final infarct, while Tmax > 5.6 seconds (sensitivity: 76.8%, specificity: 70.3%) performed most accurately in voxel-based analysis. Conclusion: Among Chinese acute stroke patients, volume of Tmax >6 seconds may precisely target ischemic penumbra tissue as good as voxel-based analysis performed, albeit no concordant MRP parameter is found to accurately predict infarct core because reperfusion occurred within 24 h after thrombolysis fails to restrain the infarct growth.]]> Sat 24 Mar 2018 07:23:34 AEDT ]]>