https://ogma.newcastle.edu.au/vital/access/ /manager/Index ${session.getAttribute("locale")} 5 https://ogma.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://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:52831 Wed 28 Feb 2024 16:31:25 AEDT ]]> https://ogma.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://ogma.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://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: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://ogma.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://ogma.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://ogma.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://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: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://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:36439 Thu 27 Jan 2022 15:55:31 AEDT ]]> https://ogma.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://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:46655 Mon 28 Nov 2022 17:43:31 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:48932 Mon 17 Apr 2023 15:37:11 AEST ]]> https://ogma.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://ogma.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://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:42288 Fri 19 Aug 2022 14:58:34 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:35602 Fri 13 Sep 2019 15:57:13 AEST ]]> https://ogma.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 ]]>