1,720,991 research outputs found
Cardiac monitoring after stroke in COVID 19: time to move to wearables and early experience with zio patches
No full textBenefits of a regional CT artificial intelligence work steam in identifying patients for transfer to a comprehensive stroke centre (CSC) for mechanical thrombectomy
No full textArtificial intelligence identifies stroke patients with large vessel occlusion and those with an ischaemic penumbra who may benefit from thrombolysis or thrombectomy. The creation of a regional imaging stream enables earlier detection and faster transfer from primary stroke centre (PSC) to CSC
Experience with CT perfusion scanning (CTP) in treating wake up strokes
No full textIntroduction: CTP with artificial intelligence is now available in manyUK hospitals, and some patients with wake-up symptoms and unclearonset time benefit from thrombolysis using CTP.Method: We describe our experience of cases using RAPID AI and CTPoutside historic time windows.Results: 72 year old with hemianopia, right hemiparesis, and visuospatialneglect. CTA/CTP showed a 25ml occipital penumbra (T max >6.0s volume)with no core (CBF<30% volume) and an occluded left PCA.Thrombolysed at 7hrs 15min and NIHSS 16 - 6.76 year old presented with dysphasia and right hemiparesis. CTP showed42ml left frontotemporal penumbra, no core. Thrombolysed at 9hrs afterlast well, NIHSS 6-3.82 year old wake up hemianopia and right hemiparesis, CTP 37ml temporo-occipital penumbra, no core, thrombolysed at 6hrs, NIHSS 8-1.92 year old awoke with ataxic hemiparesis, previous multiple comorbidity.CT, CTA, CTP no infarct, LVO or penumbra. Not thrombolysed givenfrailty, but a subsequent dwMRI showed a small thalamic infarct.72 year old awoke with right leg weakness and dysphasia NIHSS 6,CT,CTA,CTP no infarct, LVO or penumbra. Not thrombolysed. dwMRIhigh up left frontal infarct missed by CTP.Conclusion: We saw clinical improvements with no adverse outcomesincluding symptomatic haemorrhage in 3 wake up patients with thrombolysiswith a penumbra but no core infarction on CTP. Small deep andhigher up anterior cerebral artery (ACA) infarcts may be missed, anddwMRI with FLAIR looking for a mismatch should be considered inpatients presenting with pure lacunar and ACA territory syndromes
ESOC 2023 abstract book: benefits of Zio patch monitoring in detecting early atrial fibrillation after stroke
No full textBackground and aims: Atrial fibrillation (AF) causes up to 30% of ischaemic stroke, and earlier detection results in faster anticoagulation reducing stroke recurrence. We compared conventional Holter monitoring with Zio patches to assess detection rates, time from request to result, and the impact on outpatient appointments.Methods: we retrospectively compared 339 patients who underwent standard Holter monitoring with 349 patients who had a Zio patch applied for 14 days. Zio patches were fitted as inpatients or sent to patients’ homes for self-application, whereas Holter monitoring required separate hospital attendance for fitting and removal.Results: AF was detected in 7.2% in the Zio group compared with 3.2% in the Holter group. 32% of AF was detected in Zio patches applied within 48hrs of stroke, suggesting a benefit from early hyperacute monitoring. With Holter, average time from referral to test was 42 days and 58 days to result, compared with 29 days and 51 days with Zio. With Zio, mean time to AF detection was 6.3 days and wear time 13.4/14 days (95% of target wear time). 41% of patients with Holter monitoring needed face to face follow-up cardiology appointments compared with 19% with Zio.Conclusions: Zio patches detected more than double the rates of AF compared with usual Holter monitoring. Diagnostic yield was highest within 48hrs of stroke. Time to result was faster, with earlier anticoagulation. Patients did not need to attend hospital for Zio patch fitting and the need for follow up appointments was halved compared with usual monitoring
Oral anticoagulation after intracranial haemorrhage: A survey of UK stroke physicians
No full textIntroduction: Observational studies suggest that starting oral anticoagulation (OAC) after intracranial haemorrhage (ICH) is beneficial, but a randomised controlled trial (RCT) is needed to confirm this. We assessed opinion about this treatment uncertainty amongst stroke physicians in the UK. Method: In May 2015, we used Survey Monkey to email an online questionnaire to 289 doctors on the delegation logs at 111 hospital sites participating in the REstart or STop Antithrombotics Randomised Trial (www.RESTARTtrial.org; ISRCTN71907627), followed by 3 email reminders to non-responders. Results: Of 289 invitees, one had opted out of Survey Monkey, 17 emails bounced, 109 (38%) did not respond, and 15 partially completed the survey, leaving 147 (51%) complete responses. 95% of respondents were uncertain whether to start OAC in at least some patients with indications for OAC after ICH. Physicians would randomise patients with atrial fibrillation (AF) and a CHA2DS2-VASc score >1 (88%), recurrent venous thromboembolism (78%) or other cardiac indications (80%). One quarter of respondents would prefer to use adjusted dose warfarin and the rest would use a new OAC (of whom 50% would use apixaban and 29% would use any new OAC). In a RCT the preferred comparator was avoidance of all antithrombotic drugs for patients with lone AF (73%) and an antiplatelet drug for patients with a past history of vaso-occlusive disease (89%). 82% of respondents were just as, or more, keen to participate in RESTART-OAC than RESTART-antiplatelets. Discussion: Equipoise about starting OAC after ICH and physicians' keenness to participate support the need for RESTART-OAC
Impact of prehospital stroke video triage (PSVT) on thrombolysis and mechanical thrombectomy rates and reduction in neurological disability and length of stay at University Hospital Southampton
No full textIntroduction: 465 patients underwent PSVT between June 2023 andMay 2025. 32 patients received intravenous thrombolysis and 11 mechanicalthrombectomy. We review the results on reperfusion treatmentMethod: We examined treatment times, length of stay and neurologicaloutcomes in patients treated with thrombolysis and thrombectomy andcompared them with SSNAP data for the same periodResults or details of the case: 32 patients underwent thrombolysis.Door to CT scanning time was halved from 50 min to 26 min. Door toneedle time was 10 minutes faster, reduced from 1:05min to 55min withvideo. Stroke onset time to thrombolysis was 45min quicker, and meanNIHSS 10 pretreatment and 5 post lysis. 20/32 patients were dischargedwithin 48hrs with minimal disability.In the thrombectomy group, door to groin puncture times were faster,pretreatment NIHSS 15 and post 8, with a mean length of stay 4 days andmean 6-month mRS 2.Conclusion: PSVT allows prioritisation of reperfusion cases with fasterthrombolysis and thrombectomy times resulting in a greater reduction inNIHSS and disability with earlier reperfusion treatment, shorter length ofstay and better long-term outcomes. The next challenge is to increaseparamedic and clinician engagement to realise further benefits on patientoutcomes
Antiepileptic drugs for the primary and secondary prevention of seizures after subarachnoid haemorrhage
No full textBackground: subarachnoid haemorrhage may result in seizures both acutely and in the longer term. The use of antiepileptic drugs (AEDs) in the primary and secondary prevention of seizures after subarachnoid haemorrhage is uncertain, and there is currently no consensus on treatment.Objectives: to assess the effects of AEDs for the primary and secondary prevention of seizures after subarachnoid haemorrhage.Search methods: we searched the Cochrane Epilepsy Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (2013, Issue 1) in The Cochrane Library, and MEDLINE (1946 to 12th March 2013). We checked the reference lists of articles retrieved from these searches.Selection criteria: we considered all randomised and quasi-randomised controlled trials in which patients were assigned to a treatment (one or more AEDs) or placebo.Data collection and analysis: two review authors (RM and JK) independently screened and assessed the methodological quality of the studies. If studies were included, one author extracted the data and the other checked it.Main results: no relevant studies were found.Authors' conclusions: there was no evidence to support or refute the use of antiepileptic drugs for the primary or secondary prevention of seizures related to subarachnoid haemorrhage. Well-designed randomised controlled trials are urgently needed to guide clinical practice
Feasibility of reporting results of large randomised controlled trials to participants: experience from the Fluoxetine Or Control Under Supervision (FOCUS) trial
No full textObjectives: informing research participants of the results of studies in which they took part is viewed as an ethical imperative. However, there is little guidance in the literature about how to do this. The Fluoxetine Or Control Under Supervision trial randomised 3127 patients with a recent acute stroke to 6 months of fluoxetine or placebo and was published in the Lancet on 5 December 2018. The trial team decided to inform the participants of the results at exactly the same time as the Lancet publication, and also whether they had been allocated fluoxetine or placebo. In this report, we describe how we informed participants of the results.Design: in the 6-month and 12-month follow-up questionnaires, we invited participants to provide an email address if they wished to be informed of the results of the trial. We re-opened our trial telephone helpline between 5 December 2018 and 31 March 2019.Setting: UK stroke services.Participants: 3127 participants were randomised. 2847 returned 6-month follow-up forms and 2703 returned 12-month follow-up forms; the remaining participants had died (380), withdrawn consent or did not respond.Results: of those returning follow-up questionnaires, a total of 1845 email addresses were provided and a further 50 people requested results to be sent by post. Results were sent to all email and postal addresses provided; 309 emails were returned unrecognised. Seventeen people replied, of whom three called the helpline and the rest responded by email.Conclusion: it is feasible to disseminate results of large trials to research participants, though only around 60% of those randomised wanted to receive the results. The system we developed was efficient and required very little resource, and could be replicated by trialists in the future.</div
Successful case of thrombectomy in A 64 year old man with distal thrombus and a right Mca M3 occlusion in whom intravenous thrombolysis was contraindicated
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