13 research outputs found
Thrombectomy in Stroke Patients With Low Alberta Stroke Program Early Computed Tomography Score: Is Modified Thrombolysis in Cerebral Infarction (mTICI) 2c/3 Superior to mTICI 2b?
No full textBackground and Purpose Outcomes following mechanical thrombectomy (MT) are strongly correlated with successful recanalization, traditionally defined as modified Thrombolysis in Cerebral Infarction (mTICI) ≥2b. This retrospective cohort study aimed to compare the outcomes of patients with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS; 2–5) who achieved mTICI 2b versus those who achieved mTICI 2c/3 after MT.Methods This study utilized data from the Stroke Thrombectomy and Aneurysm Registry (STAR), which combined databases from 32 thrombectomy-capable stroke centers between 2013 and 2023. The study included only patients with low ASPECTS who achieved mTICI 2b, 2c, or 3 after MT for internal carotid artery or middle cerebral artery (M1) stroke.Results Of the 10,229 patients who underwent MT, 234 met the inclusion criteria. Of those, 98 (41.9%) achieved mTICI 2b, and 136 (58.1%) achieved mTICI 2c/3. There were no significant differences in baseline characteristics between the two groups. The 90-day favorable outcome (modified Rankin Scale score: 0–3) was significantly better in the mTICI 2c/3 group than in the mTICI 2b group (adjusted odds ratio 2.35; 95% confidence interval [CI] 1.18–4.81; P=0.02). Binomial logistic regression revealed that achieving mTICI 2c/3 was significantly associated with higher odds of a favorable 90-day outcome (odds ratio 2.14; 95% CI 1.07–4.41; P=0.04).Conclusion In patients with low ASPECTS, achieving an mTICI 2c/3 score after MT is associated with a more favorable 90-day outcome. These findings suggest that mTICI 2c/3 is a better target for MT than mTICI 2b in patients with low ASPECTS
Concurrent Anterior Cerebral Artery and Middle Cerebral Artery Occlusions Predict Poor Neurological Outcome Despite Successful Thrombectomy in Anterior Circulation Stroke
No full textBACKGROUND AND OBJECTIVES: Despite successful endovascular thrombectomy for acute ischemic stroke, a significant proportion of patients demonstrate fast and early progression of infarct core and fail to achieve functional independence at 90 days. The aim of this study was to evaluate the impact of thrombus location and the potential impact of collaterals on concurrent middle cerebral artery (MCA) and anterior cerebral artery (ACA) occlusion. METHODS: Data were included from a multicenter registry for patients undergoing endovascular thrombectomy for anterior circulation stroke from 32 international centers between 2015 and 2021. Patients were included based on thrombus location and categorized into intracranial internal carotid artery (ICA), ICA + MCA, ICA + ACA, or MCA + ACA cohorts. The primary outcome was 90-day functional independence, defined as a modified Rankin Score (mRS) of 0-2. Secondary outcomes included successful recanalization, procedure time, and rates of postprocedural hemorrhage. RESULTS: In total, 2067 patients were included in the study with 83 patients (4%) having concurrent MCA + ACA occlusions. There were no differences in age, comorbidities, or intravenous thrombolysis use between the ICA and MCA + ACA groups. On univariate analysis, the MCA + ACA group had a significantly lower proportion of patients achieving mRS 0-2 at 90 days (12% vs 33%, P .05); however, mortality was higher in the MCA + ACA group (22 vs 13%) ( P < .05). On multivariate regression, MCA + ACA location was an independent predictor of lower odds of mRS 0-2 compared with the ICA group overall (adjusted odds ratio = 0.52, P = .048) and in patients with successful recanalization (adjusted odds ratio = 0.45, P = .035). CONCLUSION: Despite similar vascular territories, concurrent occlusion of the MCA and ACA segments results in worse clinical outcomes compared with intracranial ICA occlusion
Supplemental material for Oedema extension distance in intracerebral haemorrhage: Association with baseline characteristics and long-term outcome
No full textSupplemental Material for Oedema extension distance in intracerebral haemorrhage: Association with baseline characteristics and long-term outcome by Robert Hurford, Andy Vail, Calvin Heal, Wendy C Ziai, Jesse Dawson, Santosh B Murthy, Xia Wang, Craig S Anderson, Daniel F Hanley, Adrian R Parry-Jones and on behalf of the VISTA-ICH Collaborators: the STRONG STAR Consortium in European Stroke Journal</p
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Abstract P20: Bridging Therapy Increases Hemorrhagic Complications Without Improving Functional Outcomes in Atrial Fibrillation Associated Stroke
No full text* on behalf of the Stroke Thrombectomy and Aneurysm Registry (STAR) Collaborators Introduction: Intravenous thrombolysis complications are enriched in AF associated stroke, as these patients have worse functional outcomes, less effective recanalization, and increased rates of hemorrhagic complications. These data suggest that AF patients may be at particularly high risk for complications of bridging therapy for large vessel occlusions treated with mechanical thrombectomy (MT). Here we determine whether clinical outcomes differ in AF associated stroke treated with MT and bridging therapy. Methods: We performed a retrospective cohort study of the Stroke and Aneurysm Registry (STAR) from January 2015 to December 2018 and identified 4,169 patients who underwent MT for an anterior circulation stroke, 1,517 (36.4 %) of which had comorbid AF. Prospectively defined baseline characteristics and clinical outcomes were compared. Results: Hemorrhagic complications after MT were similar in patients with or without AF. In patients without AF, bridging therapy improved 90-day outcomes (aOR 1.32, 1.02-1.74, p<0.05) without increasing hemorrhagic complications. In patients with AF, bridging therapy independently predicted hemorrhagic complications in AF patients (aOR 2.08, 1.06-4.06, p<0.033) without improving functional outcomes. Conclusions: Bridging therapy in AF patients undergoing thrombectomy independently increased the odds of intracranial hemorrhage and did not improve functional outcomes. AF patients may represent a high-risk subgroup for thrombolytic complications. Randomized trials are warranted to determine whether patients with AF associated stroke may benefit by deferring bridging therapy at thrombectomy-capable centers
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Abstract 148: Mechanical Thrombectomy for Distal Occlusions: Efficacy, Functional and Safety Outcomes. Insights From the STAR Collaboration
No full textBackground:
Mechanical thrombectomy (MT) is the standard of care for acute ischemic stroke due to large vessel occlusions. There is strong evidence supporting the benefit of MT in proximal anterior circulation vessel occlusions and basilar occlusions. However, data regarding the efficacy and safety of MT in distal occlusions is scarce. In this study, we aim to report the efficacy, functional and safety outcomes of MT for distal occlusions.
Methods:
This a retrospective study from 14 comprehensive stroke centers across 4 countries. For the purpose of this study, distal occlusion was defined as MCA occlusion distal to M2 (M3-4 segments), any segments of ACA and any segments of PCA. Patients with concomitant proximal occlusions were excluded from this study.
Results:
Of 2826 patients, 111 patients were included in this study (mean (SD) age: 69 (13), 51% of patients were female, and 52% received tPA). Median onset to groin time was 241 (IQR, 136 minutes), median NIHSS on admission was 11 (IQR, 8), and median ASPECTS was 10 (IQR, 1). The procedure was done using ADAPT, stent retriever, and Solumbra techniques in 58%, 17% and 15% of patients respectively. Successful revascularization (mTICI 2b-3) and complete revascularization (mTICI 3) were achieved in 78% and 35% of our cohort, respectively. Median procedure time (puncture to revascularization or end of the procedure) was 29 minutes (IQR 42 minutes) and the median number of attempts was 1 (IQR=2). Five percent of patients suffered procedural complications Hemorrhagic complications occurred in 11% of patients of whom only 4% were PH2 hemorrhage. At the last follow up, mRS 0-2 was achieved in 53% of patients.
Conclusion:
Up to our knowledge, this represents the largest study to the date investigating the safety and efficacy of MT in distal occlusions treatment. MT was safe and achieved a high rate of successful revascularization with an acceptable safety profile
William Paget and the late-Henrican polity, 1543-1547
No full textThis thesis explores the late-Henrican polity through the archive and perspective of William
Paget, Henry VIII's secretary at the end of his reign. Paget's papers as secretary (1543-1547), that
form the basis of the thesis, are an extensive, unique and relatively under-used source. From this
starting-point Paget's role as secretary is explored and he is revealed as the personal servant of
the king, whose natural environment was the court. As such he was an influential source of
counsel and perhaps the key patronage-broker at court. In this context Paget also had a significant
influence over the operation of the dry stamp at the end of the reign. Equally, Paget's role in
shaping the function of the secretary and his relations with the recently formed privy council was
of considerable importance, providing the template for later Tudor secretaries.
Diplomacy in the uncertain world of the 1540s was one of Paget's primary concerns and his
priorities can be seen as trying to provide security and stability for the realm. This is revealed not
only in his 'Consultation' of August 1546 but also in his diplomacy with the French, the
Schmalkaldic League and the Papacy. In this he sometimes found himself at odds with the king
and leading a privy council united in a desire for peace.
Politically Paget has traditionally been cast as an ambitious politique, the 'master of practices'
and part of the earl of Hertford's reform party. Whilst acknowledging Paget's close relations with
Hertford this thesis questions the factional interpretation of the last years of the reign and argues
that the predominant concern of Paget and his fellow privy councillors was a peaceful succession
in which unanimity rather than conflict was the key-note
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Thrombectomy in Stroke Patients With Low Alberta Stroke Program Early Computed Tomography Score: Is Modified Thrombolysis in Cerebral Infarction (mTICI) 2c/3 Superior to mTICI 2b?
No full textBackground and Purpose Outcomes following mechanical thrombectomy (MT) are strongly correlated with successful recanalization, traditionally defined as modified Thrombolysis in Cerebral Infarction (mTICI) ≥2b. This retrospective cohort study aimed to compare the outcomes of patients with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS; 2–5) who achieved mTICI 2b versus those who achieved mTICI 2c/3 after MT.Methods This study utilized data from the Stroke Thrombectomy and Aneurysm Registry (STAR), which combined databases from 32 thrombectomy-capable stroke centers between 2013 and 2023. The study included only patients with low ASPECTS who achieved mTICI 2b, 2c, or 3 after MT for internal carotid artery or middle cerebral artery (M1) stroke.Results Of the 10,229 patients who underwent MT, 234 met the inclusion criteria. Of those, 98 (41.9%) achieved mTICI 2b, and 136 (58.1%) achieved mTICI 2c/3. There were no significant differences in baseline characteristics between the two groups. The 90-day favorable outcome (modified Rankin Scale score: 0–3) was significantly better in the mTICI 2c/3 group than in the mTICI 2b group (adjusted odds ratio 2.35; 95% confidence interval [CI] 1.18–4.81; P=0.02). Binomial logistic regression revealed that achieving mTICI 2c/3 was significantly associated with higher odds of a favorable 90-day outcome (odds ratio 2.14; 95% CI 1.07–4.41; P=0.04).Conclusion In patients with low ASPECTS, achieving an mTICI 2c/3 score after MT is associated with a more favorable 90-day outcome. These findings suggest that mTICI 2c/3 is a better target for MT than mTICI 2b in patients with low ASPECTS
Mapping age- and sex-specifc HIV prevalence in adults in sub-Saharan Africa, 2000–2018
No full textBackground. Human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) is still among the leading causes of disease burden and mortality in sub-Saharan Africa (SSA), and the world is not on track to meet targets set for ending the epidemic by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Sustainable Development Goals (SDGs). Precise HIV burden information is critical for effective geographic and epidemiological targeting of prevention and treatment interventions. Age- and sex-specific HIV prevalence estimates are widely available at the national level, and region-wide local estimates were recently published for adults overall. We add further dimensionality to previous analyses by estimating HIV prevalence at local scales, stratified into sex-specific 5-year age groups for adults ages 15–59 years across SSA. Methods. We analyzed data from 91 seroprevalence surveys and sentinel surveillance among antenatal care clinic (ANC) attendees using model-based geostatistical methods to produce estimates of HIV prevalence across 43 countries in SSA, from years 2000 to 2018, at a 5 × 5-km resolution and presented among second administrative level (typically districts or counties) units. Results. We found substantial variation in HIV prevalence across localities, ages, and sexes that have been masked in earlier analyses. Within-country variation in prevalence in 2018 was a median 3.5 times greater across ages and sexes, compared to for all adults combined. We note large within-district prevalence differences between age groups: for men, 50% of districts displayed at least a 14-fold difference between age groups with the highest and lowest prevalence, and at least a 9-fold difference for women. Prevalence trends also varied over time; between 2000 and 2018, 70% of all districts saw a reduction in prevalence greater than five percentage points in at least one sex and age group. Meanwhile, over 30% of all districts saw at least a five percentage point prevalence increase in one or more sex and age group. Conclusions. As the HIV epidemic persists and evolves in SSA, geographic and demographic shifts in prevention and treatment efforts are necessary. These estimates offer epidemiologically informative detail to better guide more targeted interventions, vital for combating HIV in SSA
Personalising the learning of young children with the use of ICT : an action research case in a Greek primary school
No full textThis thesis is an account of an action research project undertaken in a Greek
primary private school. The project aimed at personalising the students’ learning
with the use of ICT. The project ran for three consecutive school years and involved
students (twenty-six in year 1, sixteen in year 2, and fifty-one in year 3) and, their
parents (in years 1 and 2). The students were eight-years old when the project
started. The focus of the innovation concerned the teaching and learning of English
as a Foreign Language.
The project was an attempt to create a partnership with students and to offer
opportunities for students to make choices in their learning. In year 1 teaching
methods, including argumentative processes, learning task design and assessment
processes, were re-designed and students were encouraged to engage in
collaborative learning. All these changes were sustained in year 2 and the use of
ICT, including online discussion, was introduced to enhance and extend
collaboration and learning. The use of on line ‘chat’ was extended to parents as a
way of communication with school. All these innovations were sustained in year 3
and further exploration of students’ and parents’ perceptions of learning with
technology carried out.
Action research is employed as a methodological approach in this study. In
particular, the study reports on cycles of implementation and reflection carried out
over three years. A variety of methods were used. Diaries were selected to record
situations, questionnaires to access the perceptions of the children and parents, and
chat logs and interviews used to explore these perceptions in greater depth. The mix
of methods enabled comparison and contrast not just between data derived by
different methods but by different sources as well, i.e. parents and children.
The main theoretical concepts explored in this thesis are Personalised Learning, ICT
use, and Collaboration. This research project sees Personalised Learning as the
‘focal innovation’ and ICT use as embedded within personalisation. Collaboration is
considered a fundamental construct in both personalisation and the embedded use
of ICT. This thesis asks whether personalisation is a coherent concept and whether
it can be sustained with the use of ICT. It finds that personalised learning can offer a
coherent organising principle for pedagogic reform, and can be defined by its
concern for collective co-production of knowledge, student voice, assessment for
learning, learning-to-learn strategies, and student centeredness. Personalised
learning and ICT are recognised as a good match and personalised learning is seen
to need ICT in order to be sustained. However, innovation requires time and
evaluation of outcomes is value laden. The thesis finds action research to be an
appropriate methodology for curriculum reform
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Concurrent Anterior Cerebral Artery and Middle Cerebral Artery Occlusions Predict Poor Neurological Outcome Despite Successful Thrombectomy in Anterior Circulation Stroke
No full textDespite successful endovascular thrombectomy for acute ischemic stroke, a significant proportion of patients demonstrate fast and early progression of infarct core and fail to achieve functional independence at 90 days. The aim of this study was to evaluate the impact of thrombus location and the potential impact of collaterals on concurrent middle cerebral artery (MCA) and anterior cerebral artery (ACA) occlusion.
Data were included from a multicenter registry for patients undergoing endovascular thrombectomy for anterior circulation stroke from 32 international centers between 2015 and 2021. Patients were included based on thrombus location and categorized into intracranial internal carotid artery (ICA), ICA + MCA, ICA + ACA, or MCA + ACA cohorts. The primary outcome was 90-day functional independence, defined as a modified Rankin Score (mRS) of 0-2. Secondary outcomes included successful recanalization, procedure time, and rates of postprocedural hemorrhage.
In total, 2067 patients were included in the study with 83 patients (4%) having concurrent MCA + ACA occlusions. There were no differences in age, comorbidities, or intravenous thrombolysis use between the ICA and MCA + ACA groups. On univariate analysis, the MCA + ACA group had a significantly lower proportion of patients achieving mRS 0-2 at 90 days (12% vs 33%, P .05); however, mortality was higher in the MCA + ACA group (22 vs 13%) (P < .05). On multivariate regression, MCA + ACA location was an independent predictor of lower odds of mRS 0-2 compared with the ICA group overall (adjusted odds ratio = 0.52, P = .048) and in patients with successful recanalization (adjusted odds ratio = 0.45, P = .035).
Despite similar vascular territories, concurrent occlusion of the MCA and ACA segments results in worse clinical outcomes compared with intracranial ICA occlusion
