Title: Stability of Large Diffusion/Perfusion Mismatch in Anterior Circulation Strokes for 4 or More Hours

Size: px
Start display at page:

Download "Title: Stability of Large Diffusion/Perfusion Mismatch in Anterior Circulation Strokes for 4 or More Hours"

Transcription

1 Author's response to reviews Title: Stability of Large Diffusion/Perfusion Mismatch in Anterior Circulation Strokes for 4 or More Hours Authors: Ramon G. Gonzalez (rggonzalez@partners.org) Reza Hakimelahi (rhakimelahi@partners.org) Pamela W. Schaefer (pschaefer@partners.org) Luca Roccatagliata (lroccatagliata@neurologia.unige.it) Alma G. Sorensen (sorensen@nmr.mgh.harvard.edu) Aneesh B. Singhal (asinghal@partners.org) Version: 2 Date: 9 December 2009 Author's response to reviews: see over

2 Reviewer 1 comments and responses The authors examined the time course of mismatch in a small randomized trial of patients with acute stroke not eligible for thrombolysis and found an astounding stability of the PWI/DWI mismatch. Major points: The technical aspects of MRI have been described. However it is lacking the MTT threshold for pathological values (3 seconds?). We did not use numerical thresholds. As described in the Methods section, regions of abnormal MTT were drawn by experienced neuroradiologists by visual inspection who were blinded as to treatment, time of scan, etc. Our primary observation that the mismatch was unchanged at 4 hours in most patients was entirely unexpected and would be unlikely to be changed by use of the numerical thresholds. Additional comments on the relationship of MTT to other hemodynamic parameters can be found in the Discussion, paragraph 4. See also the response to Reviewer 4 comment 2. I would suggest to separate Results from Discussion The Results and Discussion sections are now separate. Is it possible to give also the times to MRI from symptom onset rather than from the start of gas therapy? The time from symptom onset to the first scan are shown in Table 1 and in Figure 3. You report results of a randomizes trial. Does a trial registration number exist? This was a preliminary single-center pilot study started in 2001 before the requirement of clinical trial registration was implemented. Hence the study was not registered and does not have a registration number. The pilot study was published in 2005.

3 Reviewer 2 comments and responses The authors report a series of 14 acute stroke patients who received DWI and PWI. The patients were imaged systematically at 4 different time points between the acute situation and one week later. All patients had proximal occlusion of a major artery, either the MCA or the (distal?) ICA? Yes, all patients had MCA or distal ICA occlusion (details below). We have clarified this important point in the manuscript (Results, paragraph 1). The main result is that many patients have diffusion/perfusion mismatch over a prolonged time period, often with parallel DWI lesion growth. This is an interesting observation. Major revisions: My main criticism concerns the conclusions, which are too speculative. The persistence of mismatch does not mean that this is persisting penumbral tissue. In addition, nobody knows whether therapeutic approaches will be of benefit in these patients. We agree and have eliminated the term penumbra or replaced it with hypoperfused tissue throughout the manuscript. We have modified the discussion to make clear that our observations are preliminary and speculative with respect to the possible therapeutic implications (Discussion paragraph 7). Minor revisions: The percentage of patients with proximal (extracranial) ICA occlusion should be given. In these patients mismatch may persist potentially forever, which does not mean that the tissue is at relevant risk. Of the 16 subjects, 11 had MCA embolism from atrial fibrillation, 1 had cryptogenic MCA embolism, and 4 patients had artery to artery embolism to the MCA stem or distal ICA from the ipsilateral carotid artery (2 had ICA origin atherosclerosis, 1 ICA dissection, and 1 cocaine-associated ICA bulb thrombosis). Thus, all had acute MCA / distal ICA occlusion. This is in the Results, paragraph 1. MTT thresholds would be helpful to discriminate between areas at risk and oligemia. We did not use numerical thresholds. As described in the Methods section, regions of abnormal MTT were drawn by experienced neuroradiologists by visual inspection who were blinded as to treatment, time of scan, etc. Our primary observation that the mismatch was unchanged at 4 hours in most patients was entirely unexpected and would be unlikely to be changed by use of the numerical thresholds. An overview of MRI-based hemodynamic parameters is now included in the Discussion, paragraph 4. See also the response to Reviewer 4 comment 2.

4 Reviewer 3 comments and responses The authors aimed at determining the stability of the ischemic penumbra (by assessing persistence of a DWI/PWI mismatch) in 14 stroke patients with proximal anterior circulation artery MCA-occlusion. The mean onset-to-door-time was 7.5 hours (ie, outside time window for tpa), the mean NIHSS was DWI/PWI mismatch was assessed at baseline, 4h, 24h and 1 week. Compared to baseline, both the mean DWI and the mean MTT lesion volumes at 4 hours did not change significantly. The authors conclude that the ischemic penumbra in patients with ICA- or MCA-occlusion may be stable for 4 hours or more. This small prospective observational study provides clinically relevant data on the stability of the ischemic penumbra in patients with occlusion of proximal arteries that are not eligible for tpa (outside time window). The manuscript is well-written and examines an interesting and important topic. The paper is well structured, the methods are appropriate and clearly defined. Interestingly, the mean DWI lesion volume (as a measure of the infarct core) and the mean MTT lesion volume remained stable at 4 hours after baseline (ie, the infarct core did not grow, and the "penumbra" remained stable) as one may have expected. At 24 hours, the DWI lesion volumes had increased and the MTT lesion volumes had decreased, but there was still a DWI/PWI mismatch of 20% or more in all but 2 patients. This finding conflicts with the common concept that the infarct core grows rapidly, ie within minutes and the first hours after onset. However, in the present patients were included beyond the time window for tpa at a mean onset-to-door-time of 7.5 hours. It may well be that the DWI lesions in these selected patients did continuously grow within the first hours and then remained rather stable (ie, at baseline and 4 hours). Anyway, the stable mismatch indeed suggests that these patients had a rather good collateral blood supply that may prevent from further lesion growth for at least some hours, but not forever. Hence, delayed reperfusion even many hours after onset may rescue tissue in these patients. However, the authors discuss that in acute stroke, there may be time for advanced imaging such as multiparametric MR imaging (because the lesions do not grow within this time anyway). This is not compatible with the time-is-brain concept and should not be stated in this way. From all that we know to date: the earlier recanalization the better! It rather appears that the data of the present study strongly support the need for careful selection of patients eligible for thrombolysis that is not solely based on time, but on persistence of vessel occlusion and on presence of salvageable tissue. The time that is necessary to perform reasonable diagnostic procedures may justify a short delay of thrombolysis in patients that would otherwise not be treated at all, but this time still needs to be as short as possible! The authors should discuss this point.

5 These are excellent points. We fully agree and we made the appropriate modification to the Discussion (paragraph 8) to emphasize these points. Moreover, the authors may wish to discuss whether DWI lesion volumes really reflect infarct core volumes, and whether infarct core growth is really reflected by DWI lesion volume growth. Could it be that infarct cores grew but MR imaging did not detect lesion growth? While this is possible, it is unlikely. The best data is derived from animal studies that have shown that the diffusion abnormalities precede infarction and it has never been reported that an early infarct is larger than the diffusion abnormality. In humans, the DWI volume in untreated individuals is the same or smaller than the final infarct, as was case for the patients in this study. With time chronic infarcts may shrink due to encephalomalacic changes. It is well established that a completed infarct displayed by neuroimaging correlates highly with infarct as determined by post mortem evaluation. The stability of the DWI abnormality was also supported by our finding that the ADC values of the lesions did not change at 4 hours after the initial scan. Comments addressing these points are now in the Discussion, paragraphs 2 and 3.

6 Reviewer 4 comments and responses General comments: This is a very interesting manuscript that sheds light on a clinically relevant topic. Although the patient sample is small, the results are clear and have to be discussed in the future. The paper should be published after revision. The mansucript is well prepared and the figures/tables are correct. However, several issues have to be discussed. Major Compulsory Revisions: 1. The equation mismatch=penumbra has to be used with more caution. There are several studies that show the discrepancy between different definitions of mismatch and the underlying penumbra (e.g. by PET/MR studies in stroke). This is important since the result of the revised study may well show a persistance of mismatch (in the definition used by the authors) but does not necessarily document a persitance of penumbra. This has to be clearly focussed and evaluated in the discussion. This leads to the issue that the used MTT definition may not adequately define the tissue at risk. Respective references should be provided. The point is well taken and we have replaced the term penumbra with hypoperfused tissue throughout the manuscript. We have modified the discussion to indicate the persistence of mismatch does not necessarily document a persistence of a penumbra. 2. It is not clear what threshold of MTT prolongation was used. Again, several studies have shown, that the used threshold is of major importance to separate benign oligemia from tissue at risk. A simple visual definition may be misleading. We agree that numerical thresholds are of major importance to identify tissue at risk. Numerical thresholds are used with MR hemodynamic parameters such as cerebral blood flow, Tmax and TTP (time to peak) to try to identify underperfused tissue that is most likely to undergo transition to infarction. Such thresholds are not typically used for MTT, because CBF which is equal to CBV/MTT is a more reliable metric. MTT is sensitive to all hemodynamically altered tissues including areas of true ischemia, benign oligemia and fully compensated tissue. The advantage is that MTT provides very high image contrast compared normally perfused tissues. This can be appreciated in Figure 1. We have expanded on this topic in the Discussion, paragraph Using MTT, it should be discussed whether this is the best parameter map to define the tissue at risk. This issue is addressed above and in the Discussion, paragraph Similarly, the threshold for DWI-lesion should be explained. Visual inspection was used. We realized that the stability of the size of the DWI lesion for 4 hours would be met with some disbelief. Indeed, we were surprised with the result!

7 For that reason, we have included Figure 2 which shows for each patient the image slice with the largest DWI lesion, and corresponding images for each time point. Readers can therefore judge for themselves. Note also that radc did not worsen on serial imaging, which appears consistent with the stability of DWI lesions. Further comments on DWI are in the Discussion, paragraphs 2 and Why were relative ADC maps calculated? Some investigators consider the relative decline in ADC values to be an indicator of severity of ischemia. We found that patients who were on room air had no change in ADC at 4 hours while those on NBO had a slight increase in this value at 4 hours. 6. Were the data tested for normal distribution? The data were found to have a normal distribution using the Kolmogorov-Smirnov Test. In addition to this, we re-analyzed our data with the Wilcoxon Test and it confirmed our original results. 7. In Figure 3, the treatment allocation should be added to the bars. We have added notations to the figure for this purpose. 8. Since the association of mismatch and clinical score is of major importance (if mismatch is really "tissue at risk" than it should contribute to the clinical deficit), a graph (or table) showing the development of NIHSS values and DWI/mismatch values for each patient should be added. We agree that this is important. While the NIHSS at each time point for every patient is already shown in Table 1, we have added a new bar graph (figure 3b) that displays these data. We believe that this will make it easier for the reader to appreciate the relationship of the mismatch to the NIHSS. 9. As described in comment Nr. 1, the expression penumbral stability (page 10, last para) is not correct and should be replaced. We have done this. 10. The conclusion "stable mismatch=late endovascular approach" (page 11, first line) seems too simple and does not account for e.g. DWI lesion size and bleeding risk. The conclusion from the very interesting data is too short and should be discussed more detailed. We agree with this very important point, and we have added relevant comments to the Discussion, paragraph It would be helpful to see the data from figure 4 divided by treatment allocation. What is the effect of treatment allocation? There is a slight decrease in DWI volume in patients that received NBO and slight increase in patients on room air at 4 hours. This is now stated in the results.

8 12. The comparison of mean values for MTT volumes between the measurements may be difficult. Although there was no mean difference between 0 h and 4 h (page 8, last para), figure 3 shows several patients with large variations whitin 4 h. Thus, different patterns may have been lumped together. Were the mean differences for each patient tested as well? The reviewer is correct that different perfusion patterns may have been lumped together, or that arterial recanalization might have occurred by 4 hours. However, in this study serial MTT lesion volume analysis and serial MR-angiography (performed at baseline and 4 hours) showed reperfusion (>50% reduction in MTT lesion volume) and partial arterial recanalization (distal clot migration) in only 1 patient. As suggested we performed a pair-wise analysis of mismatch volumes at baseline and 4 hours and we found no significant difference. This has been added to paragraph in the Results that the reviewer identified. 13. Data about recanalisation at the various time points should be added. Data on recanalization at 4 hours (1 patient) and 24 hours (4 patients) has been added to the Results, paragraphs 5 and Was a continuouos blood pressure monitoring available? This could be of importance in cases of relevant mismatch changes. Blood pressure was obtained at the time of each serial MRI scan. There was no significant change in mean arterial BP from baseline to 4 hours (p=0.6, paired t-test). We have added this important point to the Results, paragraph 1.

occlusions. Cerebral perfusion is driven fundamentally by regional cerebral

occlusions. Cerebral perfusion is driven fundamentally by regional cerebral Appendix Figures Figure A1. Hemodynamic changes that may occur in major anterior circulation occlusions. Cerebral perfusion is driven fundamentally by regional cerebral perfusion pressure (CPP). In response

More information

Advanced Neuroimaging for Acute Stroke

Advanced Neuroimaging for Acute Stroke Advanced Neuroimaging for Acute Stroke E. Bradshaw Bunney, MD, FACEP Professor Department Of Emergency Medicine University of Illinois at Chicago Swedish American Belvidere Hospital Disclosures FERNE Board

More information

The DAWN of a New Era for Wake-up Stroke

The DAWN of a New Era for Wake-up Stroke The DAWN of a New Era for Wake-up Stroke Alan H. Yee, D.O. Stroke and Critical Care Neurology Department of Neurology University of California Davis Medical Center Objectives Review Epidemiology and Natural

More information

Acute Ischemic Stroke Imaging. Ronald L. Wolf, MD, PhD Associate Professor of Radiology

Acute Ischemic Stroke Imaging. Ronald L. Wolf, MD, PhD Associate Professor of Radiology Acute Ischemic Stroke Imaging Ronald L. Wolf, MD, PhD Associate Professor of Radiology Title of First Slide of Substance An Illustrative Case 2 Disclosures No financial disclosures Off-label uses of some

More information

ACUTE ISCHEMIC STROKE. Current Treatment Approaches for Acute Ischemic Stroke

ACUTE ISCHEMIC STROKE. Current Treatment Approaches for Acute Ischemic Stroke ACUTE ISCHEMIC STROKE Current Treatment Approaches for Acute Ischemic Stroke EARLY MANAGEMENT OF ACUTE ISCHEMIC STROKE Rapid identification of a stroke Immediate EMS transport to nearest stroke center

More information

On Call Guide to CT Perfusion. Updated: March 2011

On Call Guide to CT Perfusion. Updated: March 2011 On Call Guide to CT Perfusion Updated: March 2011 CT Stroke Protocol 1. Non contrast CT brain 2. CT perfusion: contrast 40cc bolus dynamic imaging at 8 slice levels ~ 60 sec creates perfusion color maps

More information

Place for Interventional Radiology in Acute Stroke

Place for Interventional Radiology in Acute Stroke Place for Interventional Radiology in Acute Stroke Dr Lakmalie Paranahewa MBBS, MD(Radiology), FRCR Consultant Interventional Radiologist Asiri Group of Hospitals Objectives Imaging in Stroke Neurovascular

More information

Comparison of Five Major Recent Endovascular Treatment Trials

Comparison of Five Major Recent Endovascular Treatment Trials Comparison of Five Major Recent Endovascular Treatment Trials Sample size 500 # sites 70 (100 planned) 316 (500 planned) 196 (833 estimated) 206 (690 planned) 16 10 22 39 4 Treatment contrasts Baseline

More information

ACUTE STROKE IMAGING

ACUTE STROKE IMAGING ACUTE STROKE IMAGING Mahesh V. Jayaraman M.D. Director, Inter ventional Neuroradiology Associate Professor Depar tments of Diagnostic Imaging and Neurosurger y Alper t Medical School at Brown University

More information

11/1/2018. Disclosure. Imaging in Acute Ischemic Stroke 2018 Neuro Symposium. Is NCCT good enough? Keystone Heart Consultant, Stock Options

11/1/2018. Disclosure. Imaging in Acute Ischemic Stroke 2018 Neuro Symposium. Is NCCT good enough? Keystone Heart Consultant, Stock Options Disclosure Imaging in Acute Ischemic Stroke 2018 Neuro Symposium Keystone Heart Consultant, Stock Options Kevin Abrams, M.D. Chief of Radiology Medical Director of Neuroradiology Baptist Hospital, Miami,

More information

Endovascular Therapy: Beyond the Guidelines

Endovascular Therapy: Beyond the Guidelines Endovascular Therapy: Beyond the Guidelines Ashutosh P. Jadhav, MD PhD Assistant Professor, Neurology and Neurological Surgery Center for Neuro-endovascular Therapy UPMC Stroke Institute Pittsburgh, PA

More information

How to Interpret CT/CTA for Acute Stroke in the Age of Endovascular Clot Retrieval

How to Interpret CT/CTA for Acute Stroke in the Age of Endovascular Clot Retrieval How to Interpret CT/CTA for Acute Stroke in the Age of Endovascular Clot Retrieval Peter Howard MD FRCPC Disclosures No conflicts to disclose How to Interpret CT/CTA for Acute Stroke in the Age of Endovascular

More information

STATE OF THE ART IMAGING OF ACUTE STROKE

STATE OF THE ART IMAGING OF ACUTE STROKE STATE OF THE ART IMAGING OF ACUTE STROKE Marin Penkov UH St Ivan Rilski Sofia RadiologyTogether 2-3 June 2017 GOALS The concept and significance of penumbra CT and MRI Basic Principles Clinical application

More information

framework for flow Objectives Acute Stroke Treatment Collaterals in Acute Ischemic Stroke framework & basis for flow

framework for flow Objectives Acute Stroke Treatment Collaterals in Acute Ischemic Stroke framework & basis for flow Acute Stroke Treatment Collaterals in Acute Ischemic Stroke Objectives role of collaterals in acute ischemic stroke collateral therapeutic strategies David S Liebeskind, MD Professor of Neurology & Director

More information

AMSER Case of the Month: March 2019

AMSER Case of the Month: March 2019 AMSER Case of the Month: March 2019 62 year-old male with left-sided weakness Ashley Graziano OMS IV, Lake Erie College of Osteopathic Medicine Erik Yannone MD, Charles Q. Li MD, Warren Chang MD, Matthew

More information

Carotid Embolectomy and Endarterectomy for Symptomatic Complete Occlusion of the Carotid Artery as a Rescue Therapy in Acute Ischemic Stroke

Carotid Embolectomy and Endarterectomy for Symptomatic Complete Occlusion of the Carotid Artery as a Rescue Therapy in Acute Ischemic Stroke This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 License (www.karger.com/oa-license), applicable to the online version of the article

More information

Endovascular Treatment for Acute Ischemic Stroke

Endovascular Treatment for Acute Ischemic Stroke ular Treatment for Acute Ischemic Stroke Vishal B. Jani MD Assistant Professor Interventional Neurology, Division of Department of Neurology. Creighton University/ CHI health Omaha NE Disclosure None 1

More information

CT INTERPRETATION COURSE

CT INTERPRETATION COURSE CT INTERPRETATION COURSE Refresher Course ASTRACAT October 2012 Stroke is a Clinical Diagnosis A clinical syndrome characterised by rapidly developing clinical symptoms and/or signs of focal loss of cerebral

More information

Stroke Treatment Beyond Traditional Time Windows. Rishi Gupta, MD, MBA

Stroke Treatment Beyond Traditional Time Windows. Rishi Gupta, MD, MBA Stroke Treatment Beyond Traditional Time Windows Rishi Gupta, MD, MBA Director, Stroke and Neurocritical Care Endovascular Neurosurgery Wellstar Health System THE PAST THE PRESENT 2015 American Heart Association/American

More information

Mechanical thrombectomy in Plymouth. Will Adams. Will Adams

Mechanical thrombectomy in Plymouth. Will Adams. Will Adams Mechanical thrombectomy in Plymouth Will Adams Will Adams History Intra-arterial intervention 1995 (NINDS) iv tpa improved clinical outcome in patients treated within 3 hours of ictus but limited recanalisation

More information

Update on Early Acute Ischemic Stroke Interventions

Update on Early Acute Ischemic Stroke Interventions Update on Early Acute Ischemic Stroke Interventions Diana Goodman MD Lead Neurohospitalist Maine Medical Center Assistant Professor of Neurology, Tufts University School of Medicine I have no disclosures

More information

CT Perfusion is Essential for Stroke Triage. Maarten Lansberg, MD PhD Associate Professor of Neurology Stanford University, Stanford Stroke Center

CT Perfusion is Essential for Stroke Triage. Maarten Lansberg, MD PhD Associate Professor of Neurology Stanford University, Stanford Stroke Center CT Perfusion is Essential for Stroke Triage Maarten Lansberg, MD PhD Associate Professor of Neurology Stanford University, Stanford Stroke Center CT Perfusion is Essential for Stroke Triage Disclosures:

More information

Imaging Stroke: Is There a Stroke Equivalent of the ECG? Albert J. Yoo, MD Director of Acute Stroke Intervention Massachusetts General Hospital

Imaging Stroke: Is There a Stroke Equivalent of the ECG? Albert J. Yoo, MD Director of Acute Stroke Intervention Massachusetts General Hospital Imaging Stroke: Is There a Stroke Equivalent of the ECG? Albert J. Yoo, MD Director of Acute Stroke Intervention Massachusetts General Hospital Disclosures Penumbra, Inc. research grant (significant) for

More information

Case 1 5/26/2017 ENDOVASCULAR MECHANICAL THROMBECTOMY IN PATIENTS WITH ACUTE ISCHEMIC STROKE

Case 1 5/26/2017 ENDOVASCULAR MECHANICAL THROMBECTOMY IN PATIENTS WITH ACUTE ISCHEMIC STROKE ENDOVASCULAR MECHANICAL THROMBECTOMY IN PATIENTS WITH ACUTE ISCHEMIC STROKE Rhonda Whiteman Racing Against the Clock Workshop June 1, 2017 Objectives To discuss the hyperacute ischemic stroke management

More information

Practical Considerations in the Early Treatment of Acute Stroke

Practical Considerations in the Early Treatment of Acute Stroke Practical Considerations in the Early Treatment of Acute Stroke Matthew E. Fink, MD Neurologist-in-Chief Weill Cornell Medical College New York-Presbyterian Hospital mfink@med.cornell.edu Disclosures Consultant

More information

Imaging in Stroke. D Nagaraja, N Karthik

Imaging in Stroke. D Nagaraja, N Karthik Imaging in Stroke D Nagaraja, N Karthik Cerebro-vascular disease (stroke) is the second leading cause of death. Prior to CT era, diagnosis was essentially clinical supported by angio and lumbar puncture.

More information

Background. Recommendations for Imaging of Acute Ischemic Stroke: A Scientific Statement From the American Heart Association

Background. Recommendations for Imaging of Acute Ischemic Stroke: A Scientific Statement From the American Heart Association for Imaging of Acute Ischemic Stroke: A Scientific Statement From the American Heart Association An Scientific Statement from the Stroke Council, American Heart Association and American Stroke Association

More information

Imaging Acute Stroke and Cerebral Ischemia

Imaging Acute Stroke and Cerebral Ischemia Department of Radiology University of California San Diego Imaging Acute Stroke and Cerebral Ischemia John R. Hesselink, M.D. Causes of Stroke Arterial stenosis Thrombosis Embolism Dissection Hypotension

More information

Hypoperfusion Intensity Ratio Predicts Infarct Progression and Functional Outcome in the DEFUSE 2 Cohort

Hypoperfusion Intensity Ratio Predicts Infarct Progression and Functional Outcome in the DEFUSE 2 Cohort Hypoperfusion Intensity Ratio Predicts Infarct Progression and Functional Outcome in the DEFUSE 2 Cohort Jean Marc Olivot, MD, PhD; Michael Mlynash, MD, MS; Manabu Inoue, MD, PhD; Michael P. Marks, MD;

More information

UPDATES IN INTRACRANIAL INTERVENTION Jordan Taylor DO Metro Health Neurology 2015

UPDATES IN INTRACRANIAL INTERVENTION Jordan Taylor DO Metro Health Neurology 2015 UPDATES IN INTRACRANIAL INTERVENTION Jordan Taylor DO Metro Health Neurology 2015 NEW STUDIES FOR 2015 MR CLEAN ESCAPE EXTEND-IA REVASCAT SWIFT PRIME RECOGNIZED LIMITATIONS IV Alteplase proven benefit

More information

Endovascular Treatment Updates in Stroke Care

Endovascular Treatment Updates in Stroke Care Endovascular Treatment Updates in Stroke Care Autumn Graham, MD April 6-10, 2017 Phoenix, AZ Endovascular Treatment Updates in Stroke Care Autumn Graham, MD Associate Professor of Clinical Emergency Medicine

More information

Neuro-vascular Intervention in Stroke. Will Adams Consultant Neuroradiologist Plymouth Hospitals NHS Trust

Neuro-vascular Intervention in Stroke. Will Adams Consultant Neuroradiologist Plymouth Hospitals NHS Trust Neuro-vascular Intervention in Stroke Will Adams Consultant Neuroradiologist Plymouth Hospitals NHS Trust Stroke before the mid 1990s Swelling Stroke extension Haemorrhagic transformation Intravenous thrombolysis

More information

MR RESCUE: Primary Results

MR RESCUE: Primary Results MR RESCUE: Primary Results (Mechanical Retrieval and REcanalization of Stroke Clots Using Embolectomy) Funded by NIH-NINDS UCLA SPOTRIAS Grant: P50 NS044378 Clinical Trials.gov Number NCT00389467 FDA IDE

More information

Index of Changes. Examiner 1

Index of Changes. Examiner 1 Index of Changes Examiner 1 Previous Page: 84 Current Page: 76 Suggested changes: 1. There are different methods to assess the penumbra or mismatch in acute ischemic stroke: some are pure imaging-based

More information

IV tpa and mechanical thrombectomy case selection

IV tpa and mechanical thrombectomy case selection IV tpa and mechanical thrombectomy case selection 22 April 2017, 9.50-10.30 Deidre De Silva SGH campus, NNI, Singapore OUTLINE Reperfusion concept Case Selection factors IV tpa & Mechanical Thrombectomy

More information

The association between neurological deficit in acute ischemic stroke and mean transit time

The association between neurological deficit in acute ischemic stroke and mean transit time Neuroradiology (2006) 48: 69 77 DOI 10.1007/s00234-005-0012-9 DIAGNOSTIC NEURORADIOLOGY Peter D. Schellinger Lawrence L. Latour Chen-Sen Wu Julio A. Chalela Steven Warach The association between neurological

More information

Acute Ischemic Stroke Imaging Innovations

Acute Ischemic Stroke Imaging Innovations Acute Ischemic Stroke Imaging Innovations Guilherme Dabus, MD, FAHA Director, Fellowship NeuroInterventional Surgery Miami Cardiac & Vascular Institute Baptist Neuroscience Center Baptist Neuroscience

More information

Intravenous thrombolysis State of Art. Carlos A. Molina Stroke Unit. Hospital Vall d Hebron Barcelona

Intravenous thrombolysis State of Art. Carlos A. Molina Stroke Unit. Hospital Vall d Hebron Barcelona Intravenous thrombolysis State of Art Carlos A. Molina Stroke Unit. Hospital Vall d Hebron Barcelona Independent predictors of good outcome after iv tpa Factor SE OR(95%CI) p Constant 0.467(0.69) Recanalization

More information

STROKE - IMAGING. Dr RAJASEKHAR REDDY 2nd Yr P.G. RADIODIAGNOSIS KIMS,Narkatpalli.

STROKE - IMAGING. Dr RAJASEKHAR REDDY 2nd Yr P.G. RADIODIAGNOSIS KIMS,Narkatpalli. STROKE - IMAGING Dr RAJASEKHAR REDDY 2nd Yr P.G. RADIODIAGNOSIS KIMS,Narkatpalli. STROKE Describes a clinical event that consists of sudden onset of neurological symptoms Types Infarction - occlusion of

More information

5/31/2018. Interventional Therapies that Expand Time Windows for Acute Ischemic Stroke Treatment. Disclosures. Impact of clot burden

5/31/2018. Interventional Therapies that Expand Time Windows for Acute Ischemic Stroke Treatment. Disclosures. Impact of clot burden Good Outcome (%) Rankin 0-2 at 90 days 5/31/2018 Interventional Therapies that Expand Time Windows for Acute Ischemic Stroke Treatment Disclosures Cerenovus: I am on Executive Committee for ARISE2 Trial

More information

Recanalization of Chronic Carotid Artery Occlusion Objective Improvement Of Cerebral Perfusion

Recanalization of Chronic Carotid Artery Occlusion Objective Improvement Of Cerebral Perfusion Recanalization of Chronic Carotid Artery Occlusion Objective Improvement Of Cerebral Perfusion Paul Hsien-Li Kao, MD Assistant Professor National Taiwan University Medical School and Hospital ICA stenting

More information

Effect of Collateral Blood Flow on Patients Undergoing Endovascular Therapy for Acute Ischemic Stroke

Effect of Collateral Blood Flow on Patients Undergoing Endovascular Therapy for Acute Ischemic Stroke Effect of Collateral Blood Flow on Patients Undergoing Endovascular Therapy for Acute Ischemic Stroke Michael P. Marks, MD; Maarten G. Lansberg, MD; Michael Mlynash, MD; Jean-Marc Olivot, MD; Matus Straka,

More information

Remission of diffusion lesions in acute stroke magnetic resonance imaging

Remission of diffusion lesions in acute stroke magnetic resonance imaging ORIGINAL RESEARCH Remission of diffusion lesions in acute stroke magnetic resonance imaging F. A. Fellner 1, M. R. Vosko 2, C. M. Fellner 1, D. Flöry 1 1. AKH Linz, Institute of Radiology, Austria. 2.

More information

Broadening the Stroke Window in Light of the DAWN Trial

Broadening the Stroke Window in Light of the DAWN Trial Broadening the Stroke Window in Light of the DAWN Trial South Jersey Neurovascular and Stroke Symposium April 26, 2018 Rohan Chitale, MD Assistant Professor of Neurological Surgery Vanderbilt University

More information

Advances in Neuro-Endovascular Care for Acute Stroke

Advances in Neuro-Endovascular Care for Acute Stroke Advances in Neuro-Endovascular Care for Acute Stroke Ciarán J. Powers, MD, PhD, FAANS Associate Professor Program Director Department of Neurological Surgery Surgical Director Comprehensive Stroke Center

More information

Strokecenter Key lessons of MR CLEAN study

Strokecenter Key lessons of MR CLEAN study Strokecenter Key lessons of MR CLEAN study Diederik Dippel Disclosures Funded by the Dutch Heart Foundation Nominal, unrestricted grants from AngioCare BV Medtronic/Covidien/EV3 MEDAC Gmbh/LAMEPRO Penumbra

More information

What Have We Learned: Selection for Endovascular Stroke Therapy

What Have We Learned: Selection for Endovascular Stroke Therapy What Have We Learned: Selection for Endovascular Stroke Therapy Raul G Nogueira, MD Associate Professor in Neurology, Neurosurgery, and Radiology Emory University Director, Neuroendovascular Service Director,

More information

Spontaneous Recanalization after Complete Occlusion of the Common Carotid Artery with Subsequent Embolic Ischemic Stroke

Spontaneous Recanalization after Complete Occlusion of the Common Carotid Artery with Subsequent Embolic Ischemic Stroke Original Contribution Spontaneous Recanalization after Complete Occlusion of the Common Carotid Artery with Subsequent Embolic Ischemic Stroke Abstract Introduction: Acute carotid artery occlusion carries

More information

Endovascular Treatment for Acute Ischemic Stroke: Curtis A. Given II, MD Co-Director, Neurointerventional Services Baptist Physician Lexington

Endovascular Treatment for Acute Ischemic Stroke: Curtis A. Given II, MD Co-Director, Neurointerventional Services Baptist Physician Lexington Endovascular Treatment for Acute Ischemic Stroke: Curtis A. Given II, MD Co-Director, Neurointerventional Services Baptist Physician Lexington Disclosures: SWIFT PRIME site (Medtronic) Physician Proctor

More information

ESCAPE Endovascular treatment for Small Core and Anterior circulation Proximal occlusion with Emphasis on minimizing CT to recanalization times

ESCAPE Endovascular treatment for Small Core and Anterior circulation Proximal occlusion with Emphasis on minimizing CT to recanalization times ESCAPE Endovascular treatment for Small Core and Anterior circulation Proximal occlusion with Emphasis on minimizing CT to recanalization times Michael D Hill, Mayank Goyal on behalf of the ESCAPE Trial

More information

Disclosure. Advances in Interventional Neurology. Disclosure. Natural History of Disease 3/15/2018. Vishal B. Jani MD

Disclosure. Advances in Interventional Neurology. Disclosure. Natural History of Disease 3/15/2018. Vishal B. Jani MD Advances in Interventional Neurology Disclosure Vishal B. Jani MD Medical Director Vascular Neurology Consultant Interventional Neurology CHI Health Assistant Professor, Creighton University School of

More information

Mechanical thrombectomy beyond the 6 hours. Mahmoud Rayes, MD Medical Director, Stroke program Greenville Memorial Hospital

Mechanical thrombectomy beyond the 6 hours. Mahmoud Rayes, MD Medical Director, Stroke program Greenville Memorial Hospital Mechanical thrombectomy beyond the 6 hours Mahmoud Rayes, MD Medical Director, Stroke program Greenville Memorial Hospital Disclosures None Worldwide statistics 1 IN 6 people will have a stroke at some

More information

RBWH ICU Journal Club February 2018 Adam Simpson

RBWH ICU Journal Club February 2018 Adam Simpson RBWH ICU Journal Club February 2018 Adam Simpson 3 THROMBOLYSIS Reperfusion therapy has become the mainstay of therapy for ischaemic stroke. Thrombolysis is now well accepted within 4.5 hours. - Improved

More information

Extra- and intracranial tandem occlusions in the anterior circulation - clinical outcome of endovascular treatment in acute major stroke.

Extra- and intracranial tandem occlusions in the anterior circulation - clinical outcome of endovascular treatment in acute major stroke. Extra- and intracranial tandem occlusions in the anterior circulation - clinical outcome of endovascular treatment in acute major stroke. Poster No.: C-1669 Congress: ECR 2014 Type: Scientific Exhibit

More information

Stroke Update Elaine J. Skalabrin MD Medical Director and Neurohospitalist Sacred Heart Medical Center Stroke Center

Stroke Update Elaine J. Skalabrin MD Medical Director and Neurohospitalist Sacred Heart Medical Center Stroke Center Stroke Update 2015 Elaine J. Skalabrin MD Medical Director and Neurohospitalist Sacred Heart Medical Center Stroke Center Objectives 1. Review successes in systems of care approach to acute ischemic stroke

More information

Figures for Draft Response to IMS III, MR RESCUE, and SYNTHSESIS Trials

Figures for Draft Response to IMS III, MR RESCUE, and SYNTHSESIS Trials Figures for Draft Response to IMS III, MR RESCUE, and SYNTHSESIS Trials Figure 1: Lay Press Judgment May Belie a Deeper Examination of the Data. Truman ultimately defeated Dewey for the Presidency Subject

More information

Dynamic susceptibility contract-enhanced MRI is increasingly

Dynamic susceptibility contract-enhanced MRI is increasingly Influence of Arterial Input Function on Hypoperfusion Volumes Measured With Perfusion-Weighted Imaging Vincent N. Thijs, MD; Diederik M. Somford, MD; Roland Bammer, PhD; Wim Robberecht, MD, PhD; Michael

More information

Rapid identification of a major diffusion/perfusion mismatch in distal internal carotid artery or middle cerebral artery ischemic stroke

Rapid identification of a major diffusion/perfusion mismatch in distal internal carotid artery or middle cerebral artery ischemic stroke Rapid identification of a major diffusion/perfusion mismatch in distal internal carotid artery or middle cerebral artery ischemic stroke The Harvard community has made this article openly available. Please

More information

Unclogging The Pipes. Zahraa Rabeeah MD Chief Resident February 9,2018

Unclogging The Pipes. Zahraa Rabeeah MD Chief Resident February 9,2018 Unclogging The Pipes Zahraa Rabeeah MD Chief Resident February 9,2018 Please join Polleverywhere by texting: ZRABEEAH894 to 37607 Disclosures None Objectives Delineate the differences between TPA vs thrombectomy

More information

CVA Updates Karen Greenberg, DO, FACOEP. Director Neurologic Emergency Department Crozer Chester Medical Center

CVA Updates Karen Greenberg, DO, FACOEP. Director Neurologic Emergency Department Crozer Chester Medical Center CVA Updates 2018 Karen Greenberg, DO, FACOEP Director Neurologic Emergency Department Crozer Chester Medical Center Disclosure I have the following financial relationship with the manufacturer of any commercial

More information

Mechanical Thrombectomy of Large Vessel Occlusions Using Stent Retriever Devices

Mechanical Thrombectomy of Large Vessel Occlusions Using Stent Retriever Devices Mechanical Thrombectomy of Large Vessel Occlusions Using Stent Retriever Devices Joey English MD, PhD Medical Director, Neurointerventional Services California Pacific Medical Center Hospitals, San Francisco,

More information

Assessing Tissue Oxygenation and Predicting Tissue Outcome in Acute Stroke

Assessing Tissue Oxygenation and Predicting Tissue Outcome in Acute Stroke The Danish National Research Foundation s Center of Functionally Integrative Neuroscience Aarhus University / Aarhus University Hospital - DENMARK Assessing Tissue Oxygenation and Predicting Tissue Outcome

More information

EFFECTIVENESS OF CTA AND CTP IN GUIDING MANAGEMENT DECISIONS FOR ACUTE STROKE

EFFECTIVENESS OF CTA AND CTP IN GUIDING MANAGEMENT DECISIONS FOR ACUTE STROKE EFFECTIVENESS OF CTA AND CTP IN GUIDING MANAGEMENT DECISIONS FOR ACUTE STROKE Jon Benton MS-4, Chirag Dani MD, Vincent Persaud MD, Bilal A. Manzer, Macksood Aftab DO, MHA OBJECTIVES 1. Utility of advanced

More information

Disclosure. + Outline. What is a stroke? Role of imaging in stroke Ischemic stroke Venous infarct Current topics

Disclosure. + Outline. What is a stroke? Role of imaging in stroke Ischemic stroke Venous infarct Current topics + Kathleen R. Fink, MD University of Washington 5 th Nordic Emergency Radiology Course May 21, 2015 + Disclosure My spouse receives research salary support from: Bracco BayerHealthcare Guerbet Thank you

More information

Stroke Clinical Trials Update Transitioning to an Anatomic Diagnosis in Ischemic Stroke

Stroke Clinical Trials Update Transitioning to an Anatomic Diagnosis in Ischemic Stroke Stroke Clinical Trials Update Transitioning to an Anatomic Diagnosis in Ischemic Stroke Alexander A. Khalessi MD MS Director of Endovascular Neurosurgery Surgical Director of NeuroCritical Care University

More information

Reperfusion therapy improves outcomes of patients with acute

Reperfusion therapy improves outcomes of patients with acute Published September 25, 2014 as 10.3174/ajnr.A4103 ORIGINAL RESEARCH BRAIN Combining MRI with NIHSS Thresholds to Predict Outcome in Acute Ischemic Stroke: Value for Patient Selection P.W. Schaefer, B.

More information

Whole brain CT perfusion maps with paradoxical low mean transit time to predict infarct core

Whole brain CT perfusion maps with paradoxical low mean transit time to predict infarct core Whole brain CT perfusion maps with paradoxical low mean transit time to predict infarct core Poster No.: B-292 Congress: ECR 2011 Type: Scientific Paper Topic: Neuro Authors: S. Chakraborty, M. E. Ahmad,

More information

Ongoing Acute Stroke Studies 10/5/2015

Ongoing Acute Stroke Studies 10/5/2015 Ongoing Acute Stroke Studies 10/5/2015 Wade S. Smith, MD, PhD Director UCSF Neurovascular Service Daryl R. Gress Professor of Neurocritical Care and Stroke Disclosures NIH U10 NS 086494 (PI) NorCal RCC

More information

Assessment Of Collateral Pathways In Acute Ischemic Cerebrovascular Stroke Using A Mansour Grading Scale; A New Scale, A Pilot Study

Assessment Of Collateral Pathways In Acute Ischemic Cerebrovascular Stroke Using A Mansour Grading Scale; A New Scale, A Pilot Study ISPUB.COM The Internet Journal of Interventional Medicine Volume 3 Number 1 Assessment Of Collateral Pathways In Acute Ischemic Cerebrovascular Stroke Using A Mansour Grading Scale; A New Scale, A Pilot

More information

The Language of Stroke

The Language of Stroke The Language of Stroke Examination / Imaging / Diagnosis / Treatment Dr Suzanne Busch A lot of letters! CBF CVA ICH CVD CBV DWI US MRI/MRA CAA CTA CTP ICA MCA SAH WMD TIA MCA Agnosia A lot of big words!

More information

Is there even a time window?

Is there even a time window? Is there even a time window? A brief summary of key 2018 trials: DAWN and DEFUSE-3 For Neurosciences Update Conference, February 22, 2018 Maxim D. Hammer, M.D. Executive Summary Based on DAWN and DEFUSE-3,

More information

Interventional Neuroradiology. & Stroke INR PROCEDURES INR PROCEDURES. Dr Steve Chryssidis. 25-Sep-17. Interventional Neuroradiology

Interventional Neuroradiology. & Stroke INR PROCEDURES INR PROCEDURES. Dr Steve Chryssidis. 25-Sep-17. Interventional Neuroradiology Interventional Neuroradiology Interventional Neuroradiology & Stroke Dr Steve Chryssidis Interventional Neuroradiology (INR) is a subspecialty within Radiology INR -- broadly defined as treatment by endovascular

More information

Acute Stroke Treatment Update for 2008

Acute Stroke Treatment Update for 2008 Acute Stroke Treatment Update for 2008 * Michael R. Dobbs, MD Assistant Professor of Neurology, Preventive Medicine, and Graduate Center for Toxicology University of Kentucky College of Medicine The Stroke

More information

Comparison of Magnetic Resonance Imaging Mismatch Criteria to Select Patients for Endovascular Stroke Therapy

Comparison of Magnetic Resonance Imaging Mismatch Criteria to Select Patients for Endovascular Stroke Therapy Comparison of Magnetic Resonance Imaging Mismatch Criteria to Select Patients for Endovascular Stroke Therapy Nishant K. Mishra, MBBS, PhD, FESO; Gregory W. Albers, MD; Søren Christensen, PhD; Michael

More information

Drano vs. MR CLEAN Review of New Endovascular Therapy for Acute Ischemic Stroke Patients

Drano vs. MR CLEAN Review of New Endovascular Therapy for Acute Ischemic Stroke Patients Drano vs. MR CLEAN Review of New Endovascular Therapy for Acute Ischemic Stroke Patients Peter Panagos, MD, FACEP, FAHA Associate Professor Emergency Medicine and Neurology Washington University School

More information

Case Report Successful Mechanical Thrombectomy of a Middle Cerebral Artery Occlusion 14 Hours after Stroke Onset

Case Report Successful Mechanical Thrombectomy of a Middle Cerebral Artery Occlusion 14 Hours after Stroke Onset Hindawi Case Reports in Neurological Medicine Volume 2017, Article ID 9289218, 4 pages https://doi.org/10.1155/2017/9289218 Case Report Successful Mechanical Thrombectomy of a Middle Cerebral Artery Occlusion

More information

[(PHY-3a) Initials of MD reviewing films] [(PHY-3b) Initials of 2 nd opinion MD]

[(PHY-3a) Initials of MD reviewing films] [(PHY-3b) Initials of 2 nd opinion MD] 2015 PHYSICIAN SIGN-OFF (1) STUDY NO (PHY-1) CASE, PER PHYSICIAN REVIEW 1=yes 2=no [strictly meets case definition] (PHY-1a) CASE, IN PHYSICIAN S OPINION 1=yes 2=no (PHY-2) (PHY-3) [based on all available

More information

What is the best imaging protocol for LVO screening when outside of 0-6h window?

What is the best imaging protocol for LVO screening when outside of 0-6h window? Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention Zentrum für Radiologie und Endoskopie WLNC, Los Angeles/CA, USA, May 15-17, 2017 What is the best imaging protocol for LVO screening

More information

Endovascular Procedures (Angioplasty and/or Stenting) for Intracranial Arterial Disease (Atherosclerosis and Aneurysms)

Endovascular Procedures (Angioplasty and/or Stenting) for Intracranial Arterial Disease (Atherosclerosis and Aneurysms) Endovascular Procedures (Angioplasty and/or Stenting) for Intracranial Arterial Disease (Atherosclerosis and Aneurysms) Policy Number: 2.01.54 Last Review: 11/2018 Origination: 4/2006 Next Review: 11/2019

More information

The role of CT perfusion in patients selection for acute treatment

The role of CT perfusion in patients selection for acute treatment The role of CT perfusion in patients selection for acute treatment Enrico Fainardi Unità Operativa di Neuroradiologia, Dipartimento di Neuroscienze e Riabilitazione, Azienda Ospedaliero-Universitaria,

More information

Reliability of CT Perfusion in the Evaluation of the Ischaemic Penumbra

Reliability of CT Perfusion in the Evaluation of the Ischaemic Penumbra Reliability of CT Perfusion in the Evaluation of the Ischaemic Penumbra JOSÉ EDUARDO ALVES, ÂNGELO CARNEIRO, JOÃO XAVIER Department of Neuroradiology, Centro Hospitalar do Porto; Porto, Portugal Key words:

More information

12/4/2017. Disclosures. Study organization. Stryker Medtronic Penumbra Viz Route 92. Data safety monitoring board Tudor G.

12/4/2017. Disclosures. Study organization. Stryker Medtronic Penumbra Viz Route 92. Data safety monitoring board Tudor G. 12/4/2017 Update on Stroke Trials:Extending the Window DWI or CTP Assessment with Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention with Trevo NP001713

More information

AHA/ASA Guideline. Downloaded from by on November 7, 2018

AHA/ASA Guideline. Downloaded from   by on November 7, 2018 AHA/ASA Guideline 2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular

More information

Medical Policy. MP Computed Tomography Perfusion Imaging of the Brain

Medical Policy. MP Computed Tomography Perfusion Imaging of the Brain Medical Policy MP 6.01.49 BCBSA Ref. Policy: 6.01.49 Last Review: 09/28/2017 Effective Date: 09/28/2017 Section: Radiology Related Policies 2.01.54 Endovascular Procedures for Intracranial Arterial Disease

More information

Mechanical Thrombectomy: Where Are We Now? T. Adam Oliver, MD Tallahassee Neurological Clinic Tallahassee, Florida TMH Neurosymposium June 11, 2016

Mechanical Thrombectomy: Where Are We Now? T. Adam Oliver, MD Tallahassee Neurological Clinic Tallahassee, Florida TMH Neurosymposium June 11, 2016 Mechanical Thrombectomy: Where Are We Now? T. Adam Oliver, MD Tallahassee Neurological Clinic Tallahassee, Florida TMH Neurosymposium June 11, 2016 none DISCLOSURES Where did we come from? Spiotta, et

More information

Stroke: The First Critical Hour. Alina Candal, RN, PCC, MICN Kevin Andruss, MD, FACEP

Stroke: The First Critical Hour. Alina Candal, RN, PCC, MICN Kevin Andruss, MD, FACEP Stroke: The First Critical Hour Alina Candal, RN, PCC, MICN Kevin Andruss, MD, FACEP Disclosures We have no actual or potential conflicts of interest in relation to this presentation. Objectives Discuss

More information

Benign Oligemia Despite a Malignant MRI Profile in Acute Ischemic Stroke

Benign Oligemia Despite a Malignant MRI Profile in Acute Ischemic Stroke CASE REPORT J Clin Neurol 2010;6:41-45 Print ISSN 1738-6586 / On-line ISSN 2005-5013 10.3988/jcn.2010.6.1.41 Benign Oligemia Despite a Malignant MRI Profile in Acute Ischemic Stroke Oh Young Bang, MD a

More information

Endovascular Clot Retrieval. Teddy Wu Neurologist (and Stroke enthusiast) Christchurch Hospital

Endovascular Clot Retrieval. Teddy Wu Neurologist (and Stroke enthusiast) Christchurch Hospital Endovascular Clot Retrieval Teddy Wu Neurologist (and Stroke enthusiast) Christchurch Hospital Something you can do tomorrow Melbourne half marathon 2016 In 2009 Simple approach to stroke - blocked artery,

More information

Parameter Optimized Treatment for Acute Ischemic Stroke

Parameter Optimized Treatment for Acute Ischemic Stroke Heart & Stroke Barnett Memorial Lectureship and Visiting Professorship Parameter Optimized Treatment for Acute Ischemic Stroke December 2, 2016, Thunder Bay, Ontario Adnan I. Qureshi MD Professor of Neurology,

More information

CME. Clinical MRI of Acute Ischemic Stroke. Review. R. Gilberto Gonzalez, MD, PhD 1 3 * JOURNAL OF MAGNETIC RESONANCE IMAGING 36: (2012)

CME. Clinical MRI of Acute Ischemic Stroke. Review. R. Gilberto Gonzalez, MD, PhD 1 3 * JOURNAL OF MAGNETIC RESONANCE IMAGING 36: (2012) CME JOURNAL OF MAGNETIC RESONANCE IMAGING 36:259 271 (2012) Review Clinical MRI of Acute Ischemic Stroke R. Gilberto Gonzalez, MD, PhD 1 3 * This article is accredited as a journal-based CME activity.

More information

Interventional Stroke Treatment

Interventional Stroke Treatment Interventional Stroke Treatment Vishal B. Jani MD Medical Director Vascular Neurology Consultant Interventional Neurology CHI Health Assistant Professor, Creighton University School of Medicine Omaha,

More information

Evidence for Mechanical ThrombectomyFor Acute Ischemic Stroke. Kenneth V Snyder MD PhD SUNY Buffalo, NY

Evidence for Mechanical ThrombectomyFor Acute Ischemic Stroke. Kenneth V Snyder MD PhD SUNY Buffalo, NY Evidence for Mechanical ThrombectomyFor Acute Ischemic Stroke Kenneth V Snyder MD PhD SUNY Buffalo, NY Disclosure Speaker name:... I have the following potential conflicts of interest to report: Honorarium

More information

Diagnostic improvement from average image in acute ischemic stroke

Diagnostic improvement from average image in acute ischemic stroke Diagnostic improvement from average image in acute ischemic stroke N. Magne (1), E.Tollard (1), O. Ozkul- Wermester (2), V. Macaigne (1), J.-N. Dacher (1), E. Gerardin (1) (1) Department of Radiology,

More information

Stroke 101. Maine Cardiovascular Health Summit. Eileen Hawkins, RN, MSN, CNRN Pen Bay Stroke Program Coordinator November 7, 2013

Stroke 101. Maine Cardiovascular Health Summit. Eileen Hawkins, RN, MSN, CNRN Pen Bay Stroke Program Coordinator November 7, 2013 Stroke 101 Maine Cardiovascular Health Summit Eileen Hawkins, RN, MSN, CNRN Pen Bay Stroke Program Coordinator November 7, 2013 Stroke Statistics Definition of stroke Risk factors Warning signs Treatment

More information

Acute Stroke Treatment KPNC Stroke EXPRESS

Acute Stroke Treatment KPNC Stroke EXPRESS Acute Stroke Treatment 2018 KPNC Stroke EXPRESS EXpediting the PRocess of Evaluating & Stopping Stroke 1 Jeffrey G. Klingman, MD The Permanente Medical Group Stroke Treatment in the old days Prior to 1996:

More information

Where are we heading and where are the big challenges?

Where are we heading and where are the big challenges? Where are we heading and where are the big challenges? Christopher Levi Neurologist, John Hunter Hospital, Newcastle & Liverpool Hospital, Sydney Executive Director, Sydney Partnership for Health Education

More information

OBJECTIVES: INTRODUCTION ADVANCES IN ACUTE STROKE CARE

OBJECTIVES: INTRODUCTION ADVANCES IN ACUTE STROKE CARE Brian A. Stettler, MD Assistant Professor, Department of Emergency Medicine, University of Cincinnati College of Medicine Member, Greater Cincinnati/Northern Kentucky Stroke Team Cincinnati, Ohio OBJECTIVES:

More information

Shawke A. Soueidan, MD. Riverside Neurology & Sleep Specialists

Shawke A. Soueidan, MD. Riverside Neurology & Sleep Specialists Shawke A. Soueidan, MD Riverside Neurology & Sleep Specialists 757-221-0110 Epidemiology of stroke 2018 Affects nearly 800,000 people in the US annually Approximately 600000 first-ever strokes and 185000

More information

Complete Recovery of Perfusion Abnormalities in a Cardiac Arrest Patient Treated with Hypothermia: Results of Cerebral Perfusion MR Imaging

Complete Recovery of Perfusion Abnormalities in a Cardiac Arrest Patient Treated with Hypothermia: Results of Cerebral Perfusion MR Imaging pissn 2384-1095 eissn 2384-1109 imri 2018;22:56-60 https://doi.org/10.13104/imri.2018.22.1.56 Complete Recovery of Perfusion Abnormalities in a Cardiac Arrest Patient Treated with Hypothermia: Results

More information

9/18/16. Setting: Community ED, 30k admissions per year Time: Friday night, 11pm. CC: Syncope

9/18/16. Setting: Community ED, 30k admissions per year Time: Friday night, 11pm. CC: Syncope William A. Knight IV MD, FACEP Associate Professor Emergency Medicine & Neurosurgery University of Cincinnati September 21, 2016 (William.knight@uc.edu) ED as the Front Door Spectrum of care with Endovascular

More information