Search

Background PP‐007 is a polyethylene glycol (PEG)ylated bovine carboxyhemoglobin gas transfer molecule with pleotropic cytoprotective effects, vasodilatation, plasma expansion, and optimization of oxygen delivery. Rodent middle cerebral artery occlusion models have demonstrated that PP‐007 increases blood flow in the collateral circulation and reduces final infarct volumes, supporting a potential role as neuroprotective agent in acute ischemic stroke. We aim to evaluate the safety and feasibility of PP‐007 as an adjunctive treatment to mechanical thrombectomy (MT) in patients with stroke secondary to large vessel occlusion. Methods HEMERA‐1 (CarboxyHEMoglobin OxygEn delivery for Revascularization in Acute Stroke) was a multicenter, prospective, randomized, controlled phase 1 clinical trial. Anterior circulation large vessel occlusion patients were assigned in a 3:1 ratio to receive either PP‐007 (320 mg/kg: 30 min bolus followed by 2‐h infusion) plus MT or MT alone within 24 hours after symptom onset. Comprehensive safety evaluation was performed by independent Data Monitoring Safety Board and Imaging Core Lab. Results From October 1, 2021 to June 30, 2022, a total of 17 patients were recruited. Age, baseline National Institutes of Health Stroke Scale score, and Alberta Stroke Program Early CT Score were 74.8±12.7 years, 17.3±4.2, and 7.9±1.8, respectively. Twelve patients were randomized to PP‐007 plus MT, 1 was randomized but not treated, 4 patients were randomized to MT alone. Recanalization of the occluded vessel was achieved in all patients. A transient systolic blood pressure increase (20–40 mm Hg) during the bolus was observed in all PP‐007 patients without any clinical consequences. There were no other safety concerns. Conclusion No significant safety concerns were identified for the adjunctive use of PP‐007 in patients undergoing MT. (The study was funded by Prolong Pharmaceuticals. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04677777.

Introduction Spontaneous intracranial hemorrhage (ICH) is associated with significant morbidity and mortality. Mobile Stroke Unit (MSU) provides a unique opportunity to assess patients in the hyperacute phase of ICH to track outcomes. Methods Methods: We conducted a retrospective review of patients with spontaneous ICH diagnosed on two different MSUs in the United States. Patients were divided into three groups based on symptom onset/last known well (LKW): Group 1: 0–1 hours from LKW, Group 2: 1–2 hours from LKW, and Group 3: 2–4 hours from LKW. We compared neurological decline (ND) rates between MSU and Emergency Department (ED) arrival for patients in the three groups. Neurological decline was defined as a decrease in GCS by ≥ 2 points or an increase in NIHSS ≥ 4 points between MSU and ED examination. χ2 test was used to compare the proportion of patients who experience ND between MSU and ED transport. We also assessed and compared pre‐defined factors that could be associated with ND in the three groups. CT scans done on MSU were compared to those done on ED arrival. Results Results: Fifty‐fourpatients met the study criteria. The mean age was 62, and 69% were male. Median MSU NIHSS was 18, and median ED NIHSS was 19. The mean MSU GCS was 14, and ED GCS was 12. The mean hematoma volume on the MSU CT head was 21 cc and 24 cc on the ED CT head. Mean MSU MAP was 136, and MAP on ED arrival was 120. Thirty‐three percent (18/54) of patients experienced ND between MSU and ED transport. Forty percent (n = 10/25) patients in group 1, 22% (n = 4/18) in group 2 and 36%(n = 4/11) in group 3 had ND (chi‐square 0.45). Overall, patients with ND experienced significantly high mortality (OR 5.091, p = 0.029, CI 1.24‐20.78). On univariate analysis, variables significantly associated with ND were MSU NIHSS, hematoma volume, and presence of hydrocephalus on MSU CT scan. No variables were significant to predict ND on multivariate analysis (Hematoma Expansion OR 1.028, CI 0.99‐1.05; Hydrocephalus OR 3.70 CI 0.67‐20.43) Conclusions Conclusion: One‐thirdof ICH patients experience neurological decline between MSU and ED transport within four hours of symptom onset and are at a significantly higher risk of mortality. Higher ND rates are likely due to earlier diagnosis of ICH on MSU. Due to the smaller sample size, we did not find significant variables associated with ND. However, various ways of providing rapid medical and surgical treatment to these patients should be explored in future studies to assess the effect on functional outcomes.

Background The rapidly changing treatment landscape for large vessel occlusion acute ischemic stroke, now more than ever, has added to the complexity of emergent decision making and the demand for neurointerventionists. Ensuring exposure of neurology trainees to neurointervention and the availability of well‐defined pathways for those interested in this career is crucial. Here we report the results from our large survey of neurology trainee attitudes toward neurointervention training. Methods An online survey targeting trainee impressions on the current state of vascular neurology, neurocritical care, and neurointervention training was conducted as a mandatory requirement for trainee registration in the Society for Vascular and Interventional Neurology Break meeting in April 2020. Quantitative results are reported in proportions, and qualitative results are described. Chi‐square test was used to determine association between categorical variables. Results Of the 725 respondents from 49 countries who participated in this conference, 450 (62%) were trainees. A total of 30% of trainees did not have access to neurointervention training, and 40% believed that neurology residency, vascular neurology, or neurocritical care fellowship do not adequately prepare them for a career in neurointervention. A total of 237/321 (73%) trainees whose institutional neurointervention practice included neurologists or a mix of subspecialty backgrounds including a neurologist had an opportunity to spend elective time in a neurology–angiography suite compared with 49/89 (55%) if the institutional neurointervention practice consisted of neurosurgeons or radiologists alone (P=0.001). A total of 49% of trainees each preferred the introduction of a mandatory or an elective neurointervention module during residency. A total of 60% of trainees preferred no to minimal exposure at the medical student level. Conclusions This international survey of trainees reinforces the existing gap in neurointervention exposure for neurology trainees. Inclusion of neurointervention faculty that come from a neurology training background and exposure to neurointervention will be crucial to support trainees interested in a neurointervention career pathway.