Search

Supplemental material, sj-docx-1-wso-10.1177_17474930231184369 for Mechanical thrombectomy with intra-arterial thrombolysis versus mechanical thrombectomy alone in patients with acute ischemic stroke: A systematic review and meta-analysis by Adnan I Qureshi, Abdullah Lodhi, Iqra N Akhtar, Xiaoyu Ma, Danish Kherani, Chun Shing Kwok, Daniel E Ford, Daniel F Hanley, Ameer E Hassan, Thanh N Nguyen, Alejandro M Spiotta and Syed F Zaidi in International Journal of Stroke

Coma and disorders of consciousness (DoC) are highly prevalent and constitute a burden for patients, families, and society worldwide. As part of the Curing Coma Campaign, the Neurocritical Care Society partnered with the National Institutes of Health to organize a symposium bringing together experts from all over the world to develop research targets for DoC. The conference was structured along six domains: (1) defining endotype/phenotypes, (2) biomarkers, (3) proof-of-concept clinical trials, (4) neuroprognostication, (5) long-term recovery, and (6) large datasets. This proceedings paper presents actionable research targets based on the presentations and discussions that occurred at the conference. We summarize the background, main research gaps, overall goals, the panel discussion of the approach, limitations and challenges, and deliverables that were identified.

Supplemental material, WSO908144 Supplemental material for Primary intraventricular hemorrhage outcomes in the CLEAR III trial by Sarah E Nelson, W Andrew Mould, Dheeraj Gandhi, Richard E Thompson, Sarah Salter, Rachel Dlugash, Issam A Awad, Daniel F Hanley and Wendy Ziai in International Journal of Stroke

Supplemental Material for A randomized 500-subject open-label phase 3 clinical trial of minimally invasive surgery plus alteplase in intracerebral hemorrhage evacuation (MISTIE III) by Wendy C Ziai, Nichol McBee, Karen Lane, Kennedy R Lees, Jesse Dawson, Paul Vespa, Richard E Thompson, A David Mendelow, Carlos S Kase, J Ricardo Carhuapoma, Carol B Thompson, Steven W Mayo, Pat Reilly, Scott Janis, Craig S Anderson, Mark R Harrigan, Paul J Camarata, Jean-Louis Caron, Mario Zuccarello, Issam A Awad, Daniel F Hanley and On Behalf of the MISTIE III Investigators in International Journal of Stroke

Supplemental 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

Under-enrolling minority patients in clinical trials reduces generalizability. CLEAR III, a randomized controlled trial, presented an opportunity to assess African American (AA) participation.AA enrollment was compared to U.S. population and NINDS trial data then stratified by region; census data for 42 recruitment cities were compared to screening and randomization percentages, using simple linear regression.AAs were 25% of screens and 45.1% of enrollments (n=370), more than twice the 19.8% participation rate reported by the 2011 NINDS Advisory Panel on Health Disparities Research and triple the projected 13.9% 2014 U.S. population. Conversion rates were (AA vs. non-AA): overall (8.7% vs. 3.4%, p0.001); Northeast (7.7% vs. 2.9%, p0.001); South (8.2% vs. 4.0%, p0.001); Midwest (10.3% vs. 3.6%, p0.01); and West (8.9% vs. 3.8%, p=0.02). AA enrollments ranged from 0% to 100% (mean: 40.4%). AA screening ranged from 0% to 63.7% (mean: 23.2%). AA city census ranged from 1.3% to 82.7% (mean: 28.0%); higher census was associated with higher screening (p0.0001) and enrollment (p=0.004).AAs were willing to enroll in an acute stroke trial. AA city census rates should be considered when selecting enrollment centers and setting recruitment goals. Factors leading to successful AA recruitment should be further investigated, as population-based participation is a goal in all trials.

Introduction Analysis of reliable registry data can direct future research to influence clinical care. Data from the Virtual International Stroke Trials Archive have been used to test hypotheses and inform trial design. We sought to expand Virtual International Stroke Trials Archive into a broader stroke resource with new opportunities for research and international collaboration. Methods Using procedures initially developed for an acute stroke trial archive, we invited trialists to lodge data on rehabilitation, secondary prevention, intracerebral haemorrhage, imaging, and observational stroke studies. Results We have extended Virtual International Stroke Trials Archive into six subsections: Virtual International Stroke Trials Archive-Acute ( n = 28 190 patients’ data), Virtual International Stroke Trials Archive-Rehab ( n = 10 194), Virtual International Stroke Trials Archive-intracerebral haemorrhage ( n = 1829), Virtual International Stroke Trials Archive-Prevention, Virtual International Stroke Trials Archive-Imaging ( n = 1300), and Virtual International Stroke Trials Archive-Plus ( n = 6573). Enrollment continues, with commitments for the contribution of six further trials to Virtual International Stroke Trials Archive-Prevention, 13 trials to Virtual International Stroke Trials Archive-Rehab, and one registry to Virtual International Stroke Trials Archive-Plus. Data on age, type of stroke, medical history, outcomes by modified Rankin scale and Barthel Index (BI), mortality, and adverse events are available for analyses. The Virtual International Stroke Trials Archive network encourages the development of young investigators and provides opportunities for international peer review and collaboration. Conclusions Application of the original Virtual International Stroke Trials Archive concepts beyond acute stroke trials can extend the value of clinical research at low cost, without threatening commercial or intellectual property interests. This delivers valuable research output to inform the efficiency of future stroke research. We invite stroke researchers to participate actively in Virtual International Stroke Trials Archive and encourage the extension of Virtual International Stroke Trials Archive principles to other disease areas.

BACKGROUND AND PURPOSE: Animal models have clearly shown a critical role for extravascular blood in the initiation of the vasogenic edema associated with intracerebral hemorrhage (ICH). Nevertheless, the relevance of these observations to the human disease process has not been evaluated. With a prospectively collected cohort of nine patients, we report the relation between intraparenchymal blood clot volume and elevation of perihematoma brain tissue (and homologous contralateral brain tissue) apparent diffusion coefficient (ADC). METHODS: Patients with acute and subacute supratentorial ICH were prospectively evaluated by using diffusion-weighted imaging. ADC was measured in perihematoma tissue and in homologous contralateral regions. The relationship between ADC and volume of hematoma was determined by using linear regression analysis. RESULTS: Nine patients were enrolled in the study. The mean hematoma volume was 30.8 cc (range, 2.6–74 cc). The ADC in the perihematoma regions was 172.5 × 10(−5) mm(2)/s (range, 120.1–302.5 × 10(−5) mm(2)/s) and in the contralateral corresponding regions of interest was 87.6 × 10(−5) mm(2)/s (range, 76.5–102.1 × 10(−5) mm(2)/s) (P=.02). The Pearson correlation coefficient for the ADC in surrounding edema and hematoma volume was 0.7 (P=.04). The correlation coefficient between hematoma volume and contralateral hemisphere ADC was 0.8 (P=.02). CONCLUSION: We report a significant direct correlation between ICH volume and degree of ADC elevation in perihematoma and ADC values in contralateral corresponding brain tissue. These findings suggest a dose-effect interaction between volume and concentration of blood products and intensity of response that brain tissue exhibits in blood-mediated edema. Prospective natural history and interventional studies are required to confirm this biologically meaningful correlation in patients with ICH.