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105. Association Between Duration of Transient Neurological Events and Diffusion‐Weighted Brain Lesions

Author

Joundi, Raed A., primary, Yu, Amy Y. X., additional, Smith, Eric E., additional, Zerna, Charlotte, additional, Penn, Andrew M., additional, Balshaw, Robert F., additional, Votova, Kristine, additional, Bibok, Maximilian B., additional, Penn, Melanie, additional, Saly, Viera, additional, Hegedus, Janka, additional, Coutts, Shelagh B., additional, Nikolejsin, Alison, additional, Trivedi, Anurag, additional, Cook, Jaclyn, additional, Morrison, Jaclyn, additional, Blackwood, Kaitlin, additional, Richards, Karen, additional, Nealis, Madeline, additional, Beattyova, Pavla, additional, Rosenberg, Priya, additional, Frost, Sheilah, additional, Grant, Carolyn, additional, Hedgedus, Janka, additional, Grant, Sarah, additional, Watson, Tim, additional, Sedgwick, Colin, additional, Lesperance, Mary L., additional, Croteau, Nicole S., additional, Appireddy, Ramana, additional, Field, Thalia S., additional, Dubuc, Veronique, additional, Demchuk, Andrew M., additional, Jambula, Anitha, additional, Le, Anne, additional, Menon, Bijoy K., additional, Calvert, Carly, additional, Kenney, Carol, additional, Nikneshan, Davar, additional, Klourfeld, Evgenia, additional, Wagner, Gabrielle, additional, Klein, Gary, additional, Aram, Heidi, additional, Desai, Jamsheed, additional, Ryckborst, Karla, additional, Bilston, Lisa, additional, Hill, Michael D., additional, Almekhlafi, Mohammed, additional, Godfrey, Nathan, additional, Imoukheude, Oje, additional, Stys, Peter, additional, Barber, Philip A., additional, Couillard, Phillippe, additional, Eswaradas, Prasanna, additional, Rhandawa, Privia, additional, Bal, Simerpreet, additional, Peters, Steven, additional, Save, Supriya, additional, Subramaniam, Suresh, additional, Musuka, Tapuwa, additional, Stewart, Teri, additional, and Hong, Zachary M., additional

Published
2023
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106. Safety, Functional Disability, Health Care Utilization and Quality of Life Outcomes in Elderly Receiving Alteplase and Tenecteplase a Secondary Analysis from the Act Trial

Author

Singh, Nishita, primary, Bala, Fouzi, additional, Ademola, Ayoola, additional, Almekhlafi, Mohammed, additional, Coutts, Shelagh B., additional, Deschaintre, Yan, additional, Khosravani, Houman, additional, Buck, Brian, additional, Appireddy, Ramana, additional, Moreau, Francois, additional, Gubitz, Gord, additional, Tkach, Aleksander, additional, Catanese, Luciana, additional, Dowlatshahi, Dar, additional, Medvedev, George, additional, Mandzia, Jennifer, additional, Pikula, Aleksandra, additional, Shankar, Jai Jai, additional, Poppe, Alexandre Y., additional, Williams, Heather, additional, Field, Thalia S., additional, Manosalva, Alejandro, additional, Siddiqui, Muzaffar, additional, Zafar, Atif, additional, Imoukhoude, Oje, additional, Hunter, Gary, additional, Shamy, Michel, additional, Demchuk, Andrew M., additional, Swartz, Richard H., additional, Hill, Michael D., additional, Sajobi, Tolulope, additional, Menon, Bijoy K., additional, and Ganesh, Aravind, additional

Published
2023
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108. sj-docx-1-wso-10.1177_17474930231168517 – Supplemental material for The credibility of subgroup analyses reported in stroke trials is low: A systematic review

Author

Ademola, Ayoola, Thabane, Lehana, Adekanye, Joel, Okikiolu, Ayooluwanimi, Babatunde, Samuel, Almekhlafi, Mohammed A, Menon, Bijoy K, Hill, Michael D, Hildebrand, Kevin A, and Sajobi, Tolulope T

Subjects
FOS: Clinical medicine, Cardiology, Medicine, 110904 Neurology and Neuromuscular Diseases
Abstract

Supplemental material, sj-docx-1-wso-10.1177_17474930231168517 for The credibility of subgroup analyses reported in stroke trials is low: A systematic review by Ayoola Ademola, Lehana Thabane, Joel Adekanye, Ayooluwanimi Okikiolu, Samuel Babatunde, Mohammed A Almekhlafi, Bijoy K Menon, Michael D Hill, Kevin A Hildebrand and Tolulope T Sajobi in International Journal of Stroke

Published
2023
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109. sj-docx-1-eso-10.1177_23969873231183766 – Supplemental material for Impact of vessel tortuosity and radiological thrombus characteristics on the choice of first-line thrombectomy strategy: Results from the ESCAPE-NA1 trial

Author

Bala, Fouzi, Cimflova, Petra, Singh, Nishita, Zhang, Jianhai, Kappelhof, Manon, Kim, Beom Joon, Najm, Mohamed, Golan, Rotem, Elebute, Ibukun, Benali, Faysal, Terreros, Nerea Arrarte, Marquering, Henk, Majoie, Charles, Almekhlafi, Mohammed, Goyal, Mayank, Hill, Michael D, Qiu, Wu, and Menon, Bijoy K

Subjects
FOS: Clinical medicine, Cardiology, Medicine, 110904 Neurology and Neuromuscular Diseases
Abstract

Supplemental material, sj-docx-1-eso-10.1177_23969873231183766 for Impact of vessel tortuosity and radiological thrombus characteristics on the choice of first-line thrombectomy strategy: Results from the ESCAPE-NA1 trial by Fouzi Bala, Petra Cimflova, Nishita Singh, Jianhai Zhang, Manon Kappelhof, Beom Joon Kim, Mohamed Najm, Rotem Golan, Ibukun Elebute, Faysal Benali, Nerea Arrarte Terreros, Henk Marquering, Charles Majoie, Mohammed Almekhlafi, Mayank Goyal, Michael D Hill, Wu Qiu and Bijoy K Menon in European Stroke Journal

Published
2023
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111. MR imaging of carotid webs

Author

Boesen, Mari E., Eswaradass, Prasanna Venkatesan, Singh, Dilip, Mitha, Alim P., Goyal, Mayank, Frayne, Richard, and Menon, Bijoy K.

Published
2017
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112. International controlled study of revascularization and outcomes following COVID-positive mechanical thrombectomy

Author

North American Neurovascular COVID-19 (NAN-C) Consortium &amp, Dmytriw, Adam A, Ghozy, Sherief, Sweid, Ahmad, Piotin, Michel, Bekelis, Kimon, Sourour, Nader, Raz, Eytan, Vela-Duarte, Daniel, Linfante, Italo, Dabus, Guilherme, Kole, Max, Martínez-Galdámez, Mario, Nimjee, Shahid M, Lopes, Demetrius K, Hassan, Ameer E, Kan, Peter, Ghorbani, Mohammad, Levitt, Michael R, Escalard, Simon, Missios, Symeon, Shapiro, Maksim, Clarençon, Fréderic, Elhorany, Mahmoud, Tahir, Rizwan A, Youssef, Patrick P, Pandey, Aditya S, Starke, Robert M, El Naamani, Kareem, Abbas, Rawad, Mansour, Ossama Y, Galvan, Jorge, Billingsley, Joshua T, Mortazavi, Abolghasem, Walker, Melanie, Dibas, Mahmoud, Settecase, Fabio, Heran, Manraj KS, Kuhn, Anna L, Puri, Ajit S, Menon, Bijoy K, Sivakumar, Sanjeev, Mowla, Ashkan, D'Amato, Salvatore, Zha, Alicia M, Cooke, Daniel, Vranic, Justin E, Regenhardt, Robert W, Rabinov, James D, Stapleton, Christopher J, Goyal, Mayank, Wu, Hannah, Cohen, Jake, Turkel-Parella, David, Xavier, Andrew, Waqas, Muhammad, Tutino, Vincent, Siddiqui, Adnan, Gupta, Gaurav, Nanda, Anil, Khandelwal, Priyank, Tiu, Cristina, Portela, Pere C, Perez de la Ossa, Natalia, Urra, Xabier, de Lera, Mercedes, Arenillas, Juan F, Ribo, Marc, Requena, Manuel, Piano, Mariangela, Pero, Guglielmo, De Sousa, Keith, Al-Mufti, Fawaz, Hashim, Zafar, Nayak, Sanjeev, Renieri, Leonardo, Du, Rose, Aziz-Sultan, Mohamed A, Liebeskind, David, Nogueira, Raul G, Abdalkader, Mohamad, Nguyen, Thanh N, Vigilante, Nicholas, Siegler, James E, Grossberg, Jonathan A, Saad, Hassan, Gooch, Michael R, Herial, Nabeel A, Rosenwasser, Robert H, Tjoumakaris, Stavropoula, Patel, Aman B, Tiwari, Ambooj, and Jabbour, Pascal

Subjects
North American Neurovascular COVID-19 (NAN-C) Consortium &amp, Male, Neurology & Neurosurgery, Endovascular Procedures, Clinical Sciences, Neurosciences, COVID-19, morbidity, mortality, stroke, Society of Vascular and Interventional Neurology (SVIN) Investigators, Brain Ischemia, Treatment Outcome, Cross-Sectional Studies, Good Health and Well Being, Clinical Research, large vessel occlusion, Humans, Thrombectomy, Retrospective Studies
Abstract

Background and purposePrevious studies suggest that mechanisms and outcomes in patients with COVID-19-associated stroke differ from those in patients with non-COVID-19-associated strokes, but there is limited comparative evidence focusing on these populations. The aim of this study, therefore, was to determine if a significant association exists between COVID-19 status with revascularization and functional outcomes following thrombectomy for large vessel occlusion (LVO), after adjustment for potential confounding factors.MethodsA cross-sectional, international multicenter retrospective study was conducted in consecutively admitted COVID-19 patients with concomitant acute LVO, compared to a control group without COVID-19. Data collected included age, gender, comorbidities, clinical characteristics, details of the involved vessels, procedural technique, and various outcomes. A multivariable-adjusted analysis was conducted.ResultsIn this cohort of 697 patients with acute LVO, 302 had COVID-19 while 395 patients did not. There was a significant difference (p

Published
2022

113. Improving access and efficiency of ischemic stroke treatment across four Canadian provinces using a stepped wedge trial: Methodology

Author

Kamal, Noreen, Aljendi, Shadi, Carter, Alix, Cora, Elena A., Chandler, Tania, Clift, Fraser, Fok, Patrick T., Goldstein, Judah, Gubitz, Gordon, Hill, Michael D., Menon, Bijoy K., Metcalfe, Brian, Mrklas, Kelly J., Phillips, Stephen, Theriault, Scott, Van Der Linde, Etienne, Volders, David, and Williams, Heather

Published
2022
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115. Aetiology of extracranial carotid free-floating thrombus in a prospective multicentre cohort

Author

Dowlatshahi, Dar, primary, Lum, Cheemun, additional, Menon, Bijoy K, additional, Bharatha, Aditya, additional, Dave, Prasham, additional, Puac-Polanco, Paulo, additional, Blacquiere, Dylan, additional, Stotts, Grant, additional, Shamy, Michel, additional, Momoli, Franco, additional, Thornhill, Rebecca, additional, Lun, Ronda, additional, and Torres, Carlos, additional

Published
2022
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121. Computed Tomographic Perfusion Predicts Poor Outcomes in a Randomized Trial of Endovascular Therapy

Author

Wannamaker, Robert, Guinand, Taurian, Menon, Bijoy K., Demchuk, Andrew, Goyal, Mayank, Frei, Donald, Bharatha, Aditya, Jovin, Tudor G., Shankar, Jai, Krings, Timo, Baxter, Blaise, Holmstedt, Christine, Swartz, Richard, Dowlatshahi, Dar, Chan, Richard, Tampieri, Donatella, Choe, Hana, Burns, Paul, Gentile, Nina, Rempel, Jeremy, Shuaib, Ashfaq, Buck, Brian, Bivard, Andrew, Hill, Michael, and Butcher, Kenneth

Published
2018
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122. Impact of vessel tortuosity and radiological thrombus characteristics on the choice of first-line thrombectomy strategy: Results from the ESCAPE-NA1 trial.

Author

Bala, Fouzi, Cimflova, Petra, Singh, Nishita, Zhang, Jianhai, Kappelhof, Manon, Kim, Beom Joon, Najm, Mohamed, Golan, Rotem, Elebute, Ibukun, Benali, Faysal, Terreros, Nerea Arrarte, Marquering, Henk, Majoie, Charles, Almekhlafi, Mohammed, Goyal, Mayank, Hill, Michael D, Qiu, Wu, and Menon, Bijoy K

Published
2023
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123. SPD matrices representing artery anatomy for first-pass effect prediction by aggregated networks with multi-scale attentions.

Author

Zhang, Jianhai, Bala, Fouzi, Cimflova, Petra, Singh, Nishita, Benali, Faysal, Hill, Michael D., Menon, Bijoy K., and Qiu, Wu

Subjects
CONVOLUTIONAL neural networks, CEREBRAL circulation, ANATOMY, ENDOVASCULAR surgery, ISCHEMIC stroke
Abstract

First-pass Effect(FPE) for Endovascular Therapy(EVT) is associated with good clinical outcome (mRS2) of patients with Acute Ischaemic Stroke (AIS). A rapid and accurate prediction of FPE before EVT can help neurointerventionists plan the procedure and avoid delays in restoration of cerebral blood flow. However, there are rare studies focused on FPE prediction on arterial vessel anatomy immediately. The intractable difficulty lies in extracting discriminative features to represent a wide variety of vessels with irregular vessel shapes. In this paper, we propose a Symmetric Positive Definite(SPD) matrix-based feature representation extracted from the centerline of arterial vessels, encoding the global discriminative information over the artery for predicting FPE. Subsequently, a collaborative network of multi-scale Convolutional Neural Network(CNN) and Multiple Layer Perception (MLP) with specific attentions is developed. Specifically, the CNN is used for capturing the features among the multi-scale local neighbours of the curve. MLPs are used for capturing more prominent global discriminative features at different scales. The attention mechanism is used to better filter and extract the useful information for feature fusion. Quantitative experimental results demonstrate that our proposed method is able to predict FPE accurately, outperforming the manually defined features and traditional machine learning-based methods in this task, regarding the metrics of AUC, precision, sensitivity, specificity and accuracy. [ABSTRACT FROM AUTHOR]

Published
2023
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124. Correlation Between Computed Tomography-Based Tissue Net Water Uptake and Volumetric Measures of Cerebral Edema After Reperfusion Therapy

Author

Ng, Felix C., Yassi, Nawaf, Sharma, Gagan, Brown, Scott B., Goyal, Mayank, Majoie, Charles B. L. M., Jovin, Tudor G., Hill, Michael D., Muir, Keith W., Saver, Jeffrey L., Guillemin, Francis, Demchuk, Andrew M., Menon, Bijoy K., San Roman, Luis, White, Philip, van der Lugt, Aad, Ribo, Marc, Bracard, Serge, Mitchell, Peter J., Davis, Stephen M., Sheth, Kevin N., Kimberly, W. Taylor, Campbell, Bruce C., V, Radiology & Nuclear Medicine, Radiology and nuclear medicine, ACS - Atherosclerosis & ischemic syndromes, Radiology and Nuclear Medicine, ACS - Microcirculation, and ANS - Neurovascular Disorders

Subjects
Advanced and Specialized Nursing, iodine, infarction, Endovascular Procedures, Water, Brain Edema, Cerebral Infarction, Stroke, Treatment Outcome, Reperfusion, Humans, Neurology (clinical), hemorrhage, Cardiology and Cardiovascular Medicine, Tomography, X-Ray Computed, Thrombectomy
Abstract

Background: Cerebral edema after large hemispheric infarction is associated with poor functional outcome and mortality. Net water uptake (NWU) quantifies the degree of hypoattenuation on unenhanced-computed tomography (CT) and is increasingly used to measure cerebral edema in stroke research. Hemorrhagic transformation and parenchymal contrast staining after thrombectomy may confound NWU measurements. We investigated the correlation of NWU measured postthrombectomy with volumetric markers of cerebral edema and association with functional outcomes. Methods: In a pooled individual patient level analysis of patients presenting with anterior circulation large hemispheric infarction (core 80–300 mL or Alberta Stroke Program Early CT Score ≤5) in the HERMES (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke trials) data set, cerebral edema was defined as the volumetric expansion of the ischemic hemisphere expressed as a ratio to the contralateral hemisphere(rHV). NWU and midline-shift were compared with rHV as the reference standard on 24-hour follow-up CT, adjusted for hemorrhagic transformation and the use of thrombectomy. Association between edema markers and day 90 functional outcomes (modified Rankin Scale) was assessed using ordinal logistic regression. Results: Overall (n=144), there was no correlation between NWU and rHV (r s =0.055, P =0.51). In sub-group analyses, a weak correlation between NWU with rHV was observed after excluding patients with any degree of hemorrhagic transformation (r s =0.211, P =0.015), which further improved after excluding thrombectomy patients (r s =0.453, P =0.001). Midline-shift correlated strongly with rHV in all sub-group analyses (r s >0.753, P =0.001). Functional outcome at 90 days was negatively associated with rHV (adjusted common odds ratio, 0.46 [95% CI, 0.32–0.65]; P P P =0.84), adjusted for age, baseline National Institutes of Health Stroke Scale, and thrombectomy. Prognostic performance of NWU improved after excluding patients with hemorrhagic transformation and thrombectomy (adjusted odds ratio, 0.90 [95% CI, 0.80–1.02]; P =0.10). Conclusions: NWU correlated poorly with conventional markers of cerebral edema and was not associated with clinical outcome in the presence of hemorrhagic transformation and thrombectomy. Measuring NWU postthrombectomy requires validation before implementation into clinical research. At present, the use of NWU should be limited to baseline CT, or follow-up CT only in patients without hemorrhagic transformation or treatment with thrombectomy.

Published
2022
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128. Intra-arterial injection of mesenchymal stem cells to accelerate neointima formation after endovascular stenting in a rabbit model

Author

Panchendrabose, Kapilan, primary, Muram, Sandeep, additional, Belanger, Brooke L., additional, Eesa, Muneer, additional, Almekhlafi, Mohammed A., additional, Goyal, Mayank, additional, Wong, John H., additional, Sen, Arindom, additional, Menon, Bijoy K., additional, Har, Bryan, additional, and Mitha, Alim P., additional

Published
2022
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129. AcT Trial: Protocol for a Pragmatic Registry‐Linked Randomized Clinical Trial

Author

Sajobi, Tolulope, primary, Singh, Nishita, additional, Almekhlafi, Mohammed A., additional, Buck, Brian, additional, Ademola, Ayoola, additional, Coutts, Shelagh B., additional, Deschaintre, Yan, additional, Khosravani, Houman, additional, Appireddy, Ramana, additional, Moreau, Francois, additional, Phillips, Stephen, additional, Gubitz, Gord, additional, Tkach, Aleksander, additional, Catanese, Luciana, additional, Dowlatshahi, Dar, additional, Medvedev, George, additional, Mandzia, Jennifer, additional, Pikula, Aleksandra, additional, Shankar, J.J., additional, Williams, Heather, additional, Field, Thalia S., additional, Manosalva, Alejandro, additional, Siddiqui, Muzaffar, additional, Zafar, Atif, additional, Imoukhoude, Oje, additional, Hunter, Gary, additional, Sehgal, Arshia, additional, Zhang, Qiao, additional, Doram, Craig, additional, Hill, Michael D., additional, Shamy, Michel, additional, Kenney, Carol, additional, Swartz, Richard H., additional, and Menon, Bijoy K., additional

Published
2022
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131. Effectiveness and safety of EVT in patients with acute LVO and low NIHSS

Author

Kim, Beom Joon, primary, Menon, Bijoy K., additional, Yoo, Joonsang, additional, Han, Jung Hoon, additional, Kim, Bum Joon, additional, Kim, Chi Kyung, additional, Kim, Jae Guk, additional, Kim, Joon-Tae, additional, Park, Hyungjong, additional, Baik, Sung Hyun, additional, Han, Moon-Ku, additional, Kang, Jihoon, additional, Kim, Jun Yup, additional, Lee, Keon-Joo, additional, Park, Jong-Moo, additional, Kang, Kyusik, additional, Lee, Soo Joo, additional, Cha, Jae-Kwan, additional, Kim, Dae-Hyun, additional, Jeong, Jin-Heon, additional, Park, Tai Hwan, additional, Park, Sang-Soon, additional, Lee, Kyung Bok, additional, Lee, Jun, additional, Hong, Keun-Sik, additional, Cho, Yong-Jin, additional, Park, Hong-Kyun, additional, Lee, Byung-Chul, additional, Yu, Kyung-Ho, additional, Oh, Mi-Sun, additional, Kim, Dong-Eog, additional, Ryu, Wi-Sun, additional, Choi, Kang-Ho, additional, Choi, Jay Chol, additional, Kim, Joong-Goo, additional, Kwon, Jee-Hyun, additional, Kim, Wook-Joo, additional, Shin, Dong-Ick, additional, Yum, Kyu Sun, additional, Sohn, Sung-Il, additional, Hong, Jeong-Ho, additional, Kim, Chulho, additional, Lee, Sang-Hwa, additional, Lee, Juneyoung, additional, Almekhlafi, Mohammed A., additional, Demchuk, Andrew, additional, and Bae, Hee-Joon, additional

Published
2022
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132. Ethical Justification for Deferral of Consent in the AcT Trial for Acute Ischemic Stroke

Author

Faris, Hannah, primary, Dewar, Brian, additional, Dowlatshahi, Dar, additional, Ramji, Alnar, additional, Kenney, Carol, additional, Page, Stacey, additional, Buck, Brian, additional, Hill, Michael D., additional, Coutts, Shelagh B., additional, Almekhlafi, Mohammed, additional, Sajobi, Tolulope, additional, Singh, Nishita, additional, Sehgal, Arshia, additional, Swartz, Richard H., additional, Menon, Bijoy K., additional, and Shamy, Michel, additional

Published
2022
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133. Intravenous tenecteplase compared with alteplase for acute ischaemic stroke in Canada (AcT): a pragmatic, multicentre, open-label, registry-linked, randomised, controlled, non-inferiority trial

Author

Menon, Bijoy K, primary, Buck, Brian H, additional, Singh, Nishita, additional, Deschaintre, Yan, additional, Almekhlafi, Mohammed A, additional, Coutts, Shelagh B, additional, Thirunavukkarasu, Sibi, additional, Khosravani, Houman, additional, Appireddy, Ramana, additional, Moreau, Francois, additional, Gubitz, Gord, additional, Tkach, Aleksander, additional, Catanese, Luciana, additional, Dowlatshahi, Dar, additional, Medvedev, George, additional, Mandzia, Jennifer, additional, Pikula, Aleksandra, additional, Shankar, Jai, additional, Williams, Heather, additional, Field, Thalia S, additional, Manosalva, Alejandro, additional, Siddiqui, Muzaffar, additional, Zafar, Atif, additional, Imoukhuede, Oje, additional, Hunter, Gary, additional, Demchuk, Andrew M, additional, Mishra, Sachin, additional, Gioia, Laura C, additional, Jalini, Shirin, additional, Cayer, Caroline, additional, Phillips, Stephen, additional, Elamin, Elsadig, additional, Shoamanesh, Ashkan, additional, Subramaniam, Suresh, additional, Kate, Mahesh, additional, Jacquin, Gregory, additional, Camden, Marie-Christine, additional, Benali, Faysal, additional, Alhabli, Ibrahim, additional, Bala, Fouzi, additional, Horn, MacKenzie, additional, Stotts, Grant, additional, Hill, Michael D, additional, Gladstone, David J, additional, Poppe, Alexandre, additional, Sehgal, Arshia, additional, Zhang, Qiao, additional, Lethebe, Brendan Cord, additional, Doram, Craig, additional, Ademola, Ayoola, additional, Shamy, Michel, additional, Kenney, Carol, additional, Sajobi, Tolulope T, additional, Swartz, Richard H, additional, Srivastava, Abhilekh, additional, Aljammaz, Ahmed M, additional, Akindotun, Akintomide Femi, additional, Jin, Albert Y, additional, Fraser, Alexander, additional, Khaw, Alexander V, additional, Lemnaru, Alexandru, additional, Southwell, Alisia, additional, Ramji, Alnar, additional, Alvarado-Bolaños, Alonso, additional, Mouminah, Amr, additional, Lahlouh, Amro B, additional, Yu, Amy Y, additional, Alrohimi, Anas, additional, Lavoie, Andre, additional, Rogge, Andrea, additional, Micieli, Andrew, additional, Nguyen, Andrew Linh, additional, Callaghan-Brown, Angelique, additional, Florendo-Cumbermack, Anita, additional, Wadhwa, Ankur, additional, Beaudoin, Ann-Marie, additional, Cayley, Anne, additional, Liddy, Anne Marie, additional, Trivedi, Anurag, additional, Katsanos, Aristeidis H, additional, Shuaib, Ashfaq, additional, Butt, Asif Javed, additional, Bereznyakova, Olena, additional, Beauchamp, Beth, additional, Mahlitz, Breane, additional, Graham, Brett R, additional, Dewar, Brian, additional, Durafourt, Bryce A, additional, Holtby, Caitlin, additional, Jackson-Tarlton, Caitlin S, additional, Bockus, Caitlyn, additional, Stephenson, Caroline, additional, Galloway, Camille, additional, Odier, Céline, additional, Deacon, Charles, additional, Zerna, Charlotte, additional, Vekhande, Chetan C, additional, Bocti, Christian, additional, Stapf, Christian, additional, Hawkes, Christine, additional, Stables, Christine Anne, additional, Bogiatzi, Chrysi, additional, Rodriguez, Claudia, additional, Candale-Radu, Claudia, additional, Murphy, Colleen, additional, Casserly, Courtney Sarah, additional, Fok, Daniel, additional, Boasquevisque, Danielle de Sa, additional, Wile, Daryl, additional, Volders, David, additional, Sahlas, Demetrios J, additional, Shand, Elaine, additional, Cora, Elena Adela, additional, Battista, Eliane Di, additional, Stewart, Eileen, additional, Junk, Emily, additional, Harrison, Emma L, additional, Frenette, Eric, additional, Teleg, Ericka, additional, Abdellah, Eslam, additional, Ghrooda, Esseddeeg, additional, Akthar, Farhana, additional, Evoy, François, additional, Klein, Gary M, additional, Maclean, Genoveva, additional, Jickling, Glen C, additional, Hawthorne, Glenda, additional, Boyd, Gordon, additional, Walker, Gregory, additional, Saposnik, Gustavo, additional, Lau, H Lee, additional, Badr, Hanan E, additional, Toma, Hassanain, additional, Kalashyan, Hayrapet, additional, Marion-Moffet, Hugo, additional, Grant, Ian, additional, Fatakdawala, Idris, additional, Beaulieu-Boire, Isabelle, additional, Williams, Janice, additional, Brar, Jaskiran, additional, Rivest, Jean, additional, Wang, Jeffrey Z, additional, Dawe, Jessica, additional, Stang, Jillian, additional, Day, Joanne, additional, Miller, Jodi, additional, Gorman, Johnathon, additional, Hopyan, Julia Jasmine, additional, Lee, Julian, additional, Kromm, Julie, additional, Foster, Kaitlyn, additional, Ratnayake, Kanchana, additional, Perera, Kanjana S, additional, Murray, Karina Villaluna, additional, Ryckborst, Karla, additional, Lin, Katie, additional, Sage, Kayla, additional, Sivakuma, Keithan, additional, MacDonald, Kelly A, additional, Ng, Kelvin Kuan, additional, Merchant, Ketki, additional, Khan, Khurshid, additional, Ghavami, Kimia, additional, Johnston, Kyra, additional, Mai, Lauren M, additional, White, Leah, additional, Barratt, Lee, additional, Longpre, Linda, additional, Crellin, Lisa, additional, Peeling, Lissa, additional, Piquette, Lori, additional, Lomax, Lysa Boissé, additional, Sadeghi, Mahsa, additional, Kamra, Maneesha, additional, Lavoie-April, Manuel, additional, Moores, Margaret, additional, Bullrich, Maria Bres, additional, McClelland, Marie, additional, Salluzzi, Marina, additional, Wilcox, Mark, additional, Boulos, Mark I, additional, Marko, Martha, additional, Boyko, Matthew, additional, Lantagne-Hurtubise, Maude, additional, AlHamid, May Adel, additional, Shawawrah, Mays, additional, Kelly, Michael E, additional, Thorne, Michael W D, additional, Bussiere, Miguel, additional, Dominc Tse, Ming Yin, additional, Benguzzi, Mowad, additional, Sharma, Mukul, additional, Horton, Myles, additional, Newcommon, Nancy, additional, Simon, Nandy-Shelwine, additional, Parks, Natalie E, additional, Sultan, Nazeem, additional, Markovic, Nevena, additional, Daneault, Nicole, additional, Ishaque, Noman, additional, Fairall, Paige, additional, Kostyrko, Pawel B, additional, Stys, Peter K, additional, Teal, Philip, additional, Couillard, Philippe, additional, King-Azote, Princess, additional, Collier, Quentin, additional, Epp, Rachel, additional, Nair, Radhika, additional, Joundi, Raed A, additional, Jassal, Rajive, additional, Schneider, Raphael, additional, Hosseini, Reza, additional, Bouchard, Rosalie, additional, Whelan, Ruth, additional, Cooley, S Regan, additional, Sujanthan, Sajeevan, additional, Mansoor, Salman, additional, Yip,, Samuel, additional, Wasyliw, Sanchea, additional, Taylor, Sean W., additional, Friedman, Sebastian, additional, Mann, Sharan, additional, Maley, Sharleen Weese, additional, Chiasson, Sherry, additional, Hu, Sherry Xueying, additional, Althubait, Shorog, additional, Himed, Shuhira, additional, Chen, Shuo, additional, Bal, Simerpreet S, additional, Page, Stacey A, additional, Beck, Stacey D, additional, Woodroffe, Stephanie, additional, Reiter, Stephanie D, additional, Gaal, Stephen van, additional, Peters, Steven Ray, additional, Darvesh, Sultan, additional, Save, Supriya, additional, Alcock, Susan, additional, Piercey, Susannah, additional, Adam, Suzie, additional, Gosselin, Sylvie, additional, Fitzpatrick, Tess, additional, Perron, Thomas-Louis, additional, Stewart, Tim, additional, Benstead, Timothy J, additional, Naidoo, Vishaya, additional, Wahab, Wasan Abd, additional, Oczkowski, Wiesław, additional, Kingston, William, additional, Leduc, William, additional, To, William T H, additional, Yu, Yeyao Joe, additional, Liu, Zhongyu A, additional, and Aljundi, Ziad Ezzat, additional

Published
2022
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135. Use of Noncontrast Computed Tomography and Computed Tomographic Perfusion in Predicting Intracerebral Hemorrhage After Intravenous Alteplase Therapy

Author

Batchelor, Connor, Pordeli, Pooneh, d’Esterre, Christopher D., Najm, Mohamed, Al-Ajlan, Fahad S., Boesen, Mari E., McDougall, Connor, Hur, Lisa, Fainardi, Enrico, Shankar, Jai Jai Shiva, Rubiera, Marta, Khaw, Alexander V., Hill, Michael D., Demchuk, Andrew M., Sajobi, Tolulope T., Goyal, Mayank, Lee, Ting-Yim, Aviv, Richard I., and Menon, Bijoy K.

Published
2017
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136. Regional Comparison of Multiphase Computed Tomographic Angiography and Computed Tomographic Perfusion for Prediction of Tissue Fate in Ischemic Stroke

Author

d’Esterre, Christopher D., Trivedi, Anurag, Pordeli, Pooneh, Boesen, Mari, Patil, Shivanand, Hwan Ahn, Seong, Najm, Mohamed, Fainardi, Enrico, Shankar, Jai Jai Shiva, Rubiera, Marta, Almekhlafi, Mohammed A., Mandzia, Jennifer, Khaw, Alexander V., Barber, Philip, Coutts, Shelagh, Hill, Michael D., Demchuk, Andrew M., Sajobi, Tolulope, Forkert, Nils D., Goyal, Mayank, Lee, Ting-Yim, and Menon, Bijoy K.

Published
2017
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138. Early Trajectory of Stroke Severity Predicts Long-Term Functional Outcomes in Ischemic Stroke Subjects: Results From the ESCAPE Trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times)

Author

Sajobi, Tolulope T., Menon, Bijoy K., Wang, Meng, Lawal, Oluwaseyi, Shuaib, Ashfaq, Williams, David, Poppe, Alexandre Y., Jovin, Tudor G., Casaubon, Leanne K., Devlin, Thomas, Dowlatshahi, Dar, Fanale, Chris, Lowerison, Mark W., Demchuk, Andrew M., Goyal, Mayank, and Hill, Michael D.

Published
2017
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140. Predicting DWI-FLAIR mismatch on NCCT: the role of artificial intelligence in hyperacute decision making.

Author

Beom Joon Kim, Kairan Zhu, Wu Qiu, Singh, Nishita, McDonough, Rosalie, Cimflova, Petra, Bala, Fouzi, Jongwook Kim, Yong Soo Kim, Hee-Joon Bae, and Menon, Bijoy K.

Subjects
ARTIFICIAL intelligence, DECISION making, STROKE patients, DIFFUSION magnetic resonance imaging, MAGNETIC resonance imaging
Abstract

Background: The presence of diffusion-weighted imaging (DWI) and fluidattenuated inversion recovery (FLAIR) mismatch was used to determine eligibility for intravenous thrombolysis in clinical trials. However, due to the restricted availability of MRI and the ambiguity of image assessment, it is not widely implemented in clinical practice. Methods: A total of 222 acute ischemic stroke patients underwent non-contrast computed tomography (NCCT), DWI, and FLAIR within 1 h of one another. Human experts manually segmented ischemic lesions on DWI and FLAIR images and independently graded the presence of DWI-FLAIR mismatch. Deep learning (DL) models based on the nnU-net architecture were developed to predict ischemic lesions visible on DWI and FLAIR images using NCCT images. Inexperienced neurologists evaluated the DWI-FLAIR mismatch on NCCT images without and with the model's results. Results: The mean age of included subjects was 71.8 ± 12.8 years, 123 (55%) were male, and the baseline NIHSS score was a median of 11 [IQR, 6-18]. All images were taken in the following order: NCCT - DWI - FLAIR, starting after a median of 139 [81-326] min after the time of the last known well. Intravenous thrombolysis was administered in 120 patients (54%) after NCCT. The DL model's prediction on NCCT images revealed a Dice coefficient and volume correlation of 39.1% and 0.76 for DWI lesions and 18.9% and 0.61 for FLAIR lesions. In the subgroup with 15 mL or greater lesion volume, the evaluation of DWI-FLAIR mismatch from NCCT by inexperienced neurologists improved in accuracy (from 0.537 to 0.610) and AUC-ROC (from 0.493 to 0.613). Conclusion: The DWI-FLAIR mismatch may be reckoned using NCCT images through advanced artificial intelligence techniques. [ABSTRACT FROM AUTHOR]

Published
2023
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141. Cost-effectiveness of testing for CYP2C19 loss-of-function carriers following transient ischemic attack/minor stroke: A Canadian perspective.

Author

Micieli, Andrew, Singh, Nishita, Jahn, Beate, Siebert, Uwe, Menon, Bijoy K, and Demchuk, Andrew M

Subjects
TRANSIENT ischemic attack, STROKE, CYTOCHROME P-450 CYP2C19, COST effectiveness, QUALITY-adjusted life years, DRUG carriers
Abstract

Background: The CHANCE-2 study compared 3 weeks of aspirin–ticagrelor to aspirin–clopidogrel in CYP2C19 loss-of-function (LOF) allele carriers following a transient ischemic attack (TIA)/minor stroke and demonstrated a modestly lower risk of stroke recurrence with aspirin–ticagrelor. This stroke protection was largely for minor stroke and came at an increased risk of bleeding. The cost-effectiveness of implementing testing for LOF allele status to personalize antiplatelet regimen for secondary stroke prevention after a TIA/minor stroke in the Canadian health care context is unknown. Methods: Cost-effectiveness analysis using a decision-analytic Markov cohort model with a lifetime horizon was performed to determine the costs and health benefits of testing for LOF allele status compared with no testing (current standard of care). The population of interest was patients living in Canada who suffered a TIA/minor stroke. Outcomes of interest were life-years gained (LYG), quality-adjusted life years (QALY) gained, costs (reported in 2022 Canadian dollars), and the incremental cost-effectiveness ratio (ICER). We adopted the perspective of the Federal, Provincial, and Territorial Ministries of Health and used a 1.5% annual discount rate. Sensitivity analyses were performed to assess uncertainty. Results: Compared to standard of care, LOF allele testing leads to 0.14 LYG (undiscounted), 0.12 QALYs gained (undiscounted), and additional lifetime costs of CAD$432 (discounted) per patient. The ICER of the LOF allele testing strategy is CAD$4310 per QALY gained compared with standard of care. The probabilistic sensitivity analyses demonstrated that LOF allele testing was cost-effective in more than 99.99% of simulations using a willingness-to-pay threshold of CAD$50,000 per QALY. Conclusion: Based on available evidence, testing for LOF allele followed by short duration 3 weeks of aspirin–ticagrelor compared to standard-of-care aspirin–clopidogrel can lead to prolonged life and improved quality of life and can be considered very cost-effective when compared with other well-accepted technologies in health and medicine. [ABSTRACT FROM AUTHOR]

Published
2023
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143. Alteplase Compared to Tenecteplase in patients with Acute Ischemic Stroke (AcT) Trial: Protocol for a Pragmatic Registry linked Randomized Clinical Trial

Author

Sajobi, Tolulope, primary, Singh, Nishita, additional, Almekhlafi, Mohammed A., additional, Buck, Brian, additional, Ademola, Ayoola, additional, Coutts, Shelagh B., additional, Deschaintre, Yan, additional, Khosravani, Houman, additional, Appireddy, Ramana, additional, Moreau, Francois, additional, Phillips, Stephen, additional, Gubitz, Gord, additional, Tkach, Aleksander, additional, Catanese, Luciana, additional, Dowlatshahi, Dar, additional, Medvedev, George, additional, Mandzia, Jennifer, additional, Pikula, Aleksandra, additional, Shankar, J.J., additional, Williams, Heather, additional, Field, Thalia S., additional, Manosalva, Alejandro, additional, Siddiqui, Muzaffar, additional, Zafar, Atif, additional, Imoukhoude, Oje, additional, Hunter, Gary, additional, Sehgal, Arshia, additional, Zhang, Qiao, additional, Doram, Craig, additional, Hill, Michael D., additional, Shamy, Michel, additional, Kenney, Carol, additional, Swartz, Richard H., additional, and Menon, Bijoy K., additional

Published
2022
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145. T max Volumes Predict Final Infarct Size and Functional Outcome in Ischemic Stroke Patients Receiving Endovascular Treatment

Author

Fainardi, Enrico, primary, Busto, Giorgio, additional, Rosi, Andrea, additional, Scola, Elisa, additional, Casetta, Ilaria, additional, Bernardoni, Andrea, additional, Saletti, Andrea, additional, Arba, Francesco, additional, Nencini, Patrizia, additional, Limbucci, Nicola, additional, Mangiafico, Salvatore, additional, Demchuk, Andrew, additional, Almekhlafi, Mohammed A, additional, Goyal, Mayank, additional, Lee, Ting Y., additional, Menon, Bijoy K., additional, and Morotti, Andrea, additional

Published
2022
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146. Automated Perfusion Calculations vs. Visual Scoring of Collaterals and CBV-ASPECTS

Author

Psychogios, Marios-Nikos, Sporns, Peter B., Ospel, Johanna, Katsanos, Aristeidis H., Kabiri, Reza, Flottmann, Fabian A., Menon, Bijoy K., Horn, Mackenzie, Liebeskind, David S., Honda, Tristan, Ribo, Marc, Ruiz, Manuel Requena, Kabbasch, Christoph, Lichtenstein, Thorsten, Maurer, Christoph J., Berlis, Ansgar, Hellstern, Victoria, Henkes, Hans, Möhlenbruch, Markus A., Seker, Fatih, Ernst, Marielle S., Liman, Jan, Tsivgoulis, Georgios, and Brehm, Alex

Subjects
Aged, 80 and over, Male, Acute ischemic stroke, Collaterals, Perfusion imaging, Brain Ischemia, Cerebral Angiography, Stroke, Automation, Treatment Outcome, Patient selection, Cerebrovascular Circulation, Reperfusion, Humans, Original Article, Female, Tomography, X-Ray Computed, Vision, Ocular, Automated evaluation, Aged, Retrospective Studies, Thrombectomy
Abstract

Purpose Use of automated perfusion software has gained importance for imaging of stroke patients for mechanical thrombectomy (MT). We aim to compare four perfusion software packages: 1) with respect to their association with 3‑month functional outcome after successful reperfusion with MT in comparison to visual Cerebral Blood Volume - Alberta Stroke Program Early CT Score (CBV-ASPECTS) and collateral scoring and 2) with respect to their agreement in estimation of core and penumbra volume. Methods This retrospective, multicenter cohort study (2015–2019) analyzed data from 8 centers. We included patients who were functionally independent before and underwent successful MT of the middle cerebral artery. Primary outcome measurements were the relationship of core and penumbra volume calculated by each software, qualitative assessment of collaterals and CBV-APECTS with 3‑month functional outcome and disability (modified Rankin scale >2). Quantitative differences between perfusion software measurements were also assessed. Results A total of 215 patients (57% women, median age 77 years) from 8 centers fulfilled the inclusion criteria. Multivariable analyses showed a significant association of RAPID core (common odds ratio, cOR 1.02; p = 0.015), CBV-ASPECTS (cOR 0.78; p = 0.007) and collaterals (cOR 0.78; p = 0.001) with 3‑month functional outcome (shift analysis), while RAPID core (OR 1.02; p = 0.018), CBV-ASPECTS (OR 0.77; p = 0.024), collaterals (OR 0.78; p = 0.007) and OLEA core (OR 1.02; p = 0.029) were significantly associated with 3‑month functional disability. Mean differences on core estimates between VEOcore and RAPID were 13.4 ml, between syngo.via and RAPID 30.0 ml and between OLEA and RAPID −3.2 ml. Conclusion Collateral scoring, CBV-ASPECTS and RAPID were independently associated with functional outcome at 90 days. Core and Penumbra estimates using automated software packages varied significantly and should therefore be used with caution. Electronic supplementary material The online version of this article (10.1007/s00062-020-00974-3) contains supplementary material, which is available to authorized users.

Published
2020

147. sj-pdf-1-wso-10.1177_17474930221111898 – Supplemental material for Cost-effectiveness of testing for CYP2C19 loss-of-function carriers following transient ischemic attack/minor stroke: A Canadian perspective

Author

Micieli, Andrew, Singh, Nishita, Jahn, Beate, Siebert, Uwe, Menon, Bijoy K, and Demchuk, Andrew M

Subjects
FOS: Clinical medicine, Cardiology, Medicine, 110904 Neurology and Neuromuscular Diseases
Abstract

Supplemental material, sj-pdf-1-wso-10.1177_17474930221111898 for Cost-effectiveness of testing for CYP2C19 loss-of-function carriers following transient ischemic attack/minor stroke: A Canadian perspective by Andrew Micieli, Nishita Singh, Beate Jahn, Uwe Siebert, Bijoy K Menon and Andrew M Demchuk in International Journal of Stroke

Published
2022
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148. Off-Label Use of Tenecteplase for the Treatment of Acute Ischemic Stroke A Systematic Review and Meta-analysis

Author

Katsanos, Aristeidis H, Psychogios, Klearchos, Turc, Guillaume, Sacco, Simona, de Sousa, Diana Aguiar, De Marchis, Gian Marco, Palaiodimou, Lina, Filippou, Dimitrios K, Ahmed, Niaz, Sarraj, Amrou, Menon, Bijoy K, Tsivgoulis, Georgios, Martinez Rico, Clara, McMaster University [Hamilton, Ontario], Metropolitan Hospital [Piraeus, Greece] (MH), GHU Paris Psychiatrie et Neurosciences, Centre Hospitalier Sainte Anne [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut de psychiatrie et neurosciences de Paris (IPNP - U1266 Inserm), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), FHU NeuroVasc [Site Sainte-Anne, Paris] (GHU-PPN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), University of L'Aquila [Italy] (UNIVAQ), Lusófona University [Lisbon], University of Basel (Unibas), National and Kapodistrian University of Athens (NKUA), Karolinska University Hospital [Stockholm], Karolinska Institutet [Stockholm], The University of Texas Health Science Center at Houston (UTHealth), University of Calgary, and The University of Tennessee Health Science Center [Memphis] (UTHSC)

Subjects
Stroke, Observational Studies as Topic, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, Tenecteplase, Humans, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Off-Label Use, General Medicine, [SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Brain Ischemia, Ischemic Stroke
Abstract

International audience; Importance: Tenecteplase is being evaluated as an alternative thrombolytic agent for the treatment of acute ischemic stroke (AIS) within ongoing randomized clinical trials (RCTs). In addition, nonrandomized clinical experiences with off-label use of tenecteplase vs alteplase for AIS treatment are being published.Objective: To evaluate the available evidence on the safety and efficacy of intravenous tenecteplase compared with intravenous alteplase provided by nonrandomized studies.Data sources: Eligible studies were identified by searching MEDLINE and Scopus databases. No language or other restrictions were imposed. The literature search was conducted on October 12, 2021. This meta-analysis used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was written according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) proposal.Study selection: Nonrandomized studies (prospective or retrospective) comparing intravenous tenecteplase (at any dose) with intravenous alteplase in patients with AIS were included in the analysis.Data extraction and synthesis: The crude odds ratios (ORs) and 95% CIs were calculated for the association of tenecteplase vs alteplase with the outcomes of interest and adjusted ORs were extracted if provided. Estimates using random-effects models were pooled.Main outcomes and measures: The primary outcome was the probability of good functional outcome (modified Rankin scale [mRS] score, 0-2) at 90 days.Results: Six studies were identified including a total of 1820 patients (618 [34%] treated with tenecteplase). Patients receiving tenecteplase had higher odds of 3-month good functional outcome (crude odds ratio [OR], 1.22; 95% CI, 0.90-1.66; adjusted OR, 1.60, 95% CI, 1.08-2.37), successful recanalization (crude OR, 2.82; 95% CI, 1.12-7.10; adjusted OR, 2.38; 95% CI, 1.18-4.81), and early neurological improvement (crude OR, 4.88; 95% CI, 2.03-11.71; adjusted OR, 7.60; 95% CI, 1.97-29.41). No significant differences were detected in 3-month excellent functional outcome proportions (mRS score 0-1; crude OR, 1.53; 95% CI, 0.81-2.91; adjusted OR, 2.51; 95% CI, 0.66- 9.49), symptomatic intracranial hemorrhage (crude OR, 0.97; 95% CI, 0.44-2.16; adjusted OR, 1.16; 95% CI, 0.13-10.50), or parenchymal hematoma (crude OR, 1.20; 95% CI, 0.24-5.95).Conclusions and relevance: Evidence from nonrandomized studies suggests tenecteplase is as safe as alteplase and potentially associated with improved functional outcomes compared with alteplase. Based on these findings, enrollment in the ongoing RCTs appears to be appropriate.

Published
2022
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149. Safety and Efficacy of Tenecteplase Compared With Alteplase in Patients With Large Vessel Occlusion Stroke: A Prespecified Secondary Analysis of the ACT Randomized Clinical Trial

Author

Bala, Fouzi, Singh, Nishita, Buck, Brian, Ademola, Ayoola, Coutts, Shelagh B., Deschaintre, Yan, Khosravani, Houman, Appireddy, Ramana, Moreau, Francois, Phillips, Stephen, Gubitz, Gord, Tkach, Aleksander, Catanese, Luciana, Dowlatshahi, Dar, Medvedev, George, Mandzia, Jennifer, Pikula, Aleksandra, Shankar, Jai Jai, Williams, Heather, Field, Thalia S., Manosalva Alzate, Alejandro, Siddiqui, Muzaffar, Zafar, Atif, Imoukhoude, Oje, Hunter, Gary, Alhabli, Ibrahim, Benali, Faysal, Horn, MacKenzie, Hill, Michael D., Shamy, Michel, Sajobi, Tolulope T., Swartz, Richard H., Menon, Bijoy K., and Almekhlafi, Mohammed

Abstract

IMPORTANCE: It is unknown whether intravenous thrombolysis using tenecteplase is noninferior or preferable compared with alteplase for patients with acute ischemic stroke. OBJECTIVE: To examine the safety and efficacy of tenecteplase compared to alteplase among patients with large vessel occlusion (LVO) stroke. DESIGN, SETTING, AND PARTICIPANTS: This was a prespecified analysis of the Intravenous Tenecteplase Compared With Alteplase for Acute Ischaemic Stroke in Canada (ACT) randomized clinical trial that enrolled patients from 22 primary and comprehensive stroke centers across Canada between December 10, 2019, and January 25, 2022. Patients 18 years and older with a disabling ischemic stroke within 4.5 hours of symptom onset were randomly assigned (1:1) to either intravenous tenecteplase or alteplase and were monitored for up to 120 days. Patients with baseline intracranial internal carotid artery (ICA), M1-middle cerebral artery (MCA), M2-MCA, and basilar occlusions were included in this analysis. A total of 1600 patients were enrolled, and 23 withdrew consent. EXPOSURES: Intravenous tenecteplase (0.25 mg/kg) vs intravenous alteplase (0.9 mg/kg). MAIN OUTCOMES AND MEASURES: The primary outcome was the proportion of modified Rankin scale (mRS) score 0-1 at 90 days. Secondary outcomes were an mRS score from 0 to 2, mortality, and symptomatic intracerebral hemorrhage. Angiographic outcomes were successful reperfusion (extended Thrombolysis in Cerebral Infarction scale score 2b-3) on first and final angiographic acquisitions. Multivariable analyses (adjusting for age, sex, National Institute of Health Stroke Scale score, onset-to-needle time, and occlusion location) were carried out. RESULTS: Among 1577 patients, 520 (33.0%) had LVO (median [IQR] age, 74 [64-83] years; 283 [54.4%] women): 135 (26.0%) with ICA occlusion, 237 (45.6%) with M1-MCA, 117 (22.5%) with M2-MCA, and 31 (6.0%) with basilar occlusions. The primary outcome (mRS score 0-1) was achieved in 86 participants (32.7%) in the tenecteplase group vs 76 (29.6%) in the alteplase group. Rates of mRS 0-2 (129 [49.0%] vs 131 [51.0%]), symptomatic intracerebral hemorrhage (16 [6.1%] vs 11 [4.3%]), and mortality (19.9% vs 18.1%) were similar in the tenecteplase and alteplase groups, respectively. No difference was noted in successful reperfusion rates in the first (19 [9.2%] vs 21 [10.5%]) and final angiogram (174 [84.5%] vs 177 [88.9%]) among 405 patients who underwent thrombectomy. CONCLUSIONS AND RELEVANCE: The findings in this study indicate that intravenous tenecteplase conferred similar reperfusion, safety, and functional outcomes compared to alteplase among patients with LVO.

Published
2023
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