Progesterone for Traumatic Brain Injury, Experimental Clinical Treatment III Trial Revisited: Objective Classification of Traumatic Brain Injury With Brain Imaging Segmentation and Biomarker Levels.

Objective: This post hoc study of the Progesterone for Traumatic Brain Injury, Experimental Clinical Treatment (ProTECT) III trial investigates whether improving traumatic brain injury (TBI) classification, using serum biomarkers (glial fibrillary acidic protein [GFAP] and ubiquitin carboxyl-terminal esterase L1 [UCH-L1]) and algorithmically assessed total lesion volume, could identify a subset of responders to progesterone treatment, beyond broad measures like the Glasgow Coma Scale (GCS) and Glasgow Outcome Scale-Extended (GOS-E), which may fail to capture subtle changes in TBI recovery.

Design: Brain lesion volumes on CT scans were quantified using Brain Lesion Analysis and Segmentation Tool for CT. Patients were classified into true-positive and true-negative groups based on an optimization scheme to determine a threshold that maximizes agreement between radiological assessment and objectively measured lesion volume.

Traumatic Brain Injury Severity Measured by Clinical, Radiographical, and Blood Biomarker Measures Is Associated with Non-Neurological Organ Dysfunction: A Secondary Analysis of ProTECT III and Bio-ProTECT.

Non-neurological organ dysfunction (NNOD) is a prevalent complication and contributes to poor outcome after traumatic brain injury (TBI). Contributing factors to NNOD may include initial TBI severity, but this relationship has not been rigorously studied. The objectives of this study were to describe the frequency and timing of NNOD after TBI, evaluate the association between NNOD and outcome (mortality and Glasgow Outcome Score-Extended [GOSE] at 6 months post-injury), and examine the relationship between multimodal markers of initial TBI severity and NNOD.

Outcomes of Patients With Embolic Stroke of Undetermined Source Treated With Antiplatelet Agents or Anticoagulation: A Multicenter Cohort Study.

Background And Objectives: Embolic stroke of undetermined source (ESUS) can be attributed to a variety of potential embolic sources, with differential response to anticoagulation.

Methods: A multicenter, retrospective observational cohort study (27 sites) of consecutive adult patients with acute ischemic stroke due to ESUS (admitted 2015-2024) was conducted. The aim was to compare outcomes after antiplatelet(s) vs anticoagulant (±antiplatelet) treatment in patients with ESUS across potential embolic sources.

Post-Thrombectomy Flat-Panel CT Contrast Staining ASPECTS and Functional Outcome Prediction.

Background: As indications for and utilization of mechanical thrombectomy continue to expand, there has been an increasing focus on developing improved tools for functional outcome prediction. We aim to evaluate the reliability of utilizing the areas of contrast staining for the Alberta Stroke Program Early CT Score (s-ASPECTS) rating in immediate post-thrombectomy flat-panel computed tomography and investigate its outcome predictive performance.

Methods: Retrospective analysis of a prospectively collected institutional mechanical thrombectomy database spanning March 2018 to February 2024.

Cost-Effectiveness Analysis of Early Minimally Invasive Removal of Intracerebral Hemorrhage.

Background: Supratentorial intracerebral hemorrhage (ICH) is common and often devastating. In a randomized controlled trial, ICH evacuation with minimally invasive trans-sulcal parafascicular surgery (MIPS) improved functional outcomes at 180 days compared with medical management (MM), primarily in patients with lobar hemorrhages. The cost-effectiveness of MIPS compared with MM is explored.

Global challenges in the access of endovascular treatment for acute ischemic stroke (global MT access).

Background: Mechanical thrombectomy (MT) is the standard of care for eligible acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) since 2015.

Aim: Our aim was to determine the key challenges for MT implementation and access worldwide.

Methods: We conducted an international online survey consisting of 37 questions, distributed through the World Stroke Organization network and as invited by co-authors between December 2022 and March 2023.

Carotid web catheter angiography hemodynamic parameters.

Background: Carotid web (CaW)-related contrast stagnation on digital subtraction angiography (DSA) may be a marker supporting the pathophysiological theory of stasis and thrombosis/embolization. We aim to assess the correlation between DSA hemodynamic parameters with CT angiography (CTA) structural measurements and clinical characteristics.

Methods: Cross-sectional analysis of consecutive patients with CaW who underwent CTA+DSA.

Mode of Onset Modifies the Effect of Time to Endovascular Reperfusion on Clinical Outcomes after Acute Ischemic Stroke: An Analysis of the DAWN Trial.

Objective: We aimed to assess the impact of time to endovascular thrombectomy (EVT) on clinical outcomes in the DAWN trial, while also exploring the potential effect modification of mode of stroke onset on this relationship.

Methods: The association between every 1-h treatment delay with 90-day functional independence (modified Rankin Scale [mRS] score 0-2), symptomatic intracranial hemorrhage, and 90-day mortality was explored in the overall population and in three modes of onset subgroups (wake-up vs. witnessed vs.

Trial of Early Minimally Invasive Removal of Intracerebral Hemorrhage.

Background: Trials of surgical evacuation of supratentorial intracerebral hemorrhages have generally shown no functional benefit. Whether early minimally invasive surgical removal would result in better outcomes than medical management is not known.

Methods: In this multicenter, randomized trial involving patients with an acute intracerebral hemorrhage, we assessed surgical removal of the hematoma as compared with medical management.

Dialect identification, intelligibility ratings, and acceptability ratings of dysarthric speech in two American English dialects.

The current study explored the intelligibility and acceptability ratings of dysarthric speakers with African American English (AAE) and General American English (GAE) dialects by listeners who identify as GAE or AAE speakers, as well as listener ability to identify dialect in dysarthric speech. Eighty-six listeners rated the intelligibility and acceptability of sentences extracted from a passage read by speakers with dysarthria. Samples were used from the Atlanta Motor Speech Disorders Corpus and ratings were collected via self-report.

Association Between Body Mass Index and Functional Outcomes in Patients With Intracerebral Hemorrhage.

Background And Objectives: Evidence of the so-called "obesity paradox," which refers to the protective effect and survival benefit of obesity in patients with spontaneous intracerebral hemorrhage (ICH), remains controversial. This study aims to determine the association between body mass index (BMI) and functional outcomes in patients with ICH and whether it is modified by race/ethnicity.

Methods: Included individuals were derived from the Ethnic/Racial Variations of Intracerebral Hemorrhage study, which prospectively recruited 1,000 non-Hispanic White, 1,000 non-Hispanic Black, and 1,000 Hispanic patients with spontaneous ICH.

Optical Coherence Tomography in the Evaluation of Suspected Carotid Webs.

Background: Carotid web (CaW) is a subtype of fibromuscular dysplasia that predominantly involves the intimal layer of the arterial wall and is commonly overlooked as a separate causative entity for recurrent strokes. CaW is defined as a shelf-like lesion at the carotid bulb, although different morphological features have been reported. Optical coherence tomography (OCT) has been described in the literature as a useful microscopic and cross-sectional tomographic imaging tool.

Emergent use of ticagrelor during endovascular reperfusion in large arterial occlusions.

Objective: Given many emerging indications for endovascular interventions in ischemic strokes, a safe and effective adjuvant antiplatelet regimen for acute revascularization has become a subject of interest. Ticagrelor is a direct oral P2Y12 inhibitor that may achieve rapid platelet suppression than standard oral therapies. We report our experience of Ticagrelor use in revascularization of acute large arterial steno-occlusive disease, describing procedural post-procedure thrombotic events, major hemorrhages, and other clinical outcomes.

Comparison of CT Perfusion Software Packages for Thrombectomy Eligibility.

Introduction: Computed tomography perfusion (CTP) has played an important role in patient selection for mechanical thrombectomy (MT) in acute ischemic stroke. We aimed to investigate the agreement between perfusion parametric maps of 3 software packages - RAPID (RapidAI-IschemaView), Viz CTP(Viz.ai), and e-CTP(Brainomix) - in estimating baseline ischemic core volumes of near completely/completely reperfused patients.

Clot composition and recanalization outcomes in mechanical thrombectomy.

Background: Mechanical thrombectomy (MT) has become standard for large vessel occlusions, but rates of complete recanalization are suboptimal. Previous reports correlated radiographic signs with clot composition and a better response to specific techniques. Therefore, understanding clot composition may allow improved outcomes.

Optimization of collateral grading on computer tomography angiography.

BackgroundAs compared to single-phase CTA (sCTA), multi-phase CTA (mCTA) has been shown to more accurately estimate collateral flow in acute ischemic stroke (AIS). We sought to determine the characterization of poor collaterals across the three different phases of the mCTA. We also attempted to establish the optimal arterio-venous contrast timing parameters on sCTA that would prevent false positive reads of poor collateral status.

Changes in the care of acute cerebrovascular and cardiovascular conditions during the first year of the covid-19 pandemic in 746 hospitals in the USA: retrospective analysis.

Objective: To measure the impact of the covid-19 pandemic on admissions to hospital and interventions for acute ischemic stroke and acute myocardial infarction.

Design: A retrospective analysis.

Setting: 746 qualifying hospitals in the USA from the Premier Healthcare Database.

Early Minimally Invasive Removal of Intracerebral Hemorrhage (ENRICH): Study protocol for a multi-centered two-arm randomized adaptive trial.

Background: Intracerebral hemorrhage (ICH) is a potentially devastating condition with elevated early mortality rates, poor functional outcomes, and high costs of care. Standard of care involves intensive supportive therapy to prevent secondary injury. To date, there is no randomized control study demonstrating benefit of early evacuation of supratentorial ICH.

Characterizing Fast and Slow Progressors in Anterior Circulation Large Vessel Occlusion Strokes.

Background And Purpose: Infarct growth rate (IGR) in acute ischemic stroke is highly variable. We sought to evaluate impact of symptom-reperfusion time on outcomes in patients undergoing mechanical thrombectomy (MT).

Methods: A prospectively maintained database from January,2012-August,2020 was reviewed.

Risk Factors Associated With Mortality and Neurologic Disability After Intracerebral Hemorrhage in a Racially and Ethnically Diverse Cohort.

Introduction: Intracerebral hemorrhage (ICH) is the most severe subtype of stroke. Its mortality rate is high, and most survivors experience significant disability.

Objective: To assess primary patient risk factors associated with mortality and neurologic disability 3 months after ICH in a large, racially and ethnically balanced cohort.

Falsely normal CT perfusion ischemic core readings are common and often associated with deep infarcts.

Background: Proper identification of infarct extent is crucial for thrombectomy and prognostication. We sought to study the frequency and topographic aspects of those cases in which CT perfusion (CTP) misses a core lesion that is present on initial non-contrast CT (NCCT).

Methods: A review was carried out of a prospectively collected database of endovascular patients with anterior circulation large vessel occlusion strokes from January 2014 to November 2018.

Comparative analysis between 1-D, 2-D and 3-D carotid web quantification.

Background: Carotid webs (CaW) are now recognized as a cause of ischemic stroke in young patients. The thromboembolic potential appears related to the CaW's morphology and consequent impact on local flow dynamics. We aim to evaluate the reliability of different measurement methods for the quantification of CaW and their relationship to symptomatic status, presence of large vessel occlusion stroke (LVOS), clot burden and final infarct volume.

Carotid Web Phenotype Is Uncommonly Associated With Classic Fibromuscular Dysplasia: A Retrospective Observational Study.

Background And Purpose: Carotid web (CaW) is an intimal form of fibromuscular dysplasia (FMD) involving the carotid bulb which has been increasingly recognized as a potential cause of recurrent ischemic strokes. It is overlooked as a separate entity and often dismissed if no coexistent signs of classic FMD changes are observed. We aim to evaluate the frequency of classic FMD in high-yield vascular territories in patients with symptomatic CaW.