Mortality After Cerebral Venous Thrombosis.

Objectives: Cerebral venous thrombosis (CVT) has historically had a poor prognosis, but advances in diagnosis and treatment may have improved outcomes. This study evaluated mortality rates, causes of death, and predictors of early and late mortality in CVT using international data.

Methods: In this multicenter cohort study, we analyzed data from adults with CVT enrolled between 1995 and 2021.

Shear Stress Targeted Delivery of Nitroglycerin to Brain Collaterals Improves Ischaemic Stroke Outcome.

In patients with ischaemic stroke, retrograde perfusion of the penumbra by leptomeningeal collateral vessels (LMCs) strongly predicts clinical outcome, suggesting that enhancing LMC flow can offer a novel therapeutic approach. Using in vivo measurements and computational modelling it is shown that LMCs experience elevated fluid shear stress that is significantly higher than that in other blood vessels during ischaemic stroke in rats and humans. We exploit this to selectively enhance flow in LMCs using shear-activated nanoparticle aggregates carrying the vasodilator nitroglycerin (NG-NPAs) that specifically release drug in regions of vessels with high wall shear stress (≥100 dyne cm).

Effects of simvastatin treatment on leptomeningeal collateral vessels: resistance, number and diameter.

Good leptomeningeal collateral vessels (LMC) are associated with smaller lesion volume and better patient outcomes from ischaemic stroke, but their architecture varies greatly between individuals. Statins can stimulate angiogenesis and show promise for stimulating cerebral collaterogenesis. Statins could thus improve LMC grade and ensure all patients receive positive outcomes from treatment.

Brain fluid physiology in ischaemic stroke; more than just oedema.

Background: Cerebrospinal fluid and interstitial fluid dynamics are critical for maintaining homeostasis in the central nervous system. These fluids facilitate waste clearance, micronutrient distribution, and provide a tightly regulated ionic environment. Ischaemic stroke, a leading cause of morbidity and mortality, disrupts this delicate system, compounding the physiological challenges posed by the condition.

Implementation and sustainment of virtual reality stroke workflow training for physician trainees at comprehensive stroke centres: a quantitative and qualitative study.

Background: Variation in stroke treatment metrics highlight a need for approaches to improve clinical processes. Training interventions can improve outcomes, but Australian physician trainees do not currently receive formal process-directed stroke training. Virtual reality (VR) stroke workflow training has proven acceptable, usable, useful and feasible in trial contexts, but how to integrate VR training into physician training remains unclear.

Collateral assessment on magnetic resonance imaging/angiography up to 30 hours after stroke onset.

Purpose: We aimed to validate hyperintense vessel sign (HVS) on FLAIR imaging or posterior cerebral artery (PCA) laterality on MR angiography beyond 4.5 hours after stroke onset.

Materials And Methods: Data from acute ischemic stroke patients with internal carotid or middle cerebral artery occlusion who underwent CT perfusion imaging at baseline, follow-up MR perfusion imaging and angiography within 30 hours after stroke, without effective recanalization on follow-up imaging, were analysed retrospectively.

The effect of nitroglycerin treatment on cerebral ischaemia: A systematic review and meta-analysis of animal studies.

Background: Nitroglycerin has been of considerable interest as a treatment for ischaemic stroke. Recent clinical trials with nitroglycerin transdermal patches during the acute phase of stroke failed to improve functional outcomes. Systematic review and meta-analysis of the effectiveness of nitroglycerin in preclinical models of ischaemic stroke has not previously been reported, despite several clinical trials.

Exploring ischemic core growth rate and endovascular therapy benefit in large core patients.

After stroke onset, ischemic brain tissue will progress to infarction unless blood flow is restored. Core growth rate measures the infarction speed from stroke onset. This multicenter cohort study aimed to explore whether core growth rate influences benefit from the reperfusion treatment of endovascular thrombectomy in large ischemic core stroke patients.

TACTICS VR Stroke Telehealth Virtual Reality Training for Health Care Professionals Involved in Stroke Management at Telestroke Spoke Hospitals: Module Design and Implementation Study.

Background: Stroke management in rural areas is more variable and there is less access to reperfusion therapies, when compared with metropolitan areas. Delays in treatment contribute to worse patient outcomes. To improve stroke management in rural areas, health districts are implementing telestroke networks.

Role of cardiac computed tomography in hyperacute stroke assessment.

Background: Incorporating cardiac CT with hyperacute stroke imaging may increase the yield for cardioembolic sources. It is not clarified whether stroke severity influences on rates of intracardiac thrombus. We aimed to investigate a National Institutes of Health Stroke Scale (NIHSS) threshold below which acute cardiac CT was unnecessary.

Blood Pressure Variability Is Associated with Infarct Growth in Acute Ischaemic Stroke.

Introduction: Evidence-based blood pressure (BP) targets in acute ischaemic stroke are lacking. Previous observational studies have focused on single baseline BP and clinical outcomes, without consideration for dynamic changes. We aim to determine the association between BP parameters including variability, peak, nadir, median and mean during stroke and infarct growth (primary outcome), risk of haemorrhagic transformation, and functional outcome (secondary outcomes).

Effect of short-term exposure to air pollution on daily cardio- and cerebrovascular hospitalisations in areas with a low level of air pollution.

Exposure to air pollution is associated with increased cardio- and cerebrovascular diseases. However, the evidence regarding the short-term effect of air pollution on cardio- and cerebrovascular hospitalisations in areas with relatively low air pollution levels is limited. This study aims to examine the effect of short-term exposure to different air pollutants on hospital admissions due to cardio- and cerebrovascular diseases in rural and regional Australia with low air pollution.

Secondary prevention of stroke. A telehealth-delivered physical activity and diet pilot randomized trial (ENAbLE-pilot).

Background: Improving physical activity levels and diet quality are important for secondary stroke prevention.

Aim: To test the feasibility and safety of 6-month, co-designed telehealth-delivered interventions to increase physical activity and improve diet quality.

Methods: A 2 × 2 factorial trial (physical activity (PA); diet (DIET); PA + DIET; control) randomized, open-label, blinded endpoint trial.

"Wasting time": a qualitative study of stroke survivors' experiences of boredom in non-therapy time during inpatient rehabilitation.

Purpose: Stroke survivors regularly report experiencing boredom during inpatient rehabilitation which may detrimentally affect mood, learning and engagement in activities important for functional recovery. This study explores how stroke survivors meaningfully occupy their non-therapy time and their experiences of boredom, to further our understanding of this complex phenomenon.

Methods: Secondary analysis of transcripts from semi-structured interviews with stroke survivors exploring activity during non-therapy time.

A method for rapid machine learning development for data mining with doctor-in-the-loop.

Classifying free-text from historical databases into research-compatible formats is a barrier for clinicians undertaking audit and research projects. The aim of this study was to (a) develop interactive active machine-learning model training methodology using readily available software that was (b) easily adaptable to a wide range of natural language databases and allowed customised researcher-defined categories, and then (c) evaluate the accuracy and speed of this model for classifying free text from two unique and unrelated clinical notes into coded data. A user interface for medical experts to train and evaluate the algorithm was created.

"Are we there yet?" expectations and experiences with lower limb robotic exoskeletons: a qualitative evaluation of the therapist perspective.

Purpose: Lower limb robotic exoskeletons can assist movement, however, clinical uptake in neurorehabilitation is limited. The views and experiences of clinicians are pivotal to the successful clinical implementation of emerging technologies. This study investigates therapist perspectives of the clinical use and future role of this technology in neurorehabilitation.

Ultra-Long Transfers for Endovascular Thrombectomy-Mission Impossible?: The Australia-New Zealand Experience.

Background: Endovascular thrombectomy (EVT) access in remote areas is limited. Preliminary data suggest that long distance transfers for EVT may be beneficial; however, the magnitude and best imaging strategy at the referring center remains uncertain. We hypothesized that patients transferred >300 miles would benefit from EVT, achieving rates of functional independence (modified Rankin Scale [mRS] score of 0-2) at 3 months similar to those patients treated at the comprehensive stroke center in the randomized EVT extended window trials and that the selection of patients with computed tomography perfusion (CTP) at the referring site would be associated with ordinal shift toward better outcomes on the mRS.

Association of Endovascular Thrombectomy With Functional Outcome in Patients With Acute Stroke With a Large Ischemic Core.

Background And Objectives: Endovascular thrombectomy (EVT) is effective for patients with large vessel occlusion (LVO) stroke with smaller volumes of CT perfusion (CTP)-defined ischemic core. However, the benefit of EVT is unclear in those with a core volume >70 mL. We aimed to compare outcomes of EVT and non-EVT patients with an ischemic core volume ≥70 mL, hypothesizing that there would be a benefit from EVT for fair outcome (3-month modified Rankin scale [mRS] 0-3) after stroke.

Ischemic Lesion Growth in Patients with a Persistent Target Mismatch After Large Vessel Occlusion.

Background: Failure to reperfuse a cerebral occlusion resulting in a persistent penumbral pattern has not been fully described.

Methods: We retrospectively reviewed patients with anterior large vessel occlusion who did not receive reperfusion, and underwent repeated perfusion imaging, with baseline imaging < 6 h after onset and follow-up scans from 16-168 h. A persistent target mismatch (PTM) was defined as core volume of < 100 mL, mismatch ratio > 1.