يعرض 1 - 10 نتائج من 38 نتيجة بحث عن '"Frei, Donald, F"', وقت الاستعلام: 0.72s تنقيح النتائج
  1. 1
    دورية أكاديمية

    المصدر: Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ; page 1-8 ; ISSN 0317-1671 2057-0155

    مصطلحات موضوعية: Neurology (clinical), Neurology, General Medicine

    الوصف: Background and purpose: To assess cost-effectiveness of late time-window endovascular treatment (EVT) in a clinical trial setting and a “real-world” setting. Methods: Data are from the randomized ESCAPE trial and a prospective cohort study (ESCAPE-LATE). Anterior circulation large vessel occlusion patients presenting > 6 hours from last-known-well were included, whereby collateral status was an inclusion criterion for ESCAPE but not ESCAPE-LATE. A Markov state transition model was built to estimate lifetime costs and quality-adjusted life-years (QALYs) for EVT in addition to best medical care vs. best medical care only in a clinical trial setting (comparing ESCAPE-EVT to ESCAPE control arm patients) and a “real-world” setting (comparing ESCAPE-LATE to ESCAPE control arm patients). We performed an unadjusted analysis, using 90-day modified Rankin Scale(mRS) scores as model input and analysis adjusted for baseline factors. Acceptability of EVT was calculated using upper/lower willingness-to-pay thresholds of 100,000 USD/50,000 USD/QALY. Results: Two-hundred and forty-nine patients were included (ESCAPE-LATE: n = 200, ESCAPE EVT-arm: n = 29, ESCAPE control-arm: n = 20). Late EVT in addition to best medical care was cost effective in the unadjusted analysis both in the clinical trial and real-world setting, with acceptability 96.6%–99.0%. After adjusting for differences in baseline variables between the groups, late EVT was marginally cost effective in the clinical trial setting (acceptability:49.9%–61.6%), but not the “real-world” setting (acceptability:32.9%–42.6%). Conclusion: EVT for LVO-patients presenting beyond 6 hours was cost effective in the clinical trial setting and “real-world” setting, although this was largely related to baseline patient differences favoring the “real-world” EVT group. After adjusting for these, EVT benefit was reduced in the trial setting, and absent in the real-world setting.

  2. 2
    دورية أكاديمية

    المصدر: Interventional Neuroradiology; Jun2024, Vol. 30 Issue 3, p372-379, 8p

    مستخلص: Introduction: The purpose of this study was to report our initial experience of using a large-bore (0.096″ inner diameter) access catheter in neurovascular interventions. Methods: Data were retrospectively collected from 5 sites in the US for neurovascular procedures performed using a large-bore access catheter. The effectiveness outcome was technical success, defined as the access catheter's successfully reaching its target vessel without conversion to direct carotid puncture or to a smaller-bore access catheter and successfully completing the intended neurointervention. Results: One hundred and thirteen procedures performed in 112 patients were included in this study. The mean age of the patients was 67.5 years (SD 16.2), and about half (49.1%) were female. The most common primary access sites were the femoral (64.6%) or radial (32.7%) artery. Challenging anatomic variations included severe vessel tortuosity (26/81, 32.1%), type II aortic arch (17/88, 19.3%), type III aortic arch (14/88, 15.9%), bovine arch (16/104, 15.4%), severe angle (<30°) between the subclavian and target vessel (11/74, 14.9%), and subclavian loop (7/79, 8.9%). The median access time to branch view was 18 min (IQR 11-28, N = 75). The technical success rate was 94.7%. Two dissections (1.8%) were related to the large-bore access catheter. Access site complications occurred in 2 patients (1.8%). Four additional symptomatic periprocedural complications not related to the large-bore access catheter occurred (7.1%). Conclusion: For neurovascular interventions, a 0.096″ inner diameter access catheter could be used with both femoral and radial arterial approaches, had a high technical success rate, and had a low rate of periprocedural complications. [ABSTRACT FROM AUTHOR]

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  3. 3
    دورية أكاديمية
  4. 4
    دورية أكاديمية

    المؤلفون: Almekhlafi, Mohammed, A, Goyal, Mayank, Dippel, Diederik, W J, Majoie, Charles, B L M, Campbell, Bruce, C V, Muir, Keith, W, Demchuk, Andrew, M, Bracard, Serge, Guillemin, Francis, Jovin, Tudor, G, Mitchell, Peter, J, White, Philip, Hill, Michael, D, Brown, Scott, Saver, Jeffrey, L, Berkhemer, Olvert, A, Fransen, Puck, S S, Beumer, Debbie, van den Berg, Lucie, A, Lingsma, Hester, F, Yoo, Albert, J, Schonewille, Wouter, J, Vos, Jan, Albert, Nederkoorn, Paul, J, Wermer, Marieke, J H, van Walderveen, Marianne, a A, Staals, Julie, Hofmeijer, Jeannette, van Oostayen, Jacques, A, Lycklama À Nijeholt, Geert, J, Boiten, Jelis, Brouwer, Patrick, A, Emmer, Bart, J, de Bruijn, Sebastiaan, F, van Dijk, Lukas, C, Kappelle, L, Jaap, Lo, Rob, H, van Dijk, Ewoud, J, de Vries, Joost, de Kort, Paul, L M, van Rooij, Willem, Jan J, van den Berg, Jan, S P, van Hasselt, Boudewijn, a a M, Aerden, Leo, a M, Dallinga, René, J, Visser, Marieke, C, Bot, Joseph, C J, Vroomen, Patrick, C, Eshghi, Omid, Schreuder, Tobien, H C M L, Heijboer, Roel, J J, Keizer, Koos, Tielbeek, Alexander, V, den Hertog, Heleen, M, Gerrits, Dick, G, van den Berg-Vos, Renske, M, Karas, Giorgos, B, Steyerberg, Ewout, W, Flach, H, Zwenneke, Marquering, Henk, A, Sprengers, Marieke, E S, Jenniskens, Sjoerd, F M, Beenen, Ludo, F M, van den Berg, René, Koudstaal, Peter, J, van Zwam, Wim, H, Roos, Yvo, B W E M, van Der Lugt, Aad, van Oostenbrugge, Robert, J, Menon, Bijoy, K, Eesa, Muneer, Rempel, Jeremy, L, Thornton, John, Roy, Daniel, Willinsky, Robert, A, Sapkota, Biggya, L, Dowlatshahi, Dar, Frei, Donald, F, Kamal, Noreen, R, Montanera, Walter, J, Poppe, Alexandre, y, Ryckborst, Karla, J, Silver, Frank, L, Shuaib, Ashfaq, Tampieri, Donatella, Williams, David, Bang, Oh, Young, Baxter, Blaise, W, Burns, Paul, A, Choe, Hana, Heo, Ji-Hoe, Holmstedt, Christine, A, Jankowitz, Brian, Kelly, Michael, Linares, Guillermo, Mandzia, Jennifer, L, Shankar, Jai, Sohn, Sung-Il, Swartz, Richard, H, Coutts, Shelagh, B, Smith, Eric, E, Morrish, William, F, Weill, Alain, Subramaniam, Suresh, Mitha, Alim, P, Wong, John, H, Lowerison, Mark, W, Sajobi, Tolulope, T, Bonafe, Alain, Diener, Hans, C, Levy, Elad, I, Pereira, Vitor, M, Albers, Gregory, W, Cognard, Christophe, Cohen, David, J, Hacke, Werner, Jansen, Olav, Mattle, Heinrich, P, Nogueira, Raul, G, Siddiqui, Adnan, H, Yavagal, Dileep, R, Devlin, Thomas, G, Lopes, Demetrius, K, Reddy, Vivek, K, Du Mesnil de Rochemont, Richard, Singer, Oliver, C, Jahan, Reza, Kleinig, Timothy, J, Dewey, Helen, M, Churilov, Leonid, Yassi, Nawaf, Yan, Bernard, Dowling, Richard, J, Parsons, Mark, W, Oxley, Thomas, J, Wu, Teddy, y, Brooks, Mark, Simpson, Marion, A, Miteff, Ferdinand, Levi, Christopher, R, Krause, Martin, Harrington, Timothy, J, Faulder, Kenneth, C, Steinfort, Brendan, S, Priglinger, Miriam, Ang, Timothy, Scroop, Rebecca, Barber, Philip, A, Mcguinness, Ben, Wijeratne, Tissa, Phan, Thanh, G, Chong, Winston, Chandra, Ronil, V, Bladin, Christopher, F, Badve, Monica, Rice, Henry, de Villiers, Laetitia, Ma, Henry, Desmond, Patricia, M, Donnan, Geoffrey, A, Davis, Stephen, M, Chamorro, Angel, Cobo, Erik, de Miquel, María, A, Molina, Carlos, A, Rovira, Alex, San Román, Luis, Serena, Joaquín, Abilleira, Sonia, Ribó, Marc, Millán, Mònica, Urra, Xabier, Cardona, Pere, López-Cancio, Elena, Tomasello, Alejandro, Castaño, Carlos, Blasco, Jordi, Aja, Lucía, Dorado, Laura, Quesada, Helena, Rubiera, Marta, Hernandez-Pérez, María, von Kummer, Rüdiger, Gallofré, Miquel, Dávalos, Antoni, Ford, Gary, A, Messow, Claudia-Martina, Ford, Ian, Murray, Alicia, Clifton, Andrew, Brown, Martin, M, Madigan, Jeremy, Lenthall, Rob, Robertson, Fergus, Dixit, Anand, Cloud, Geoffrey, C, Wardlaw, Joanna, Freeman, Janet, Ducrocq, Xavier, Mas, Jean, Louis, Soudant, Marc, Oppenheim, Catherine, Moulin, Thierry

    المساهمون: University of Calgary, Erasmus University Medical Center Rotterdam (Erasmus MC), Department of Radiology and Nuclear Medicine Amsterdam, VU University Medical Center Amsterdam, University of Melbourne, University of Glasgow, Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Département de neuroradiologie diagnostique et thérapeutique CHRU Nancy, Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre d'investigation clinique Nancy (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), The Royal Melbourne Hospital, Newcastle University Newcastle, Altair Development, David Geffen School of Medicine Los Angeles, University of California Los Angeles (UCLA), University of California (UC)-University of California (UC)

    المصدر: ISSN: 2168-6149.

    الوصف: International audience ; The benefits of endovascular thrombectomy (EVT) are time dependent. Prior studies may have underestimated the time-benefit association because time of onset is imprecisely known. OBJECTIVE To assess the lifetime outcomes associated with speed of endovascular thrombectomy in patients with acute ischemic stroke due to large-vessel occlusion (LVO). DATA SOURCES PubMed was searched for randomized clinical trials of stent retriever thrombectomy devices vs medical therapy in patients with anterior circulation LVO within 12 hours of last known well time, and for which a peer-reviewed, complete primary results article was published by August 1, 2020.

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    دورية أكاديمية
  6. 6
    دورية أكاديمية

    المصدر: Journal of the American Heart Association ; volume 6, issue 6 ; ISSN 2047-9980

    الوصف: Background Cerebral venous thrombosis is a rare cause of stroke that poses diagnostic, therapeutic, and prognostic challenges. Mainstay treatment is systemic anticoagulation, but endovascular treatment is increasingly advocated. Our objectives were to describe the epidemiology, treatment, and prognosis of 152 patients with cerebral venous thrombosis. Methods and Results This was a retrospective study of consecutive cerebral venous thrombosis cases from 2006 to 2013 at a comprehensive stroke center through hospital discharge. Predictors of full recovery (modified Rankin Scale scores 0–1) were analyzed with multiple logistic regression and presented as adjusted odds ratios ( AORs ) with 95% confidence intervals ( CIs ). The population was young (average age: 42 years), majority female (69%), and commonly presenting with cerebral edema (63%), and 72% were transferred in. All patients received systemic anticoagulation; 49% (n=73) required endovascular treatment. Reasons for requiring endovascular treatment included cerebral edema, herniation, or hemorrhagic infarct (n=38); neurologic decline (n=17); rethrombosis, persistent occlusion, or clot propagation (n=10); extensive clot burden (n=7); and persistent headache despite anticoagulation (n=1). There were 7 (10%) procedural complications. Recanalization was successful (61%), partial (30%), and unsuccessful (9%). Overall, 60% fully recovered. Positive predictors of full recovery included hormonal etiology, particularly for patients who were transferred in ( AOR : 7.06 [95% CI, 2.27–21.96], interaction P =0.03) and who had migraine history ( AOR : 4.87 [95% CI, 1.01–23.50], P =0.05), whereas negative predictors of full recovery were cerebral edema ( AOR : 0.11 [95% CI, 0.04–0.34], P <0.001) and motor weakness ( AOR : 0.28 [95% CI, 0.09–0.96], P =0.04). Conclusions As one of the largest cohort studies, our findings suggest that cerebral edema, history of migraine, and hormonal etiology were prognostic and that endovascular treatment might be a safe and effective ...

  7. 7
    دورية أكاديمية

    المساهمون: penumbra

    المصدر: Interventional Neuroradiology ; page 159101992211270 ; ISSN 1591-0199 2385-2011

    مصطلحات موضوعية: General Medicine

    الوصف: Introduction The purpose of this study was to report our initial experience of using a large-bore (0.096″ inner diameter) access catheter in neurovascular interventions. Methods Data were retrospectively collected from 5 sites in the US for neurovascular procedures performed using a large-bore access catheter. The effectiveness outcome was technical success, defined as the access catheter's successfully reaching its target vessel without conversion to direct carotid puncture or to a smaller-bore access catheter and successfully completing the intended neurointervention. Results One hundred and thirteen procedures performed in 112 patients were included in this study. The mean age of the patients was 67.5 years (SD 16.2), and about half (49.1%) were female. The most common primary access sites were the femoral (64.6%) or radial (32.7%) artery. Challenging anatomic variations included severe vessel tortuosity (26/81, 32.1%), type II aortic arch (17/88, 19.3%), type III aortic arch (14/88, 15.9%), bovine arch (16/104, 15.4%), severe angle (<30°) between the subclavian and target vessel (11/74, 14.9%), and subclavian loop (7/79, 8.9%). The median access time to branch view was 18 min (IQR 11-28, N = 75). The technical success rate was 94.7%. Two dissections (1.8%) were related to the large-bore access catheter. Access site complications occurred in 2 patients (1.8%). Four additional symptomatic periprocedural complications not related to the large-bore access catheter occurred (7.1%). Conclusion For neurovascular interventions, a 0.096″ inner diameter access catheter could be used with both femoral and radial arterial approaches, had a high technical success rate, and had a low rate of periprocedural complications.

  8. 8
    دورية أكاديمية

    المصدر: Stroke ; volume 47, issue 12, page 2993-2998 ; ISSN 0039-2499 1524-4628

    الوصف: Background and Purpose— Infarct in a new previously unaffected territory (INT) is a potential complication of endovascular treatment. We applied a recently proposed methodology to identify and classify INTs in the ESCAPE randomized controlled trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times). Methods— The core laboratory identified INTs on 24-hour follow-up imaging, blinded to treatment allocation, after assessing all baseline imaging. INTs were classified into 3 types (I–III) and 2 subtypes (A/B) based on size and if catheter manipulation was likely performed across the vessel territory ostium. Logistic regression was used to understand the effect of multiple a priori identified variables on INT occurrence. Ordinal logistic regression was used to analyze the effect of INTs on modified Rankin Scale shift at 90 days. Results— From 308 patients included, 14 INTs (4.5% overall; 2.8% on follow-up noncontrast computed tomography, 11.7% on follow-up magnetic resonance imaging) were identified (5.0% in endovascular treatment arm versus 4.0% in control arm [ P =0.7]). The use of intravenous alteplase was associated with a 68% reduction in the odds of INT occurrence (3.0% with versus 9.1% without; odds ratio, 0.32; 95% confidence interval, 0.11–0.96; adjusted for age, sex, and treatment type). No other variables were associated with INTs. INT occurrence was associated with reduced probability of good clinical outcome (common odds ratio, 0.25; 95% confidence interval, 0.09–0.74; adjusted for age, type of treatment, and follow-up scan). Conclusions— INTs are uncommon, detected more frequently on follow-up magnetic resonance imaging, and affect clinical outcome. In experienced centers, endovascular treatment is likely not causal, whereas intravenous alteplase may be therapeutic. Clinical Trial Registration— URL: http://www.clinicaltrials.govTest . Unique identifier: NCT01778335.

  9. 9
    دورية أكاديمية

    المصدر: Circulation ; volume 133, issue 23, page 2279-2286 ; ISSN 0009-7322 1524-4539

    الوصف: Background— The Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke (ESCAPE) trial used innovative imaging and aggressive target time metrics to demonstrate the benefit of endovascular treatment in patients with acute ischemic stroke. We analyze the impact of time on clinical outcome and the effect of patient, hospital, and health system characteristics on workflow within the trial. Methods and Results— Relationship between outcome (modified Rankin Scale) and interval times was modeled by using logistic regression. Association between time intervals (stroke onset to arrival in endovascular-capable hospital, to qualifying computed tomography, to groin puncture, and to reperfusion) and patient, hospital, and health system characteristics were modeled by using negative binomial regression. Every 30-minute increase in computed tomography-to-reperfusion time reduced the probability of achieving a functionally independent outcome (90-day modified Rankin Scale 0–2) by 8.3% ( P =0.006). Symptom onset-to-imaging time was not associated with outcome ( P >0.05). Onset-to-endovascular hospital arrival time was 42% (34 minutes) longer among patients receiving intravenous alteplase at the referring hospital (drip and ship) versus direct transfer (mothership). Computed tomography-to-groin puncture time was 15% (8 minutes) shorter among patients presenting during work hours versus off hours, 41% (24 minutes) shorter in drip-ship patients versus mothership, and 43% (22 minutes) longer when general anesthesia was administered. The use of a balloon guide catheter during endovascular procedures shortened puncture-to-reperfusion time by 21% (8 minutes). Conclusions— Imaging-to-reperfusion time is a significant predictor of outcome in the ESCAPE trial. Inefficiencies in triaging, off-hour presentation, intravenous alteplase administration, use of general anesthesia, and endovascular techniques offer major opportunities for improvement in workflow. Clinical Trial Registration— URL: ...

  10. 10
    دورية أكاديمية

    المصدر: Stroke: Vascular and Interventional Neurology ; volume 1, issue S1 ; ISSN 2694-5746

    الوصف: This meeting abstract was removed due to the OA licensing requirements of this journal. The full abstract is listed here : https://www.svin.org/files/SVIN_2021_Abstracts_for_Web.pdfTest