ORCID Profile
0000-0002-1717-6083
Current Organisations
Imperial College London
,
Imperial College Healthcare NHS Trust
,
Royal College of Radiologists
,
Royal College of Physicians
,
University of Cambridge
,
Royal Melbourne Hospital
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Publisher: Elsevier BV
Date: 11-2017
DOI: 10.1016/J.JSTROKECEREBROVASDIS.2017.05.042
Abstract: The Alberta Stroke Program Early Computed Tomography Score (ASPECTS) on non-contrast computed tomography (NCCT) is dependent on the visibility of early ischemic change. The goal of our study was to evaluate whether time from ischemic stroke onset to initial NCCT influences the inter-rater variability and prognostic accuracy of ASPECTS for a 3-month functional outcome. Ischemic stroke patients treated with intravenous tissue plasminogen activator (IV-tPA) from 2007 to 2014 at the Royal Melbourne Hospital were included. ASPECTS were blindly assessed by 2 independent raters with inter-rater agreement determined by weighted kappa. Onset time to computed tomography time was dichotomized at the median (≤100 and >100 minutes). Outcome was assessed using the modified Rankin Scale. Logistic regression and receiver operating characteristic analysis were used to assess the prognostic utility of ASPECTS in the early and later time periods. There were 379 patients included. Inter-rater agreement was significantly lower in the early time period: kappa = .75 (95% confidence interval (CI), .59-.84) ≤ 100 minutes versus .92 (95% CI, .91-.93) > 100 minutes, P 100 minutes = .66 (95% CI, .59-.73), P = .055. This study demonstrated a significantly lower inter-rater agreement and a trend toward reduced prognostic accuracy of ASPECTS in earlier time periods. The use of ASPECTS to select patients for revascularization in early time windows may be unreliable.
Publisher: S. Karger AG
Date: 11-12-2020
DOI: 10.1159/000512603
Abstract: b i Introduction: /i /b We examined the impact of the coronavirus disease 2019 (COVID-19) pandemic on our regional stroke thrombectomy service in the UK. b i Methods: /i /b This was a single-center health service evaluation. We began testing for COVID-19 on 3 March and introduced a modified “COVID Stroke Thrombectomy Pathway” on 18 March. We analyzed the clinical, procedural and outcome data for 61 consecutive stroke thrombectomy patients between 1 January and 30 April. We compared the data for January and February (“pre-COVID,” i n /i = 33) versus March and April (“during COVID,” i n /i = 28). b i Results: /i /b Patient demographics were similar between the 2 groups (mean age 71 ± 12.8 years, 39% female). During the COVID-19 pandemic, (a) total stroke admissions fell by 17% but the thrombectomy rate was maintained at 20% of ischemic strokes (b) successful recanalization rate was maintained at 81% (c) early neurological outcomes (neurological improvement following thrombectomy and inpatient mortality) were not significantly different (d) use of general anesthesia fell significantly from 85 to 32% as intended and (e) time intervals from onset to arrival, groin puncture, and recanalization were not significantly different, whereas internal delays for external referrals significantly improved for door-to-groin puncture (48 [interquartile range (IQR) 39–57] vs. 33 [IQR 27–44] minutes, i /i = 0.013) and door-to-recanalization (82.5 [IQR 61–110] vs. 60 [IQR 55–70] minutes, i /i = 0.018). b i Conclusion: /i /b The COVID-19 pandemic has had a negative impact on the stroke admission numbers but not stroke thrombectomy rate, successful recanalization rate, or early neurological outcome. Internal delays actually improved during the COVID-19 pandemic. Further studies should examine the effects of the COVID-19 pandemic on longer term outcome.
Publisher: S. Karger AG
Date: 2017
DOI: 10.1159/000479707
Abstract: b i Background: /i /b Alberta Stroke Program Early CT Score (ASPECTS) assesses early ischemic change on non-contrast CT (NCCT). We hypothesised that assessing ASPECTS regions on CT Perfusion (CTP) rather than NCCT would improve inter-rater agreement and prognostic accuracy, particularly in patients presenting early after stroke onset. b i Methods: /i /b Ischemic stroke patients treated with intravenous alteplase from 2009 to 2014 at our institution were included in this study. Inter-rater agreement and prognostic accuracy of ASPECTS across modalities were analysed by the time between stroke onset and initial NCCT, dichotomized 1st quartile versus quartiles 2-4, referred to as epochs. ASPECTS was assessed by 2 independent raters, blinded to stroke onset time, with agreement determined by weighted kappa (& #x03BA sub w /sub ). Prognostic accuracy for favourable outcome (modified Rankin Scale 0-2) was assessed using the receiver-operating characteristic analysis. b i Results: /i /b A total of 227 participants were included. There was significant time-by-CT modality interaction for ASPECTS, i /i 0.0001. The inter-rater agreement of ASPECTS on NCCT significantly increased as onset to CT time increased (& #x03BA sub w /sub epoch 1 = 0.76 vs. & #x03BA sub w /sub epoch 2-4 = 0.89, i /i = 0.04), whereas agreement using CTP parameters was stable across epochs. Inter-rater agreement for CTP-ASPECTS was significantly higher than NCCT in early epoch: Tmax & #x03BA sub w /sub = 0.96, i /i = 0.002 cerebral blood volume (CBV) & #x03BA sub w /sub = 0.95, i /i = 0.003 cerebral blood flow (CBF) & #x03BA sub w /sub = 0.94, i /i = 0.006, with no differences in the later epochs. Prognostic accuracy of ASPECTS on NCCT in epoch 1 were (area under the ROC curves [AUC] = 0.52, 95% CI 0.48-0.56), CBV (AUC = 0.55, 95% CI 0.42-0.69, CBF (AUC = 0.58, 95% CI 0.46-0.71) and Tmax (AUC = 0.62, 95% CI 0.49-0.75), i /i = 0.46 between modalities. b i Conclusions: /i /b CTP can improve reliability when assessing the extent of ischemic changes, particularly in patients imaged early after stroke onset.
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Neil Rane.