Bernard Yan (Australia)
Royal Melbourne Hospital NeurologyAuthor Of 4 Presentations
A RANDOMIZED CONTROLLED TRIAL OF DIRECT ENDOVASCULAR CLOT RETRIEVAL VERSUS STANDARD BRIDGING THROMBOLYSIS WITH ENDOVASCULAR CLOT RETRIEVAL WITHIN 4.5 HOURS OF STROKE ONSET
Prehospital Strategies for Brain Hemorrhage Management
Abstract
Abstract Body
Mobile stroke units (MSUs) substantially reduce reperfusion therapy times in acute ischemic stroke (AIS). Phase III trials in the USA and Europe have shown that they improve clinical outcomes, compared with standard of care in emergency departments. MSUs are also an ideal platform for treatment of intracerebral hemorrhage (ICH). The Melbourne MSU has been operational since 2017. In a final diagnosis of stroke, approximately 15% of our cases have intracranial hemorrhages, predominantly ICH, smaller numbers of subarachnoid, subdural and extradural hemorrhages. Around 50% were treated with intravenous anti-hypertensive treatment. Patients were bypassed to a comprehensive stroke centre from the MSU in about one third of cases. Compared to patients with MSU-AIS, patients with ICH had faster onset to emergency call and onset to scene arrival times. We are conducting the STOP-MSU trial which is randomizing patients to tranexamic acid (TXA) versus placebo within 2 hours of the onset of ICH, testing the hypothesis that TXA will reduce ICH growth at 24 hours. This ongoing trial has recruited over 100 patients, about a third from the Melbourne MSU and the remainder from emergency departments in Australia, New Zealand, Taiwan, Vietnam and Finland. MSUs can facilitate ultra-early ICH diagnosis, treatment and triage.
THE DETRIMENTAL IMPACT OF NOT MAINTAINING ACCESS TO STROKE UNITS DURING THE COVID-19 PANDEMIC
Abstract
Background and Aims
Changes to hospital resourcing related to acute stroke care have occurred as a by-product of the COVID-19 pandemic. There is uncertainty on the impacts this has had on the quality of care. We aimed to compare the provision of acute stroke care provided in stroke units with alternate ward settings during the pandemic.
Methods
Patients admitted with stroke or transient ischaemic attack from 61 hospitals contributing data to the Australian Stroke Clinical Registry in 2019 and 2020 were included. Interrupted time series analysis was conducted to assess trends in the provision of therapies before and after two critical pandemic time points in Australia: the first wave (starting 1/3/2020); and the second wave (between 9/7/2020-20/10/2020).
Results
There were 19,164 admissions in 2019 and 19,131 admissions in 2020 included, with no differences in age and sex between years (mean age 73 years, 56% male). Fewer patients were provided treatment in a stroke unit in 2020 compared to 2019 (72% vs 77%, p<0.001). There were greater declines in the provision of hyperacute aspirin and secondary prevention medications at discharge in alternate wards than stroke units during the second wave (between 0.41% and 1.31% per week). Provision of mobilisation and swallow screening/assessment declined in alternate wards only. Provision of care planning at discharge improved in alternate wards relative to stroke units by 0.49% per week during the first wave and 1.14% per week during the second wave.
Conclusions
Maintaining access to stroke units is paramount to ensuring best practice care even during a pandemic.
DIRECT MECHANICAL THROMBECTOMY VERSUS BRIDGING THERAPY FOR ACUTE ISCHAEMIC STROKE–A CUMULATIVE STUDY-LEVEL META-ANALYSIS OF THE DIRECT-MT, MRCLEAN-NOIV, DEVT, SKIP AND SWIFT-DIRECT RCTS: PLACEHOLDER ABSTRACT
Abstract
Background and Aims
Whether direct mechanical thrombectomy (MT) in acute ischaemic stroke patients with large vessel occlusion (LVO) is equally effective as intravenous thrombolysis (IVT) with alteplase followed by MT remains a matter of debate. Primary aim of this study was to test non-inferiority of direct mechanical thrombectomy using summary estimates of study-level aggregate data of all randomized controlled trials evaluating direct MT vs IVT followed by MT. Secondary aims included superiority testing of IVT followed by MT versus direct MT and presentation of relevant secondary outcomes.
Methods
We performed a PROSPERO registered, prespecified, systematic review of electronic databases (Web of Science, PubMed, Embase) and meta-analysis with data presentation adherent to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Random effects models were used to pool the study-level data. The primary outcome used for non-inferiority and superiority testing was good functional outcome at 90 days (mRS≤2). The non-inferiority margin was prespecified. Secondary outcomes included excellent functional outcome (mRS≤1), mortality, symptomatic intracranial haemorrhage (sICH), successful reperfusion (TICI≥2b) and procedure-related complications. Five RCTs comprising 2043 patients (xy dMT, yx bridging therapy) were included.
Results
To be determined.
Conclusions
To be determined.
Presenter of 2 Presentations
A RANDOMIZED CONTROLLED TRIAL OF DIRECT ENDOVASCULAR CLOT RETRIEVAL VERSUS STANDARD BRIDGING THROMBOLYSIS WITH ENDOVASCULAR CLOT RETRIEVAL WITHIN 4.5 HOURS OF STROKE ONSET
DIRECT MECHANICAL THROMBECTOMY VERSUS BRIDGING THERAPY FOR ACUTE ISCHAEMIC STROKE–A CUMULATIVE STUDY-LEVEL META-ANALYSIS OF THE DIRECT-MT, MRCLEAN-NOIV, DEVT, SKIP AND SWIFT-DIRECT RCTS: PLACEHOLDER ABSTRACT
Abstract
Background and Aims
Whether direct mechanical thrombectomy (MT) in acute ischaemic stroke patients with large vessel occlusion (LVO) is equally effective as intravenous thrombolysis (IVT) with alteplase followed by MT remains a matter of debate. Primary aim of this study was to test non-inferiority of direct mechanical thrombectomy using summary estimates of study-level aggregate data of all randomized controlled trials evaluating direct MT vs IVT followed by MT. Secondary aims included superiority testing of IVT followed by MT versus direct MT and presentation of relevant secondary outcomes.
Methods
We performed a PROSPERO registered, prespecified, systematic review of electronic databases (Web of Science, PubMed, Embase) and meta-analysis with data presentation adherent to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Random effects models were used to pool the study-level data. The primary outcome used for non-inferiority and superiority testing was good functional outcome at 90 days (mRS≤2). The non-inferiority margin was prespecified. Secondary outcomes included excellent functional outcome (mRS≤1), mortality, symptomatic intracranial haemorrhage (sICH), successful reperfusion (TICI≥2b) and procedure-related complications. Five RCTs comprising 2043 patients (xy dMT, yx bridging therapy) were included.
Results
To be determined.
Conclusions
To be determined.
Moderator of 1 Session
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