3,684 results match your criteria Anterior Circulation Stroke


Trans-cranial Doppler predicts early neurologic deterioration in anterior circulation ischemic stroke after successful endovascular treatment.

Chin Med J (Engl) 2020 Jun 26. Epub 2020 Jun 26.

Department of Neurology, Liangxiang Hospital of Beijing Fangshan District, Beijing 102246, China.

Background: Early neurologic deterioration (END) may occur in patients with anterior circulation ischemic stroke (ACIS) after receiving endovascular treatment (EVT). Hemodynamic insufficiency, re-occlusion, and post-re-canalization hyper-perfusion are likely to play a critical role in END. We hypothesized that hemodynamic changes can predict END in patients with ACIS post-successful EVT using trans-cranial Doppler (TCD). Read More

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http://dx.doi.org/10.1097/CM9.0000000000000881DOI Listing

Endovascular Treatment of Giant Intracranial Aneurysms.

Cureus 2020 May 26;12(5):e8290. Epub 2020 May 26.

Radiology, Miami Cardiac & Vascular Institute/Miami Neuroscience Institute, Miami, USA.

Objective Giant intracranial aneurysms (GIAs) are associated with a high risk of rupture and have a high mortality rate when they rupture (65-100%). The traditional microsurgical approach to secure these lesions is challenging, and as such endovascular embolization has been increasingly selected as a treatment option. Methods We performed a retrospective analysis of consecutive patients with ruptured and unruptured GIAs at three medical centers from October 2008 to April 2016. Read More

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http://dx.doi.org/10.7759/cureus.8290DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7317134PMC

Intracranial Calcification is Predictive for Hemorrhagic Transformation and Prognosis After Intravenous Thrombolysis in Non-Cardioembolic Stroke Patients.

J Atheroscler Thromb 2020 Jun 27. Epub 2020 Jun 27.

Stroke Center, Department of Neurology, the First Hospital of Jilin University.

Aim: Hemorrhagic transformation is the major complication of intravenous thrombolysis. Calcification is used widely as an imaging indicator of atherosclerotic burden and cerebrovascular function. The relationship between intracranial calcification and hemorrhagic transformation has not been explored fully. Read More

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http://dx.doi.org/10.5551/jat.55889DOI Listing

Relationship between stroke etiology and collateral status in anterior circulation large vessel occlusion.

J Neurol 2020 Jun 25. Epub 2020 Jun 25.

Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria.

Background And Purpose: Clinical outcome after mechanical thrombectomy (MT) for large vessel occlusion (LVO) stroke is influenced by the intracerebral collateral status. We tested the hypothesis that patients with preexisting ipsilateral extracranial carotid artery stenosis (CAS) would have a better collateral status compared to non-CAS patients. Additionally, we evaluated MT-related adverse events and outcome for both groups. Read More

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http://dx.doi.org/10.1007/s00415-020-10009-zDOI Listing

Multiple hypointense vessels on susceptibility-weighted imaging predict early neurological deterioration in acute ischaemic stroke patients with severe intracranial large artery stenosis or occlusion receiving intravenous thrombolysis.

Stroke Vasc Neurol 2020 Jun 24. Epub 2020 Jun 24.

Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong, China

Background And Purpose: Early neurological deterioration (END) is a common feature in patients with acute ischaemic stroke (AIS) receiving thrombolysis. This study aimed to investigate whether the presence of multiple hypointense vessels (MHVs) on susceptibility-weighted imaging (SWI) could predict END in patients with the anterior circulation AIS treated with recombinant tissue plasminogen activator (r-tPA).

Methods: This was a retrospective study focusing on AIS patients suffering from symptomatic stenosis or occlusion of the middle cerebral artery or internal carotid artery with r-tPA treatment. Read More

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http://dx.doi.org/10.1136/svn-2020-000343DOI Listing

Multiphasic Computed Tomography Angiography Findings for Identifying Pseudo-Occlusion of the Internal Carotid Artery.

Stroke 2020 Jun 26:STROKEAHA120029512. Epub 2020 Jun 26.

Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea. (J.J., K.-J.A., B.-s.K.).

Background And Purpose: Differentiation between pseudo-occlusion and true occlusion of internal carotid artery (ICA) is important in treatment planning for acute ischemic stroke patients. We compared the findings of multiphasic computed tomography angiography between cervical ICA pseudo-occlusion and true occlusion at the cervical ICA in patients with anterior circulation acute ischemic stroke to determine their diagnostic value.

Methods: Thirty patients with nonvisualization of the proximal ICA were included. Read More

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http://dx.doi.org/10.1161/STROKEAHA.120.029512DOI Listing

Hypoperfusion Distal to Anterior Circulation Intracranial Atherosclerosis is Associated with Recurrent Stroke.

J Neuroimaging 2020 Jun 24. Epub 2020 Jun 24.

Department of Neurology, New York University, New York, NY.

Background And Purpose: In patients with symptomatic vertebrobasilar intracranial atherosclerotic disease (ICAD), impaired distal flow predicts recurrent stroke, but limited data exist on the association between perfusion status and recurrent stroke in anterior circulation ICAD.

Methods: This is a retrospective study of patients hospitalized for symptomatic ICAD with 50-99% stenosis of the intracranial carotid or middle cerebral artery. The primary outcome is recurrent symptomatic ischemic stroke in the territory of the artery with ≥50% stenosis within 90 days. Read More

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http://dx.doi.org/10.1111/jon.12710DOI Listing

Clinical risk factors for post-stroke urinary incontinence during rehabilitation.

Int J Rehabil Res 2020 Jun 17. Epub 2020 Jun 17.

Department for Rehabilitation of Patients after Stroke, University Rehabilitation Institute, Republic of Slovenia.

Urinary incontinence (UI) is a common problem after stroke. Risk factors for UI seem to be multifactorial. There is still controversy in which risk factors contribute to UI. Read More

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http://dx.doi.org/10.1097/MRR.0000000000000424DOI Listing

Pivotal Trial of the Neuroform Atlas Stent for Treatment of Anterior Circulation Aneurysms: One-Year Outcomes.

Stroke 2020 Jul 17;51(7):2087-2094. Epub 2020 Jun 17.

Cooper University Hospital, Camden (B.T.J.).

Background And Purpose: Stent-assisted coil embolization using the new generation Neuroform Atlas Stent System has shown promising safety and efficacy. The primary study results of the anterior circulation aneurysm cohort of the treatment of wide-neck, saccular, intracranial, aneurysms with the Neuroform Atlas Stent System (ATLAS trial [Safety and Effectiveness of the Treatment of Wide Neck, Saccular Intracranial Aneurysms With the Neuroform Atlas Stent System]) are presented.

Methods: ATLAS IDE trial (Investigational Device Exemption) is a prospective, multicenter, single-arm, open-label study of wide-neck (neck ≥4 mm or dome-to-neck ratio <2) intracranial aneurysms in the anterior circulation treated with the Neuroform Atlas Stent and approved coils. Read More

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http://dx.doi.org/10.1161/STROKEAHA.119.028418DOI Listing

Endovascular Thrombectomy for Acute Ischemic Stroke Beyond 6 Hours From Onset: A Real-World Experience.

Stroke 2020 Jul 17;51(7):2051-2057. Epub 2020 Jun 17.

Emergency Department Stroke Unit, Sapienza University Hospital, Rome (E.N., D.T.).

Background And Purpose: To evaluate outcome and safety of endovascular treatment beyond 6 hours of onset of ischemic stroke due to large vessel occlusion in the anterior circulation, in routine clinical practice.

Methods: From the Italian Registry of Endovascular Thrombectomy, we extracted clinical and outcome data of patients treated for stroke of known onset beyond 6 hours. Additional inclusion criteria were prestroke modified Rankin Scale score ≤2 and ASPECTS score ≥6. Read More

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http://dx.doi.org/10.1161/STROKEAHA.119.027974DOI Listing

Thrombolysis Outcomes in Acute Ischemic Stroke by Fluid-Attenuated Inversion Recovery Hyperintense Arteries.

Stroke 2020 Jul 17;51(7):2240-2243. Epub 2020 Jun 17.

The George Institute for Global Health, Faculty of Medicine, University of New South Wales Sydney, Australia (Z.Z., S.Y., C.D., A.M., T.T.-Y., C.C., X.W., X.C., J.C., C.S.A.).

Background And Purpose: To determine factors associated with fluid-attenuated inversion recovery (FLAIR) hyperintense arteries (FLAIR-HAs) on magnetic resonance imaging and their prognostic significance in thrombolysis-treated patients with acute ischemic stroke from the ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study) trial alteplase-dose arm.

Methods: Patients with acute ischemic stroke (N=293) with brain magnetic resonance imaging (FLAIR and diffusion-weighted imaging sequences) scanned <4.5 hours of symptom onset were assessed for location and extent (score) of FLAIR-HAs, infarct volume, large vessel occlusion (LVO), and other ischemic signs. Read More

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http://dx.doi.org/10.1161/STROKEAHA.119.028550DOI Listing

Treatment strategies of ruptured intracranial aneurysms associated with moyamoya disease.

Br J Neurosurg 2020 Jun 22:1-7. Epub 2020 Jun 22.

Department of Neurosurgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.

The purpose of this study was to present our experience in the management of ruptured intracranial aneurysms associated with moyamoya disease (MMD), and to discuss their treatment strategies and the timing of revascularization surgery. Thirteen patients who had ruptured intracranial aneurysms associated with MMD were enrolled in this study. Different treatment strategies were adopted based on the location of the aneurysms. Read More

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http://dx.doi.org/10.1080/02688697.2020.1781058DOI Listing

Bovine Arch and Stroke Laterality.

J Am Heart Assoc 2020 Jun 17:e015390. Epub 2020 Jun 17.

Department of Radiology Montefiore Medical Center Albert Einstein College of Medicine Bronx NY.

Background Left-hemispheric strokes are more frequent and often have a worse outcome than their right-hemispheric counterparts. This study aimed to evaluate whether cardioembolic stroke laterality is affected by anatomical characteristics of the aortic arch. We hypothesized that laterality varies between patients with bovine versus standard arch. Read More

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http://dx.doi.org/10.1161/JAHA.119.015390DOI Listing

Ablation of Vitamin D Signaling Compromises Cerebrovascular Adaptation to Carotid Artery Occlusion in Mice.

Cells 2020 Jun 12;9(6). Epub 2020 Jun 12.

Institute of Translational Medicine, Semmelweis University, 1094 Budapest, Hungary.

Vitamin D insufficiency has been associated with increased incidence and severity of cerebrovascular disorders. We analyzed the impact of impaired vitamin D signaling on the anatomical and functional aspects of cerebrovascular adaptation to unilateral carotid artery occlusion (CAO), a common consequence of atherosclerosis and cause of ischemic stroke. Cerebrocortical blood flow (CoBF) showed a significantly increased drop and delayed recovery after CAO in mice carrying a functionally inactive vitamin D receptor (VDR) with the most sustained perfusion deficit in the temporal cortex. Read More

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http://dx.doi.org/10.3390/cells9061457DOI Listing

Adjustment of Stent Retriever Length to Clot Extent Affects First-Pass Reperfusion in Endovascular Treatment of Acute Ischemic Stroke.

Cerebrovasc Dis 2020 Jun 16:1-8. Epub 2020 Jun 16.

Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany.

Background: Stent retriever technology has evolved, and significantly longer devices have become available for mechanical thrombectomy (MT) of large cerebral vessel occlusions in ischemic stroke. We hypothesized that increased stent retriever length may improve the rate of complete angiographic reperfusion and decrease the respective number of attempts, resulting in a better clinical outcome.

Methods: Retrospective analysis of patients with large vessel occlusion in the anterior and posterior circulation treated with stent retriever MT. Read More

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http://dx.doi.org/10.1159/000508028DOI Listing

Arterial culprit plaque characteristics revealed by magnetic resonance Vessel Wall imaging in patients with single or multiple infarcts.

Magn Reson Imaging 2020 Jun 10. Epub 2020 Jun 10.

Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China; CAS key Laboratory of Health Informatics, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China. Electronic address:

Purpose: To investigate characteristics of intra- and extracranial arterial culprit plaques between patients with single infarct and multiple-infarcts by a head-neck combined high resolution magnetic resonance vessel wall imaging (HR-MRVWI).

Materials And Methods: Forty-three patients with recent ischemic stroke due to large artery atherosclerosis were enrolled. The head-neck combined HR-MRVWI was performed in all patients both pre- and post-contrast administration. Read More

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http://dx.doi.org/10.1016/j.mri.2020.06.004DOI Listing
June 2020
2.022 Impact Factor

Endovascular treatment in older adults with acute ischemic stroke in the MR CLEAN Registry.

Neurology 2020 Jun 11. Epub 2020 Jun 11.

From the Department of Neurology (A.E.G., Y.B.W.E.M.R., J.M.C.), Department of Radiology and Nuclear Medicine (K.M.T., I.G.H.J., H.A.M., R.v.d.B., C.B.L.M.M.), Department of Internal Medicine (H.C.W.), Geriatrics Section, and Department of Biomedical Engineering and Physics (H.A.M.), Amsterdam UMC, University of Amsterdam; Department of Public Health (H.F.L.), Department of Neurology (R.A.v.d.G., B.R., D.W.J.D.), and Department of Radiology and Nuclear Medicine (R.A.v.d.G., B.R.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (W.H.), Maastricht University Medical Center; and Department of Neurology (W.J.S.), Sint Antonius Hospital Nieuwegein, the Netherlands.

Objective: To explore clinical outcomes in older adults with acute ischemic stroke treated with endovascular thrombectomy (EVT).

Methods: We included consecutive patients (2014-2016) with an anterior circulation occlusion undergoing EVT from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry. We assessed the effect of age (dichotomized at ≥80 years and as continuous variable) on the modified Rankin Scale (mRS) score at 90 days, symptomatic intracranial hemorrhage (sICH), and reperfusion rate. Read More

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http://dx.doi.org/10.1212/WNL.0000000000009764DOI Listing

Safety and efficacy of glibenclamide combined with rtPA in acute cerebral ischemia with occlusion/stenosis of anterior circulation (SE-GRACE): study protocol for a randomized controlled trial.

BMC Neurol 2020 Jun 11;20(1):239. Epub 2020 Jun 11.

Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou North Avenue 1838#, Guangzhou, 510515, China.

Background: Thrombolysis with recombinant tissue plasminogen activator (rtPA) improves outcome for patients with acute ischemic stroke (AIS), but many of them still have substantial disability. Glibenclamide (US adopted name, glyburide), a long-acting sulfonylurea, shows promising result in treating AIS from both preclinical and clinical studies. This study investigates the safety and efficacy of glibenclamide combined with rtPA in treating AIS patients. Read More

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http://dx.doi.org/10.1186/s12883-020-01823-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7291425PMC

Are Genetic Variants Associated with the Location of Cerebral Arterial Lesions in Stroke Patients?

Cerebrovasc Dis 2020 Jun 11:1-7. Epub 2020 Jun 11.

Stroke Center and Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea,

Background: Genetic variants may play a role in determining the location of cerebral atherosclerosis. We aimed to investigate the association between RNF213, MMP2, and genetic polymorphisms linked to vascular tortuosity with the location of cerebral arterial atherosclerosis.

Methods: A prospective case-control study was conducted on patients with ischemic stroke and age- and sex-matched stroke-free controls. Read More

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http://dx.doi.org/10.1159/000508301DOI Listing

Should the Management of Embolic Stroke in the Elderly Be Changed if They Also Have COVID-19?

Eur J Case Rep Intern Med 2020 25;7(6):001736. Epub 2020 May 25.

Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal.

Introduction: A strong association between stroke and atrial fibrillation (AF) has been demonstrated. Anticoagulation for the prevention of stroke in high-risk patients has the benefit of improving the life expectancy, quality of life, autonomy and social functioning of the patient. The COVID-19 pandemic poses challenges for stroke patients because of the association between SARS-CoV-2 infection and thromboembolic risk. Read More

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http://dx.doi.org/10.12890/2020_001736DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7279903PMC

Thrombectomy for Stroke in the Public Health Care System of Brazil.

N Engl J Med 2020 06;382(24):2316-2326

From the Departments of Neurology (S.O.M., A.C.S., L.A.C.), Interventional Neuroradiology (M.B.F.), and Social Medicine (M.B.W.), Federal University of Rio Grande do Sul, and Hospital de Clínicas de Porto Alegre (S.O.M., A.C.S., L.A.C., M.B.W.), Porto Alegre, the Departments of Interventional Neuroradiology (F.M.A., D.B.) and Neurology (F.O.L., J.J.F.C., F.M.C., D.B.), Hospital Geral de Fortaleza, and the Department of Post-Graduate Medical Sciences, University of Fortaleza, Fortaleza (F.M.C.), the Departments of Neurology (L.C.R.) and Neurosurgery (B.S.M.P., E.W.), Instituto Hospital de Base do Distrito Federal, Brasilia, the Stroke Neurology Division, Departments of Interventional Neuroradiology (D.G.A., G.S.N.) and Neuroscience and Behavioral Sciences (F.A.D., O.M.P.-N.), Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, the Departments of Neurology (G.S.S., M.M.A.) and Interventional Neuroradiology (M.E.F.), Universidade Federal de São Paulo and Academic Research Organization, Hospital Israelita Albert Einstein (G.S.S.), the Department of Neurology, Universidade Estadual de Campinas (F.B.C.), and the Department of Neurology and Interventional Neuroradiology, Hospital de Base de São José do Rio Preto (R.C.T.H.), São Paulo, the Department of Neurology, Hospital Estadual Central de Vitória, Vitória (J.A.F.), the Department of Neurology, Universidade Federal do Paraná, Curitiba (V.F.Z.), the Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador (J.O.-F.), the Department of Neurology, Hospital Pró-Cardíaco, Rio de Janeiro (D.C.B.), and Administrative Director of the National Council of Municipal Health Secretariats, Bauru (J.E.F.P.) - all in Brazil; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (D.S.L., J.L.S.); the Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati (J.B.); the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Autonomous University of Barcelona, Barcelona (C.A.M.); and the Department of Neurology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta (R.G.N.).

Background: Randomized trials involving patients with stroke have established that outcomes are improved with the use of thrombectomy for large-vessel occlusion. These trials were performed in high-resource countries and have had limited effects on medical practice in low- and middle-income countries.

Methods: We studied the safety and efficacy of thrombectomy in the public health system of Brazil. Read More

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http://dx.doi.org/10.1056/NEJMoa2000120DOI Listing

Effect of emergent carotid stenting during endovascular therapy for acute anterior circulation stroke patients with tandem occlusion: A multicenter, randomized, clinical trial (TITAN) protocol.

Int J Stroke 2020 Jun 9:1747493020929948. Epub 2020 Jun 9.

Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, Nancy University Hospital, Nancy, France.

Background And Hypothesis: There is no consensus on the optimal endovascular management of the extracranial internal carotid artery steno-occlusive lesion in patients with acute ischemic stroke due to tandem occlusion. We hypothesized that intracranial mechanical thrombectomy plus emergent internal carotid artery stenting (and at least one antiplatelet therapy) is superior to intracranial mechanical thrombectomy alone in patients with acute tandem occlusion.

Study Design: TITAN is an investigator-initiated, multicenter, prospective, randomized, open-label, blinded-endpoint (PROBE) study. Read More

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http://dx.doi.org/10.1177/1747493020929948DOI Listing

Carotid artery webs in embolic stroke of undetermined source with large intracranial vessel occlusion.

Int J Stroke 2020 Jun 9:1747493020929945. Epub 2020 Jun 9.

Department of Interventional Neuroradiology, Hôpital Lariboisière, University of Paris, Paris, France.

Background: Whether carotid artery web can be considered as a potential source of arterial thromboembolism in ischemic stroke remains uncertain.

Aims: In a large sample of individuals with large intracranial artery occlusion, we compared the prevalence of carotid artery webs between patients with and without embolic stroke of undetermined source.

Methods: In a single-center study of consecutive patients with anterior circulation ischemic stroke referred for mechanical thrombectomy, the presence of carotid artery web was systematically assessed by two independent readers. Read More

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http://dx.doi.org/10.1177/1747493020929945DOI Listing

Longer 6-mm Diameter Stent Retrievers Are Effective for Achieving Higher First Pass Success with Fibrin-Rich Clots.

Interv Neurol 2020 Jan 18;8(2-6):187-195. Epub 2019 Jun 18.

Interventional Neuroradiology and Endovascular Neurosurgery, Miami Cardiac and Vascular Institute, Baptist Hospital, Miami, Florida, USA.

First pass success (FPS) can be defined as in vitro retrieval of clot in a single pass during mechanical thrombectomy (MT) for acute large vessel occlusion (LVO). Despite advancements in MT technology, retrieval of fibrin-rich clots remains a challenge. Therefore, the effect of stent retriever length on FPS for fibrin-rich clots was investigated by using Solitaire 6 × 40 versus 6 × 30 mm devices with a balloon guide catheter (BGC) or distal access catheter (DAC) and sheath, in an in vitro model of anterior circulation neurovascular anatomy. Read More

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http://dx.doi.org/10.1159/000499974DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7253866PMC
January 2020

Predictors of Acute Neurological Worsening after Endovascular Thrombectomy.

Interv Neurol 2020 Jan 18;8(2-6):172-179. Epub 2019 Jun 18.

Department of Neurology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas, USA.

Background: Successful reperfusion after endovascular thrombectomy (EVT) correlates with good outcome. However, radiographic reperfusion does not always translate into good clinical outcomes even if the reperfusion occurs early after the stroke onset. Reasons for neurological worsening (NW) are thought to be many, such as progression of the stroke, hemorrhagic conversion post tissue plasminogen activator and/or EVT, and procedural complications such as vessel dissection or perforation, distal emboli, and re-occlusion. Read More

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http://dx.doi.org/10.1159/000499973DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7253857PMC
January 2020

Impact of MRI Selection on Triage of Endovascular Therapy in Acute Ischemic Stroke: The MRI in Acute Management of Ischemic Stroke (MIAMIS) Registry.

Interv Neurol 2020 Jan 15;8(2-6):135-143. Epub 2019 Mar 15.

Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA.

Background: The recently published multicenter randomized DAWN trial confirmed greater outcome benefit of endovascular therapy (ET) for anterior circulation large vessel occlusion ischemic stroke from 6 to 24 h from symptom onset compared to medical management in patients selected by advanced imaging with MRI or perfusion CT to identify mismatch between clinical deficit and infarct volume, which represents salvageable penumbra. The debate of CT over MRI is usually the potentially increase time consumption and the difficulty in establishing an adequate standardized workflow utilizing MRI during the hyperacute phase.

Purpose: While CT-based selection of patients is the current standard of care, we sought to determine the time impact of the alternative approach of MRI selection in the 0-12 h window. Read More

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http://dx.doi.org/10.1159/000490580DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7253863PMC
January 2020

Prospective Endovascular Treatment in Acute Ischemic Stroke Evaluating Non-Contrast Head CT versus CT Perfusion (PLEASE No CTP).

Interv Neurol 2020 Jan 28;8(2-6):116-122. Epub 2019 Feb 28.

Zeenat Qureshi Stroke Institute, St. Cloud, Minnesota, USA.

Background: Studies have shown a lack of agreement of computed tomography perfusion (CTP) in the selection of acute ischemic stroke (AIS) patients for endovascular treatment.

Purpose: To demonstrate whether non-contrast computed tomography (CT) within 8 h of symptom onset is comparable to CTP imaging.

Methods: Prospective study of consecutive anterior circulation AIS patients with a National Institute of Health Stroke Scale (NIHSS) score > 7 presenting within 8 h of symptom onset with endovascular treatment. Read More

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http://dx.doi.org/10.1159/000496615DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7253852PMC
January 2020

Head or Neck First? Speed and Rates of Reperfusion in Thrombectomy for Tandem Large Vessel Occlusion Strokes.

Interv Neurol 2020 Jan 15;8(2-6):92-100. Epub 2019 Feb 15.

Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, Nancy, France.

Background: We aim to evaluate the speed and rates of reperfusion in tandem large vessel occlusion acute stroke patients undergoing upfront cervical lesion treatment (Neck-First: angioplasty and/or stent before thrombectomy) as compared to direct intracranial occlusion therapy (Head-First) in a large international multicenter cohort.

Methods: The Thrombectomy In TANdem Lesions (TITAN) collaboration pooled individual data of prospectively collected thrombectomy international databases for all consecutive anterior circulation tandem patients who underwent emergent thrombectomy. The co-primary outcome measures were rates of successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b/3) and time from groin puncture to successful reperfusion. Read More

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http://dx.doi.org/10.1159/000496292DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7253855PMC
January 2020

Deciding Thrombolysis in AIS Based on Automated versus on WhatsApp Interpreted ASPECTS, a Reliability and Cost-Effectiveness Analysis in Developing System of Care.

Front Neurol 2020 19;11:333. Epub 2020 May 19.

Neuroradiology Department, Alexandria University, Alexandria, Egypt.

Automated ASPECTS has the potential of reducing interobserver variability in the determination of early ischemic changes. We aimed to assess the performance of an automated ASPECTS vs. ASPECTS interpreted for sent CT images on WhatsApp and to correlate these results with the outcome. Read More

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http://dx.doi.org/10.3389/fneur.2020.00333DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7248253PMC

Tandem Carotid Lesions in Acute Ischemic Stroke: Mechanisms, Therapeutic Challenges, and Future Directions.

AJNR Am J Neuroradiol 2020 Jun 4. Epub 2020 Jun 4.

Stroke Center (L.D.), Department of Neurology, Neurological Hospital, Hospices Civils de Lyon, Lyon, France.

Approximately 15% of patients undergoing endovascular thrombectomy for anterior circulation acute ischemic stroke have a tandem lesion, defined as a severe stenosis or occlusion of the cervical internal carotid artery ipsilateral to its intracranial occlusion. Patients with tandem lesions have worse outcomes than patients with isolated intracranial occlusions, but the optimal management of their carotid lesions during endovascular thrombectomy remains controversial. The main options commonly used in current practice include acute stent placement in the carotid lesion versus thrombectomy alone without definitive revascularization of the carotid artery. Read More

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http://dx.doi.org/10.3174/ajnr.A6582DOI Listing

Delayed functional independence after thrombectomy: temporal characteristics and predictors.

J Neurointerv Surg 2020 Jun 2. Epub 2020 Jun 2.

Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

Background: Variability in early neurological improvement after endovascular thrombectomy (EVT) for large vessel occlusion (LVO) stroke is well documented. Understanding the temporal progression of functional independence after EVT, especially delayed functional independence in patients who do not experience early improvement, is essential for prognostication and rehabilitation.

Objective: To determine the incidence of early and delayed functional independence and identify associated predictors after EVT. Read More

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http://dx.doi.org/10.1136/neurintsurg-2020-016111DOI Listing

Local anesthesia versus general anesthesia during endovascular therapy for acute stroke: a propensity score analysis.

J Neurointerv Surg 2020 Jun 2. Epub 2020 Jun 2.

Department of Diagnostic and Interventional Neuroradiology, University Hospital Centre Nancy, Nancy, Lorraine, France.

Background: To date, the choice of optimal anesthetic management during endovascular therapy (EVT) of acute ischemic stroke patients remains subject to debate. We aimed to compare functional outcomes and complication rates of EVT according to the first-line anesthetic management in two comprehensive stroke centers: local anesthesia (LA) versus general anesthesia (GA).

Methods: Retrospective analysis of prospectively collected databases, identifying all consecutive EVT for strokes in the anterior circulation performed between January 1, 2018 and December 31, 2018 in two EVT-capable stroke centers. Read More

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http://dx.doi.org/10.1136/neurintsurg-2020-015916DOI Listing

Leukoaraiosis and acute ischemic stroke: 90-day clinical outcome following endovascular recanalization, with proposed "L-ASPECTS".

J Neurointerv Surg 2020 Jun 2. Epub 2020 Jun 2.

Radiology, Mayo Clinic, Rochester, Minnesota, USA.

Background: To assess if leukoaraiosis severity is associated with outcome in patients with acute ischemic stroke (AIS) following endovascular thrombectomy, and to propose a leukoaraiosis-related modification to the ASPECTS score.

Methods: A retrospective review was completed of AIS patients that underwent mechanical thrombectomy for anterior circulation large vessel occlusion. The primary outcome measure was 90-day mRS. Read More

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http://dx.doi.org/10.1136/neurintsurg-2020-015957DOI Listing

Incidence of Acute Ischemic Stroke With Visible Arterial Occlusion: A Population-Based Study (Dijon Stroke Registry).

Stroke 2020 Jul 3;51(7):2122-2130. Epub 2020 Jun 3.

Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), Department of Neurology, University of Burgundy, University Hospital of Dijon, France.

Background And Purpose: Because of several methodological limitations, previous studies focusing on the prevalence of large vessel occlusion in ischemic stroke (IS) patients provided conflicting results. We evaluated the incidence of IS with a visible arterial occlusion using a comprehensive population-based registry.

Methods: Patients with acute IS were prospectively identified among residents of Dijon, France, using a population-based registry (2013-2017). Read More

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http://dx.doi.org/10.1161/STROKEAHA.120.029949DOI Listing

Collateral Status at Single-Phase and Multiphase CT Angiography versus CT Perfusion for Outcome Prediction in Anterior Circulation Acute Ischemic Stroke.

Radiology 2020 Jun 2:192029. Epub 2020 Jun 2.

From the Jiangsu Key Laboratory of Molecular and Functional Imaging and Center of Interventional Radiology and Vascular Surgery, Departments of Radiology (Z.W., T.Y.T., C.H.Z., Y.Z., Z.Z., D.L.Z., G.D., S.H.J., G.J.T.), and Neurology (J.X., L.Y.G., Z.J.Z.), Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Rd, Nanjing 210009, China.

Background Collateral status assessed with single- or multiphase CT angiography can be used to predict outcome in patients with acute ischemic stroke (AIS); however, little is known about whether these measures could be comparable with CT perfusion parameters. Purpose To compare the predictive ability of collateral score systems assessed with single- or multiphase CT angiography and CT perfusion parameters in determining clinical outcomes in patients with AIS. Materials and Methods In this retrospective study, data obtained from October 2017 to August 2018 in consecutive patients with AIS caused by isolated anterior circulation large artery occlusion and that were obtained within 24 hours after onset were reviewed. Read More

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http://dx.doi.org/10.1148/radiol.2020192029DOI Listing
June 2020
6.867 Impact Factor

A single-center comparative study of the SWIM technique in the treatment of acute ischemic stroke due to anterior circulation occlusion.

Thromb Res 2020 Aug 15;192:131-133. Epub 2020 May 15.

Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China. Electronic address:

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http://dx.doi.org/10.1016/j.thromres.2020.05.011DOI Listing

Safety and efficacy of ticagrelor as single antiplatelet therapy in prevention of thromboembolic complications associated with the Pipeline Embolization Device (PED): multicenter experience.

J Neurointerv Surg 2020 May 29. Epub 2020 May 29.

Department of Neurology, Ain Shams University Faculty of Medicine, Cairo, Egypt

Background: Flow diversion (FD) is a common treatment modality for complex intracranial aneurysms. A major concern regarding the use of FD is thromboembolic events (TEE). There is debate surrounding the optimal antiplatelet regimen to prevent TEE. Read More

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http://dx.doi.org/10.1136/neurintsurg-2020-015978DOI Listing

Mechanical thrombectomy for ischaemic stroke in the anterior circulation: off-hours effect.

J Neurol 2020 May 28. Epub 2020 May 28.

Univ-Lille, INSERM U 1172-1, CHU Lille, Lille, France.

Background: Patients treated at off-hours for acute conditions have increased mortality rates. This effect has been poorly evaluated in patients treated by mechanical thrombectomy (MT).

Objective: This study aimed at comparing outcomes between patients treated at off-hours and at working hours by MT for acute stroke due to large-vessel occlusion in the anterior circulation, in a well-organised network. Read More

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http://dx.doi.org/10.1007/s00415-020-09946-6DOI Listing

Stroke and mechanical thrombectomy in patients with COVID-19: technical observations and patient characteristics.

J Neurointerv Surg 2020 Jul 25;12(7):648-653. Epub 2020 May 25.

Department of Neurosurgery and Radiology, Columbia University Medical Center, New York, New York, USA.

Background: COVID-19 infections have been shown to be associated with a range of thromboembolic disease.

Objective: To describe our endovascular experience in a consecutive series of patients with COVID-19 who presented with large vessel occlusions, and to describe unique findings in this population.

Methods: Mechanical thrombectomy was performed on five consecutive patients with COVID-19 with large vessel occlusions. Read More

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http://dx.doi.org/10.1136/neurintsurg-2020-016220DOI Listing

Incomplete or failed thrombectomy in acute stroke patients with Alberta Stroke Program Early Computed Tomography Score 0-5 - how harmful is trying?

Eur J Neurol 2020 May 25. Epub 2020 May 25.

Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Background And Purpose: It is currently unknown whether mechanical thrombectomy (MT) for ischaemic stroke patients with low initial Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is clinically beneficial or even harmful. The purpose of this study was to investigate whether failed or incomplete MT in acute large vessel occlusion stroke with an initial ASPECTS ≤ 5 is associated with worse clinical outcome compared to patients not undergoing MT.

Methods: This observational cohort study included a consecutive sample of patients with anterior circulation stroke and initial ASPECTS ≤ 5 admitted between March 2015 and August 2019. Read More

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http://dx.doi.org/10.1111/ene.14358DOI Listing

DEVT: A randomized, controlled, multicenter trial of direct endovascular treatment versus standard bridging therapy for acute stroke patients with large vessel occlusion in the anterior circulation - Protocol.

Int J Stroke 2020 May 23:1747493020925349. Epub 2020 May 23.

Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China.

Background: Eight randomized controlled trials have consistently shown that endovascular treatment plus best medical treatment improves outcome after acute anterior proximal intracranial large vessel occlusion strokes. Whether intravenous thrombolysis prior to endovascular treatment in patients with anterior circulation, large vessel occlusion is of any additional benefits remains unclear.

Objective: This study compares the safety and efficacy of direct endovascular treatment versus intravenous recombinant tissue-type plasminogen activator bridging with endovascular treatment (bridging therapy) in acute stroke patients with intracranial internal carotid artery or middle cerebral artery-M1 occlusion within 4. Read More

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http://dx.doi.org/10.1177/1747493020925349DOI Listing
May 2020
3.833 Impact Factor

Predictors of Successful First-Pass Thrombectomy with a Balloon Guide Catheter: Results of a Decision Tree Analysis.

Transl Stroke Res 2020 May 23. Epub 2020 May 23.

Department of Clinical Radiology, Institute of Clinical Radiology and Neuroradiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany.

Complete recanalization after a single retrieval maneuver is an interventional goal in acute ischemic stroke and an independent factor for good clinical outcome. Anatomical biomarkers for predicting clot removal difficulties have not been comprehensively analyzed and await unused. We retrospectively evaluated 200 consecutive patients who suffered acute stroke and occlusion of the anterior circulation and were treated with mechanical thrombectomy through a balloon guide catheter (BGC). Read More

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http://dx.doi.org/10.1007/s12975-020-00784-2DOI Listing

[Acute ischemic stroke in anterior territory: endovascular treatment].

Medicina (B Aires) 2020 ;80(3):211-218

Servicio de Neurorradiología Intervencionista-ENERI, Clínica La Sagrada Familia, Buenos Aires, Argentina.

Endovascular treatment (EVT) has become the standard of care for acute ischemic stroke (AIS) with proximal large vessel occlusions (LVO). However, it is still unknown whether these results can be generalized to clinical practice. We aimed to perform a retrospective review of patients who received EVT up to 24 hours, and to assess safety and efficacy in everyday clinical practice. Read More

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Hemorrhagic onset intracranial artery dissection of middle cerebral artery followed by progressive arterial stenosis with genetic variant RNF213 p.Arg4810Lys (rs112735431).

World Neurosurg 2020 May 10. Epub 2020 May 10.

Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.

Background: Intracranial arterial dissection (IAD) is known to exhibit various patterns of arterial imaging features such as stenosis and dilation; however, the genetic background of IAD has not been elucidated so far. RNF213 was recently identified as a susceptibility gene for moyamoya disease (MMD) and intracranial artery stenosis (ICAS). More recently, RNF213 p. Read More

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http://dx.doi.org/10.1016/j.wneu.2020.04.241DOI Listing

Asymmetrical cortical vessel sign predicts prognosis after acute ischemic stroke.

Brain Behav 2020 May 20:e01657. Epub 2020 May 20.

Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, China.

Introduction: To assess whether the asymmetrical cortical vessel sign (ACVS) on susceptibility-weighted imaging (SWI) could predict 90-day poor outcomes in anterior circulation acute ischemic stroke (AIS) patients treated with recombinant tissue plasminogen activator (r-tPA).

Methods: Clinical data of consecutive patients with anterior circulation AIS treated with r-tPA were retrospectively analyzed. Clinical variables included age, sex, vascular risk factors, NIHSS score, onset to treatment time, and initial hematologic and neuroimaging findings. Read More

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http://dx.doi.org/10.1002/brb3.1657DOI Listing

Thrombectomy Technique Predicts Outcome in Posterior Circulation Stroke-Insights from the STAR Collaboration.

Neurosurgery 2020 May 20. Epub 2020 May 20.

Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina.

Background: Randomized controlled trials evaluating mechanical thrombectomy (MT) for acute ischemic stroke predominantly studied anterior circulation patients. Both procedural and clinical predictors of outcome in posterior circulation patients have not been evaluated in large cohort studies.

Objective: To investigate technical and clinical predictors of functional independence after posterior circulation MT while comparing different frontline thrombectomy techniques. Read More

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http://dx.doi.org/10.1093/neuros/nyaa179DOI Listing
May 2020
3.620 Impact Factor

Early successful reperfusion after endovascular therapy reduces malignant middle cerebral artery infarction occurrence in young patients with large diffusion-weighted imaging lesions.

Eur J Neurol 2020 May 20. Epub 2020 May 20.

Department of Neurology, Rothschild Foundation Hospital, Paris.

Background And Purpose: Malignant middle cerebral artery infarction (MMI) is a severe complication of acute ischaemic stroke (AIS). The aim of our study was to assess whether successful reperfusion after endovascular therapy (EVT) in AIS with clinical and imaging predictors of MMI decreased its occurrence.

Methods: Data were collected between January 2014 and July 2018 in a monocentric prospective AIS registry of patients treated with EVT. Read More

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http://dx.doi.org/10.1111/ene.14330DOI Listing

Effect of treatment technique on radiation exposure in mechanical thrombectomy for acute ischaemic stroke: A matched-pair analysis.

Neuroradiol J 2020 May 18:1971400920925433. Epub 2020 May 18.

Department of Neuroradiology, Heidelberg University Hospital, Germany.

Objective: This study aimed to compare radiation exposure (RE) in patients receiving mechanical thrombectomy (MT) for large-vessel occlusions in the anterior circulation using direct thrombo-aspiration (DT) versus stent-retriever thrombectomy under continuous distal aspiration (STA).

Methods: This was a retrospective single-centre analysis of an Institutional Review Board-approved stroke database of a comprehensive stroke centre focusing on RE per dose area product, procedure time (PT) and fluoroscopy time (FT) in patients receiving MT. Patients who received MT with DT were matched with patients treated using STA according to occlusion location, mode of anaesthesia, manoeuvre count and sex. Read More

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http://dx.doi.org/10.1177/1971400920925433DOI Listing

The Relation Between Aortic Arch Branching Types and the Laterality of Cardio-Embolic Stroke.

J Stroke Cerebrovasc Dis 2020 Jul 13;29(7):104917. Epub 2020 May 13.

Department of Neuroscience, Stroke Unit - Neurology Clinic, Ospedale Civile di Baggiovara, AOU di Modena, Italy; Faculty of Medicine, Department of Neurology, Mansoura University, Mansoura 35511, Egypt. Electronic address:

Background And Purpose: The trajectory of cardiogenic emboli could be affected by anatomical and flow characteristics of the aortic arch. We aimed to study the relation between the different aortic arch patterns and the laterality of cardiogenic emboli.

Methods: 192 cardioembolic strokes were classified into 3 groups according to the type of the aortic arch; type 1 (n = 69), type 2 (n = 49), type 3 (n = 74). Read More

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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.104917DOI Listing

Exophthalmos following mechanical thrombectomy for anterior circulation stroke: A retrospective study and review of literature.

Interv Neuroradiol 2020 May 14:1591019920926079. Epub 2020 May 14.

Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.

Background: Anecdotal cases of exophthalmos after acute mechanical thrombectomy have been described. We sought to estimate the incidence in a large cohort of patients with acute anterior circulation stroke treated with mechanical thrombectomy. Secondarily, we aimed to evaluate the underlying mechanism and to differentiate it on imaging from other pathology with similar clinical orbital features. Read More

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http://dx.doi.org/10.1177/1591019920926079DOI Listing