1,825 results match your criteria Mechanical Thrombolysis in Acute Stroke


Better Endovascular Mechanical Thrombectomy Outcome in Atrial Fibrillation Patients with Acute Ischemic Stroke - A Single Center Experience.

J Chin Med Assoc 2020 Jul 6. Epub 2020 Jul 6.

Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.

Background: Endovascular thrombectomy (EVT) has become the standard treatment for acute ischemic stroke with large vessel occlusion. Atrial fibrillation (AF) is one of the major causes. However, the impact of AF on the treatment has not yet been clearly discussed. Read More

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http://dx.doi.org/10.1097/JCMA.0000000000000377DOI Listing

Safety of Anticoagulation in Patients Treated With Urgent Reperfusion for Ischemic Stroke Related to Atrial Fibrillation.

Authors:
Michela Giustozzi Monica Acciarresi Giancarlo Agnelli Valeria Caso Fabio Bandini Georgios Tsivgoulis Shadi Yaghi Karen L Furie Prasanna Tadi Cecilia Becattini Marialuisa Zedde Azmil H Abdul-Rahim Kennedy R Lees Andrea Alberti Michele Venti Cataldo D'Amore Maria Giulia Mosconi Ludovica Anna Cimini Paolo Bovi Monica Carletti Alberto Rigatelli Manuel Cappellari Jukka Putaala Liisa Tomppo Turgut Tatlisumak Simona Marcheselli Alessandro Pezzini Loris Poli Alessandro Padovani Vieri Vannucchi Sung-Il Sohn Gianni Lorenzini Rossana Tassi Francesca Guideri Maurizio Acampa Giuseppe Martini George Ntaios George Athanasakis Konstantinos Makaritsis Efstathia Karagkiozi Konstantinos Vadikolias Chrissoula Liantinioti Aikaterini Theodorou Panagiotis Halvatsiotis Nicola Mumoli Franco Galati Simona Sacco Cindy Tiseo Francesco Corea Walter Ageno Marta Bellesini Giorgio Silvestrelli Alfonso Ciccone Alessia Lanari Umberto Scoditti Licia Denti Michelangelo Mancuso Elena Ferrari Leonardo Ulivi Giovanni Orlandi Nicola Giannini Tiziana Tassinari Maria Luisa De Lodovici Christina Rueckert Antonio Baldi Danilo Toni Federica Letteri Martina Giuntini Enrico Maria Lotti Yuriy Flomin Alessio Pieroni Odysseas Kargiotis Theodore Karapanayiotides Serena Monaco Mario Maimone Baronello Laszló Csiba Lilla Szabó Alberto Chiti Elisa Giorli Massimo Del Sette Davide Imberti Dorjan Zabzuni Boris Doronin Vera Volodina Patrik Michel Peter Vanacker Kristian Barlinn Jessica Barlinn Dirk Deleu Vanessa Gourbali Maurizio Paciaroni Luca Masotti

Stroke 2020 Jul 10:STROKEAHA120030143. Epub 2020 Jul 10.

Internal Medicine, Santa Maria Nuova Hospital, Firenze, Italy (V. Vannucchi, L.M.).

Background And Purpose: The optimal timing for starting oral anticoagulant after an ischemic stroke related to atrial fibrillation remains a challenge, mainly in patients treated with systemic thrombolysis or mechanical thrombectomy. We aimed at assessing the incidence of early recurrence and major bleeding in patients with acute ischemic stroke and atrial fibrillation treated with thrombolytic therapy and/or thrombectomy, who then received oral anticoagulants for secondary prevention.

Methods: We combined the dataset of the RAF and the RAF-NOACs (Early Recurrence and Major Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation Treated With Non-Vitamin K Oral Anticoagulants) studies, which were prospective observational studies carried out from January 2012 to March 2014 and April 2014 to June 2016, respectively. Read More

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http://dx.doi.org/10.1161/STROKEAHA.120.030143DOI Listing

The impact of FLAIR vascular hyperintensity on clinical severity and outcome : A retrospective study in stroke patients with proximal middle cerebral artery stenosis or occlusion.

Neurol Sci 2020 Jul 8. Epub 2020 Jul 8.

Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China.

Background: The clinical significance of fluid-attenuated inversion recovery vascular hyperintensity (FVH) has not been clarified. The aim of this study was to clarify the effects of FVH on the clinical severity and long-term prognosis of patients with proximal middle cerebral artery (MCA) occlusion or severe stenosis.

Method: Because their clinical and imaging data is not accessible, we excluded the patients being treated with IV thrombolysis or mechanical thrombectomy. Read More

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http://dx.doi.org/10.1007/s10072-020-04513-3DOI Listing

Tandem stents thrombectomy as a rescue treatment for refractory large vessel occlusions.

J Neurointerv Surg 2020 Jul 8. Epub 2020 Jul 8.

Department of Neurointerventional Radiology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China

Background: Mechanical thrombectomy with a stent retriever (SR) and/or aspiration is the 'gold standard' for the treatment of acute ischemic stroke due to large vessel occlusion (LVO). However, sometimes clots may not be retrievable with a single SR alone or combined with aspiration.

Objective: To assess the safety and efficacy of a novel tandem stents thrombectomy (TST) technique as a rescue treatment for acute LVO that is refractory to conventional attempts. Read More

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http://dx.doi.org/10.1136/neurintsurg-2020-015822DOI Listing

Efficacy and Safety of Mechanical Thrombectomy for Acute Mild Ischemic Stroke with Large Vessel Occlusion.

Med Sci Monit 2020 Jul 6;26:e926110. Epub 2020 Jul 6.

Department of Neurology, Wuhan University, Renmin Hospital, Wuhan, Hubei, China (mainland).

BACKGROUND The suitability of mechanical thrombectomy (MT) for patients with acute mild ischemic stroke (AMIS) caused by large vessel occlusion (LVO) is controversial. This study evaluated MT in patients with AMIS and LVO. MATERIAL AND METHODS Forty-seven patients diagnosed as AMIS with LVO received MT or intravenous thrombolysis (IVT). Read More

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http://dx.doi.org/10.12659/MSM.926110DOI Listing

Predictors of malignant middle cerebral artery infarction after mechanical thrombectomy.

Rev Neurol (Paris) 2020 Jul 2. Epub 2020 Jul 2.

Neurosurgery, university hospital, Rennes, France.

Introduction: Several predictors have been described to early diagnose malignant middle cerebral artery infarction (MMI) and select patient for hemicraniectomy. Nevertheless, few studies have assessed them among patients with acute ischemic stroke undergoing mechanical endovascular thrombectomy (MET). The overall objective in this study was to evaluate these predictors in patients undergoing MET in the purpose to guide the medical care in the acute phase. Read More

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http://dx.doi.org/10.1016/j.neurol.2020.01.352DOI Listing

Motor evoked potentials during revascularization in ischemic stroke predict motor pathway ischemia and clinical outcome.

Clin Neurophysiol 2020 Jun 18. Epub 2020 Jun 18.

Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.

Objective: The relevance of motor evoked potential (MEP) recovery during mechanical endovascular thrombectomy (MT) in patients with ischemic stroke is unclear. We correlated MEP recovery during MT to symptom improvement and to ischemia in eloquent motor areas on magnetic resonance imaging (MRI) and compared the predictive value of MEPs to visual angiographic reperfusion status, classified by modified Thrombolysis in Cerebral Infarction grading (mTICI).

Methods: Patients with hemisyndrome and large-vessel occlusion undergoing MT were included (n35, 49% females; 73. Read More

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http://dx.doi.org/10.1016/j.clinph.2020.05.026DOI Listing

Contemporary Management of Acute Ischemic Stroke Across the Continuum: From TeleStroke to Intra-Arterial Management.

Mayo Clin Proc 2020 Jul;95(7):1512-1529

Departments of Neurology and Neurologic Surgery, Mayo Clinic, Jacksonville, FL.

In this comprehensive contemporary review of acute ischemic stroke management, what is new and different will be highlighted beginning with prehospital stroke systems of care, emergency medical systems, and mobile stroke units, followed by hospital stroke teams, emergency evaluation, telemedicine, and brain and vascular imaging, and finishing with emergency treatments including thrombolysis and mechanical thrombectomy. Read More

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http://dx.doi.org/10.1016/j.mayocp.2020.04.002DOI Listing

Intravenous Thrombolysis Guided by Perfusion CT with Alteplase in >4.5 Hours from Stroke Onset.

Cerebrovasc Dis 2020 Jul 2:1-6. Epub 2020 Jul 2.

Stroke Unit, University Hospital Virgen del Rocío, Sevilla, Spain,

Introduction: The benefit of intravenous thrombolysis (IVT) in wake-up stroke (WUS), stroke of unknown time of onset (SUKO), or when time exceeds 4.5 h from last-seen-normal (LSN) guided by CT perfusion (CTP) or MRI has been recently suggested. However, there is limited information of IVT in those patients in real-world studies. Read More

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http://dx.doi.org/10.1159/000509013DOI Listing

Antiplatelet therapy within 24 hours of tPA: lessons learned from patients requiring combined thrombectomy and stenting for acute ischemic stroke.

J Cerebrovasc Endovasc Neurosurg 2020 Mar 31;22(1):1-7. Epub 2020 Mar 31.

Department of Neurosurgery, University of California, San Diego, La Jolla, CA, USA.

Objective: Although stroke guidelines recommend antiplatelets be started 24 hours after tissue plasminogen activator (tPA), select mechanical thrombectomy (MT) patients with luminal irregularities or underlying intracranial atherosclerotic disease may benefit from earlier antiplatelet administration.

Methods: We explore the safety of early (<24 hours) post-tPA antiplatelet use by retrospectively reviewing patients who underwent MT and stent placement for acute ischemic stroke from June 2015 to April 2018 at our institution.

Results: Six patients met inclusion criteria. Read More

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http://dx.doi.org/10.7461/jcen.2020.22.1.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7307608PMC

Efficacy and Safety of Endovascular Treatment in Acute Tandem Carotid Occlusions: Analysis of a Single-Center Cohort.

Cerebrovasc Dis Extra 2020 Jun 24;10(2):50-58. Epub 2020 Jun 24.

Service of Neurology, University Hospital "Central de Asturias" and ISPA, Oviedo, Spain,

Introduction: Acute ischemic strokes with tandem occlusions, which represent 10-20% of all ischemic strokes, have a particularly poor prognosis. Since emergent treatment of tandem lesions has not been specifically addressed in randomized trials, there is an absence of standardized management.

Objective: We sought to assess the efficacy and safety of acute endovascular treatment in stroke due to tandem occlusions in our center and compare the results with previous reports. Read More

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http://dx.doi.org/10.1159/000507919DOI Listing

Mechanical Thrombectomy in Basilar Artery Occlusion: Clinical Outcomes Related to Posterior Circulation Collateral Score.

Stroke 2020 Jul 17;51(7):2045-2050. Epub 2020 Jun 17.

Department of Neurosurgery (J.S.P.), Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital.

Background And Purpose: Basilar artery occlusion (BAO) is associated with a high risk of disability and mortality. The objective of this study was to investigate prognostic factors in patients with acute basilar artery occlusion treated with mechanical thrombectomy, focusing on collateral status and recanalization time from symptom onset.

Methods: Eligible patients from January 2012 to October 2019 who underwent endovascular treatment due to acute BAO were reviewed. Read More

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http://dx.doi.org/10.1161/STROKEAHA.120.029861DOI Listing

Recent advances in devices for mechanical thrombectomy.

Expert Rev Med Devices 2020 Jun 25:1-9. Epub 2020 Jun 25.

Interventional Neuroradiology Department, Fondation Rothschild Hospital , Paris, France.

Introduction: Acute ischemic stroke (AIS) secondary to the occlusion of a large intracranial vessel (LVO) is a recognized public health problem. Mechanical thrombectomy (MT) has gained full acceptance: Class A, Level 1 in 2015 after the publication of numerous trials. Further meta-analyses have scrutinized extensively those results and international recommendations and guidelines have been given. Read More

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http://dx.doi.org/10.1080/17434440.2020.1784004DOI Listing

Emerging therapies in acute ischemic stroke.

F1000Res 2020 5;9. Epub 2020 Jun 5.

Department of Vascular Neurology, University of California, Los Angeles, 635 Charles E Young Drive South, Suite 225, Los Angeles, California, 90095-7334, USA.

Thrombolysis and mechanical thrombectomy have revolutionized the care of patients with acute ischemic stroke. The number of patients who can benefit from these treatments continues to increase as new studies demonstrate that not just time since stroke onset but also collateral circulation influences outcome. Technologies such as telestroke, mobile stroke units, and artificial intelligence are playing an increasing role in identifying and treating stroke. Read More

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http://dx.doi.org/10.12688/f1000research.21100.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7276937PMC

Innovative use of artificial intelligence and digital communication in acute stroke pathway in response to COVID-19.

Future Healthc J 2020 Jun;7(2):169-173

Royal Berkshire NHS Foundation Trust, Reading, UK.

Acute stroke care demands real-time, specialist-led treatment decisions, including thrombolysis and referral for mechanical thrombectomy. Pathways designed to deliver time-critical interventions for stroke patients are under intense pressure due to the impact of COVID-19 pandemic. In response to this unprecedented burden on acute care services, stroke clinicians are having to reconfigure existing clinical pathways both within and between hospitals. Read More

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http://dx.doi.org/10.7861/fhj.2020-0034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7296572PMC

Diffusion-Weighted Imaging-Fluid-Attenuated Inversion Recovery Mismatch Is Associated with 90-Day Functional Outcomes in Patients Undergoing Mechanical Thrombectomy.

Cerebrovasc Dis 2020 Jun 16:1-9. Epub 2020 Jun 16.

Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan,

Background And Purpose: Diffusion-weighted imaging-fluid-attenuated inversion recovery (DWI-FLAIR) mismatch is an early sign of acute ischemic stroke. DWI-FLAIR mismatch was reported to be valuable to select patients with unknown onset stroke who are eligible to receive intravenous thrombolysis (IVT), but its utility is less studied in patients undergoing mechanical thrombectomy (MT) for acute large vessel occlusion (LVO). We thus investigated the functional outcomes at 90 days between patients with DWI-FLAIR mismatch and those with match who underwent MT for LVO. Read More

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http://dx.doi.org/10.1159/000508369DOI 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

Severe Leukoaraiosis Is Associated with Poor Outcome after Successful Recanalization of M1 Middle Cerebral Artery Occlusion Strokes.

Cerebrovasc Dis 2020 Jun 12:1-9. Epub 2020 Jun 12.

Department of Neurology, Paracelsus Medical University, Salzburg, Austria.

Background: Severe leukoaraiosis (LA) is an established risk factor for poor outcome after mechanical thrombectomy (MT) for large vessel occlusion stroke. There is uncertainty whether this association also applies to successfully recanalized patients with M1 segment middle cerebral artery (MCA) occlusions.

Methods: A retrospective single-centre study of patients with successful reperfusion (thrombolysis in cerebral infarction, TICI 2b or 3) after MT for an M1 MCA occlusion was performed over a 7-year period. Read More

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http://dx.doi.org/10.1159/000508209DOI Listing

Feasibility of Distal Mechanical Thrombectomy in M3, A3 and P3 Segments via a 0.013-inch Delivery System: Preliminary Experience.

Turk Neurosurg 2020 May 28. Epub 2020 May 28.

Fatih Sultan Mehmet Training and Research Hospital, Department of Radiology, Istanbul, Turkey.

Aim: The cerebral territories supplied by distal vessels, although relatively small, can be remarkably eloquent. It is unclear whether mechanical thrombectomy should be performed in the distal vasculature. This study aimed to assess the safety and efficacy of distal thrombectomy (DT) using a Catch View mini (CVm) device via a microcatheter with a 0. Read More

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http://dx.doi.org/10.5137/1019-5149.JTN.30083-20.2DOI Listing

Mechanical Thrombectomy in Acute Ischemic Stroke Using a Manually Expandable Stent Retriever (Tigertriever) : Preliminary Single Center Experience.

Clin Neuroradiol 2020 Jun 11. Epub 2020 Jun 11.

Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie und Nuklearmedizin, Knappschaftskrankenhaus Bochum-Universitätsklinikum Bochum, In der Schornau 23-25, 44829, Bochum, Germany.

Objective: The aim of this study was to evaluate the safety and efficacy of a manually expandable stent retriever (Tigertriever, Rapid Medical, Yoqneam, Israel) in the treatment of acute ischemic stroke caused by intracranial large vessel occlusions (LVO).

Methods: We performed a single center retrospective analysis of all patients treated by mechanical thrombectomy due to LVO using the Tigertriever. The angiographic and clinical success was evaluated by the modified thrombolysis in cerebral infarction score (mTICI) and the modified Rankin score (mRS). Read More

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http://dx.doi.org/10.1007/s00062-020-00919-wDOI Listing

Feasibility and safety of thrombectomy for isolated occlusions of the posterior cerebral artery: a multicenter experience and systematic literature review.

J Neurointerv Surg 2020 Jun 11. Epub 2020 Jun 11.

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

Background: Substantial clinical evidence supporting the benefit of mechanical thrombectomy (MT) for distal occlusions within the posterior circulation is still missing. This study aims to investigate the procedural feasibility and safety of MT for isolated occlusions of the posterior cerebral artery.

Methods: We retrospectively reviewed patients from three stroke centers with acute ischemic stroke attributed to isolated posterior cerebral artery occlusion (IPCAOs) who underwent MT between January 2014 and December 2019. Read More

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http://dx.doi.org/10.1136/neurintsurg-2020-016059DOI 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

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

Revascularization outcomes following acute ischemic stroke in patients taking direct oral anticoagulants: a single hospital cohort study.

J Thromb Thrombolysis 2020 Jun 6. Epub 2020 Jun 6.

Department of Vascular Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia.

Successful revascularization therapy is of paramount importance in patients suffering acute ischemic stroke (AIS). However, there is currently only limited evidence on revascularization outcomes for patients suffering AIS while treated with direct oral anticoagulants (DOACs). The aim of our study was to determine the efficacy and safety of intravenous thrombolysis (IVT) and mechanical reperfusion (MeR) in AIS patients taking DOACs, and compare them to randomized clinical trials (RCTs), which included patients without DOAC treatment. Read More

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http://dx.doi.org/10.1007/s11239-020-02168-7DOI Listing

RECO Flow Restoration Device Versus Solitaire FR With the Intention for Thrombectomy Study (REDIRECT): a prospective randomized controlled trial.

J Neurosurg 2020 Jun 5:1-9. Epub 2020 Jun 5.

1Department of Neurosurgery, The First People's Hospital of Changzhou/The Third Affiliated Hospital of Soochow University, Changzhou.

Objective: The RECO flow restoration (FR) device is a new stent retriever designed for rapid flow restoration in acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). Here, the authors compared the efficacy and safety of the RECO device with the predicate Solitaire FR stent retriever.

Methods: The RECO Flow Restoration Device Versus Solitaire FR With the Intention for Thrombectomy Study (REDIRECT) was a multicenter, prospective, open randomized controlled trial. Read More

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http://dx.doi.org/10.3171/2020.3.JNS193356DOI Listing
June 2020
3.737 Impact Factor

Cerebral ischemic and hemorrhagic complications of coronavirus disease 2019.

Int J Stroke 2020 Jun 26:1747493020937189. Epub 2020 Jun 26.

Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, USA.

Background: The coronavirus disease 2019 is associated with neurological manifestations including stroke.

Objectives: We present a case series of coronavirus disease 2019 patients from two institutions with acute cerebrovascular pathologies. In addition, we present a pooled analysis of published data on large vessel occlusion in the setting of coronavirus disease 2019 and a concise summary of the pathophysiology of acute cerebrovascular disease in the setting of coronavirus disease 2019. Read More

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http://dx.doi.org/10.1177/1747493020937189DOI Listing

Direct admission versus secondary transfer for acute ischemic stroke patients treated with thrombectomy: a systematic review and meta-analysis.

J Neurol 2020 Jun 3. Epub 2020 Jun 3.

School of Basic Medicine, Xinxiang Medical University, No.601 Jinsui Avenue, Xinxiang, 453000, China.

Background And Purpose: Randomized controlled trials have demonstrated that mechanical thrombectomy (MT) could provide more benefit than standard medical care for acute ischemic stroke (AIS) patients due to emergent large vessel occlusion. However, most primary stroke centers (PSCs) are unable to perform MT, and MT can only be performed in comprehensive stroke centers (CSCs) with on-site interventional neuroradiologic services. Therefore, there is an ongoing debate regarding whether patients with suspected AIS should be directly admitted to CSCs or secondarily transferred to CSCs from PSCs. Read More

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http://dx.doi.org/10.1007/s00415-020-09877-2DOI Listing

Factors influencing early neurological improvement after mechanical thrombectomy among patients with acute basilar artery occlusion: a single center prospective observational cohort study.

J Thromb Thrombolysis 2020 Jun 2. Epub 2020 Jun 2.

Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, 119 South Fourth Ring West Road, Fengtai District, Beijing, 100050, China.

The predictive value of and the influencing factors associated with early neurological improvement (ENI) among patients with acute basilar artery occlusion (BAO) have not been well studied. The present study aimed to evaluate whether ENI predicted a better functional outcome and to identify the influencing factors of ENI. We performed a prospective observational analysis among 187 patients with acute BAO who underwent endovascular treatment (EVT) in Beijing Tiantan Hospital from January 2012 to July 2018. Read More

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http://dx.doi.org/10.1007/s11239-020-02153-0DOI Listing

The selection of an optimal transportation strategy in urgent stroke missions: a simulation study.

Scand J Trauma Resusc Emerg Med 2020 Jun 1;28(1):48. Epub 2020 Jun 1.

Centre for Pre-hospital Emergency Care, Kuopio University Hospital, P.O. Box 1777, FI-70210, Kuopio, Finland.

Background: Stroke causes death, disability and increases the use of healthcare resources worldwide. The outcome of intravenous thrombolysis and mechanical endovascular thrombectomy highly depends on the delay from symptom onset to initiation of definitive treatment. The purpose of this study was to compare the various patient transportation strategies to minimize pre-hospital delays. Read More

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http://dx.doi.org/10.1186/s13049-020-00747-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7268427PMC

Efficacy and Safety of Recanalization Therapy for Acute Ischemic Stroke With Large Vessel Occlusion: A Systematic Review.

Stroke 2020 Jul 3;51(7):2026-2035. Epub 2020 Jun 3.

Cerebrovascular Diseases Research Institute, Xuanwu Hospital (C.W., W.Z., X.J.), Capital Medical University, Beijing, China.

Background And Purpose: The optimal recanalization strategy for acute ischemic stroke with large vessel occlusion continues to be an area of active interest. Network meta-analysis can provide insight when direct comparative evidence is lacking.

Methods: A systematic review of the literature using PubMed, Embase, the Cochrane Central Register of Controlled Trials, and SinoMed was performed, and a search was conducted for clinical trials on ClinicalTrials. Read More

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http://dx.doi.org/10.1161/STROKEAHA.119.028624DOI Listing

Treatment of Acute Ischemic Stroke due to Large Vessel Occlusion With COVID-19: Experience From Paris.

Stroke 2020 May 29:STROKEAHA120030574. Epub 2020 May 29.

From the Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France.

Background And Purpose: Higher rates of strokes have been observed in patients with coronavirus disease 2019 (COVID-19), but data regarding the outcomes of COVID-19 patients suffering from acute ischemic stroke due to large vessel occlusion (LVO) are lacking. We report our initial experience in the treatment of acute ischemic stroke with LVO in patients with COVID-19.

Methods: All consecutive patients with COVID-19 with acute ischemic stroke due to LVO treated in our institution during the 6 first weeks of the COVID-19 outbreak were included. Read More

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http://dx.doi.org/10.1161/STROKEAHA.120.030574DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7282400PMC

Effect of Balloon Guide Catheter Utilization on the Incidence of Sub-angiographic Peripheral Emboli on High-Resolution DWI After Thrombectomy: A Prospective Observational Study.

Front Neurol 2020 7;11:386. Epub 2020 May 7.

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

Thrombus fragmentation causing distal emboli is a feared complication during mechanical thrombectomy (MT). We aimed to investigate the impact of procedural parameters and thrombus properties on the incidence of peripheral emboli after MT for large vessel occlusions (LVO). We performed a prospective analysis of patients with LVO stroke successfully treated with MT, defined as a score of 2b, 2c, or 3 on the thrombolysis in cerebral infarction (TICI) scale. Read More

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http://dx.doi.org/10.3389/fneur.2020.00386DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7221024PMC

Assessment of computed tomography perfusion software in predicting spatial location and volume of infarct in acute ischemic stroke patients: a comparison of Sphere, Vitrea, and RAPID.

J Neurointerv Surg 2020 May 26. Epub 2020 May 26.

Biomedical Engineering, University at Buffalo-The State University of New York, Buffalo, New York, USA

Background: CT perfusion (CTP) infarct and penumbra estimations determine the eligibility of patients with acute ischemic stroke (AIS) for endovascular intervention. This study aimed to determine volumetric and spatial agreement of predicted RAPID, Vitrea, and Sphere CTP infarct with follow-up fluid attenuation inversion recovery (FLAIR) MRI infarct.

Methods: 108 consecutive patients with AIS and large vessel occlusion were included in the study between April 2019 and January 2020 . Read More

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http://dx.doi.org/10.1136/neurintsurg-2020-015966DOI Listing

Direct Common Carotid Artery Puncture: Rescue Mechanical Thrombectomy Strategy in Acute Ischemic Stroke.

Neurointervention 2020 Jul 26;15(2):60-66. Epub 2020 May 26.

Department of Neurology, Medical Faculty, Eskisehir Osmangazi University, Eskisehir, Turkey.

Purpose: In a minority of cases, the transfemoral approach cannot be performed due to unfavorable anatomical barriers. In such cases, direct common carotid artery puncture (DCCAP) is an important alternative for rescue mechanical thrombectomy. The purpose of this study was to evaluate the efficacy and safety of DCCAP in patients with an unaccessible femoral route for mechanical thrombectomy. Read More

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http://dx.doi.org/10.5469/neuroint.2020.00010DOI 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

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

Management of acute ischemic stroke in patients with COVID-19 infection: Insights from an international panel.

Am J Emerg Med 2020 07 11;38(7):1548.e5-1548.e7. Epub 2020 May 11.

Tiantan Comprehensive Stroke Center, Beijing Tiantan Hospital, Capital Medical University Beijing, China.

Objective: To present guidance for clinicians caring for adult patients with acuteischemic stroke with confirmed or suspected COVID-19 infection.

Methods: The summary was prepared after review of systematic literature reviews,reference to previously published stroke guidelines, personal files, and expert opinionby members from 18 countries.

Results: The document includes practice implications for evaluation of stroke patientswith caution for stroke team members to avoid COVID-19 exposure, during clinicalevaluation and conduction of imaging and laboratory procedures with specialconsiderations of intravenous thrombolysis and mechanical thrombectomy in strokepatients with suspected or confirmed COVID-19 infection. Read More

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http://dx.doi.org/10.1016/j.ajem.2020.05.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7211609PMC

Endovascular treatment or general treatment: how should acute ischemic stroke patients choose to benefit from them the most?: A systematic review and meta-analysis.

Medicine (Baltimore) 2020 May;99(20):e20187

College of Life Sciences, Zhejiang Chinese Medical University.

Background: Acute ischemic stroke due to large-vessel occlusion is a leading cause of death and disability, and therapeutic time window was limited to 4.5 hour when treated with intravenous thrombolysis. It has been acknowledged that endovascular treatment (EVT) is superior to general treatment (only medication, including intravenous recombinant tissue plasminogen activator (rt-PA)) in improving the outcome of AIS since 2015. Read More

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http://dx.doi.org/10.1097/MD.0000000000020187DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7254577PMC

[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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Improved outcomes after reperfusion therapies for ischemic stroke: a "real-world" study in a developing country.

Curr Neurovasc Res 2020 May 20. Epub 2020 May 20.

University of the Region of Joinville, Post-Graduation Program on Health and Environment, Hospital Israelita Albert Einstein, São Paulo. Brazil.

Background: It is unknown if improvements in ischemic stroke (IS) outcomes reported after cerebral reperfusion therapies (CRT) in developed countries are also applicable to the "real world" scenario of low-and-middle income countries. We aimed to measure the long-term outcomes of severe IS treated or not with CRT in Brazil.

Methods: There were included patients from a stroke center of a state-run hospital. Read More

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http://dx.doi.org/10.2174/1567202617666200521083132DOI Listing

The New Fully Radiopaque Aperio Hybrid Stent Retriever: Efficient and Safe? An Early Multicenter Experience.

World Neurosurg 2020 May 17. Epub 2020 May 17.

Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany. Electronic address:

Objective: To investigate the visibility, safety, and efficacy of the full-length radiopaque Aperio Hybrid stent retriever (APH) in mechanical thrombectomy of large vessel occlusions.

Methods: Multicentric retrospective analysis of patients with stroke, treated with the APH due to an acute ischemic stroke by large vessel occlusions in the anterior or posterior circulation, was performed. We focused on technical and angiographic parameters including device visibility, perfusion results (modified thrombolysis in cerebral infarction scale [mTICI]), procedural times, periprocedural complications, and favorable clinical outcome (modified Rankin Scale, 0-2) at discharge and after 90 days. Read More

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http://dx.doi.org/10.1016/j.wneu.2020.05.104DOI Listing

Mechanical Thrombectomy for Acute Ischemic Stroke Amid the COVID-19 Outbreak: Decreased Activity, and Increased Care Delays.

Stroke 2020 07 20;51(7):2012-2017. Epub 2020 May 20.

Neuroradiology Department, CH Sainte-Anne, Paris, France (B.K., W.B.H., G.B.).

Background And Purpose: The efficiency of prehospital care chain response and the adequacy of hospital resources are challenged amid the coronavirus disease 2019 (COVID-19) outbreak, with suspected consequences for patients with ischemic stroke eligible for mechanical thrombectomy (MT).

Methods: We conducted a prospective national-level data collection of patients treated with MT, ranging 45 days across epidemic containment measures instatement, and of patients treated during the same calendar period in 2019. The primary end point was the variation of patients receiving MT during the epidemic period. Read More

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http://dx.doi.org/10.1161/STROKEAHA.120.030373DOI Listing

Impact of introducing endovascular treatment on acute ischemic stroke outcomes: A shift from an era of medical management to thrombectomy in Japan.

Heliyon 2020 May 13;6(5):e03945. Epub 2020 May 13.

Department of Neurosurgery, Kobe University Graduate School of Medicine, Hyogo, Japan.

Background: Endovascular treatment (EVT) has increasingly become the standard treatment of acute cerebral large vessel occlusion (LVO). We evaluated the impact of introducing EVT on LVO therapy in a single center where intravenous thrombolysis (IVT) had been the only recanalization therapy.

Materials And Methods: Between April 2013 and March 2017, 354 consecutive patients with LVO admitted to our institution were analyzed. Read More

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http://dx.doi.org/10.1016/j.heliyon.2020.e03945DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7226659PMC

Acute revascularization treatments for ischemic stroke in the Stroke Units of Triveneto, northeast Italy: time to treatment and functional outcomes.

J Thromb Thrombolysis 2020 May 18. Epub 2020 May 18.

Stroke Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.

It is not known whether the current territorial organization for acute revascularization treatments in ischemic stroke patients guarantees similar time to treatment and functional outcomes among different levels of institutional stroke care. We aimed to assess the impact of time to treatment on functional outcomes in ischemic stroke patients who received intravenous thrombolysis (IVT) alone, bridging (IVT plus thrombectomy), or primary thrombectomy in level 1 and level 2 Stroke Units (SUs) in Triveneto, a geographical macroarea in Northeast of Italy. We conducted an analysis of data prospectively collected from 512 consecutive ischemic stroke patients who received IVT and/or mechanical thrombectomy in 25 SUs from September 17th to December 9th 2018. Read More

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http://dx.doi.org/10.1007/s11239-020-02142-3DOI Listing

Effect of Endovascular Treatment With Medical Management vs Standard Care on Severe Cerebral Venous Thrombosis: The TO-ACT Randomized Clinical Trial.

JAMA Neurol 2020 May 18. Epub 2020 May 18.

Department of Neurology, Amsterdam University Medical Centers, Amsterdam, the Netherlands.

Importance: To date, only uncontrolled studies have evaluated the efficacy and safety of endovascular treatment (EVT) in patients with cerebral venous thrombosis (CVT), leading to the lack of recommendations on EVT for CVT.

Objective: To evaluate the efficacy and safety of EVT in patients with a severe form of CVT.

Design, Setting, And Participants: TO-ACT (Thrombolysis or Anticoagulation for Cerebral Venous Thrombosis) was a multicenter, open-label, blinded end point, randomized clinical trial conducted in 8 hospitals in 3 countries (the Netherlands, China, and Portugal). Read More

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http://dx.doi.org/10.1001/jamaneurol.2020.1022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7235912PMC

Postcardiac Surgery Acute Stroke Therapies: A Systematic Review.

J Cardiothorac Vasc Anesth 2020 Apr 20. Epub 2020 Apr 20.

Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada. Electronic address:

Objective: To identify interventions for the treatment of acute ischemic stroke after cardiac surgery and to report the efficacy of these treatments.

Design: Systematic review and narrative synthesis PARTICIPANTS: Patients with ischemic stroke after cardiac surgery.

Interventions: Treatment efficacy of intra-arterial thrombolysis (IAT) and/or endovascular mechanical thrombectomy (EMT). Read More

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http://dx.doi.org/10.1053/j.jvca.2020.03.041DOI Listing

Does endovascular therapy change outcomes in nonagenarians with acute ischemic stroke?

J Clin Neurosci 2020 May 13. Epub 2020 May 13.

Department of Neurological Surgery, University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX 75390, USA; Department of Neurology and Neurotherapeutics, University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX 75390, USA. Electronic address:

Background: Ischemic strokes can be devastating for elderly patients, and randomized control trials of mechanical thrombectomy have shown encouraging results. We present the first analysis of clinical outcomes in nonagenarians with acute ischemic stroke treated with best medical therapy compared to endovascular revascularization therapy.

Methods: A retrospective analysis was performed on 42 patients 90 years or older who were treated for acute ischemic stroke. Read More

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http://dx.doi.org/10.1016/j.jocn.2020.04.060DOI Listing

Predictors of poor clinical outcome despite complete reperfusion in acute ischemic stroke patients.

J Neurointerv Surg 2020 May 15. Epub 2020 May 15.

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

Background: In patients suffering from acute ischemic stroke from large vessel occlusion (LVO), mechanical thrombectomy (MT) often leads to successful reperfusion. Only approximately half of these patients have a favorable clinical outcome. Our aim was to determine the prognostic factors associated with poor clinical outcome following complete reperfusion. Read More

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http://dx.doi.org/10.1136/neurintsurg-2020-015889DOI Listing

Impact of endovascular reperfusion on low National Institutes of Health Stroke Scale score large-vessel occlusion stroke.

J Stroke Cerebrovasc Dis 2020 Jul 13;29(7):104836. Epub 2020 May 13.

Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo NY USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo NY USA; Canon Stroke and Vascular Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo NY USA; Jacobs Institute, Buffalo NY USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo NY USA. Electronic address:

Introduction: Effectiveness of mechanical thrombectomy for mild-deficit stroke due to large-vessel occlusion is controversial. We present a single-center consecutive case series on thrombectomy for large-vessel occlusion mild stroke. We evaluated various thrombectomy parameters to better understand disagreement in the literature. Read More

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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.104836DOI Listing

Impact of HbA1C (glycated hemoglobin) and glucose on outcomes of mechanical thrombectomy in patients with large artery occlusion.

Curr Neurovasc Res 2020 May 14. Epub 2020 May 14.

Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul. Korea.

Objective: This study evaluated the relationship between HbA1c (glycated hemoglobin), admission serum glucose levels and outcomes in patients with large artery occlusion (LAO) treated with mechanical thrombectomy (MT).

Methods: A total of 413 patients were enrolled, and the following outcomes were reviewed: successful recanalization, symptomatic hemorrhage, favorable outcome (modified Rankin Scale, mRS scores of 0-2), and mortality at 3 months. Receiver operating characteristic (ROC) curve analysis was undertaken to identify the cutoff values for HbA1C and glucose to discriminate between favorable and unfavorable outcome. Read More

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http://dx.doi.org/10.2174/1567202617666200514115446DOI Listing