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https://www.readbyqxmd.com/read/30012822/increased-blood-pressure-variability-contributes-to-worse-outcome-after-intracerebral-hemorrhage-an-analysis-of-atach-2
#1
Adam de Havenon, Jennifer J Majersik, Gregory Stoddard, Ka-Ho Wong, J Scott McNally, A Gordon Smith, Natalia S Rost, David L Tirschwell
BACKGROUND AND PURPOSE: Increased systolic blood pressure variability (BPV) is associated with worse outcome after acute ischemic stroke and may also have a negative impact after intracerebral hemorrhage. We sought to determine whether increased BPV was detrimental in the ATACH-2 (Antihypertensive Treatment of Acute Cerebral Hemorrhage II) trial. METHODS: The primary outcome of our study was a 3-month follow-up modified Rankin Scale of 3 to 6, and the secondary outcome was a utility-weighted modified Rankin Scale...
July 16, 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29988509/regional-dominant-frequency-a-new-tool-for-wave-break-identification-during-atrial-fibrillation
#2
Mohammad Hassan Shariat, Javad Hashemi, Saeed Gazor, Damian P Redfearn
Cardiac mapping systems are based on the time/frequency feature analyses of intracardiac electrograms recorded from individual bipolar/unipolar electrodes. Signals from each electrode are processed independently. Such approaches fail to investigate the interrelationship between simultaneously recorded channels of any given mapping catheter during atrial fibrillation (AF). We introduce a novel signal processing technique that reflects regional dominant frequency (RDF) components. We show that RDF can be used to identify and characterize variation and disorganization in wavefront propagation- wave breaks...
2018: Frontiers in Cardiovascular Medicine
https://www.readbyqxmd.com/read/29789395/blood-pressure-attained-analysis-of-atach-2-trial
#3
Adnan I Qureshi, Yuko Y Palesch, Lydia D Foster, William G Barsan, Joshua N Goldstein, Daniel F Hanley, Chung Y Hsu, Claudia S Moy, Mushtaq H Qureshi, Robert Silbergleit, Jose I Suarez, Kazunori Toyoda, Haruko Yamamoto
BACKGROUND AND PURPOSE: We compared the rates of death or disability, defined by modified Rankin Scale score of 4 to 6, at 3 months in patients with intracerebral hemorrhage according to post-treatment systolic blood pressure (SBP)-attained status. METHODS: We divided 1000 subjects with SBP ≥180 mm Hg who were randomized within 4.5 hours of symptom onset as follows: SBP <140 mm Hg achieved or not achieved within 2 hours; subjects in whom SBP <140 mm Hg was achieved within 2 hours were further divided: SBP <140 mm Hg for 21 to 22 hours (reduced and maintained) or SBP was ≥140 mm Hg for at least 2 hours during the period between 2 and 24 hours (reduced but not maintained)...
June 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29710119/cerebral-microbleeds-and-the-effect-of-intensive-blood-pressure-reduction-on-hematoma-expansion-and-functional-outcomes-a-secondary-analysis-of-the-atach-2-randomized-clinical-trial
#4
Ashkan Shoamanesh, Andrea Morotti, Javier M Romero, Jamary Oliveira-Filho, Frieder Schlunk, Michael J Jessel, Alison M Ayres, Anastasia Vashkevich, Kristin Schwab, Mohammad R Afzal, Christy Cassarly, Renee H Martin, Adnan I Qureshi, Steven M Greenberg, Jonathan Rosand, Joshua N Goldstein
Importance: Response to intensive blood pressure (BP) lowering in acute intracerebral hemorrhage (ICH) might vary with the degree of underlying cerebral small vessel disease. Objectives: To characterize cerebral microbleeds (CMBs) in acute ICH and to assess the potential for interaction between underlying small vessel disease (as indicated by CMB number and location) and assignment to acute intensive BP targeting for functional outcomes and hematoma expansion. Design, Setting, and Participants: Preplanned subgroup analyses in the Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 (ATACH-2) trial were performed...
July 1, 2018: JAMA Neurology
https://www.readbyqxmd.com/read/29669875/predicting-intracerebral-hemorrhage-expansion-with-noncontrast-computed-tomography-the-bat-score
#5
Andrea Morotti, Dar Dowlatshahi, Gregoire Boulouis, Fahad Al-Ajlan, Andrew M Demchuk, Richard I Aviv, Liyang Yu, Kristin Schwab, Javier M Romero, M Edip Gurol, Anand Viswanathan, Christopher D Anderson, Yuchiao Chang, Steven M Greenberg, Adnan I Qureshi, Jonathan Rosand, Joshua N Goldstein
BACKGROUND AND PURPOSE: Although the computed tomographic angiography spot sign performs well as a biomarker for hematoma expansion (HE), computed tomographic angiography is not routinely performed in the emergency setting. We developed and validated a score to predict HE-based on noncontrast computed tomography (NCCT) findings in spontaneous acute intracerebral hemorrhage. METHODS: After developing the score in a single-center cohort of patients with intracerebral hemorrhage (n=344), we validated it in a large clinical trial population (n=954) and in a multicenter intracerebral hemorrhage cohort (n=241)...
May 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28730267/phantom-based-standardization-of-ct-angiography-images-for-spot-sign-detection
#6
MULTICENTER STUDY
Andrea Morotti, Javier M Romero, Michael J Jessel, Andrew M Hernandez, Anastasia Vashkevich, Kristin Schwab, Joseph D Burns, Qaisar A Shah, Thomas A Bergman, M Fareed K Suri, Mustapha Ezzeddine, Jawad F Kirmani, Sachin Agarwal, Angela Hays Shapshak, Steven R Messe, Chitra Venkatasubramanian, Katherine Palmieri, Christopher Lewandowski, Tiffany R Chang, Ira Chang, David Z Rose, Wade Smith, Chung Y Hsu, Chun-Lin Liu, Li-Ming Lien, Chen-Yu Hsiao, Toru Iwama, Mohammad Rauf Afzal, Christy Cassarly, Steven M Greenberg, Renee' Hebert Martin, Adnan I Qureshi, Jonathan Rosand, John M Boone, Joshua N Goldstein
PURPOSE: The CT angiography (CTA) spot sign is a strong predictor of hematoma expansion in intracerebral hemorrhage (ICH). However, CTA parameters vary widely across centers and may negatively impact spot sign accuracy in predicting ICH expansion. We developed a CT iodine calibration phantom that was scanned at different institutions in a large multicenter ICH clinical trial to determine the effect of image standardization on spot sign detection and performance. METHODS: A custom phantom containing known concentrations of iodine was designed and scanned using the stroke CT protocol at each institution...
September 2017: Neuroradiology
https://www.readbyqxmd.com/read/28701501/blood-pressure-reduction-and-noncontrast-ct-markers-of-intracerebral-hemorrhage-expansion
#7
RANDOMIZED CONTROLLED TRIAL
Andrea Morotti, Gregoire Boulouis, Javier M Romero, H Bart Brouwers, Michael J Jessel, Anastasia Vashkevich, Kristin Schwab, Mohammad Rauf Afzal, Christy Cassarly, Steven M Greenberg, Reneé Hebert Martin, Adnan I Qureshi, Jonathan Rosand, Joshua N Goldstein
OBJECTIVE: To validate various noncontrast CT (NCCT) predictors of hematoma expansion in a large international cohort of ICH patients and investigate whether intensive blood pressure (BP) treatment reduces ICH growth and improves outcome in patients with these markers. METHODS: We analyzed patients enrolled in the Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH-II) randomized controlled trial. Participants were assigned to intensive (systolic BP <140 mm Hg) vs standard (systolic BP <180 mm Hg) treatment within 4...
August 8, 2017: Neurology
https://www.readbyqxmd.com/read/28628707/intensive-blood-pressure-reduction-and-spot-sign-in-intracerebral-hemorrhage-a-secondary-analysis-of-a-randomized-clinical-trial
#8
RANDOMIZED CONTROLLED TRIAL
Andrea Morotti, H Bart Brouwers, Javier M Romero, Michael J Jessel, Anastasia Vashkevich, Kristin Schwab, Mohammad Rauf Afzal, Christy Cassarly, Steven M Greenberg, Renee Hebert Martin, Adnan I Qureshi, Jonathan Rosand, Joshua N Goldstein
Importance: The computed tomographic angiography (CTA) spot sign is associated with intracerebral hemorrhage (ICH) expansion and may mark those patients most likely to benefit from intensive blood pressure (BP) reduction. Objective: To investigate whether the spot sign is associated with ICH expansion across a wide range of centers and whether intensive BP reduction decreases hematoma expansion and improves outcome in patients with ICH and a spot sign. Design, Setting, and Participants: SCORE-IT (Spot Sign Score in Restricting ICH Growth) is a preplanned prospective observational study nested in the Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH-II) randomized clinical trial...
August 1, 2017: JAMA Neurology
https://www.readbyqxmd.com/read/28004328/management-of-acute-hypertensive-response-in-intracerebral-hemorrhage-patients-after-atach-2-trial
#9
Shahram Majidi, Jose I Suarez, Adnan I Qureshi
Acute hypertensive response is elevation of systolic blood pressure (SBP) in the first 24 h after symptom onset which is highly prevalent in patients with intracerebral hemorrhage (ICH). Observational studies suggested association between acute hypertensive response and hematoma expansion, peri-hematoma edema and death and disability, and possible reduction in these adverse outcomes with treatment of acute hypertensive response. Recent clinical trials have focused on determining the clinical efficacy of early intensive SBP reduction in ICH patients...
October 2017: Neurocritical Care
https://www.readbyqxmd.com/read/27276234/intensive-blood-pressure-lowering-in-patients-with-acute-cerebral-hemorrhage
#10
RANDOMIZED CONTROLLED TRIAL
Adnan I Qureshi, Yuko Y Palesch, William G Barsan, Daniel F Hanley, Chung Y Hsu, Renee L Martin, Claudia S Moy, Robert Silbergleit, Thorsten Steiner, Jose I Suarez, Kazunori Toyoda, Yongjun Wang, Haruko Yamamoto, Byung-Woo Yoon
BACKGROUND: Limited data are available to guide the choice of a target for the systolic blood-pressure level when treating acute hypertensive response in patients with intracerebral hemorrhage. METHODS: We randomly assigned eligible participants with intracerebral hemorrhage (volume, <60 cm(3)) and a Glasgow Coma Scale (GCS) score of 5 or more (on a scale from 3 to 15, with lower scores indicating worse condition) to a systolic blood-pressure target of 110 to 139 mm Hg (intensive treatment) or a target of 140 to 179 mm Hg (standard treatment) in order to test the superiority of intensive reduction of systolic blood pressure to standard reduction; intravenous nicardipine to lower blood pressure was administered within 4...
September 15, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/26613260/aesthetic-crown-lengthening-periodontal-and-patient-centred-outcomes
#11
Cléverson O Silva, Jéssica M S Soumaille, Fabiano C Marson, Patrícia S Progiante, Dimitris N Tatakis
AIM: The objective of this prospective study was to assess clinical and patient-centred outcomes of aesthetic crown lengthening surgery for the treatment of altered passive eruption. MATERIALS AND METHODS: Twenty-two patients were treated and followed up for 6 months. The evaluated clinical parameters included, among others, probing depth, clinical attachment level, clinical crown length (CLc ), cemento-enamel junction to alveolar bone crest distance, gingival width (GW) and gingival display (GD)...
December 2015: Journal of Clinical Periodontology
https://www.readbyqxmd.com/read/26588787/new-insights-into-blood-pressure-control-for-intracerebral-haemorrhage
#12
REVIEW
Lisa S Manning, Thompson G Robinson
Although blood pressure (BP) levels may rise in the weeks preceding intracerebral haemorrhage (ICH), in contrast to findings in the ischaemic stroke population, the initial post-ICH BP is often much higher than the last pre-morbid level. Elevated BP is therefore common in acute ICH, often with markedly elevated levels, and is associated with poor outcomes, though the exact pathophysiological mechanisms remain unclear. The Antihypertensive Treatment of Acute Cerebral Haemorrhage (ATACH) trial and the INTEnsive blood pressure Reduction in Acute Cerebral haemorrhage Trial (INTERACT) demonstrated that early and intensive lowering of elevated BP in the acute ICH period is feasible and safe...
2015: Frontiers of Neurology and Neuroscience
https://www.readbyqxmd.com/read/24350872/interact2-a-reason-for-optimism-with-spontaneous-intracerebral-hemorrhage
#13
P Alan Barber, Timothy J Kleinig
The first Intensive Blood Pressure Reduction in Acute Intracerebral Hemorrhage Trial (INTERACT1) study found that early intensive BP lowering seemed to attenuate haematoma growth when compared with a more conservative guideline based policy. Clinicians were therefore waiting with anticipation for the results of INTERACT2, in which 2839 patients with spontaneous ICH and a systolic BP between 150 and 220 mmHg were randomly assigned to receive intensive anti-hypertensive therapy with a systolic target of <140 mmHg within one hour, or a standard guideline recommended treatment of <180 mmHg...
January 2014: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/24142579/acute-hypertensive-response-management-in-patients-with-acute-stroke
#14
REVIEW
Syeda L Alqadri, Varun Sreenivasan, Adnan I Qureshi
Acute elevation in blood pressure (acute hypertensive response) is commonly observed in the early period of both ischemic and hemorrhagic stroke. The management of acute hypertensive response depends upon the underlying intracranial pathology. Management of acute hypertensive response has been the focus of many trials and studies such as the SCAST trial, CHHIPS trial, COSSACS trial, INTERACT, and ATACH trial, which are discussed here. However, there were many limitations to these trials including time of presentation, different pathophysiology of ischemic strokes versus hemorrhagic strokes, and patient related factors...
December 2013: Current Cardiology Reports
https://www.readbyqxmd.com/read/23609118/increased-brain-volume-among-good-grade-patients-with-intracerebral-hemorrhage-results-from-the-antihypertensive-treatment-of-acute-cerebral-hemorrhage-atach-study
#15
MULTICENTER STUDY
Adnan I Qureshi, Shahram Majidi, Waqas I Gilani, Yuko Y Palesch, Renee Martin, Jill Novitzke, Salvador Cruz-Flores, Asad Ehtisham, Joshua N Goldstein, Jawad F Kirmani, Haitham M Hussein, M Fareed K Suri, Nauman Tariq
BACKGROUND: We ascertained the occurrence of global cerebral edema manifesting as increased brain volume in subjects with intracerebral hemorrhage (ICH) and explored the relationship between subject characteristics and three month outcomes. METHODS: A post-hoc analysis of a multicenter prospective study that recruited patients with ICH, elevated SBP ≥170 mm Hg, and Glasgow Coma Scale (GCS) score ≥8, who presented within 6 h of symptom onset was performed. Computed tomographic (CT) scans at baseline and 24 h, submitted to a core image laboratory, were analyzed to measure total brain, hematoma, and perihematoma edema volumes from baseline and 24-h CT scans using image analysis software...
June 2014: Neurocritical Care
https://www.readbyqxmd.com/read/23233387/reliability-of-hematoma-volume-measurement-at-local-sites-in-a-multicenter-acute-intracerebral-hemorrhage-clinical-trial
#16
MULTICENTER STUDY
Haitham M Hussein, Nauman A Tariq, Yuko Y Palesch, Adnan I Qureshi
BACKGROUND AND PURPOSE: The reliability of hematoma volume (HV) measurement using the ABC/2 method in multicenter clinical trials is unknown. We determined the accuracy of ABC/2 method as an on-site test in comparison with the gold standard central HV-assessment and semiautomatic HV-assessment. Method- We analyzed data from an acute intracerebral hemorrhage multicenter clinical trial. HV was measured by site investigators to determine enrollment eligibility (<60 cm(3)) using the ABC/2 method (on-site HV), and independently by the core-imaging laboratory using computer-based analysis (Medical Image Processing, Analysis, and Visualization [MIPAV] HV)...
January 2013: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/23230462/mobile-applications-for-handheld-devices-to-screen-and-randomize-acute-stroke-patients-in-clinical-trials
#17
Ai Qureshi, B Connelly, Ei Abbott, E Maland, J Kim, J Blake
The availability of internet connectivity and mobile application software used by low-power handheld devices makes smart phones of unique value in time-sensitive clinical trials. Trial-specific applications can be downloaded by investigators from various mobile software distribution platforms or web applications delivered over HTTP. The Antihypertensive Treatment in Acute Cerebral Hemorrhage (ATACH) II investigators in collaboration with MentorMate released the ATACH-II Patient Recruitment mobile application available on iPhone, Android, and Blackberry in 2011...
August 2012: Journal of Vascular and Interventional Neurology
https://www.readbyqxmd.com/read/23230461/score-it-the-spot-sign-score-in-restricting-ich-growth%C3%A2-an-atach-ii-ancillary-study
#18
Jn Goldstein, Hb Brouwers, Jm Romero, K McNamara, K Schwab, Sm Greenberg, J Rosand
INTRODUCTION: The ATACH-II trial is designed to evaluate whether intensive blood pressure reduction can reduce hematoma growth and improve outcome. However, it is difficult to determine, at presentation, which patients are at highest risk of ongoing bleeding, and will receive the most clinical benefit from blood pressure therapy. It may be that improved predictive markers will lead to efficient, personalized selection of optimal therapy. We hypothesize that specific imaging findings on CT angiography (CTA) and MRI will mark those patients who receive the most benefit from intensive blood pressure reduction...
August 2012: Journal of Vascular and Interventional Neurology
https://www.readbyqxmd.com/read/23230459/the-importance-of-an-independent-oversight-committee-to-preserve-treatment-fidelity-ensure-protocol-compliance-and-adjudicate-safety-endpoints-in-the-atach-ii-trial
#19
Na McBee, Df Hanley, Cs Kase, K Lane, Jr Carhuapoma
In response to growing trends and accepted U.S. Food and Drug Administration (FDA) guidance, the ATACH II trial leadership developed the independent oversight committee (IOC) as a mechanism to adjudicate the trial safety endpoints and to evaluate treatment fidelity and protocol compliance. To accomplish these tasks, the IOC reviews the first three subjects enrolled at each study center and all serious adverse events that occur across all study centers. The IOC makes recommendations to the steering committee regarding the aggregation of, or trend in, adverse events at particular sites and discusses homogeneity, or lack thereof, in the principles and intensity of the overall care...
August 2012: Journal of Vascular and Interventional Neurology
https://www.readbyqxmd.com/read/23230458/expansion-of-recruitment-time-window-in-antihypertensive-treatment-of-acute-cerebral-hemorrhage-atach-ii-trial
#20
Ai Qureshi, Yy Palesch
The Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH) II trial is an ongoing multi-center, randomized phase III trial to determine the efficacy of early, intensive, antihypertensive treatment using intravenous (IV) nicardipine initiated within 3 h of onset of intracerebral hemorrhage (ICH). On March 11th, 2012, the National Institutes of Neurological Disorders and Stroke approved recruitment of patients with ICH within 4.5 h of symptom onset. The expansion of recruitment window was based on the recent ATACH-I study analysis that suggests reduction of hematoma expansion and death, and disability in those subjects who were treated within 4...
August 2012: Journal of Vascular and Interventional Neurology
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