Publications
129 results found
D'Anna L, Barba L, Foschi M, et al., 2024, Safety and outcomes of different endovascular treatment techniques for anterior circulation ischaemic stroke in the elderly: data from the Imperial College Thrombectomy Registry., J Neurol, Vol: 271, Pages: 1366-1375
BACKGROUND: Although previous studies investigated the main predictors of outcomes after endovascular thrombectomy (EVT) in patients aged 80 years and older, less is known about the impact of the procedural features on outcomes in elderly patients. The aim of this study was to investigate the influence of EVT technical procedures on the main 3-month outcomes in a population of patients aged 80 years and older. METHODS: This observational, prospective, single-centre study included consecutive patients with acute LVO ischaemic stroke of the anterior circulation. The study outcomes were functional independence at 3 months after EVT (defined as a mRS score of 0-2), successful reperfusion (mTICI ≥ 2b), incidence of haeamorrhagic transformation, and 90-day all cause of mortality. RESULTS: Our cohort included 497 patients with acute ischaemic stroke due to LVO treated with EVT. Among them, 105 (21.1%) patients were aged ≥ 80 years. In the elderly group, multivariable regression analysis showed that thromboaspiration technique vs stent-retriever was the single independent predictor of favourable post-procedural TICI score (OR = 7.65, 95%CI = 2.22-26.32, p = 0.001). CONCLUSIONS: Our study suggests that EVT for LVO stroke in the elderly could be safe. The use of thromboaspiration was associated with positive reperfusion outcome in this population. Further studies in larger series are warranted to confirm the present results and to evaluate the safety and efficacy of EVT in the elderly and oldest adults.
D'Anna L, Ornello R, Foschi M, et al., 2024, Outcomes of mechanical thrombectomy in acute stroke patients with atrial fibrillation detected after stroke versus known atrial fibrillation., J Thromb Thrombolysis, Vol: 57, Pages: 445-452
We aim to compare the outcomes in patients with atrial fibrillation detected after stroke (AFDAS) and their counterparts with known AF (KAF) presenting with large vessel occlusion (LVO) treated with mechanical thrombectomy (MT). This observational, prospective study included consecutive patients with acute LVO ischemic stroke of the anterior circulation with AFDAS, KAF and without AF. The primary study outcome was functional independence at 90 days after stroke. The secondary study outcomes were variation of the NIHSS score at 24 h, rate of successful reperfusion, death at 90 days and rate of immediate complications post-procedure. Overall, our cohort included 518 patients with acute ischemic stroke and LVO treated with MT, with 289 (56.8%) without a diagnosis of AF; 107 (21%) with AFDAS; 122 (22.2%) with KAF. There was no significant difference in terms of functional independence at 90 days after stroke between the three groups. Regarding the secondary study outcome, the rate of symptomatic intracranial haemorrhage (sICH) and/or parenchymal hematoma (PH) were significantly higher in the group of patients without AF (respectively, P = 0.030 and < 0.010). Logistic regression analysis showed that the subtypes of AF were not statistically significantly associated with functional independence at 90 days after stroke and with the likelihood of any ICH. Our results suggest that the subtypes of AF are not associated with clinical and safety outcomes of MT in patients with acute stroke and LVO. Further studies are needed to confirm our findings.
van Voorst H, Pitkänen J, van Poppel L, et al., 2024, Deep learning-based white matter lesion volume on CT is associated with outcome after acute ischemic stroke., Eur Radiol
BACKGROUND: Intravenous thrombolysis (IVT) before endovascular treatment (EVT) for acute ischemic stroke might induce intracerebral hemorrhages which could negatively affect patient outcomes. Measuring white matter lesions size using deep learning (DL-WML) might help safely guide IVT administration. We aimed to develop, validate, and evaluate a DL-WML volume on CT compared to the Fazekas scale (WML-Faz) as a risk factor and IVT effect modifier in patients receiving EVT directly after IVT. METHODS: We developed a deep-learning model for WML segmentation on CT and validated with internal and external test sets. In a post hoc analysis of the MR CLEAN No-IV trial, we associated DL-WML volume and WML-Faz with symptomatic-intracerebral hemorrhage (sICH) and 90-day functional outcome according to the modified Rankin Scale (mRS). We used multiplicative interaction terms between WML measures and IVT administration to evaluate IVT treatment effect modification. Regression models were used to report unadjusted and adjusted common odds ratios (cOR/acOR). RESULTS: In total, 516 patients from the MR CLEAN No-IV trial (male/female, 291/225; age median, 71 [IQR, 62-79]) were analyzed. Both DL-WML volume and WML-Faz are associated with sICH (DL-WML volume acOR, 1.78 [95%CI, 1.17; 2.70]; WML-Faz acOR, 1.53 95%CI [1.02; 2.31]) and mRS (DL-WML volume acOR, 0.70 [95%CI, 0.55; 0.87], WML-Faz acOR, 0.73 [95%CI 0.60; 0.88]). Only in the unadjusted IVT effect modification analysis WML-Faz was associated with more sICH if IVT was given (p = 0.046). Neither WML measure was associated with worse mRS if IVT was given. CONCLUSION: DL-WML volume and WML-Faz had a similar relationship with functional outcome and sICH. Although more sICH might occur in patients with more severe WML-Faz receiving IVT, no worse functional outcome was observed. CLINICAL RELEVANCE STATEMENT: White matter lesion severity on baseline CT in acute ischemic stroke patients has a similar predictive value if measured wit
Broderick M, Burridge J, Demain S, et al., 2024, Multicentre pilot randomised control trial of a self-directed exergaming intervention for poststroke upper limb rehabilitation: research protocol, BMJ Open, Vol: 14, ISSN: 2044-6055
Introduction: Technology-facilitated, self-directed upper limb (UL) rehabilitation, as an adjunct to conventional care, could enhance poststroke UL recovery compared with conventional care alone, without imposing additional resource burden. The proposed pilot randomised controlled trial (RCT) aims to assess whether stroke survivors will engage in self-directed UL training, explore factors associated with intervention adherence and evaluate the study design for an RCT testing the efficacy of a self-directed exer-gaming intervention for UL recovery after stroke.Methods and analysis: This is a multicentre, internal pilot RCT; parallel design, with nested qualitative methods. The sample will consist of stroke survivors with UL paresis, presenting within the previous 30 days. Participants randomised to the intervention group will be trained to use an exergaming device and will be supported to adopt this as part of their self-directed rehabilitation (ie, without formal support/supervision) for a 3-month period. The primary outcome will be the Fugl Meyer Upper Extremity Assessment (FM-UE) at 6 months poststroke. Secondary outcomes are the Action Research Arm Test (ARAT), the Barthel Index and the Modified Rankin Scale. Assessment time points will be prior to randomisation (0–1 month poststroke), 3 months and 6 months poststroke. A power calculation to inform sample size required for a definitive RCT will be conducted using FM-UE data from the sample across 0–6 months time points. Semistructured qualitative interviews will examine factors associated with intervention adoption. Reflexive thematic analysis will be used to code qualitative interview data and generate key themes associated with intervention adoption.Ethics and dissemination: The study protocol (V.1.9) was granted ethical approval by the Health Research Authority, Health and Care Research Wales, and the London- Harrow Research Ethics Committee (ref. 21/LO/0054) on 19 May 2021. Trial res
Marcus A, Bentley P, Rueckert D, 2023, Concurrent ischemic lesion age estimation and segmentation of CT brain using a transformer-based network, IEEE Transactions on Medical Imaging, Vol: 42, Pages: 3463-3473, ISSN: 0278-0062
The cornerstone of stroke care is expedient management that varies depending on the time since stroke onset. Consequently, clinical decision making is centered on accurate knowledge of timing and often requires a radiologist to interpret Computed Tomography (CT) of the brain to confirm the occurrence and age of an event. These tasks are particularly challenging due to the subtle expression of acute ischemic lesions and the dynamic nature of their appearance. Automation efforts have not yet applied deep learning to estimate lesion age and treated these two tasks independently, so, have overlooked their inherent complementary relationship. To leverage this, we propose a novel end-to-end multi-task transformer-based network optimized for concurrent segmentation and age estimation of cerebral ischemic lesions. By utilizing gated positional self-attention and CT-specific data augmentation, the proposed method can capture long-range spatial dependencies while maintaining its ability to be trained from scratch under low-data regimes commonly found in medical imaging. Furthermore, to better combine multiple predictions, we incorporate uncertainty by utilizing quantile loss to facilitate estimating a probability density function of lesion age. The effectiveness of our model is then extensively evaluated on a clinical dataset consisting of 776 CT images from two medical centers. Experimental results demonstrate that our method obtains promising performance, with an area under the curve (AUC) of 0.933 for classifying lesion ages ≤4.5 hours compared to 0.858 using a conventional approach, and outperforms task-specific state-of-the-art algorithms.
Marcus A, Bentley P, Rueckert D, 2023, Stroke Outcome and Evolution Prediction from CT Brain Using a Spatiotemporal Diffusion Autoencoder, Machine Learning in Clinical Neuroimaging. MLCN 2023. Lecture Notes in Computer Science, vol 14312.
Broderick M, O'Shea R, Burridge J, et al., 2023, Examining Usability, Acceptability, and Adoption of a Self-Directed, Technology-Based Intervention for Upper Limb Rehabilitation After Stroke: Cohort Study., JMIR Rehabil Assist Technol, Vol: 10, ISSN: 2369-2529
BACKGROUND: Upper limb (UL) recovery after stroke is strongly dependent upon rehabilitation dose. Rehabilitation technologies present pragmatic solutions to dose enhancement, complementing therapeutic activity within conventional rehabilitation, connecting clinicians with patients remotely, and empowering patients to drive their own recovery. To date, rehabilitation technologies have been poorly adopted. Understanding the barriers to adoption may shape strategies to enhance technology use and therefore increase rehabilitation dose, thus optimizing recovery potential. OBJECTIVE: We examined the usability, acceptability, and adoption of a self-directed, exercise-gaming technology within a heterogeneous stroke survivor cohort and investigated how stroke survivor characteristics, technology usability, and attitudes toward technology influenced adoption. METHODS: A feasibility study of a novel exercise-gaming technology for self-directed UL rehabilitation in early subacute stroke survivors (N=30) was conducted in an inpatient, acute hospital setting. Demographic and clinical characteristics were recorded; participants' performance in using the system (usability) was assessed using a 4-point performance rating scale (adapted from the Barthel index), and adherence with the system was electronically logged throughout the trial. The technology acceptance model was used to formulate a survey examining the acceptability of the system. Spearman rank correlations were used to examine associations between participant characteristics, user performance (usability), end-point technology acceptance, and intervention adherence (adoption). RESULTS: The technology was usable for 87% (n=26) of participants, and the overall technology acceptance rating was 68% (95% CI 56%-79%). Participants trained with the device for a median of 26 (IQR 16-31) minutes daily over an enrollment period of 8 (IQR 5-14) days. Technology adoption positively correlated with user performance (usability) (ρ=0
D'Anna L, Romoli M, Foschi M, et al., 2023, Outcomes of mechanical thrombectomy in orally anticoagulated patients with anterior circulation large vessel occlusion: a propensity-matched analysis of the Imperial College Thrombectomy Registry, JOURNAL OF NEUROLOGY, ISSN: 0340-5354
D'Anna L, 2023, Endovascular thrombectomy with or without intravenous thrombolysis for anterior circulation large vessel occlusion in the Imperial College London Thrombectomy Registry, Journal of Clinical Medicine, Vol: 12, Pages: 1-9, ISSN: 2077-0383
Background and purpose. Mechanical thrombectomy (MT) is the standard of care for eligible patients with a large vessel occlusion (LVO) acute ischemic stroke. Among patients undergoing MT there has been uncertainty regarding the role of intravenous thrombolysis (IVT) and previous trials have yielded conflicting results regarding clinical outcomes. We aim to investigate clinical, reperfusion outcomes and safety of MT with or without IVT for ischemic stroke due to anterior circulation LVO. Materials and Methods. This observational, prospective, single-centre study included consecutive patients with acute LVO ischemic stroke of the anterior circulation. The primary outcomes were the rate of in-hospital mortality, symptomatic intracranial haemorrhage and functional independence (mRS 0–2 at 90 days). Results. We enrolled a total of 577 consecutive patients: 161 (27.9%) were treated with MT alone while 416 (72.1%) underwent IVT and MT. Patients with MT who were treated with IVT had lower rates of in-hospital mortality (p = 0.037), higher TICI reperfusion grades (p = 0.007), similar rates of symptomatic intracranial haemorrhage (p = 0.317) and a higher percentage of functional independence mRS (0–2) at 90 days (p = 0.022). Bridging IVT with MT compared to MT alone was independently associated with a favorable post-intervention TICI score (>2b) (OR, 1.716; 95% CI, 1.076–2.735, p = 0.023). Conclusions. Our findings suggest that combined treatment with MT and IVT is safe and results in increased reperfusion rates as compared to MT alone.
D'Anna L, Dolkar T, Vittay O, et al., 2023, Comparison of Drip-and-ship versus Mothership models of Mechanical Thrombectomy delivery in a real world setting: Analysis from the Imperial College London Thrombectomy Registry, Publisher: SAGE PUBLICATIONS LTD, Pages: 4-4, ISSN: 1747-4930
Vanstone K, Almedom L, Faisal SWA, et al., 2023, The relationship between natural behaviour, motivation and functional outcome after stroke, Publisher: SAGE PUBLICATIONS LTD, Pages: 113-114, ISSN: 1747-4930
Marcus A, Bentley P, Rueckert D, 2023, Stroke Outcome and Evolution Prediction from CT Brain Using a Spatiotemporal Diffusion Autoencoder, Lecture Notes in Computer Science, Publisher: Springer Nature Switzerland, Pages: 153-162, ISBN: 9783031448577
Marcus A, Bentley P, Rueckert D, 2022, Concurrent Ischemic Lesion Age Estimation and Segmentation of CT Brain Using a Transformer-Based Network, Pages: 52-62, ISBN: 9783031178986
The cornerstone of stroke care is expedient management that varies depending on the time since stroke onset. Consequently, clinical decision making is centered on accurate knowledge of timing and often requires a radiologist to interpret Computed Tomography (CT) of the brain to confirm the occurrence and age of an event. These tasks are particularly challenging due to the subtle expression of acute ischemic lesions and their dynamic nature. Automation efforts have not yet applied deep learning to estimate lesion age and treated these two tasks independently, so, have overlooked their inherent complementary relationship. To leverage this, we propose a novel end-to-end multi-task transformer-based network optimized for concurrent segmentation and age estimation of cerebral ischemic lesions. By utilizing gated positional self-attention and CT-specific data augmentation, our method can capture long-range spatial dependencies while maintaining its ability to be trained from scratch under low-data regimes commonly found in medical imaging. Further, to better combine multiple predictions, we incorporate uncertainty by utilizing quantile loss to facilitate estimating a probability density function of lesion age. The effectiveness of our model is then extensively evaluated on a clinical dataset consisting of 776 CT images from two medical centers. Experimental results demonstrate that our method obtains promising performance, with an area under the curve (AUC) of 0.933 for classifying lesion ages ≤ 4.5 h compared to 0.858 using a conventional approach, and outperforms task-specific state-of-the-art algorithms.
Broderick M, Almedom L, Burdet E, et al., 2021, Self-Directed Exergaming for Stroke Upper Limb Impairment Increases Exercise Dose Compared to Standard Care, NEUROREHABILITATION AND NEURAL REPAIR, Vol: 35, Pages: 974-985, ISSN: 1545-9683
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Weeden M, Khan A, Shroff D, et al., 2021, ACUTE STROKE IN PATIENTS UNDERGOING VENOUS-VENOUS EXTRACORPOREAL MEMBRANE OXYGENATION FOR COVID-19 VS. NON-COVID VIRAL PNEUMONITIS: A SINGLE-CENTRE COHORT STUDY, Publisher: SAGE PUBLICATIONS LTD, Pages: 114-114, ISSN: 1747-4930
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D'Anna L, Ellis N, Bentley P, et al., 2021, Delivering telemedicine consultations for patients with transient ischaemic attack during the COVID-19 pandemic in a comprehensive tertiary stroke centre in the United Kingdom, European Journal of Neurology, Vol: 28, Pages: 3456-3460, ISSN: 1351-5101
Background and purposeThe global COVID-19 pandemic led many stroke centres worldwide to shift from in-person to telemedicine consultations to assess patients with transient ischaemic attacks (TIAs). We aimed to investigate the impact of telemedicine during the COVID-19 pandemic on the management and outcome of the patients with TIA.MethodsWe retrospectively analysed data from a registry of consecutive TIA patients assessed at the Stroke Department, Imperial College Health Care Trust, London, during the national lockdown period (between March 23 2020 and 30 June 2020). As controls, we evaluated the clinical reports and stroke quality metrics of patients presenting to the TIA clinic in the same period of 2019.ResultsBetween 23 March 2020 and 30 June 2020, 136 patients were assessed using the telemedicine TIA clinic, compared to 180 patients evaluated with face-to-face consultation in the same period in 2019. Patients’ characteristics were similar in both groups. At 3 months after the TIA, there were no significant differences in the proportion of patients admitted to the hospital for recurrent TIA/stroke or any other cardiovascular cause from the 2020 period compared to the same period in 2019.ConclusionsOur analysis showed that during the pandemic, our telemedicine consultations of TIA patients were not associated with an increased 3-month rate of recurrent TIA/stroke or cardiovascular hospital admissions. More robust studies looking at this model of care will be needed to assess its long-term effects on patients and health care systems.
D'Anna L, Filippidis FT, Harvey K, et al., 2021, Extent of white matter lesion is associated with early hemorrhagic transformation in acute ischemic stroke related to atrial fibrillation, Brain and Behavior, Vol: 11, Pages: 1-8, ISSN: 2162-3279
BackgroundHemorrhagic transformation (HT) after stroke, related to atrial fibrillation (AF), is a frequent complication, and it can be associated with a delay in the (re-)initiation of oral anticoagulation therapy. We investigated the effect of the presence and severity of white matter disease (WMD) on early HT after stroke related to AF.MethodsA consecutive series of patients with recent (<4 weeks) ischemic stroke and AF, treated at the Hyper Acute Stroke Unit of the Imperial College London between 2010 and 2017, were enrolled. Patients with brain MRI performed 24–72 h from stroke onset and not yet started on anticoagulant treatment were included. WMD was graded using the Fazekas score.ResultsAmong the 441 patients eligible for the analysis, 91 (20.6%) had any HT. Patients with and without HT showed similar clinical characteristics. Patients with HT had a larger diffusion-weighted imaging (DWI) infarct volume compared to patients without HT (p < .001) and significant difference in the distribution of the Fazekas score (p = .001). On multivariable analysis, HT was independently associated with increasing DWI infarct volume (odd ratio (OR), 1.03; 95% confidence interval (CI), 1.01–1.05; p < .001), higher Fazekas scores (OR, 1.94; 95% CI, 1.47–2.57; p < .001) and history of previous intracranial hemorrhage (OR, 4.80; 95% CI, 1.11–20.80; p = .036).ConclusionsPresence and severity of WMD is associated with increased risk of development of early HT in patients with stroke and AF. Further evidence is needed to provide reliable radiological predictors of the risk of HT in cardioembolic stroke.
Formstone L, Huo W, Wilson S, et al., 2021, Quantification of motor function post-stroke using wearable inertial and ,echanomyographic Sensors, IEEE Transactions on Neural Systems and Rehabilitation Engineering, Vol: 29, Pages: 1158-1167, ISSN: 1534-4320
Subjective clinical rating scales represent the goldstandard diagnosis of motor function following stroke, however in practice they suffer from well-recognised limitations including variance between assessors, low inter-rater reliability and low resolution. Automated systems have been proposed for empirical quantification but have significantly impacted clinical practice. We address translational challenges in this arena through: (1) implementation of a novel sensor suite fusing inertial measurement and mechanomyography (MMG) to quantify hand and wrist motor function; and (2) introduction of a new range of signal features extracted from the suite to supplement predicted clinical scores. The wearable sensors, signal features, and sensor fusion algorithms have been combined to produce classified ratings from the Fugl-Meyer clinical assessment rating scale. Furthermore, we have designed the system to augment clinical rating with several sensor-derived supplementary features encompassing critical aspects of motor dysfunction (e.g. joint angle, muscle activity, etc.). Performance is validated through a large-scale study on a poststroke cohort of 64 patients. Fugl-Meyer Assessment tasks were classified with 75% accuracy for gross motor tasks and 62% for hand/wrist motor tasks. Of greater import, supplementary features demonstrated concurrent validity with Fugl-Meyer ratings, evidencing their utility as new measures of motor function suited to automated assessment. Finally, the supplementary features also provide continuous measures of sub-components of motor function, offering the potential to complement low accuracy but well-validated clinical rating scales when high-quality motor outcome measures are required. We believe this work provides a basis for widespread clinical adoption of inertial-MMG sensor use for post-stroke clinical motor assessment.Index Terms—Stroke, Fugl-Meyer assessment, automated upper-limb assessment, wearables, machine learning, mechanomyogra
Ken-Dror G, Wade C, Sharma SS, et al., 2021, SARS-CoV-2 antibody seroprevalence in NHS healthcare workers in a large double-sited UK hospital, CLINICAL MEDICINE, Vol: 21, Pages: E290-E294, ISSN: 1470-2118
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Kwan J, Brown M, Bentley P, et al., 2021, Impact of COVID-19 pandemic on a regional stroke thrombectomy service in the United Kingdom, Cerebrovascular Diseases, Vol: 50, Pages: 178-184, ISSN: 1015-9770
Introduction: We examined the impact of the COVID-19 pandemic on our regional stroke thrombectomy service in the UK. Methods: This was a single-centre health service evaluation. We began testing for COVID-19 on 3 March and introduced a modified “COVID Stroke Thrombectomy Pathway” on 18 March. We included 61 consecutive stroke thrombectomy patients admitted between 1 January and 30 April, and analyzed data on patient demographics, thrombectomy procedures, thrombectomy pathway time-points, and early neurological outcomes. We compared the data for January and February (“pre-COVID”, n=33) vs. March and April (“during COVID”, n=28). Results: Patient demographics were similar between the two groups (mean age 71±12.8 years, 39% female). During the COVID-19 pandemic, a) total stroke admissions fell by 17% but the stroke thrombectomy rate was maintained at 17%; b) successful recanalization rate was maintained at 81%; c) early neurological outcomes (neurological improvement following thrombectomy and inpatient mortality) were not significantly different; d) use of general anesthesia fell significantly from 85% to 32% as intended; and e) time intervals from onset to arrival, groin puncture, and recanalization were not significantly different, whereas internal delays for external referrals were significantly reduced for door-to-groin puncture [48 (IQR 39-57) vs. 33 (IQR 27-44) minutes, p=.013] and door-to-recanalization [82·5 (IQR 61-110) vs. 60 (IQR 55-70) minutes, p=.018].Conclusion: The COVID-19 pandemic had lowered stroke admission numbers but not stroke thrombectomy rate, successful recanalization rate, or chance of a favorable outcome. Internal delays were actually reduced during the COVID-19 pandemic. Further studies can examine the effects of COVID-19 pandemic on longer term outcome after stroke thrombectomy.
Drumm B, Bentley P, Brown Z, et al., 2021, Abstract P99: impact of the Covid-19 pandemic on stroke thrombolysis rate and delay to thrombolysis treatment in a regional stroke centre in London, UK, International Stroke Conference 2021, Publisher: Ovid Technologies (Wolters Kluwer Health), Pages: 1-1, ISSN: 0039-2499
Introduction: There are reports of changes in the numbers of stroke admissions and time intervals to receiving emergency treatments during the COVID-19 pandemic. We examined the impact of the COVID-19 pandemic on the stroke thrombolysis rate and delay to thrombolysis treatment in a regional stroke centre in London, UK.Methods: COVID-19 testing began at our hospital on 3 March 2020. Clinical data for all acute stroke admissions were routinely collected as part of a national Sentinel Stroke National Audit Programme (SSNAP) and all thrombolysis data were entered into our local thrombolysis database. We retrospectively extracted the relevant patient data for the period of March to May 2020 (COVID group) and compared to the same period in 2019 (pre-COVID group).Results: Compared with pre-COVID, there was a 17.5% fall in total stroke admissions (from 315 to 260) during COVID; but there were no significant differences in the demographics, stroke severity, proportions with known time of onset, or median onset-to-arrival time. The thrombolysis rates amongst ischemic strokes were not significantly different between the two groups (59/260=23% pre-COVID vs. 41/228=18% COVID, p=.19). For thrombolysis patients, their stroke severity and demographics were similar between the two both groups. Median onset-to-needle time was significantly longer by 22 minutes during COVID [127 (IQR 94-160) vs. 149 (IQR 110-124) minutes, p=.045]; this delay to treatment was almost entirely due to a longer median onset-to-arrival time by 16 minutes during COVID (p=.029). Favorable early neurological outcomes post-thrombolysis (defined as an improvement in NIHSS by ≥4 points at 24 hours) were similar (45% vs. 46%, p=.86).Conclusion: COVID-19 pandemic had a negative impact on prehospital delays which in turn significantly increased onset-to-needle time, but without affecting the chance of a favorable early neurological outcome. Our data highlight the need to maintain public awareness of taking immedi
D'Anna L, Brown M, Oishi S, et al., 2021, Impact of national lockdown on the hyperacute stroke care and rapid transient ischaemic attack outpatient service in a comprehensive tertiary stroke centre during the COVID-19 pandemic, Frontiers in Neurology, Vol: 12, ISSN: 1664-2295
Background: The COVID-19 pandemic is having major implications for stroke services worldwide. We aimed to study the impact of the national lockdown period during the COVID-19 outbreak on stroke and transient ischemic attack (TIA) care in London, UK. Methods: We retrospectively analyzed data from a quality improvement registry of consecutive patients presenting with acute ischemic stroke and TIA to the Stroke Department, Imperial College Health Care Trust London during the national lockdown period (between March 23rd and 30th June 2020). As controls, we evaluated the clinical reports and stroke quality metrics of patients presenting with stroke or TIA in the same period of 2019. Results: Between March 23rd and 30th June 2020, we documented a fall in the number of stroke admissions by 31.33% and of TIA outpatient referrals by 24.44% compared to the same period in 2019. During the lockdown, we observed a significant increase in symptom onset-to-door time in patients presenting with stroke (median = 240 vs. 160 min, p = 0.020) and TIA (median = 3 vs. 0 days, p = 0.002) and a significant reduction in the total number of patients thrombolysed [27 (11.49%) vs. 46 (16.25%, p = 0.030)]. Patients in the 2020 cohort presented with a lower median pre-stroke mRS (p = 0.015), but an increased NIHSS (p = 0.002). We registered a marked decrease in mimic diagnoses compared to the same period of 2019. Statistically significant differences were found between the COVID and pre-COVID cohorts in the time from onset to door (median 99 vs. 88 min, p = 0.026) and from onset to needle (median 148 vs. 126 min, p = 0.036) for thrombolysis whilst we did not observe any significant delay to reperfusion therapies (door-to-needle and door-to-groin puncture time). Conclusions: National lockdown in the UK due to the COVID-19 pandemic was associated with a significant decrease in acute stroke admission and TIA evaluations at our stroke center. Moreover, a lower proportion of acute stroke patients in
Clarke AK, Atashzar SF, Vecchio AD, et al., 2021, Deep learning for robust decomposition of high-density surface EMG signals, IEEE Transactions on Biomedical Engineering, Vol: 68, Pages: 526-534, ISSN: 0018-9294
Blind source separation (BSS) algorithms, such as gradient convolution kernel compensation (gCKC), can efficiently and accurately decompose high-density surface electromyography (HD-sEMG) signals into constituent motor unit (MU) action potential trains. Once the separation matrix is blindly estimated on a signal interval, it is also possible to apply the same matrix to subsequent signal segments. Nonetheless, the trained separation matrices are sub-optimal in noisy conditions and require that incoming data undergo computationally expensive whitening. One unexplored alternative is to instead use the paired HD-sEMG signal and BSS output to train a model to predict MU activations within a supervised learning framework. A gated recurrent unit (GRU) network was trained to decompose both simulated and experimental unwhitened HD-sEMG signal using the output of the gCKC algorithm. The results on the experimental data were validated by comparison with the decomposition of concurrently recorded intramuscular EMG signals. The GRU network outperformed gCKC at low signal-to-noise ratios, proving superior performance in generalising to new data. Using 12 seconds of experimental data per recording, the GRU performed similarly to gCKC, at rates of agreement of 92.5% (84.5%-97.5%) and 94.9% (88.8%-100.0%) respectively for GRU and gCKC against matched intramuscular sources.
Auepanwiriyakul C, Waibel S, Songa J, et al., 2020, Accuracy and acceptability of wearable motion tracking for inpatient monitoring using smartwatches, Sensors, Vol: 20, ISSN: 1424-8220
Inertial Measurement Units (IMUs) within an everyday consumer smartwatch offer a convenient and low-cost method to monitor the natural behaviour of hospital patients. However, their accuracy at quantifying limb motion, and clinical acceptability, have not yet been demonstrated. To this end we conducted a two-stage study: First, we compared the inertial accuracy of wrist-worn IMUs, both research-grade (Xsens MTw Awinda, and Axivity AX3) and consumer-grade (Apple Watch Series 3 and 5), and optical motion tracking (OptiTrack). Given the moderate to strong performance of the consumer-grade sensors, we then evaluated this sensor and surveyed the experiences and attitudes of hospital patients (N = 44) and staff (N = 15) following a clinical test in which patients wore smartwatches for 1.5–24 h in the second study. Results indicate that for acceleration, Xsens is more accurate than the Apple Series 5 and 3 smartwatches and Axivity AX3 (RMSE 1.66 ± 0.12 m·s−2; R2 0.78 ± 0.02; RMSE 2.29 ± 0.09 m·s−2; R2 0.56 ± 0.01; RMSE 2.14 ± 0.09 m·s−2; R2 0.49 ± 0.02; RMSE 4.12 ± 0.18 m·s−2; R2 0.34 ± 0.01 respectively). For angular velocity, Series 5 and 3 smartwatches achieved similar performances against Xsens with RMSE 0.22 ± 0.02 rad·s−1; R2 0.99 ± 0.00; and RMSE 0.18 ± 0.01 rad·s−1; R2 1.00± SE 0.00, respectively. Surveys indicated that in-patients and healthcare professionals strongly agreed that wearable motion sensors are easy to use, comfortable, unobtrusive, suitable for long-term use, and do not cause anxiety or limit daily activities. Our results suggest that consumer smartwatches achieved moderate to strong levels of accuracy compared to laboratory gold-standard and are acceptable for pervasive monitoring of motion/behaviour within hospital settings.
Auepanwiriyakul C, Waibel S, Songa J, et al., 2020, Accuracy and Acceptability of Wearable Motion Tracking Smartwatches for Inpatient Monitoring, Sensors, ISSN: 1424-8220
<jats:p>: Inertial Measurement Units (IMUs) within an everyday consumer smartwatch offer a convenient and low-cost method to monitor the natural behaviour of hospital patients. However, their accuracy at quantifying limb motion, and clinical acceptability, have not yet been demonstrated. To this end we conducted a two-stage study: First, we compared the inertial accuracy of wrist-worn IMUs, both research-grade (Xsens MTw Awinda, and Axivity AX3) and consumer-grade (Apple Watch Series 3 and 5), relative to gold-standard optical motion tracking (OptiTrack). Given the moderate to the strong performance of the consumer-grade sensors we then evaluated this sensor and surveyed the experiences and attitudes of hospital patients (N=44) and staff (N=15) following a clinical test in which patients wore smartwatches for 1.5-24 hours in the second study. Results indicate that for acceleration, Xsens is more accurate than the Apple smartwatches and Axivity AX3 (RMSE 0.17+/-0.01 g; R2 0.88+/-0.01; RMSE 0.22+/-0.01 g; R2 0.64+/-0.01; RMSE 0.42+/-0.01 g; R2 0.43+/-0.01, respectively). However, for angular velocity, the smartwatches are marginally more accurate than Xsens (RMSE 1.28+/-0.01 rad/s; R2 0.85+/-0.00; RMSE 1.37+/-0.01 rad/s; R2 0.82+/-0.01, respectively). Surveys indicated that in-patients and healthcare professionals strongly agreed that wearable motion sensors are easy to use, comfortable, unobtrusive, suitable for long term use, and do not cause anxiety or limit daily activities. Our results suggest that smartwatches achieved moderate to strong levels of accuracy compared to a gold-standard reference and are likely to be accepted as a pervasive measure of motion/behaviour within hospitals.</jats:p>
Chen L, Cuervas-Mons CG, Ramji S, et al., 2020, AUTOMATED AGE ESTIMATION OF ISCHAEMIC LESIONS FROM UNENHANCED CT, Publisher: SAGE PUBLICATIONS LTD, Pages: 296-296, ISSN: 1747-4930
Broderick M, Bentley P, Burridge J, et al., 2020, SELF-ADMINISTERED GAMING EXERCISES FOR STROKE ARM DISABILITY INCREASE EXERCISE DURATION BY MORE THAN TWO-FOLD AND REPETITIONS MORE THAN TEN-FOLD COMPARED TO STANDARD CARE, Publisher: SAGE PUBLICATIONS LTD, Pages: 255-255, ISSN: 1747-4930
D'Anna L, Filippidis FT, Antony S, et al., 2020, Early initiation of direct anticoagulation after stroke in patients with atrial fibrillation., European Journal of Neuroscience, Vol: 27, Pages: 2168-2175, ISSN: 0953-816X
BACKGROUND: The safety of early initiation of anticoagulant therapy in patients with ischaemic stroke related to atrial fibrillation (AF) is unknown. We investigated the safety of early initiation of direct oral anticoagulants (DOACs), vitamin K antagonists (VKAs) or no anticoagulation. METHODS: This observational, retrospective, single-centre study included consecutive patients with recent (< 4 weeks) ischaemic stroke and AF. The primary outcome was the rate of major (intra- and extracranial) bleeding in patients on different treatment schemes: DOACs, VKAs and not anticoagulated. We also investigated the rate of ischaemic cerebrovascular events and mortality. RESULTS: We included 959 consecutive patients with AF and ischaemic stroke followed up for an average time of 16.1 days after the index event. 559 patients of 959 (58.3%) were anticoagulated with either VKAs (259) or DOACs (300). Anticoagulation was started after a mean time of 7± 9.4 in the DOACs group and 11.9± 19.7 in the VKAs group. Early initiation of any anticoagulant was not associated with an increased risk of any major bleeding (OR 0.49; CI, 0.21-1.16) and in particular of intracranial bleeding (OR 0.47; CI, 0.17-1.29; p = 0.143) compared with no anticoagulation. In contrast to VKAs (OR 0.78; CI, 0.28-2.13), treatment with DOACs (OR 0.32; CI, 0.10-0.96) reduced the rate of major bleeding compared to no-anticoagulation. Early recurrences of ischaemic stroke did not differ significantly among the three groups. CONCLUSIONS: Starting DOACs within a mean time of 7 days after stroke appears safe. Randomised controlled studies are needed to establish the added efficacy of starting anticoagulation early after stroke.
D'Anna L, Filippidis F, Nthony S, et al., 2020, EARLY INITIATION OF DIRECT ANTICOAGULATION AFTER STROKE IN PATIENTS WITH ATRIAL FIBRILLATION: THE EIDASAF STUDY., Publisher: SAGE PUBLICATIONS LTD, Pages: 547-547, ISSN: 1747-4930
Bentley P, Sharma P, 2020, Distinguishing early from late seizures after cerebral venous thrombosis Cinderepilepsy, NEUROLOGY, Vol: 95, Pages: 513-514, ISSN: 0028-3878
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