Imperial College London

Dr Joseph Kwan MD FRCP FESO FAHA

Faculty of MedicineDepartment of Brain Sciences

Honorary Senior Lecturer
 
 
 
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Contact

 

joseph.kwan

 
 
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Location

 

Sir Alexander Fleming BuildingSouth Kensington Campus

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Summary

 

Publications

Publication Type
Year
to

137 results found

D'Anna L, Ornello R, Foschi M, Romoli M, Abu-Rumeileh S, Dolkar T, Vittay O, Dixon L, Bentley P, Brown Z, Hall C, Jamil S, Jenkins H, Kwan J, Patel M, Rane N, Roi D, Singh A, Venter M, Kalladka D, Malik A, Halse O, Sacco S, Banerjee S, Lobotesis Ket 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.

Journal article

D'Anna L, Barba L, Foschi M, Romoli M, Abu-Rumeileh S, Dolkar T, Vittay O, Dixon L, Bentley P, Brown Z, Hall C, Halse O, Jamil S, Jenkins H, Kalladka D, Kwan J, Malik A, Patel M, Rane N, Roi D, Singh A, Venter M, Banerjee S, Lobotesis Ket 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.

Journal article

Gruia D-C, Trender W, Hellyer P, Banerjee S, Kwan J, Zetterberg H, Hampshire A, Geranmayeh Fet al., 2023, IC3 Protocol: a longitudinal observational study of cognition after stroke using novel digital health technology, BMJ Open, Vol: 13, ISSN: 2044-6055

Introduction Stroke is a major cause of death and disability worldwide, frequently resulting in persistent cognitive deficits among survivors. These deficits negatively impact recovery and therapy engagement, and their treatment is consistently rated as high priority by stakeholders and clinicians. Although clinical guidelines endorse cognitive screening for poststroke management, there is currently no gold-standard approach for identifying cognitive deficits after stroke, and clinical stroke services lack the capacity for long-term cognitive monitoring and care. Currently, available assessment tools are either not stroke-specific, not in-depth or lack scalability, leading to heterogeneity in patient assessments.Methods and analysis To address these challenges, a cost-effective, scalable and comprehensive screening tool is needed to provide a stroke-specific assessment of cognition. The current study presents such a novel digital tool, the Imperial Comprehensive Cognitive Assessment in Cerebrovascular Disease (IC3), designed to detect both domain-general and domain-specific cognitive deficits in patients after stroke with minimal input from a health professional. To ensure its reliability, we will use multiple validation approaches, and aim to recruit a large normative sample of age-matched, gender-matched and education-matched UK-based controls. Moreover, the IC3 assessment will be integrated within a larger prospective observational longitudinal clinical trial, where poststroke cognition will be examined in tandem with brain imaging and blood biomarkers to identify novel multimodal biomarkers of recovery after stroke. This study will enable deeper cognitive phenotyping of patients at a large scale, while identifying those with highest risk of progressive cognitive decline, as well as those with greatest potential for recovery.Ethics and dissemination This study has been approved by South West—Frenchay Research Ethics Committee (IRAS 299333) and authorised by

Journal article

Shum EN-Y, Lau BH-P, Cheung KS-L, Chan CL-W, Siu JC-Y, Luk JK-H, Kwan JS-K, Chan GM-Y, Pat LY-C, Martin Pet al., 2023, Multiple Roads to Success: A Latent Class Analysis on Successful Ageing Among Hong Kong Near-Centenarians and Centenarians (NCC)., Int J Aging Hum Dev

Notwithstanding the oldest-old cohort being the fastest-growing population in most ageing societies, characterizing successful ageing in adults of advanced age, such as nonagenarians and centenarians, remains challenging. This study investigated the successful ageing subphenotypes using the data from Hong Kong Centenarian Study 2. Between April 2021 and September 2022, 146 family caregivers of community-dwelling older adults aged 95 or above were interviewed by phone. Latent class analysis identified three classes-Overall Frail (46.6%) with poor mobility, cognitive and functional health, Nonambulant (37.0%) but good functional health, and Robust (16.4%) with overall good health-from 11 indicators based on caregivers' reports. Although we found a low prevalence of fulfillment of all indicators of successful ageing, our findings will help care professionals appreciate the heterogeneity underlying partial successful ageing in this vulnerable cohort for segmented and targeted healthy longevity interventions.

Journal article

Arias-Colinas M, Gea A, Khattab A, Vassallo M, Allen SC, Kwan Jet al., 2023, Inflammatory Cytokines Are Associated with Cognitive Dysfunction and Depressive State during Acute Bacterial Infections and the Recovery Phase., Int J Mol Sci, Vol: 24

During a bacterial infection, individuals may present with behavioral changes referred to as sickness behavior, which has been suggested is induced by the inflammatory markers that are released because of the infective immunological challenge. However, few studies have explored this multidimensional phenomenon in naturally occurring conditions. A longitudinal observational study was conducted to explore the role of inflammatory cytokines in mediating the sickness behavior during a bacterial infection. There were 13, 11 and 37 participants in the infection, hospital control and healthy groups, respectively. They were all followed up for 6 weeks and their inflammatory markers were quantified throughout those weeks. Cognitive function and depressive state were assessed by means of the Mini-Mental State Examination (MMSE) and Cornell Scale for Depression in Dementia (CSDD). Reductions in proinflammatory markers C-Reactive protein (CRP), interleukin - 6 (IL6) and tumor necrosis factor-α (TNFα) and increments in anti-inflammatory markers (interleukin - 4 (IL4)) were associated with an improvement in CSDD and MSEE in patients recovering from a bacterial infection. The correlation between inflammatory makers and CSDD was statistically significant for the CRP (r = 0.535, p = 0.001), the IL6 (r = 0.499, p < 0.001), the TNFα (r = 0.235, p = 0.007) and the IL4 (r = -0.321, p = 0.018). Inflammatory cytokines may mediate sickness behavior during acute illness. These results may enhance the understanding of the pathophysiology and potential treatment strategies to palliate this sickness behavior.

Journal article

D'Anna L, Romoli M, Foschi M, Abu-Rumeileh S, Dolkar T, Vittay O, Dixon L, Bentley P, Brown Z, Hall C, Jamil S, Jenkins H, Kwan J, La Cava R, Patel M, Rane N, Roi D, Singh A, Venter M, Halse O, Malik A, Kalladka D, Banerjee S, Lobotesis Ket 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

Journal article

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.

Journal article

Gruia DC, Combrie S, Coghlin J, Trender W, Hellyer P, Kwan J, Banerjee S, Hampshire A, Geranmayeh Fet al., 2023, Large-scale Reliability/Validity Assessments And Quantification Of Cognition Within The Imperial College Comprehensive Assessment For Cerebrovascular Disease (IC3): A Novel In-depth, Self-administered, Online Cognitive Tool, International Stroke Conference (ISC), Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0039-2499

Conference paper

Nguyen TN, Qureshi MM, Klein P, Yamagami H, Mikulik R, Czlonkowska A, Abdalkader M, Sedova P, Sathya A, Lo HC, Mansour OY, Vanguru HR, Lesaine E, Tsivgoulis G, Loochtan A, Demeestere J, Uchino K, Inoa V, Goyal N, Charidimou A, Siegler JE, Yaghi S, de Sousa DA, Mohammaden MH, Haussen DC, Kristoffersen ES, Lereis VP, Scollo SD, Campbell BC, Ma A, Thomas JO, Parsons MW, Singhal S, Slater L-A, Martins RT, Enzinger C, Gattringer T, Rahman A, Bonnet T, Ligot N, De Raedt S, Lemmens R, Vanacker P, Vandervorst F, Conforto AB, Hidalgo RCT, Neves LDO, Martins RT, Mora Cuervo DL, Rebello LC, Santiago IB, da Silva IL, Sakelarova T, Kalpachki R, Alexiev F, Catanese L, Cora EA, Goyal M, Hill MD, Kelly ME, Khosravani H, Lavoie P, Peeling L, Pikula A, Rivera R, Chen H-S, Chen Y, Huo X, Miao Z, Yang S, Bedekovic MR, Bralic M, Budincevic H, Corredor-Quintero AB, Lara-Sarabia OE, Cabal M, Tenora D, Fibrich P, Herzig R, Hrabanovska E, Hlinovsky D, Jurak L, Kadlcikova J, Karpowicz I, Klecka L, Kovar M, Lauer D, Neumann J, Palouskova H, Reiser M, Rekova P, Rohan V, Skoda O, Skorna M, Sramek M, Zakova L, Christensen H, Drenck N, Iversen HK, Truelsen TC, Wienecke T, Sobh K, Ylikotila P, Alpay K, Strbian D, Bernady P, Casenave P, Dan M, Faucheux J-M, Gentric J-C, Magro E, Sabben C, Reiner P, Rouanet F, Bohmann FO, Boskamp S, Mbroh J, Nagel S, Nolte CH, Ringleb PA, Rosenkranz M, Poli S, Thomalla G, Karapanayiotides T, Koutroulou I, Kargiotis O, Palaiodimou L, Barrientos Guerra JD, Huded V, Menon B, Nagendra S, Prajapati C, Sylaja PN, Pramana NAK, Sani AF, Ghoreishi A, Farhoudi M, Hokmabadi ES, Abu Raya T, Kalmanovich SA, Ronen L, Sabetay SI, Acampa M, Adami A, Castellan L, Longoni M, Ornello R, Renieri L, Bigliani CR, Romoli M, Sacco S, Salmaggi A, Sangalli D, Zini A, Doijiri R, Fukuda H, Fujinaka T, Fujita K, Imamura H, Sakai N, Kanamaru T, Kimura N, Kono R, Miyake K, Sakaguchi M, Sakai K, Sonoda K, Todo K, Miyashita F, Tokuda N, Matsumaru Y, Matsumoto S, Ohara N, Shindo S, Takenobu Y, Yoshiet al., 2023, Global Impact of the COVID-19 Pandemic on Stroke Volumes and Cerebrovascular Events A 1-Year Follow-up, NEUROLOGY, Vol: 100, Pages: E408-E421, ISSN: 0028-3878

Journal article

Malik A, Drumm B, D'Anna L, Brooks I, Low B, Raha O, Shabbir K, Vittay O, Kwan J, Brown Z, Halse O, Jamil S, Kalladka D, Venter M, Jenkins H, Rane N, Singh A, Patel M, Hall C, Fatania G, Roi D, Lobotesis K, Banerjee Set al., 2022, Mechanical thrombectomy in acute basilar artery stroke: a systematic review and Meta-analysis of randomized controlled trials (vol 22, 415, 2022), BMC NEUROLOGY, Vol: 22

Journal article

Mahmud M, Saad AR, Hadi Z, Elliot J, Prendergast M, Kwan J, Seemungal Bet al., 2022, Prevalence of stroke in acute vertigo presentations: A UK tertiary stroke centre perspective, Journal of the Neurological Sciences, Vol: 442, Pages: 1-7, ISSN: 0022-510X

Journal article

Malik A, Drumm B, D'Anna L, Brooks I, Low B, Raha O, Shabbir K, Vittay O, Kwan J, Brown Z, Halse O, Jamil S, Kalladka D, Venter M, Jenkins H, Rane N, Singh A, Patel M, Hall C, Fatania G, Roi D, Lobotesis K, Banerjee Set al., 2022, Mechanical thrombectomy in acute basilar artery stroke: a systematic review and Meta-analysis of randomized controlled trials, BMC Neurology, Vol: 22, ISSN: 1471-2377

Background:The evidence for mechanical thrombectomy in acute basilar artery occlusion has until now remained inconclusive with basilar artery strokes associated with high rates of death and disability. This systematic review and meta-analysis will summarize the available evidence for the effectiveness of mechanical thrombectomy in acute basilar artery occlusion compared to best medical therapy.Methods:We conducted a systematic review and meta-analysis of randomized controlled trials using Embase, Medline and the Cochrane Central Register of Controlled Trials (CENTRAL). We calculated risk ratios (RRs) and 95% confidence intervals (CIs) to summarize the effect estimates for each outcome.Results:We performed a random effects (Mantel-Haenszel) meta-analysis of the four included randomized controlled trials comprising a total of 988 participants. We found a statistically significant improvement in the rates of those with a good functional outcome (mRS 0–3, RR 1.54, 1.16–2.06, p = 0.003) and functional independence (mRS 0–2, RR 1.69, 1.05–2.71, p = 0.03) in those who were treated with thrombectomy when compared to best medical therapy alone. Thrombectomy was associated with a higher level of sICH (RR 7.12, 2.16–23.54, p = 0.001) but this was not reflected in a higher mortality rate, conversely the mortality rate was significantly lower in the intervention group (RR 0.76, 0.65–0.89, p = 0.0004).Conclusions:Our meta-analysis of the recently presented randomized controlled studies is the first to confirm the disability and mortality benefit of mechanical thrombectomy in basilar artery stroke.

Journal article

Liu X, Ip MS-M, Lau KK, Lam DC-L, Lee TM-C, Kwan J, Chan KPFet al., 2022, Impact of Sleep Disturbances on Longitudinal Cognitive Performance in Patients with Transient Ischemic Attack and Minor Stroke, Publisher: KARGER, Pages: 110-111, ISSN: 1015-9770

Conference paper

Wong MN, Baig FN, Chan YK, Ng ML, Zhu FF, Kwan JSKet al., 2022, Transcranial direct current stimulation over the primary motor cortex improves speech production in post-stroke dysarthric speakers: A randomized pilot study, PLOS ONE, Vol: 17, ISSN: 1932-6203

Journal article

Cheung EYW, Chau ACM, Shea Y-F, Chiu PKC, Kwan JSK, Mak HKFet al., 2022, Level of Amyloid-β (Aβ) Binding Leading to Differential Effects on Resting State Functional Connectivity in Major Brain Networks, BIOMEDICINES, Vol: 10

Journal article

Bao Y-W, Shea Y-F, Chiu PK-C, Kwan JSK, Chan FH-W, Chow W-S, Chan K-H, Mak HK-Fet al., 2022, The fractional amplitude of low-frequency fluctuations signals related to amyloid uptake in high-risk populations-A pilot fMRI study, FRONTIERS IN AGING NEUROSCIENCE, Vol: 14, ISSN: 1663-4365

Journal article

Chen X-K, Kwan JS-K, Wong GT-C, Yi Z-N, Chun-Hang A, Chang RC-Cet al., 2022, Leukocyte invasion of the brain after peripheral trauma in zebrafish (<i>Danio rerio</i>), EXPERIMENTAL AND MOLECULAR MEDICINE, Vol: 54, Pages: 973-987, ISSN: 1226-3613

Journal article

Nguyen TN, Qureshi MM, Klein P, Yamagami H, Abdalkader M, Mikulik R, Sathya A, Mansour OY, Czlonkowska A, Lo H, Field TS, Charidimou A, Banerjee S, Yaghi S, Siegler JE, Sedova P, Kwan J, de Sousa DA, Demeestere J, Inoa V, Omran SS, Zhang L, Michel P, Strambo D, Marto JP, Nogueira RGet al., 2022, Global Impact of the COVID-19 Pandemic on Cerebral Venous Thrombosis and Mortality, JOURNAL OF STROKE, Vol: 24, Pages: 256-+, ISSN: 2287-6391

Journal article

Arias-Colinas M, Gea A, Khattab A, Vassallo M, Allen SC, Kwan Jet al., 2022, The Association between Inflammatory Biomarkers and Cardiovascular Autonomic Dysfunction after Bacterial Infection, APPLIED SCIENCES-BASEL, Vol: 12

Journal article

Wong CK, Huang D, Zhou M, Hai J, Yue WS, Li W-H, Yin L-X, Zuo M-L, Feng YQ, Tan N, Chen JY, Kwan J, Siu CWet al., 2022, Antithrombotic therapy and the risk of new-onset dementia in elderly patients with atrial fibrillation, POSTGRADUATE MEDICAL JOURNAL, Vol: 98, Pages: 98-103, ISSN: 0032-5473

Journal article

Lam K, Kwan JSK, Kwan CW, Chi Iet al., 2022, Factors Associated with Development of New Joint Contractures in Long-Term Care Residents, JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION, Vol: 23, Pages: 92-97, ISSN: 1525-8610

Journal article

Chang RS, Leung WCY, Vassallo M, Sykes L, Wood EB, Kwan Jet al., 2022, Antiepileptic drugs for the primary and secondary prevention of seizures after stroke, COCHRANE DATABASE OF SYSTEMATIC REVIEWS, ISSN: 1469-493X

Journal article

Kwan J, Hafdi M, Chiang LLW, Myint PK, Wong LS, Quinn TJet al., 2022, Antithrombotic therapy to prevent cognitive decline in people with small vessel disease on neuroimaging but without dementia, COCHRANE DATABASE OF SYSTEMATIC REVIEWS, ISSN: 1469-493X

Journal article

Cheung EYW, Shea YF, Chiu PKC, Kwan J, Mak HKFet al., 2021, Diagnostic Efficacy of Voxel-Mirrored Homotopic Connectivity in Vascular Dementia as Compared to Alzheimer’s Related Neurodegenerative Diseases—A Resting State fMRI Study, Life, Vol: 11, Pages: 1108-1108

<jats:p>Previous studies have demonstrated that functional connectivity (FC) of different brain regions in resting state function MRI were abnormal in patients suffering from mild cognitive impairment (MCI) and Alzheimer’s disease (AD) when comparing to healthy controls (HC) using seed based, independent component analysis (ICA) or small world network techniques. A new technique called voxel-mirrored homotopic connectivity (VMHC) was used in the current study to evaluate the value of interhemispheric functional connectivity (IFC) as a diagnostic tool to differentiate vascular dementia (VD) from other Alzheimer’s related neurodegenerative diseases. Eighty-three participants were recruited from the university hospital memory clinic. A multidisciplinary panel formed by a neuroradiologist and two geriatricians classified the participants into VD (13), AD (16), MCI (29), and HC (25) based on clinical history, Montreal Cognitive Assessment Hong Kong version (HK‑MoCA) neuropsychological score, structural MRI, MR perfusion, and 18-F Flutametamol (amyloid) PET-CT findings of individual subjects. We adopted the calculation method used by Kelly et al. (2011) and Zuo et al. (2010) in obtaining VMHC maps. Specific patterns of VMHC maps were obtained for VD, AD, and MCI to HC comparison. VD showed significant reduction in VMHC in frontal orbital gyrus and gyrus rectus. Increased VMHC was observed in default mode network (DMN), executive control network (ECN), and the remaining salient network (SN) regions. AD showed a reduction of IFC in all DMN, ECN, and SN regions; whereas MCI showed VMHC reduction in vSN, and increased VMHC in DMN and ECN. When combining VMHC values of relevant brain regions, the accuracy was improved to 87%, 92%, and 83% for VD, AD, and MCI from HC, respectively, in receiver operating characteristic (ROC) analysis. Through studying the VMHC maps and using VMHC values in relevant brain regions, VMHC can be considered as a reliable diagnostic

Journal article

D'Anna L, Ellis N, Bentley P, Brown Z, Halse O, Jamil S, Jenkins H, Malik A, Kalladka D, Kwan J, Venter M, Banerjee Set 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.

Journal article

Nogueira RG, Qureshi MM, Abdalkader M, Martins SO, Yamagami H, Qiu Z, Mansour OY, Sathya A, Czlonkowska A, Tsivgoulis G, Aguiar de Sousa D, Demeestere J, Mikulik R, Vanacker P, Siegler JE, Kõrv J, Biller J, Liang CW, Sangha NS, Zha AM, Czap AL, Holmstedt CA, Turan TN, Ntaios G, Malhotra K, Tayal A, Loochtan A, Ranta A, Mistry EA, Alexandrov AW, Huang DY, Yaghi S, Raz E, Sheth SA, Mohammaden MH, Frankel M, Bila Lamou EG, Aref HM, Elbassiouny A, Hassan F, Menecie T, Mustafa W, Shokri HM, Roushdy T, Sarfo FS, Alabi TO, Arabambi B, Nwazor EO, Sunmonu TA, Wahab K, Yaria J, Mohammed HH, Adebayo PB, Riahi AD, Sassi SB, Gwaunza L, Ngwende GW, Sahakyan D, Rahman A, Ai Z, Bai F, Duan Z, Hao Y, Huang W, Li G, Li W, Liu G, Luo J, Shang X, Sui Y, Tian L, Wen H, Wu B, Yan Y, Yuan Z, Zhang H, Zhang J, Zhao W, Zi W, Leung TW, Chugh C, Huded V, Menon B, Pandian JD, Sylaja PN, Usman FS, Farhoudi M, Hokmabadi ES, Horev A, Reznik A, Sivan Hoffmann R, Ohara N, Sakai N, Watanabe D, Yamamoto R, Doijiri R, Tokuda N, Yamada T, Terasaki T, Yazawa Y, Uwatoko T, Dembo T, Shimizu H, Sugiura Y, Miyashita F, Fukuda H, Miyake K, Shimbo J, Sugimura Y, Yagita Y, Takenobu Y, Matsumaru Y, Yamada S, Kono R, Kanamaru T, Yamazaki H, Sakaguchi M, Todo K, Yamamoto N, Sonoda K, Yoshida T, Hashimoto H, Nakahara I, Kondybayeva A, Faizullina K, Kamenova S, Zhanuzakov M, Baek J-H, Hwang Y, Lee JS, Lee SB, Moon J, Park H, Seo JH, Seo K-D, Sohn SI, Young CJ, Ahdab R, Wan Zaidi WA, Aziz ZA, Basri HB, Chung LW, Ibrahim AB, Ibrahim KA, Looi I, Tan WY, Yahya NW, Groppa S, Leahu P, Al Hashmi AM, Imam YZ, Akhtar N, Pineda-Franks MC, Co CO, Kandyba D, Alhazzani A, Al-Jehani H, Tham CH, Mamauag MJ, Venketasubramanian N, Chen C-H, Tang S-C, Churojana A, Akil E, Aykaç Ö, Ozdemir AO, Giray S, Hussain SI, John S, Le Vu H, Tran AD, Nguyen HH, Nhu Pham T, Nguyen TH, Nguyen TQ, Gattringer T, Enzinger C, Killer-Oberpfalzer M, Bellante F, De Blauwe S, Vanhooren G, De Raedt S, Dusart A, Lemmens R, Ligot N, Pierre Rutgers M, Yperzeet al., 2021, Global Impact of COVID-19 on Stroke Care and IV Thrombolysis., Neurology, Vol: 96, Pages: e2824-e2838

OBJECTIVE: To measure the global impact of COVID-19 pandemic on volumes of IV thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with 2 control 4-month periods. METHODS: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. RESULTS: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95% confidence interval [CI] -11.7 to -11.3, p < 0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95% CI -13.8 to -12.7, p < 0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95% CI -13.7 to -10.3, p = 0.001). Recovery of stroke hospitalization volume (9.5%, 95% CI 9.2-9.8, p < 0.0001) was noted over the 2 later (May, June) vs the 2 earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was noted in 3.3% (1,722/52,026) of all stroke admissions. CONCLUSIONS: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID-19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months.

Journal article

Best JG, Ambler G, Wilson D, Lee K-J, Lim J-S, Shiozawa M, Koga M, Li L, Lovelock C, Chabriat H, Hennerici M, Wong YK, Mak HKF, Prats-Sanchez L, Martinez-Domeno A, Inamura S, Yoshifuji K, Arsava EM, Horstmann S, Purrucker J, Lam BYK, Wong A, Kim YD, Song T-J, Lemmens R, Eppinger S, Gattringer T, Uysal E, Tanriverdi Z, Bornstein NM, Ben Assayag E, Hallevi H, Molad J, Nishihara M, Tanaka J, Coutts SB, Polymeris A, Wagner B, Seiffge DJ, Lyrer P, Algra A, Kappelle LJ, Salman RA-S, Jager HR, Lip GYH, Fischer U, El-Koussy M, Mas J-L, Legrand L, Karayiannis C, Thanh P, Gunkel S, Christ N, Abrigo J, Leung T, Chu W, Chappell F, Makin S, Hayden D, Williams DJ, Mess WH, Nederkoorn PJ, Barbato C, Browning S, Wiegertjes K, Tuladhar AM, Maaijwee N, Guevarra AC, Yatawara C, Mendyk A-M, Delmaire C, Kohler S, van Oostenbrugge R, Zhou Y, Xu C, Hilal S, Gyanwali B, Chen C, Lou M, Staals J, Bordet R, Kandiah N, de Leeuw F-E, Simister R, Hendrikse J, Kelly PJ, Wardlaw J, Soo Y, Fluri F, Srikanth V, Calvet D, Jung S, Kwa VIH, Engelter ST, Peters N, Smith EE, Hara H, Yakushiji Y, Orken DN, Fazekas F, Thijs V, Heo JH, Mok V, Veltkamp R, Ay H, Imaizumi T, Gomez-Anson B, Lau KK, Jouvent E, Rothwell PM, Toyoda K, Bae H-J, Marti-Fabregas J, Werring DJet al., 2021, Development of imaging-based risk scores for prediction of intracranial haemorrhage and ischaemic stroke in patients taking antithrombotic therapy after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies, Lancet Neurology, Vol: 20, Pages: 294-303, ISSN: 1474-4422

BackgroundBalancing the risks of recurrent ischaemic stroke and intracranial haemorrhage is important for patients treated with antithrombotic therapy after ischaemic stroke or transient ischaemic attack. However, existing predictive models offer insufficient performance, particularly for assessing the risk of intracranial haemorrhage. We aimed to develop new risk scores incorporating clinical variables and cerebral microbleeds, an MRI biomarker of intracranial haemorrhage and ischaemic stroke risk.MethodsWe did a pooled analysis of individual-patient data from the Microbleeds International Collaborative Network (MICON), which includes 38 hospital-based prospective cohort studies from 18 countries. All studies recruited participants with previous ischaemic stroke or transient ischaemic attack, acquired baseline MRI allowing quantification of cerebral microbleeds, and followed-up participants for ischaemic stroke and intracranial haemorrhage. Participants not taking antithrombotic drugs were excluded. We developed Cox regression models to predict the 5-year risks of intracranial haemorrhage and ischaemic stroke, selecting candidate predictors on biological relevance and simplifying models using backward elimination. We derived integer risk scores for clinical use. We assessed model performance in internal validation, adjusted for optimism using bootstrapping. The study is registered on PROSPERO, CRD42016036602.FindingsThe included studies recruited participants between Aug 28, 2001, and Feb 4, 2018. 15 766 participants had follow-up for intracranial haemorrhage, and 15 784 for ischaemic stroke. Over a median follow-up of 2 years, 184 intracranial haemorrhages and 1048 ischaemic strokes were reported. The risk models we developed included cerebral microbleed burden and simple clinical variables. Optimism-adjusted c indices were 0·73 (95% CI 0·69–0·77) with a calibration slope of 0·94 (0·81–1·06) for the intracrania

Journal article

Kwan J, Brown M, Bentley P, D'Anna L, Hall C, Halse O, Jamil S, Jenkins H, Kalladka D, Patel M, Rane N, Singh A, Venter M, Lobotesis K, Banerjee Set 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.

Journal article

Drumm B, Bentley P, Brown Z, D’Anna L, Dolkar T, Halse O, Jamil SA, Jenkins H, Kalladka D, Venter M, Banerjee S, Kwan Jet 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

Conference paper

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