Table_1_Assessing the diagnostic accuracy of CT perfusion: a systematic review.docx

Background and purposeComputed tomography perfusion (CTP) has successfully extended the time window for reperfusion therapies in ischemic stroke. However, the published perfusion parameters and thresholds vary between studies. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy Studies (PRISMA-DTA) guidelines, we conducted a systematic review to investigate the accuracy of parameters and thresholds for identifying core and penumbra in adult stroke patients.MethodsWe searched Medline, Embase, the Cochrane Library, and reference lists of manuscripts up to April 2022 using the following terms “computed tomography perfusion,” “stroke,” “infarct,” and “penumbra.” Studies were included if they reported perfusion thresholds and undertook co-registration of CTP to reference standards. The quality of studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool and Standards for Reporting of Diagnostic Accuracy (STARD) guidelines.ResultsA total of 24 studies were included. A meta-analysis could not be performed due to insufficient data and significant heterogeneity in the study design. When reported, the mean age was 70.2 years (SD+/−3.69), and the median NIHSS on admission was 15 (IQR 13–17). The perfusion parameter identified for the core was relative cerebral blood flow (rCBF), with a median threshold of ConclusionA single threshold and parameter may not always accurately differentiate penumbra from core and oligemia. Further refinement of parameters is needed in the current era of reperfusion therapy.</p

sj-docx-2-eso-10.1177_23969873241231702 – Supplemental material for Asymptomatic coronary artery disease in ischaemic stroke survivors: A systematic review and meta-analysis

Supplemental material, sj-docx-2-eso-10.1177_23969873241231702 for Asymptomatic coronary artery disease in ischaemic stroke survivors: A systematic review and meta-analysis by Rahul G Muthalaly, Timothy B Abrahams, Nitesh Nerlekar, Adam J Nelson, Sean Tan, Jasmine Chan, Thanh Phan, Henry Ma and Stephen J Nicholls in European Stroke Journal</p

sj-tiff-3-eso-10.1177_23969873241231702 – Supplemental material for Asymptomatic coronary artery disease in ischaemic stroke survivors: A systematic review and meta-analysis

Supplemental material, sj-tiff-3-eso-10.1177_23969873241231702 for Asymptomatic coronary artery disease in ischaemic stroke survivors: A systematic review and meta-analysis by Rahul G Muthalaly, Timothy B Abrahams, Nitesh Nerlekar, Adam J Nelson, Sean Tan, Jasmine Chan, Thanh Phan, Henry Ma and Stephen J Nicholls in European Stroke Journal</p

sj-docx-1-eso-10.1177_23969873241231702 – Supplemental material for Asymptomatic coronary artery disease in ischaemic stroke survivors: A systematic review and meta-analysis

Supplemental material, sj-docx-1-eso-10.1177_23969873241231702 for Asymptomatic coronary artery disease in ischaemic stroke survivors: A systematic review and meta-analysis by Rahul G Muthalaly, Timothy B Abrahams, Nitesh Nerlekar, Adam J Nelson, Sean Tan, Jasmine Chan, Thanh Phan, Henry Ma and Stephen J Nicholls in European Stroke Journal</p

Table_1_Rapid outpatient transient ischemic attack clinic and stroke service activity during the SARS-CoV-2 pandemic: a multicenter time series analysis.docx

Background and aimRapid outpatient evaluation and treatment of TIA in structured clinics have been shown to reduce stroke recurrence. It is unclear whether short-term downtrends in TIA incidence and admissions have had enduring impact on TIA clinic activity. This study aims to measure the impact of the pandemic on hospitals with rapid TIA clinics.MethodsRelevant services were identified by literature search and contacted. Three years of monthly data were requested – a baseline pre-COVID period (April 2018 to March 2020) and an intra-COVID period (April 2020 to March 2021). TIA presentations, ischemic stroke presentations, and reperfusion trends inclusive of IV thrombolysis (IVT) and endovascular thrombectomy (EVT) were recorded. Pandemic impact was measured with interrupted time series analysis, a segmented regression approach to test an effect of an intervention on a time-dependent outcome using a defined impact model.ResultsSix centers provided data for a total of 6,231 TIA and 13,191 ischemic stroke presentations from Australia (52.1%), Canada (35.0%), Italy (7.6%), and England (5.4%). TIA clinic volumes remained constant during the pandemic (2.9, 95% CI –1.8 to 7.6, p = 0.24), as did ischemic stroke (2.9, 95% CI –7.8 to 1.9, p = 0.25), IVT (−14.3, 95% CI −36.7, 6.1, p ConclusionThis suggests that the pandemic has not had an enduring effect on TIA clinic or stroke service activity for these centers. Furthermore, the disproportionate decrease in IVT suggests that patients may be presenting outside the IVT window during the pandemic – delays in seeking treatment in this group could be the target for public health intervention.</p