Browsing by Author "Nguyen, Thanh"
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Publication Did COVID-19 impact stroke services? A multicenter study(2022) Shokri, Hossam; El Nahas, Nevine; El Basiony, Ahmed; Nguyen, Thanh; Abdalkader, Mohamad; Klein, Piers; Lavados, Pablo; Olavarría, Verónica; Amaya, Pablo; Llanos, Natalia; Brola, Waldemar; Michał, Lipowski; Melgarejo, Donoband; Cardozo, Analia; Caballero, Cesar; Pedrozo, Fatima; Rahman, Aminur; Hokmabadi, Elyar; Jalili, Javad; Farhoudi, Mehdi; Aref, Hany; Roushdy, TamerBackground: It has been reported that acute stroke services were compromised during COVID-19 due to various pandemic-related issues. We aimed to investigate these changes by recruiting centers from different countries. Methods: Eight countries participated in this cross-sectional, observational, retrospective study by providing data from their stroke data base. We compared 1 year before to 1 year during COVID-19 as regards onset to door (OTD), door to needle (DTN), door to groin (DTG), duration of hospital stay, National Institute of Health Stroke Scale (NIHSS) at baseline, 24 h, and at discharge as well as modified Rankin score (mRS) on discharge and at 3 months follow-up. Results: During the pandemic year, there was a reduction in the number of patients, median age was significantly lower, admission NIHSS was higher, hemorrhagic stroke increased, and OTD and DTG showed no difference, while DTN time was longer, rtPA administration was decreased, thrombectomy was more frequent, and hospital stay was shorter. mRS was less favorable on discharge and at 3 months. Conclusion: COVID-19 showed variable effects on stroke services. Some were negatively impacted as the number of patients presenting to hospitals, DTN time, and stroke outcome, while others were marginally affected as the type of management.Item Intracranial Angioplasty and Stent Placement After Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) Trial: Present State and Future Considerations(2012) Qureshi, Adnan I.; Al-Senani, Fahmi M.; Husain, Shakir; Janjua, Nazli A.; Lanzino, Giuseppe; Lavados, Pablo; Nguyen, Thanh; Raymond, Jean; Shah, Qaisar A.; Suarez, Jose I.; K. Suri, M. Fareed; Tolun, RehaThe results of prematurely terminated stenting and aggressive medical management for preventing recurrent stroke in intracranial stenosis (SAMMPRIS) due to excessively high rate of stroke and death in patients randomized to intracranial stent placement is expected to affect the practice of endovascular therapy for intracranial atherosclerotic disease. The purpose of this report is to review the components of the designs and methods SAMMPRIS trial and to describe the influence of those components on the interpretation of trial results. METHODS A critical review of the patient population included in SAMMPRIS is conducted with emphasis on “generalizability of results” and “bias due to cherry picking phenomenon.” The technical aspects of endovascular treatment protocol consisting of intracranial angioplasty and stent placement using the Gateway balloon and Wingspan self-expanding nitinol stent and credentialing criteria of trial interventionalists are reviewed. The influence of each component is estimated based on previous literature including multicenter clinical trials reporting on intracranial angioplasty and stent placement. RESULTS The inclusion criteria used in the trial ensured that patients with adverse clinical or angiographic characteristics were excluded. Self-expanding stent as the sole stent, technique of prestent angioplasty, periprocedural antiplatelet treatment, and intraprocedural antico-agulation are unlikely to adversely influence the results of intracranial stent placement. A more permissive policy toward primary angioplasty as an acceptable treatment option may have reduced the overall periprocedural complication rates by providing a safer option in technically challenging lesions. The expected impact of a more rigorous credentialing process on periprocedural stroke and/or death rate following intracranial stent placementin SAMMPRIS such as the one used in carotid revascularization endarterectomy versus stenting trial remains unknown. CONCLUSION The need for developing new and effective treatments for patients with symptomatic in-tracranial stenosis cannot be undermined. The data support modification but not discon-tinuation of our approach to intracranial angioplasty and/or stent placement for intracra-nial stenosis. There are potential patients in whom angioplasty and/or stent placement might be the best approach, and a new trial with appropriate modifications in patient selection and design may be warranted.