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Abstract

Background and Objectives

Endovascular thrombectomy (EVT) is effective for patients with large vessel occlusion (LVO) stroke with smaller volumes of CT perfusion (CTP)-defined ischemic core. However, the benefit of EVT is unclear in those with a core volume >70 mL. We aimed to compare outcomes of EVT and non-EVT patients with an ischemic core volume ≥70 mL, hypothesizing that there would be a benefit from EVT for fair outcome (3-month modified Rankin scale [mRS] 0–3) after stroke.

Methods

A retrospective analysis of patients enrolled into a multicenter (Australia, China, and Canada) registry (2012–2020) who underwent CTP within 24 hours of stroke onset and had a baseline ischemic core volume ≥70 mL was performed. The primary outcome was the estimation of the association of EVT in patients with core volume ≥70 mL and within 70–100 and ≥100 mL subgroups with fair outcome.

Results

Of the 3,283 patients in the registry, 299 had CTP core volume ≥70 mL and 269 complete data (135 had core volume between 70 and 100 mL and 134 had core volume ≥100 mL). EVT was performed in 121 (45%) patients. EVT-treated patients were younger (median 69 vs 75 years; p = 0.011), had lower prestroke mRS, and smaller median core volumes (92 [79–116.5] mL vs 105.5 [85.75–138] mL, p = 0.004). EVT-treated patients had higher odds of achieving fair outcome in adjusted analysis (30% vs 13.9% in the non-EVT group; adjusted odds ratio [aOR] 2.1, 95% CI 1–4.2, p = 0.038). The benefit was seen predominantly in those with 70–100 mL core volume (71/135 [52.6%] EVT-treated), with 54.3% in the EVT-treated vs 21% in the non-EVT group achieving a fair outcome (aOR 2.5, 95% CI 1–6.2, p = 0.005). Of those with a core volume ≥100 mL, 50 of the 134 (37.3%) underwent EVT. Proportions of fair outcome were very low in both groups (8.1% vs 8.7%; p = 0.908).

Discussion

We found a positive association of EVT with the 3-month outcome after stroke in patients with a baseline CTP ischemic core volume 70–100 mL but not in those with core volume ≥100 mL. Randomized data to confirm these findings are required.

Classification of Evidence

This study provides Class III evidence that EVT is associated with better motor outcomes 3 months after CTP-defined ischemic stroke with a core volume of 70–100 mL.

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Letters to the Editor

Information & Authors

Information

Published In

Neurology®
Volume 99Number 13September 27, 2022
Pages: e1345-e1355
PubMed: 35803723

Publication History

Received: November 22, 2021
Accepted: May 16, 2022
Published online: July 8, 2022
Published in print: September 27, 2022

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Disclosure

M.W. Parsons reported research partnership with Apollo Medical Imaging (discounted software for clinical trials). The other authors report no relevant disclosures. Go to Neurology.org/N for full disclosures.

Study Funding

This study was funded by the National Health and Medical Research Council Program Grant (ID 1113352) and the Sylvia and Charles Viertel Charitable Foundation.

Authors

Affiliations & Disclosures

Carlos Garcia-Esperon, PhD https://orcid.org/0000-0001-8843-5890
From the Department of Neurology (C.G.-E., F.M., N.J.S., C.R.L.), John Hunter Hospital, New Lambton Heights; College of Health, Medicine, and Wellbeing (C.G.-E., F.M., N.J.S., C.R.L., M.W.P.), University of Newcastle; Hunter Medical Research Institute (C.G.-E., C.C., L.L., F.M., N.J.S., C.R.L., M.W.P.), Newcastle; Melbourne Brain Center at the Royal Melbourne Hospital (A.B., H.J., L.C., M.W.P.), University of Melbourne, Parkville; Melbourne Medical School (H.J., L.C.), University of Melbourne, Victoria; Prince of Wales Clinical School (K.B.), University of New South Wales, Sydney; Royal Adelaide Hospital (T.J.K.); Box Hill Hospital (P.M.C.C.), Melbourne; Eastern Health Clinical School (P.M.C.C.), Monash University, Melbourne, Australia; Huashan Hospital (X.C., Q.D.), Fudan University, Shanghai, China; Neuroradiology Section (R.I.A.), Department of Radiology, The Ottawa Hospital and University of Ottawa, Ontario, Canada; and Department of Neurology (L.L., M.W.P.), Liverpool Hospital, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Australia.
Disclosure
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1.
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1.
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From the Department of Neurology (C.G.-E., F.M., N.J.S., C.R.L.), John Hunter Hospital, New Lambton Heights; College of Health, Medicine, and Wellbeing (C.G.-E., F.M., N.J.S., C.R.L., M.W.P.), University of Newcastle; Hunter Medical Research Institute (C.G.-E., C.C., L.L., F.M., N.J.S., C.R.L., M.W.P.), Newcastle; Melbourne Brain Center at the Royal Melbourne Hospital (A.B., H.J., L.C., M.W.P.), University of Melbourne, Parkville; Melbourne Medical School (H.J., L.C.), University of Melbourne, Victoria; Prince of Wales Clinical School (K.B.), University of New South Wales, Sydney; Royal Adelaide Hospital (T.J.K.); Box Hill Hospital (P.M.C.C.), Melbourne; Eastern Health Clinical School (P.M.C.C.), Monash University, Melbourne, Australia; Huashan Hospital (X.C., Q.D.), Fudan University, Shanghai, China; Neuroradiology Section (R.I.A.), Department of Radiology, The Ottawa Hospital and University of Ottawa, Ontario, Canada; and Department of Neurology (L.L., M.W.P.), Liverpool Hospital, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Australia.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
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1.
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Research Support, Government Entities:
1.
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1.
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1.
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1.
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From the Department of Neurology (C.G.-E., F.M., N.J.S., C.R.L.), John Hunter Hospital, New Lambton Heights; College of Health, Medicine, and Wellbeing (C.G.-E., F.M., N.J.S., C.R.L., M.W.P.), University of Newcastle; Hunter Medical Research Institute (C.G.-E., C.C., L.L., F.M., N.J.S., C.R.L., M.W.P.), Newcastle; Melbourne Brain Center at the Royal Melbourne Hospital (A.B., H.J., L.C., M.W.P.), University of Melbourne, Parkville; Melbourne Medical School (H.J., L.C.), University of Melbourne, Victoria; Prince of Wales Clinical School (K.B.), University of New South Wales, Sydney; Royal Adelaide Hospital (T.J.K.); Box Hill Hospital (P.M.C.C.), Melbourne; Eastern Health Clinical School (P.M.C.C.), Monash University, Melbourne, Australia; Huashan Hospital (X.C., Q.D.), Fudan University, Shanghai, China; Neuroradiology Section (R.I.A.), Department of Radiology, The Ottawa Hospital and University of Ottawa, Ontario, Canada; and Department of Neurology (L.L., M.W.P.), Liverpool Hospital, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Australia.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
From the Department of Neurology (C.G.-E., F.M., N.J.S., C.R.L.), John Hunter Hospital, New Lambton Heights; College of Health, Medicine, and Wellbeing (C.G.-E., F.M., N.J.S., C.R.L., M.W.P.), University of Newcastle; Hunter Medical Research Institute (C.G.-E., C.C., L.L., F.M., N.J.S., C.R.L., M.W.P.), Newcastle; Melbourne Brain Center at the Royal Melbourne Hospital (A.B., H.J., L.C., M.W.P.), University of Melbourne, Parkville; Melbourne Medical School (H.J., L.C.), University of Melbourne, Victoria; Prince of Wales Clinical School (K.B.), University of New South Wales, Sydney; Royal Adelaide Hospital (T.J.K.); Box Hill Hospital (P.M.C.C.), Melbourne; Eastern Health Clinical School (P.M.C.C.), Monash University, Melbourne, Australia; Huashan Hospital (X.C., Q.D.), Fudan University, Shanghai, China; Neuroradiology Section (R.I.A.), Department of Radiology, The Ottawa Hospital and University of Ottawa, Ontario, Canada; and Department of Neurology (L.L., M.W.P.), Liverpool Hospital, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Australia.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
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1.
NONE
Legal Proceedings:
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Leonid Churilov, PhD
From the Department of Neurology (C.G.-E., F.M., N.J.S., C.R.L.), John Hunter Hospital, New Lambton Heights; College of Health, Medicine, and Wellbeing (C.G.-E., F.M., N.J.S., C.R.L., M.W.P.), University of Newcastle; Hunter Medical Research Institute (C.G.-E., C.C., L.L., F.M., N.J.S., C.R.L., M.W.P.), Newcastle; Melbourne Brain Center at the Royal Melbourne Hospital (A.B., H.J., L.C., M.W.P.), University of Melbourne, Parkville; Melbourne Medical School (H.J., L.C.), University of Melbourne, Victoria; Prince of Wales Clinical School (K.B.), University of New South Wales, Sydney; Royal Adelaide Hospital (T.J.K.); Box Hill Hospital (P.M.C.C.), Melbourne; Eastern Health Clinical School (P.M.C.C.), Monash University, Melbourne, Australia; Huashan Hospital (X.C., Q.D.), Fudan University, Shanghai, China; Neuroradiology Section (R.I.A.), Department of Radiology, The Ottawa Hospital and University of Ottawa, Ontario, Canada; and Department of Neurology (L.L., M.W.P.), Liverpool Hospital, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Australia.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
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1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
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1.
NONE
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1.
NONE
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Longting Lin, PhD
From the Department of Neurology (C.G.-E., F.M., N.J.S., C.R.L.), John Hunter Hospital, New Lambton Heights; College of Health, Medicine, and Wellbeing (C.G.-E., F.M., N.J.S., C.R.L., M.W.P.), University of Newcastle; Hunter Medical Research Institute (C.G.-E., C.C., L.L., F.M., N.J.S., C.R.L., M.W.P.), Newcastle; Melbourne Brain Center at the Royal Melbourne Hospital (A.B., H.J., L.C., M.W.P.), University of Melbourne, Parkville; Melbourne Medical School (H.J., L.C.), University of Melbourne, Victoria; Prince of Wales Clinical School (K.B.), University of New South Wales, Sydney; Royal Adelaide Hospital (T.J.K.); Box Hill Hospital (P.M.C.C.), Melbourne; Eastern Health Clinical School (P.M.C.C.), Monash University, Melbourne, Australia; Huashan Hospital (X.C., Q.D.), Fudan University, Shanghai, China; Neuroradiology Section (R.I.A.), Department of Radiology, The Ottawa Hospital and University of Ottawa, Ontario, Canada; and Department of Neurology (L.L., M.W.P.), Liverpool Hospital, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Australia.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
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Kenneth Butcher, PhD
From the Department of Neurology (C.G.-E., F.M., N.J.S., C.R.L.), John Hunter Hospital, New Lambton Heights; College of Health, Medicine, and Wellbeing (C.G.-E., F.M., N.J.S., C.R.L., M.W.P.), University of Newcastle; Hunter Medical Research Institute (C.G.-E., C.C., L.L., F.M., N.J.S., C.R.L., M.W.P.), Newcastle; Melbourne Brain Center at the Royal Melbourne Hospital (A.B., H.J., L.C., M.W.P.), University of Melbourne, Parkville; Melbourne Medical School (H.J., L.C.), University of Melbourne, Victoria; Prince of Wales Clinical School (K.B.), University of New South Wales, Sydney; Royal Adelaide Hospital (T.J.K.); Box Hill Hospital (P.M.C.C.), Melbourne; Eastern Health Clinical School (P.M.C.C.), Monash University, Melbourne, Australia; Huashan Hospital (X.C., Q.D.), Fudan University, Shanghai, China; Neuroradiology Section (R.I.A.), Department of Radiology, The Ottawa Hospital and University of Ottawa, Ontario, Canada; and Department of Neurology (L.L., M.W.P.), Liverpool Hospital, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Australia.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
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1.
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1.
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Timothy J. Kleinig, PhD
From the Department of Neurology (C.G.-E., F.M., N.J.S., C.R.L.), John Hunter Hospital, New Lambton Heights; College of Health, Medicine, and Wellbeing (C.G.-E., F.M., N.J.S., C.R.L., M.W.P.), University of Newcastle; Hunter Medical Research Institute (C.G.-E., C.C., L.L., F.M., N.J.S., C.R.L., M.W.P.), Newcastle; Melbourne Brain Center at the Royal Melbourne Hospital (A.B., H.J., L.C., M.W.P.), University of Melbourne, Parkville; Melbourne Medical School (H.J., L.C.), University of Melbourne, Victoria; Prince of Wales Clinical School (K.B.), University of New South Wales, Sydney; Royal Adelaide Hospital (T.J.K.); Box Hill Hospital (P.M.C.C.), Melbourne; Eastern Health Clinical School (P.M.C.C.), Monash University, Melbourne, Australia; Huashan Hospital (X.C., Q.D.), Fudan University, Shanghai, China; Neuroradiology Section (R.I.A.), Department of Radiology, The Ottawa Hospital and University of Ottawa, Ontario, Canada; and Department of Neurology (L.L., M.W.P.), Liverpool Hospital, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Australia.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
From the Department of Neurology (C.G.-E., F.M., N.J.S., C.R.L.), John Hunter Hospital, New Lambton Heights; College of Health, Medicine, and Wellbeing (C.G.-E., F.M., N.J.S., C.R.L., M.W.P.), University of Newcastle; Hunter Medical Research Institute (C.G.-E., C.C., L.L., F.M., N.J.S., C.R.L., M.W.P.), Newcastle; Melbourne Brain Center at the Royal Melbourne Hospital (A.B., H.J., L.C., M.W.P.), University of Melbourne, Parkville; Melbourne Medical School (H.J., L.C.), University of Melbourne, Victoria; Prince of Wales Clinical School (K.B.), University of New South Wales, Sydney; Royal Adelaide Hospital (T.J.K.); Box Hill Hospital (P.M.C.C.), Melbourne; Eastern Health Clinical School (P.M.C.C.), Monash University, Melbourne, Australia; Huashan Hospital (X.C., Q.D.), Fudan University, Shanghai, China; Neuroradiology Section (R.I.A.), Department of Radiology, The Ottawa Hospital and University of Ottawa, Ontario, Canada; and Department of Neurology (L.L., M.W.P.), Liverpool Hospital, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Australia.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
From the Department of Neurology (C.G.-E., F.M., N.J.S., C.R.L.), John Hunter Hospital, New Lambton Heights; College of Health, Medicine, and Wellbeing (C.G.-E., F.M., N.J.S., C.R.L., M.W.P.), University of Newcastle; Hunter Medical Research Institute (C.G.-E., C.C., L.L., F.M., N.J.S., C.R.L., M.W.P.), Newcastle; Melbourne Brain Center at the Royal Melbourne Hospital (A.B., H.J., L.C., M.W.P.), University of Melbourne, Parkville; Melbourne Medical School (H.J., L.C.), University of Melbourne, Victoria; Prince of Wales Clinical School (K.B.), University of New South Wales, Sydney; Royal Adelaide Hospital (T.J.K.); Box Hill Hospital (P.M.C.C.), Melbourne; Eastern Health Clinical School (P.M.C.C.), Monash University, Melbourne, Australia; Huashan Hospital (X.C., Q.D.), Fudan University, Shanghai, China; Neuroradiology Section (R.I.A.), Department of Radiology, The Ottawa Hospital and University of Ottawa, Ontario, Canada; and Department of Neurology (L.L., M.W.P.), Liverpool Hospital, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Australia.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Qiang Dong, PhD
From the Department of Neurology (C.G.-E., F.M., N.J.S., C.R.L.), John Hunter Hospital, New Lambton Heights; College of Health, Medicine, and Wellbeing (C.G.-E., F.M., N.J.S., C.R.L., M.W.P.), University of Newcastle; Hunter Medical Research Institute (C.G.-E., C.C., L.L., F.M., N.J.S., C.R.L., M.W.P.), Newcastle; Melbourne Brain Center at the Royal Melbourne Hospital (A.B., H.J., L.C., M.W.P.), University of Melbourne, Parkville; Melbourne Medical School (H.J., L.C.), University of Melbourne, Victoria; Prince of Wales Clinical School (K.B.), University of New South Wales, Sydney; Royal Adelaide Hospital (T.J.K.); Box Hill Hospital (P.M.C.C.), Melbourne; Eastern Health Clinical School (P.M.C.C.), Monash University, Melbourne, Australia; Huashan Hospital (X.C., Q.D.), Fudan University, Shanghai, China; Neuroradiology Section (R.I.A.), Department of Radiology, The Ottawa Hospital and University of Ottawa, Ontario, Canada; and Department of Neurology (L.L., M.W.P.), Liverpool Hospital, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Australia.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
From the Department of Neurology (C.G.-E., F.M., N.J.S., C.R.L.), John Hunter Hospital, New Lambton Heights; College of Health, Medicine, and Wellbeing (C.G.-E., F.M., N.J.S., C.R.L., M.W.P.), University of Newcastle; Hunter Medical Research Institute (C.G.-E., C.C., L.L., F.M., N.J.S., C.R.L., M.W.P.), Newcastle; Melbourne Brain Center at the Royal Melbourne Hospital (A.B., H.J., L.C., M.W.P.), University of Melbourne, Parkville; Melbourne Medical School (H.J., L.C.), University of Melbourne, Victoria; Prince of Wales Clinical School (K.B.), University of New South Wales, Sydney; Royal Adelaide Hospital (T.J.K.); Box Hill Hospital (P.M.C.C.), Melbourne; Eastern Health Clinical School (P.M.C.C.), Monash University, Melbourne, Australia; Huashan Hospital (X.C., Q.D.), Fudan University, Shanghai, China; Neuroradiology Section (R.I.A.), Department of Radiology, The Ottawa Hospital and University of Ottawa, Ontario, Canada; and Department of Neurology (L.L., M.W.P.), Liverpool Hospital, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Australia.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Ferdinand Miteff, MD
From the Department of Neurology (C.G.-E., F.M., N.J.S., C.R.L.), John Hunter Hospital, New Lambton Heights; College of Health, Medicine, and Wellbeing (C.G.-E., F.M., N.J.S., C.R.L., M.W.P.), University of Newcastle; Hunter Medical Research Institute (C.G.-E., C.C., L.L., F.M., N.J.S., C.R.L., M.W.P.), Newcastle; Melbourne Brain Center at the Royal Melbourne Hospital (A.B., H.J., L.C., M.W.P.), University of Melbourne, Parkville; Melbourne Medical School (H.J., L.C.), University of Melbourne, Victoria; Prince of Wales Clinical School (K.B.), University of New South Wales, Sydney; Royal Adelaide Hospital (T.J.K.); Box Hill Hospital (P.M.C.C.), Melbourne; Eastern Health Clinical School (P.M.C.C.), Monash University, Melbourne, Australia; Huashan Hospital (X.C., Q.D.), Fudan University, Shanghai, China; Neuroradiology Section (R.I.A.), Department of Radiology, The Ottawa Hospital and University of Ottawa, Ontario, Canada; and Department of Neurology (L.L., M.W.P.), Liverpool Hospital, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Australia.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Neil J. Spratt, PhD
From the Department of Neurology (C.G.-E., F.M., N.J.S., C.R.L.), John Hunter Hospital, New Lambton Heights; College of Health, Medicine, and Wellbeing (C.G.-E., F.M., N.J.S., C.R.L., M.W.P.), University of Newcastle; Hunter Medical Research Institute (C.G.-E., C.C., L.L., F.M., N.J.S., C.R.L., M.W.P.), Newcastle; Melbourne Brain Center at the Royal Melbourne Hospital (A.B., H.J., L.C., M.W.P.), University of Melbourne, Parkville; Melbourne Medical School (H.J., L.C.), University of Melbourne, Victoria; Prince of Wales Clinical School (K.B.), University of New South Wales, Sydney; Royal Adelaide Hospital (T.J.K.); Box Hill Hospital (P.M.C.C.), Melbourne; Eastern Health Clinical School (P.M.C.C.), Monash University, Melbourne, Australia; Huashan Hospital (X.C., Q.D.), Fudan University, Shanghai, China; Neuroradiology Section (R.I.A.), Department of Radiology, The Ottawa Hospital and University of Ottawa, Ontario, Canada; and Department of Neurology (L.L., M.W.P.), Liverpool Hospital, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Australia.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Christopher R. Levi, PhD
From the Department of Neurology (C.G.-E., F.M., N.J.S., C.R.L.), John Hunter Hospital, New Lambton Heights; College of Health, Medicine, and Wellbeing (C.G.-E., F.M., N.J.S., C.R.L., M.W.P.), University of Newcastle; Hunter Medical Research Institute (C.G.-E., C.C., L.L., F.M., N.J.S., C.R.L., M.W.P.), Newcastle; Melbourne Brain Center at the Royal Melbourne Hospital (A.B., H.J., L.C., M.W.P.), University of Melbourne, Parkville; Melbourne Medical School (H.J., L.C.), University of Melbourne, Victoria; Prince of Wales Clinical School (K.B.), University of New South Wales, Sydney; Royal Adelaide Hospital (T.J.K.); Box Hill Hospital (P.M.C.C.), Melbourne; Eastern Health Clinical School (P.M.C.C.), Monash University, Melbourne, Australia; Huashan Hospital (X.C., Q.D.), Fudan University, Shanghai, China; Neuroradiology Section (R.I.A.), Department of Radiology, The Ottawa Hospital and University of Ottawa, Ontario, Canada; and Department of Neurology (L.L., M.W.P.), Liverpool Hospital, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Australia.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Mark W. Parsons, PhD
From the Department of Neurology (C.G.-E., F.M., N.J.S., C.R.L.), John Hunter Hospital, New Lambton Heights; College of Health, Medicine, and Wellbeing (C.G.-E., F.M., N.J.S., C.R.L., M.W.P.), University of Newcastle; Hunter Medical Research Institute (C.G.-E., C.C., L.L., F.M., N.J.S., C.R.L., M.W.P.), Newcastle; Melbourne Brain Center at the Royal Melbourne Hospital (A.B., H.J., L.C., M.W.P.), University of Melbourne, Parkville; Melbourne Medical School (H.J., L.C.), University of Melbourne, Victoria; Prince of Wales Clinical School (K.B.), University of New South Wales, Sydney; Royal Adelaide Hospital (T.J.K.); Box Hill Hospital (P.M.C.C.), Melbourne; Eastern Health Clinical School (P.M.C.C.), Monash University, Melbourne, Australia; Huashan Hospital (X.C., Q.D.), Fudan University, Shanghai, China; Neuroradiology Section (R.I.A.), Department of Radiology, The Ottawa Hospital and University of Ottawa, Ontario, Canada; and Department of Neurology (L.L., M.W.P.), Liverpool Hospital, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Australia.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
on behalf of the INSPIRE Study group
From the Department of Neurology (C.G.-E., F.M., N.J.S., C.R.L.), John Hunter Hospital, New Lambton Heights; College of Health, Medicine, and Wellbeing (C.G.-E., F.M., N.J.S., C.R.L., M.W.P.), University of Newcastle; Hunter Medical Research Institute (C.G.-E., C.C., L.L., F.M., N.J.S., C.R.L., M.W.P.), Newcastle; Melbourne Brain Center at the Royal Melbourne Hospital (A.B., H.J., L.C., M.W.P.), University of Melbourne, Parkville; Melbourne Medical School (H.J., L.C.), University of Melbourne, Victoria; Prince of Wales Clinical School (K.B.), University of New South Wales, Sydney; Royal Adelaide Hospital (T.J.K.); Box Hill Hospital (P.M.C.C.), Melbourne; Eastern Health Clinical School (P.M.C.C.), Monash University, Melbourne, Australia; Huashan Hospital (X.C., Q.D.), Fudan University, Shanghai, China; Neuroradiology Section (R.I.A.), Department of Radiology, The Ottawa Hospital and University of Ottawa, Ontario, Canada; and Department of Neurology (L.L., M.W.P.), Liverpool Hospital, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Australia.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE

Notes

Correspondence Dr. Garcia-Esperon [email protected]
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
INSPIRE Study Group coinvestigators are listed in the Appendix 2 at the end of the article.
Submitted and externally peer reviewed. The handling editors were José Merino, MD, MPhil, FAAN and Brad Worrall, MD, MSc, FAAN.

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