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Background and Purpose-Acute rates of recanalization after intravenous (IV) recombinant tissue plasminogen activator (rt-PA) in proximal vessel occlusion have been estimated sparingly, typically using transcranial Doppler (TCD). We aimed to study acute recanalization rates of IV rt-PA in CT angiogram-proven proximal (internal carotid artery [ICA], M1 middle cerebral artery [MCA], M2-MCA, and basilar artery) occlusions and their effects on outcome. Materials and Methods-The CT angiogram database of the Calgary stroke program was reviewed for the period 2002 to 2009. All patients with proximal vessel occlusions receiving IV rt-PA who were assessed for recanalization by TCD or angiogram (for acute endovascular treatment) were included for analysis. Rates of acute recanalization as observed on TCD/first run of angiogram and postendovascular therapy recanalization rates were noted. Modified Rankin Scale score Յ2 at 3 months was used as a good outcome. Results-Among 1341 patients in the CT angiogram database, 388 patients with proximal occlusion were identified. Of these, 216 patients had received IV rt-PA; 127 patients underwent further imaging to assess recanalization. Among the patients undergoing TCD (nϭ46) and cerebral angiogram (nϭ103), only 27 (21.25%) patients had acute recanalization. By occlusion subtype, the rates of recanalization were: distal ICA (with or without ICA neck occlusion or stenotic disease) 1 of 24 (4.4%); M1-MCA (with or without ICA neck occlusion or stenotic disease) 21 of 65 (32.3%); M2-MCA 4 of 13 (30.8%); and basilar artery 1 of 25 (4%). Onset to rt-PA time was comparable in patients with and without recanalization. Recanalization (PϽ0.0001; risk ratio, 2.7; 95% confidence interval, 1.5-4.6) was the strongest predictor of outcome (adjusted for age and National Institutes of Health Stroke Scale score). Key Words: intracranial occlusion Ⅲ ischemic stroke Ⅲ recanalization Ⅲ thrombolysis I ntravenous (IV) recombinant tissue plasminogen activator (rt-PA) treatment for acute ischemic stroke 1,2 works by achieving recanalization of intracranial occlusion resulting in restoration of flow and prevention of infarct expansion. 3 Data on recanalization after IV thrombolysis are limited to small angiographic and transcranial Doppler (TCD) monitoring studies. 4 None of the major IV thrombolysis trials has assessed the baseline occlusion status or recanalization rates after treatment. In an era when there is increasing use of endovascular therapies for recanalization, in the absence of robust evidence from randomized controlled trials, there is a desperate need for clear data on the rates of recanalization with IV rt-PA. 5 The present study reports the rates of acute recanalization of proximal intracranial vessel occlusions identified by baseline CT angiography (CTA) among acute ischemic stroke patients treated with IV rt-PA. Conclusions- Patients and MethodsWe identified patients presenting with acute ischemic stroke secondary to major vessel occlusion from the CT Angiography database of the Calgary St...

Background Mental disorders are among the leading causes of non-fatal disease burden in India, but a systematic understanding of their prevalence, disease burden, and risk factors is not readily available for each state of India. In this report, we describe the prevalence and disease burden of each mental disorder for the states of India, from 1990 to 2017. Methods We used all accessible data from multiple sources to estimate the prevalence of mental disorders, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) caused by these disorders for all the states of India from 1990 to 2017, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study. We assessed the heterogeneity and time trends of mental disorders across the states of India. We grouped states on the basis of their Socio-demographic Index (SDI), which is a composite measure of per-capita income, mean education, and fertility rate in women younger than 25 years. We also assessed the association of major mental disorders with suicide deaths. We calculated 95% uncertainty intervals (UIs) for the point estimates. Findings In 2017, 197•3 million (95% UI 178•4-216•4) people had mental disorders in India, including 45•7 million (42•4-49•8) with depressive disorders and 44•9 million (41•2-48•9) with anxiety disorders. We found a significant, but modest, correlation between the prevalence of depressive disorders and suicide death rate at the state level for females (r²=0•33, p=0•0009) and males (r²=0•19, p=0•015). The contribution of mental disorders to the total DALYs in India increased from 2•5% (2•0-3•1) in 1990 to 4•7% (3•7-5•6) in 2017. In 2017, depressive disorders contributed the most to the total mental disorders DALYs (33•8%, 29•5-38•5), followed by anxiety disorders (19•0%, 15•9-22•4), idiopathic developmental intellectual disability (IDID; 10•8%, 6•3-15•9), schizophrenia (9•8%, 7•7-12•4), bipolar disorder (6•9%, 4•9-9•6), conduct disorder (5•9%, 4•0-8•1), autism spectrum disorders (3•2%, 2•7-3•8), eating disorders (2•2%, 1•7-2•8), and attention-deficit hyperactivity disorder (ADHD; 0•3%, 0•2-0•5); other mental disorders comprised 8•0% (6•1-10•1) of DALYs. Almost all (>99•9%) of these DALYs were made up of YLDs. The DALY rate point estimates of mental disorders with onset predominantly in childhood and adolescence (IDID, conduct disorder, autism spectrum disorders, and ADHD) were higher in low SDI states than in middle SDI and high SDI states in 2017, whereas the trend was reversed for mental disorders that manifest predominantly during adulthood. Although the prevalence of mental disorders with onset in childhood and adolescence decreased in India from 1990 to 2017, with a stronger decrease in high SDI and middle SDI states than in low SDI states, the prevalence of mental disorders that manifest predominantly during adulthood increased during this period. Interpretation One in seven Indians were affected by mental disorders of varying severity in 2017. The proportional contribution of mental disorders to the t...

BACKGROUND AND PURPOSE:The regional leptomeningeal score is a strong and reliable imaging predictor of good clinical outcomes in acute anterior circulation ischemic strokes and can therefore be used for imaging based patient selection. Efforts to determine biological determinants of collateral status are needed if techniques to alter collateral behavior and extend time windows are to succeed.