Gagan Sharma
A5101657401- Acute Ischemic Stroke Management
- Cerebrovascular and Carotid Artery Diseases
- Traumatic Brain Injury and Neurovascular Disturbances
- Venous Thromboembolism Diagnosis and Management
- Intracerebral and Subarachnoid Hemorrhage Research
- Stroke Rehabilitation and Recovery
- Advanced MRI Techniques and Applications
- Advanced Neuroimaging Techniques and Applications
- Neurosurgical Procedures and Complications
- MRI in cancer diagnosis
- Cardiac Imaging and Diagnostics
- Medical Imaging and Analysis
- Advanced X-ray and CT Imaging
- Cardiac, Anesthesia and Surgical Outcomes
- Peripheral Artery Disease Management
- Advanced Computing and Algorithms
- Retinal and Optic Conditions
- E-commerce and Technology Innovations
- Brain Tumor Detection and Classification
- Radiomics and Machine Learning in Medical Imaging
- Spam and Phishing Detection
- Neurological Disease Mechanisms and Treatments
- Intracranial Aneurysms: Treatment and Complications
- Image Enhancement Techniques
- Cancer-related gene regulation
The Royal Melbourne Hospital
2016-2025
UNSW Sydney
2023-2025
Ingham Institute
2024-2025
Liverpool Hospital
2023-2025
The University of Melbourne
2015-2024
Christchurch Hospital
2021-2024
University of Bern
2024
Royal Adelaide Hospital
2021-2024
University Hospital of Bern
2024
Health and Education Research Management and Epidemiologic Services (United States)
2023
The time to initiate intravenous thrombolysis for acute ischemic stroke is generally limited within 4.5 hours after the onset of symptoms. Some trials have suggested that treatment window may be extended in patients who are shown but not yet infarcted brain tissue on imaging.
Intravenous infusion of alteplase is used for thrombolysis before endovascular thrombectomy ischemic stroke. Tenecteplase, which more fibrin-specific and has longer activity than alteplase, given as a bolus may increase the incidence vascular reperfusion.
Trials of the efficacy and safety endovascular thrombectomy in patients with large ischemic strokes have been carried out limited populations. Download a PDF Research Summary. We performed prospective, randomized, open-label, adaptive, international trial involving stroke due to occlusion internal carotid artery or first segment middle cerebral assess within 24 hours after onset. Patients had ischemic-core volume, defined as an Alberta Stroke Program Early Computed Tomography Score 3 5...
<h3>Importance</h3> Intravenous thrombolysis with tenecteplase improves reperfusion prior to endovascular thrombectomy for ischemic stroke compared alteplase. <h3>Objective</h3> To determine whether 0.40 mg/kg of safely before vs 0.25 in patients large vessel occlusion stroke. <h3>Design, Setting, and Participants</h3> Randomized clinical trial at 27 hospitals Australia 1 New Zealand using open-label treatment blinded assessment radiological outcomes. Patients were enrolled from December...
Importance Whether endovascular thrombectomy (EVT) efficacy for patients with acute ischemic stroke and large cores varies depending on the extent of injury is uncertain. Objective To describe relationship between imaging estimates irreversibly injured brain (core) at-risk regions (mismatch) clinical outcomes EVT treatment effect. Design, Setting, Participants An exploratory analysis SELECT2 trial, which randomized 352 adults (18-85 years) due to occlusion internal carotid or middle cerebral...
Basilar artery occlusion is associated with high risk of disability and mortality. This study aimed to assess the prognostic value a new radiological score: Artery on Computed Tomography Angiography (BATMAN) score.A retrospective analysis consecutive stroke patients basilar diagnosed computed tomographic angiography was performed. BATMAN score 10-point angiography-based grading system which incorporates thrombus burden presence collaterals. Reliability assessed intraclass coefficient...
Background Advanced imaging may refine patient selection for ischemic stroke treatment but delays to acquire and process the have limited implementation. Aims We examined feasibility of in clinical practice using fully automated software EXTEND trial program. Methods CTP perfusion-diffusion MRI data were processed fully-automated generate a yes/no ‘mismatch’ classification that determined eligibility therapies. The technical failure/mismatch error rate time image treat with CT vs. MR-based...
The relevance of impaired microvascular tissue-level reperfusion despite complete upstream macrovascular angiographic (no-reflow) in human stroke remains controversial. We investigated the prevalence and clinical-radiologic features this phenomenon its associations with outcomes 3 international randomized controlled thrombectomy trials prespecified follow-up perfusion imaging.In a pooled analysis Extending Time for Thrombolysis Emergency Neurological Deficits-Intra-Arterial (EXTEND-IA;...
Importance The role of endovascular thrombectomy is uncertain for patients presenting beyond 24 hours the time they were last known well. Objective To evaluate functional and safety outcomes (EVT) vs medical management in with large-vessel occlusion Design, Setting, Participants This retrospective observational cohort study enrolled between July 2012 December 2021 at 17 centers across United States, Spain, Australia, New Zealand. Eligible had occlusions internal carotid artery or middle...
Hyperacute cardiac CT has shown greater yield for intracardiac thrombus identification compared with transthoracic echocardiography. However, routine use comes higher cost and additional contrast radiation exposure. Pretest of patients low probability would enable rationalization its use. Arterial input function (AIF) curves are generated automatically as part brain perfusion CT. Time from scan onset to the end AIF (AIF dispersal) is correlated left ventricular ejection fraction. We...
Background and Purpose- The volume of estimated ischemic core using computed tomography perfusion (CTP) imaging can identify stroke patients who are likely to benefit from reperfusion, particularly beyond standard time windows. We assessed the accuracy pretreatment CTP in with successful endovascular reperfusion. Methods- Patients HERMES (Highly Effective Reperfusion Evaluated Multiple Endovascular Stroke Trials) EXTEND-IA TNK (Tenecteplase Versus Alteplase Before Therapy for Ischemic...
Intracerebral hemorrhage is a serious potential complication of stroke thrombolysis. We investigated the optimal computed tomography perfusion (CTP) parameter to predict cerebral parenchymal hematoma (PH) in acute ischemic stroke.Patients with hyperacute had whole-brain CTP and follow-up tomography/MRI identify hemorrhagic transformation. The association 3 parameters relative blood flow, volume, time maximum (Tmax) PH was examined using receiver operating characteristic analysis multivariate...
To investigate the efficacy of tenecteplase (TNK), a genetically modified variant alteplase with greater fibrin specificity and longer half-life than alteplase, prior to endovascular thrombectomy (EVT) in patients basilar artery occlusion (BAO).To determine whether TNK is associated better reperfusion rates EVT BAO, clinical procedural data consecutive BAO from Basilar Artery Treatment Management (BATMAN) registry Tenecteplase vs Alteplase before Endovascular Therapy for Ischemic Stroke...
The objective of this study was to evaluate functional and safety outcomes endovascular thrombectomy (EVT) versus medical management (MM) in patients with M2 occlusion examine their association perfusion imaging mismatch stroke severity.In a pooled, patient-level analysis 3 randomized controlled trials (EXTEND-IA, EXTEND-and IA-TNK parts 1 2) 2 prospective nonrandomized studies (INSPIRE SELECT), we evaluated EVT 90-day independence (modified Rankin Scale [mRS] = 0-2) isolated occlusions as...
To assess the accuracy of baseline CT perfusion (CTP) ischemic core estimates.
Intracranial occlusion site, contrast permeability, and clot burden are thrombus characteristics that influence alteplase-associated reperfusion. In this study, we assessed the reperfusion efficacy of tenecteplase alteplase in subgroups based on these a pooled analysis EXTEND-IA TNK trial (Tenecteplase Versus Alteplase Before Endovascular Therapy for Ischemic Stroke).Patients with large vessel were randomized to treatment (0.25 or 0.4 mg/kg) before thrombectomy hospitals across Australia New...
Early treatment with intravenous alteplase increases the probability of lytic-induced reperfusion in large vessel occlusion (LVO) patients. The relationship tenecteplase-induced and timing thrombolytic administration has not been explored. In this study, we performed a comparative analysis tenecteplase rates assessed their to time administration.
Background and Purpose- The benefit of endovascular therapy in extended time windows has been demonstrated patients with anterior circulation large vessel occlusion ischemic stroke favorable imaging profile. We evaluated whether collaterals thrombus burden influence the associations between revascularization, time-to-treatment, outcome therapy-treated basilar artery occlusion. Methods- retrospectively analyzed clinical data consecutive included multicenter Basilar Artery Treatment Management...