Full Text Journal Articles by
Author Dar Dowlatshahi

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Advanced consent for acute stroke trials.

Michel Shamy, Brian Dewar, Naomi Niznick, Stuart Nicholls, Dar Dowlatshahi,

Lancet Neurol (The Lancet. Neurology)
[2021, 20(3):170]

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Rationalisations for women-only randomised controlled trials in conditions that affect both sexes: a scoping review protocol.

Ainsley Matthewson, Olena Bereznyakova, Brian Dewar, Alexandra Davis, Mark Fedyk, Vignan Yogendrakumar, Dean A Fergusson, Sophia Gocan, Dar Dowlatshahi, Robert Fahed, Michel Shamy,

<h4>Introduction</h4>Women have historically been under-represented in randomised controlled trials (RCTs), including many landmark RCTs that established standards of care. In light of this fact, some modern researchers are calling for replication of earlier landmark trials with women only. This approach is ethically concerning, in that it would require some enrolled ... Read more >>

BMJ Open (BMJ open)
[2021, 11(2):e043370]

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Direct oral anticoagulants in treatment of cerebral venous thrombosis: a systematic review.

Gauruv Bose, Justin Graveline, Vignan Yogendrakumar, Risa Shorr, Dean A Fergusson, Gregoire Le Gal, Jonathan Coutinho, Marcelo Mendonça, Miguel Viana-Baptista, Simon Nagel, Dar Dowlatshahi,

<h4>Objectives</h4>Current guidelines do not recommend direct oral anticoagulants (DOACs) to treat cerebral venous thrombosis (CVT) despite their benefits over standard therapy. We performed a systematic review to summarise the published experience of DOAC therapy in CVT.<h4>Data sources</h4>MEDLINE, Embase and COCHRANE databases up to 18 November 2020.<h4>Eligibility criteria</h4>All published articles of ... Read more >>

BMJ Open (BMJ open)
[2021, 11(2):e040212]

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Improved Segmentation of the Intracranial and Ventricular Volumes in Populations with Cerebrovascular Lesions and Atrophy Using 3D CNNs.

Emmanuel E Ntiri, Melissa F Holmes, Parisa M Forooshani, Joel Ramirez, Fuqiang Gao, Miracle Ozzoude, Sabrina Adamo, Christopher J M Scott, Dar Dowlatshahi, Jane M Lawrence-Dewar, Donna Kwan, Anthony E Lang, Sean Symons, Robert Bartha, Stephen Strother, Jean-Claude Tardif, Mario Masellis, Richard H Swartz, Alan Moody, Sandra E Black, Maged Goubran,

Successful segmentation of the total intracranial vault (ICV) and ventricles is of critical importance when studying neurodegeneration through neuroimaging. We present iCVMapper and VentMapper, robust algorithms that use a convolutional neural network (CNN) to segment the ICV and ventricles from both single and multi-contrast MRI data. Our models were trained ... Read more >>

Neuroinformatics (Neuroinformatics)
[2021, :]

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Noncontrast Computed Tomography Markers as Predictors of Revised Hematoma Expansion in Acute Intracerebral Hemorrhage.

Wen-Song Yang, Shu-Qiang Zhang, Yi-Qing Shen, Xiao Wei, Li-Bo Zhao, Xiong-Fei Xie, Lan Deng, Xin-Hui Li, Xin-Ni Lv, Fa-Jin Lv, Dar Dowlatshahi, Qi Li, Peng Xie,

Background Noncontrast computed tomography (NCCT) markers are the emerging predictors of hematoma expansion in intracerebral hemorrhage. However, the relationship between NCCT markers and the dynamic change of hematoma in parenchymal tissues and the ventricular system remains unclear. Methods and Results We included 314 consecutive patients with intracerebral hemorrhage admitted to ... Read more >>

J Am Heart Assoc (Journal of the American Heart Association)
[2021, 10(3):e018248]

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Is This Contrast? Is This Blood? An Agreement Study on Post-thrombectomy Computed Tomography Scans.

Ronda Lun, Gregory B Walker, Adrien Guenego, Mohammed Kassab, Eduardo Portela, Vignan Yogendrakumar, George Medvedev, Ken Wong, Michel Shamy, Dar Dowlatshahi, Robert Fahed,

<b>Background:</b> Hemorrhagic transformation after acute ischemic stroke is a dreaded and severe complication of thrombolysis and thrombectomy. However, its detection on post-thrombectomy conventional non-contrast computed tomography (CT) scan can be complicated by the frequent (and sometimes concomitant) presence of contrast, resulting in changes in management. <b>Aims:</b> Our objective was to ... Read more >>

Front Neurol (Frontiers in neurology)
[2020, 11:593098]

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Thrombus Migration and Fragmentation After Intravenous Alteplase Treatment: The INTERRSeCT Study.

Tomoyuki Ohara, Bijoy K Menon, Fahad S Al-Ajlan, MacKenzie Horn, Mohamed Najm, Abdulaziz Al-Sultan, Josep Puig, Dar Dowlatshahi, Ana I Calleja Sanz, Sung-Il Sohn, Seong H Ahn, Alexandre Y Poppe, Robert Mikulik, Negar Asdaghi, Thalia S Field, Albert Jin, Talip Asil, Jean-Martin Boulanger, Federica Letteri, Sadanand Dey, James W Evans, Mayank Goyal, Michael D Hill, Mohammed Almekhlafi, Andrew M Demchuk, ,

<h4>Background and purpose</h4>There is interest in what happens over time to the thrombus after intravenous alteplase. We study the effect of alteplase on thrombus structure and its impact on clinical outcome in patients with acute stroke.<h4>Methods</h4>Intravenous alteplase treated stroke patients with intracranial internal carotid artery or middle cerebral artery occlusion ... Read more >>

Stroke (Stroke)
[2021, 52(1):203-212]

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Early Recanalization With Alteplase in Stroke Because of Large Vessel Occlusion in the ESCAPE Trial.

Johanna M Ospel, Nishita Singh, Mohammed A Almekhlafi, Bijoy K Menon, Asif Butt, Alexandre Y Poppe, Ashutov Jadhav, Frank L Silver, Ruchir Shah, Dar Dowlatshahi, Alan M O'Hare, Andrew M Demchuk, Mayank Goyal, Michael D Hill,

<h4>Background and purpose</h4>Quantitating the effect of intravenous alteplase on the technical outcome of early recanalization of large vessel occlusions aids understanding. We report the prevalence of early recanalization in patients with stroke because of large vessel occlusion treated with and without intravenous alteplase and endovascular thrombectomy, and its association with ... Read more >>

Stroke (Stroke)
[2021, 52(1):304-307]

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Prevalence and the predictive performance of the dynamic CT-angiography spot sign in an observational cohort with intracerebral hemorrhage.

Dar Dowlatshahi, Hee Sahng Chung, Michael Reaume, Matthew J Hogan, Dylan Blacquiere, Grant Stotts, Michel Shamy, Franco Momoli, Richard Aviv, Andrew M Demchuk, Santanu Chakraborty,

The CT-angiography (CTA) spot sign is a predictor of hematoma expansion (HE). We have previously reported on the use of dynamic CTA (dCTA) to detect spot sign, and to study its formation over the acquisition period. In this study, we report the frequency of dCTA spot sign in acute intracerebral ... Read more >>

Medicine (Baltimore) (Medicine)
[2020, 99(47):e23278]

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Revised intracerebral hemorrhage expansion definitions: Relationship with care limitations.

Ronda Lun, Vignan Yogendrakumar, Greg Walker, Michel Shamy, Robert Fahed, Adnan Qureshi, Dar Dowlatshahi,

<h4>Background</h4>Hematoma expansion is an important therapeutic target in intracerebral hemorrhage. Recently proposed hematoma expansion definitions have not been validated, and no previous definition has accounted for withdrawal of care.<h4>Aims</h4>To externally validate revised definitions of hematoma expansion that incorporate intraventricular hemorrhage, and to test their validity in the context of withdrawal ... Read more >>

Int J Stroke (International journal of stroke : official journal of the International Stroke Society)
[2020, :1747493020967255]

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Physician preparedness for resource allocation decisions under pandemic conditions: A cross-sectional survey of Canadian physicians, April 2020.

Brian Dewar, Joanna E Anderson, Edmund S H Kwok, Tim Ramsay, Dar Dowlatshahi, Robert Fahed, Claire Dyason, Michel Shamy,

<h4>Background</h4>Under the pandemic conditions created by the novel coronavirus of 2019 (COVID-19), physicians have faced difficult choices allocating scarce resources, including but not limited to critical care beds and ventilators. Past experiences with severe acute respiratory syndrome (SARS) and current reports suggest that making these decisions carries a heavy emotional ... Read more >>

PLoS One (PloS one)
[2020, 15(10):e0238842]

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Canadian stroke best practice recommendations: Management of Spontaneous Intracerebral Hemorrhage, 7th Edition Update 2020.

Ashkan Shoamanesh Co-Chair, M Patrice Lindsay, Lana A Castellucci, Anne Cayley, Mark Crowther, Kerstin de Wit, Shane W English, Sharon Hoosein, Thien Huynh, Michael Kelly, Cian J O'Kelly, Jeanne Teitelbaum, Samuel Yip, Dar Dowlatshahi, Eric E Smith, Norine Foley, Aleksandra Pikula, Anita Mountain, Gord Gubitz, Laura C Gioia,

Spontaneous intracerebral hemorrhage is a particularly devastating type of stroke with greater morbidity and mortality compared with ischemic stroke and can account for half or more of all deaths from stroke. The seventh update of the <i>Canadian Stroke Best Practice Recommendations</i> includes a new stand-alone module on intracerebral hemorrhage, with ... Read more >>

Int J Stroke (International journal of stroke : official journal of the International Stroke Society)
[2020, :1747493020968424]

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Recommandations canadiennes pour les pratiques optimales de soins de l’AVC, septième édition : l’acide acétylsalicylique pour la prévention d’événements vasculaires.

Theodore Wein, M Patrice Lindsay, David J Gladstone, Alexandre Poppe, Alan Bell, Leanne K Casaubon, Norine Foley, Shelagh B Coutts, Jafna Cox, James Douketis, Thalia Field, Laura Gioia, Jeffrey Habert, Eddy Lang, Shamir R Mehta, Christine Papoushek, William Semchuk, Mikul Sharma, Jacob A Udell, Stephanie Lawrence, Anita Mountain, Gord Gubitz, Dar Dowlatshahi, Anne Simard, Andrea de Jong, Eric E Smith, ,

CMAJ (CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne)
[2020, 192(40):E1174-E1184]

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Thrombectomy vs medical management in low NIHSS acute anterior circulation stroke.

Ondrej Volny, Charlotte Zerna, Ales Tomek, Michal Bar, Miloslav Rocek, Radek Padr, Filip Cihlar, Miroslava Nevsimalova, Lubomir Jurak, Roman Havlicek, Martin Kovar, Petr Sevcik, Vladimir Rohan, Jan Fiksa, David Cernik, Rene Jura, Daniel Vaclavik, Petra Cimflova, Josep Puig, Dar Dowlatshahi, Alexander V Khaw, Enrico Fainardi, Mohamed Najm, Andrew M Demchuk, Bijoy K Menon, Robert Mikulik, Michael D Hill,

<h4>Objective</h4>To undertake an effectiveness and safety analysis of EVT in patients with LVO and NIH Stroke Scale (NIHSS) score ≤6 using datasets of multicenter and multinational nature.<h4>Methods</h4>We pooled patients with anterior circulation occlusion from 3 prospective international cohorts. Patients were eligible if presentation occurred within 12 hours from last known ... Read more >>

Neurology (Neurology)
[2020, 95(24):e3364-e3372]

Cited: 2 times

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Diagnosis of Transient Ischemic Attack: Sex-Specific Differences From a Retrospective Cohort Study.

Sophia Gocan, Tess Fitzpatrick, Chu Qi Wang, Monica Taljaard, Wei Cheng, Aline Bourgoin, Dar Dowlatshahi, Grant Stotts, Michel Shamy,

<h4>Background and purpose</h4>Research suggests that women and men may present with different transient ischemic attack (TIA) and stroke symptoms. We aimed to explore symptoms and features associated with a definite TIA/stroke diagnosis and whether those associations differed by sex.<h4>Methods</h4>We completed a retrospective cohort study of patients referred to The Ottawa ... Read more >>

Stroke (Stroke)
[2020, 51(11):3371-3374]

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Clinical Course of Acute Ischemic Stroke Due to Medium Vessel Occlusion With and Without Intravenous Alteplase Treatment.

Johanna M Ospel, Bijoy K Menon, Andrew M Demchuk, Mohammed A Almekhlafi, Nima Kashani, Arnuv Mayank, Enrico Fainardi, Marta Rubiera, Alexander Khaw, Jai J Shankar, Dar Dowlatshahi, Josep Puig, Sung-Il Sohn, Seong H Ahn, Alexandre Poppe, Ana Calleja, Michael D Hill, Mayank Goyal,

<h4>Background and purpose</h4>Available data on the clinical course of patients with acute ischemic stroke due to medium vessel occlusion (MeVO) are mostly limited to those with M2 segment occlusions. Outcomes are generally better compared with more proximal occlusions, but many patients will still suffer from severe morbidity. We aimed to ... Read more >>

Stroke (Stroke)
[2020, 51(11):3232-3240]

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Prevalence of non-contrast CT abnormalities in adults with reversible cerebral vasoconstriction syndrome: protocol for a systematic review and meta-analysis.

Ryan Daniel Gotesman, Naomi Niznick, Brian Dewar, Dean A Fergusson, Risa Shorr, Michel Shamy, Dar Dowlatshahi,

<h4>Introduction</h4>Reversible cerebral vasoconstriction syndrome (RCVS) is characterised by severe, recurrent thunderclap headaches (TCHs) and vasoconstriction of cerebral arteries that resolve within 3 months. Abnormalities on non-contrast CT (NCCT) such as ischaemic strokes, intracerebral haemorrhage and subarachnoid haemorrhages are frequently observed on brain imaging of patients with RCVS though their prevalence ... Read more >>

BMJ Open (BMJ open)
[2020, 10(9):e041776]

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Advanced consent for participation in acute care randomised control trials: protocol for a scoping review.

Naomi Niznick, Ronda Lun, Brian Dewar, Dar Dowlatshahi, Michel Shamy,

<h4>Introduction</h4>Informed consent is essential to clinical research, though obtaining informed consent for participation in research for emergency conditions is challenging. Adapted consent methods include consent from a substitute-decision maker, deferral of consent and waiver of consent. A novel approach is to use advanced consent, where a potential participant provides consent ... Read more >>

BMJ Open (BMJ open)
[2020, 10(10):e039172]

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Recurrence of cervical artery dissection: protocol for a systematic review.

Elizabeth Lounsbury, Brian Dewar, Alexandra Davis, Dean A Fergusson, Dar Dowlatshahi, Michel Shamy,

<h4>Introduction</h4>Cervical artery dissection, including carotid and vertebral artery dissection, is an important cause of stroke in the young. Risk of developing cervical artery dissection has been associated with physical activity in various forms and has been presumed to be related to minor trauma and mechanical stretching of the cervical arteries. ... Read more >>

BMJ Open (BMJ open)
[2020, 10(9):e037124]

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People With Lived Experience at the Centre of Canadian Stroke Best Practice Recommendations: A Model for Guideline Developers.

M Patrice Lindsay, Natalie Gierman, Jocelyn E Harris, Gavin Arthur, Moira E Teed, Anita Mountain, Gordon Gubitz, Eric E Smith, Dar Dowlatshahi, Andrea de Jong, Leigh C P Botly,

Actively engaging people with lived experience (PWLE) in stroke-related clinical practice guideline development has not been effectively implemented. This pilot project evaluated the feasibility, perceived value, and effectiveness of the Community Consultation and Review Panel (CCRP), a new model to engage PWLE in the writing and review of Canadian Stroke ... Read more >>

J Patient Exp (Journal of patient experience)
[2020, 7(6):951-956]

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Decreased Stroke Presentation Rates at a Comprehensive Stroke Center during COVID-19.

Dar Dowlatshahi, Grant Stotts, Aline Bourgoin, Sophia Gocan, Laura Dunn, Jodi Powell, Frank L Silver, Greg Walker, Vignan Yogendrakumar, Robert Fahed, Dylan Blacquiere, Michel Shamy,

We reviewed stroke care delivery during the COVID-19 pandemic at our stroke center and provincial telestroke system. We counted referrals to our prevention clinic, code strokes, thrombolysis, endovascular thrombectomies, and activations of a provincial telestroke system from February to April of 2017-2020. In April 2020, there was 28% reduction in ... Read more >>

Can J Neurol Sci (The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques)
[2021, 48(1):118-121]

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Natural history of recovery after intracerebral haemorrhage: a scoping review protocol.

Sara Massicotte, Ronda Lun, Vignan Yogendrakumar, Brian Dewar, Alexandra Davies, Dean A Fergusson, Michel Shamy, Dar Dowlatshahi,

<h4>Introduction</h4>Clinical trials for intracerebral haemorrhage typically measure outcomes in the same way and at the same time points as trials for ischaemic stroke. However, there is growing evidence that the trajectory of recovery following intracerebral haemorrhage may differ significantly from that following ischaemic stroke. A better understanding of current approaches ... Read more >>

BMJ Open (BMJ open)
[2020, 10(8):e039460]

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Distribution and predictive performance of the temporal phase of dynamic spot sign appearance in acute intracerebral hemorrhage.

Hee Sahng Chung, Santanu Chakraborty, Michael Reaume, Vignan Yogendrakumar, Matthew J Hogan, Dylan Blacquiere, Grant Stotts, Michel Shamy, Richard I Aviv, Dar Dowlatshahi,

<h4>Background</h4>Dynamic CT angiography (dCTA) contrast extravasation, known as the "dynamic spot sign", can predict hematoma expansion (HE) in intracerebral hemorrhage (ICH). Recent reports suggest the phase of spot sign appearance is related to the magnitude of HE. We used dCTA to explore the association between the phase of spot sign ... Read more >>

PLoS One (PloS one)
[2020, 15(8):e0236196]

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Assessment of Sex Differences in Recovery of Motor and Sensory Impairments Poststroke.

Rachel L Hawe, Tyler Cluff, Dar Dowlatshahi, Michael D Hill, Sean P Dukelow,

<i>Background</i>. Understanding potential sex differences in stroke recovery is important for prognosis, ensuring appropriate allocation of health care resources, and for stratification in research studies. Previously, functional measures have shown poorer outcomes for females, however, little is known about sex differences that may exist in specific motor and sensory impairments. ... Read more >>

Neurorehabil Neural Repair (Neurorehabilitation and neural repair)
[2020, 34(8):746-757]

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The Ontario Neurodegenerative Disease Research Initiative

Kelly Sunderland, Derek Beaton, Stephen Arnott, Peter Kleinstiver, Donna Kwan, Jane Lawrence-Dewar, Joel Ramirez, Brian Tan, Robert Bartha, Sandra Black, Michael Borrie, Donald Brien, Leanne Casaubon, Brian Coe, Benjamin Cornish, Allison Dilliott, Dar Dowlatshahi, Elizabeth Finger, Corinne Fischer, Andrew Frank, Julia Fraser, Morris Freedman, Barry Greenberg, David Grimes, Ayman Hassan, Wendy Hatch, Robert Hegele, Christopher Hudson, Mandar Jog, Sanjeev Kumar, Anthony Lang, Brian Levine, Wendy Lou, Jennifer Mandzia, Connie Marras, William McIlroy, Manuel Montero-Odasso, David Munoz, Douglas Munoz, Joseph Orange, David Park, Stephen Pasternak, Frederico Pieruccini- Faria, Tarek Rajji, Angela Roberts, John Robinson, Ekaterina Rogaeva, Demetrios Sahlas, Gustavo Saposnik, Christopher J.M. Scott, Dallas Seitz, Christen Shoesmith, Thomas D.L. Steeves, Michael Strong, Stephen Strother, Richard Swartz, Sean Symons, David Tang-Wai, Maria Carmela Tartaglia, Angela Troyer, John Turnbull, Lorne Zinman, Paula McLaughlin, Mario Masellis, Malcolm Binns,

<h4>Objective</h4> In individuals over the age of 65, concomitant neurodegenerative pathologies contribute to cognitive and/or motor decline and can be aggravated by cerebrovascular disease, but our understanding of how these pathologies synergize to produce the decline represents an important knowledge gap. The Ontario Neurodegenerative Disease Research Initiative (ONDRI), a multi-site, ... Read more >>

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