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Conjoint Professor Chris Levi

Conjoint Professor

School of Medicine and Public Health

Stroke of Genius

Internationally renowned stroke clinical researcher, Conjoint Professor Chris Levi is on a medical mission: "Cure more, improve more, harm less".

Professor Chris Levi with patient

Working on more than eight ground-breaking research projects improving stroke treatment options for patients, Professor Levi is on target to meet his goal, launching what he has described as "the most important acute stroke trial globally".

A clot-busting drug, Tenecteplase (TNK) will be trialled at 50 major hospitals around the world. Its potential to cure stroke in some patients has earned TNK the nickname 'The New Kid' on the stroke block.

Professor Levi and fellow University of Newcastle researcher Professor Mark Parsons, are the principal investigators on this global acute stroke trial.

One in six people will experience a stroke in their lifetime. In Australia alone, there are 50,000 strokes every year - enough to fill the Sydney Cricket Ground

"TNK is a clot-dissolving drug developed by industry and derived from a naturally occurring protein from the blood vessel wall. The trial will test TNK against the current standard clot-busting drug Alteplase," he said.

"Alteplase is good if it works. However, we need better, more effective and safer treatments.  Alteplase carries a small, but significant, risk of bleeding and only dissolves the clot in 30-40% of cases. TNK in Phase 2 Trial looks considerably better. We saw patients affected by stroke making almost miraculous recoveries on TNK."

Published in the prestigious New England Journal of Medicine, findings from Phase 2 Trial showed that two-thirds of patients treated with TNK displayed major improvement within 24 hours, and 72 per cent showed excellent recovery within three months after their stroke.

The TNK Phase 3 Trial begins in Australia and New Zealand in February 2014 and in Europe and Asia in mid-2014.

Australia's No 1 cause of disability

Following his arrival at the University of Newcastle in 1999 to establish the Hunter Medical Research Institute (HMRI) Stroke Research Group, Professor Levi led the group to its current position, recognised globally as one of the leading teams for stroke research in imaging, clinical trials, health systems research and stroke genetics.

"Ten thousand people die from stroke each year in Australia. A quarter of those people are aged under 55," Professor Levi said.

"Death is one thing, disability is another. With 20,000 people left disabled by stroke in Australia, it's a major problem and the number one cause of disability. It is truly sad to see the impact of stroke on the patients and their families and communities.

"Frustration has been my driver. As a clinician, not being able to do enough for my patients or knowing that our health systems could be better is what drives me in research. The problem stares me in the face every day. "

Stroke of genes

Part of a team of researchers from the University of Newcastle credited with making a major genetic discovery in stroke, Professor Levi said the future is in tailored medical care.

"We're using genetics to unravel the complex biology of the brain and to see if it can give us a clue to pre-determining factors of stroke," Professor Levi said.

Published in Nature Genetics in 2012, the discovery of the signal located within a regulatory DNA on Chromosome 6 (6p21.1) is strongly associated with large artery atherosclerotic stroke, which represent one quarter of acute strokes.

"We don't know very much about the genetics of stroke as yet. It's a very complex disease genetically, influenced by many genes and environmental factors. Most of these genetic factors are unknown but once we learn enough about them we'll be able to better profile people and advise if they are at risk of stroke."

Part of an International Stroke Genetics Consortium, Meta-Stroke, Professor Levi and his team are also collecting samples from patients with acute stroke, investigating genetic factors that could influence responsiveness to clot-busting treatment.

"It's not just about whether you will have a stroke, we're also looking at how well you might do after a stroke and what treatment plan might work best for you."

"The body's enzyme systems are all under genetic control. Our genes basically set the plan for all of our body function and drugs. Pharmacological agents are influenced in both their efficacy and their safety by our enzyme systems in our body, which are influenced by our genes."

Setting the standard for stroke care

Professor Levi's drive and stellar reputation led him to being selected by the Australian Government to help set the upcoming national standards for treatment for stroke patients, as part of the Australian Commission for Quality and Safety in Health Care Clinical Standards and Indicators Group.

"We're moving into an era in stroke medicine where it will be treatment tailored to the patient. Why? It's because every stroke is a bit different, every cause is a little different and it's not a one-size-fits-all-situation," Professor Levi said.

"Alteplase has been guideline approved for years, it's been out there on the market, but the proportion of stroke patients that get access to it across the country is only about five per cent. It should be in the order of 20 to 25 per cent.

"The Newcastle health system has been re-engineered over the past seven years so that 20 to 30 per cent are receiving clot-busting drugs within the 4.5 hour treatment window. We have achieved this through a number of initiatives."

Working with Stroke Awareness, Professor Levi's team has been promoting the FAST: Face, Arms, Speech and Time to call 000 message to raise community awareness of the signs of stroke and the importance of acting quickly to get treatment.

At the next stage, a Pre-hospital Acute Stroke Triage (PAST) program was introduced to both metropolitan and rural regions establishing systems to improve pre-hospital care and enhance access to clot-busting drugs. Techniques included bypass of smaller hospitals, helicopter transfer where needed, ambulance guidelines and cutting red tape. The system was introduced in the Hunter Region in 2007 and in 2013 was adopted across the state of New South Wales.

In the stroke of time

Professor Levi is also involved in two health systems studies, one aiming to improve diagnosis and treatment of transient ischaemic attack and minor stroke patients in general practices and hospitals, the other aiming to better implement clot-busting treatment.

INSIST, a National Health and Medical Research Council funded comparison study of Trans Ischemic Attacks (TIA) and minor strokes compares treatment of TIA patients from 20 different general practices in the Hunter Region to data collected by Oxford and Auckland Universities. The study assesses how GPs determine if someone is having a stroke, what happens to the patient, how they are looked after and what the long-term outcomes are.

The Thrombolysis ImPlementation in Stroke (TIPS) trial is a cluster-randomised trial that is testing strategies to boost the implementation of clot-busting drug treatment. It is testing various strategies including advanced training, education, behaviour change, executive support and more. The TIPS trial is running across 20 hospitals in QLD, NSW and Victoria.

Imaging in one stroke

The stroke research team have world leading expertise in the application of advanced CT imaging technology to acute stroke diagnosis and treatment.

Under the leadership of colleague Prof Mark Parsons, and working as a Toshiba International Luminary Site, the group have pioneered how brain perfusion imaging can better select individual patients for clot-busting treatment by identifying how much brain tissue remains viable at different time points after the onset of stroke.

The imaging analysis techniques and their applications are a world-first. Professor Levi is also investigating how combining CT imaging and ultrasound (fusion ultrasound) can be used to determine precisely when a clot has been dissolved and a blocked artery opens.

Professor Levi credits the integrated health care system in operation between the local community, John Hunter and Mater Hospitals, HMRI and the University as key to his group's success across many areas of stroke research. The various national, international and local research networks they have built is another reason for their achievements.

"Across the University and medical sector, we have people working with the Stroke Research Group in cognitive issues and depression post-stroke, imaging, nutrition, physical activity and more."

"By working together in an integrated system, we are making huge advances. The army of people we have pooled together is helping to win the battle against this crippling condition."

Stroke of Genius

Internationally renowned stroke clinical researcher, Conjoint Professor Chris Levi is on a medical mission: "Cure more, improve more, harm less".Working on more than eight ground-breaking research projects improving stroke treatment options for patients, Professor Levi is on target to meet…

Read more

Agent of change

The stroke treatments pioneered by Professor Chris Levi and his team have transformed lives and medical practice.

As a clinician, Conjoint Professor Chris Levi sees evidence of the benefits of his research every time he sends a healthy patient home.

The internationally recognised stroke neurologist and researcher and the stroke research team at John Hunter Hospital, have driven breakthroughs in treatments and developed protocols that have vastly improved the outcomes for hundreds of stroke sufferers in the Hunter region. These approaches are now being adopted across Australia.

"For the right candidate, our treatment is dramatic – it is a cure for stroke," Levi says. "Twenty years ago, I would have said that was impossible."

Levi is the director of Acute Stroke Services at John Hunter Hospital.

The groundbreaking model of care developed by his team of medical researchers and clinicians combines the use of thrombolytic therapy, or 'clot-busting' drugs, with CT imaging of the brain. In suitable patients the clot-busting drug tPA can dissolve the blockage in their brain that has caused the stroke and prevent further damage. CT imaging is undertaken first to identify the areas of the brain that are salvageable.

Another integral part of the care model is a triage protocol that arms frontline health workers with the skills to identify stroke sufferers eligible for the treatment and fast track their passage to the acute stroke unit at the John Hunter Hospital. There is narrow four-and-a-half-hour window of opportunity for effective clot-busting therapy.

"By combining the treatments with our triage protocol we have improved our implementation of clot-busting therapy at John Hunter Hospital from 4 per cent of patients to over 20 per cent, which means more than 100 patients a year are receiving this therapy,'' Levi says.

"When successful, the treatment has great benefits for the patient – it can mean the difference between living dependently or independently.

"From a community perspective, it is also highly beneficial. With an estimated cost of up to $500,000 for a stroke patient with high care needs, the effective use of tPA is significantly reducing pressure on the health care budget."

Levi's stroke research group has attracted National Health and Medical Research Council grants to implement in hospitals across three states the combination of thrombolytic therapy and brain imaging. Hospitals across Sydney are also implementing the Hunter New England Health stroke treatment protocol.

Only about one third of stroke sufferers are suitable for tPA, and to receive it they must arrive at a hospital equipped to deliver the treatment within four and a half hours. The other two thirds of patients may be ineligible for a variety of reasons, including risk of excessive bleeding, past illnesses or contradictory drug treatments.

Because of this, Levi and his team are also leading research into treatments for those not eligible for thrombolytic therapy. One project is a joint study with Harbin Medical University in China, into methods of cooling the brain after a stroke.

The brain is put into hibernation, which 'buys' time for the clot to break up by itself. Researchers at Harbin are developing a helmet that works locally to cool the brain, while members of the team in Newcastle are experimenting with whole body cooling.

Newcastle researchers are also leading an international multi-centre trial of a new-generation clot-busting drug called tenecteplase or TNK, which they have shown in early trials to be more effective than alteplase or tPA.

Another exciting project is the Australian Stroke Genetics Initiative, led by Newcastle stroke researchers in collaboration with the University's Centre for Bioinformatics, Biomarker Discovery and Information-Based Medicine. Its first study, published this year in Nature Genetics, established a previously undiscovered genetic signal associated with a particular type of stroke.

"The wide range of research and the significant improvements to patient outcomes across all facets of stroke treatment verifies Newcastle's leadership role in this area," Levi says.

"Working at the nexus of stroke research and treatment, working with patients every day, spurs us on to keep moving developments from the lab and into clinical practice."

Professor Levi researches in collaboration with the Hunter Medical Research Institute's (HMRI) Brain and Mental Health Program. HMRI is a partnership between the University, the Hunter New England Local Health District and the community.

Visit the HMRI website

Professor Chris Levi with medical equipment

Agent of change

The stroke treatments pioneered by Professor Chris Levi and his team have transformed lives and medical practice.

Read more

Career Summary

Biography

Stroke is the leading cause of long term adult disability and is the second leading cause of death, nationally and globally.  Professor Chris Levi’s contribution and overarching research vision is the translation of experimental stroke therapies into the clinical domain for the effective prevention and treatment of stroke.  To this end, he has pioneered significant improvements in prevention, clinical treatment and patient outcomes. 

When Professor Levi took up his appointment at John Hunter Hospital in 1998, there was no stroke research in the Hunter region.  His leadership and ability to attract substantial competitive funding has seen the establishment of the Stroke Research Program.  The success of this program led to its incorporation into the University of Newcastle Priority Research Centre (PRC) for Translational Neuroscience and Mental Health Research in 2007.  In 2009, he was appointed Director of the PRC, continuing in this role until 2014, when he was appointed Director, Clinical Research and Translation, Hunter New England Local Health District. 

The John Hunter Hospital Acute Stroke Service and Stroke Research Program are considered today to be the leading clinical stroke centre and benchmark for clinical stroke research in Australia, a world-class facility where clinical medicine and the research environment meet.  A key advantage of being a clinician-researcher is the potential to closely align day-to-day clinical work, where important and highly relevant research questions arise, with a research program linking to clinical activities and hospital infrastructure.  The originality of Professor Levi’s contribution has been his focus on translating research ideas into the discovery of new knowledge for implementation in clinical settings, and mobilising collaborative efforts across facilities and disciplines to improve patient outcomes.  To do this he has harnessed skills and resources to build research teams, research capacity, infrastructure and professional networks to achieve his vision, leading to better patient outcomes following stroke. 

Professor Levi is a highly respected clinician researcher with >250 peer-reviewed publications and over 160 invited talks and sessions chaired at major national and international meetings, as well as extensive experience serving on steering committees of major clinical trials.  His strong international reputation is supported by publications in preeminent journals such as Nature Genetics, New England Journal of Medicine, and Lancet.  In 2013, he commenced a five year NHMRC Practitioner Fellowship. 

Research Expertise
Clinical research across the domains of observational epidemiology (case control studies, cohort studies, prevalence and incident studies), interventional clinical trials (trials in antithrombotic therapy in stroke prevention, acute stroke therapy trials), health services work (cluster randomised trials of health services interventions, health service redesign), brain imaging research (neurovascular ultrasound particularly transcranial Doppler embolus protection, multi-modal CT imaging and MRI brain imaging). Research activities have been spread approximately equally across the above domains with an emphasis on clinical trials and stroke imaging. 

Teaching Expertise
Undergraduate - teaching in the form of formal lectures, small group tutorials, bedside tutorials and one on one clinical teaching on clinical wards and outpatients clinics. Postgraduate - formal lectures, small group tutorials bedside tutorials and formal mentoring of FRACP candidates. 

Collaborations
Prof Levi is currently leading an NHMRC Partnership Grant funded cluster randomised trial across 20 Australian acute stroke units testing strategies to better implement thrombolysis for acute ischaemic stroke (TIPS).  During recent years he established the Australian Stroke Genetics Collaborative (ASGC), and represents the ASGC on the International Stroke Genetics Consortium metaanalysis group, ‘Metastroke’. He was principal investigator on the successful 2009 ASGC NHMRC project grant, which to date has led to publications in Nature Genetics, Stroke and Annals of Neurology. He was also instrumental in establishing an international collaboration between the University of Newcastle and Hunter Medical Research Institute, and Harbin Medical University and its major teaching hospitals, the First and Second Affiliated Hospitals in China. 

He is a Honorary Principal Research Fellow for Florey Neurosciences Institute (FNI), University of Melbourne and has strong and ongoing collaborations with FNI. His leadership of statewide and national stroke health services research project have led to the formation of collaborative networks across Australian academic stroke neurology. 


Qualifications

  • Bachelor of Medicine, Bachelor of Surgery (Hons), University of New South Wales
  • Bachelor of Medical Science, University of New South Wales

Keywords

  • Acute stroke therapies
  • Basic Neurosciences
  • Brain imaging
  • Hypothermia
  • Neurology
  • Stroke
  • Stroke genetics
  • Transcranial Doppler

Fields of Research

Code Description Percentage
110999 Neurosciences not elsewhere classified 70
111799 Public Health and Health Services not elsewhere classified 30

Professional Experience

Academic appointment

Dates Title Organisation / Department
4/08/2014 -  Director, Clinical Research and Translation, Research Innovation and Partnership Hunter New England Area Health Service
Australia
21/01/2013 -  Honorary Professor of Neurology University of Gothenburg and Sahlgrenska University Hospital
Sweden
1/01/2013 -  Practitioner Fellow

NHMRC - Practitioner Fellowships (Formerly Practioner Fellowships Scheme)

NHMRC (National Health & Medical Research Council)
1/01/2010 -  Conjoint Professor

Neurology

University of Newcastle
School of Medicine and Public Health
Australia
19/01/2009 - 10/02/2014 Director, Priority Research Centre for Translational Neuroscience and Mental Health The University of Newcastle
Australia
1/01/2009 -  Honorary Professorial Fellow The Florey Institute of Neuroscience and Mental Health
Australia
1/01/1999 - 1/12/2002 Member Hunter Area Research Ethics Committee
Australia

Membership

Dates Title Organisation / Department
6/10/2015 -  Fellow Australian Academy of Health and Medical Sciences
Australia
1/01/2010 -  Expert Advisory Sub-committee to the Federal Health Minister Australian Population Health Development Principle Committee (APHDPC)
Australia
1/01/2010 -  Member National Stroke Foundation Clinical Council
Australia
1/01/1999 -  Stroke Society of Australasia, Committee Member Stroke Society of Australasia
Australia

Professional appointment

Dates Title Organisation / Department
1/01/2012 -  Clinical Lead Hunter New England Stroke Stream
Australia
1/01/2009 - 31/12/2014 Director Acute Stroke Services, John Hunter Hospital
Australia
1/01/2005 - 31/12/2009 Medical Director National Stroke Foundation
1/01/2003 - 31/12/2007 Chairman John Hunter Hospital, Division of Medicine
Australia
9/02/1998 -  Senior Staff Specialist John Hunter Hospital, Newcastle
Australia

Awards

Award

Year Award
2015 Hunter New England Health Quality Awards, Translational Research Category
Hunter New England Local Health District
2012 Premier's Public Sector Awards
NSW Health
2009 Award for Research Excellence
Hunter Medical Research Institute
2007 Quality Improvement Awards. Category: Health Care Performance Indicators.
Australian Council on Healthcare Standards (ACHS)
2007 Premier’s Public Sector Awards. Category: Reflect the State Plan – A New Direction for NSW.
NSW Department of Premier and Cabinet
2007 NSW Health Awards. Category: Build Regional and Other Partnerships for Health.
NSW Ministry of Health
2007 Quality Awards. Category: Build Regional and Other Partnerships for Health
Hunter New England Local Health District

Nomination

Year Award
2011 Australian Museum Eureka Awards, Rewarding Science -Translational Research
The Australian Museum Society

Research Award

Year Award
2005 Dudley Homer Vose Research Award
Heart Foundation

Invitations

Keynote Speaker

Year Title / Rationale
2014 Hunter New England Local Health District Telethrombolysis Pathway
2014 Thrombolysis Implementation in Stroke
2014 Concussion and Neck Injuries in Sport
2014 Feasibility and accuracy of fusion TCCD in monitoring acute stroke treatment
2014 What’s new in Neuroscience
2014 Process of care in stroke thrombolysis – opportunities for improvement
2014 Acute Stroke Therapy for Rural and Regional Stroke Sufferers
2014 Advanced Imaging edophenotypes and stroke outcomes
2013 Reducing Variation in patient care: The benefits of standarisation in Stroke Management.
2013 Transient Ischaemic Attacks (TIAs)
2013 Comprehensive Stroke Service
2013 Where do the new oral anticoagulants fit in contemporary stroke prevention
2013 Thromboembolic Risk – Evidence, Assessment and Treatment
2013 TCCD- CTA fusion Imaging
2013 Clinical Stroke Update
2013 Recognising and Managing Transient Ischaemic Attack
2012 Genetic Determinants of stroke
2012 Thrombolysis Implementation Plan for Stroke
2012 Hypothermia and neuroprotection for stroke
2012 Experimental Stroke
2012 Recent advances in stroke genetics
2012 Protecting the brain
2012 The development in thrombolysis and related issues
2012 Acute Stroke therapies, past, present and future
2012 Why do Neurologists need so many flies
2012 Metro and Regional PAST projects
2011 Can hypothermia be used to extend the window for good arterial reperfusion
2011 Stroke Interventions in Older People
2011 Tenecteplase for stroke, Phase III
2011 Correlating microembolism following vessel recanalization with severity of perfusion lesion volumes and infarct volumes
2011 The John West Principle – Application in Stroke Thrombolysis

Panel Participant

Year Title / Rationale
2014 Palliation should be inititated early in stroke patients with poor prognosis
2014 Stroke Recovery is all about Plasticity Debate
2013 Beat Stroke; Keep the pressure down
2012 Australian Stroke Trials Network
2012 Frontiers in Stroke Neuroscience
2011 Starting up and Running a Stroke Service

Participant

Year Title / Rationale
2005 Cholesterol and Stroke
Organisation: World Congress of Neurology

Speaker

Year Title / Rationale
2013 CLOTBUSTER trial
2013 Thrombolysis Implementation in Stroke (TIPS) trial
2012 GoTH: GWAS genetics of tPA associated haemorrhagic infarction
2012 Implementation of Stroke Thrombolysis and TIPS trial
2012 Establishing Collaborations and Priorities in Clinical and Translational Stroke Rehabilitation Research
2012 Acute Stroke Partnership
2012 Training the next generation of stroke physician – are we sitting on our hands
2011 US guided management of CEA patients
2011 Hyperacute trials using advanced imaging
2011 Hyperacute stroke retrieval services; The Hunter New England Health Experience
2011 Fever, hyperglycaemic and dysphagia management in acute stoke; Final results of the Quality in Acute Stroke Care (QASC) trial
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Publications

For publications that are currently unpublished or in-press, details are shown in italics.


Journal article (318 outputs)

Year Citation Altmetrics Link
2017 Pagram H, Bivard A, Lincz LF, Levi C, 'Immunity and stroke, the hurdles of stroke research translation', International Journal of Stroke, 12 123-131 (2017)

© 2016, © 2016 World Stroke Organization. Immunomodulatory therapies after stroke have the potential to provide clinical benefit to a subset of patients, but risk subverting the... [more]

© 2016, © 2016 World Stroke Organization. Immunomodulatory therapies after stroke have the potential to provide clinical benefit to a subset of patients, but risk subverting the protective, healing aspects of the innate immune response. Neutrophils clear necrotic cerebral tissue and are important in immunomodulation, but can also contribute to tissue injury. Human trials for immunomodulatory stroke treatments in the sub-acute time frame have attempted to prevent peripheral neutrophil infiltration, but none have been successful and one trial demonstrated harm. These unselected trials had broad inclusion criteria and appear to not have had a specific treatment target. Unfortunately, due to the heterogeneous nature of brain ischemia in humans resulting in variation in clinical severity, the negative effect of thrombolytic drugs on the blood¿brain barrier, and the heterogeneity of immune response, it may only be a subset of stroke patients who can realistically benefit from immunomodulation therapies. Translational research strategies require both an understanding of lab practices which create highly controlled environments in contrast to clinical practice where the diagnosis of stroke does not require the identification of a vessel occlusion. These differences between lab and clinical practices can be resolved through the integration of appropriate patient selection criteria and use of advanced imaging and ridged patient selection practices in clinical trials which will be an important part to the success of any future trials of translational research such as immunomodulation.

DOI 10.1177/1747493016676622
Co-authors Christopher Levi, Andrew Bivard, Lisa Lincz
2017 Magin P, Joyce T, Levi C, Lasserson D, 'Patients' anticipated actions following transient ischaemic attack symptoms: A qualitative vignette-based study', BMC Family Practice, 18 (2017)

© 2017 The Author(s). Background: Transient Ischaemic Attack (TIA) requires urgent investigation and management. Urgent management reduces the risk of subsequent stroke markedly,... [more]

© 2017 The Author(s). Background: Transient Ischaemic Attack (TIA) requires urgent investigation and management. Urgent management reduces the risk of subsequent stroke markedly, but non-presentation or delays in patient presentation to health services have been found to compromise timely management. We aimed to explore general practice patients' anticipated responses to TIA symptoms. Methods: This was a qualitative study employing semi-structured telephone interviews. Participants were recruited from respondents in an earlier quantitative study based in Australian general practices. Maximum variation purposive sampling of patients from that study (on the basis of age, rurality, gender and previous experience of stroke/TIA) continued until thematic saturation was achieved. After initial interviews explored knowledge of TIA and potential responses, subsequent interviews further explored anticipated responses via clinical vignettes containing TIA and non-TIA symptoms. Transcribed interviews were coded independently by two researchers. Data collection and analysis were concurrent and cumulative, using a process of iterative thematic analysis and constant comparison. A schema explaining participants' anticipated actions emerged during this process and was iteratively tested in later interviews. Results: Thirty-seven interviews were conducted and a 'spectrum of action', from watchful waiting (only responding if symptoms recurred) to summoning an ambulance immediately, was established. Intermediate actions upon the spectrum were: intending to mention the episode to a general practitioner (GP) at a routine appointment; consulting a GP non-urgently; consulting a general practitioner (GP) urgently; and attending an Emergency Department urgently. The substrate for decision-making relating to this spectrum operated via three constructs: the 'individual set' of the participant (their inherent disposition towards action in response to health matters in general), their 'discriminatory power' (the ability to discriminate TIA symptoms from non-TIA symptoms) and their 'effective access' to health-care services. Conclusions: Policies to improve patients' accessing care (and accessing care urgently) post-TIA should address these three determinants of anticipated action.

DOI 10.1186/s12875-017-0594-4
Co-authors Christopher Levi, Parker Magin
2017 Demeestere J, Garcia-Esperon C, Garcia-Bermejo P, Ombelet F, Mcelduff P, Bivard A, et al., 'Evaluation of hyperacute infarct volume using ASPECTS and brain CT perfusion core volume', Neurology, 88 2248-2253 (2017) [C1]

© 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology. Objective: To compare the accuracy of Alberta Stroke Program Early ... [more]

© 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology. Objective: To compare the accuracy of Alberta Stroke Program Early Computed Tomography Score (ASPECTS) and CT perfusion to detect established infarction in acute anterior circulation stroke. Methods: We performed an observational study in 59 acute anterior circulation ischemic stroke patients who underwent brain noncontrast CT, CT perfusion, and MRI within 100 minutes from CT imaging. ASPECTS scores were calculated by 4 blinded vascular neurologists. The accuracy of ASPECTS and CT perfusion core volume to detect an acute MRI diffusion lesion of =70 mL was evaluated using receiver operating characteristics analysis and optimum cutoff values were calculated using Youden J. Results: Median ASPECTS score was 8 (interquartile range [IQR] 5-9). Median CT perfusion core volume was 22 mL (IQR 10.4-71.9). Median MRI diffusion lesion volume was 24.5 mL (IQR 10-63.9). No significant difference was found between the accuracy of CT perfusion and ASPECTS (c statistic 0.95 vs 0.87, p value for difference = 0.17). The optimum ASPECTS cutoff score to detect a diffusion-weighted imaging lesion =70 mL was < 7 (sensitivity 0.74, specificity 0.86, Youden J = 0.60) and the optimum CT perfusion core volume cutoff was =50 mL (sensitivity 0.86, specificity 0.97, Youden J = 0.84). The CT perfusion core lesion covered a median of 100% (IQR 86%-100%) of the acute MRI lesion volume (Pearson R = 0.88; R 2 = 0.77). Conclusions: We found no significant difference between the accuracy of CT perfusion and ASPECTS to predict hyperacute MRI lesion volume in ischemic stroke.

DOI 10.1212/WNL.0000000000004028
Citations Scopus - 2Web of Science - 2
Co-authors Patrick Mcelduff, Andrew Bivard, Christopher Levi, Mark Parsons
2017 Traylor M, Malik R, Nalls MA, Cotlarciuc I, Radmanesh F, Thorleifsson G, et al., 'Genetic variation at 16q24.2 is associated with small vessel stroke.', Ann Neurol, 81 383-394 (2017)
DOI 10.1002/ana.24840
Citations Scopus - 2Web of Science - 2
Co-authors Christopher Levi
2017 Bivard A, Levi C, Parsons M, 'Response by Bivard et al to Letter Regarding Article, "Validating a Predictive Model of Acute Advanced Imaging Biomarkers in Ischemic Stroke".', Stroke, 48 e226 (2017)
DOI 10.1161/STROKEAHA.117.017613
Co-authors Andrew Bivard, Mark Parsons, Christopher Levi
2017 Liebeskind DS, Woolf GW, Shuaib A, Aaron S, Albers G, Alexandrov A, et al., 'Collaterals 2016: Translating the collaterome around the globe', International Journal of Stroke, 12 338-342 (2017)

© 2017, © 2017 World Stroke Organization. Collaterals 2016 (third International Symposium on Collaterals to the Brain) was a multidisciplinary scientific conference focused on c... [more]

© 2017, © 2017 World Stroke Organization. Collaterals 2016 (third International Symposium on Collaterals to the Brain) was a multidisciplinary scientific conference focused on collateral circulation in acute ischemic stroke. Decisive challenges include generalizability of optimal triage and selection paradigms based on collateral status for definitive treatment of acute ischemic stroke, rapid dissemination of expert methods, and the urgent need to leverage networking opportunities for stroke science related to the hemodynamics of collaterals. The collaterome, or individual capacity to offset ischemia in the brain, and determination of a favorable collateral profile have become pivotal factors in consideration of the precision medicine of stroke decision-making. The conference convened over 50 invited faculty from around the world to connect on-site participants at a state-of-the-art facility with remote audiences in more than 22 countries and regions. The 2½-day program was structured into 40-min sessions devoted to key issues in translating the collaterome in acute stroke therapy across the globe. This unique forum of expertise emphasized the timely impact of collaterals on a monumental scale, encouraging maximal participation, rapid diffusion and added value of a diverse networking resource. The meeting format established a model geographical framework and innovative videoconferencing platform for future scientific conferences.

DOI 10.1177/1747493017701942
Co-authors Christopher Levi, Neil Spratt
2017 Larsson SC, King A, Madigan J, Levi C, Norris JW, Markus HS, 'Prognosis of carotid dissecting aneurysms: Results from CADISS and a systematic review.', Neurology, 88 646-652 (2017)
DOI 10.1212/WNL.0000000000003617
Citations Scopus - 1Web of Science - 1
Co-authors Christopher Levi
2017 Gardner AJ, Wojtowicz M, Terry DP, Levi CR, Zafonte DO R, Iverson GL, 'Video and clinical screening of national rugby league players suspected of sustaining concussion.', Brain Inj, 1-7 (2017)
DOI 10.1080/02699052.2017.1358399
Co-authors Andrew Gardner, Christopher Levi
2017 Bivard A, Huang X, Levi CR, Spratt N, Campbell BCV, Cheripelli BK, et al., 'Tenecteplase in ischemic stroke offers improved recanalization: Analysis of 2 trials.', Neurology, 89 62-67 (2017)
DOI 10.1212/WNL.0000000000004062
Co-authors Andrew Bivard, Christopher Levi, Neil Spratt, Mark Parsons
2017 Bivard A, Levi C, Lin L, Cheng X, Aviv R, Spratt NJ, et al., 'Validating a Predictive Model of Acute Advanced Imaging Biomarkers in Ischemic Stroke', Stroke, 48 645-650 (2017) [C1]

© 2017 American Heart Association, Inc. Background and Purpose - Advanced imaging to identify tissue pathophysiology may provide more accurate prognostication than the clinical m... [more]

© 2017 American Heart Association, Inc. Background and Purpose - Advanced imaging to identify tissue pathophysiology may provide more accurate prognostication than the clinical measures used currently in stroke. This study aimed to derive and validate a predictive model for functional outcome based on acute clinical and advanced imaging measures. Methods - A database of prospectively collected sub-4.5 hour patients with ischemic stroke being assessed for thrombolysis from 5 centers who had computed tomographic perfusion and computed tomographic angiography before a treatment decision was assessed. Individual variable cut points were derived from a classification and regression tree analysis. The optimal cut points for each assessment variable were then used in a backward logic regression to predict modified Rankin scale (MRS) score of 0 to 1 and 5 to 6. The variables remaining in the models were then assessed using a receiver operating characteristic curve analysis. Results - Overall, 1519 patients were included in the study, 635 in the derivation cohort and 884 in the validation cohort. The model was highly accurate at predicting MRS score of 0 to 1 in all patients considered for thrombolysis therapy (area under the curve [AUC] 0.91), those who were treated (AUC 0.88) and those with recanalization (AUC 0.89). Next, the model was highly accurate at predicting MRS score of 5 to 6 in all patients considered for thrombolysis therapy (AUC 0.91), those who were treated (0.89) and those with recanalization (AUC 0.91). The odds ratio of thrombolysed patients who met the model criteria achieving MRS score of 0 to 1 was 17.89 (4.59-36.35, P < 0.001) and for MRS score of 5 to 6 was 8.23 (2.57-26.97, P < 0.001). Conclusions - This study has derived and validated a highly accurate model at predicting patient outcome after ischemic stroke.

DOI 10.1161/STROKEAHA.116.015143
Citations Scopus - 4Web of Science - 3
Co-authors Mark Parsons, Christopher Levi, Neil Spratt, Andrew Bivard
2017 Malik R, Dau T, Gonik M, Sivakumar A, Deredge DJ, Edeleva EV, et al., 'Common coding variant in SERPINA1 increases the risk for large artery stroke', Proceedings of the National Academy of Sciences of the United States of America, 114 3613-3618 (2017) [C1]

Large artery atherosclerotic stroke (LAS) shows substantial heritability not explained by previous genome-wide association studies. Here, we explore the role of coding variation i... [more]

Large artery atherosclerotic stroke (LAS) shows substantial heritability not explained by previous genome-wide association studies. Here, we explore the role of coding variation in LAS by analyzing variants on the HumanExome BeadChip in a total of 3,127 cases and 9,778 controls from Europe, Australia, and South Asia. We report on a nonsynonymous single-nucleotide variant in serpin family A member 1 (SERPINA1) encoding alpha-1 antitrypsin [AAT; p.V213A; P = 5.99E-9, odds ratio (OR) = 1.22] and confirm histone deacetylase 9 (HDAC9) as a major risk gene for LAS with an association in the 3?-UTR (rs2023938; P = 7.76E-7, OR = 1.28). Using quantitative microscale thermophoresis, we show that M1 (A213) exhibits an almost twofold lower dissociation constant with its primary target human neutrophil elastase (NE) in lipoprotein-containing plasma, but not in lipid-free plasma. Hydrogen/deuterium exchange combined with mass spectrometry further revealed a significant difference in the global flexibility of the two variants. The observed stronger interaction with lipoproteins in plasma and reduced global flexibility of the Val-213 variant most likely improve its local availability and reduce the extent of proteolytic inactivation by other proteases in atherosclerotic plaques. Our results indicate that the interplay between AAT, NE, and lipoprotein particles is modulated by the gate region around position 213 in AAT, far away from the unaltered reactive center loop (357-360). Collectively, our findings point to a functionally relevant balance between lipoproteins, proteases, and AAT in atherosclerosis.

DOI 10.1073/pnas.1616301114
Citations Scopus - 2Web of Science - 1
Co-authors Lisa Lincz, Christopher Levi, Liz Holliday, John Attia
2017 Wong R, Ahmad W, Davies A, Spratt N, Boyle A, Levi C, et al., 'Assessment of cerebral blood flow in adult patients with aortic coarctation.', Cardiol Young, 27 1606-1613 (2017)
DOI 10.1017/S1047951117000920
Co-authors Neil Spratt, Andrew Boyle, Christopher Levi, Peter Howe, Rachel Wong
2017 Gardner AJ, Kohler RMN, Levi CR, Iverson GL, 'Usefulness of Video Review of Possible Concussions in National Youth Rugby League', International Journal of Sports Medicine, 38 71-75 (2017) [C1]
DOI 10.1055/s-0042-116072
Co-authors Andrew Gardner, Christopher Levi
2017 Alemseged F, Shah DG, Diomedi M, Sallustio F, Bivard A, Sharma G, et al., 'The Basilar Artery on Computed Tomography Angiography Prognostic Score for Basilar Artery Occlusion', Stroke, 48 631-637 (2017)

© 2017 American Heart Association, Inc. Background and Purpose - Basilar artery occlusion is associated with high risk of disability and mortality. This study aimed to assess the... [more]

© 2017 American Heart Association, Inc. Background and Purpose - Basilar artery occlusion is associated with high risk of disability and mortality. This study aimed to assess the prognostic value of a new radiological score: the Basilar Artery on Computed Tomography Angiography (BATMAN) score. Methods - A retrospective analysis of consecutive stroke patients with basilar artery occlusion diagnosed on computed tomographic angiography was performed. BATMAN score is a 10-point computed tomographic angiography-based grading system which incorporates thrombus burden and the presence of collaterals. Reliability was assessed with intraclass coefficient correlation. Good outcome was defined as modified Rankin Scale score of =3 at 3 months and successful reperfusion as thrombolysis in cerebral infarction 2b-3. BATMAN score was externally validated and compared with the Posterior Circulation Collateral score. Results - The derivation cohort included 83 patients with 41 in the validation cohort. In receiver operating characteristic (ROC) analysis, BATMAN score had an area under receiver operating characteristic curve of 0.81 (95% confidence interval [CI], 0.7-0.9) in derivation cohort and an area under receiver operating characteristic curve of 0.74 (95% CI, 0.6-0.9) in validation cohort. In logistic regression adjusted for age and clinical severity, BATMAN score of < 7 was associated with poor outcome in derivation cohort (odds ratio, 5.5; 95% CI, 1.4-21; P=0.01), in validation cohort (odds ratio, 6.9; 95% CI, 1.4-33; P=0.01), and in endovascular patients, after adjustment for recanalization and time to treatment (odds ratio, 4.8; 95% CI, 1.2-18; P=0.01). BATMAN score of < 7 was not associated with recanalization. Interrater agreement was substantial (intraclass coefficient correlation, 0.85; 95% CI, 0.8-0.9). BATMAN score had greater accuracy compared with Posterior Circulation Collateral score (P=0.04). Conclusions - The addition of collateral quality to clot burden in BATMAN score seems to improve prognostic accuracy in basilar artery occlusion patients.

DOI 10.1161/STROKEAHA.116.015492
Citations Scopus - 1
Co-authors Mark Parsons, Christopher Levi, Andrew Bivard
2017 Demeestere J, Garcia-Esperon C, Lin L, Bivard A, Ang T, Smoll NR, et al., 'Validation of the National Institutes of Health Stroke Scale-8 to Detect Large Vessel Occlusion in Ischemic Stroke', Journal of Stroke and Cerebrovascular Diseases, 26 1419-1426 (2017) [C1]

© 2017 National Stroke Association Background Patients with acute ischemic stroke and large vessel occlusion (LVO) may benefit from prehospital identification and transfer to a c... [more]

© 2017 National Stroke Association Background Patients with acute ischemic stroke and large vessel occlusion (LVO) may benefit from prehospital identification and transfer to a center offering endovascular therapy. Aims We aimed to assess the accuracy of an existing 8-item stroke scale (National Institutes of Health Stroke Scale-8 [NIHSS-8]) for identification of patients with acute stroke with LVO. Methods We retrospectively calculated NIHSS-8 scores in a population of consecutive patients with presumed acute stroke assessed by emergency medical services (EMS). LVO was identified on admission computed tomography angiography. Accuracy to identify LVO was calculated using receiver operating characteristics analysis. We used weighted Cohen's kappa statistics to assess inter-rater reliability for the NIHSS-8 score between the EMS and the hospital stroke team on a prospectively evaluated subgroup. Results Of the 551 included patients, 381 had a confirmed ischemic stroke and 136 patients had an LVO. NIHSS scores were significantly higher in patients with LVO (median 18; interquartile range 14-22). The NIHSS-8 score reliably predicted the presence of LVO (area under the receiver operating characteristic curve.82). The optimum NIHSS-8 cutoff of 8 or more had a sensitivity of.81, specificity of.75, and Youden index of.56 for prediction of LVO. The EMS and the stroke team reached substantial agreement (¿ =.69). Conclusions Accuracy of the NIHSS-8 to identify LVO in a population of patients with suspected acute stroke is comparable to existing prehospital stroke scales. The scale can be performed by EMS with reasonable reliability. Further validation in the field is needed to assess accuracy of the scale to identify patients with LVO eligible for endovascular treatment in a prehospital setting.

DOI 10.1016/j.jstrokecerebrovasdis.2017.03.020
Co-authors Mark Parsons, Andrew Bivard, Christopher Levi, Neil Spratt
2017 Gardner AJ, Iverson GL, Wojtowicz M, Levi CR, Kay-Lambkin F, Schofield PW, et al., 'MR Spectroscopy Findings in Retired Professional Rugby League Players', International Journal of Sports Medicine, (2017)
DOI 10.1055/s-0042-120843
Co-authors Peter Schofield, Frances Kaylambkin, Christopher Levi, Peter Stanwell, Andrew Gardner
2017 Biros E, Moran CS, Maguire J, Holliday E, Levi C, Golledge J, 'Upregulation of arylsulfatase B in carotid atherosclerosis is associated with symptoms of cerebral embolization', Scientific Reports, 7 1-8 (2017) [C1]
DOI 10.1038/s41598-017-04497-9
Co-authors Liz Holliday, Christopher Levi
2017 Gao J, Parsons MW, Kawano H, Levi CR, Evans T-J, Lin L, Bivard A, 'Visibility of CT Early Ischemic Change Is Significantly Associated with Time from Stroke Onset to Baseline Scan beyond the First 3 Hours of Stroke Onset', JOURNAL OF STROKE, 19 340-346 (2017)
DOI 10.5853/jos.2016.01424
Co-authors Christopher Levi, Andrew Bivard, Mark Parsons
2017 Demeestere J, Sewell C, Rudd J, Ang T, Jordan L, Wills J, et al., 'The establishment of a telestroke service using multimodal CT imaging decision assistance: "Turning on the fog lights"', JOURNAL OF CLINICAL NEUROSCIENCE, 37 1-5 (2017)
DOI 10.1016/j.jocn.2016.10.018
Citations Scopus - 1Web of Science - 1
Co-authors Andrew Bivard, Christopher Levi, Neil Spratt, Mark Parsons
2017 Davey AR, Lasserson DS, Levi CR, Magin PJ, 'Managing transient ischaemic attacks in Australia: a qualitative study.', Fam Pract, 34 606-611 (2017)
DOI 10.1093/fampra/cmx030
Co-authors Parker Magin, Christopher Levi
2017 Bivard A, Lillicrap T, Krishnamurthy V, Holliday E, Attia J, Pagram H, et al., 'MIDAS (Modafinil in Debilitating Fatigue After Stroke): A Randomized, Double-Blind, Placebo-Controlled, Cross-Over Trial.', Stroke, 48 1293-1298 (2017)
DOI 10.1161/STROKEAHA.116.016293
Co-authors Liz Holliday, Mark Parsons, Andrew Bivard, Michael Nilsson, Christopher Levi, John Attia
2017 Thomas LC, Hall LA, Attia JR, Holliday EG, Markus HS, Levi CR, 'Seasonal Variation in Spontaneous Cervical Artery Dissection: Comparing between UK and Australian Sites', Journal of Stroke and Cerebrovascular Diseases, 26 177-185 (2017)

© 2017 National Stroke Association Background Cervical artery dissection (CAD) is a lea ding cause of stroke among middle-aged adults, but the etiology is unclear. Some reports o... [more]

© 2017 National Stroke Association Background Cervical artery dissection (CAD) is a lea ding cause of stroke among middle-aged adults, but the etiology is unclear. Some reports of seasonal variation in CAD incidence have been suggested but may reflect extreme climatic conditions. Seasonal variation may implicate more transient seasonal causes such as proinflammatory or hypercoagulable states. This study aimed to assess whether CAD incidence varied with season between UK and Australian sites. Also, this study aimed to determine whether there was a different pattern of seasonal variation between arteries (carotid and vertebral) and any association between CAD incidence and clinical factors. Methods This was a retrospective observational study of patients older than 18 years with radiological diagnosis of internal carotid or vertebral arterial dissection, from sites in Australia and the UK. Clinical variables were compared between autumn-winter and spring-summer and site of dissection. Results A total of 133 CAD cases were documented in Australia and 242 in the UK. There was a seasonal pattern to CAD incidence in countries in both the northern and the southern hemispheres, with a trend for dissection to occur more commonly in autumn, winter, and spring than in summer (incidence rate ratios [IRR] 1.4-1.5, P¿ < ¿.05). CAD counts were also slightly higher in internal carotid than in vertebral artery (IRRs 1.168, 1.43, and 1.127, respectively). Neither systolic blood pressure nor pulse pressure was significantly associated with CAD counts. Conclusions CAD occurs more commonly in cooler months regardless of geographical location, suggesting transient seasonal causes may be important in the pathophysiology. This effect was slightly higher in internal carotid than in vertebral artery, suggesting differing trigger mechanisms between dissection sites.

DOI 10.1016/j.jstrokecerebrovasdis.2016.09.006
Co-authors Christopher Levi, Liz Holliday, John Attia, Lucy Thomas
2017 Cadilhac DA, Andrew NE, Lannin NA, Middleton S, Levi CR, Dewey HM, et al., 'Quality of Acute Care and Long-Term Quality of Life and Survival: The Australian Stroke Clinical Registry', Stroke, 48 1026-1032 (2017)

© 2017 American Heart Association, Inc. Background and Purpose-Uncertainty exists over whether quality improvement strategies translate into better health-related quality of life... [more]

© 2017 American Heart Association, Inc. Background and Purpose-Uncertainty exists over whether quality improvement strategies translate into better health-related quality of life (HRQoL) and survival after acute stroke. We aimed to determine the association of best practice recommended interventions and outcomes after stroke. Methods-Data are from the Australian Stroke Clinical Registry during 2010 to 2014. Multivariable regression was used to determine associations between 3 interventions: received acute stroke unit (ASU) care and in various combinations with prescribed antihypertensive medication at discharge, provision of a discharge care plan, and outcomes of survival and HRQoL (EuroQoL 5-dimensional questionnaire visual analogue scale) at 180 days, by stroke type. An assessment was also made of outcomes related to the number of processes patients received. Results-There were 17 585 stroke admissions (median age 77 years, 47% female; 81% managed in ASUs; 80% ischemic stroke) from 42 hospitals (77% metropolitan) assessed. Cumulative benefits on outcomes related to the number of care processes received by patients. ASU care was associated with a reduced likelihood of death (hazard ratio, 0.49; 95% confidence interval, 0.43-0.56) and better HRQoL (coefficient, 21.34; 95% confidence interval, 15.50-27.18) within 180 days. For those discharged from hospital, receiving ASU+antihypertensive medication provided greater 180-day survival (hazard ratio, 0.45; 95% confidence interval, 0.38-0.52) compared with ASU care alone (hazard ratio, 0.64; 95% confidence interval, 0.54-0.76). HRQoL gains were greatest for patients with intracerebral hemorrhage who received care bundles involving discharge processes (range of increase, 11%-19%). Conclusions-Patients with stroke who receive best practice recommended hospital care have improved long-term survival and HRQoL.

DOI 10.1161/STROKEAHA.116.015714
Citations Scopus - 2Web of Science - 1
Co-authors Christopher Levi
2017 Cadilhac DA, Kilkenny MF, Levi CR, Lannin NA, Thrift AG, Kim J, et al., 'Risk-adjusted hospital mortality rates for stroke: evidence from the Australian Stroke Clinical Registry (AuSCR).', Med J Aust, 206 345-350 (2017)
Citations Web of Science - 3
Co-authors Christopher Levi
2017 Marsden DL, Dunn A, Callister R, McElduff P, Levi CR, Spratt NJ, 'Interval circuit training for cardiorespiratory fitness is feasible for people after stroke', INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION, 24 190-202 (2017)
DOI 10.12968/ijtr.2017.24.5.190
Co-authors Robin Callister, Christopher Levi, Patrick Mcelduff, Neil Spratt
2017 Bivard A, Lincz LF, Maquire J, Parsons M, Levi C, 'Platelet microparticles: a biomarker for recanalization in rtPA-treated ischemic stroke patients.', Ann Clin Transl Neurol, 4 175-179 (2017)
DOI 10.1002/acn3.392
Co-authors Mark Parsons, Andrew Bivard, Christopher Levi, Lisa Lincz
2017 Kawano H, Bivard A, Lin L, Ma H, Cheng X, Aviv R, et al., 'Perfusion computed tomography in patients with stroke thrombolysis.', Brain, 140 684-691 (2017)
DOI 10.1093/brain/aww338
Citations Web of Science - 1
Co-authors Christopher Levi, Andrew Bivard, Mark Parsons
2017 Bivard A, Huang X, McElduff P, Levi CR, Campbell BCV, Cheripelli BK, et al., 'Impact of Computed Tomography Perfusion Imaging on the Response to Tenecteplase in Ischemic Stroke Analysis of 2 Randomized Controlled Trials', CIRCULATION, 135 440-+ (2017)
DOI 10.1161/CIRCULATIONAHA.116.022582
Citations Scopus - 2Web of Science - 2
Co-authors Mark Parsons, Patrick Mcelduff, Christopher Levi, Andrew Bivard
2017 Bhaskar S, Bivard A, Stanwell P, Parsons M, Attia JR, Nilsson M, Levi C, 'Baseline collateral status and infarct topography in post-ischaemic perilesional hyperperfusion: An arterial spin labelling study', Journal of Cerebral Blood Flow and Metabolism, 37 1148-1162 (2017) [C1]

© The Author(s) 2016. Focal hyperperfusion after acute ischaemic stroke could be of prognostic value depending upon its spatial localisation and temporal dynamics. Factors associ... [more]

© The Author(s) 2016. Focal hyperperfusion after acute ischaemic stroke could be of prognostic value depending upon its spatial localisation and temporal dynamics. Factors associated with late stage (12-24 h) perilesional hyperperfusion, identified using arterial spin labelling, are poorly defined. A prospective cohort of acute ischaemic stroke patients presenting within 4.5 h of symptom onset were assessed with multi-modal computed tomography acutely and magnetic resonance imaging at 24 ± 8 h. Multivariate logistic regression analysis and receiver operating characteristics curves were used. One hundred and nineteen hemispheric acute ischaemic stroke patients (mean age = 71 ± 12 years) with 24 h arterial spin labelling imaging were included. Forty-Two (35.3%) patients showed perilesional hyperperfusion on arterial spin labelling at 24 h. Several factors were independently associated with perilesional hyperperfusion: good collaterals (71% versus 29%, P < 0.0001; OR = 5, 95% CI = [1.6, 15.7], P = 0.005), major reperfusion (81% versus 48%, P = < 0.0001; OR = 7.5, 95% CI = [1.6, 35.1], P = 0.01), penumbral salvage (76.2% versus 47%, P = 0.002; OR = 6.6, 95% CI = [1.8, 24.5] , P = 0.004), infarction in striatocapsular (OR = 9.5, 95% CI = [2.6, 34], P = 0.001) and in cortical superior division middle cerebral artery (OR = 4.7, 95% CI = [1.4, 15.7] , P = 0.012) territory. The area under the receiver operating characteristic curve was 0.91. Our results demonstrate good arterial collaterals, major reperfusion, penumbral salvage, and infarct topographies involving cortical superior middle cerebral artery and striatocapsular are associated with perilesional hyperperfusion.

DOI 10.1177/0271678X16653133
Citations Scopus - 1Web of Science - 1
Co-authors Michael Nilsson, Peter Stanwell, Christopher Levi, John Attia, Andrew Bivard, Mark Parsons
2017 Lin L, Cheng X, Bivard A, Levi CR, Dong Q, Parsons MW, 'Quantifying reperfusion of the ischemic region on whole-brain computed tomography perfusion.', Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism, 37 2125-2136 (2017)
DOI 10.1177/0271678x16661338
Citations Web of Science - 2
Co-authors Mark Parsons, Christopher Levi, Andrew Bivard
2017 Craig LE, Taylor N, Grimley R, Cadilhac DA, McInnes E, Phillips R, et al., 'Development of a theory-informed implementation intervention to improve the triage, treatment and transfer of stroke patients in emergency departments using the Theoretical Domains Framework (TDF): the T-3 Trial', IMPLEMENTATION SCIENCE, 12 (2017) [C1]
DOI 10.1186/s13012-017-0616-6
Co-authors Christopher Levi
2017 Jolly TAD, Cooper PS, Rennie JL, Levi CR, Lenroot R, Parsons MW, et al., 'Age-related decline in task switching is linked to both global and tract-specific changes in white matter microstructure', Human Brain Mapping, 38 1588-1603 (2017) [C1]

© 2016 Wiley Periodicals, Inc. Task-switching performance relies on a broadly distributed frontoparietal network and declines in older adults. In this study, they investigated wh... [more]

© 2016 Wiley Periodicals, Inc. Task-switching performance relies on a broadly distributed frontoparietal network and declines in older adults. In this study, they investigated whether this age-related decline in task switching performance was mediated by variability in global or regional white matter microstructural health. Seventy cognitively intact adults (43¿87 years) completed a cued-trials task switching paradigm. Microstructural white matter measures were derived using diffusion tensor imaging (DTI) analyses on the diffusion-weighted imaging (DWI) sequence. Task switching performance decreased with increasing age and radial diffusivity (RaD), a measure of white matter microstructure that is sensitive to myelin structure. RaD mediated the relationship between age and task switching performance. However, the relationship between RaD and task switching performance remained significant when controlling for age and was stronger in the presence of cardiovascular risk factors. Variability in error and RT mixing cost were associated with RaD in global white matter and in frontoparietal white matter tracts, respectively. These findings suggest that age-related increase in mixing cost may result from both global and tract-specific disruption of cerebral white matter linked to the increased incidence of cardiovascular risks in older adults. Hum Brain Mapp 38:1588¿1603, 2017. © 2016 Wiley Periodicals, Inc.

DOI 10.1002/hbm.23473
Citations Scopus - 1
Co-authors Patrick Cooper, Frini Karayanidis, Christopher Levi, Pat Michie, Mark Parsons
2017 Middleton S, Coughlan K, Mnatzaganian G, Low Choy N, Dale S, Jammali-Blasi A, et al., 'Mortality Reduction for Fever, Hyperglycemia, and Swallowing Nurse-Initiated Stroke Intervention: QASC Trial (Quality in Acute Stroke Care) Follow-Up', Stroke, 48 1331-1336 (2017)

© 2017 American Heart Association, Inc. Background and Purpose - Implementation of nurse-initiated protocols to manage fever, hyperglycemia, and swallowing dysfunction decreased ... [more]

© 2017 American Heart Association, Inc. Background and Purpose - Implementation of nurse-initiated protocols to manage fever, hyperglycemia, and swallowing dysfunction decreased death and disability 90 days poststroke in the QASC trial (Quality in Acute Stroke Care) conducted in 19 Australian acute stroke units (2005-2010). We now examine long-term all-cause mortality. Methods - Mortality was ascertained using Australia's National Death Index. Cox proportional hazards regression compared time to death adjusting for correlation within stroke units using the cluster sandwich (Huber-White estimator) method. Primary analyses included treatment group only unadjusted for covariates. Secondary analysis adjusted for age, sex, marital status, education, and stroke severity using multiple imputation for missing covariates. Results - One thousand and seventy-six participants (intervention n=600; control n=476) were followed for a median of 4.1 years (minimum 0.3 to maximum 70 months), of whom 264 (24.5%) had died. Baseline demographic and clinical characteristics were generally well balanced by group. The QASC intervention group had improved long-term survival ( > 20%), but this was only statistically significant in adjusted analyses (unadjusted hazard ratio [HR], 0.79; 95% confidence interval [CI] , 0.58-1.07; P=0.13; adjusted HR, 0.77; 95% CI, 0.59-0.99; P=0.045). Older age (75-84 years; HR, 4.9; 95% CI, 2.8-8.7; P < 0.001) and increasing stroke severity (HR, 1.5; 95% CI, 1.3-1.9; P < 0.001) were associated with increased mortality, while being married (HR, 0.70; 95% CI, 0.49-0.99; P=0.042) was associated with increased likelihood of survival. Cardiovascular disease (including stroke) was listed either as the primary or secondary cause of death in 80% (211/264) of all deaths. Conclusions - Our results demonstrate the potential long-term and sustained benefit of nurse-initiated multidisciplinary protocols for management of fever, hyperglycemia, and swallowing dysfunction. These protocols should be a routine part of acute stroke care.

DOI 10.1161/STROKEAHA.116.016038
Co-authors Catherine Deste, Christopher Levi, Patrick Mcelduff
2016 Wright IMR, Latter JL, Dyson RM, Levi CR, Clifton VL, 'Videomicroscopy as a tool for investigation of the microcirculation in the newborn', PHYSIOLOGICAL REPORTS, 4 (2016) [C1]
DOI 10.14814/phy2.12941
Citations Scopus - 1Web of Science - 1
Co-authors Christopher Levi, Vicki Clifton, Ian Wright, Joanna Latter
2016 Gardner AJ, Kohler RMN, Levi CR, Iverson GL, 'Usefulness of Video Review of Possible Concussions in National Youth Rugby League. International Journal of Sports Medicine,', International Journal of Sports Medicine, (2016)
Co-authors Christopher Levi
2016 Gardner AJ, Iverson GL, Stanwell P, Moore T, Ellis J, Levi CR, 'A video analysis of use of the new ¿Concussion Interchange Rule¿ in the National Rugby League', International Journal of Sports Medicine, 37 267-273 (2016) [C1]
DOI 10.1055/s-0035-1565203
Citations Scopus - 2Web of Science - 3
Co-authors Andrew Gardner, Christopher Levi, Peter Stanwell
2016 Rosand J, Mitchell BD, Ay H, de Bakker PIW, Gwinn K, Kittner SJ, et al., 'Loci associated with ischaemic stroke and its subtypes (SiGN): A genome-wide association study', The Lancet Neurology, 15 174-184 (2016) [C1]

© 2016 Elsevier Ltd. Background: The discovery of disease-associated loci through genome-wide association studies (GWAS) is the leading genetic approach to the identification of ... [more]

© 2016 Elsevier Ltd. Background: The discovery of disease-associated loci through genome-wide association studies (GWAS) is the leading genetic approach to the identification of novel biological pathways underlying diseases in humans. Until recently, GWAS in ischaemic stroke have been limited by small sample sizes and have yielded few loci associated with ischaemic stroke. We did a large-scale GWAS to identify additional susceptibility genes for stroke and its subtypes. Methods: To identify genetic loci associated with ischaemic stroke, we did a two-stage GWAS. In the first stage, we included 16 851 cases with state-of-the-art phenotyping data and 32 473 stroke-free controls. Cases were aged 16 to 104 years, recruited between 1989 and 2012, and subtypes of ischaemic stroke were recorded by centrally trained and certified investigators who used the web-based protocol, Causative Classification of Stroke (CCS). We constructed case-control strata by identifying samples that were genotyped on nearly identical arrays and were of similar genetic ancestral background. We cleaned and imputed data by use of dense imputation reference panels generated from whole-genome sequence data. We did genome-wide testing to identify stroke-associated loci within each stratum for each available phenotype, and we combined summary-level results using inverse variance-weighted fixed-effects meta-analysis. In the second stage, we did in-silico lookups of 1372 single nucleotide polymorphisms identified from the first stage GWAS in 20 941 cases and 364 736 unique stroke-free controls. The ischaemic stroke subtypes of these cases had previously been established with the Trial of Org 10 172 in Acute Stroke Treatment (TOAST) classification system, in accordance with local standards. Results from the two stages were then jointly analysed in a final meta-analysis. Findings: We identified a novel locus (G allele at rs12122341) at 1p13.2 near TSPAN2 that was associated with large artery atherosclerosis-related stroke (first stage odds ratio [OR] 1·21, 95% CI 1·13-1·30, p=4·50 × 10 -8 ; joint OR 1·19, 1·12-1·26, p=1·30 × 10 -9 ). Our results also supported robust associations with ischaemic stroke for four other loci that have been reported in previous studies, including PITX2 (first stage OR 1·39, 1·29-1·49, p=3·26 × 10 -19 ; joint OR 1·37, 1·30-1·45, p=2·79 × 10 -32 ) and ZFHX3 (first stage OR 1·19, 1·11-1·27, p=2·93 × 10 -7 ; joint OR 1·17, 1·11-1·23, p=2·29 × 10 -10 ) for cardioembolic stroke, and HDAC9 (first stage OR 1·29, 1·18-1·42, p=3·50 × 10 -8 ; joint OR 1·24, 1·15-1·33, p=4·52 × 10 -9 ) for large artery atherosclerosis stroke. The 12q24 locus near ALDH2, which has previously been associated with all ischaemic stroke but not with any specific subtype, exceeded genome-wide significance in the meta-analysis of small artery stroke (first stage OR 1·20, 1·12-1·28, p=6·82 × 10 -8 ; joint OR 1·17, 1·11-1·23, p=2·92 × 10 -9 ). Other loci associated with stroke in previous studies, including NINJ2, were not confirmed. Interpretation: Our results suggest that all ischaemic stroke-related loci previously implicated by GWAS are subtype specific. We identified a novel gene associated with large artery atherosclerosis stroke susceptibility. Follow-up studies will be necessary to establish whether the locus near TSPAN2 can be a target for a novel therapeutic approach to stroke prevention. In view of the subtype-specificity of the associations detected, the rich phenotyping data available in the Stroke Genetics Network (SiGN) are likely to be crucial for further genetic discoveries related to ischaemic stroke. Funding: US National Institute of Neurological Disorders and Stroke, National Institutes of Health.

DOI 10.1016/S1474-4422(15)00338-5
Citations Scopus - 19
Co-authors Christopher Levi, Liz Holliday, John Attia
2016 Kawano H, Levi C, Inatomi Y, Pagram H, Kerr E, Bivard A, et al., 'International benchmarking for acute thrombolytic therapy implementation in Australia and Japan', Journal of Clinical Neuroscience, 29 87-91 (2016) [C1]

© 2016 Elsevier Ltd. All rights reserved. Although a wide range of strategies have been established to improve intravenous tissue plasminogen activator (IV-tPA) treatment rates, ... [more]

© 2016 Elsevier Ltd. All rights reserved. Although a wide range of strategies have been established to improve intravenous tissue plasminogen activator (IV-tPA) treatment rates, international benchmarking has not been regularly used as a systems improvement tool. We compared acute stroke codes (ASC) between two hospitals in Australia and Japan to study the activation process and potentially improve the implementation of thrombolysis. Consecutive patients who were admitted to each hospital via ASC were prospectively collected. We compared IV-tPA rates, factors contributing to exclusion from IV-tPA, and pre- and in-hospital process of care. IV-tPA treatment rates were significantly higher in the Australian hospital than in the Japanese (41% versus 25% of acute ischaemic stroke patients, p = 0.0016). In both hospitals, reasons for exclusion from IV-tPA treatment were intracerebral haemorrhage, mild symptoms, and stroke mimic. Patients with baseline National Institutes of Health Stroke Scale score =5 were more likely to be excluded from IV-tPA in the Japanese hospital. Of patients treated with IV-tPA, the door-to-needle time (median, 63 versus 54 minutes, p = 0.0355) and imaging-to-needle time (34 versus 27 minutes, p = 0.0220) were longer in the Australian hospital. Through international benchmarking using cohorts captured under ASC, significant differences were noted in rates of IV-tPA treatment and workflow speed. This variation highlights opportunity to improve and areas to focus targeted practice improvement strategies.

DOI 10.1016/j.jocn.2015.10.043
Co-authors Andrew Bivard, Neil Spratt, Christopher Levi, Mark Parsons
2016 Bivard A, Cheng X, Lin LT, Levi C, Spratt N, Kleinig T, et al., 'Global White Matter Hypoperfusion on CT Predicts Larger Infarcts and Hemorrhagic Transformation after Acute Ischemia', CNS Neuroscience and Therapeutics, 22 238-243 (2016) [C1]

© 2016 John Wiley &amp; Sons Ltd. Introduction: Presence of white matter hyperintensity (WMH) on MRI is a marker of cerebral small vessel disease and is associated with increas... [more]

© 2016 John Wiley & Sons Ltd. Introduction: Presence of white matter hyperintensity (WMH) on MRI is a marker of cerebral small vessel disease and is associated with increased small vessel stroke and increased risk of hemorrhagic transformation (HT) after thrombolysis. Aim: We sought to determine whether white matter hypoperfusion (WMHP) on perfusion CT (CTP) was related to WMH, and if WMHP predisposed to acute lacunar stroke subtype and HT after thrombolysis. Methods: Acute ischemic stroke patients within 12 h of symptom onset at 2 centers were prospectively recruited between 2011 and 2013 for the International Stroke Perfusion Imaging Registry. Participants routinely underwent baseline CT imaging, including CTP, and follow-up imaging with MRI at 24 h. Results: Of 229 ischemic stroke patients, 108 were Caucasians and 121 Chinese. In the contralateral white matter, patients with acute lacunar stroke had lower cerebral blood flow (CBF) and cerebral blood volume (CBV), compared to those with other stroke subtypes (P = 0.041). There were 46 patients with HT, and WMHP was associated with increased risk of HT (R 2 = 0.417, P = 0.002). Compared to previously reported predictors of HT, WMHP performed better than infarct core volume (R 2 = 0.341, P = 0.034), very low CBV volume (R 2 = 0.249, P = 0.026), and severely delayed perfusion (Tmax > 14 second R 2 = 0.372, P = 0.011). Patients with WMHP also had larger acute infarcts and increased infarct growth compared to those without WMHP (mean 28 mL vs. 13 mL P < 0.001). Conclusion: White matter hypoperfusion remote to the acutely ischemic region on CTP is a marker of small vessel disease and was associated with increased HT, larger acute infarct cores, and greater infarct growth.

DOI 10.1111/cns.12491
Citations Scopus - 1Web of Science - 1
Co-authors Neil Spratt, Andrew Bivard, Christopher Levi, Mark Parsons
2016 Huang X, MacIsaac R, Thompson JL, Levin B, Buchsbaum R, Haley EC, et al., 'Tenecteplase versus alteplase in stroke thrombolysis: An individual patient data meta-analysis of randomized controlled trials.', Int J Stroke, 11 534-543 (2016) [C1]
DOI 10.1177/1747493016641112
Citations Scopus - 4Web of Science - 4
Co-authors Mark Parsons, Christopher Levi
2016 Gardner A, Iverson G, Wojtowicz M, Levi C, Kay-Lambkin F, Schofield P, et al., 'MR spectroscopy findings in retired professional rugby league players', International Journal of Sports Medicine, In press (2016)
Co-authors Frances Kaylambkin, Peter Schofield, Peter Stanwell, Christopher Levi
2016 Bhaskar S, Bivard A, Stanwell P, Attia JR, Parsons M, Nilsson M, Levi C, 'Association of Cortical Vein Filling with Clot Location and Clinical Outcomes in Acute Ischaemic Stroke Patients', SCIENTIFIC REPORTS, 6 (2016) [C1]
DOI 10.1038/srep38525
Co-authors Mark Parsons, Peter Stanwell, John Attia, Michael Nilsson, Andrew Bivard, Christopher Levi
2016 Nagpal A, Kremer KL, Hamilton-Bruce MA, Kaidonis X, Milton AG, Levi C, et al., 'TOOTH (The Open study Of dental pulp stem cell Therapy in Humans): Study protocol for evaluating safety and feasibility of autologous human adult dental pulp stem cell therapy in patients with chronic disability after stroke', INTERNATIONAL JOURNAL OF STROKE, 11 575-585 (2016)
DOI 10.1177/1747493016641111
Citations Scopus - 3Web of Science - 3
Co-authors Christopher Levi
2016 Marsden DL, Dunn A, Callister R, McElduff P, Levi CR, Spratt NJ, 'A Home- and Community-Based Physical Activity Program Can Improve the Cardiorespiratory Fitness and Walking Capacity of Stroke Survivors', Journal of Stroke and Cerebrovascular Diseases, 25 2386-2398 (2016) [C1]

© 2016 National Stroke Association Background The cardiorespiratory fitness of stroke survivors is low. Center-based exercise programs that include an aerobic component have been... [more]

© 2016 National Stroke Association Background The cardiorespiratory fitness of stroke survivors is low. Center-based exercise programs that include an aerobic component have been shown to improve poststroke cardiorespiratory fitness. This pilot study aims to determine the feasibility, safety, and preliminary efficacy of an individually tailored home- and community-based exercise program to improve cardiorespiratory fitness and walking capacity in stroke survivors. Methods Independently ambulant, community-dwelling stroke survivors were recruited. The control (n¿=¿10) and intervention (n¿=¿10) groups both received usual care. In addition the intervention group undertook a 12-week, individually tailored, home- and community-based exercise program, including once-weekly telephone or e-mail support. Assessments were conducted at baseline and at 12 weeks. Feasibility was determined by retention and program participation, and safety by adverse events. Efficacy measures included change in cardiorespiratory fitness (peak oxygen consumption [VO 2peak ]) and distance walked during the Six-Minute Walk Test (6MWT). Analysis of covariance was used for data analysis. Results All participants completed the study with no adverse events. All intervention participants reported undertaking their prescribe d program. VO 2peak improved more in the intervention group (1.17¿±¿.29¿L/min to 1.35¿±¿.33¿L/min) than the control group (1.24¿±¿.23¿L/min to 1.24¿±¿.33¿L/min, between-group difference¿=¿.18¿L/min, 95% confidence interval [CI]:.01-.36). Distance walked improved more in the intervention group (427¿±¿123¿m to 494¿±¿67m) compared to the control group (456¿±¿101m to 470¿±¿106m, between-group difference¿=¿45¿m, 95% CI:.3-90). Conclusions Our individually tailored approach with once-weekly telephone or e-mail support was feasible and effective in selected stroke survivors. The 16% greater improvement in VO 2peak during the 6MWT achieved in the intervention versus control group is comparable to improvements attained in supervised, center-based programs.

DOI 10.1016/j.jstrokecerebrovasdis.2016.06.007
Citations Scopus - 4Web of Science - 4
Co-authors Patrick Mcelduff, Christopher Levi, Neil Spratt, Robin Callister
2016 Bhaskar S, Bivard A, Parsons M, Nilsson M, Attia JR, Stanwell P, Levi C, 'Delay of late-venous phase cortical vein filling in acute ischemic stroke patients: Associations with collateral status', Journal of Cerebral Blood Flow and Metabolism, 37 671-682 (2016) [C1]

© The Author(s) 2016. Evaluation of the venous system may be useful in stroke prognostication and patient selection for acute intervention strategies. We report a novel phenomeno... [more]

© The Author(s) 2016. Evaluation of the venous system may be useful in stroke prognostication and patient selection for acute intervention strategies. We report a novel phenomenon, delayed-late venous phase cortical vein filling, observed on dynamic computed tomography angiography obtained using multidetector computed tomography scanner, in acute ischemic stroke patients. The aim of this study was to examine the frequency of delayed-late venous phase cortical vein filling and assess its association to baseline collateral status. Dynamic computed tomography angiography images of acute ischemic stroke patients, being assessed for reperfusion therapy, were prospectively studied. Delayed-late venous phase cortical vein filling was defined by late venous phase opacification of cortical veins despite contrast clearance from contralateral cortical veins on dynamic computed tomography angiography. Time to peak of maximum arterial enhancement was recorded. A total of 117 patients (mean age = 70.6 ± 13.3 years; males = 48%) with hemispheric ischemic stroke who underwent acute dynamic computed tomography angiography were included in the study. Overall, 56 (48%) demonstrated delayed-late venous phase cortical vein filling. Poor collateralization (OR = 13.50; 95% CI = (4.2, 43); p = 0.0001) and longer time to peak of maximum arterial enhancement (OR = 3.2; 95% CI = (1.96, 5.3); p= 0.0001) were positively associated with delayed-late venous phase cortical vein filling. Delayed-late venous phase cortical vein filling was independently associated with poor baseline collateral status (75% vs. 15%, p = 0.0001; OR = 14.38; 95% CI = (4.33, 47.8); p = 0.0001). Delayed-late venous phase cortical vein filling is frequently seen in patients with acute ischemic stroke and is associated with poor baseline collateralization.

DOI 10.1177/0271678X16637611
Citations Scopus - 2Web of Science - 3
Co-authors Mark Parsons, John Attia, Andrew Bivard, Michael Nilsson, Peter Stanwell, Christopher Levi
2016 Zheng D, Sato S, Arima H, Heeley E, Delcourt C, Cao Y, et al., 'Estimated GFR and the Effect of Intensive Blood Pressure Lowering after Acute Intracerebral Hemorrhage', American Journal of Kidney Diseases, 68 94-102 (2016) [C1]

© 2016 The Authors. Background: The kidney-brain interaction has been a topic of growing interest. Past studies of the effect of kidney function on intracerebral hemorrhage (ICH)... [more]

© 2016 The Authors. Background: The kidney-brain interaction has been a topic of growing interest. Past studies of the effect of kidney function on intracerebral hemorrhage (ICH) outcomes have yielded inconsistent findings. Although the second, main phase of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2) suggests the effectiveness of early intensive blood pressure (BP) lowering in improving functional recovery after ICH, the balance of potential benefits and harms of this treatment in those with decreased kidney function remains uncertain. Study Design: Secondary analysis of INTERACT2, which randomly assigned patients with ICH with elevated systolic BP (SBP) to intensive (target SBP < 140 mm Hg) or contemporaneous guideline-based (target SBP < 180 mm Hg) BP management. Setting & Participants: 2,823 patients from 144 clinical hospitals in 21 countries. Predictors Admission estimated glomerular filtration rates (eGFRs) of patients were categorized into 3 groups based on the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) creatinine equation: normal or high, mildly decreased, and moderately to severely decreased ( > 90, 60-90, and < 60 mL/min/1.73 m 2 , respectively). Outcomes: The effect of admission eGFR on the primary outcome of death or major disability at 90 days (defined as modified Rankin Scale scores of 3-6) was analyzed using a multivariable logistic regression model. Potential effect modification of intensive BP lowering treatment by admission eGFR was assessed by interaction terms. Results: Of 2,623 included participants, 912 (35%) and 280 (11%) had mildly and moderately/severely decreased eGFRs, respectively. Patients with moderately/severely decreased eGFRs had the greatest risk for death or major disability at 90 days (adjusted OR, 1.82; 95% CI, 1.28-2.61). Effects of early intensive BP lowering were consistent across different eGFRs (P = 0.5 for homogeneity). Limitations: Generalizability issues arising from a clinical trial population. Conclusions: Decreased eGFR predicts poor outcome in acute ICH. Early intensive BP lowering provides similar treatment effects in patients with ICH with decreased eGFRs.

DOI 10.1053/j.ajkd.2016.01.020
Citations Scopus - 1
Co-authors Neil Spratt, Mark Parsons, Christopher Levi
2016 Jolly TAD, Cooper PS, Wan Ahmadul Badwi SA, Phillips NA, Rennie JL, Levi CR, et al., 'Microstructural white matter changes mediate age-related cognitive decline on the Montreal Cognitive Assessment (MoCA)', Psychophysiology, 53 258-267 (2016) [C1]

© 2016 Society for Psychophysiological Research. Although the relationship between aging and cognitive decline is well established, there is substantial individual variability in... [more]

© 2016 Society for Psychophysiological Research. Although the relationship between aging and cognitive decline is well established, there is substantial individual variability in the degree of cognitive decline in older adults. The present study investigates whether variability in cognitive performance in community-dwelling older adults is related to the presence of whole brain or tract-specific changes in white matter microstructure. Specifically, we examine whether age-related decline in performance on the Montreal Cognitive Assessment (MoCA), a cognitive screening tool, is mediated by the white matter microstructural decline. We also examine if this relationship is driven by the presence of cardiovascular risk factors or variability in cerebral arterial pulsatility, an index of cardiovascular risk. Sixty-nine participants (aged 43-87) completed behavioral and MRI testing including T1 structural, T2-weighted FLAIR, and diffusion-weighted imaging (DWI) sequences. Measures of white matter microstructure were calculated using diffusion tensor imaging analyses on the DWI sequence. Multiple linear regression revealed that MoCA scores were predicted by radial diffusivity (RaD) of white matter beyond age or other cerebral measures. While increasing age and arterial pulsatility were associated with increasing RaD, these factors did not mediate the relationship between total white matter RaD and MoCA. Further, the relationship between MoCA and RaD was specific to participants who reported at least one cardiovascular risk factor. These findings highlight the importance of cardiovascular risk factors in the presentation of cognitive decline in old age. Further work is needed to establish whether medical or lifestyle management of these risk factors can prevent or reverse cognitive decline in old age.

DOI 10.1111/psyp.12565
Citations Scopus - 2Web of Science - 1
Co-authors Karen Drysdale, Christopher Levi, Frini Karayanidis, Mark Parsons, Pat Michie, Patrick Cooper
2016 Lillicrap T, Krishnamurthy V, Attia J, Nilsson M, Levi CR, Parsons MW, Bivard A, 'Modafinil In Debilitating fatigue After Stroke (MIDAS): study protocol for a randomised, double-blinded, placebo-controlled, crossover trial', TRIALS, 17 (2016)
Citations Scopus - 1Web of Science - 1
Co-authors Christopher Levi, Andrew Bivard, Mark Parsons, John Attia, Michael Nilsson
2016 Bhaskar S, Stanwell P, Bivard A, Spratt N, Walker R, Kitsos GH, et al., 'The influence of initial stroke severity on the likelihood of unfavourable clinical outcome and death at 90 days following acute ischemic stroke: A tertiary hospital stroke register study', Neurology India, In press (2016)
Co-authors Andrew Bivard, Michael Nilsson, Neil Spratt, Christopher Levi, John Attia, Mark Parsons, Peter Stanwell
2016 Traylor M, Adib-Samii P, Harold D, Dichgans M, Williams J, Lewis CM, et al., 'Shared genetic contribution to ischemic stroke and Alzheimer's disease', Annals of Neurology, 79 739-747 (2016)

© 2016 The Authors. Annals of Neurology published by Wiley Periodicals, Inc. on behalf of American Neurological Association. Objective Increasing evidence suggests epidemiologica... [more]

© 2016 The Authors. Annals of Neurology published by Wiley Periodicals, Inc. on behalf of American Neurological Association. Objective Increasing evidence suggests epidemiological and pathological links between Alzheimer's disease (AD) and ischemic stroke (IS). We investigated the evidence that shared genetic factors underpin the two diseases. Methods Using genome-wide association study (GWAS) data from METASTROKE + (15,916 IS cases and 68,826 controls) and the International Genomics of Alzheimer's Project (IGAP; 17,008 AD cases and 37,154 controls), we evaluated known associations with AD and IS. On the subset of data for which we could obtain compatible genotype-level data (4,610 IS cases, 1,281 AD cases, and 14,320 controls), we estimated the genome-wide genetic correlation (rG) between AD and IS, and the three subtypes (cardioembolic, small vessel, and large vessel), using genome-wide single-nucleotide polymorphism (SNP) data. We then performed a meta-analysis and pathway analysis in the combined AD and small vessel stroke data sets to identify the SNPs and molecular pathways through which disease risk may be conferred. Results We found evidence of a shared genetic contribution between AD and small vessel stroke (rG [standard error] = 0.37 [0.17] ; p = 0.011). Conversely, there was no evidence to support shared genetic factors in AD and IS overall or with the other stroke subtypes. Of the known GWAS associations with IS or AD, none reached significance for association with the other trait (or stroke subtypes). A meta-analysis of AD IGAP and METASTROKE + small vessel stroke GWAS data highlighted a region (ATP5H/KCTD2/ICT1) associated with both diseases (p = 1.8 × 10 -8 ). A pathway analysis identified four associated pathways involving cholesterol transport and immune response. Interpretation Our findings indicate shared genetic susceptibility to AD and small vessel stroke and highlight potential causal pathways and loci. Ann Neurol 2016;79:739-747

DOI 10.1002/ana.24621
Citations Scopus - 4
Co-authors Liz Holliday, Christopher Levi
2016 Fradgley EA, Paul CL, Bryant J, Collins N, Ackland SP, Bellamy D, Levi CR, 'Collaborative Patient-Centered Quality Improvement: A Cross-Sectional Survey Comparing the Types and Numbers of Quality Initiatives Selected by Patients and Health Professionals.', Eval Health Prof, 39 475-495 (2016) [C1]
DOI 10.1177/0163278716659524
Co-authors Stephen Ackland, Christopher Levi, Elizabeth Fradgley, Chris Paul
2016 Malik R, Traylor M, Pulit SL, Bevan S, Hopewell JC, Holliday EG, et al., 'Low-frequency and common genetic variation in ischemic stroke The METASTROKE collaboration', NEUROLOGY, 86 1217-1226 (2016) [C1]
DOI 10.1212/WNL.0000000000002528
Citations Scopus - 13Web of Science - 13
Co-authors John Attia, Christopher Levi, Liz Holliday
2016 Cadilhac DA, Kim J, Lannin NA, Levi CR, Dewey HM, Hill K, et al., 'Better outcomes for hospitalized patients with TIA when in stroke units: An observational study', Neurology, 86 2042-2048 (2016) [C1]

© 2016 American Academy of Neurology. Objectives: To investigate differences in management and outcomes for patients admitted to the hospital with TIA according to care on a stro... [more]

© 2016 American Academy of Neurology. Objectives: To investigate differences in management and outcomes for patients admitted to the hospital with TIA according to care on a stroke unit (SU) or alternate ward setting up to 180 days post event. Methods: TIA admissions from 40 hospitals participating in the Australian Stroke Clinical Registry during 2010-2013 were assessed. Propensity score matching was used to assess outcomes by treatment group including Cox proportional hazards regression to compare survival differences and other appropriate multivariable regression models for outcomes including health-related quality of life and readmissions. Results: Among 3,007 patients with TIA (mean age 73 years, 54% male), 1,110 pairs could be matched. Compared to management elsewhere in hospitals, management in an SU was associated with improved cumulative survival at 180 days post event (hazard ratio 0.57, 95% confidence interval 0.35-0.94; p 5 0.029), despite not being statistically significant at 90 days (hazard ratio 0.66, 95% confidence interval 0.33-1.31; p 5 0.237). Overall, there were no differences for being discharged on antihypertensive medication or with a care plan, and the 90- to 180-day self-reported outcomes between these groups were similar. In subgroup analyses of 461matched pairs treated in hospitals in one Australian state (Queensland), patients treated in an SU were more often prescribed aspirin within 48 hours (73% vs 62%, p , 0.001) and discharged on antithrombotic medications (84% vs 71%, p , 0.001) than those not treated in an SU. Conclusions: Hospitalized patients with TIA managed in SUs had better survival at 180 days than those treated in alternate wards, potentially through better management, but further research is needed.

DOI 10.1212/WNL.0000000000002715
Citations Scopus - 6Web of Science - 7
Co-authors Christopher Levi
2016 Tomkins AJ, Hood RJ, Pepperall D, Null CL, Levi CR, Spratt NJ, 'Thrombolytic Recanalization of Carotid Arteries Is Highly Dependent on Degree of Stenosis, Despite Sonothrombolysis.', J Am Heart Assoc, 5 (2016) [C1]
DOI 10.1161/JAHA.115.002716
Citations Scopus - 1Web of Science - 1
Co-authors Neil Spratt, Christopher Levi
2016 Traylor M, Rutten-Jacobs LCA, Thijs V, Holliday EG, Levi C, Bevan S, et al., 'Genetic Associations With White Matter Hyperintensities Confer Risk of Lacunar Stroke', Stroke, 47 1174-1179 (2016) [C1]

© 2016 American Heart Association, Inc. Background and Purpose - White matter hyperintensities (WMH) are increased in patients with lacunar stroke. Whether this is because of sha... [more]

© 2016 American Heart Association, Inc. Background and Purpose - White matter hyperintensities (WMH) are increased in patients with lacunar stroke. Whether this is because of shared pathogenesis remains unknown. Using genetic data, we evaluated whether WMH-associated genetic susceptibility factors confer risk of lacunar stroke, and therefore whether they share pathogenesis. Methods - We used a genetic risk score approach to test whether single nucleotide polymorphisms associated with WMH in community populations were associated with magnetic resonance imaging-confirmed lacunar stroke (n=1,373), as well as cardioembolic (n=1,331) and large vessel (n=1,472) Trial of Org 10172 in Acute Stroke Treatment subtypes, against 9,053 controls. Second, we separated lacunar strokes into those with WMH (n=568) and those without (n=787) and tested for association with the risk score in these 2 groups. In addition, we evaluated whether WMH-associated single nucleotide polymorphisms are associated with lacunar stroke, or in the 2 groups. Results - The WMH genetic risk score was associated with lacunar stroke (odds ratio [OR; 95% confidence interval [CI]]=1.14 [1.06-1.22] ; P=0.0003), in patients both with and without WMH (WMH: OR [95% CI]=1.15 [1.05-1.26] ; P=0.003 and no WMH: OR [95% CI]=1.11 [1.02-1.21] ; P=0.019). Conversely, the risk score was not associated with cardioembolic stroke (OR [95% CI]=1.03 [0.97-1.09] ; P=0.63) or large vessel stroke (OR [95% CI]=0.99 [0.93,1.04] ; P=0.39). However, none of the WMH-associated single nucleotide polymorphisms passed Bonferroni-corrected significance for association with lacunar stroke. Conclusions - Genetic variants that influence WMH are associated with an increased risk of lacunar stroke but not cardioembolic or large vessel stroke. Some genetic susceptibility factors seem to be sha red across different radiological manifestations of small vessel disease.

DOI 10.1161/STROKEAHA.115.011625
Citations Scopus - 2Web of Science - 2
Co-authors Liz Holliday, Christopher Levi
2016 Anderson CS, Robinson T, Lindley RI, Arima H, Lavados PM, Lee TH, et al., 'Low-dose versus standard-dose intravenous alteplase in acute ischemic stroke', New England Journal of Medicine, 374 2313-2323 (2016) [C1]

Copyright © 2016 Massachusetts Medical Society. BACKGROUND: Thrombolytic therapy for acute ischemic stroke with a lower-than-standard dose of intravenous alteplase may improve re... [more]

Copyright © 2016 Massachusetts Medical Society. BACKGROUND: Thrombolytic therapy for acute ischemic stroke with a lower-than-standard dose of intravenous alteplase may improve recovery along with a reduced risk of intracerebral hemorrhage. METHODS: Using a 2-by-2 quasi-factorial open-label design, we randomly assigned 3310 patients who were eligible for thrombolytic therapy (median age, 67 years; 63% Asian) to low-dose intravenous alteplase (0.6 mg per kilogram of body weight) or the standard dose (0.9 mg per kilogram); patients underwent randomization within 4.5 hours after the onset of stroke. The primary objective was to determine whether the low dose would be noninferior to the standard dose with respect to the primary outcome of death or disability at 90 days, which was defined by scores of 2 to 6 on the modified Rankin scale (range, 0 [no symptoms] to 6 [death] ). Secondary objectives were to determine whether the low dose would be superior to the standard dose with respect to centrally adjudicated symptomatic intracerebral hemorrhage and whether the low dose would be noninferior in an ordinal analysis of modified Rankin scale scores (testing for an improvement in the distribution of scores). The trial included 935 patients who were also randomly assigned to intensive or guideline-recommended blood-pressure control. RESULTS: The primary outcome occurred in 855 of 1607 participants (53.2%) in the low-dose group and in 817 of 1599 participants (51.1%) in the standard-dose group (odds ratio, 1.09; 95% confidence interval [CI], 0.95 to 1.25; the upper boundary exceeded the noninferiority margin of 1.14; P=0.51 for noninferiority). Low-dose alteplase was noninferior in the ordinal analysis of modified Rankin scale scores (unadjusted common odds ratio, 1.00; 95% CI, 0.89 to 1.13; P=0.04 for noninferiority). Major symptomatic intracerebral hemorrhage occurred in 1.0% of the participants in the low-dose group and in 2.1% of the participants in the standard-dose group (P=0.01); fatal events occurred within 7 days in 0.5% and 1.5%, respectively (P=0.01). Mortality at 90 days did not differ significantly between the two groups (8.5% and 10.3%, respectively; P=0.07). CONCLUSIONS: This trial involving predominantly Asian patients with acute ischemic stroke did not show the noninferiority of low-dose alteplase to standard-dose alteplase with respect to death and disability at 90 days. There were significantly fewer symptomatic intracerebral hemorrhages with low-dose alteplase.

DOI 10.1056/NEJMoa1515510
Citations Scopus - 41Web of Science - 32
Co-authors Mark Parsons, Christopher Levi
2016 Paul CL, Ryan A, Rose S, Attia JR, Kerr E, Koller C, Levi CR, 'How can we improve stroke thrombolysis rates? A review of health system factors and approaches associated with thrombolysis administration rates in acute stroke care', IMPLEMENTATION SCIENCE, 11 (2016) [C1]
DOI 10.1186/s13012-016-0414-6
Citations Scopus - 2Web of Science - 4
Co-authors John Attia, Chris Paul, Christopher Levi
2016 Bull NJ, Turner A, Levi C, Hunter M, 'Effect of Core Temperature and Embolic Load During Cardiac Surgery on Motion Perception', Heart Lung and Circulation, 25 512-519 (2016) [C1]

© 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Background: Cognitive decline p... [more]

© 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Background: Cognitive decline post-cardiac surgery is of clinical concern. To better understand it a sensitive and specific measure of post-surgery brain impairment is required. The cerebral territory most likely to be adversely affected by surgery is the posterior "watershed" territory. Methods: We have designed a psychophysical task involving reading letters defined by motion aimed at measuring the integrity of a cortical area (MT) located in this territory. Patients undergoing coronary artery bypass grafting (CABG) and a healthy control group were given the psychophysical test twice, pre- and post-surgery for the patient group. Results: There was no overall difference in performance between the surgery group and the control group at either pre- or post-surgery testing. However, multivariate analysis of surgical variables such as body temperature and embolic load to the brain as measured by Transcranial Doppler showed that patients with warmer core temperatures and higher embolic loads performed significantly worse on the motion defined letter reading tasks than those with more favourable surgical variables. Conclusions: These results demonstrate that high embolic load and warm core body temperatures lead to poor motion perception post-cardiac surgery, implying damage to the posterior watershed cortex.

DOI 10.1016/j.hlc.2015.11.002
Co-authors Mick Hunter, Christopher Levi
2016 Ren S, Hure A, Peel R, D'Este C, Abhayaratna W, Tonkin A, et al., 'Rationale and design of a randomized controlled trial of pneumococcal polysaccharide vaccine for prevention of cardiovascular events: The Australian Study for the Prevention through Immunization of Cardiovascular Events (AUSPICE)', AMERICAN HEART JOURNAL, 177 58-65 (2016)
DOI 10.1016/j.ahj.2016.04.003
Citations Scopus - 1Web of Science - 1
Co-authors David Newby, Christopher Levi, Roseanne Peel, Alexis Hure, Philip Hansbro, Mark Mcevoy, Catherine Deste, D Durrheim, John Attia
2016 Middleton S, Levi C, Dale S, Cheung NW, McInnes E, Considine J, et al., 'Triage, treatment and transfer of patients with stroke in emergency department trial (the T-3 Trial): a cluster randomised trial protocol', IMPLEMENTATION SCIENCE, 11 (2016)
DOI 10.1186/s13012-016-0503-6
Citations Scopus - 1Web of Science - 1
Co-authors Christopher Levi, Patrick Mcelduff, Catherine Deste
2016 Pagram H, Bivard A, Lincz LF, Levi C, 'Peripheral Immune Cell Counts and Advanced Imaging as Biomarkers of Stroke Outcome.', Cerebrovasc Dis Extra, 6 120-128 (2016) [C1]
DOI 10.1159/000450620
Citations Scopus - 1
Co-authors Christopher Levi, Andrew Bivard, Lisa Lincz
2016 Cheng YC, Stanne TM, Giese AK, Ho WK, Traylor M, Amouyel P, et al., 'Genome-Wide Association Analysis of Young-Onset Stroke Identifies a Locus on Chromosome 10q25 Near HABP2', Stroke, 47 307-316 (2016) [C1]

© 2016 American Heart Association, Inc. Background and Purpose - Although a genetic contribution to ischemic stroke is well recognized, only a handful of stroke loci have been id... [more]

© 2016 American Heart Association, Inc. Background and Purpose - Although a genetic contribution to ischemic stroke is well recognized, only a handful of stroke loci have been identified by large-scale genetic association studies to date. Hypothesizing that genetic effects might be stronger for early-versus late-onset stroke, we conducted a 2-stage meta-analysis of genome-wide association studies, focusing on stroke cases with an age of onset < 60 years. Methods. The discovery stage of our genome-wide association studies included 4505 cases and 21968 controls of European, South-Asian, and African ancestry, drawn from 6 studies. In Stage 2, we selected the lead genetic variants at loci with association P < 5×10 -6 and performed in silico association analyses in an independent sample of =1003 cases and 7745 controls. Results.One stroke susceptibility locus at 10q25 reached genome-wide significance in the combined analysis of all samples from the discovery and follow-up stages (rs11196288; odds ratio =1.41; P=9.5×10 -9 ). The associated locus is in an intergenic region between TCF7L2 and HABP2. In a further analysis in an independent sample, we found that 2 single nucleotide polymorphisms in high linkage disequilibrium with rs11196288 were significantly associated with total plasma factor VII.activating protease levels, a product of HABP2. Conclusions.HABP2, which encodes an extracellular serine protease involved in coagulation, fibrinolysis, and inflammatory pathways, may be a genetic susceptibility locus for early-onset stroke.

DOI 10.1161/STROKEAHA.115.011328
Citations Scopus - 6Web of Science - 4
Co-authors Liz Holliday, Christopher Levi
2016 Kawano H, Bivard A, Lin L, Spratt NJ, Miteff F, Parsons MW, Levi CR, 'Relationship between Collateral Status, Contrast Transit, and Contrast Density in Acute Ischemic Stroke', Stroke, 47 742-749 (2016) [C1]

© 2015 American Heart Association, Inc. Background and Purpose-Collateral circulation is recognized to influence the life expectancy of the ischemic penumbra in acute ischemic st... [more]

© 2015 American Heart Association, Inc. Background and Purpose-Collateral circulation is recognized to influence the life expectancy of the ischemic penumbra in acute ischemic stroke. The best method to quantify collateral status on acute imaging is uncertain. We aimed to determine the relationship between visual collateral status, quantitative collateral assessments, baseline computed tomographic perfusion measures, and tissue outcomes on follow-up imaging. Methods-Sixty-six consecutive patients with acute ischemic stroke clinically eligible for recanalization therapy and with M1 or M2 middle cerebral artery occlusion were evaluated. We compared the visual collateral scoring with measures of contrast peak time delay and contrast peak density. We also compared these measures for their ability to predict perfusion lesion and infarct core volumes, final infarct, and infarct growth. Results-Shorter contrast peak time delay (P=0.041) and higher contrast peak density (P=0.002) were associated with good collateral status. Shorter contrast peak time delay correlated with higher contrast peak density (ß=-4.413; P=0.037). In logistic regression analysis after adjustment for age, sex, onset-computed tomographic time, and occlusion site, higher contrast peak density was independently associated with good collateral status (P=0.009). Multiple regression analysis showed that higher contrast peak density was an independent predictor of smaller perfusion lesion volume (P=0.029), smaller ischemic core volume (P=0.044), smaller follow-up infarct volume (P=0.005), and smaller infarct growth volume (P=0.010). Conclusions-Visual collateral status, contrast peak density, and contrast peak time delay were inter-related, and good collateral status was strongly associated with contrast peak density. Contrast peak density in collateral vessel may be an important factor in tissue fate in acute ischemic stroke.

DOI 10.1161/STROKEAHA.115.011320
Citations Scopus - 6Web of Science - 6
Co-authors Mark Parsons, Neil Spratt, Christopher Levi, Andrew Bivard
2016 Lin L, Bivard A, Krishnamurthy V, Levi CR, Parsons MW, 'Whole-Brain CT Perfusion to Quantify Acute Ischemic Penumbra and Core', RADIOLOGY, 279 876-887 (2016) [C1]
DOI 10.1148/radiol.2015150319
Citations Scopus - 7Web of Science - 6
Co-authors Mark Parsons, Andrew Bivard, Christopher Levi
2016 Bivard A, Lou M, Levi CR, Krishnamurthy V, Cheng X, Aviv RI, et al., 'Too good to treat? ischemic stroke patients with small computed tomography perfusion lesions may not benefit from thrombolysis', Annals of Neurology, 80 286-293 (2016) [C1]

© 2016 American Neurological Association Objective: Although commonly used in clinical practice, there remains much uncertainty about whether perfusion computed tomography (CTP) ... [more]

© 2016 American Neurological Association Objective: Although commonly used in clinical practice, there remains much uncertainty about whether perfusion computed tomography (CTP) should be used to select stroke patients for acute reperfusion therapy. In this study, we tested the hypothesis that a small acute perfusion lesion predicts good clinical outcome regardless of thrombolysis administration. Methods: We used a prospectively collected cohort of acute ischemic stroke patients being assessed for treatment with IV-alteplase, who had CTP before a treatment decision. Volumetric CTP was retrospectively analyded to identify patients with a small perfusion lesion ( < 15ml in volume). The primary analysis was excellent 3-month outcome in patients with a small perfusion lesion who were treated with alteplase compared to those who were not treated. Results: Of 1526 patients, 366 had a perfusion lesion < 15ml and were clinically eligible for alteplase (212 being treated and 154 not treated). Median acute National Institutes of Health Stroke Scale score was 8 in each group. Of the 366 patients with a small perfusion lesion, 227 (62%) were modified Rankin Scale (mRS) 0 to 1 at day 90. Alteplase-treated patients were less likely to achieve 90-day mRS 0 to 1 (57%) than untreated patients (69%; relative risk [RR] = 0.83; 95% confidence interval [CI] , 0.71¿0.97; p = 0.022) and did not have different rates of mRS 0 to 2 (72% treated patients vs 77% untreated; RR, 0.93; 95% CI, 0.82¿1.95; p = 0.23). Interpretation: This large observational cohort suggests that a portion of ischemic stroke patients clinically eligible for alteplase therapy with a small perfusion lesion have a good natural history and may not benefit from treatment. Ann Neurol 2016;80:286¿293.

DOI 10.1002/ana.24714
Citations Scopus - 1Web of Science - 1
Co-authors Patrick Mcelduff, Christopher Levi, Andrew Bivard, Mark Parsons
2016 Tran T, Cotlarciuc I, Yadav S, Hasan N, Bentley P, Levi C, et al., 'Candidate-gene analysis of white matter hyperintensities on neuroimaging', Journal of Neurology, Neurosurgery and Psychiatry, 87 260-266 (2016) [C1]

Background: White matter hyperintensities (WMH) are a common radiographic finding and may be a useful endophenotype for small vessel diseases. Given high heritability of WMH, we h... [more]

Background: White matter hyperintensities (WMH) are a common radiographic finding and may be a useful endophenotype for small vessel diseases. Given high heritability of WMH, we hypothesised that certain genotypes may predispose individuals to these lesions and consequently, to an increased risk of stroke, dementia and death. We performed a meta-analysis of studies investigating candidate genes and WMH to elucidate the genetic susceptibility to WMH and tested associated variants in a new independent WMH cohort. We assessed a causal relationship of WMH to methylene tetrahydrofolate reductase (MTHFR). Methods: Database searches through March 2014 were undertaken and studies investigating candidate genes in WMH were assessed. Associated variants were tested in a new independent ischaemic cohort of 1202 WMH patients. Mendelian randomization was undertaken to assess a causal relationship between WMH and MTHFR. Results: We identified 43 case-control studies interrogating eight polymorphisms in seven genes covering 6,314 WMH cases and 15,461 controls. Fixedeffects meta-analysis found that the C-allele containing genotypes of the aldosterone synthase CYP11B2 T(-344)C gene polymorphism were associated with a decreased risk of WMH (OR=0.61; 95% CI, 0.44 to 0.84; p=0.003). Using mendelian randomisation the association among MTHFR C677T, homocysteine levels and WMH, approached, but did not reach, significance (expected OR=1.75; 95% CI, 0.90-3.41; observed OR=1.68; 95% CI, 0.97-2.94). Neither CYP11B2 T(-344)C nor MTHFR C677T were significantly associated when tested in a new independent cohort of 1202 patients with WMH. Conclusions: There is a genetic basis to WMH but anonymous genome wide and exome studies are more likely to provide novel loci of interest.

DOI 10.1136/jnnp-2014-309685
Citations Scopus - 1Web of Science - 2
Co-authors Christopher Levi
2016 Traylor M, Zhang CR, Adib-Samii P, Devan WJ, Parsons OE, Lanfranconi S, et al., 'Genome-wide meta-analysis of cerebral white matter hyperintensities in patients with stroke', Neurology, 86 146-153 (2016) [C1]

© 2015 American Academy of Neurology. Objective: For 3,670 stroke patients from the United Kingdom, United States, Australia, Belgium, and Italy, we performed a genome-wide meta-... [more]

© 2015 American Academy of Neurology. Objective: For 3,670 stroke patients from the United Kingdom, United States, Australia, Belgium, and Italy, we performed a genome-wide meta-analysis of white matter hyperintensity volumes (WMHV) on data imputed to the 1000 Genomes reference dataset to provide insights into disease mechanisms. Methods: We first sought to identify genetic associations with white matter hyperintensities in a stroke population, and then examined whether genetic loci previously linked to WMHV in community populations are also associated in stroke patients. Having established that genetic associations are shared between the 2 populations, we performed a meta-analysis testing which associations with WMHV in stroke-free populations are associated overall when combined with stroke populations. Results: There were no associations at genome-wide significance with WMHV in stroke patients. All previously reported genome-wide significant associations with WMHV in community populations shared direction of effect in stroke patients. In a meta-analysis of the genome-wide significant and suggestive loci (p < 5 × 10-6) from community populations (15 single nucleotide polymorphisms in total) and from stroke patients, 6 independent loci were associated with WMHV in both populations. Four of these are novel associations at the genome-wide level (rs72934505 [NBEAL1], p 2.2 × 10-8; rs941898 [EVL] , p 4.0 × 10-8; rs962888 [C1QL1], p 1.1 × 10-8; rs9515201 [COL4A2] , p 6.9 × 10-9). Conclusions: Genetic associations with WMHV are shared in otherwise healthy individuals and patients with stroke, indicating common genetic susceptibility in cerebral small vessel disease.

DOI 10.1212/WNL.0000000000002263
Citations Scopus - 7Web of Science - 5
Co-authors Christopher Levi
2016 Cereda CW, Christensen S, Campbell BC, Mishra NK, Mlynash M, Levi C, et al., 'A benchmarking tool to evaluate computer tomography perfusion infarct core predictions against a DWI standard.', Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism, 36 1780-1789 (2016) [C1]
DOI 10.1177/0271678x15610586
Citations Scopus - 4Web of Science - 5
Co-authors Christopher Levi, Mark Parsons
2016 Bivard A, Yassi N, Krishnamurthy V, Lin L, Levi C, Spratt NJ, et al., 'A comprehensive analysis of metabolic changes in the salvaged penumbra', Neuroradiology, 58 409-415 (2016) [C1]

© 2016, Springer-Verlag Berlin Heidelberg. Introduction: We aimed to assess metabolite profiles in peri-infarct tissue with magnetic resonance spectroscopy (MRS) and correlate th... [more]

© 2016, Springer-Verlag Berlin Heidelberg. Introduction: We aimed to assess metabolite profiles in peri-infarct tissue with magnetic resonance spectroscopy (MRS) and correlate these with early and late clinical recovery. Methods: One hundred ten anterior circulation ischemic stroke patients presenting to hospital within 4.5¿h of symptom onset and treated with intravenous thrombolysis were studied. Patients underwent computer tomography perfusion (CTP) scanning and subsequently 3-T magnetic resonance imaging (MRI) 24¿h after stroke onset, including single-voxel, short-echo-time (30¿ms) MRS, and diffusion- and perfusion-weighted imaging (DWI and PWI). MRS voxels were placed in the peri-infarct region in reperfused penumbral tissue. A control voxel was placed in the contralateral homologous area. Results: The concentrations of total creatine (5.39 vs 5.85¿mM, p = 0.044) and N-acetylaspartic acid (NAA, 6.34 vs 7.13¿mM ± 1.57, p < 0.001) were reduced in peri-infarct tissue compared to the matching contralateral region. Baseline National Institutes of Health Stroke Score was correlated with glutamate concentration in the reperfused penumbra at 24¿h (r 2 = 0.167, p = 0.017). Higher total creatine was associated with better neurological outcome at 24¿h (r 2 = 0.242, p = 0.004). Lower peri-infarct glutamate was a stronger predictor of worse 3-month clinical outcome (area under the curve (AUC) 0.89, p < 0.001) than DWI volume (AUC = 0.79, p < 0.001). Conclusion: Decreased glutamate, creatine, and NAA concentrations are associated with poor neurological outcome at 24¿h and greater disability at 3¿months. The significant metabolic variation in salvaged tissue may potentially explain some of the variability seen in stroke recovery despite apparently successful reperfusion.

DOI 10.1007/s00234-015-1638-x
Citations Scopus - 1
Co-authors Neil Spratt, Mark Parsons, Andrew Bivard, Christopher Levi
2016 Rutten-Jacobs LCA, Traylor M, Adib-Samii P, Thijs V, Sudlow C, Rothwell PM, et al., 'Association of MTHFR C677T Genotype with Ischemic Stroke Is Confined to Cerebral Small Vessel Disease Subtype', Stroke, 47 646-651 (2016) [C1]

© 2016 American Heart Association, Inc. Elevated plasma homocysteine levels are associated with stroke. However, this might be a reflection of bias or confounding because trials ... [more]

© 2016 American Heart Association, Inc. Elevated plasma homocysteine levels are associated with stroke. However, this might be a reflection of bias or confounding because trials have failed to demonstrate an effect from homocystein e lowering in stroke patients, although a possible benefit has been suggested in lacunar stroke. Genetic studies could potentially overcome these issues because genetic variants are inherited randomly and are fixed at conception. Therefore, we tested the homocysteine levels-associated genetic variant MTHFR C677T for association with magnetic resonance imaging-confirmed lacunar stroke and compared this with associations with large artery and cardioembolic stroke subtypes. Methods-We included 1359 magnetic resonance imaging-confirmed lacunar stroke cases, 1824 large artery stroke cases, 1970 cardioembolic stroke cases, and 14 448 controls, all of European ancestry. Furthermore, we studied 3670 ischemic stroke patients in whom white matter hyperintensities volume was measured. We tested MTHFR C677T for association with stroke subtypes and white matter hyperintensities volume. Because of the established association of homocysteine with hypertension, we additionally stratified for hypertension status. Results-MTHFR C677T was associated with lacunar stroke (P=0.0003) and white matter hyperintensity volume (P=0.04), but not with the other stroke subtypes. Stratifying the lacunar stroke cases for hypertension status confirmed this association in hypertensive individuals (P=0.0002), but not in normotensive individuals (P=0.30). Conclusions-MTHFR C677T was associated with magnetic resonance imaging-confirmed lacunar stroke, but not large artery or cardioembolic stroke. The association may act through increased susceptibility to, or interaction with, high blood pressure. This heterogeneity of association might explain the lack of effect of lowering homocysteine in secondary prevention trials which included all strokes.

DOI 10.1161/STROKEAHA.115.011545
Citations Scopus - 4Web of Science - 4
Co-authors Christopher Levi
2016 Sato S, Delcourt C, Heeley E, Arima H, Zhang S, Al-Shahi Salman R, et al., 'Significance of Cerebral Small-Vessel Disease in Acute Intracerebral Hemorrhage', Stroke, 47 701-707 (2016) [C1]

© 2016 American Heart Association, Inc. The significance of structural changes associated with cerebral small-vessel disease (SVD), including white matter lesions (WML), lacunes,... [more]

© 2016 American Heart Association, Inc. The significance of structural changes associated with cerebral small-vessel disease (SVD), including white matter lesions (WML), lacunes, and brain atrophy, to outcome from acute intracerebral hemorrhage is uncertain. We determined associations of computed tomographic radiological manifestations of cerebral SVD and outcomes, and in terms of any differential effect of early intensive blood pressure-lowering treatment, in the large-scale Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2). Methods-We graded WML (van Swieten scale), the presence of lacunes, and brain atrophy (2 linear measurements and visual rating) for 2069 of 2839 patients with available baseline brain computed tomography ( < 6 hours of intracerebral hemorrhage onset) by 3 independent neurologists blind to clinical data. Results-WML grade and 2 linear measurements of brain atrophy were associated with death or major disability at 90 days: multivariable-adjusted odds ratios for WML (grade 3 and 4 versus 0), frontal ratio, and third ventricle Sylvian fissure distance (most versus least severe atrophy quartile) were 1.42 (95% confidence interval, 1.02-1.98), 1.47 (1.08-1.99), and 1.64 (1.21-2.22), respectively (all P for trend < 0.05). There was no association between lacunes and outcomes. There were no significant differences in the effects of intensive blood pressure-lowering across subgroups of cerebral SVD. Conclusions-Preexisting cerebral SVD manifestations of WML and brain atrophy predict poor outcome in acute intracerebral hemorrhage. There is no apparent hazard of early intensive lowering of blood pressure according to the INTERACT2 protocol, in patients with underlying cerebral SVD.

DOI 10.1161/STROKEAHA.115.012147
Citations Scopus - 6Web of Science - 7
Co-authors Christopher Levi
2015 Priglinger M, Arima H, Anderson C, Krause M, Chalmers J, Anderson CS, et al., 'No relationship of lipid-lowering agents to hematoma growth: Pooled analysis of the intensive blood pressure reduction in acute cerebral hemorrhage trials studies', Stroke, 46 857-859 (2015)

© 2015 American Heart Association, Inc. Background and Purpose: Controversy persists over statins and risk of intracerebral hemorrhage. We determined associations of premorbid li... [more]

© 2015 American Heart Association, Inc. Background and Purpose: Controversy persists over statins and risk of intracerebral hemorrhage. We determined associations of premorbid lipid-lowering therapy and outcomes among participants of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trials (INTERACT). Methods: The pooled data of INTERACT 1 and 2 (international, multicenter, prospective, open, blinded end point, randomized controlled trials of patients with intracerebral hemorrhage [ < 6 hours] and elevated systolic blood pressure) were analyzed with regard to associations of baseline lipid-lowering treatment and clinical outcomes of 3184 participants in a multivariate model. Associations of lipid-lowering therapy and hematoma growth (baseline to 24 hours) in computed tomographic substudies participants (n=1310) were estimated in ANCOVA. Results: Among 204 patients (6.5%) with baseline lipid-lowering treatment, 90-day clinical outcomes were not significantly different after adjustment for confounding variables including region and age. In the computed tomographic substudy, 24-hour hematoma growth was greater in 124 patients (9%) with, compared with those without, prior lipid-lowering therapy. However, this association was not significant between groups (9.2 versus 6.8 mL; P < 0.13), after adjustment for prior antithrombotic therapy. Conclusions: No independent associations were found between lipid-lowering medication and adverse outcomes in patients with intracerebral hemorrhage.

DOI 10.1161/STROKEAHA.114.007664
Citations Scopus - 4
Co-authors Mark Parsons, Christopher Levi
2015 Adib-Samii P, Devan W, Traylor M, Lanfranconi S, Zhang CR, Cloonan L, et al., 'Genetic architecture of white matter hyperintensities differs in hypertensive and nonhypertensive ischemic stroke', Stroke, 46 348-353 (2015) [C1]

© 2015 American Heart Association, Inc. BACKGROUND AND PURPOSE - : Epidemiological studies suggest that white matter hyperintensities (WMH) are extremely heritable, but the under... [more]

© 2015 American Heart Association, Inc. BACKGROUND AND PURPOSE - : Epidemiological studies suggest that white matter hyperintensities (WMH) are extremely heritable, but the underlying genetic variants are largely unknown. Pathophysiological heterogeneity is known to reduce the power of genome-wide association studies (GWAS). Hypertensive and nonhypertensive individuals with WMH might have different underlying pathologies. We used GWAS data to calculate the variance in WMH volume (WMHV) explained by common single nucleotide polymorphisms (SNPs) as a measure of heritability (SNP heritability [HSNP]) and tested the hypothesis that WMH heritability differs between hypertensive and nonhypertensive individuals. METHODS - : WMHV was measured on MRI in the stroke-free cerebral hemisphere of 2336 ischemic stroke cases with GWAS data. After adjustment for age and intracranial volume, we determined which cardiovascular risk factors were independent predictors of WMHV. Using the genome-wide complex trait analysis tool to estimate HSNP for WMHV overall and within subgroups stratified by risk factors found to be significant in multivariate analyses. RESULTS - : A significant proportion of the variance of WMHV was attributable to common SNPs after adjustment for significant risk factors (HSNP=0.23; P=0.0026). HSNP estimates were higher among hypertensive individuals (HSNP=0.45; P=7.99×10); this increase was greater than expected by chance (P=0.012). In contrast, estimates were lower, and nonsignificant, in nonhypertensive individuals (HSNP=0.13; P=0.13). CONCLUSIONS - : A quarter of variance is attributable to common SNPs, but this estimate was greater in hypertensive individuals. These findings suggest that the genetic architecture of WMH in ischemic stroke differs between hypertensives and nonhypertensives. Future WMHV GWAS studies may gain power by accounting for this interaction.

DOI 10.1161/STROKEAHA.114.006849
Citations Scopus - 10Web of Science - 9
Co-authors Christopher Levi
2015 Joubert J, Davis SM, Hankey GJ, Levi C, Olver J, Gonzales G, Donnan GA, 'ICARUSS, the Integrated Care for the Reduction of Secondary Stroke trial: Rationale and design of a randomized controlled trial of a multimodal intervention to prevent recurrent stroke in patients with a recent cerebrovascular event, ACTRN=12611000264987', International Journal of Stroke, 10 773-777 (2015) [C3]

© 2015 World Stroke Organization. Background: The majority of strokes, both ischaemic and haemorrhagic, are attributable to a relatively small number of risk factors which are re... [more]

© 2015 World Stroke Organization. Background: The majority of strokes, both ischaemic and haemorrhagic, are attributable to a relatively small number of risk factors which are readily manageable in primary care setting. Implementation of best-practice recommendations for risk factor management is calculated to reduce stroke recurrence by around 80%. However, risk factor management in stroke survivors has generally been poor at primary care level. A model of care that supports long-term effective risk factor management is needed. Aim: To determine whether the model of Integrated Care for the Reduction of Recurrent Stroke (ICARUSS) will, through promotion of implementation of best-practice recommendations for risk factor management reduce the combined incidence of stroke, myocardial infarction and vascular death in patients with recent stroke or transient ischaemic attack (TIA) of the brain or eye. Design: A prospective, Australian, multicentre, randomized controlled trial. Setting: Academic stroke units in Melbourne, Perth and the John Hunter Hospital, New South Wales. Subjects: 1000 stroke survivors recruited as from March 2007 with a recent ( < 3 months) stroke (ischaemic or haemorrhagic) or a TIA (brain or eye). Randomization: Randomization and data collection are performed by means of a central computer generated telephone system (IVRS). Intervention: Exposure to the ICARUSS model of integrated care or usual care. Primary outcome: The composite of stroke, MI or death from any vascular cause, whichever occurs first. Secondary outcomes: Risk factor management in the community, depression, quality of life, disability and dementia. Statistical power: With 1000 patients followed up for a median of one-year, with a recurrence rate of 7-10% per year in patients exposed to usual care, the study will have at least 80% power to detect a significant reduction in primary end-points Conclusion: The ICARUSS study aims to recruit and follow up patients between 2007 and 2013 and demonstrate the effectiveness of exposure to the ICARUSS model in stroke survivors to reduce recu rrent stroke or vascular events and promote the implementation of best practice risk factor management at primary care level.

DOI 10.1111/ijs.12510
Co-authors Christopher Levi
2015 Rutten-Jacobs LCA, Traylor M, Adib-Samii P, Thijs V, Sudlow C, Rothwell PM, et al., 'Common NOTCH3 Variants and Cerebral Small-Vessel Disease', Stroke, 46 1482-1487 (2015) [C1]
DOI 10.1161/STROKEAHA.114.008540
Citations Scopus - 6Web of Science - 6
Co-authors Christopher Levi
2015 Rannikmäe K, Davies G, Thomson PA, Bevan S, Devan WJ, Falcone GJ, et al., 'Common variation in COL4A1/COL4A2 is associated with sporadic cerebral small vessel disease', Neurology, 84 918-926 (2015) [C1]

© 2015 American Academy of Neurology. Objectives: We hypothesized that common variants in the collagen genes COL4A1/COL4A2 are associated with sporadic forms of cerebral small ve... [more]

© 2015 American Academy of Neurology. Objectives: We hypothesized that common variants in the collagen genes COL4A1/COL4A2 are associated with sporadic forms of cerebral small vessel disease. Methods: We conducted meta-analyses of existing genotype data among individuals of European ancestry to determine associations of 1,070 common single nucleotide polymorphisms (SNPs) in the COL4A1/COL4A2 genomic region with the following: intracerebral hemorrhage and its subtypes (deep, lobar) (1,545 cases, 1,485 controls); ischemic stroke and its subtypes (cardioembolic, large vessel disease, lacunar) (12,389 cases, 62,004 controls); and white matter hyperintensities (2,733 individuals with ischemic stroke and 9,361 from population-based cohorts with brain MRI data). We calculated a statistical significance threshold that accounted for multiple testing and linkage disequilibrium between SNPs (p < 0.000084). Results: Three intronic SNPs in COL4A2 were significantly associated with deep intracerebral hemorrhage (lead SNP odds ratio [OR] 1.29, 95% confidence interval [CI] 1.14-1.46, p = 0.00003; r 2 > 0.9 between SNPs). Although SNPs associated with deep intracerebral hemorrhage did not reach our significance threshold for association with lacunar ischemic stroke (lead SNP OR 1.10, 95% CI 1.03-1.18, p = 0.0073), and with white matter hyperintensity volume in symptomatic ischemic stroke patients (lead SNP OR 1.07, 95% CI 1.01-1.13, p = 0.016), the direction of association was the same. There was no convincing evidence of association with white matter hyperintensities in population-based studies or with non-small vessel disease cerebrovascular phenotypes. Conclusions: Our results indicate an association between common variation in the COL4A2 gene and symptomatic small vessel disease, particularly deep intracerebral hemorrhage. These findings merit replication studies, including in ethnic groups of non-European ancestry.

DOI 10.1212/WNL.0000000000001309
Citations Scopus - 18Web of Science - 15
Co-authors Liz Holliday, Christopher Levi, John Attia
2015 Campbell BCV, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, et al., 'Endovascular therapy for ischemic stroke with perfusion-imaging selection', New England Journal of Medicine, 372 1009-1018 (2015) [C1]

Copyright © 2015 Massachusetts Medical Society. Background: Trials of endovascular therapy for ischemic stroke have produced variable results. We conducted this study to test whe... [more]

Copyright © 2015 Massachusetts Medical Society. Background: Trials of endovascular therapy for ischemic stroke have produced variable results. We conducted this study to test whether more advanced imaging selection, recently developed devices, and earlier intervention improve outcomes. Methods: We randomly assigned patients with ischemic stroke who were receiving 0.9 mg of alteplase per kilogram of body weight less than 4.5 hours after the onset of ischemic stroke either to undergo endovascular thrombectomy with the Solitaire FR (Flow Restoration) stent retriever or to continue receiving alteplase alone. All the patients had occlusion of the internal carotid or middle cerebral artery and evidence of salvageable brain tissue and ischemic core of less than 70 ml on computed tomographic (CT) perfusion imaging. The coprimary outcomes were reperfusion at 24 hours and early neurologic improvement (.8-point reduction on the National Institutes of Health Stroke Scale or a score of 0 or 1 at day 3). Secondary outcomes included the functional score on the modified Rankin scale at 90 days. Results: The trial was stopped early because of efficacy after 70 patients had undergone randomization (35 patients in each group). The percentage of ischemic territory that had undergone reperfusion at 24 hours was greater in the endovascular-therapy group than in the alteplase-only group (median, 100% vs. 37%; P < 0.001). Endovascular therapy, initiated at a median of 210 minutes after the onset of stroke, increased early neurologic improvement at 3 days (80% vs. 37%, P = 0.002) and improved the functional outcome at 90 days, with more patients achieving functional independence (score of 0 to 2 on the modified Rankin scale, 71% vs. 40%; P = 0.01). There were no significant differences in rates of death or symptomatic intracerebral hemorrhage. Conclusions: In patients with ischemic stroke with a proximal cerebral arterial occlusion and salvageable tissue on CT perfusion imaging, early thrombectomy with the Solitaire FR stent retriever, as compared with alteplase alone, improved reperfusion, early neurologic recovery, and functional outcome. (Funded by the Australian National Health and Medical Research Council and others; EXTEND-IA ClinicalTrials.gov number, NCT01492725, and Australian New Zealand Clinical Trials Registry number, ACTRN12611000969965.)

DOI 10.1056/NEJMoa1414792
Citations Scopus - 1149Web of Science - 1033
Co-authors John Attia, Neil Spratt, Mark Parsons, Christopher Levi
2015 Ang TE, Bivard A, Levi C, Ma H, Hsu CY, Campbell B, et al., 'Multi-modal CT in acute stroke: Wait for a serum creatinine before giving intravenous contrast? No!', International Journal of Stroke, 10 1014-1017 (2015) [C1]

© 2015 World Stroke Organization. Background: Multi-modal CT (MMCT) to guide decision making for reperfusion treatment is increasingly used, but there remains a perceived risk of... [more]

© 2015 World Stroke Organization. Background: Multi-modal CT (MMCT) to guide decision making for reperfusion treatment is increasingly used, but there remains a perceived risk of contrast-induced nephropathy (CIN). At our center, MMCT is used empirically without waiting for serum-creatinine (sCR) or renal profiling. Aims: To determine the incidence of CIN, examine the risk factors predisposing to its development, and investigate its effects on clinical outcome in the acute stroke population. Methods: An institution-wide protocol was implemented for acute stroke presentations to have MMCT (100-150ml nonionic tri-iodinated contrast, perfusion CT and CT angiography) without waiting for serum-creatinine to minimize delays. Intravenous saline is routinely infused (80-125ml/h) for at least 24-h after MMCT. Serial creatinine levels were measured at baseline, risk period, and follow-up. Renal profiles and clinical progress were reviewed up to 90 days. Results: We analyzed 735 consecutive patients who had MMCT for the evaluation of acute ischemic or hemorrhagic stroke during the last five-years. A total of 623 patients met the inclusion criteria for analysis: 16 cases (2·6%) biochemically qualified as CIN; however, the risk period serum-creatinine for 15 of these cases was confounded by dehydration, urinary tract infection, or medications. None of the group had progression to chronic kidney disease or required dialysis. Conclusions: The incidence of CIN is low when MMCT is used routinely to assess acute stroke patients. In this population, CIN was a biochemical phenomenon that did not have clinical manifestations, cause chronic kidney disease, require dialysis, or negatively impact on 90-day mRS outcomes. Renal profiling and waiting for a baseline serum-creatinine are an unnecessary delay to emergency reperfusion treatment. International Journal of Stroke

DOI 10.1111/ijs.12605
Citations Scopus - 4Web of Science - 6
Co-authors Mark Parsons, Christopher Levi, Andrew Bivard
2015 Traylor M, Rutten-Jacobs LCA, Holliday EG, Malik R, Sudlow C, Rothwell PM, et al., 'Differences in Common Genetic Predisposition to Ischemic Stroke by Age and Sex', Stroke, 46 3042-3047 (2015) [C1]

© 2015 American Heart Association, Inc. Background and Purpose-Evidence from epidemiological studies points to differences in factors predisposing to stroke by age and sex. Wheth... [more]

© 2015 American Heart Association, Inc. Background and Purpose-Evidence from epidemiological studies points to differences in factors predisposing to stroke by age and sex. Whether these arise because of different genetic influences remained untested. Here, we use data from 4 genome-wide association data sets to study the relationship between genetic influence on stroke with both age and sex. Methods-Using genomic-relatedness-matrix restricted maximum likelihood methods, we performed 4 analyses: (1) we calculated the genetic correlation between groups divided by age and (2) by sex, (3) we calculated the heritability of age-at-stroke-onset, and (4) we evaluated the evidence that heritability of stroke is greater in women than in men. Results-We found that genetic factors influence age at stroke onset (h 2 [SE]=18.0 [6.8] ; P=0.0038), with a trend toward a stronger influence in women (women: h 2 [SE]=21.6 [3.5] ; Men: h 2 [SE]=13.9 [2.8] ). Although a moderate proportion of genetic factors was shared between sexes (rG [SE]=0.68 [0.16] ) and between younger and older cases (rG [SE]=0.70 [0.17] ), there was evidence to suggest that there are genetic susceptibility factors that are specific to sex (P=0.037) and to younger or older groups (P=0.056), particularly for women (P=0.0068). Finally, we found a trend toward higher heritability of stroke in women although this was not significantly greater than in men (P=0.084). Conclusions-Our results indicate that there are genetic factors that are either unique to or have a different effect between younger and older age groups and between women and men. Performing large, well-powered genome-wide association study analyses in these groups is likely to uncover further associations.

DOI 10.1161/STROKEAHA.115.009816
Citations Scopus - 8Web of Science - 9
Co-authors Liz Holliday, Christopher Levi
2015 Purvis T, Longworth M, Kilkenny M, Worthington J, Pollack M, Levi C, Cadilhac D, 'Factors associated with stroke patients experiencing severe complications in acute hospitals in New South Wales (Australia)', INTERNATIONAL JOURNAL OF STROKE, 10 361-361 (2015)
Co-authors Christopher Levi
2015 Markus HS, Hayter E, Levi C, Feldman A, Venables G, Norris J, et al., 'Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial', LANCET NEUROLOGY, 14 361-367 (2015) [C1]
DOI 10.1016/S1474-4422(16)70018-9
Citations Scopus - 95Web of Science - 72
Co-authors Christopher Levi
2015 Gardner AJ, Iverson GL, Quinn TN, Makdissi M, Levi CR, Shultz SR, et al., 'A preliminary video analysis of concussion in the National Rugby League', Brain Injury, 29 1182-1185 (2015) [C1]
DOI 10.3109/02699052.2015.1034179
Citations Scopus - 8Web of Science - 7
Co-authors Peter Stanwell, Christopher Levi, Andrew Gardner
2015 Gardner A, Iverson GL, Levi CR, Schofield PW, Kay-Lambkin F, Kohler RMN, Stanwell P, 'A systematic review of concussion in rugby league', British Journal of Sports Medicine, 49 495-498 (2015) [C1]

© 2015, BMJ Publishing Group. All rights reserved. Objectives: Concussion remains one of the inherent risks of participation in rugby league. While other injuries incurred by rug... [more]

© 2015, BMJ Publishing Group. All rights reserved. Objectives: Concussion remains one of the inherent risks of participation in rugby league. While other injuries incurred by rugby league players have been well studied, less focus and attention has been directed towards concussion. Review method: The current review examined all articles published in English from 1900 up to June 2013 pertaining to concussion in rugby league players. Data sources: Publications were retrieved via six databases using the key search terms: rugby league, league, football; in combination with injury terms: athletic injuries, concussion, sports concussion, sports-related concussion, brain concussion, brain injury, brain injuries, mild traumatic brain injury, mTBI, traumatic brain injury, TBI, craniocerebral trauma, head injury and brain damage. Observational, cohort, correlational, cross-sectional and longitudinal studies were all included. Results: 199 rugby league injury publications were identified. 39 (20%) were related in some way to concussion. Of the 39 identified articles, 6 (15%) had the main aim of evaluating concussion, while the other 33 reported on concussion incidence as part of overall injury data analyses. Rugby league concussion incidence rates vary widely from 0.0 to 40.0/1000 playing hours, depending on the definition of injury (time loss vs no time loss). The incidence rates vary across match play versus training session, seasons (winter vs summer) and playing position (forwards vs backs). The ball carrier has been found to be at greater risk for injury than tacklers. Concussion accounts for 29% of all injuries associated with illegal play, but only 9% of injuries sustained in legal play. Conclusions: In comparison with other collision sports, research evaluating concussion in rugby league is limited. With such limited published rugby league data, there are many aspects of concussion that require attention, and future research may be directed towards these unanswered questions.

DOI 10.1136/bjsports-2013-093102
Citations Scopus - 12Web of Science - 10
Co-authors Christopher Levi, Peter Stanwell, Andrew Gardner, Peter Schofield, Frances Kaylambkin
2015 Grady AM, Bryant J, Carey ML, Paul CL, Sanson-Fisher RW, Levi CR, 'Agreement with evidence for tissue Plasminogen Activator use among emergency physicians: A cross-sectional survey', BMC Research Notes, 8 (2015) [C1]

© 2015 Grady et al. Background: Emergency department staff play a crucial role in the triage of stroke patients and therefore the capacity to deliver time-dependent treatments su... [more]

© 2015 Grady et al. Background: Emergency department staff play a crucial role in the triage of stroke patients and therefore the capacity to deliver time-dependent treatments such as tissue Plasminogen Activator. This study aimed to identify among emergency physicians, (1) rates of agreement with evidence supporting tissue Plasminogen Activator use in acute stroke care; and (2) individual and hospital factors associated with high agreement with evidence supporting tissue Plasminogen Activator use. Methods: Australian fellows and trainees of the Australasian College for Emergency Medicine were invited to complete an online cross-sectional survey assessing perceptions of tissue Plasminogen Activator use in acute stroke. Demographic and hospital characteristics were also collected. Results: 429 Australasian College for Emergency Medicine members responded (13% response rate). Almost half (47.2%) did not agree with any statements regarding the benefits of tissue Plasminogen Activator use for acute stroke. Perceived routine administration of tissue Plasminogen Activator by the head of respondents' emergency department was significantly associated with high agreement with the evidence supporting tissue Plasminogen Activator use in acute stroke. Conclusions: Agreement with evidence supporting tissue Plasminogen Activator use in acute stroke is not high among responding Australian emergency physicians. In order for tissue Plasminogen Activator treatment to become widely accepted and adopted in emergency settings, beliefs and attitudes towards treatment need to be in accordance with clinical practice guidelines.

DOI 10.1186/s13104-015-1242-5
Citations Scopus - 1
Co-authors Rob Sanson-Fisher, Mariko Carey, Christopher Levi, Chris Paul
2015 Berling I, Brown SGA, Miteff F, Levi C, Isbister GK, 'Intracranial haemorrhages associated with venom induced consumption coagulopathy in Australian snakebites (ASP-21)', Toxicon, 102 8-13 (2015) [C1]

© 2015 Published by Elsevier Ltd. All rights reserved. Intracranial haemorrhage (ICH) is a rare life-threatening consequence of venom induced consumption coagulopathy in snake-bi... [more]

© 2015 Published by Elsevier Ltd. All rights reserved. Intracranial haemorrhage (ICH) is a rare life-threatening consequence of venom induced consumption coagulopathy in snake-bite. It is unclear why certain patients haemorrhage. We aimed to investigate ICH in snake envenoming. Cases of venom-induced consumption coagulopathy from July 2005-June 2014 were identified from the Australian Snakebite Project, a prospective multicentre cohort of snake-bites. Cases with venom-induced consumption coagulopathy were extracted with data on the snake-bite, clinical effects, laboratory investigations, treatment and outcomes. 552 cases had venom-induced consumption coagulopathy; median age, 40 y (2-87 y), 417 (76%) males, 253 (46%) from brown snakes and 17 died (3%). There were 6/552 (1%) cases of ICH; median age, 71 y (59-80 y), three males and five from brown snakes. All received antivenom and five died. All six had a history of hypertension. Time to onset of clinical effects consistent with ICH was 8-12 h in four cases, and within 3 h in two. Difficult to manage hypertension and vomiting were common. One patient had a normal cerebral CT on presentation and after the onset of focal neurological effects a repeat CT showed an ICH. ICH is rare in snake-bite with only 1% of patients with coagulopathy developing one. Older age and hypertension were associated with ICH.

DOI 10.1016/j.toxicon.2015.05.012
Citations Scopus - 2Web of Science - 1
Co-authors Christopher Levi, Geoffrey Isbister
2015 Sales M, Quain D, Lasserson D, Levi C, Oldmeadow C, Jiwa M, et al., 'Quality of referrals and guideline compliance for time to consultation at an acute neurovascular clinic', Journal of Stroke and Cerebrovascular Diseases, 24 874-880 (2015) [C1]

© 2015 by National Stroke Association. Background: The Age, Blood pressure, Clinical features, Duration of symptoms, Diabetes (ABCD2) score can be used to predict early recurrent... [more]

© 2015 by National Stroke Association. Background: The Age, Blood pressure, Clinical features, Duration of symptoms, Diabetes (ABCD2) score can be used to predict early recurrent stroke risk following Transient ischemic attack (TIA). Given that recurrent stroke risk can be as high as 20% in the first week, international guidelines recommend ''high-risk'' TIAs (ABCD2 .3) be seen by specialist services such as dedicated acute neurovascular clinics within 24 hours. The goal of this study was to examine the associations of both quality of referrals to a specialist acute clinic and of "guideline congruence" of time-to-clinic consultation after TIA/minor stroke. We hypothesized highquality referrals containing key clinical elements would be associated with greater guideline congruence. Methods: A retrospective analysis of referrals to an acute neurovascular clinic within a tertiary care hospital of consecutive patients with TIA/minor stroke. Quality of general practitioner and emergency department referrals was defined on the basis of information content enabling ABCD2-based risk stratification by the clinic triage service. Time-to-clinic consultation was used to define "guideline congruence." Results: Referrals of 148 consecutive eligible patients were reviewed. Sixty-six percent of cases were subsequently neurologist-diagnosed as TIA or minor stroke. Seventy-nine percent were referred by general practitioners. Fifty-three percent of referrals were of high quality, but quality was not associated with guideline congruence. Of the high-risk patients, only 3.6% were seen at the clinic within 24 hours of index event and 31.3% within 24 hours of referral. Conclusions: Current guidelines are pathophysiologically logical and evidence based, but are difficult to implement. Improving quality of primary-secondary communication by improved referral quality is unlikely to improve guideline compliance. Alternative strategies are needed to reduce recurrent stroke risk after TIA/minor stroke.

DOI 10.1016/j.jstrokecerebrovasdis.2014.12.004
Citations Scopus - 1Web of Science - 1
Co-authors Christopher Levi, Mark Parsons, Christopher Oldmeadow, Parker Magin
2015 Achterberg S, Kappelle LJ, De Bakker PIW, Traylor M, Algra A, Van Der Graaf Y, et al., 'No additional prognostic value of genetic information in the prediction of vascular events after cerebral ischemia of arterial origin: The PROMISe study', PLoS ONE, 10 (2015) [C1]

© 2015 Achterberg et al. Background: Patients who have suffered from cerebral ischemia have a high risk of recurrent vascular events. Predictive models based on classical risk fa... [more]

© 2015 Achterberg et al. Background: Patients who have suffered from cerebral ischemia have a high risk of recurrent vascular events. Predictive models based on classical risk factors typically have limited prognostic value. Given that cerebral ischemia has a heritable component, genetic information might improve performance of these risk models. Our aim was to develop and compare two models: one containing traditional vascular risk factors, the other also including genetic information. Methods and Results: We studied 1020 patients with cerebral ischemia and genotyped them with the Illumina Immunochip. Median follow-up time was 6.5 years; the annual incidence of new ischemic events (primary outcome, n=198) was 3.0%. The prognostic model based on classical vascular risk factors had an area under the receiver operating characteristics curve (AUC-ROC) of 0.65 (95% confidence interval 0.61-0.69). When we added a genetic risk score based on prioritized SNPs from a genome-wide association study of ischemic stroke (using summary statistics from the METASTROKE study which included 12389 cases and 62004 controls), the AUC-ROC remained the same. Similar results were found for the secondary outcome ischemic stroke. Conclusions: We found no additional value of genetic information in a prognostic model for the risk of ischemic events in patients with cerebral ischemia of arterial origin. This is consistent with a complex, polygenic architecture, where many genes of weak effect likely act in concert to influence the heritable risk of an individual to develop (recurrent) vascular events. At present, genetic information cannot help clinicians to distinguish patients at high risk for recurrent vascular events.

DOI 10.1371/journal.pone.0119203
Citations Scopus - 1
Co-authors Christopher Levi, Liz Holliday
2015 Tavener M, Thijsen A, Hubbard IJ, Francis JL, Grennall C, Levi C, Byles J, 'Acknowledging How Older Australian Women Experience Life After Stroke: How Does the WHO 18-Item Brief ICF Core Set for Stroke Compare?', Health Care Women Int, 36 1311-1326 (2015) [C1]
DOI 10.1080/07399332.2015.1055747
Citations Scopus - 1Web of Science - 1
Co-authors Julie Byles, Isobel Hubbard, Meredith Tavener, Christopher Levi
2015 Huang Y, Sharma VK, Robinson T, Lindley RI, Chen X, Kim JS, et al., 'Rationale, design, and progress of the ENhanced Control of Hypertension ANd Thrombolysis strokE stuDy (ENCHANTED) trial: An international multicenter 2×2 quasi-factorial randomized controlled trial of low- vs. standard-dose rt-PA and early intensive vs. guideline-recommended blood pressure lowering in patients with acute ischaemic stroke eligible for thrombolysis treatment', International Journal of Stroke, 10 778-788 (2015) [C3]

© 2015 World Stroke Organization. Rationale: Controversy exists over the optimal dose of intravenous (iv) recombinant tissue plasminogen activator (rt-PA) and degree of blood pre... [more]

© 2015 World Stroke Organization. Rationale: Controversy exists over the optimal dose of intravenous (iv) recombinant tissue plasminogen activator (rt-PA) and degree of blood pressure (BP) control in acute ischaemic stroke (AIS). Asian studies suggest low-dose (0·6mg/kg) is more efficacious than standard-dose (0·9mg/kg) iv rt-PA, and guidelines recommend reducing systolic BP to < 185mmHg before and < 180mmHg after use of iv rt-PA, despite observational studies indicating better outcomes at much lower ( < 140mmHg) systolic BP levels in this patient group. Aims: The study aims to assess in thrombolysis-eligible AIS patients whether: (i) low-dose (0·6mg/kg body weight; maximum 60mg) iv rt-PA has non-inferior efficacy and lower risk of symptomatic intracerebral haemorrhage (sICH) compared to standard-dose (0·9mg/kg body weight; maximum 90mg) iv rt-PA; and (ii) early intensive BP lowering (systolic target 130-140mmHg) has superior efficacy and lower risk of any ICH compared to guideline-recommended BP control (systolic target < 180mmHg). Design: The ENhanced Control of Hypertension And Thrombolysis strokE stuDy (ENCHANTED) trial is an independent,2×2 quasi-factorial, active-comparison, prospective, randomized, open blinded endpoint (PROBE), clinical trial that is evaluating Arm [A] 'rt-PA dose' and/or Arm [B] 'BP control', using central Internet randomization and data collection in patients fulfilling local criteria for thrombolysis and clinician uncertainty over the study treatments. The treatment arms will be analyzed separately. Study outcomes: The primary study outcome in both trial Arms is death or disability according to the modified Rankin scale (mRS, scores 2-6) assessed at 90 days. Secondary outcomes include sICH, any ICH, a shift ('improvement') in function across mRS scores, separately on death and disability, early neurological deterioration, recurrent major vascular events, health-related quality of life, length of hospital stay, need for permanent residential care, and health care costs. Results: Following launch of the trial in February 2012, the study has recruited more than 2500 patients across a global network of approximately 100 sites in 15 countries. The required sample sizes are 3300 for Arm [A] and 2300 for Arm [B] , which will provide > 90% power to detect non-inferiority of low-dose iv rt-PA and superiority of intensive BP lowering on the primary clinical outcome, respectively. Conclusions: Low-dose iv rt-PA and early intensive BP lowering could provide more affordable and safer use of thrombolysis treatment for patients with AIS worldwide.

DOI 10.1111/ijs.12486
Citations Scopus - 20Web of Science - 15
Co-authors Mark Parsons, Christopher Levi
2015 Lindley RI, Levi CR, 'The spectacular recent trials of urgent neurointervention for acute stroke: Fuel for a revolution', Medical Journal of Australia, 203 i-iii (2015) [C3]
DOI 10.5694/mja15.00395
Citations Scopus - 1Web of Science - 1
Co-authors Christopher Levi
2015 Karaszewski B, Houlden H, Smith EE, Markus HS, Charidimou A, Levi C, Werring DJ, 'What causes intracerebral bleeding after thrombolysis for acute ischaemic stroke? Recent insights into mechanisms and potential biomarkers', Journal of Neurology, Neurosurgery and Psychiatry, 86 1127-1136 (2015) [C1]

The overall population benefit of intravascular recombinant tissue plasminogen activator (rtPA) on functional outcome in ischaemic stroke is clear, but there are some treated pati... [more]

The overall population benefit of intravascular recombinant tissue plasminogen activator (rtPA) on functional outcome in ischaemic stroke is clear, but there are some treated patients who are harmed by early symptomatic intracranial haemorrhage (ICH). Although several clinical and radiological factors increase the risk of rtPA-related ICH, none of the currently available risk prediction tools are yet useful for practical clinical decision-making, probably reflecting our limited understanding of the underlying mechanisms. Finding new methods to identify patients at highest risk of rtPArelated ICH, or new measures to limit risk, are urgent challenges in acute stroke therapy research. In this article, we focus on the potential underlying mechanisms of rtPA-related ICH, highlight promising candidate risk biomarkers and suggest future research directions.

DOI 10.1136/jnnp-2014-309705
Citations Scopus - 10Web of Science - 10
Co-authors Christopher Levi
2015 Eastwood K, Paterson BJ, Levi C, Givney R, Loewenthal M, DE Malmanche T, et al., 'Adult encephalitis surveillance: experiences from an Australian prospective sentinel site study.', Epidemiol Infect, 143 3300-3307 (2015) [C1]
DOI 10.1017/S0950268815000527
Citations Scopus - 1Web of Science - 1
Co-authors Christopher Levi, D Durrheim
2015 Dale S, Levi C, Ward J, Grimshaw JM, Jammali-Blasi A, D'Este C, et al., 'Barriers and enablers to implementing clinical treatment protocols for fever, hyperglycaemia, and swallowing dysfunction in the quality in acute stroke care (QASC) project-a mixed methods study', Worldviews on Evidence-Based Nursing, 12 41-50 (2015) [C1]

© 2015 Sigma Theta Tau International. Background: The Quality in Acute Stroke Care (QASC) trial evaluated systematic implementation of clinical treatment protocols to manage feve... [more]

© 2015 Sigma Theta Tau International. Background: The Quality in Acute Stroke Care (QASC) trial evaluated systematic implementation of clinical treatment protocols to manage fever, sugar, and swallow (FeSS protocols) in acute stroke care. This cluster-randomised controlled trial was conducted in 19 stroke units in Australia. Aim: To describe perceived barriers and enablers preimplementation to the introduction of the FeSS protocols and, postimplementation, to determine which of these barriers eventuated as actual barriers. Methods: Preimplementation: Workshops were held at the intervention stroke units (n = 10). The first workshop involved senior clinicians who identified perceived barriers and enablers to implementation of the protocols, the second workshop involved bedside clinicians. Postimplementation, an online survey with stroke champions from intervention sites was conducted. Results: A total of 111 clinicians attended the preimplementation workshops, identifying 22 barriers covering four main themes: (a) need for new policies, (b) limited workforce (capacity), (c) lack of equipment, and (d) education and logistics of training staff. Preimplementation enablers identified were: support by clinical champions, medical staff, nursing management and allied health staff; easy adaptation of current protocols, care-plans, and local policies; and presence of specialist stroke unit staff. Postimplementation, only five of the 22 barriers identified preimplementation were reported as actual barriers to adoption of the FeSS protocols, namely, no previous use of insulin infusions; hyperglycaemic protocols could not be commenced without written orders; medical staff reluctance to use the ASSIST swallowing screening tool; poor level of engagement of medical staff; and doctors' unawareness of the trial. Linking Evidence to Action: The process of identifying barriers and enablers preimplementation allowed staff to take ownership and to address barriers and plan for change. As only five of the 22 barriers identified preimplementation were reported to be actual barriers at completion of the trial, this suggests that barriers are often overcome whilst some are only ever perceived rather than actual barriers.

DOI 10.1111/wvn.12078
Citations Scopus - 7Web of Science - 6
Co-authors Christopher Levi, Catherine Deste
2015 Cheng YC, Anderson CD, Bione S, Keene K, Maguire JM, Nalls M, et al., 'Are myocardial infarction-associated single-nucleotide polymorphisms associated with ischemic stroke? (vol 43, pg 980, 2012)', STROKE, 46 E204-E204 (2015) [C3]
DOI 10.1161/STR.0000000000000073
Co-authors Christopher Levi, Pablo Moscato, Liz Holliday, Lisa Lincz, John Attia
2015 Gardner AJ, Tan CO, Ainslie PN, van Donkelaar P, Stanwell P, Levi CR, Iverson GL, 'Cerebrovascular reactivity assessed by transcranial Doppler ultrasound in sport-related concussion: a systematic review', British Journal of Sports Medicine, 49 1050-1055 (2015) [C1]
DOI 10.1136/bjsports-2014-093901
Citations Scopus - 8Web of Science - 9
Co-authors Christopher Levi, Peter Stanwell, Andrew Gardner
2015 Bivard A, Levi C, Krishnamurthy V, McElduff P, Miteff F, Spratt NJ, et al., 'Perfusion computed tomography to assist decision making for stroke thrombolysis', Brain, 138 1919-1931 (2015) [C1]

© 2015 The Author. The use of perfusion imaging to guide selection of patients for stroke thrombolysis remains controversial because of lack of supportive phase three clinical tr... [more]

© 2015 The Author. The use of perfusion imaging to guide selection of patients for stroke thrombolysis remains controversial because of lack of supportive phase three clinical trial evidence. We aimed to measure the outcomes for patients treated with intravenous recombinant tissue plasminogen activator (rtPA) at a comprehensive stroke care facility where perfusion computed tomography was routinely used for thrombolysis eligibility decision assistance. Our overall hypothesis was that patients with 'target' mismatch on perfusion computed tomography would have improved outcomes with rtPA. This was a prospective cohort study of consecutive ischaemic stroke patients who fulfilled standard clinical/non-contrast computed tomography eligibility criteria for treatment with intravenous rtPA, but for whom perfusion computed tomography was used to guide the final treatment decision. The 'real-time' perfusion computed tomography assessments were qualitative; a large perfusion computed tomography ischaemic core, or lack of significant perfusion lesion-core mismatch were considered relative exclusion criteria for thrombolysis. Specific volumetric perfusion computed tomography criteria were not used for the treatment decision. The primary analysis compared 3-month modified Rankin Scale in treated versus untreated patients after 'off-line' (post-treatment) quantitative volumetric perfusion computed tomography eligibility assessment based on presence or absence of 'target' perfusion lesion-core mismatch (mismatch ratio > 1.8 and volume > 15 ml, core < 70 ml). In a second analysis, we compared outcomes of the perfusion computed tomography-selected rtPA-treated patients to an Australian historical cohort of non-contrast computed tomography-selected rtPA-treated patients. Of 635 patients with acute ischaemic stroke eligible for rtPA by standard criteria, thrombolysis was given to 366 patients, with 269 excluded based on visual real-time perfusion computed tomography assessm ent. After off-line quantitative perfusion computed tomography classification: 253 treated patients and 83 untreated patients had 'target' mismatch, 56 treated and 31 untreated patients had a large ischaemic core, and 57 treated and 155 untreated patients had no target mismatch. In the primary analysis, only in the target mismatch subgroup did rtPA-treated patients have significantly better outcomes (odds ratio for 3-month, modified Rankin Scale 0-2 = 13.8, P < 0.001). With respect to the perfusion computed tomography selected rtPA-treated patients (n = 366) versus the clinical/non-contrast computed tomography selected rtPA-treated patients (n = 396), the perfusion computed tomography selected group had higher adjusted odds of excellent outcome (modified Rankin Scale 0-1 odds ratio 1.59, P = 0.009) and lower mortality (odds ratio 0.56, P = 0.021). Although based on observational data sets, our analyses provide support for the hypothesis that perfusion computed tomography improves the identification of patients likely to respond to thrombolysis, and also those in whom natural history may be difficult to modify with treatment.

DOI 10.1093/brain/awv071
Citations Scopus - 18Web of Science - 15
Co-authors Andrew Bivard, Neil Spratt, Christopher Levi, Mark Parsons, Patrick Mcelduff
2015 Magin P, Dunbabin J, Goode S, Valderas JM, Levi C, D'Souza M, et al., 'Patients' responses to transient ischaemic attack symptoms: A cross-sectional questionnaire study in Australian general practices', British Journal of General Practice, 65 e24-e31 (2015) [C1]

©British Journal of General Practice Background Consensus guidelines for transient ischaemic attack (TIA) recommend urgent investigation and management, but delays in management ... [more]

©British Journal of General Practice Background Consensus guidelines for transient ischaemic attack (TIA) recommend urgent investigation and management, but delays in management occur and are attributable to patient and health system factors. Aim To establish general practice patients' anticipated responses to T IA symptoms, and associations of appropriate responses. Design and setting A cross-sectional questionnaire-based study in Australian general practices. Method Consecutive patients attending general practices completed questionnaires that contained the Stroke Action Test (STAT) adapted for TIA about demographic, health system use, and stroke risk factors. STAT elicits appropriate or inappropriate anticipated responses to 28 symptom complexes. Anticipated actions in-hours and out-of-hours were elicited. Associations of independent variables with adapted-STAT scores were tested with multiple linear regression. Results There were 854 participants (response rate 76.9%). Urgent healthcare-seeking responses to transient neurological symptoms ranged from 96.8% for right-sided weakness with dysphasia to 59.1% for sudden dizziness. Associations of higher adapted-STAT scores were older age, Indigenous status, previous after-hours services use, self-perception of health as poor, and familiarity with a stroke public awareness campaign. A personal or family history of stroke, smoking status, and time of event (in-hours/out-of-hours) were not significantly associated with adapted-STAT scores. Conclusion Most general practice attendees expressed intentions to seek health care urgently for most symptoms suggestive of TIA, with highest levels of urgency observed in high stroke-risk scenarios. Intentions were not associated with a number of major risk factors for TIA and might be improved by further educational interventions, either targeted or at population level.

DOI 10.3399/bjgp15X683125
Citations Scopus - 2Web of Science - 2
Co-authors Christopher Levi, Parker Magin
2015 Menon BK, Campbell BCV, Levi C, Goyal M, 'Role of Imaging in Current Acute Ischemic Stroke Workflow for Endovascular Therapy', STROKE, 46 1453-1461 (2015) [C1]
DOI 10.1161/STROKEAHA.115.009160
Citations Scopus - 37Web of Science - 33
Co-authors Christopher Levi
2015 Mcleod DD, Parsons MW, Hood R, Hiles B, Allen J, Mccann SK, et al., 'Perfusion computed tomography thresholds defining ischemic penumbra and infarct core: Studies in a rat stroke model', International Journal of Stroke, 10 553-559 (2015) [C1]

© 2013 World Stroke Organization. Background: Perfusion computed tomography is becoming more widely used as a clinical imaging tool to predict potentially salvageable tissue (isc... [more]

© 2013 World Stroke Organization. Background: Perfusion computed tomography is becoming more widely used as a clinical imaging tool to predict potentially salvageable tissue (ischemic penumbra) after ischemic stroke and guide reperfusion therapies. Aims: The study aims to determine whether there are important changes in perfusion computed tomography thresholds defining ischemic penumbra and infarct core over time following stroke. Methods: Permanent middle cerebral artery occlusion was performed in adult outbred Wistar rats (n=6) and serial perfusion computed tomography scans were taken every 30 mins for 2h. To define infarction thresholds at 1h and 2h post-stroke, separate groups of rats underwent 1h (n=6) and 2h (n=6) of middle cerebral artery occlusion followed by reperfusion. Infarct volumes were defined by histology at 24h. Co-registration with perfusion computed tomography maps (cerebral blood flow, cerebral blood volume, and mean transit time) permitted pixel-based analysis of thresholds defining infarction, using receiver operating characteristic curves. Results: Relative cerebral blood flow was the perfusion computed tomography parameter that most accurately predicted penumbra (area under the curve=0·698) and also infarct core (area under the curve=0·750). A relative cerebral blood flow threshold of < 75% of mean contralateral cerebral blood flow most accurately predicted penumbral tissue at 0·5h (area under the curve=0·660), 1h (area under the curve=0·659), 1·5h (area under the curve=0·636), and 2h (area under the curve=0·664) after stroke onset. A relative cerebral blood flow threshold of < 55% of mean contralateral most accurately predicted infarct core at 1h (area under the curve=0·765) and at 2h (area under the curve=0·689) after middle cerebral artery occlusion. Conclusions: The data provide perfusion computed tomography defined relative cerebral blood flow thresholds for infarct core and ischemic penumbra within the first two hours after experimental stroke in rats. These thresholds were shown to be stable to define the volume of infarct core and penumbra within this time window.

DOI 10.1111/ijs.12147
Citations Scopus - 7Web of Science - 7
Co-authors Lucy Murtha, Neil Spratt, Christopher Levi, Damian Mcleod, Mark Parsons
2015 Tomkins AJ, Schleicher N, Murtha L, Kaps M, Levi CR, Nedelmann M, Spratt NJ, 'Platelet rich clots are resistant to lysis by thrombolytic therapy in a rat model of embolic stroke', Experimental and Translational Stroke Medicine, 7 (2015) [C1]

© 2015 Tomkins et al. Background: Early recanalization of occluded vessels in stroke is closely associated with improved clinical outcome. Microbubble-enhanced sonothrombolysis i... [more]

© 2015 Tomkins et al. Background: Early recanalization of occluded vessels in stroke is closely associated with improved clinical outcome. Microbubble-enhanced sonothrombolysis is a promising therapy to improve recanalization rates and reduce the time to recanalization. Testing any thrombolytic therapy requires a model of thromboembolic stroke, but to date these models have been highly variable with regards to clot stability. Here, we developed a model of thromboembolic stroke in rats with site-specific delivery of platelet-rich clots (PRC) to the main stem of the middle cerebral artery (MCA). This model was used in a subsequent study to test microbubble-enhanced sonothrombolysis. Methods: In Study 1 we investigated spontaneous recanalization rates of PRC in vivo over 4 hours and measured infarct volumes at 24 hours. In Study 2 we investigated tPA-mediated thrombolysis and microbubble-enhanced sonothrombolysis in this model. Results: Study 1 demonstrated stable occlusion out to 4 hours in 5 of 7 rats. Two rats spontaneously recanalized at 40 and 70 minutes post-embolism. Infarct volumes were not significantly different in recanalized rats, 43.93 ± 15.44% of the ischemic hemisphere, compared to 48.93 ± 3.9% in non-recanalized animals (p = 0.7). In Study 2, recanalization was not observed in any of the groups post-treatment. Conclusions: Site specific delivery of platelet rich clots to the MCA origin resulted in high rates of MCA occlusion, low rates of spontaneous clot lysis and large infarction. These platelet rich clots were highly resistant to tPA with or without microbubble-enhanced sonothrombolysis. This resistance of platelet rich clots to enhanced thrombolysis may explain recanalization failures clinically and should be an impetus to better clot-type identification and alternative recanalization methods.

DOI 10.1186/s13231-014-0014-y
Citations Scopus - 7
Co-authors Neil Spratt, Lucy Murtha, Christopher Levi
2015 Tomkins AJ, Hood RJ, Levi CR, Spratt NJ, 'Tissue Plasminogen Activator for preclinical stroke research: Neither "rat" nor "human" dose mimics clinical recanalization in a carotid occlusion model', SCIENTIFIC REPORTS, 5 (2015) [C1]
DOI 10.1038/srep16026
Citations Scopus - 3Web of Science - 3
Co-authors Christopher Levi, Neil Spratt
2015 Holliday EG, Traylor M, Malik R, Bevan S, Falcone G, Hopewell JC, et al., 'Genetic Overlap Between Diagnostic Subtypes of Ischemic Stroke', STROKE, 46 615-+ (2015) [C1]
DOI 10.1161/STROKEAHA.114.007930
Citations Scopus - 15Web of Science - 12
Co-authors Christopher Levi, Christopher Oldmeadow, Liz Holliday, John Attia, Lisa Lincz, Rodney Scott
2015 Hubbard IJ, Carey LM, Budd TW, Levi C, McElduff P, Hudson S, et al., 'A Randomized Controlled Trial of the Effect of Early Upper-Limb Training on Stroke Recovery and Brain Activation', Neurorehabilitation and Neural Repair, 29 703-713 (2015) [C1]

© 2015 American Society of Neurorehabilitation. Background. Upper-limb (UL) dysfunction is experienced by up to 75% of patients poststroke. The greatest potential for functional ... [more]

© 2015 American Society of Neurorehabilitation. Background. Upper-limb (UL) dysfunction is experienced by up to 75% of patients poststroke. The greatest potential for functional improvement is in the first month. Following reperfusion, evidence indicates that neuroplasticity is the mechanism that supports this recovery. Objective. This preliminary study hypothesized increased activation of putative motor areas in those receiving intensive, task-specific UL training in the first month poststroke compared with those receiving standard care. Methods. This was a single-blinded, longitudinal, randomized controlled trial in adult patients with an acute, first-ever ischemic stroke; 23 participants were randomized to standard care (n = 12) or an additional 30 hours of task-specific UL training in the first month poststroke beginning week 1. Patients were assessed at 1 week, 1 month, and 3 months poststroke. The primary outcome was change in brain activation as measured by functional magnetic resonance imaging. Results. When compared with the standard-care group, the intensive-training group had increased brain activation in the anterior cingulate and ipsilesional supplementary motor areas and a greater reduction in the extent of activation (P =.02) in the contralesional cerebellum. Intensive training was associated with a smaller deviation from mean recovery at 1 month (Pr > F0 = 0.017) and 3 months (Pr > F = 0.006), indicating more consistent and predictable improvement in motor outcomes. Conclusion. Early, more-intensive, UL training was associated with greater changes in activation in putative motor (supplementary motor area and cerebellum) and attention (anterior cingulate) regions, providing support for the role of these regions and functions in early recovery poststroke.

DOI 10.1177/1545968314562647
Citations Scopus - 8Web of Science - 7
Co-authors Patrick Mcelduff, Christopher Levi, Isobel Hubbard, Bill Budd, Mark Parsons
2015 Thomas LC, Rivett DA, Attia JR, Levi C, 'Risk factors and clinical presentation of cervical arterial dissection: Preliminary results of a prospective case-control study', Journal of Orthopaedic and Sports Physical Therapy, 45 503-511 (2015) [C1]

Copyright ©2015 Journal of Orthopaedic &amp; Sports Physical Therapy®. All rights reserved. STUDY DESIGN: Cross-sectional case-control study. OBJECTIVES: To identify risk fact... [more]

Copyright ©2015 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved. STUDY DESIGN: Cross-sectional case-control study. OBJECTIVES: To identify risk factors and clinical presentation of individuals with cervical arterial dissection. BACKGROUND: Cervical arterial dissection is a common cause of stroke in young people and has in rare cases been associated with cervical manipulative therapy. The mechanism is considered to involve pre-existing arterial susceptibility and a precipitating event, such as minor trauma. Identification of individuals at risk or early recognition of a dissection in progress could help expedite medical intervention and avoid inappropriate treatment. METHODS: Participants were individuals 55 years of age or younger from the Hunter region of New South Wales, Australia with radiologically confirmed vertebral or internal carotid artery dissection and an age- and sex-matched comparison group. Participants were interviewed about risk factors, preceding events, and clinical features of their stroke. Physical examination of joint mobility and soft tissue compliance was undertaken. RESULTS: Twenty-four participants with cervical arterial dissection and 21 matched comparisons with ischemic stroke but not dissection were included in the study. Seventeen (71%) of the 24 participants with dissection reported a recent history of minor mechanical neck trauma or strain, with 4 of these 17 reporting recent neck manipulative therapy treatment. Cardiovascular risk factors were uncommon, with the exception of diagnosed migraine. Among the participants with dissection, 67% reported transient ischemic features in the month prior to their admission for dissection. CONCLUSION: Recent minor mechanical trauma or strain to the head or neck appears to be associated with cervical arterial dissection. General cardiovascular risk factors, with the exception of migraine, were not important risk factors for dissection in this cohort. Preceding transient neurological symptoms appear to occur commonly and may assist in the identification of this serious pathology.

DOI 10.2519/jospt.2015.5877
Citations Scopus - 6Web of Science - 4
Co-authors Lucy Thomas, Christopher Levi, John Attia, Darren Rivett
2014 Paul CL, Levi CR, D'Este CA, Parsons MW, Bladin CF, Lindley RI, et al., 'Thrombolysis ImPlementation in Stroke (TIPS): Evaluating the effectiveness of a strategy to increase the adoption of best evidence practice - protocol for a cluster randomised controlled trial in acute stroke care', Implementation Science, 9 (2014) [C3]

Background: Stroke is a leading cause of death and disability internationally. One of the three effective interventions in the acute phase of stroke care is thrombolytic therapy w... [more]

Background: Stroke is a leading cause of death and disability internationally. One of the three effective interventions in the acute phase of stroke care is thrombolytic therapy with tissue plasminogen activator (tPA), if given within 4.5 hours of onset to appropriate cases of ischaemic stroke.Objectives: To test the effectiveness of a multi-component multidisciplinary collaborative approach compared to usual care as a strategy for increasing thrombolysis rates for all stroke patients at intervention hospitals, while maintaining accepted benchmarks for low rates of intracranial haemorrhage and high rates of functional outcomes for both groups at three months.Methods and design: A cluster randomised controlled trial of 20 hospitals across 3 Australian states with 2 groups: multi- component multidisciplinary collaborative intervention as the experimental group and usual care as the control group. The intervention is based on behavioural theory and analysis of the steps, roles and barriers relating to rapid assessment for thrombolysis eligibility; it involves a comprehensive range of strategies addressing individual-level and system-level change at each site. The primary outcome is the difference in tPA rates between the two groups post-intervention. The secondary outcome is the proportion of tPA treated patients in both groups with good functional outcomes (modified Rankin Score (mRS < 2) and the proportion with intracranial haemorrhage (mRS =2), compared to international benchmarks.Discussion: TIPS will trial a comprehensive, multi-component and multidisciplinary collaborative approach to improving thrombolysis rates at multiple sites. The trial has the potential to identify methods for optimal care which can be implemented for stroke patients during the acute phase. Study findings will include barriers and solutions to effective thrombolysis implementation and trial outcomes will be published whether significant or not.Trial registration: Australian New Zealand Clinical Trials Registry: ACTRN12613000939796. © 2014 Paul et al.; licensee BioMed Central Ltd.

DOI 10.1186/1748-5908-9-38
Citations Scopus - 5Web of Science - 4
Co-authors Christopher Levi, Mark Parsons, John Attia, Catherine Deste, Chris Paul, Frans Henskens, Rob Sanson-Fisher
2014 Traylor M, Mäkelä K-M, Kilarski LL, Holliday EG, Devan WJ, Nalls MA, et al., 'A novel MMP12 locus is associated with large artery atherosclerotic stroke using a genome-wide age-at-onset informed approach.', PLoS Genet, 10 e1004469 (2014) [C1]
DOI 10.1371/journal.pgen.1004469
Citations Scopus - 23Web of Science - 22
Co-authors Christopher Levi, John Attia, Liz Holliday
2014 Ay H, Arsava EM, Andsberg G, Benner T, Brown RD, Chapman SN, et al., 'Pathogenic Ischemic Stroke Phenotypes in the NINDS-Stroke Genetics Network', STROKE, 45 3589-3596 (2014) [C1]
DOI 10.1161/STROKEAHA.114.007362
Citations Scopus - 8Web of Science - 5
Co-authors Christopher Levi
2014 Bivard A, Levi C, Krishnamurthy V, Hislop-Jambrich J, Salazar P, Jackson B, et al., 'Defining acute ischemic stroke tissue pathophysiology with whole brain CT perfusion', JOURNAL OF NEURORADIOLOGY, 41 307-315 (2014) [C1]
DOI 10.1016/j.neurad.2013.11.006
Citations Scopus - 17Web of Science - 15
Co-authors Andrew Bivard, Mark Parsons, Christopher Levi
2014 Meretoja A, Churilov L, Campbell BCV, Aviv RI, Yassi N, Barras C, et al., 'The Spot sign and Tranexamic acid On Preventing ICH growth - AUStralasia Trial (STOP-AUST): Protocol of a phase II randomized, placebo-controlled, double-blind, multicenter trial', International Journal of Stroke, 9 519-524 (2014) [C3]

Rationale: No evidence-based acute therapies exist for intracerebral hemorrhage. Intracerebral hemorrhage growth is an important determinant of patient outcome. Tranexamic acid is... [more]

Rationale: No evidence-based acute therapies exist for intracerebral hemorrhage. Intracerebral hemorrhage growth is an important determinant of patient outcome. Tranexamic acid is known to reduce hemorrhage in other conditions. Aim: The study aims to test the hypothesis that intracerebral hemorrhage patients selected with computed tomography angiography contrast extravasation 'spot sign' will have lower rates of hematoma growth when treated with intravenous tranexamic acid within 4·5-hours of stroke onset compared with placebo. Design: The Spot sign and Tranexamic acid On Preventing ICH growth - AUStralasia Trial is a multicenter, prospective, 1:1 randomized, double-blind, placebo-controlled, investigator-initiated, academic Phase II trial. Intracerebral hemorrhage patients fulfilling clinical criteria (e.g. Glasgow Coma Scale > 7, intracerebral hemorrhage volume < 70ml, no identified secondary cause of intracerebral hemorrhage, no thrombotic events within the previous 12 months, no planned surgery) and demonstrating contrast extravasation on computed tomography angiography will receive either intravenous tranexamic acid 1g 10-min bolus followed by 1g eight-hour infusion or placebo. A second computed tomography will be performed at 24 ± 3 hours to evaluate intracerebral hemorrhage growth and patients followed up for three-months. Study outcomes: The primary outcome measure is presence of intracerebral hemorrhage growth by 24 ± 3 hours, defined as either > 33% or > 6ml increase from baseline, and will be adjusted for baseline intracerebral hemorrhage volume. Secondary outcome measures include growth as a continuous measure, thromboembolic events, and the three-month modified Rankin Scale score. Discussion: This is the first trial to evaluate the efficacy of tranexamic acid in intracerebral hemorrhage patients selected based on an imaging biomarker of high likelihood of hematoma growth. The trial is registered as NCT01702636. © 2013 World Stroke Organization.

DOI 10.1111/ijs.12132
Citations Scopus - 23Web of Science - 22
Co-authors Christopher Levi, Mark Parsons, Neil Spratt
2014 Kilarski LL, Achterberg S, Devan WJ, Traylor M, Malik R, Lindgren A, et al., 'Meta-analysis in more than 17,900 cases of ischemic stroke reveals a novel association at 12q24.12', NEUROLOGY, 83 678-685 (2014) [C1]
Citations Scopus - 37Web of Science - 38
Co-authors Christopher Levi, Liz Holliday
2014 Bivard A, Krishnamurthy V, Stanwell P, Levi C, Spratt NJ, Davis S, Parsons M, 'Arterial Spin Labeling Versus Bolus-Tracking Perfusion in Hyperacute Stroke', Stroke, 45 127-133 (2014) [C1]
DOI 10.1161/STROKEAHA.113.003218
Citations Scopus - 14Web of Science - 14
Co-authors Christopher Levi, Mark Parsons, Peter Stanwell, Neil Spratt, Andrew Bivard
2014 Dichgans M, Malik R, König IR, Rosand J, Clarke R, Gretarsdottir S, et al., 'Shared genetic susceptibility to ischemic stroke and coronary artery disease : A genome-wide analysis of common variants', Stroke, 45 24-36 (2014) [C1]

Background and Purpose-Ischemic stroke (IS) and coronary artery disease (CAD) share several risk factors and each has a substantial heritability. We conducted a genome-wide analys... [more]

Background and Purpose-Ischemic stroke (IS) and coronary artery disease (CAD) share several risk factors and each has a substantial heritability. We conducted a genome-wide analysis to evaluate the extent of shared genetic determination of the two diseases. Methods-Genome-wide association data were obtained from the METASTROKE, Coronary Artery Disease Genomewide Replication and Meta-analysis (CARDIoGRAM), and Coronary Artery Disease (C4D) Genetics consortia. We first analyzed common variants reaching a nominal threshold of significance (P < 0.01) for CAD for their association with IS and vice versa. We then examined specific overlap across phenotypes for variants that reached a high threshold of significance. Finally, we conducted a joint meta-analysis on the combined phenotype of IS or CAD. Corresponding analyses were performed restricted to the 2167 individuals with the ischemic large artery stroke (LAS) subtype. Results-Common variants associated with CAD at P < 0.01 were associated with a significant excess risk for IS and for LAS and vice versa. Among the 42 known genome-wide significant loci for CAD, 3 and 5 loci were significantly associated with IS and LAS, respectively. In the joint meta-analyses, 15 loci passed genome-wide significance (P < 5×10-8) for the combined phenotype of IS or CAD and 17 loci passed genome-wide significance for LAS or CAD. Because these loci had prior evidence for genome-wide significance for CAD, we specifically analyzed the respective signals for IS and LAS and found evidence for association at chr12q24/SH2B3 (PIS=1.62×10-7) and ABO (PIS=2.6×10-4), as well as at HDAC9 (PLAS=2.32×10-12), 9p21 (PLAS=3.70×10-6), RAI1-PEMT-RASD1 (PLAS=2.69×10-5), EDNRA (PLAS=7.29×10-4), and CYP17A1-CNNM2-NT5C2 (PLAS=4.9×10-4). Conclusions-Our results demonstrate substantial overlap in the genetic risk of IS and particularly the LAS subtype with CAD. © 2013 American Heart Association, Inc.

DOI 10.1161/STROKEAHA.113.002707
Citations Scopus - 103Web of Science - 103
Co-authors Christopher Levi
2014 Malik R, Bevan S, Nalls MA, Holliday EG, Devan WJ, Cheng YC, et al., 'Multilocus genetic risk score associates with ischemic stroke in case-control and prospective cohort studies', Stroke, 45 394-402 (2014) [C1]

Background and Purpose - Genome-wide association studies have revealed multiple common variants associated with known risk factors for ischemic stroke (IS). However, their aggrega... [more]

Background and Purpose - Genome-wide association studies have revealed multiple common variants associated with known risk factors for ischemic stroke (IS). However, their aggregate effect on risk is uncertain. We aimed to generate a multilocus genetic risk score (GRS) for IS based on genome-wide association studies data from clinical-based samples and to establish its external validity in prospective population-based cohorts. Methods - Three thousand five hundred forty-eight clinic-based IS cases and 6399 controls from the Wellcome Trust Case Control Consortium 2 were used for derivation of the GRS. Subjects from the METASTROKE consortium served as a replication sample. The validation sample consisted of 22 751 participants from the Cohorts for Heart and Aging Research in Genomic Epidemiology consortium. We selected variants that had reached genome-wide significance in previous association studies on established risk factors for IS. Results - A combined GRS for atrial fibrillation, coronary artery disease, hypertension, and systolic blood pressure significantly associated with IS both in the case-control samples and in the prospective population-based studies. Subjects in the top quintile of the combined GRS had > 2-fold increased risk of IS compared with subjects in the lowest quintile. Addition of the combined GRS to a simple model based on sex significantly improved the prediction of IS in the combined clinic-based samples but not in the population-based studies, and there was no significant improvement in net reclassification. Conclusions - A multilocus GRS based on common variants for established cardiovascular risk factors was significantly associated with IS both in clinic-based samples and in the general population. However, the improvement in clinical risk prediction was found to be small. © 2014 American Heart Association, Inc.

DOI 10.1161/STROKEAHA.113.002938
Citations Scopus - 24Web of Science - 21
Co-authors Christopher Levi, Liz Holliday
2014 Amarenco P, Davis S, Jones EF, Cohen AA, Heiss WD, Kaste M, et al., 'Clopidogrel plus aspirin versus warfarin in patients with stroke and aortic arch plaques', Stroke, 45 1248-1257 (2014)

BACKGROUND AND PURPOSE-: Severe atherosclerosis in the aortic arch is associated with a high risk of recurrent vascular events, but the optimal antithrombotic strategy is unclear.... [more]

BACKGROUND AND PURPOSE-: Severe atherosclerosis in the aortic arch is associated with a high risk of recurrent vascular events, but the optimal antithrombotic strategy is unclear. METHODS-: This prospective randomized controlled, open-labeled trial, with blinded end point evaluation (PROBE design) tested superiority of aspirin 75 to 150 mg/d plus clopidogrel 75 mg/d (A+C) over warfarin therapy (international normalized ratio 2-3) in patients with ischemic stroke, transient ischemic attack, or peripheral embolism with plaque in the thoracic aorta > 4 mm and no other identified embolic source. The primary end point included cerebral infarction, myocardial infarction, peripheral embolism, vascular death, or intracranial hemorrhage. Follow-up visits occurred at 1 month and then every 4 months post randomization. RESULTS-: The trial was stopped after 349 patients were randomized during a period of 8 years and 3 months. After a median follow-up of 3.4 years, the primary end point occurred in 7.6% (13/172) and 11.3% (20/177) of patients on A+C and on warfarin, respectively (log-rank, P=0.2). The adjusted hazard ratio was 0.76 (95% confidence interval, 0.36-1.61; P=0.5). Major hemorrhages including intracranial hemorrhages occurred in 4 and 6 patients in the A+C and warfarin groups, respectively. Vascular deaths occurred in 0 patients in A+C arm compared with 6 (3.4%) patients in the warfarin arm (log-rank, P=0.013). Time in therapeutic range (67% of the time for international normalized ratio 2-3) analysis by tertiles showed no significant differences across groups. CONCLUSIONS-: Because of lack of power, this trial was inconclusive and results should be taken as hypothesis generating. © 2014 American Heart Association, Inc.

DOI 10.1161/STROKEAHA.113.004251
Citations Scopus - 43
Co-authors Christopher Levi
2014 Lin L, Bivard A, Levi CR, Parsons MW, 'Comparison of computed tomographic and magnetic resonance perfusion measurements in acute ischemic stroke: Back-to-back quantitative analysis', Stroke, 45 1727-1732 (2014) [C1]

Background and Purpose: Magnetic resonance perfusion (MRP) and computed tomographic perfusion (CTP) are being increasingly applied in acute stroke trials and clinical practice, ye... [more]

Background and Purpose: Magnetic resonance perfusion (MRP) and computed tomographic perfusion (CTP) are being increasingly applied in acute stroke trials and clinical practice, yet the comparability of their perfusion values is not well validated. The aim of this study was to validate the comparability of CTP and MRP measures. METHODS-: A 3-step approach was used. Step 1 was a derivation step, where we analyzed 45 patients with acute ischemic stroke who had both CTP and MRP performed within 2 hours of each other and within 9 hours of stroke onset. In this step, we derived the optimal perfusion map with the least difference between MRP and CTP. In step 2, the optimal map was validated on whole-brain perfusion data of 15 patients. Step 3 was to apply the optimal perfusion map to define cross-modality reperfusion from acute CTP to 24-hour MRP in 45 patients and, in turn, to assess how accurately this predicted 3-month clinical outcome. RESULTS-: Among 8 different perfusion maps included in this study, time to peak of the residual function (T max ) was the only one with a nonsignificant difference between CTP and MRP in delineating perfusion defects. This was validated on whole-brain perfusion data, showing high concordance of T max between the 2 modalities (concordance correlation coefficient of Lin, > 0.91); the best concordance was at 6 s. At T max > 6 s threshold, MRP and CTP reached substantial agreement in mismatch classification (¿ > 0.61). Cross-modality reperfusion calculated by T max > 6 s strongly predicted good functional outcome at 3 months (area under the curve, 0.979; P < 0.05). CONCLUSIONS-: MRP and CTP can be used interchangeably if one uses T max measurement. © 2014 American Heart Association, Inc.

DOI 10.1161/STROKEAHA.114.005419
Citations Scopus - 18Web of Science - 18
Co-authors Christopher Levi, Mark Parsons, Andrew Bivard
2014 Bivard A, Krishnamurthy V, Stanwell P, Yassi N, Spratt NJ, Nilsson M, et al., 'Spectroscopy of reperfused tissue after stroke reveals heightened metabolism in patients with good clinical outcomes', JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM, 34 1944-1950 (2014) [C1]
DOI 10.1038/jcbfm.2014.166
Citations Scopus - 10Web of Science - 10
Co-authors Peter Stanwell, Michael Nilsson, Neil Spratt, Christopher Levi, Mark Parsons, Andrew Bivard
2014 Williams FMK, Carter AM, Hysi PG, Surdulescu G, Hodgkiss D, Soranzo N, et al., 'Ischemic stroke is associated with the ABO locus: The EuroCLOT study (vol 73, pg 16, 2013)', ANNALS OF NEUROLOGY, 75 166-167 (2014)
DOI 10.1002/ana.24105
Co-authors John Attia, Rodney Scott, Christopher Levi, Liz Holliday
2014 Holliday EG, Traylor M, Malik R, Bevan S, Maguire J, Koblar SA, et al., 'Polygenic Overlap Between Kidney Function and Large Artery Atherosclerotic Stroke', STROKE, 45 3508-+ (2014) [C1]
DOI 10.1161/STROKEAHA.114.006609
Citations Scopus - 3Web of Science - 4
Co-authors Christopher Oldmeadow, Christopher Levi, John Attia, Liz Holliday, Mark Mcevoy, Rodney Scott
2014 Bivard A, Krishnamurthy V, Levi C, McElduff P, Miteff F, Spratt N, et al., 'Stroke thrombolysis: Tissue is more important than time.', CEREBROVASCULAR DISEASES, 37 154-154 (2014)
Co-authors Christopher Levi, Andrew Bivard, Mark Parsons, Neil Spratt
2014 Bladin C, Levi C, Parsons M, Campbell B, Derdyn C, Panagos P, Creighton F, 'Magnetically-Enhanced Diffusion (MED (TM)) of Intravenous tPA in Acute Ischenic Stroke(AIS): A Phase 1 Feasibility Trial', CEREBROVASCULAR DISEASES, 37 178-178 (2014)
Co-authors Christopher Levi, Mark Parsons
2014 Gunathilake R, Krishnamurthy V, Oldmeadow C, Kerr E, Padmakumar C, Attia J, et al., 'Relationships between age, other predictive variables, and the 90-day functional outcome after intravenous thrombolysis for acute ischemic stroke', AUSTRALASIAN JOURNAL ON AGEING, 33 19-19 (2014) [E3]
Co-authors John Attia, Christopher Levi, Christopher Oldmeadow, Mark Parsons
2014 Freeland J, Levi C, Hunter M, 'Thalamic Stroke: Precursors and Outcomes for Ten Patients', BRAIN IMPAIRMENT, 15 51-57 (2014) [C1]
DOI 10.1017/BrImp.2014.4
Co-authors Mick Hunter, Christopher Levi
2014 Middleton S, Comerford D, Lydtin A, Dale S, Hill K, Dunne J, et al., 'The QASC Implementation Project: Implementing evidence based care in stroke services throughout NSW, Australia', CEREBROVASCULAR DISEASES, 37 325-325 (2014)
Co-authors Christopher Levi, Catherine Deste
2014 Bivard A, Krishnamurthy V, Levi C, McElduff P, Miteff F, Spratt N, et al., 'Does the presence of CTP mismatch predict better outcomes in thrombolysis-treated patients?', CEREBROVASCULAR DISEASES, 37 344-344 (2014)
Co-authors Andrew Bivard, Christopher Levi, Neil Spratt, Mark Parsons
2014 Cadilhac DA, Lannin NA, Kilkenny MF, Kung F, Grabsch B, Donnan GA, et al., 'Variances in hospital mortality following stroke: experiences from the Australian Stroke Clinical Registry (AuSCR)', CEREBROVASCULAR DISEASES, 37 452-452 (2014)
Co-authors Christopher Levi
2014 Bivard A, Levi C, Krishnamurthy V, McElduff P, Miteff F, Spratt N, et al., 'Better stroke outcomes despite worse baseline stroke severity - the value of a combined clinical and advanced CT selection approach to thrombolysis.', CEREBROVASCULAR DISEASES, 37 701-701 (2014)
Co-authors Mark Parsons, Christopher Levi, Andrew Bivard, Neil Spratt
2014 Drury P, Levi C, McInnes E, Hardy J, Ward J, Grimshaw JM, et al., 'Management of fever, hyperglycemia, and swallowing dysfunction following hospital admission for acute stroke in New South Wales, Australia', INTERNATIONAL JOURNAL OF STROKE, 9 23-31 (2014) [C1]
DOI 10.1111/ijs.12194
Citations Scopus - 4Web of Science - 3
Co-authors Christopher Levi, Patrick Mcelduff, Catherine Deste
2014 Campbell BCV, Mitchell PJ, Yan B, Parsons MW, Christensen S, Churilov L, et al., 'A multicenter, randomized, controlled study to investigate EXtending the time for Thrombolysis in Emergency Neurological Deficits with Intra-Arterial therapy (EXTEND-IA)', INTERNATIONAL JOURNAL OF STROKE, 9 126-132 (2014) [C3]
DOI 10.1111/ijs.12206
Citations Scopus - 46Web of Science - 41
Co-authors Christopher Levi, Mark Parsons
2014 Chan DKY, Levi C, Cordato D, O'Rourke F, Chen J, Redmond H, et al., 'Health service management study for stroke: A randomized controlled trial to evaluate two models of stroke care', INTERNATIONAL JOURNAL OF STROKE, 9 400-405 (2014) [C1]
DOI 10.1111/ijs.12240
Citations Scopus - 3Web of Science - 2
Co-authors Christopher Levi
2014 Picanço MR, Christensen S, Campbell BCV, Churilov L, Parsons MW, Desmond PM, et al., 'Reperfusion after 4·5 hours reduces infarct growth and improves clinical outcomes', International Journal of Stroke, 9 266-269 (2014) [C1]

Background: The currently proven time window for thrombolysis in ischemic stroke is 4·5h. Beyond this, the risks and benefits of thrombolysis are uncertain. Aims: To determine wh... [more]

Background: The currently proven time window for thrombolysis in ischemic stroke is 4·5h. Beyond this, the risks and benefits of thrombolysis are uncertain. Aims: To determine whether thrombolysis and reperfusion were beneficial after 4·5h, we examined clinical and radiological outcomes in patients treated with tissue plasminogen activator or placebo within 4·5-6h, using data from the Echoplanar Imaging Thrombolytic Evaluation Trial. Methods: In the Echoplanar Imaging Thrombolytic Evaluation Trial, ischemic stroke patients presenting three to six-hours after stroke onset were randomized to tissue plasminogen activator or placebo, without knowledge of magnetic resonance imaging results. This analysis was restricted to patients treated between 4·5 and 6h. The effect of tissue plasminogen activator and reperfusion on infarct growth between baseline diffusion-weighted imaging and day 90 T2 imaging was assessed, along with good neurological outcome (=8 point reduction or reaching 0-1 at 90 days on National Institutes of Health Stroke Scale) and functional outcome (modified Rankin scale). The effect of tissue plasminogen activator on reperfusion was also analyzed. Results: Sixty-nine patients were treated 4·5-6h after onset, and infarct growth was assessed in 63. Tissue plasminogen activator was associated with lower relative growth (94% vs. 168%, P=0·03) and a trend to lower absolute growth (-0·17ml versus 9·6ml, P=0·07). Reperfusion was increased in the tissue plasminogen activator group (58% versus 25%, P=0·03) and was associated with increased rates of good neurological (86% versus 28% P < 0·001) and functional (modified Rankin scale 0-2 73% versus 34%, P=0·01) outcomes. Reperfusion was strongly associated with lower relative (80% versus 189%, P < 0·001) and absolute (-2·5ml versus 40ml, P < 0·001) infarct growth. Conclusions: Thrombolysis 4·5-6h after stroke onset reduced infarct growth and increased the rate of reperfusion, which was associated with good neurological and functional outcome. © 2013 World Stroke Organization.

DOI 10.1111/ijs.12209
Citations Scopus - 7Web of Science - 5
Co-authors Christopher Levi, Mark Parsons
2014 Sheedy R, Bernhardt J, Levi CR, Longworth M, Churilov L, Kilkenny MF, Cadilhac DA, 'Are patients with intracerebral haemorrhage disadvantaged in hospitals?', International Journal of Stroke, 9 437-442 (2014) [C1]

Background and Aims: Providing evidence-based clinical care reduces disability and mortality rates following stroke. We examined if compliance with evidence-based processes of car... [more]

Background and Aims: Providing evidence-based clinical care reduces disability and mortality rates following stroke. We examined if compliance with evidence-based processes of care were different for patients with intracerebral haemorrhage when compared with ischemic stroke and sought to describe differences in health outcomes during hospitalization and at time of discharge for these stroke subtypes. Methods: The New South Wales acute stroke dataset was used. This included data from 50-100 consecutively admitted patients' medical records collected from 32 New South Wales hospitals between 2003 and 2010. Multivariable logistic regression analyses were conducted taking into account patient factors and clustering of patients by hospital. Results: Ischemic stroke and intracerebral haemorrhage cases had similar demographic features (ischemic stroke n=3467, mean age 74 years [standard deviation 13], 50% female; intracerebral haemorrhage n=275, mean age 74 years [standard deviation 13] , 48% female). Following multivariable analyses patients with intracerebral haemorrhage were less likely to be admitted to a stroke unit (adjusted odds ratio 0·65; 95% confidence interval 0·45-0·94) or receive an assessment from allied health (adjusted odds ratio 0·54; 95% confidence interval 0·33-0·89) than patients with ischemic stroke. Patients with intracerebral haemorrhage are also less likely to be independent (adjusted odds ratio 0·36; 95% confidence interval 0·3-0·5) at time of hospital discharge and had a greater odds of dying in hospital (adjusted odds ratio 2·1; 95% confidence interval 1·3-3·5). Patients that were admitted to a stroke unit had a greater odds of being independent (modified Rankin Score 0-2) at day 7-10 irrespective of stroke type or severity on admission (adjusted odds ratio 1·3; 95% confidence interval 1·01-1·66). Conclusions: Following intracerebral haemorrhage, patients were less likely to be admitted to an acute stroke unit and receive allied health interventions. Admission to stroke units improved the likelihood of being independent at days 7-10 and, therefore, more should be done to encourage evidence-based care for intracerebral haemorrhage. © 2013 World Stroke Organization.

DOI 10.1111/ijs.12223
Citations Scopus - 2Web of Science - 3
Co-authors Christopher Levi
2014 Murtha LA, Mcleod DD, Mccann SK, Pepperall D, Chung S, Levi CR, et al., 'Short-duration hypothermia after ischemic stroke prevents delayed intracranial pressure rise', International Journal of Stroke, 9 553-559 (2014) [C1]

Background: Intracranial pressure elevation, peaking three to seven post-stroke is well recognized following large strokes. Data following small-moderate stroke are limited. Thera... [more]

Background: Intracranial pressure elevation, peaking three to seven post-stroke is well recognized following large strokes. Data following small-moderate stroke are limited. Therapeutic hypothermia improves outcome after cardiac arrest, is strongly neuroprotective in experimental stroke, and is under clinical trial in stroke. Hypothermia lowers elevated intracranial pressure; however, rebound intracranial pressure elevation and neurological deterioration may occur during rewarming. Hypotheses: (1) Intracranial pressure increases 24h after moderate and small strokes. (2) Short-duration hypothermia-rewarming, instituted before intracranial pressure elevation, prevents this 24h intracranial pressure elevation. Methods: Long-Evans rats with two hour middle cerebral artery occlusion or outbred Wistar rats with three hour middle cerebral artery occlusion had intracranial pressure measured at baseline and 24h. Wistars were randomized to 2·5h hypothermia (32·5°C) or normothermia, commencing 1h after stroke. Results: In Long-Evans rats (n=5), intracranial pressure increased from 10·9±4·6mmHg at baseline to 32·4±11·4mmHg at 24h, infarct volume was 84·3±15·9mm 3 . In normothermic Wistars (n=10), intracranial pressure increased from 6·7±2·3mmHg to 31·6±9·3mmHg, infarct volume was 31·3±18·4mm 3 . In hypothermia-treated Wistars (n=10), 24h intracranial pressure did not increase (7·0±2·8mmHg, P < 0·001 vs. normothermia), and infarct volume was smaller (15·4±11·8mm 3 , P < 0·05). Conclusions: We saw major intracranial pressure elevation 24h after stroke in two rat strains, even after small strokes. Short-duration hypothermia prevented the intracranial pressure rise, an effect sustained for at least 18h after rewarming. The findings have potentially important implications for design of future clinical trials. © 2013 The Authors. International Journal of Stroke © 2013 World Stroke Organization.

DOI 10.1111/ijs.12181
Citations Scopus - 14Web of Science - 13
Co-authors Christopher Levi, Lucy Murtha, Neil Spratt, Damian Mcleod
2014 Drury P, Levi C, D'Este C, Mcelduff P, Mcinnes E, Hardy J, et al., 'Quality in Acute Stroke Care (QASC): Process evaluation of an intervention to improve the management of fever, hyperglycemia, and swallowing dysfunction following acute stroke', International Journal of Stroke, 9 766-776 (2014) [C1]

Background: Our randomized controlled trial of a multifaceted evidence-based intervention for improving the inpatient management of fever, hyperglycemia, and swallowing dysfunctio... [more]

Background: Our randomized controlled trial of a multifaceted evidence-based intervention for improving the inpatient management of fever, hyperglycemia, and swallowing dysfunction in the first three-days following stroke improved outcomes at 90 days by 15%. We designed a quantitative process evaluation to further explain and illuminate this finding. Methods: Blinded retrospective medical record audits were undertaken for patients from 19 stroke units prior to and following the implementation of three multidisciplinary evidence-based protocols (supported by team-building workshops, and site-based education and support) for the management of fever (temperature =37·5°C), hyperglycemia (glucose > 11mmol/l), and swallowing dysfunction in intervention stroke units. Results: Data from 1804 patients (718 preintervention; 1086 postintervention) showed that significantly more patients admitted to hospitals allocated to the intervention group received care according to the fever (n=186 of 603, 31% vs. n=74 of 483, 15%, P < 0·001), hyperglycemia (n=22 of 603, 3·7% vs. n=3 of 483, 0·6%, P=0·01), and swallowing dysfunction protocols (n=241 of 603, 40% vs. n=19 of 483, 4·0%, P=0·001). Significantly more patients in these intervention stroke units received four-hourly temperature monitoring (n=222 of 603, 37% vs. n=90 of 483, 19%, P < 0·001) and six-hourly glucose monitoring (194 of 603, 32% vs. 46 of 483, 9·5%, P < 0·001) within 72 hours of admission to a stroke unit, and a swallowing screen (242 of 522, 46% vs. 24 of 350, 6·8%, P=0·0001) within the first 24 hours of admission to hospital. There was no difference between the groups in the treatment of patients with fever with paracetamol (22 of 105, 21% vs. 38 of 131, 29%, P=0·78) or their hyperglycemia with insulin (40 of 100, 40% vs. 17 of 57, 30%, P=0·49). Interpretation: Our intervention resulted in better protocol adherence in intervention stroke units, which explains our main trial findings of improved patient 90-day outcomes. Although monitoring practices significantly improved, there was no difference between the groups in the treatment of fever and hyperglycemia following acute stroke. A significant link between improved treatment practices and improved outcomes would have explained further the success of our intervention, and we are still unable to explain definitively the large improvements in death and dependency found in the main trial results. One potential explanation is that improved monitoring may have led to better overall surveillance of deteriorating patients and faster initiation of treatments not measured as part of the main trial. © 2013 World Stroke Organization.

DOI 10.1111/ijs.12202
Citations Scopus - 10Web of Science - 8
Co-authors Catherine Deste, Patrick Mcelduff, Christopher Levi
2014 Gunathilake R, Krishnamurthy V, Oldmeadow C, Kerr E, Padmakumar C, Attia J, et al., 'Relationships between age, other predictive variables, and the 90-day functional outcome after intravenous thrombolysis for acute ischemic stroke', International Journal of Stroke, 9 E36-E37 (2014) [O1]
DOI 10.1111/ijs.12347
Co-authors Christopher Levi, John Attia, Christopher Oldmeadow, Mark Parsons
2014 Golledge J, Clancy P, Maguire J, Lincz L, Koblar S, Mcevoy M, et al., 'Plasma angiopoietin-1 is lower after ischemic stroke and associated with major disability but not stroke incidence', Stroke, 45 1064-1068 (2014) [C1]

BACKGROUND AND PURPOSE - : Studies in rodent models suggest that upregulating angiopoietin-1 (Angpt1) improves stroke outcomes. The aims of this study were to assess the associati... [more]

BACKGROUND AND PURPOSE - : Studies in rodent models suggest that upregulating angiopoietin-1 (Angpt1) improves stroke outcomes. The aims of this study were to assess the association of plasma Angpt1 with stroke occurrence and outcome. METHODS - : Plasma Angpt1 was measured in 336 patients who had experienced a recent stroke and 321 healthy controls with no stroke history. Patients with stroke (n=285) were reassessed at 3 months and plasma Angpt1 concentration on admission compared between those with severe and minor disability as assessed by the modified Rankin scale. In a separate cohort of 4032 community-acquired older men prospectively followed for a minimum of 6 years, the association of plasma Angpt1 with stroke incidence was examined. RESULTS - : Median plasma Angpt1 was 3-fold lower in patients who had experienced a recent stroke (6.42, interquartile range, 4.26-9.53 compared with 17.36; interquartile range, 14.01-22.46 ng/mL; P < 0.001) and remained associated with stroke after adjustment for other risk factors. Plasma Angpt1 concentrations on admission were lower in patients who had severe disability or died at 3 months (median, 5.52; interquartile range, 3.81-8.75 ng/mL for modified Rankin scale 3-6; n=91) compared with those with minor disability (median, 7.04; interquartile range, 4.75-9.92 ng/mL for modified Rankin scale 0-2; n=194), P=0.012, and remained negatively associated with severe disability or death after adjusting for other risk factors. Plasma Angpt1 was not predictive of stroke incidence in community-dwelling older men. CONCLUSIONS - : Plasma Angpt1 concentrations are low after ischemic stroke particularly in patients with poor stroke outcomes at 3 months. Interventions effective at upregulating Angpt1 could potentially improve stroke outcomes. © 2014 American Heart Association, Inc.

DOI 10.1161/STROKEAHA.113.004339
Citations Scopus - 6Web of Science - 4
Co-authors Christopher Levi, John Attia, Lisa Lincz, Mark Mcevoy
2014 Clarey J, Lasserson D, Levi C, Parsons M, Dewey H, Barber PA, et al., 'Absolute cardiovascular risk and GP decision making in TIA and minor stroke.', Fam Pract, 31 664-669 (2014) [C1]
DOI 10.1093/fampra/cmu054
Citations Scopus - 2Web of Science - 2
Co-authors Christopher Levi, Mark Parsons, Patrick Mcelduff, Parker Magin
2014 Murtha LA, Yang Q, Parsons MW, Levi CR, Beard DJ, Spratt NJ, McLeod DD, 'Cerebrospinal fluid is drained primarily via the spinal canal and olfactory route in young and aged spontaneously hypertensive rats', Fluids and Barriers of the CNS, 11 (2014) [C1]

Background: Many aspects of CSF dynamics are poorly understood due to the difficulties involved in quantification and visualization. In particular, there is debate surrounding the... [more]

Background: Many aspects of CSF dynamics are poorly understood due to the difficulties involved in quantification and visualization. In particular, there is debate surrounding the route of CSF drainage. Our aim was to quantify CSF flow, volume, and drainage route dynamics in vivo in young and aged spontaneously hypertensive rats (SHR) using a novel contrast-enhanced computed tomography (CT) method.Methods: ICP was recorded in young (2-5 months) and aged (16 months) SHR. Contrast was administered into the lateral ventricles bilaterally and sequential CT imaging was used to visualize the entire intracranial CSF system and CSF drainage routes. A customized contrast decay software module was used to quantify CSF flow at multiple locations.Results: ICP was significantly higher in aged rats than in young rats (11.52 ± 2.36 mmHg, versus 7.04 ± 2.89 mmHg, p = 0.03). Contrast was observed throughout the entire intracranial CSF system and was seen to enter the spinal canal and cross the cribriform plate into the olfactory mucosa within 9.1 ± 6.1 and 22.2 ± 7.1 minutes, respectively. No contrast was observed adjacent to the sagittal sinus. There were no significant differences between young and aged rats in either contrast distribution times or CSF flow rates. Mean flow rates (combined young and aged) were 3.0 ± 1.5 µL/min at the cerebral aqueduct; 3.5 ± 1.4 µL/min at the 3rd ventric= and 2.8 ± 0.9 µL/min at the 4th ventricle. Intracranial CSF volumes (and as percentage total brain volume) were 204 ± 97 µL (8.8 ± 4.3%) in the young and 275 ± 35 µL (10.8 ± 1.9%) in the aged animals (NS).Conclusions: We have demonstrated a contrast-enhanced CT technique for measuring and visualising CSF dynamics in vivo. These results indicate substantial drainage of CSF via spinal and olfactory routes, but there was little evidence of drainage via sagittal sinus arachnoid granulations in either young or aged animals. The data suggests that spinal and olfactory routes are the primary routes of CSF drainage and that sagittal sinus arachnoid granulations play a minor role, even in aged rats with higher ICP. © 2014 Murtha et al.; licensee BioMed Central Ltd.

DOI 10.1186/2045-8118-11-12
Citations Scopus - 15
Co-authors Damian Mcleod, Mark Parsons, Neil Spratt, Lucy Murtha, Christopher Levi
2014 Thomas LC, Rivett DA, Parsons M, Levi C, 'Risk factors, radiological features, and infarct topography of craniocervical arterial dissection.', International Journal of Stroke, 9 1073-1082 (2014) [C1]
DOI 10.1111/j.1747-4949.2012.00912.x
Citations Scopus - 3Web of Science - 3
Co-authors Darren Rivett, Lucy Thomas, Christopher Levi, Mark Parsons
2013 Parsons O, Traylor M, Linxin L, Bevan S, Sudlow C, Rothwell PM, et al., 'Impact of stroke classification systems on strength of genetic associations with ischaemic stroke', CEREBROVASCULAR DISEASES, 35 75-75 (2013)
Co-authors Christopher Levi
2013 Levi C, 'Consultant's comment', Medicine Today, 14 22 (2013) [C3]
Co-authors Christopher Levi
2013 Eissa A, Krass I, Levi C, Sturm J, Ibrahim R, Bajorek B, 'Understanding the reasons behind the low utilisation of thrombolysis in stroke', Australasian Medical Journal, 6 152-163 (2013)

Background Thrombolysis remains the only approved therapy for acute ischaemic stroke (AIS); however, its utilisation is reported to be low. Aims This study aimed to determine the ... [more]

Background Thrombolysis remains the only approved therapy for acute ischaemic stroke (AIS); however, its utilisation is reported to be low. Aims This study aimed to determine the reasons for the low utilisation of thrombolysis in clinical practice. Method Five metropolitan hospitals comprising two tertiary referral centres and three district hospitals conducted a retrospective, cross-sectional study. Researchers identified patients discharged with a principal diagnosis of AIS over a 12-month time period (July 2009-July 2010), and reviewed the medical record of systematically chosen samples. Results The research team reviewed a total of 521 records (48.8% females, mean age 74.4 ±14 years, age range 5-102 years) from the 1261 AIS patients. Sixty-nine per cent of AIS patients failed to meet eligibility criteria to receive thrombolysis because individuals arrived at the hospital later than 4.5 hours after the onset of symptoms. The factors found to be positively associated with late arrival included confusion at onset, absence of a witness at onset and waiting for improvement of symptoms. However, factors negatively associated with late arrival encompassed facial droop, slurred speech and immediately calling an ambulance. Only 14.7% of the patients arriving within 4.5 hours received thrombolysis. The main reasons for exclusion included such factors as rapidly improving symptoms (28.2%), minor symptoms (17.2%), patient receiving therapeutic anticoagulation (6.7%) and severe stroke (5.5%). Conclusion A late patient presentation represents the most significant barrier to utilising thrombolysis in the acute stroke setting. Thrombolysis continues to be currently underutilised in potentially eligible patients, and additional research is needed to identify more precise criteria for selecting patients for thrombolysis.

DOI 10.4066/AMJ.2013.1607
Citations Scopus - 8
Co-authors Christopher Levi
2013 Levi CR, 'Where do the NOACS fit in contemporary stroke prevention?', INTERNATIONAL JOURNAL OF STROKE, 8 10-10 (2013)
Co-authors Christopher Levi
2013 Thomas LC, Rivett DA, Bateman G, Stanwell P, Levi CR, 'Effect of Selected Manual Therapy Interventions for Mechanical Neck Pain on Vertebral and Internal Carotid Arterial Blood Flow and Cerebral Inflow', PHYSICAL THERAPY, 93 1563-1574 (2013) [C1]
DOI 10.2522/ptj.20120477
Citations Scopus - 9Web of Science - 8
Co-authors Lucy Thomas, Peter Stanwell, Christopher Levi, Darren Rivett
2013 Bivard A, Levi C, Spratt N, Parsons M, 'Perfusion CT in Acute Stroke: A Comprehensive Analysis of Infarct and Penumbra', RADIOLOGY, 267 543-550 (2013) [C1]
DOI 10.1148/radiol.12120971
Citations Scopus - 73Web of Science - 72
Co-authors Neil Spratt, Andrew Bivard, Christopher Levi, Mark Parsons
2013 Cadilhac DA, Purvis T, Kilkenny MF, Longworth M, Mohr K, Pollack M, Levi CR, 'Evaluation of Rural Stroke Services Does Implementation of Coordinators and Pathways Improve Care in Rural Hospitals?', STROKE, 44 2848-2853 (2013) [C1]
DOI 10.1161/STROKEAHA.113.001258
Citations Scopus - 15Web of Science - 15
Co-authors Christopher Levi
2013 Magin P, Victoire A, Zhen XM, Furler J, Pirotta M, Lasserson DS, et al., 'Under-Reporting of Socioeconomic Status of Patients in Stroke Trials Adherence to Consort Principles', STROKE, 44 2920-2922 (2013) [C1]
DOI 10.1161/STROKEAHA.113.002414
Citations Scopus - 5Web of Science - 4
Co-authors Parker Magin, Christopher Levi
2013 Kilkenny MF, Longworth M, Pollack M, Levi C, Cadilhac DA, 'Factors Associated With 28-Day Hospital Readmission After Stroke in Australia', STROKE, 44 2260-2268 (2013) [C1]
DOI 10.1161/STROKEAHA.111.000531
Citations Scopus - 15Web of Science - 15
Co-authors Christopher Levi
2013 Yassi N, Parsons MW, Christensen S, Sharma G, Bivard A, Donnan GA, et al., 'Prediction of Poststroke Hemorrhagic Transformation Using Computed Tomography Perfusion', Stroke, 44 3039-3043 (2013) [C1]
DOI 10.1161/STROKEAHA.113.002396
Citations Scopus - 14Web of Science - 12
Co-authors Christopher Levi, Mark Parsons, Andrew Bivard
2013 Adib-Samii P, Rost N, Traylor M, Devan W, Biffi A, Lanfranconi S, et al., '17q25 Locus is associated with white matter hyperintensity volume in ischemic stroke, but not with lacunar stroke status', Stroke, 44 1609-1615 (2013) [C1]
Citations Scopus - 23Web of Science - 22
Co-authors Christopher Levi, Liz Holliday
2013 Campbell BCV, Christensen S, Tress BM, Churilov L, Desmond PM, Parsons MW, et al., 'Failure of collateral blood flow is associated with infarct growth in ischemic stroke', JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM, 33 1168-1172 (2013) [C1]
DOI 10.1038/jcbfm.2013.77
Citations Scopus - 65Web of Science - 60
Co-authors Christopher Levi, Mark Parsons
2013 Menon BK, O'Brien B, Bivard A, Spratt NJ, Demchuk AM, Miteff F, et al., 'Assessment of leptomeningeal collaterals using dynamic CT angiography in patients with acute ischemic stroke', Journal of Cerebral Blood Flow and Metabolism, 33 365-371 (2013) [C1]
Citations Scopus - 67Web of Science - 60
Co-authors Andrew Bivard, Neil Spratt, Mark Parsons, Christopher Levi
2013 Campbell BCV, Christensen S, Parsons MW, Churilov L, Desmond PM, Barber PA, et al., 'Advanced imaging improves prediction of hemorrhage after stroke thrombolysis', ANNALS OF NEUROLOGY, 73 510-519 (2013) [C1]
DOI 10.1002/ana.23837
Citations Scopus - 33Web of Science - 29
Co-authors Mark Parsons, Christopher Levi
2013 Williams FMK, Carter AM, Hysi PG, Surdulescu G, Hodgkiss D, Soranzo N, et al., 'Ischemic stroke is associated with the ABO locus: The EuroCLOT Study', Annals of Neurology, 73 16-31 (2013) [C1]
Citations Scopus - 49Web of Science - 45
Co-authors Rodney Scott, Christopher Levi, John Attia, Liz Holliday
2013 Lannin NA, Anderson C, Lim J, Paice K, Price C, Faux S, et al., 'Telephone follow-up was more expensive but more efficient than postal in a national stroke registry', JOURNAL OF CLINICAL EPIDEMIOLOGY, 66 896-902 (2013) [C1]
DOI 10.1016/j.jclinepi.2013.03.005
Citations Scopus - 7Web of Science - 6
Co-authors Christopher Levi
2013 Williams JM, Navin TJ, Jude MR, Levi CR, 'Recombinant tissue plasminogen activator (rt-PA) utilisation by rural clinicians in acute ischaemic stroke: An audit of current practice and clinical outcomes', AUSTRALIAN JOURNAL OF RURAL HEALTH, 21 203-207 (2013) [C1]
DOI 10.1111/ajr.12038
Citations Scopus - 2Web of Science - 2
Co-authors Christopher Levi
2013 Williams JM, Jude MR, Levi CR, 'Recombinant tissue plasminogen activator (rt-PA) utilisation by rural clinicians in acute ischaemic stroke: A survey of barriers and enablers', Australian Journal of Rural Health, 21 262-267 (2013) [C1]

Objective: This paper identified barriers which prevent rural health care providers from utilising rt-PA in acute ischaemic stroke and proposes possible support mechanisms to incr... [more]

Objective: This paper identified barriers which prevent rural health care providers from utilising rt-PA in acute ischaemic stroke and proposes possible support mechanisms to increase its utilisation. Methods: This descriptive study uses data from anonymous surveys distributed to health care providers involved in acute stroke patient care in three rural hospitals with rt-PA pathways. Saturation sampling was used. Surveys gathered self assessed ratings of experience, practice environment, attitudes, existing support, barriers and possible enablers regarding rt-PA use in acute stroke. Results: Physicians reported the strongest barriers to the use of rt-PA in acute stroke as pre-hospital delays (91%), risk of intracerebral haemorrhage (ICH) (73%) and clinical diagnostic uncertainty (60%). They reported high levels of confidence in the support received from their stroke units (90%). Nurses identified a poor level of stroke education and knowledge on rt-PA utilisation in acute stroke. A third of nurses could correctly list six different stroke signs. The risk of ICH following rt-PA administration in stroke was also a significant barrier for nurses. Response rate from physicians was 26% (10/38) and 19% (13/69) for nurses. Conclusions: To reduce barriers to rt-PA utilisation in rural facilities physicians require education on the calculated risk of ICH as well as exposure and experience to improve their ability to confidently diagnose stroke patients who are eligible for rt-PA treatment. Education for nurses on symptoms of stroke and rt-PA utilisation and administration is recommended. © National Rural Health Alliance Inc.

DOI 10.1111/ajr.12052
Citations Scopus - 5Web of Science - 6
Co-authors Christopher Levi
2013 Bivard A, Stanwell PT, Levi CR, Parsons MW, 'Arterial spin labeling identifies tissue salvage and good clinical recovery after acute ischemic stroke', Journal of Neuroimaging, 23 391-396 (2013) [C1]
Citations Scopus - 16Web of Science - 17
Co-authors Peter Stanwell, Christopher Levi, Andrew Bivard, Mark Parsons
2013 Anderson C, Sharma V, Huang Y, Lavados P, Lindley R, Pandian J, et al., 'The Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED): First Year Experience Regarding Possible Selection Bias', CEREBROVASCULAR DISEASES, 36 20-20 (2013)
Co-authors Christopher Levi, Mark Parsons
2013 Carey LM, Seitz RJ, Parsons M, Levi C, Farquharson S, Tournier JD, et al., 'Beyond the lesion: Neuroimaging foundations for post-stroke recovery', Future Neurology, 8 507-527 (2013)

A shift is emerging in the way in which we view post-stroke recovery. This shift, supported by evidence from neuroimaging studies, encourages us to look beyond the lesion and to i... [more]

A shift is emerging in the way in which we view post-stroke recovery. This shift, supported by evidence from neuroimaging studies, encourages us to look beyond the lesion and to identify viable brain networks with capacity for plasticity. In this article, the authors review current advances in neuroimaging techniques and the new insights that they have contributed. The ability to quantify salvageable tissue, evidence of changes in remote networks, changes of functional and structural connectivity, and alterations in cortical thickness are reviewed in the context of their impact on post-stroke recovery. The value of monitoring spared structural connections and functional connectivity of brain networks within and across hemispheres is highlighted. © 2013 Future Medicine Ltd.

DOI 10.2217/fnl.13.39
Citations Scopus - 9
Co-authors Mark Parsons, Christopher Levi
2013 Marsden DL, Dunn A, Callister R, Levi CR, Spratt NJ, 'Characteristics of Exercise Training Interventions to Improve Cardiorespiratory Fitness After Stroke: A Systematic Review With Meta-analysis', NEUROREHABILITATION AND NEURAL REPAIR, 27 775-788 (2013) [C1]
DOI 10.1177/1545968313496329
Citations Scopus - 26Web of Science - 23
Co-authors Neil Spratt, Robin Callister, Christopher Levi
2013 Jolly TAD, Bateman GA, Levi CR, Parsons MW, Michie PT, Karayanidis F, 'Early detection of microstructural white matter changes associated with arterial pulsatility', FRONTIERS IN HUMAN NEUROSCIENCE, 7 (2013) [C1]
DOI 10.3389/fnhum.2013.00782
Citations Scopus - 12Web of Science - 12
Co-authors Christopher Levi, Mark Parsons, Frini Karayanidis, Pat Michie
2013 Bladin C, Levi C, Parsons M, 'Stroke thrombolysis: Leaving the past, understanding the present and moving forward ...', EMERGENCY MEDICINE AUSTRALASIA, 25 195-196 (2013) [C3]
DOI 10.1111/1742-6723.12025
Citations Scopus - 3Web of Science - 3
Co-authors Mark Parsons, Christopher Levi
2013 Zareie H, Quain DA, Parsons M, Inder KJ, McElduff P, Miteff F, et al., 'The influence of anterior cerebral artery flow diversion measured by transcranial Doppler on acute infarct volume and clinical outcome in anterior circulation stroke', INTERNATIONAL JOURNAL OF STROKE, 8 228-234 (2013) [C1]
DOI 10.1111/j.1747-4949.2012.00801.x
Citations Scopus - 4Web of Science - 4
Co-authors Christopher Levi, Patrick Mcelduff, Neil Spratt, Mark Parsons, Kerry Inder
2013 Chan DKY, Cordato D, O'Rourke F, Chan DL, Pollack M, Middleton S, Levi C, 'Comprehensive stroke units: a review of comparative evidence and experience', INTERNATIONAL JOURNAL OF STROKE, 8 260-264 (2013) [C1]
DOI 10.1111/j.1747-4949.2012.00850.x
Citations Scopus - 15Web of Science - 11
Co-authors Christopher Levi
2013 Churilov L, Liu D, Ma H, Christensen S, Nagakane Y, Campbell B, et al., 'Multiattribute selection of acute stroke imaging software platform for Extending the Time for Thrombolysis in Emergency Neurological Deficits (EXTEND) clinical trial', International Journal of Stroke, 8 204-210 (2013) [C1]
DOI 10.1111/j.1747-4949.2012.00787.x
Citations Scopus - 6Web of Science - 6
Co-authors Mark Parsons, Christopher Levi
2013 Magin P, Lasserson D, Parsons M, Spratt N, Evans M, Russell M, et al., 'Referral and triage of patients with transient ischemic attacks to an acute access clinic: Risk stratification in an Australian setting', International Journal of Stroke, 8 81-89 (2013) [C1]

Background: Transient ischemic attacks and minor stroke entail considerable risk of completed stroke but this risk is reduced by prompt assessment and treatment. Risk can be strat... [more]

Background: Transient ischemic attacks and minor stroke entail considerable risk of completed stroke but this risk is reduced by prompt assessment and treatment. Risk can be stratified according to the ABCD2 prediction score. Current guidelines suggest specialist assessment and treatment within 24h for high-risk event (ABCD2 score 4-7) and seven-days for low-risk event (ABCD2 score =3) . Aims: The study aims to establish paths to care and outcomes for patients referred by general practitioners and emergency departments to an Australian acute access transient ischemic attack service. Methods: This is a prospective audit. Primary outcomes were time from event to referral, from referral to clinic appointment, and from event to appointment. ABCD2 score was calculated for each event. Time from event was modeled using Cox proportional hazards regression. Results: There were 231 clinic attendees (general practitioner: 127; emergency department: 104). Mean time from event to referral was 9·2 days (SD 23·7, median 2), from referral to being seen in the clinic was 13·6 days (SD 19·0, median 7), and from event to being seen in the clinic was 17·2 days (SD 27·1, median 10). Of low-risk patients, 38·5% were seen within seven-days of event. Of high-risk patients, 36·7% were seen within one-day. ABCD2 score was not a significant predictor of any time interval from event to clinic attendance. There were no completed strokes prior to clinic attendance. Conclusions: Times from event to clinic assessment were in excess of current recommendations and risk stratification was suboptimal, though short-term outcomes were good. Improvements in referral mechanisms may enhance risk-stratification and triage. © 2013 World Stroke Organization.

DOI 10.1111/ijs.12014
Citations Scopus - 3Web of Science - 3
Co-authors Patrick Mcelduff, Parker Magin, Christopher Levi, Mark Parsons, Neil Spratt
2013 McLeod DD, Beard DJ, Parsons MW, Levi CR, Calford MB, Spratt NJ, 'Inadvertent Occlusion of the Anterior Choroidal Artery Explains Infarct Variability in the Middle Cerebral Artery Thread Occlusion Stroke Model', PLOS ONE, 8 (2013) [C1]
DOI 10.1371/journal.pone.0075779
Citations Scopus - 7Web of Science - 8
Co-authors Damian Mcleod, Mark Parsons, Christopher Levi, Neil Spratt
2013 Hankey GJ, Levi CR, 'Standard strategies for acute ischemic stroke within the rtPA therapeutic window: Australia', Neurology: Clinical Practice, 3 215-216 (2013) [C3]
DOI 10.1212/CPJ.0b013e318296f2cf
Co-authors Christopher Levi
2012 Campbell BCV, Tu HTH, Christensen S, Desmond PM, Levi CR, Bladin CF, et al., 'Assessing response to stroke thrombolysis validation of 24-Hour multimodal magnetic resonance imaging', Archives of Neurology, 69 46-50 (2012) [C1]
Citations Scopus - 28Web of Science - 29
Co-authors Christopher Levi, Mark Parsons
2012 Parsons M, Levi C, Davis S, 'The authors reply', New England Journal of Medicine, 367 276 (2012) [C3]
DOI 10.1056/NEJMc1205829
Co-authors Mark Parsons, Christopher Levi
2012 Parsons MW, Spratt NJ, Bivard A, Campbell B, Chung K, Miteff F, et al., 'A randomized trial of tenecteplase versus alteplase for acute ischemic stroke', New England Journal of Medicine, 366 1099-1107 (2012) [C1]
DOI 10.1056/NEJMoa1109842
Citations Scopus - 214Web of Science - 198
Co-authors Christopher Levi, Patrick Mcelduff, Mark Parsons, Neil Spratt, Andrew Bivard
2012 Parsons MW, Levi CR, Davis S, 'Tenecteplase versus alteplase for acute ischemic stroke: The authors reply', New England Journal of Medicine, 367 275-276 (2012) [C1]
Co-authors Christopher Levi, Mark Parsons
2012 Cheng YC, Anderson CD, Bione S, Keene K, Maguire JM, Nalls M, et al., 'Are myocardial infarction-associated single-nucleotide polymorphisms associated with ischemic stroke?', Stroke, 43 980-U143 (2012) [C1]
Citations Scopus - 16Web of Science - 17
Co-authors Pablo Moscato, Christopher Levi, Liz Holliday, Rodney Scott, John Attia, Lisa Lincz
2012 Campbell BCV, Christensen S, Levi CR, Desmond PM, Donnan GA, Davis SM, Parsons MW, 'Comparison of computed tomography perfusion and magnetic resonance imaging perfusion-diffusion mismatch in ischemic stroke', Stroke, 43 2648-2653 (2012) [C1]
Citations Scopus - 61Web of Science - 58
Co-authors Christopher Levi, Mark Parsons
2012 Nagakane Y, Christensen S, Ogata T, Churilov L, Ma H, Parsons MW, et al., 'Moving beyond a single perfusion threshold to define penumbra: A novel probabilistic mismatch definition', Stroke, 43 1548-1555 (2012) [C1]
Citations Scopus - 18Web of Science - 20
Co-authors Christopher Levi, Mark Parsons
2012 Middleton S, D'Este C, Grimshaw J, Ward JE, Levi C, 'Team-building intervention to improve acute stroke care Reply', LANCET, 379 1390-1390 (2012) [C3]
Co-authors Christopher Levi, Catherine Deste
2012 Middleton S, D'Este CA, Grimshaw J, Ward JE, Levi CR, 'Reply: Team-building intervention to improve acute stroke care', Lancet, 379 1390 (2012) [C3]
Co-authors Christopher Levi, Catherine Deste
2012 Middleton S, Levi CR, Ward J, 'QASC trial: Swallow surveillance rates comparable with international data', Lancet, 379 1389 (2012) [C3]
Co-authors Christopher Levi
2012 Parsons MW, Levi CR, 'Reperfusion trials for acute ischaemic stroke', The Lancet, 380 706-708 (2012) [C3]
Citations Scopus - 1Web of Science - 1
Co-authors Mark Parsons, Christopher Levi
2012 Gardner AJ, Kay-Lambkin FJ, Stanwell PT, Donnelly J, Williams WH, Hiles A, et al., 'A systematic review of diffusion tensor imaging findings in sports-related concussion', Journal of Neurotrauma, 29 2521-2538 (2012) [C1]
Citations Scopus - 60Web of Science - 52
Co-authors Andrew Gardner, Frances Kaylambkin, Christopher Levi, Peter Schofield, Peter Stanwell
2012 Bellenguez C, Bevan S, Gschwendtner A, Spencer CCA, Burgess AI, Pirinen M, et al., 'Genome-wide association study identifies a variant in HDAC9 associated with large vessel ischemic stroke', Nature Genetics, 44 328-333 (2012) [C1]
DOI 10.1038/ng.1081
Citations Scopus - 207Web of Science - 171
Co-authors Christopher Levi, John Attia, Liz Holliday
2012 Holliday EG, Maguire JM, Evans T-J, Koblar SA, Jannes J, Sturm J, et al., 'Common variants at 6p21.1 are associated with large artery atherosclerotic stroke', Nature Genetics, 44 1147-1153 (2012) [C1]
Citations Scopus - 86Web of Science - 78
Co-authors Lisa Lincz, Wayne Smith, John Attia, Mark Parsons, Roseanne Peel, Pablo Moscato, Rodney Scott, Liz Holliday, Mark Mcevoy, Christopher Oldmeadow, Christopher Levi
2012 O'Brien B, Lindley R, Levi CR, 'Stroke in the elderly: Predictable, preventable and treatable', Medicine Today, 13 20-24 (2012) [C3]
Co-authors Christopher Levi
2012 Thomas L, Rivett DA, Attia JR, Levi CR, 'Risk factors and clinical presentation of craniocervical arterial dissection: A prospective study', BMC Musculoskeletal Disorders, 13 1-6 (2012) [C3]
Co-authors Darren Rivett, Christopher Levi, John Attia, Lucy Thomas
2012 Traylor M, Farrall M, Holliday EG, Sudlow C, Hopewell JC, Cheng Y-C, et al., 'Genetic risk factors for ischaemic stroke and its subtypes (the METASTROKE Collaboration): A meta-analysis of genome-wide association studies', The Lancet Neurology, 11 951-962 (2012) [C1]
Citations Scopus - 198Web of Science - 192
Co-authors Christopher Levi, Liz Holliday
2012 Davis S, Campbell B, Christensen S, Ma H, Desmond P, Parsons MW, et al., 'Perfusion/diffusion mismatch is valid and should be used for selecting delayed interventions', Translational Stroke Research, 3 188-197 (2012) [C1]
Citations Scopus - 8Web of Science - 6
Co-authors Christopher Levi, Mark Parsons
2012 Levi CR, Zareie H, Parsons MW, 'Transcranial Doppler in acute stroke management - A 'real-time' bed-side guide to reperfusion and collateral flow', Perspectives in Medicine, 1 185-193 (2012) [C1]
Co-authors Christopher Levi, Mark Parsons
2012 Middleton S, McElduff P, Ward J, Grimshaw JM, Dale S, D'Este C, et al., 'Implementation of evidence-based treatment protocols to manage fever, hyperglycaemia, and swallowing dysfunction in acute stroke (QASC): A cluster randomised controlled trial', Dysphagia, 27 441 (2012)
DOI 10.1007/s00455-012-9400-6
Co-authors Catherine Deste, Patrick Mcelduff, Christopher Levi
2012 Alexandrov AV, Sloan MA, Tegeler CH, Newell DN, Lumsden A, Garami Z, et al., 'Practice Standards for Transcranial Doppler (TCD) Ultrasound. Part II. clinical indications and expected outcomes', Journal of Neuroimaging, 22 215-224 (2012)

Introduction: Transcranial Doppler (TCD) is a physiological ultrasound test with established safety and efficacy. Although imaging devices may be used to depict intracranial flow ... [more]

Introduction: Transcranial Doppler (TCD) is a physiological ultrasound test with established safety and efficacy. Although imaging devices may be used to depict intracranial flow superimposed on structural visualization, the end-result provided by imaging duplex or nonimaging TCD is sampling physiological flow variables through the spectral waveform assessment. Summary of Results: Clinical indications considered by this multidisciplinary panel of experts as established are: sickle cell disease, cerebral ischemia, detection of right-to-left shunts (RLS), subarachnoid hemorrhage, brain death, and periprocedural or surgical monitoring. The following TCD-procedures are performed in routine in- and outpatient clinical practice: complete or partial TCD-examination to detect normal, stenosed, or occluded intracranial vessels, collaterals to locate an arterial obstruction and refine carotid-duplex or noninvasive angiographic findings; vasomotor reactivity testing to identify high-risk patients for first-ever or recurrent stroke; emboli detection to detect, localize, and quantify cerebral embolization in real time; RLS-detection in patients with suspected paradoxical embolism or those considered for shunt closure; monitoring of thrombolysis to facilitate recanalization and detect reocclusion; monitoring of endovascular stenting, carotid endarterectomy, and cardiac surgery to detect perioperative embolism, thrombosis, hypo- and hyperperfusion. Conclusion: By defining the scope of practice, these standards will assist referring and reporting physicians and third parties involved in the process of requesting, evaluating, and acting upon TCD results. © 2010 by the American Society of Neuroimaging.

DOI 10.1111/j.1552-6569.2010.00523.x
Citations Scopus - 69
Co-authors Christopher Levi
2011 Bivard A, Spratt NJ, Levi CR, Parsons MW, 'Acute stroke thrombolysis: Time to dispense with the clock and move to tissue-based decision making?', Expert Review of Cardiovascular Therapy, 9 451-461 (2011) [C1]
Citations Scopus - 9
Co-authors Andrew Bivard, Mark Parsons, Christopher Levi, Neil Spratt
2011 McLeod DD, Parsons MW, Levi CR, Beautement S, Buxton D, Roworth B, Spratt NJ, 'Establishing a rodent stroke perfusion computed tomography model', International Journal of Stroke, 6 284-289 (2011) [C1]
DOI 10.1111/j.1747-4949.2010.00564.x
Citations Scopus - 14Web of Science - 14
Co-authors Christopher Levi, Neil Spratt, Mark Parsons, Damian Mcleod
2011 Bivard A, Spratt NJ, Levi CR, Parsons MW, 'Perfusion computer tomography: Imaging and clinical validation in acute ischaemic stroke', Brain, 134 3408-3416 (2011) [C1]
Citations Scopus - 64Web of Science - 64
Co-authors Neil Spratt, Andrew Bivard, Christopher Levi, Mark Parsons
2011 Hunter AJ, Snodgrass SN, Quain D, Parsons MW, Levi CR, 'HOBOE (head-of-bed optimization of elevation) study: Association of higher angle with reduced cerebral blood flow velocity in acute ischemic stroke', Physical Therapy, 91 1503-1512 (2011) [C1]
DOI 10.2522/ptj.20100271
Citations Scopus - 14Web of Science - 12
Co-authors Christopher Levi, Suzanne Snodgrass, Mark Parsons
2011 Nagakane Y, Christensen S, Brekenfeld C, Ma H, Churilov L, Parsons MW, et al., 'EPITHET positive result after reanalysis using baseline diffusion-weighted imaging/perfusion-weighted imaging co-registration', Stroke, 42 59-64 (2011) [C1]
DOI 10.1161/strokeaha.110.580464
Citations Scopus - 63Web of Science - 57
Co-authors Mark Parsons, Christopher Levi
2011 Campbell BCV, Christensen S, Levi CR, Desmond PM, Donnan GA, Davis SM, Parsons MW, 'Cerebral blood flow is the optimal CT perfusion parameter for assessing infarct core', Stroke, 42 3435-3440 (2011) [C1]
DOI 10.1161/strokeaha.111.618355
Citations Scopus - 118Web of Science - 105
Co-authors Mark Parsons, Christopher Levi
2011 Middleton S, McElduff P, Ward J, Grimshaw JM, Dale S, D'Este CA, et al., 'Implementation of evidence-based treatment protocols to manage fever, hyperglycaemia, and swallowing dysfunction in acute stroke (QASC): A cluster randomised controlled trial', The Lancet, 378 1699-1706 (2011) [C1]
DOI 10.1016/s0140-6736(11)61485-2
Citations Scopus - 117Web of Science - 109
Co-authors Catherine Deste, Christopher Levi, Patrick Mcelduff
2011 Parsons MW, Bivard A, McElduff P, Spratt NJ, Levi CR, 'Defining the extent of irreversible brain ischemia using perfusion computed tomography', Cerebrovascular Diseases, 31 238-245 (2011) [C1]
DOI 10.1159/000321897
Citations Scopus - 64Web of Science - 56
Co-authors Patrick Mcelduff, Christopher Levi, Neil Spratt, Andrew Bivard, Mark Parsons
2011 Campbell BCV, Costello C, Christensen S, Ebinger M, Parsons MW, Desmond PM, et al., 'Fluid-attenuated inversion recovery hyperintensity in acute ischemic stroke may not predict hemorrhagic transformation', Cerebrovascular Diseases, 32 401-405 (2011) [C1]
Citations Scopus - 14Web of Science - 13
Co-authors Christopher Levi, Mark Parsons
2011 Alvarez SD, Levi CR, 'Transient ischaemic attack and stroke prevention', Australian Doctor, 19-24 (2011) [C2]
Co-authors Christopher Levi
2011 Maguire JM, Thakkinstian A, Levi CR, Lincz L, Bisset L, Sturm J, et al., 'Impact of COX-2 rs5275 and rs20417 and GPIIIa rs5918 polymorphisms on 90-day ischemic stroke functional outcome: A novel finding', Journal of Stroke and Cerebrovascular Diseases, 20 134-144 (2011) [C1]
DOI 10.1016/j.jstrokecerebrovasdis.2009.10.011
Citations Scopus - 31Web of Science - 31
Co-authors John Attia, Christopher Levi, Rodney Scott, Lisa Lincz
2011 Thomas L, Rivett DA, Attia JR, Parsons MW, Levi CR, 'Risk factors and clinical features of craniocervical arterial dissection', Manual Therapy, 16 351-356 (2011) [C1]
DOI 10.1016/j.math.2010.12.008
Citations Scopus - 31Web of Science - 30
Co-authors Darren Rivett, Lucy Thomas, Mark Parsons, Christopher Levi, John Attia
2011 Cadilhac DA, Kilkenny MF, Longworth M, Pollack MRP, Levi CR, 'Metropolitan-rural divide for stroke outcomes: Do stroke units make a difference?', Internal Medicine Journal, 41 321-326 (2011) [C1]
DOI 10.1111/j.1445-5994.2010.02280.x
Citations Scopus - 15Web of Science - 13
Co-authors Christopher Levi
2011 Middleton S, Levi CR, Ward J, Grimshaw J, Griffiths R, D'Este CA, et al., 'Death, dependency and health status 90 days following hospital admission for acute stroke in NSW', Internal Medicine Journal, 41 736-743 (2011) [C1]
DOI 10.1111/j.1445-5994.2010.02330.x
Citations Scopus - 4Web of Science - 3
Co-authors Christopher Levi, Catherine Deste, Patrick Mcelduff
2010 Lees KR, Bluhmki E, Von Kummer R, Brott TG, Toni D, Grotta JC, et al., 'Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials', The Lancet, 375 1695-1703 (2010) [C1]
DOI 10.1016/S0140-6736(10)60491-6
Citations Scopus - 1081Web of Science - 961
Co-authors John Attia, Mark Parsons, Christopher Levi
2010 Cadilhac DA, Lannin NA, Anderson CS, Levi CR, Faux S, Price C, et al., 'Protocol and pilot data for establishing the Australian Stroke Clinical Registry', International Journal of Stroke, 5 217-226 (2010) [C1]
DOI 10.1111/j.1747-4949.2010.00430.x
Citations Scopus - 27Web of Science - 26
Co-authors Christopher Levi
2010 Garnett AR, Marsden DL, Parsons MW, Quain DA, Spratt NJ, Loudfoot AR, et al., 'The rural Prehospital Acute Stroke Triage (PAST) trial protocol: A controlled trial for rapid facilitated transport of rural acute stroke patients to a regional stroke centre', International Journal of Stroke, 5 506-513 (2010) [C1]
DOI 10.1111/j.1747-4949.2010.00522.x
Citations Scopus - 12Web of Science - 10
Co-authors Mark Parsons, Neil Spratt, Christopher Levi
2010 Simpson MA, Dewey HM, Churilov L, Ahmed N, Bladin CF, Schultz D, et al., 'Thrombolysis for acute stroke in Australia: Outcomes from the Safe Implementation of Thrombolysis in Stroke registry (2002-2008)', Medical Journal of Australia, 193 439-443 (2010) [C1]
Citations Scopus - 20Web of Science - 18
Co-authors Mark Parsons, Christopher Levi
2010 Chemmanam T, Campbell BCV, Christensen S, Nagakane Y, Desmond PM, Bladin CF, et al., 'Ischemic diffusion lesion reversal is uncommon and rarely alters perfusion-diffusion mismatch', Neurology, 75 1040-1047 (2010) [C1]
DOI 10.1212/WNL.0b013e3181f39ab6
Citations Scopus - 67Web of Science - 62
Co-authors Christopher Levi, Mark Parsons
2010 Lemmens R, Buysschaert I, Geelen V, Fernandez-Cadenas I, Montaner J, Schmidt H, et al., 'The Association of the 4q25 susceptibility variant for atrial fibrillation with stroke is limited to stroke of cardioembolic etiology', Stroke, 41 1850-1857 (2010) [C1]
DOI 10.1161/STROKEAHA.110.587980
Citations Scopus - 41Web of Science - 44
Co-authors Christopher Levi, John Attia
2010 Campbell BCV, Christensen S, Butcher KS, Gordon I, Parsons MW, Desmond PM, et al., 'Regional very low cerebral blood volume predicts hemorrhagic transformation better than diffusion-weighted imaging volume and thresholded apparent diffusion coefficient in acute ischemic stroke', Stroke, 41 82-88 (2010) [C1]
DOI 10.1161/STROKEAHA.109.562116
Citations Scopus - 68Web of Science - 60
Co-authors Mark Parsons, Christopher Levi
2010 Butcher K, Christensen S, Parsons MW, De Silva DA, Ebinger M, Levi CR, et al., 'Postthrombolysis blood pressure elevation is associated with hemorrhagic transformation', Stroke, 41 72-77 (2010) [C1]
DOI 10.1161/STROKEAHA.109.563767
Citations Scopus - 47Web of Science - 40
Co-authors Mark Parsons, Christopher Levi
2010 De Silva DA, Brekenfeld C, Ebinger M, Christensen S, Barber PA, Butcher KS, et al., 'The benefits of intravenous thrombolysis relate to the site of baseline arterial occlusion in the echoplanar imaging thrombolytic evaluation trial (EPITHET)', Stroke, 41 295-299 (2010) [C1]
DOI 10.1161/STROKEAHA.109.562827
Citations Scopus - 63Web of Science - 58
Co-authors Mark Parsons, Christopher Levi
2010 Dewey HM, Churilov L, Blacker D, Bladin C, Davis SM, Donnan GA, et al., 'Response to 'A graphic reanalysis of the NINDS Trial'', Annals of Emergency Medicine, 55 227-229 (2010) [C3]
DOI 10.1016/j.annemergmed.2009.09.026
Citations Scopus - 4Web of Science - 3
Co-authors Christopher Levi
2010 Parsons MW, Christensen S, McElduff P, Levi CR, Butcher KS, De Silva DA, et al., 'Pretreatment diffusion- and perfusion-MR lesion volumes have a crucial influence on clinical response to stroke thrombolysis', Journal of Cerebral Blood Flow and Metabolism, 30 1214-1225 (2010) [C1]
DOI 10.1038/jcbfm.2010.3
Citations Scopus - 114Web of Science - 105
Co-authors Mark Parsons, Patrick Mcelduff, Christopher Levi
2010 The VITATOPS Trial Study Group, 'B vitamins in patients with recent transient ischaemic attack or stroke in the VITAmins TO Prevent Stroke (VITATOPS) trial: a randomised, double-blind, parallel, placebo-controlled trial', Lancet Neurology, 9 855-865 (2010)
DOI 10.1016/S1474-4422(10)70187-3
Citations Scopus - 165Web of Science - 118
Co-authors Christopher Levi, Neil Spratt, Mark Parsons
2010 Campbell BCV, Christensen S, Foster SJ, Desmond PM, Parsons MW, Butcher KS, et al., 'Visual assessment of perfusion-diffusion mismatch is inadequate to select patients for thrombolysis', Cerebrovascular Diseases, 29 592-596 (2010) [C1]
DOI 10.1159/000311080
Citations Scopus - 39Web of Science - 39
Co-authors Christopher Levi, Mark Parsons
2010 Tu HTH, Campbell BCV, Christensen S, Collins M, De Silva DA, Butcher KS, et al., 'Pathophysiological determinants of worse stroke outcome in atrial fibrillation', Cerebrovascular Diseases, 30 389-395 (2010) [C1]
DOI 10.1159/000316886
Citations Scopus - 51Web of Science - 41
Co-authors Christopher Levi, Mark Parsons
2010 Marsden DL, Spratt NJ, Walker R, Barker DJ, Attia JR, Pollack MR, et al., 'Trends in stroke attack rates and case fatality in the Hunter Region, Australia 1996-2008', Cerebrovascular Diseases, 30 500-507 (2010) [C1]
DOI 10.1159/000319022
Citations Scopus - 21Web of Science - 22
Co-authors Mark Parsons, Christopher Levi, John Attia, Neil Spratt
2010 De Silva DA, Ebinger M, Christensen S, Parsons MW, Levi CR, Butcher K, et al., 'Baseline diabetic status and admission blood glucose were poor prognostic factors in the EPITHET trial', Cerebrovascular Diseases, 29 14-21 (2010) [C1]
DOI 10.1159/000255969
Citations Scopus - 32Web of Science - 32
Co-authors Mark Parsons, Christopher Levi
2010 Sangvatanakul P, Hillege S, Lalor E, Levi CR, Hill K, Middleton S, 'Setting stroke research priorities: The consumer perspective', Journal of Vascular Nursing, 28 121-131 (2010) [C1]
DOI 10.1016/j.jvn.2010.09.001
Citations Scopus - 8
Co-authors Christopher Levi
2010 Levi CR, 'Consultant's comment', Medicine Today, 11 15 (2010) [C3]
Co-authors Christopher Levi
2010 Crimmins DS, Levi CR, Gerraty P, Beer CD, Hill KM, 'Current validity of the ABCD2 score for acute risk stratification of transient ischaemic attack patients is uncertain Reply', Internal Medicine Journal, 40 470-471 (2010) [C2]
Co-authors Christopher Levi
2010 Huppatz C, Gawarikar Y, Levi CR, Kelly PM, Williams D, Dalton CB, et al., 'Should there be a standardised approach to the diagnostic workup of suspected adult encephalitis? A case series from Australia', BMC Infectious Diseases, 10 1-6 (2010) [C1]
DOI 10.1186/1471-2334-10-353
Citations Scopus - 11Web of Science - 10
Co-authors D Durrheim, Christopher Levi, Craig Dalton
2009 Middleton S, Levi CR, Ward J, Grimshaw J, Griffiths R, D'Este CA, et al., 'Fever, hyperglycaemia and swallowing dysfunction management in acute stroke: A cluster randomised controlled trial of knowledge transfer', Implementation Science, 4 1-11 (2009) [C1]
DOI 10.1186/1748-5908-4-16
Citations Scopus - 7Web of Science - 8
Co-authors Catherine Deste, Christopher Levi
2009 Levi CR, Bateman GA, Spratt NJ, McElduff P, Parsons MW, Miteff F, 'The independent predictive utility of computed tomography angiographic collateral status in acute ischaemic stroke', Brain, 132 2231-2238 (2009) [C1]
DOI 10.1093/brain/awp155
Citations Scopus - 195Web of Science - 183
Co-authors Christopher Levi, Mark Parsons, Neil Spratt, Patrick Mcelduff
2009 Parsons MW, Miteff F, Bateman GA, Spratt NJ, Loiselle A, Attia JR, Levi CR, 'Acute ischemic stroke imaging-guided tenecteplase treatment in an extended time window', Neurology, 72 915-921 (2009) [C1]
DOI 10.1212/01.wnl.0000344168.05315.9d
Citations Scopus - 77Web of Science - 66
Co-authors Christopher Levi, Mark Parsons, Neil Spratt, John Attia
2009 Ebinger M, Christensen S, De Silva DA, Parsons MW, Levi CR, Butcher KS, et al., 'Expediting MRI-based proof-of-concept stroke trials using an earlier imaging end point', Stroke, 40 1353-1358 (2009) [C1]
DOI 10.1161/strokeaha.108.532622
Citations Scopus - 26Web of Science - 27
Co-authors Mark Parsons, Christopher Levi
2009 Ebinger M, Iwanaga T, Prosser JF, De Silva DA, Christensen S, Collins M, et al., 'Clinical-diffusion mismatch and benefit from thrombolysis 3 to 6 hours after acute stroke', Stroke, 40 2572-2574 (2009) [C1]
DOI 10.1161/strokeaha.109.548073
Citations Scopus - 26Web of Science - 26
Co-authors Christopher Levi, Mark Parsons
2009 De Silva DA, Fink JN, Christensen S, Ebinger M, Bladin C, Levi CR, et al., 'Assessing reperfusion and recanalization as markers of clinical outcomes after intravenous thrombolysis in the echoplanar imaging thrombolytic evaluation trial (EPITHET)', Stroke, 40 2872-2874 (2009) [C1]
DOI 10.1161/strokeaha.108.543595
Citations Scopus - 64Web of Science - 55
Co-authors Mark Parsons, Christopher Levi
2009 Huppatz C, Durrheim DN, Levi CR, Dalton CB, Williams D, Clements MS, Kelly PM, 'Etiology of encephalitis in Australia, 1990-2007', Emerging Infectious Diseases, 15 1359-1365 (2009) [C1]
DOI 10.3201/eid1509.081540
Citations Scopus - 48Web of Science - 48
Co-authors Craig Dalton, Christopher Levi, D Durrheim
2009 Bladin C, Chambers B, New G, Denton M, Lawrence-Brown M, Levi C, et al., 'Guidelines for patient selection and performance of carotid artery stenting', Journal of Medical Imaging and Radiation Oncology, 53 538-545 (2009)

The endovascular treatment of carotid atherosclerosis with carotid artery stenting (CAS) remains controversial. Carotid endarterectomy (CEA) remains the benchmark in terms of proc... [more]

The endovascular treatment of carotid atherosclerosis with carotid artery stenting (CAS) remains controversial. Carotid endarterectomy (CEA) remains the benchmark in terms of procedural mortality and morbidity. Consensus Australasian guidelines for the safe performance of CAS were developed using the modified Delphi consensus method of iterative consultation. Selection of patients suitable for CAS needs careful consideration of clinical and patho-anatomical criteria. Randomised controlled trials and pooled analyses have demonstrated that CAS is more hazardous than CEA. The CGSC therefore recommends that CAS should not be performed in the majority of patients requiring carotid revascularisation. There is currently no evidence to support CAS as a treatment for asymptomatic carotid stenosis. The use of distal protection devices during CAS remains controversial with increased risk of clinically silent stroke. The knowledge requirements for the safe performance of CAS include an understanding of the evidence base from randomised controlled trials, carotid and aortic arch anatomy and pathology, and recognition and management of periprocedural complications. It is critical that all patients being considered for a carotid intervention have adequate pre-procedural neuroimaging and peri-procedural, independent, neurological assessment. Maintenance of proficiency in CAS requires active involvement in surgical/endovascular audit and continuing medical education programmes. These standards should apply in the public and private health-care settings. These guidelines represent the consensus of an intercollegiate committee in order to direct appropriate patient selection to perform CAS. Advances in endovascular technologies and the results of randomised controlled trials will guide future revisions of this document. © 2009 The Royal Australian and New Zealand College of Radiologists.

DOI 10.1111/j.1754-9485.2009.02120.x
Citations Scopus - 3
Co-authors Christopher Levi
2009 Levi CR, Lindley R, Smith B, Bladin C, Parsons MW, Read S, et al., 'The implementation of intravenous tissue plasminogen activator in acute ischaemic stroke: A scientific position statement from the National Stroke Foundation and the Stroke Society of Australasia', Internal Medicine Journal, 39 317-324 (2009) [C1]
DOI 10.1111/j.1445-5994.2009.01938.x
Citations Scopus - 14Web of Science - 8
Co-authors Mark Parsons, Christopher Levi
2009 Crimmins DS, Levi CR, Gerraty RP, Beer CD, Hill KM, 'Acute stroke and transient ischaemic attack management: Time to act fast', Internal Medicine Journal, 39 325-331 (2009) [C1]
DOI 10.1111/j.1445-5994.2009.01935.x
Citations Scopus - 9Web of Science - 8
Co-authors Christopher Levi
2009 Huppatz C, Kelly PM, Levi CR, Dalton CB, Williams D, Durrheim DN, 'Encephalitis in Australia, 1979-2006: Trends and aetiologies', Communicable Diseases Intelligence Quarterly Report, 33 192-197 (2009) [C1]
Citations Scopus - 15
Co-authors Christopher Levi, D Durrheim, Craig Dalton
2008 Davis SM, Donnan GA, Parsons MW, Levi CR, Butcher KS, Peeters A, et al., 'Effects of alteplase beyond 3 h after stroke in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET): A placebo-controlled randomised trial', The Lancet Neurology, 7 299-309 (2008) [C1]
DOI 10.1016/s1474-4422(08)70044-9
Citations Scopus - 666Web of Science - 602
Co-authors Mark Parsons, Christopher Levi, John Attia
2008 Davis SM, Donnan GA, Parsons MW, Levi CR, Butcher KS, Barber PA, et al., 'EPITHET: Where next? Authors' reply', The Lancet Neurology, 7 571-572 (2008) [C3]
DOI 10.1016/s1474-4422(08)70124-8
Citations Web of Science - 1
Co-authors Christopher Levi, Mark Parsons
2008 Cadilhac DA, Pearce DC, Levi CR, Donnan GA, 'Improvements in the quality of care and health outcomes with new stroke care units following implementation of a clinician-led, health system redesign programme in New South Wales, Australia', Quality and Safety in Health Care, 17 329-333 (2008) [C1]
DOI 10.1136/qshc.2007.024604
Citations Scopus - 36Web of Science - 38
Co-authors Christopher Levi
2008 Hill K, Barber A, Beer C, Beilby J, Bernhardt J, Bladin C, et al., 'Australian Clinical Guidelines for Acute Stroke Management 2007', International Journal of Stroke, 3 120-129 (2008) [C1]
DOI 10.1111/j.1747-4949.2008.00189.x
Citations Scopus - 22Web of Science - 21
Co-authors Christopher Levi
2008 Levi C, 'Response to interview with Ian Mosley', Journal of Emergency Primary Health Care, 6 (2008) [C3]
Co-authors Christopher Levi
2008 White JH, Magin PJ, Attia JR, Pollack MR, Sturm J, Levi CR, 'Exploring poststroke mood changes in community-dwelling stroke survivors: A qualitative study', Archives of Physical Medicine and Rehabilitation, 89 1701-1707 (2008) [C1]
DOI 10.1016/j.apmr.2007.12.048
Citations Scopus - 15Web of Science - 13
Co-authors Christopher Levi, Parker Magin, John Attia
2008 Scope Collaborations SCAOPE, Ist, Levi C, Parsons M, Spratt N, Evans M, Royan A, 'Predicting outcome in hyper-acute stroke: validation of a prognostic model in the Third International Stroke Trial (IST3)', Journal of Neurology Neurosurgery and Psychiatry, 79 397-400 (2008) [C1]
DOI 10.1136/jnnp.2007.126045
Citations Scopus - 27
Co-authors Christopher Levi, Neil Spratt
2008 Quain DA, Parsons MW, Loudfoot AR, Spratt NJ, Evans MK, Russell ML, et al., 'Improving access to acute stroke therapies: A controlled trial of organised pre-hospital and emergency care', Medical Journal of Australia, 189 429-433 (2008) [C1]
Citations Scopus - 77Web of Science - 66
Co-authors John Attia, Christopher Levi, Neil Spratt, Mark Parsons, Patrick Mcelduff
2008 Bateman GA, Levi CR, Schofield PW, Wang Y, Lovett EC, 'The venous manifestations of pulse wave encephalopathy: Windkessel dysfunction in normal aging and senile dementia', Neuroradiology, 50 491-497 (2008) [C1]
DOI 10.1007/s00234-008-0374-x
Citations Scopus - 58Web of Science - 53
Co-authors Peter Schofield, Christopher Levi
2008 Maguire JM, Thakkinstian A, Sturm J, Levi CR, Lincz L, Parsons MW, et al., 'Polymorphisms in platelet glycoprotein 1b [alpha] and factor VII and risk of ischemic stroke', Stroke, 39 1710-1716 (2008) [C1]
DOI 10.1161/strokeaha.107.507228
Citations Scopus - 30Web of Science - 28
Co-authors Mark Parsons, Christopher Levi, Lisa Lincz, John Attia
2008 Middleton S, Levi CR, Dale S, 'Arrival time to stroke unit as crucial a measure as arrival time to emergency department', Stroke, 39 E5 (2008) [C3]
Citations Scopus - 2Web of Science - 1
Co-authors Christopher Levi
2008 Levi C, 'BP shift justified', Australian Doctor, 23 (2008)
Co-authors Christopher Levi
2008 Williams B, Mosley I, Patrick I, Levi C, 'An update on stroke care in Australia: Interview with Ian Mosley', Journal of Emergency Primary Health Care, 6 (2008)
Co-authors Christopher Levi
2007 Abbott AL, Bladin CF, Levi CR, Chambers BR, 'What should we do with asymptomatic carotid stenosis?', International Journal of Stroke, 2 27-39 (2007) [C1]
DOI 10.1111/j.1747-4949.2007.00096.x
Citations Scopus - 51Web of Science - 40
Co-authors Christopher Levi
2007 Townend BS, Whyte S, Desborough T, Crimmins D, Markus R, Levi CR, Sturm JW, 'Longitudinal prevalence and determinants of early mood disorder post-stroke', Journal of Clinical Neuroscience, 14 429-434 (2007) [C1]
DOI 10.1016/j.jocn.2006.01.025
Citations Scopus - 44
Co-authors Christopher Levi
2007 Abbott AL, Levi CR, Stork JL, Donnan GA, Chambers BR, 'Timing of clinically significant microembolism after carotid endarterectomy', Cerebrovascular Diseases, 23 362-367 (2007) [C1]
DOI 10.1159/000099135
Citations Scopus - 21Web of Science - 16
Co-authors Christopher Levi
2007 Attia JR, Thakkinstian A, Wang Y, Lincz L, Parsons MW, Sturm J, et al., 'The PAI-1 4G/5G gene polymorphism and ischemic stroke: An association study and meta-analysis', Journal of Stroke and Cerebrovascular Diseases, 16 173-179 (2007) [C1]
DOI 10.1016/j.jstrokecerebrovasdis.2007.03.002
Citations Scopus - 33
Co-authors Rodney Scott, Lisa Lincz, John Attia, Mark Parsons, Christopher Levi
2007 Levi CR, 'Atherothrombosis, antiplatelet therapy and ischemic stroke prevention', Medicine Today Supplement, - 4-10 (2007) [C1]
Co-authors Christopher Levi
2007 White JH, Alston MK, Marquez JL, Sweetapple AL, Pollack MR, Attia JR, et al., 'Community-Dwelling Stroke Survivors: Function Is Not the Whole Story With Quality of Life', Archives of Physical Medicine and Rehabilitation, 88 1140-1146 (2007) [C1]
DOI 10.1016/j.apmr.2007.06.003
Citations Scopus - 27Web of Science - 26
Co-authors Jodie Marquez, Christopher Levi, John Attia
2007 Parsons MW, Pepper EM, Bateman GA, Wang Y, Levi CR, 'Identification of the penumbra and infarct core on hyperacute noncontrast and perfusion CT', Neurology, 68 730-736 (2007) [C1]
DOI 10.1212/01.wnl.0000256366.86353.ff
Citations Scopus - 97Web of Science - 82
Co-authors Christopher Levi, Mark Parsons
2007 Donnan GA, Levi CR, 'Glucose and the ischaemic brain: too much of a good thing?', Lancet Neurology, 6 380-381 (2007) [C3]
DOI 10.1016/s1474-4422(07)70086-8
Citations Scopus - 6Web of Science - 4
Co-authors Christopher Levi
2006 Parsons MW, Pepper EM, Chan V, Siddique S, Rajaratnam S, Rajarabram S, et al., 'Toxic brainstem encephalopathy after artemisinin treatment for breast cancer - Reply', Annals of Neurology, 59 726-726 (2006) [C3]
Citations Scopus - 1Web of Science - 2
Co-authors Mark Parsons, Christopher Levi
2006 Parsons MW, Pepper EM, Chan VWC, Siddique S, Rajaratnam S, Rajarabram S, et al., 'Reply [4] Perfusion computed tomography: prediction of final infarct extent and stroke outcome', Annals of Neurology, 59 726 (2006) [C3]
Co-authors Christopher Levi, Mark Parsons
2006 Bateman GA, Levi CR, Schofield PW, Wang Y, Lovett EC, 'Quantitative measurement of cerebral haemodynamics in early vascular dementia and Alzheimer's disease', Journal of Clinical Neuroscience, 13 563-568 (2006) [C1]
DOI 10.1016/j.jocn.2005.04.017
Citations Scopus - 39Web of Science - 33
Co-authors Christopher Levi, Peter Schofield
2006 Cadilhac DA, Lalor EE, Pearce DC, Levi CR, Donnan GA, 'Access to stroke care units in Australian public hospitals: facts and temporal progress', Internal Medicine Journal, 36 700-704 (2006) [C1]
DOI 10.1111/j.1445-5994.2006.01168.x
Citations Scopus - 26Web of Science - 24
Co-authors Christopher Levi
2006 Pepper EM, Parsons MW, Bateman GA, Levi CR, 'CT perfusion source images improve identification of early ischaemic change in hyperacute stroke', Journal of Clinical Neuroscience, 13 199-205 (2006) [C1]
DOI 10.1016/j.jocn.2005.03.030
Citations Scopus - 22Web of Science - 19
Co-authors Mark Parsons, Christopher Levi
2006 Levi CR, 'Australasia', International Journal of Stroke, 1 238-239 (2006) [C3]
DOI 10.1111/j.1747-4949.2006.00055.x
Co-authors Christopher Levi
2005 Levi CR, 'Christopher R Levi (on behalf of the Australasian Stroke Unit Network, the New South Wales Greater Metropolitan Clinical Taskforce Stroke Initiative, and the Towards a Safer Culture Stroke Expert Working Group)', MEDICAL JOURNAL OF AUSTRALIA, 182 45-45 (2005)
Co-authors Christopher Levi
2005 Bateman GA, Levi CR, Schofield PW, Wang Y, Lovett EC, 'The pathophysiology of the aqueduct stroke volume in normal pressure hydrocephalus:can co-morbidity with other forms of dementia be excluded', Neuroradiology, 47 741-748 (2005) [C1]
DOI 10.1007/s00234-005-1418-0
Citations Scopus - 46Web of Science - 40
Co-authors Peter Schofield, Christopher Levi
2005 Levi CR, 'Tissue plasminogen activator (tPA) in acute ischaemic stroke: Time for collegiate communication consensus [reply]', Medical Journal of Australia, 182 44-45 (2005) [C3]
Co-authors Christopher Levi
2005 Parsons MW, Pepper EM, Chan V, Siddique S, Rajaratnam S, Bateman GA, Levi CR, 'Perfusion computed tomography: Prediction of final infarct extent and stroke outcome', Annals of Neurology, 58 672-679 (2005) [C1]
DOI 10.1002/ana.20638
Citations Scopus - 142Web of Science - 128
Co-authors Christopher Levi, Mark Parsons
2005 Butcher K, Parsons MW, Macgregor LR, Barber PA, Chalk J, Bladin CF, et al., 'Refining the Perfusion-Diffusion Mismatch Hypothesis', Stroke, 36 1153-1159 (2005) [C1]
DOI 10.1161/01.STR.0000166181.86928.8b
Citations Scopus - 183Web of Science - 165
Co-authors Christopher Levi, Mark Parsons
2005 Abbott AL, Chambers BR, Stork JL, Levi CR, Bladin CF, Donnan GA, 'Embolic signals and prediction of ipsilateral stroke or transient ischemic attack in asymptomatic carotid stenosis: A multicenter prospective cohort study', Stroke, 36 1128-1133 (2005) [C1]
DOI 10.1161/01.str.0000166059.30464.0a
Citations Scopus - 108Web of Science - 82
Co-authors Christopher Levi
2004 Ferry CT, Fitzpatrick AM, Long PW, Levi CR, Bishop RO, 'Towards a Safer Culture: clinical pathways in acute coronary syndromes and stroke', MJA, 180 S92-S96 (2004) [C1]
Citations Scopus - 13Web of Science - 12
Co-authors Christopher Levi
2004 Levi CR, 'Tissue plasminogen activator (tPA) in acute ischaemic stroke: time for collegiate and consensus', Medical Journal of Australia, 180 634-636 (2004) [C3]
Citations Scopus - 3Web of Science - 6
Co-authors Mark Parsons, Christopher Levi
2004 Saita K, Chen M, Spratt NJ, Porritt MJ, Liberatore GT, Read SJ, et al., 'Imaging the Ischemic Penumbra with F-Fluoromisonidazole in a Rat Model of Ischemic Stroke', Stroke: a journal of cerebral circulation, 35 975-980 (2004) [C1]
DOI 10.1161/01.STR.0000121647.01941.ba
Citations Scopus - 41Web of Science - 37
Co-authors Christopher Levi, Neil Spratt
2004 Wang Y, Levi CR, 'Prognostic index for stroke mortality', Journal of Clinical Epidemiology, 57 758 (2004) [C3]
DOI 10.1016/j.jclinepi.2002.06.001
Co-authors Christopher Levi
2004 Attia JR, D'Este CA, Levi CR, 'The progress trial three years later. HOPE trial may shed some light', BMJ, 329 1403-1404 (2004) [C1]
DOI 10.1136/bmj.329.7479.1403-d
Co-authors Christopher Levi, John Attia, Catherine Deste
2004 Kimura K, Stork JL, Levi CR, Abbott AL, Donnan GA, Chambers BR, 'High Intensity Transient Signals in Patients with Carotid Stenosis May Persist after Carotid Endarterectomy', Cerebrovascular Diseases, 17 123-127 (2004) [C1]
DOI 10.1159/000075780
Citations Scopus - 4Web of Science - 2
Co-authors Christopher Levi
2003 Wang Y, Lim L, Heller RF, Fisher J, Levi CR, 'A prediction model of 1-year mortality for acute ischemic stroke patients', Archives of Physical Medicine and Rehabilitation, 84 1006-1011 (2003) [C1]
DOI 10.1016/S0003-9993(03)00032-7
Citations Scopus - 46Web of Science - 38
Co-authors Christopher Levi
2003 Turner A, Mosgrove K, Hunter M, Hudson S, Selmes C, Levi C, Edwards J, 'Processing of visual stimuli following coronary artery bypass grafting (CABG): An fMRI study', AUSTRALIAN JOURNAL OF PSYCHOLOGY, 55 29-29 (2003)
Co-authors Christopher Levi, Mick Hunter
2003 Turner A, Mosgrove K, Hunter M, Hudson S, Selmes CM, Levi CR, 'Processing of visual stimuli following coronary artery bypass grafting (CABG): An fMRI study', Australian Journal of Psychology, 55 110 (2003) [C3]
Co-authors Christopher Levi, Mick Hunter
2003 Donnan GA, Davis SM, Levi CR, 'Thrombolysis for acute ischaemic stroke: revisiting the evidence - Reply', MEDICAL JOURNAL OF AUSTRALIA, 179 387-387 (2003)
Citations Web of Science - 2
Co-authors Christopher Levi
2003 Smith BJ, Donnan GA, Davis SM, Levi CR, Johnson KR, Bailey PM, et al., 'Thrombolysis for acute ischaemic stroke: Revisiting the evidence (multiple letters)', Medical Journal of Australia, 179 386-389 (2003)
Citations Scopus - 5
Co-authors Christopher Levi, Mark Parsons
2003 Donnan GA, Davis SM, Levi CR, 'Strategies to improve outcomes after acute stroke', Medical Journal of Australia, 178 309-310 (2003) [C3]
Citations Scopus - 12Web of Science - 11
Co-authors Christopher Levi
2003 Wang Y, Levi CR, Attia JR, D'Este CA, Spratt N, Fisher JD, 'Seasonal Variation in Stroke in the Hunter Region, Australia: A 5-Year Hospital-Based Study, 1995-2000', Stroke: a journal of cerebral circulation, 34 1144-1150 (2003) [C1]
DOI 10.1161/01.STR.0000067703.71251.B6
Citations Scopus - 83Web of Science - 79
Co-authors Christopher Levi, Neil Spratt, Catherine Deste, John Attia
2003 Chambers BR, Stork J, Kimura K, Abbott A, Levi CR, Donnan GA, 'Symptomatic Carotid Artery Stenosis: Heterogeneity of Destabilizing Mechanisms?', Stroke: a journal of cerebral circulation, 34 1 (2003) [C3]
Co-authors Christopher Levi
2003 Spratt N, Wang Y, Levi CR, Ng K, Evans M, Fisher JD, 'A prospective study of predictors of prolonged hospital stay and disability after stroke', Journal of Clinical Neuroscience, 10 665-669 (2003) [C1]
DOI 10.1016/j.jocn.2002.12.001
Citations Scopus - 36Web of Science - 31
Co-authors Christopher Levi, Neil Spratt
2003 Wang Y, Levi CR, D'Este CA, Attia JR, Fisher JD, 'Variation of Stroke Attack Rates in Rural, Urban, and Coalfields Areas of the Hunter Region, Australia 1995-2000', Journal of Stroke & Cerebrovascular Diseases, 12 103-110 (2003) [C1]
DOI 10.1053/jscd.2003.12
Citations Scopus - 3
Co-authors Christopher Levi, John Attia, Catherine Deste
2003 Chambers B, Stork J, Kimura K, Abbott A, Levi C, Donnan G, 'Symptomatic carotid artery stenosis: Heterogeneity of destabilizing mechanisms? Response', STROKE, 34 E41-E41 (2003)
Co-authors Christopher Levi
2002 Levi CR, Magin PJ, Nair BR, 'Primary stroke prevention: refining the "high risk" approach', The Medical Journal of Australia, 176 303-304 (2002) [C3]
Citations Scopus - 2
Co-authors Christopher Levi, Parker Magin
2002 Bull N, Selmes CM, Turner A, Mosgrove K, Doi K, Edwards JR, et al., 'Recognition of low contrast letters as a measure of post cardiac surgery brain injury', STROKE, 33 375-375 (2002)
Co-authors Christopher Levi, Mick Hunter
2002 Stork J, Levi CR, Chambers B, Abbott A, Donnan G, 'Possible Determinants of Early microembolism After Carotid Endarterectomy', Stroke: a journal of cerebral circulation, 33 2082-2085 (2002) [C1]
Citations Scopus - 37Web of Science - 30
Co-authors Christopher Levi
2002 Stork J, Kimura K, Levi CR, Chambers B, Abbott A, Donnan G, 'Source of Microembolic Signals in Patients With High-Grade Carotid Stenosis', Stroke: a journal of cerebral circulation, 33 2014-2018 (2002) [C1]
Citations Scopus - 41Web of Science - 36
Co-authors Christopher Levi
2001 Yoon SS, Heller R, Levi CR, Wiggers JH, Fitzgerald PE, 'Knowledge of stroke risk factors, warning symptoms, and treatment among an Australian urban population', Stroke, 32 1926-1930 (2001) [C1]
DOI 10.1161/01.STR.32.8.1926
Citations Scopus - 191Web of Science - 137
Co-authors John Wiggers, Christopher Levi
2001 Levi CR, Selmes C, Chambers BR, 'Transcranial ultrasound - Clinical applications in cerebral ischaemia', Australian Prescriber, 24 137-140 (2001)

Transcranial ultrasound can rapidly and non-invasively image blood flow in the major basal intracranial arteries. Its accuracy makes it acceptable for use in screening for haemody... [more]

Transcranial ultrasound can rapidly and non-invasively image blood flow in the major basal intracranial arteries. Its accuracy makes it acceptable for use in screening for haemodynamically significant intracranial stenoses or vessel occlusions. Although it has a relatively limited field of view and is not technically feasible in approximately 10% of cases, the information obtained is becoming increasingly relevant to therapeutic decision-making in the prevention and management of stroke. Transcranial Doppler ultrasound or transcranial colour-coded duplex have the advantages of relatively low cost, ease of repeatability, and excellent safety and tolerability, but they provide inferior spatial and anatomical detail in comparison to angiographic techniques.

Citations Scopus - 6
Co-authors Christopher Levi
2001 Levi CR, Selmes C, Chambers B, 'Diagnostic tests: Transcranial ultrasound - clinical applications in cerebral ischaemia', Australian Prescriber, 24 137-140 (2001) [C2]
Co-authors Christopher Levi
2001 Levi CR, Stork J, Chambers B, Abbott A, Cameron H, Peeters A, et al., 'Dextran Reduces Embolic Signals After Carotid Endartectomy', Annals of Neurology, 50 544-547 (2001) [C1]
Citations Scopus - 31Web of Science - 26
Co-authors Christopher Levi
2001 Wang Y, Lim L, Levi CR, Heller R, Fischer J, 'A prognostic index for 30-day mortality after stroke', Journal of Clinical Epidemiology, 54 766-773 (2001) [C1]
Citations Scopus - 38Web of Science - 35
Co-authors Christopher Levi
2001 Kazui S, Levi CR, Jones E, Quang L, Calafiore P, Donnan G, 'Lacunar Stroke: Transoesophageal Echocardiographic Factors Influencing Long-Term Prognosis', Cerebrovascular Diseases, 12 325-330 (2001) [C1]
Citations Scopus - 29Web of Science - 18
Co-authors Christopher Levi
2001 Wang Y, Lim L, Levi CR, Heller R, Fisher J, 'Influence of Hyperglycemia on Stroke Mortality', Journal of Stroke and Cerebrovascular Diseases, 10 11-18 (2001) [C1]
Citations Scopus - 14
Co-authors Christopher Levi
2001 Yoon SS, Heller R, Levi CR, Wiggers JH, 'Knowledge and perception about stroke among an Australian urban population', BMC Public Health, 1 6 (2001) [C1]
Citations Scopus - 17Web of Science - 16
Co-authors John Wiggers, Christopher Levi
2000 Kazui S, Levi CR, Jones E, Quang L, Calafiore P, Donnan G, 'Risk factors for lacunar stroke: A case-control transesophageal echocardiographic study', Neurology, 54 1385-1387 (2000) [C1]
Citations Scopus - 33
Co-authors Christopher Levi
2000 Donnan GA, Kazui S, Levi CR, Jones EF, Chambers BR, Quang LC, 'Risk factors for lacunar stroke: A case-control transesophageal echocardiographic study', STROKE, 31 284-284 (2000)
Citations Web of Science - 2
Co-authors Christopher Levi
2000 Levi CR, Chambers BR, Bladin CF, Donnan GA, Stork J, Harris A, et al., '10% dextran 40 reduces microembolic signals after carotid endarterectomy', STROKE, 31 322-322 (2000)
Co-authors Christopher Levi
2000 Levi CR, Gacs Z, Schwartz R, Hudson P, Hardy D, Bull N, et al., 'The accuracy of intracranial large artery occlusive disease assessment using transcranial colour coded duplex sonography', STROKE, 31 336-336 (2000)
Co-authors Christopher Levi
2000 Wang Y, Lim L, Levi CR, Heller R, Fisher J, 'Influence of Admission Body Temperature on Stroke Mortality', Stroke, 31 404-409 (2000) [C1]
Citations Scopus - 166Web of Science - 127
Co-authors Christopher Levi
2000 Harris A, Stork J, Levi C, Chambers BR, Bladin C, Donnan GA, 'Reproducibility of microembolus detection in patients with asymptomatic internal carotid artery stenosis', STROKE, 31 294-294 (2000)
Co-authors Christopher Levi
1999 Levi CR, Harris A, Stork J, Royle J, Chambers BR, Roberts A, et al., 'Prevention of cerebral microembolism, following carotid endarterectomy: A randomised trial using perioperative intravenous 10% dextran 40', STROKE, 30 242-242 (1999)
Co-authors Christopher Levi
1999 Levi CR, Read S, Hirano T, Donnan DA, 'Panhemispheric Infarction', Journal of Stroke and Cerebrovascular Disease, 8 286-289 (1999) [C1]
Co-authors Christopher Levi
1998 Read SJ, Pettigrew L, Schimmel L, Levi CR, Bladin CF, Chambers BR, Donnan GA, 'White matter medullary infarcts: Acute subcortical infarction in the centrum ovale', CEREBROVASCULAR DISEASES, 8 289-295 (1998)
DOI 10.1159/000015868
Citations Scopus - 33Web of Science - 25
Co-authors Christopher Levi
1998 Sylivris S, Levi C, Matalanis G, Rosalion A, Buxton BF, Mitchell A, et al., 'Pattern and significance of cerebral microemboli during coronary artery bypass grafting', Annals of Thoracic Surgery, 66 1674-1678 (1998)

Background. Strokes that occur during coronary artery bypass grafting are often caused by embolism. Intraoperative transcranial Doppler monitoring can detect cerebral microemboli.... [more]

Background. Strokes that occur during coronary artery bypass grafting are often caused by embolism. Intraoperative transcranial Doppler monitoring can detect cerebral microemboli. The aims of this study were to identify the pattern of microembolic phenomena during various stages of coronary artery bypass grafting, to verify whether numbers of high-intensity transient signals correlated with early neuropsychologic deficits, and to identify, using magnetic resonance imaging scans, whether radiologic evidence of cerebral infarction correlated with microembolic numbers during the bypass period. Methods. Forty-one consecutive patients undergoing coronary bypass grafting with transcranial Doppler monitoring were enrolled in this study. All had preoperative and postoperative magnetic resonance imaging brain scans. A subgroup of 32 patients were studied by comparing microembolic load and early neuropsychological outcomes. Results. Transcranial Doppler monitoring confirmed that most microemboli occurred during cardiopulmonary bypass. A significant early neuropsychological deficit after coronary artery bypass grafting did correspond to the total microembolic load during bypass (p = 0.008). However, patients with cerebral infarction on magnetic resonance imaging had significantly more microembolic signal during the preincision phases and not during the bypass period. Conclusions. Microembolic load during bypass is associated with early neuropsychologic deficits. In contrast, patients who show evidence of strokes during coronary artery bypass grafting have a higher microembolic load during the preincision phase than those without cerebral infarction. Differing mechanisms may be responsible for these different outcomes.

DOI 10.1016/S0003-4975(98)00891-1
Citations Scopus - 106
Co-authors Christopher Levi
1998 Gaunt M, Naylor AR, Lennard N, Smith JL, Bell PRF, Levi CR, et al., 'Transcranial Doppler detected cerebral microembolism following carotid endarterectomy (multiple letters) [1]', Brain, 121 389-390 (1998)
DOI 10.1093/brain/121.2.389
Citations Scopus - 4
Co-authors Christopher Levi
1998 Levi CR, Read SJ, Hirano T, Donnan GA, 'Extensive hemispheric cerebral infarction', Journal of Stroke and Cerebrovascular Diseases, 7 398-403 (1998)

Background and Purpose: Patients with extensive hemispheric cerebral infarction have a high incidence of mortality and serious morbidity. Because of their poor prognosis, they war... [more]

Background and Purpose: Patients with extensive hemispheric cerebral infarction have a high incidence of mortality and serious morbidity. Because of their poor prognosis, they warrant attention; however, in acute stroke therapy trials they do not appear to benefit from treatment. We sought to determine the clinical features, pathophysiological mechanisms, and outcome in a series of cases with radiologically defined extensive hemispheric infarction. Methods: Cases of extensive hemispheric infarction were ascretained retrospectively from stroke admissions during a 5-year period. Extensive hemispheric infarction was defined radiologically as infarction involving greater than 75% of the middle cerebral artery territory, with or without involvement of the adjacent anterior or posterior cerebral artery territories. Clinical, risk factor, and stroke mechanism data were compared with that of a control group of ischemic stroke patients admitted during the same period. Results: Extensive hemispheric infarction occurred in 53 of 1,440 cases of ischemic stroke (3.7%). Infarction involved the middle cerebral artery territory alone in 79% of cases, and the adjacent anterior or posterior cerebral artery territories as well as 21% of cases. A cardioembolic mechanism was likely in 58% of cases; 42% had atrial fibrillation. When compared with the control group, a cardioembolic mechanism was the only feature more frequently associated with extensive hemispheric infarction. The overall in-hospital mortality rate was 52%; 84% of those discharged from hospital required nursing home care because of severe disability. Conclusion: Although uncommon, extensive hemispheric infarction is an important stroke subtype with dramatic and easily recognizable presenting clinical features, frequent cardio-embolic mechanism, an extremely poor outcome, and failure to benefit from most experimental acute stroke therapies. © 1998 National Stroke Association. All rights reserved.

DOI 10.1016/S1052-3057(98)80123-7
Citations Scopus - 2
Co-authors Christopher Levi
1997 Levi CR, OMalley HM, Fell G, Roberts AK, Hoare MC, Royle JP, et al., 'Transcranial Doppler detected cerebral microembolism following carotid endarterectomy - High microembolic signal loads predict postoperative cerebral ischaemia', BRAIN, 120 621-629 (1997)
DOI 10.1093/brain/120.4.621
Citations Scopus - 165Web of Science - 160
Co-authors Christopher Levi
1997 Levi CR, Bladin CF, Chambers BC, Donnan GA, Spencer MP, 'Clinical role of transcranial Doppler embolus detection monitoring after carotid endarterectomy [1] (multiple letters)', Stroke, 28 1845-1846 (1997)
Citations Scopus - 4
Co-authors Christopher Levi
1997 Levi CR, Bladin CF, Chambers BC, Royle JP, Donnan GA, 'Microembolic watershed infarction complicating carotid endarterectomy', Cerebrovascular Diseases, 7 185-186 (1997)
DOI 10.1159/000108189
Citations Scopus - 3
Co-authors Christopher Levi
1997 Levi CR, Roberts AK, Fell G, Hoare MC, Royle JP, Chan A, et al., 'Transcranial doppler microembolus detection in the identification of patients at high risk of perioperative stroke', European Journal of Vascular and Endovascular Surgery, 14 170-176 (1997)

Objective: Perioperative ischaemic stroke is the leading cause of morbidity and mortality associated with carotid endarterectomy (CEA). The aim was to test the hypotheses that the... [more]

Objective: Perioperative ischaemic stroke is the leading cause of morbidity and mortality associated with carotid endarterectomy (CEA). The aim was to test the hypotheses that the detection of microembolic ultrasonic signals (MES) with transcranial Doppler ultrasound (TCD) during and after the operation may be of value in identifying patients at increase perioperative stroke risk. Design: Open prospective case series. Patients and Methods: Eighty-one consecutive patients undergoing CEA with TCD monitoring. Preoperative, intraoperative and interval postoperative TCD monitoring of the middle cerebral artery (MCA) ipsilateral to the operated carotid artery. On-line pre- and intraoperative MES counting and blinded off-line analysis of postoperative MES counts. End-points were any focal neurological deficit and death at 30 days postoperatively. Results: MES were detected in 94% of patients intraoperatively and 71% of cases during the first postoperative hour. MES counts ranged from 0 to 25 per operative phase (range of median counts 0-8) and from 0 to 212 per hour postoperatively (range of median counts 0-4). Eight cases (10%) developed postoperative MES counts greater than 50/h. Five of these eight cases evolved ischaemic neurological deficits in the territory of the insonated MCA, indicating a strong association between frequent postoperative microembolism and the development of early cerebral ischaemia (¿ 2 = 34.2, p < 0.0001). Intraoperative MES counts of greater than 50/h in the early postoperative phase of carotid endarterectomy are predictive of the development of ipsilateral focal cerebral ischaemia.

DOI 10.1016/S1078-5884(97)80187-6
Citations Scopus - 33
Co-authors Christopher Levi
1997 Markus HS, Ackerstaff R, Babikian V, Bladin C, Droste D, Grosset D, et al., 'Intercenter agreement in reading Doppler embolic signals - A multicenter international study', STROKE, 28 1307-1310 (1997)
Citations Scopus - 77Web of Science - 64
Co-authors Christopher Levi
1996 Bladin CF, Levi CR, Alexandrov AV, 'Further debate on the measurement of carotid stenosis', STROKE, 27 1437-1438 (1996)
Co-authors Christopher Levi
1996 Levi CR, Mitchell A, Fitt G, Donnan GA, 'The accuracy of magnetic resonance angiography in the assessment of extracranial carotid artery occlusive disease', Cerebrovascular Diseases, 6 231-236 (1996)

The accuracy of two-dimensional time-of-flight magnetic resonance angiography (MRA) in judging diameter narrowing of the extracranial carotid artery was studied using digital subt... [more]

The accuracy of two-dimensional time-of-flight magnetic resonance angiography (MRA) in judging diameter narrowing of the extracranial carotid artery was studied using digital subtraction angiography (DSA) as the gold standard. Particular attention was paid to the specificity of the technique for 70-90% diameter stenoses. MRA and DSA examinations of 90 cervical carotid arteries were graded independently by 2 blinded readers. The examinations were compared in the categories 0-29, 30-69, 70-99 and 100% diameter narrowing (NASCET measurements). Overestimation of the degree of stenosis measured angiographically resulted in MRA sensitivity estimates of 77.8% for 0-29% angiographic stenosis and 31% for 30-69% angiographic stenosis. In the 70-99% stenosis group a false-positive rate of 21.9% resulted in 22 of 42 arteries being inappropriately placed in the high-grade stenosis group. In cases of 100% occlusion there was a false-negative rate of 35.7% (5 of 14 cases). MRA is reliable as a screening test for extracranial carotid occlusive disease. Limited ability of the technique to distinguish between ¿surgical¿ and ¿non-surgical¿ disease with inappropriate inclusion of some patients as potential surgical candidates limits its application as a single definitive pre-operative test. © 1996 S. Karger AG, Basel.

DOI 10.1159/000108026
Citations Scopus - 12
Co-authors Christopher Levi
1994 DONNAN GA, BAIRD AE, LEVI CR, 'DIAGNOSIS AND IMAGING OF STROKE', JOURNAL OF HYPERTENSION, 12 S15-S18 (1994)
Citations Web of Science - 1
Co-authors Christopher Levi
1990 LEVI CR, TYLER GR, OLSON LG, SAUNDERS NA, 'LACK OF AIRWAY RESPONSE TO NASAL IRRITATION IN NORMAL AND ASTHMATIC SUBJECTS', AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE, 20 578-582 (1990)
DOI 10.1111/j.1445-5994.1990.tb01317.x
Citations Scopus - 9Web of Science - 5
Co-authors Christopher Levi
1990 JONES BF, HOWARTH DM, LEVI CR, GLASS JS, 'PROTEINURIA IN POLYMYOSITIS', JOURNAL OF RHEUMATOLOGY, 17 859-860 (1990)
Citations Scopus - 2Web of Science - 1
Co-authors Christopher Levi
Show 315 more journal articles

Conference (248 outputs)

Year Citation Altmetrics Link
2017 Gardner A, Wojtowicz M, Terry D, Levi CR, Zafonte R, Iverson G, 'Video and clinical screening national rugby league players suspected of sustaining concussion', BRAIN INJURY (2017)
Co-authors Christopher Levi, Andrew Gardner
2016 Gardner AJ, Levi CR, Iverson GL, 'Video analysis of concussion in the National Rugby League' (2016)
Co-authors Andrew Gardner, Christopher Levi
2016 Wojtowicz M, Gardner AJ, Stanwell P, Levi CR, Shultz SR, Zafonte R, et al., 'Cortical Thickness and Subcortical Brain Volumes in Retired Professional Rugby League Players' (2016)
Co-authors Andrew Gardner, Christopher Levi, Peter Stanwell
2016 Gardner AJ, Levi CR, Iverson GL, 'Video analysis of the evidence of concussive signs in National Rugby League (NRL) match play' (2016)
Co-authors Christopher Levi, Andrew Gardner
2016 Wojtowicz M, Gardner AJ, Stanwell P, Levi C, Shultz S, Zafonte R, et al., 'Cortical and Subcortical Morphometry in Professional Rugby League Players' (2016)
Co-authors Peter Stanwell, Andrew Gardner, Christopher Levi
2016 Sato S, Delcourt C, Heeley E, Arima H, Zhang S, Al-Shahi Salman R, et al., 'Significance of Cerebral Small Vessel Disease in Acute Intracerebral Hemorrhage: The INTERACT2 Study', STROKE (2016)
Co-authors Christopher Levi
2016 Agarwal S, Bivard A, Warburton E, Parsons M, Levi C, 'COLLATERALS AND PERFUSION IMAGING AS A TISSUE CLOCK IN ACUTE STROKE', INTERNATIONAL JOURNAL OF STROKE (2016)
Co-authors Andrew Bivard, Christopher Levi, Mark Parsons
2016 Ma H, Parsons M, Campbell B, Levi C, Churilov L, Hsu C, et al., 'EXTENDING THE TIME FOR THOMBOLYSIS IN EMERGENCY NEUROLOGICAL DEFICITS (EXTEND) - SIGNIFICANT PENUMBRAL VOLUME IN EXTEND TIME WINDOW AND WAKE UP STROKE PATIENTS', INTERNATIONAL JOURNAL OF STROKE (2016)
Co-authors Mark Parsons, Christopher Levi
2016 Crowfoot G, Van der Riet P, Maguire J, Magin P, Levi C, 'RESHAPING DELIVERY OF THE FAST MESSAGE: AN ALTERNATE APPROACH TO EMPOWER PEOPLE TO SEEK HELP', INTERNATIONAL JOURNAL OF STROKE (2016)
Co-authors Christopher Levi, Parker Magin, Pamela Vanderriet
2016 Crowfoot G, Van der Riet P, Maguire J, Magin P, Levi C, 'LIFE AFTER TRANSIENT ISCHAEMIC ATTACK OR MINOR STROKE: GRIEF, LOSS AND LIMINAL SPACES', INTERNATIONAL JOURNAL OF STROKE (2016)
Co-authors Christopher Levi, Pamela Vanderriet, Parker Magin
2016 Crowfoot G, Van der Riet P, Maguire J, Magin P, Levi C, 'UNSEEN CONVERSATIONS: RENEGOTIATING MIND-BODY RELATIONSHIPS FOLLOWING A TRANSIENT ISCHAEMIC ATTACKOR MINOR STROKE', INTERNATIONAL JOURNAL OF STROKE (2016)
Co-authors Parker Magin, Pamela Vanderriet, Christopher Levi
2016 Ma H, Campbell BC, Parsons MW, Levi C, Meretoja A, Churilov L, et al., 'Extending the Time for Thombolysis in Emergency Neurological Deficits (EXTEND) - High Prevalence of Intracranial Vessel Occlusion in Wake-up-stroke Patients', STROKE (2016)
Co-authors Christopher Levi, Mark Parsons
2016 Ma H, Campbell BC, Parsons MW, Levi C, Meretoja A, Churilov L, et al., 'Extending the Time for Thombolysis in Emergency Neurological Deficits (EXTEND) - Penumbral Patterns Among Patients 4.5-9 Hrs and Wake - Up Stroke', STROKE (2016)
Co-authors Christopher Levi, Mark Parsons
2016 Bivard A, Krishnamurthy V, Levi C, Parsons M, 'Perfusion CT Identifies Ischemic Stroke Patients With a Good Natural History Regardless of Treatment', STROKE (2016)
Co-authors Mark Parsons, Andrew Bivard, Christopher Levi
2016 Paul CL, Ryan A, Attia JR, D'Este CA, Kerr E, Jayakody A, et al., 'THROMBOLYSIS IMPLEMENTATION IN STROKE (TIPS): VARIATION IN 'READINESS TO CHANGE' AND ENGAGEMENT WITH TRANSLATION STRATEGIES', INTERNATIONAL JOURNAL OF BEHAVIORAL MEDICINE (2016)
Co-authors Rob Sanson-Fisher, Christopher Levi, John Attia, Catherine Deste, Chris Paul, Frans Henskens
2016 Paul CL, Attia JR, D'Este CA, Ryan A, Kerr E, Henskens F, Levi CR, 'THROMBOLYSIS IMPLEMENTATION IN STROKE (TIPS): OUTCOMES OF A CLUSTER RANDOMISED TRIAL OF MULTIDISCIPLINARY COLLABORATIVE QUALITY IMPROVEMENT', INTERNATIONAL JOURNAL OF BEHAVIORAL MEDICINE (2016)
Co-authors John Attia, Catherine Deste, Frans Henskens, Chris Paul, Christopher Levi
2016 Conley A, Jolly T, Rennie J, Cooper P, Bateman G, Parsons M, et al., 'LONGITUDINAL CHANGES IN CEREBROVASCULAR HEALTH ON WHITE MATTER MICROSTRUCTURE AND COGNITIVE PERFORMANCE', PSYCHOPHYSIOLOGY (2016)
Co-authors Patrick Cooper, Mark Parsons, Frini Karayanidis, Christopher Levi
2016 Karayanidis F, Jolly T, Cooper P, Rennie J, Levi C, Lenroot R, et al., 'TASK SWITCHING PERFORMANCE IN OLDER ADULTS IS LINKED TO GLOBAL AND TRACT-SPECIFIC CHANGES TO WHITE MATTER MICROSTRUCTURE', PSYCHOPHYSIOLOGY (2016)
Co-authors Frini Karayanidis, Christopher Levi, Patrick Cooper
2016 Kable A, Pond CD, Baker A, Levi C, Turner A, 'Evaluating transitional care for stroke patients discharged home from hospital', INTERNATIONAL JOURNAL OF STROKE (2016)
Co-authors Christopher Levi, Dimity Pond, Ashley Kable, Amanda Baker
2016 Purvis T, Longworth M, Kilkenny M, Worthington J, Miller S, Mohr K, et al., 'Factors associated with nurses delivering quality stroke care', INTERNATIONAL JOURNAL OF STROKE (2016)
Co-authors Christopher Levi
2016 Faux S, Andrew N, Lannin N, Donnan GA, Anderson C, Hill K, et al., 'Factors associated with discharge to in-patient rehabilitation', INTERNATIONAL JOURNAL OF STROKE (2016)
Co-authors Christopher Levi
2016 Maguire JM, Holliday E, Levi C, Attia J, Koblar S, Sturm J, et al., 'Helping stroke physicians choose who to thrombolyse -Targeting Optimal Thrombolysis Outcomes" -Preliminary data.', Neurology genetics (2016)
Co-authors Lisa Lincz, Liz Holliday, Christopher Levi, John Attia
2016 Krishnamurthy V, Bivard A, Lin L, Spratt N, Levi C, Parsons M, 'Whole Brain CT Perfusion in Suspected Transient Ischemic Attack and Minor Stroke', CEREBROVASCULAR DISEASES (2016)
Co-authors Andrew Bivard, Mark Parsons, Christopher Levi, Neil Spratt
2016 Kawano H, Bivard A, Lin L, Spratt N, Miteff F, Parsons M, Levi C, 'Contrast Peak Density in Collateral Vessels May Be an Important Factor in Tissue Fate in Acute Ischemic Stroke', CEREBROVASCULAR DISEASES (2016)
Citations Web of Science - 2
Co-authors Neil Spratt, Christopher Levi, Andrew Bivard, Mark Parsons
2016 Kim J, Andrew N, Kilkenny M, Lannin N, Hill K, Grabsch B, et al., 'Changes in Post-Stroke Survival Over Time: New Evidence form the Australian Stroke Clinical Registry', CEREBROVASCULAR DISEASES (2016)
Co-authors Christopher Levi
2016 Ma H, Parsons M, Campbell B, Levi C, Churilov L, Hsu C, et al., 'Extending the Time for Thrombolysis in Emergency Neurological Deficits - The Extend Trial', CEREBROVASCULAR DISEASES (2016)
Co-authors Mark Parsons, Christopher Levi
2016 Demeestere J, Parsons M, Bivard A, Campbell B, McElduff P, Hsu C, et al., 'Tenecteplase versus Alteplase for Stroke Thrombolysis Evaluation Trial (TASTE)', CEREBROVASCULAR DISEASES (2016)
Co-authors Christopher Levi, Mark Parsons, Andrew Bivard
2016 Cadilhac D, Andrew N, Kim J, Kilkenny M, Hill K, Grabsch B, et al., 'Establishment of National Performance Benchmarks for Acute Stroke Care: New Evidence from the Australian Stroke Clinical Registry', CEREBROVASCULAR DISEASES (2016)
Co-authors Christopher Levi
2016 Dewey H, Cadilhac D, Kilkenny M, Kim J, Andrew N, Hill K, et al., 'Quality of Care Over-Time: New Evidence from the Australian Stroke Clinical Registry', CEREBROVASCULAR DISEASES (2016)
Co-authors Christopher Levi
2016 Huang HY, Ma H, Tsai CH, Hsu CY, Parsons M, Levi C, et al., 'Contrast-Induced Nephropathy Is Rare and Clinically Insignificant after Computer Tomography Arteriography and Perfusion Studies among Taiwanese Patients with Acute Ischemic Stroke', CEREBROVASCULAR DISEASES (2016)
Co-authors Mark Parsons, Christopher Levi
2016 Kilkenny M, Lannin N, Anderson C, Dewey H, Levi C, Faux S, et al., 'Stroke Care and Outcomes for Patients Who Require an Interpreter: Evidence from the Australian Stroke Clinical Registry (AuSCR)', CEREBROVASCULAR DISEASES (2016)
Co-authors Christopher Levi
2015 Zareie H, Selmes C, Kawano H, Parsons M, Spratt N, Miteff F, et al., 'Feasibility and Accuracy of Fusion TCCD in Monitoring Acute Stroke Treatment', CEREBROVASCULAR DISEASES (2015) [E3]
Co-authors Christopher Levi, Neil Spratt, Mark Parsons
2015 Campbell B, Mitchell P, Kleinig T, Dewey H, Churilov L, Yassi N, et al., 'Reperfusion and clinical outcome in the EXTEND-IA randomized trial', INTERNATIONAL JOURNAL OF STROKE (2015) [E3]
Co-authors Mark Parsons, Christopher Levi
2015 Campbell B, Mitchell P, Kleinig T, Dewey H, Churilov L, Yassi N, et al., 'Endovascular stent-thrombectomy reduces length of stay and treatment costs within 3 months of stroke', INTERNATIONAL JOURNAL OF STROKE (2015) [E3]
Co-authors Christopher Levi, Mark Parsons
2015 Campbell BCV, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, et al., 'Severe hypoperfusion in the absence of a large ischemic core should not exclude patients from reperfusion therapies', INTERNATIONAL JOURNAL OF STROKE (2015) [E3]
Co-authors Christopher Levi, Mark Parsons
2015 Andrew NE, Kilkenny MF, Lannin NA, Anderson C, Donnan GA, Hill K, et al., 'Does the association between prescription of antihypertensive medication at discharge from acute care hospitals and post-discharge outcomes vary by stroke subtype?', INTERNATIONAL JOURNAL OF STROKE (2015) [E3]
Co-authors Christopher Levi
2015 Rutten-Jacobs LCA, Traylor M, Thijs V, Sudlow C, Rothwell PM, Boncoraglio G, et al., 'Association of MTHFR genotype with lacunar stroke supports causal role for homocysteine', INTERNATIONAL JOURNAL OF STROKE (2015) [E3]
Co-authors Christopher Levi
2015 Cereda CW, Christensen S, Campbell BCV, Mishra NK, Mlynash M, Levi C, et al., 'Optimizing computer tomography perfusion with a benchmarking tool to standardize acute stroke imaging research', INTERNATIONAL JOURNAL OF STROKE (2015) [E3]
Co-authors Mark Parsons, Christopher Levi
2015 Cadilhac DA, Kilkenny MF, Dewey HM, Lannin NA, Levi C, Hill K, et al., 'Understanding in-hospital stroke management and outcomes in the Australian Stroke Clinical Registry (AUSCR)', INTERNATIONAL JOURNAL OF STROKE (2015) [E3]
Co-authors Christopher Levi
2015 Cadilhac D, Kim J, Lannin N, Levi C, Andrew N, Kilkenny M, et al., 'The quality of care provided to patients hospitalised with a transient ischemic attack', INTERNATIONAL JOURNAL OF STROKE (2015) [E3]
Co-authors Christopher Levi
2015 Purvis T, Longworth M, Kilkenny M, Worthington J, Pollack M, Levi C, et al., 'Causes and factors associated with discharge delays from acute stroke care', INTERNATIONAL JOURNAL OF STROKE (2015) [E3]
Co-authors Christopher Levi
2015 Cadilhac DA, Lannin N, Kilkenny MF, Grabsch B, Andrew NE, Kim J, et al., 'Survival advantage from stroke unit care: Evidence from the Australian Stroke Clinical Registry', INTERNATIONAL JOURNAL OF STROKE (2015) [E3]
Co-authors Christopher Levi
2015 Levi C, Lasserson D, Davey A, Quain D, Dewey H, Cadilhac D, et al., 'Investigation and management of transient ischemic attacks and minor strokes presenting in general practice compared to emergency departments - INSIST cohort study findings', INTERNATIONAL JOURNAL OF STROKE (2015) [E3]
Co-authors Parker Magin, Christopher Levi, Neil Spratt
2015 Levi C, Davey A, Lasserson D, Parsons M, Barber AP, Dewey H, et al., 'Presentation patterns of patients with transient ischemic attack (TIA) and minor stroke, compared with those of stroke/TIA mimics', INTERNATIONAL JOURNAL OF STROKE (2015) [E3]
Co-authors Mark Parsons, Christopher Levi, Parker Magin
2015 Delcourt C, Magin P, Parsons M, Jordan L-A, Young A, Quain D, Levi C, 'TRANSIENT, Tele-Response for Acute traNSIent neurological symptoms and evENTs. Project update', INTERNATIONAL JOURNAL OF STROKE (2015) [E3]
Co-authors Christopher Levi, Parker Magin, Mark Parsons
2015 Gardner AJ, Iverson GL, Wojtowicz M, Levi CR, Makdissi M, Quinn TN, et al., 'Sideline Use of the SCAT-3 for Screening Professional Rugby League Players Suspected of Sustaining Concussion' (2015) [E3]
Co-authors Christopher Levi, Andrew Gardner, Peter Stanwell
2015 Gardner AJ, Iverson GL, Wojtowicz MA, Levi CR, Makdissi M, Quinn TN, et al., 'A Systematic Video Analysis of Concussion in the National Rugby League', Neurology (2015) [E3]
Co-authors Peter Stanwell, Christopher Levi, Andrew Gardner
2015 Berling I, Brown SGA, Miteff F, Levi C, Isbister GK, 'Australian elapid envenoming and intracranial haemorrhage', CLINICAL TOXICOLOGY (2015) [E3]
Co-authors Christopher Levi, Geoffrey Isbister
2015 Kable AK, Levi C, Baker A, Pond C, Turner A, 'Discharge processes for stroke patients who are discharged home', 4th Annual NHMRC Symposium on Research Translation jointly with CIPHER (2015) [E3]
Co-authors Ashley Kable, Amanda Baker, Christopher Levi, Dimity Pond
2015 Paul CL, Levi C, Ryan A, Kerr E, Henskens F, Attia J, et al., 'Variation in site 'readiness' and engagement in an implementation trial', 4th Annual NHMRC Symposium on Research Translation jointly with CIPHER (2015) [E3]
Co-authors Rob Sanson-Fisher, Frans Henskens, Christopher Levi, Chris Paul, Catherine Deste, John Attia
2015 Bhaskar S, Bivard A, Parsons M, Nilsson M, Attia J, Stanwell P, Levi C, 'Delay of late-venous phase cortical vein filling in acute ischemic stroke patients' (2015) [E3]
Co-authors Andrew Bivard, Michael Nilsson, John Attia, Christopher Levi, Peter Stanwell, Mark Parsons
2015 Huang X, Fulton R, Parsons M, Levi C, Campbell B, Bladin C, et al., 'Tenecteplase versus alteplase in acute ischemic stroke thrombolysis: A meta-analysis of individual patient data from randomized studies', INTERNATIONAL JOURNAL OF STROKE (2015) [E3]
Co-authors Christopher Levi, Mark Parsons
2015 Bladin C, Levi C, Parsons M, Campbell B, Panagos P, Derdyn C, Creighton F, 'Can we augment stroke thrombolysis? The use of magnetically-Enhanced Diffusion (MED (TM)) of intravenous tPA in Acute Ischemic Stroke', INTERNATIONAL JOURNAL OF STROKE (2015) [E3]
Co-authors Christopher Levi, Mark Parsons
2015 Lin L, Levi C, Parsons M, 'How consistent is reperfusion in predicting good clinical outcome of stroke?', INTERNATIONAL JOURNAL OF STROKE (2015) [E3]
Co-authors Mark Parsons, Christopher Levi
2015 Gardner AJ, Iverson GL, Wojtowicz M, Levi C, Kay-Lambkin F, Schofield PW, et al., 'Magnetic Resonance Spectroscopy findings in retired professional rugby league players.', Sports Psychology Society (2015) [E3]
Co-authors Peter Schofield, Christopher Levi, Peter Stanwell, Andrew Gardner, Frances Kaylambkin
2015 Parsons M, Bivard A, Campbell B, McElduff P, Hsu C, Butcher K, et al., 'Tenecteplase versus Alteplase for Stroke Thrombolysis Evaluation (TASTE) Trial', CEREBROVASCULAR DISEASES (2015) [E3]
Co-authors Christopher Levi, Patrick Mcelduff, Andrew Bivard, Mark Parsons
2015 Makaroff AP, Attia J, Levi C, 'Seasonal variation in cervical arterial dissection in the Hunter New England region, New South Wales: a retrospective cohort study', Connect Physiotherapy Conference 2015: Conference Abstract E-book (2015) [E3]
Co-authors Christopher Oldmeadow, John Attia, Christopher Levi, Lucy Thomas
2015 Fradgley E, Paul C, Bryant J, Collins N, Ackland S, Bellamy D, Levi C, 'ADVANCING COLLABORATIVE QUALITY IMPROVEMENT IN TERTIARY SETTINGS: DO CHRONIC DISEASE OUTPATIENTS AND HEALTH PROFESSIONALS IDENTIFY SIMILAR TYPES AND NUMBERS OF QUALITY INITIATIVES?', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY (2015) [E3]
Co-authors Christopher Levi, Stephen Ackland, Elizabeth Fradgley, Chris Paul
2015 Anderson C, Lavado P, Sharma V, Huang Y, Thang NNH, Robinson T, et al., 'Randomised evaluation of low-dose rtPA and intensive BP lowering in acute ischemic stroke: the enchanted trial', JOURNAL OF THE NEUROLOGICAL SCIENCES (2015)
DOI 10.1016/j.jns.2015.08.1310
Co-authors Christopher Levi
2015 Bivard A, Huang X, Muir K, Levi C, Kalladka D, Moreton F, et al., 'Pooled analysis of Scottish and Australian randomized trials of tenecteplase versus alteplase in stroke', INTERNATIONAL JOURNAL OF STROKE (2015) [E3]
Co-authors Christopher Levi, Andrew Bivard, Mark Parsons, Neil Spratt
2015 Magin P, Najib N, Tapley A, Lasserson D, Quain D, Dewey H, et al., 'A comparison of rural and urban health-seeking behaviour and processes of care in patients with transient ischemic attack and minor stroke', INTERNATIONAL JOURNAL OF STROKE (2015) [E3]
Co-authors Mark Parsons, Parker Magin, Christopher Levi
2015 Parsons M, Bivard A, Campbell B, McElduff P, Hsu C, Butcher K, et al., 'Tenecteplase versus alteplase for stroke thrombolysis evaluation trial', INTERNATIONAL JOURNAL OF STROKE (2015) [E3]
Co-authors Mark Parsons, Patrick Mcelduff, Andrew Bivard, Christopher Levi
2015 Kawano H, Levi C, Inatomi Y, Pagram H, Kerr E, Bivard A, et al., 'International bench marking for acute stroke codes: Thrombolytic therapy access in Australia and Japan', INTERNATIONAL JOURNAL OF STROKE (2015) [E3]
Co-authors Andrew Bivard, Christopher Levi, Neil Spratt, Mark Parsons
2015 Marsden D, Dunn A, Callister R, McElduff P, Levi C, Spratt N, 'An individualised program to increase physical activity in community-dwelling stroke survivors can improve cardiorespiratory fitness and six minute walk test distance: A pilot controlled trial', INTERNATIONAL JOURNAL OF STROKE (2015) [E3]
Co-authors Christopher Levi, Patrick Mcelduff, Neil Spratt, Robin Callister
2015 Hubbard IJ, Tavener M, Thijsen A, Francis L, Grennall C, Levi C, Byles J, 'How do older Australian women experience life after stroke, and how does the WHO 18-item ICF core Set for Stroke compare?', INTERNATIONAL JOURNAL OF STROKE (2015) [E3]
Co-authors Julie Byles, Christopher Levi, Isobel Hubbard, Meredith Tavener
2015 Pagram HA, Levi C, Magin P, 'Recovery from ischemic stroke and transient ischemic attack: The role of stress', INTERNATIONAL JOURNAL OF STROKE (2015) [E3]
Co-authors Christopher Levi, Parker Magin
2015 Levi CR, Campbell BCV, Lindley RI, Nandurkar H, Parsons MW, Hankey G, 'Apixaban and patient management following stroke/TIA: A consensus guide', INTERNATIONAL JOURNAL OF STROKE (2015) [E3]
Co-authors Christopher Levi, Mark Parsons
2015 Gardner A, Levi C, Stanwell P, Iverson GL, 'A video analysis of the use of the 'concussion interchange rule' during the first year of implementation in the National Rugby League.', International Neuropsychological Society (2015) [E3]
Co-authors Andrew Gardner, Christopher Levi, Peter Stanwell
2014 Chan D, Levi C, Pollack M, Cordato D, O'Rourke F, Chen J, et al., 'A randomised controlled trial to evaluate a model of comprehensive stroke care', INTERNATIONAL JOURNAL OF STROKE (2014)
Co-authors Christopher Levi
2014 Cadilhac D, Lannin NA, Kilkenny MF, Churilov L, Kung F, Grabsch B, et al., 'Variances in hospital death mortality: Experiences from the Australian Stroke Clinical Registry (AuSCR)', INTERNATIONAL JOURNAL OF STROKE (2014)
Co-authors Christopher Levi
2014 Cadilhac D, Lannin NA, Kilkenny MF, Kung F, Grabsch B, Donnan G, et al., 'The Australian Stroke Clinical Registry - A national tool responsive to state needs', INTERNATIONAL JOURNAL OF STROKE (2014)
Co-authors Christopher Levi
2014 Joubert J, Hankey G, Levi C, Gonzales G, Olver J, Davis SM, 'Significant risk factor modification in an integrated model of care in stroke survivors', INTERNATIONAL JOURNAL OF STROKE (2014)
Co-authors Christopher Levi
2014 Ang T, Levi C, Ma H, Hsu C, Campbell B, Donnan G, et al., 'Multi-Modal CT in Acute Stroke: Wait for a Serum Creatinine Before Giving Intravenous Contrast? No!', CEREBROVASCULAR DISEASES (2014) [E3]
Co-authors Mark Parsons, Christopher Levi
2014 Lin L, Bivard A, Krishnamurthy V, Levi C, Parsons M, 'Comparison of Whole-Brain CTP and Limited-Coverage CTP', CEREBROVASCULAR DISEASES (2014) [E3]
Co-authors Andrew Bivard, Christopher Levi, Mark Parsons
2014 Lin L, Bivard A, Levi C, Parsons M, 'How to Measure Cross-Modality Reperfusion with Acute CTP and 24-Hour MRP', CEREBROVASCULAR DISEASES (2014) [E3]
Co-authors Christopher Levi, Mark Parsons, Andrew Bivard
2014 Bivard A, Krishnamurthy V, Levi C, Mcelduff P, Miteff F, Spratt N, et al., 'Stroke Thrombolysis: Tissue Is More Important Than Time', CEREBROVASCULAR DISEASES (2014) [E3]
Co-authors Andrew Bivard, Christopher Levi, Neil Spratt, Mark Parsons, Patrick Mcelduff
2014 Bivard A, Krishnamurthy V, Levi C, Mcelduff P, Miteff F, Spratt N, et al., 'Does the Presence of CTP Mismatch Predict Better Outcomes in Thrombolysis-Treated Patients?', CEREBROVASCULAR DISEASES (2014) [E3]
Co-authors Andrew Bivard, Patrick Mcelduff, Christopher Levi, Mark Parsons, Neil Spratt
2014 Bivard A, Krishnamurthy V, Levi C, Mcelduff P, Miteff F, Spratt N, et al., 'Better Stroke Outcomes Despite Worse Baseline Stroke Severity with Combined Clinical and CTP Assessment', CEREBROVASCULAR DISEASES (2014) [E3]
Co-authors Mark Parsons, Christopher Levi, Andrew Bivard, Neil Spratt, Patrick Mcelduff
2014 Ang TE, Levi C, Ma HHK, Hsu CY, Campbell B, Parsons M, 'Multi-modal CT in acute stroke: Should we wait for a serum creatinine before giving IV contrast? No!', INTERNATIONAL JOURNAL OF STROKE (2014)
Citations Web of Science - 2
Co-authors Mark Parsons, Christopher Levi
2014 Sewell C, Jordan L-A, Rudd J, Gray J, Wills J, Bulic T, et al., 'Implementation of a tele-thrombolysis service for acute stroke patients of the Manning Rural Referral Hospital: A quasi-experimental study', INTERNATIONAL JOURNAL OF STROKE (2014)
Co-authors Christopher Levi, Mark Parsons
2014 Ang T, Levi C, Henry M, Hsu C, Campbell B, Donnan G, et al., 'Multi-modal CT in acute stroke: Wait for a serum creatinine before giving intravenous contrast? No?', INTERNATIONAL JOURNAL OF STROKE (2014)
DOI 10.1111/ijs.12374_3
Co-authors Christopher Levi, Mark Parsons
2014 Marsden DL, Dunn A, Callister R, Levi CR, Spratt NJ, 'Measuring cardiorespiratory fitness after stroke via a progressive exercise test: a systematic review', CEREBROVASCULAR DISEASES (2014)
Co-authors Neil Spratt, Christopher Levi, Robin Callister
2014 Sewell C, Garnett A, Marsden D, McElduff P, Parsons M, Levi C, 'Validation of the 'Hunter 8' abbreviated National Institutes of Health Scale score for pre-hospital thrombolysis eligible stroke recognition', INTERNATIONAL JOURNAL OF STROKE (2014) [E3]
Citations Web of Science - 1
Co-authors Mark Parsons, Patrick Mcelduff, Christopher Levi
2014 Bhaskar S, Evans M, Kitsos G, Russel M, Stanwell P, Walker R, et al., 'The influence of initial stroke severity on the likelihood of death at 90 days following acute stroke: A tertiary hospital stroke register study', INTERNATIONAL JOURNAL OF STROKE (2014) [E3]
Co-authors Neil Spratt, Peter Stanwell, Christopher Levi, Mark Parsons
2014 Marsden D, Dunn A, Callister R, McElduff P, Levi C, Spratt N, 'Cardiorespiratory fitness testing and training in stroke survivors: A comparison of peak oxygen consumption results from the upright cycle test, six minute walk test and circuit exercise stations', INTERNATIONAL JOURNAL OF STROKE (2014) [E3]
Co-authors Robin Callister, Christopher Levi, Neil Spratt, Patrick Mcelduff
2014 Middleton S, Comerford D, Lydtin A, Dale S, Cadilhac D, DEste C, et al., 'The Quality in Acute Stroke Care (QASC) Implementation Project: 'To improve is to change; to be perfect is to change often' Winston Churchill', INTERNATIONAL JOURNAL OF STROKE (2014) [E3]
Co-authors Patrick Mcelduff, Catherine Deste, Christopher Levi
2014 Bivard A, Krishnamurthy V, Levi C, McElduff P, Miteff F, Spratt N, et al., 'Stroke thrombolysis: Tissue is more important than time', INTERNATIONAL JOURNAL OF STROKE (2014) [E3]
Co-authors Mark Parsons, Christopher Levi, Patrick Mcelduff, Neil Spratt, Andrew Bivard
2014 Maguire J, Lindgren A, Bevan S, Fernandez-Cadenas I, Hankey G, Jern C, et al., 'GISCOME - Genetic Influences on Ischaemic Stroke Functional Outcome: A genome wide association study', INTERNATIONAL JOURNAL OF STROKE (2014) [E3]
Co-authors Rodney Scott, Christopher Levi
2014 Bivard A, Krishnamurthy V, Levi C, McElduff P, Miteff F, Spratt N, et al., 'Does the presence of CTP mismatch predict better outcomes in thrombolysis-treated patients?', INTERNATIONAL JOURNAL OF STROKE (2014) [E3]
Co-authors Mark Parsons, Andrew Bivard, Neil Spratt, Christopher Levi, Patrick Mcelduff
2014 Zareie H, Selmes C, Kawano H, Parsons M, Spratt N, Miteff F, et al., 'Feasibility and accuracy of fusion TCCD in monitoring acute stroke treatment', INTERNATIONAL JOURNAL OF STROKE (2014) [E3]
Co-authors Christopher Levi, Mark Parsons, Neil Spratt
2014 Lin L, Bivard A, Krishnamurthy V, Levi C, Parsons M, 'Whole-brain CT perfusion measures the acute ischaemic lesion accurately and precisely', INTERNATIONAL JOURNAL OF STROKE (2014) [E3]
Co-authors Andrew Bivard, Mark Parsons, Christopher Levi
2014 Bivard A, Krishnamurthy V, Levi C, McElduff P, Miteff F, Spratt N, et al., 'Better stroke outcomes despite worse baseline stroke severity - The value of a combined clinical and advanced CT selection approach to thrombolysis', INTERNATIONAL JOURNAL OF STROKE (2014) [E3]
Co-authors Patrick Mcelduff, Neil Spratt, Christopher Levi, Mark Parsons, Andrew Bivard
2014 Gunathilake R, Krishnamurthy V, Oldmedow C, Kerr E, Padmakumar C, Attia J, et al., 'Relationships between age, other predictive variables and the 90-day functional outcome after intravenous thrombolysis for acute ischemic stroke', INTERNATIONAL JOURNAL OF STROKE (2014) [E3]
Co-authors John Attia, Christopher Oldmeadow, Mark Parsons, Christopher Levi
2014 Cadilhac D, Lannin NA, Kilkenny M, Kung F, Grabsch B, Donnan G, et al., 'Stroke data collection in the Australian Stroke Clinical Registry - Progress with a purpose', INTERNATIONAL JOURNAL OF STROKE (2014) [E3]
Co-authors Christopher Levi
2014 Lannin NA, Cadilhac D, Kilkenny M, Kung F, Grabsch B, Donnan G, et al., 'Life after stroke - A reflection on patients' experience using data from the Australian Stroke Clinical Registry (AuSCR)', INTERNATIONAL JOURNAL OF STROKE (2014) [E3]
Co-authors Christopher Levi
2014 Kerr E, Sanson-Fisher RW, Paul CL, DEste C, Parsons M, Bladin C, et al., 'Thrombolysis ImPlementation in Stroke (TIPS): Evaluating the effectiveness of a strategy to increase the adoption of best evidence practice: An overview of data collected during the baseline period', INTERNATIONAL JOURNAL OF STROKE (2014) [E3]
Co-authors Rob Sanson-Fisher, Christopher Levi, Mark Parsons, Frans Henskens, Chris Paul, John Attia, Catherine Deste
2014 Marsden D, Dunn A, Callister R, McElduff P, Levi CR, Spratt NJ, 'Can independently ambulant stroke survivors exercise for thirty minutes at a moderate intensity? An observational study', INTERNATIONAL JOURNAL OF STROKE (2014) [E3]
Co-authors Neil Spratt, Patrick Mcelduff, Christopher Levi, Robin Callister
2014 Zareie H, Selmes C, Kawano H, Parsons M, Spratt N, Miteff F, et al., 'Feasibility and accuracy of fusion TCCD in acute stroke treatment', INTERNATIONAL JOURNAL OF STROKE (2014) [E3]
Co-authors Christopher Levi, Mark Parsons, Neil Spratt
2013 Thomas L, Rivett DA, Levi C, 'The effect of selected manual therapy interventions for mechanical neck pain on vertebral and internal carotid arterial blood flow and cerebral inflow', APA 2013 Conference Abstracts eBook (2013) [E3]
Co-authors Lucy Thomas, Darren Rivett, Christopher Levi
2013 Thomas L, Rivett DA, Levi C, Stanwell P, Levi C, 'Recognition of patients presenting with or at risk of craniocervical arterial dissection: preliminary results of a prospective study', APA Conference 2013 Abstract E-Book (2013) [E3]
Co-authors Lucy Thomas, Darren Rivett, Christopher Levi
2013 Rennie JL, Jolly TA, Bateman GA, Michie PT, Levi CR, Parsons MW, Karayanidis F, 'Age-related decline in white matter organisation: Relationship to global cognitive changes in a longitudinal study', Frontiers in Human Neuroscience (2013) [E3]
DOI 10.3389/conf.fnhum.2013.212.00085
Co-authors Mark Parsons, Frini Karayanidis, Pat Michie, Christopher Levi
2013 Bladin C, Levi C, Parsons M, 'Magnetically Enhanced Diffusion (MED) for Improved Efficacy of Thrombolytic Therapy in Acute Ischemic Stroke_A Prospective First in Man Clinical Study', STROKE (2013) [E3]
Co-authors Christopher Levi, Mark Parsons
2013 Yassi N, Campbell BC, Christensen S, Sharma G, Bivard A, Lin L, et al., 'Reduced Cerebral Blood Flow on Acute Whole Brain CT Perfusion Best Predicts Hemorrhagic Transformation', STROKE (2013) [E3]
Co-authors Christopher Levi, Mark Parsons, Andrew Bivard
2013 Campbell BC, Christensen S, Yassi N, Sharma G, Bivard A, Lin L, et al., 'Comparison of Automated Whole Brain CT Perfusion Analysis with Perfusion-Diffusion MRI in Ischemic Stroke', STROKE (2013) [E3]
Co-authors Christopher Levi, Mark Parsons, Andrew Bivard
2013 Karayanidis F, Jolly T, Michie P, Parsons M, Levi C, Heathcote A, 'AGE-RELATED CHANGES IN WHITE MATTER IN FRONTO-PARIETAL AND FRONTO-STRIATAL TRACTS ARE ASSOCIATED WITH DISTINCT MEASURES OF COGNITIVE FLEXIBILITY', PSYCHOPHYSIOLOGY (2013) [E3]
Co-authors Andrew Heathcote, Pat Michie, Frini Karayanidis, Christopher Levi, Mark Parsons
2013 Karayanidis F, Jolly T, Michie P, Levi C, Parsons M, Heathcote A, 'AGE-RELATED CHANGES IN WHITE MATTER IN FRONTO-PARIETAL AND FRONTO-STRIATAL TRACTS ARE ASSOCIATED WITH DISTINCT MEASURES OF COGNITIVE FLEXIBILITY', JOURNAL OF COGNITIVE NEUROSCIENCE (2013) [E3]
Co-authors Frini Karayanidis, Andrew Heathcote, Mark Parsons, Christopher Levi, Pat Michie
2013 Yassi N, Parsons MW, Donnan GA, Christensen S, Levi CR, Desmond PM, et al., 'Infarct core volume on whole brain perfusion CT is predictive of haemorrhagic transformation after stroke', CEREBROVASCULAR DISEASES (2013) [E3]
Co-authors Christopher Levi, Mark Parsons
2013 Bivard A, Krishnamurthy V, Stanwell P, Levi C, Davis S, Parsons M, '3T MR Spectroscopy assessment of metabolic changes in the recently salvaged human ischemic penumbra', CEREBROVASCULAR DISEASES (2013) [E3]
Co-authors Andrew Bivard, Christopher Levi, Peter Stanwell, Mark Parsons
2013 Tomkins AJ, Schleicher N, Nedelmann M, Spratt NJ, 'PLATELET RICH CLOTS ARE RESISTANT TO LYSIS BY THROMBOLYTIC THERAPY IN A RAT MODEL OF EMBOLIC STROKE', CEREBROVASCULAR DISEASES (2013) [E3]
Co-authors Christopher Levi, Neil Spratt
2013 Bivard A, Stanwell P, Spratt N, Levi C, Krishnamurthy V, Davis S, Parsons M, 'Arterial spin labelling versus bolus-tracking CT and MR in hyper-acute ischemic stroke', CEREBROVASCULAR DISEASES (2013) [E3]
Co-authors Christopher Levi, Neil Spratt, Mark Parsons, Andrew Bivard, Peter Stanwell
2013 Marsden DL, Dunn A, Callister R, Levi CR, Spratt NJ, 'Exercise training interventions that are aerobic or include an aerobic component can improve cardiorespiratory fitness after stroke: a systematic review with meta-analysis', CEREBROVASCULAR DISEASES (2013) [E3]
Co-authors Robin Callister, Neil Spratt, Christopher Levi
2013 Middleton S, Levi CR, D'Este C, Grimshaw J, Cadilhac DA, Considine J, et al., 'T-3 Trial protocol: A CRCT evaluating an organisational intervention to improve triage, treatment and transfer of stroke patients in EDs', INTERNATIONAL JOURNAL OF STROKE (2013) [E3]
Citations Web of Science - 2
Co-authors Christopher Levi, Catherine Deste
2013 Bivard A, Stanwell P, Krishnamurthy V, Levi CR, Davis SM, Parsons M, 'Automated mismatch assessment of arterial spin labeling compared to conventional bolus tracking perfusion mismatch', INTERNATIONAL JOURNAL OF STROKE (2013) [E3]
Co-authors Andrew Bivard, Christopher Levi, Peter Stanwell, Mark Parsons
2013 Bivard A, Yassi N, Stanwell P, Krishnamurthy V, Levi CR, Davis SM, Parsons M, 'Spectroscopy of hyperperfused and mildly hypoperfused tissue following ischemic stroke', INTERNATIONAL JOURNAL OF STROKE (2013) [E3]
Co-authors Andrew Bivard, Peter Stanwell, Christopher Levi, Mark Parsons
2013 Lillicrap T, Tahtali M, Neely A, Wang X, Levi CR, Parsons M, et al., 'Validation of a finite element model of heat transfer in the stroke-affected brain against data from humans and non-human primates', INTERNATIONAL JOURNAL OF STROKE (2013) [E3]
Co-authors Andrew Bivard, Christopher Levi, Mark Parsons
2013 Thomas J, Parsons O, Traylor M, Li L, Bevan S, Sudlow C, et al., 'The impact of CCS and TOAST classification systems on genetic associations with ischaemic stroke', INTERNATIONAL JOURNAL OF STROKE (2013) [E3]
Co-authors Christopher Levi, Liz Holliday, John Attia
2013 Lillicrap T, Stanwell P, Neeman T, Parsons M, Spratt N, Levi CR, Lueck C, 'Variation in regional brain temperature as measured by MR thermography in healthy volunteers', INTERNATIONAL JOURNAL OF STROKE (2013) [E3]
Co-authors Mark Parsons, Peter Stanwell, Christopher Levi, Neil Spratt
2013 Marsden DL, Dunn A, Callister R, Levi CR, Spratt NJ, 'Interventions to improve cardiorespiratory fitness after stroke: a systematic review with meta-analysis', INTERNATIONAL JOURNAL OF STROKE (2013) [E3]
Co-authors Robin Callister, Neil Spratt, Christopher Levi
2013 Fuentes S, Sharma V, Huang Y, Lavados P, Lindley R, Pandian J, et al., 'The Enhanced Control of Hypertension ANd Thrombolysis strokE StuDy (ENCHANTED): first year experience regarding possible selection bias', INTERNATIONAL JOURNAL OF STROKE (2013) [E3]
Co-authors Christopher Levi, Mark Parsons
2013 Cadilhac DA, Lannin NA, Anderson CS, Grimly R, Middleton S, Andrew NE, et al., 'Stroke123: overview of a national initiative to monitor and improve stroke care', INTERNATIONAL JOURNAL OF STROKE (2013) [E3]
Co-authors Christopher Levi
2013 Middleton S, Comerford D, Dunne J, Levi CR, Quinn C, Cadilhac DA, et al., 'Quality in Acute Stroke Care (QASC) NSW state-wide implementation project', INTERNATIONAL JOURNAL OF STROKE (2013) [E3]
Co-authors Christopher Levi
2013 Marsden DL, Dunn A, Callister R, Levi CR, Spratt NJ, 'Improving cardiorespiratory fitness after stroke by using exercise interventions that are aerobic or include an aerobic component: A systematic review with meta-analysis', INTERNATIONAL JOURNAL OF STROKE (2013) [E3]
Co-authors Neil Spratt, Robin Callister, Christopher Levi
2013 Middleton S, Levi C, D'Este C, Grimshaw J, Cadilhac D, Considine J, et al., 'T-3 stroke trial protocol: Triage, treatment and transfer of patients with stroke emergency departments', INTERNATIONAL JOURNAL OF STROKE (2013) [E3]
Co-authors Catherine Deste, Christopher Levi, Patrick Mcelduff
2013 Bivard A, Stanwell P, Krishnamurthy V, Levi C, Davis S, Parsons M, 'Automated mismatch assessment of arterial spin labeling compared to conventional bolus tracking perfusion mismatch', International Journal of Stroke (2013) [E3]
DOI 10.1111/ijs.12214
Co-authors Peter Stanwell, Christopher Levi, Mark Parsons, Andrew Bivard
2012 Longworth M, Cadilhac DA, Pollack MR, Purvis T, Kilkenny M, Mohr K, et al., 'Building capacity for stroke services in rural locations: the effectiveness of Stroke Care Coordinators (SSCs) in Australia', Abstract E-book. 2012 European Stroke Conference (2012) [E3]
Co-authors Christopher Levi
2012 Marsden DL, Callister R, Dunn A, Levi CR, Spratt NJ, 'How fit is the stroke survivor? Assessing the fitness levels of stroke survivors by comparing four methods available in the clinical setting. The 'HowFITSS' Trial', Abstract E-book. 2012 European Stroke Conference (2012) [E3]
Co-authors Robin Callister, Neil Spratt, Christopher Levi
2012 Marsden DL, Garnett AR, Parsons MW, Spratt NJ, Watson T, Loudfoot A, et al., 'No thrombolysis service? No worries. A controlled trial of facilitated access for rural stroke patients to a regional thrombolysis centre - The Hunter Rural PAST Protocol', Abstract E-book. 2012 European Stroke Conference (2012) [E3]
Co-authors Mark Parsons, Patrick Mcelduff, Neil Spratt, Christopher Levi
2012 Middleton S, Drury PM, Levi CR, D'Este CA, McElduff P, Dale S, et al., 'The Quality in Acute Stroke Care (QASC) Trial: Processes of care associated with 90-day survival and independence', Abstract E-book. 2012 European Stroke Conference (2012) [E3]
Co-authors Catherine Deste, Christopher Levi, Patrick Mcelduff
2012 Middleton S, Drury P, McElduff P, Ward J, Grimshaw J, Dale S, et al., 'Doing the simple things well: Good nursing care reduces death and dependency', Abstracts. 23rd International Nursing Research Congress (2012) [E3]
Co-authors Catherine Deste, Patrick Mcelduff, Christopher Levi
2012 Jolly TAD, Bateman GA, Levi CR, Parsons MW, Karayanidis F, 'The relationship between arterial and venous pulsatility and microstructural white matter changes', Front. Hum. Neurosci. Conference Abstract: ACNS-2012 Australasian Cognitive Neuroscience Conference (2012) [E3]
Co-authors Frini Karayanidis, Christopher Levi, Mark Parsons
2012 Rennie JL, Jolly TAD, Michie PT, Levi CR, Parsons MW, Lenroot R, Karayanidis F, 'Measures of white matter decline and global cognitive ability in older adults', Front. Hum. Neurosci. Conference Abstract: ACNS-2012 Australasian Cognitive Neuroscience Conference (2012) [E3]
Co-authors Christopher Levi, Frini Karayanidis, Pat Michie, Mark Parsons
2012 Karayanidis F, Jolly TAD, Cooper PS, Levi CR, Parsons MW, Michie PT, 'Disruption to frontal white matter pathways on performance in the task-switching paradigm', Front. Hum. Neurosci. Conference Abstract: ACNS-2012 Australasian Cognitive Neuroscience Conference (2012) [E3]
Co-authors Mark Parsons, Christopher Levi, Patrick Cooper, Frini Karayanidis, Pat Michie
2012 Jolly TAD, Fulham WR, Michie PT, Levi CR, Parsons MW, Karayanidis F, 'Disruption to frontal white matter pathways related to performance on the stop-signal task', Front. Hum. Neurosci. Conference Abstract: ACNS-2012 Australasian Cognitive Neuroscience Conference (2012) [E3]
Co-authors Mark Parsons, Christopher Levi, Frini Karayanidis, Pat Michie
2012 Cooper P, Jolly TAD, Michie PT, Parsons MW, Levi CR, Fulham WR, Karayanidis F, 'The role of white matter tract disruption on age-related decline in cognitive flexibility', Combined Abstracts of 2012 Australian Psychology Conferences (2012) [E3]
Co-authors Frini Karayanidis, Christopher Levi, Pat Michie, Mark Parsons
2012 Thomas L, Rivett DA, Levi CR, 'Risk factors and clinical features of craniocervical arterial dissection. Preliminary results of a prospective study', Journal of Orthopaedic & Sports Physical Therapy (2012) [E3]
Co-authors Christopher Levi, Darren Rivett, Lucy Thomas
2012 Thomas L, Rivett DA, Levi CR, 'The effect of selected manual therapy interventions for mechanical neck pain on vertebral and internal carotid arterial blood flow and total cerebral perfusion', Journal of Orthopaedic & Sports Physical Therapy (2012) [E3]
Co-authors Christopher Levi, Lucy Thomas, Darren Rivett
2012 Levi CR, 'Recent advances in stroke genetics', Cerebrovascular Diseases (2012) [E3]
Co-authors Christopher Levi
2012 Longworth M, Cadilhac DA, Pollack M, Purvis T, Kilkenny M, Mohr K, Levi CR, 'Building capacity for stroke services in rural locations: The effectiveness of Stroke Care Coordinators in Australia', INTERNATIONAL JOURNAL OF STROKE (2012) [E3]
Co-authors Christopher Levi
2012 Drury P, Quinn C, McInnes L, Hardy J, Levi CR, D'Este C, et al., 'Implementation of an evidence-based treatment protocol to manage dysphagia in acute stroke: QASC, a cluster randomised controlled trial', INTERNATIONAL JOURNAL OF STROKE (2012) [E3]
Co-authors Catherine Deste, Christopher Levi
2012 Williams JM, Navin TJ, Levi CR, Jude M, 'Recombinant tissue plasminogen activator (rt-PA) utilisation by rural clinicians in acute ischaemic stroke: An audit of current practice and clinical outcomes', INTERNATIONAL JOURNAL OF STROKE (2012) [E3]
Co-authors Christopher Levi
2012 Marsden DL, Dunn A, Callister R, Levi CR, Spratt NJ, 'Measuring cardiorespiratory fitness and oxygen consumption after stroke - A Systematic Review', International Journal of Stroke (2012) [E3]
Co-authors Robin Callister, Neil Spratt, Christopher Levi
2012 Marsden DL, Dunn A, Callister R, Levi CR, Spratt NJ, 'Assessing stroke survivors' cardiorespiratory fitness - A comparison of four methods available in the clinical setting: Preliminary results from the 'How Fit is the Stroke Survivor?' (HowFITSS?) trial', International Journal of Stroke (2012) [E3]
Co-authors Neil Spratt, Robin Callister, Christopher Levi
2012 Campbell BCV, Christensen S, Tress BM, Desmond PM, Parsons MW, Barber PA, et al., 'Insights into the relationship of perfusion-diffusion mismatch and leptomeningeal collateral quality - Simultaneous assessment through novel visualization of perfusion imaging', International Journal of Stroke (2012) [E3]
Citations Web of Science - 1
Co-authors Mark Parsons, Christopher Levi
2012 Thomas LH, Rivett DA, Parsons MW, Levi CR, 'Radiological features of craniocervical arterial dissection and topography of the resultant infarct: Relation with risk factors', International Journal of Stroke (2012) [E3]
Co-authors Lucy Thomas, Christopher Levi, Mark Parsons, Darren Rivett
2012 Bivard A, Parsons MW, 'Defining acute ischemic stroke tissue pathophysiology using 320 slice CT perfusion', International Journal of Stroke (2012) [E3]
Co-authors Christopher Levi, Andrew Bivard, Mark Parsons
2012 Karayanidis F, Jolly TAD, Bateman GA, Michie PT, Parsons MW, Levi CR, 'Structural brain changes associated with pulse-wave encephalopathy', International Journal of Stroke (2012) [E3]
Co-authors Pat Michie, Mark Parsons, Frini Karayanidis, Christopher Levi
2012 Middleton S, Drury P, Levi CR, D'Este CA, McElduff P, Dale S, et al., 'What processes of clinical care are associated with 90-day survival and independence? Results from the Quality in Acute Stroke Care QASC Trial', International Journal of Stroke (2012) [E3]
Citations Web of Science - 1
Co-authors Patrick Mcelduff, Catherine Deste, Christopher Levi
2012 Karayanidis F, Cooper P, Jolly TAD, Michie PT, Parsons MW, Levi CR, Fulham WR, 'The influence of white matter changes with ageing and mild ischemic attacks on cognitive flexibility', International Journal of Stroke (2012) [E3]
Co-authors Frini Karayanidis, Patrick Cooper, Mark Parsons, Pat Michie, Christopher Levi
2012 Williams JM, Levi CR, Jude M, 'Recombinant tissue plasminogen activator (rt-PA) utilisation by rural clinicians in ischaemic stroke: A survey of barriers and enablers', International Journal of Stroke (2012) [E3]
Co-authors Christopher Levi
2012 Dunn A, Marsden DL, Spratt NJ, Levi CR, Callister R, 'Does knee strength affect walking speed, distance and fitness levels following stroke? Preliminary results from the 'How Fit is the Stroke Survivor?' (HowFITSS?) trial', International Journal of Stroke (2012) [E3]
Co-authors Christopher Levi, Neil Spratt, Robin Callister
2012 Garnett AR, Marsden DL, Parsons MW, Spratt NJ, Watson T, Loudfoot AR, et al., 'The Hunter Rural PAST Protocol: An innovative and effective partnership between ambulance and a regional thrombolysis centre to facilitate access for rural stroke patient to thrombolysis', International Journal of Stroke (2012) [E3]
Co-authors Patrick Mcelduff, Neil Spratt, Christopher Levi, Mark Parsons
2012 Lin L, Bivard A, Kemp D, Parsons MW, Levi CR, 'Comparison of perfusion CT and MR in hyperacute stroke', International Journal of Stroke (2012) [E3]
Co-authors Andrew Bivard, Christopher Levi, Mark Parsons
2012 Bivard A, Levi CR, Parsons MW, 'Assessing the variability of CTP post processing techniques to define the acute infarct core and penumbra', Abstract E-book. 2012 European Stroke Conference (2012) [E3]
Co-authors Mark Parsons, Christopher Levi, Andrew Bivard
2012 Bivard A, Stanwell PT, Levi CR, Parsons MW, 'Clinical utility of subacute Arterial Spin Labelling in stroke', Abstract E-book. 2012 European Stroke Conference (2012) [E3]
Co-authors Mark Parsons, Andrew Bivard, Peter Stanwell, Christopher Levi
2012 Cadilhac DA, Lannin N, Lim J, Price C, Faux S, Levi CR, et al., 'Randomised comparative efficiency of telephone versus mail follow-up in the Australian Stroke Clinical Registry (AuSCR)', Abstract E-book. 2012 European Stroke Conference (2012) [E3]
Co-authors Christopher Levi
2012 Cadilhac DA, Purvis T, Kilkenny MF, Longworth M, Pollack MR, Mohr K, et al., 'The effectiveness of the Rural Stroke Project: Impact on clinical care and patient outcomes', Abstract E-book. 2012 European Stroke Conference (2012) [E3]
Co-authors Christopher Levi
2011 Maguire JM, Holliday EG, Sturm J, Golledge J, Lewis M, Koblar S, et al., 'Australian stroke genetics collaborative: Genetic associations with ischaemic stroke functional outcome', International Journal of Stroke (2011) [E3]
Co-authors Mark Parsons, John Attia, Liz Holliday, Rodney Scott, Lisa Lincz, Pablo Moscato, Christopher Levi
2011 Bivard A, Spratt NJ, Levi CR, Parsons MW, 'CTP thresholds to detect acute ischeamic stroke tissue pathophysiology', International Journal of Stroke (2011) [E3]
Co-authors Neil Spratt, Christopher Levi, Andrew Bivard, Mark Parsons
2011 Cadilhac D, Kilkenny M, Purvis T, Longworth M, Gill M, Pollack M, Levi CR, 'The New South Wales Rural Stroke Project: Does implementation of stroke service enhancements improve stroke care in rural hospitals?', International Journal of Stroke (2011) [E3]
Co-authors Christopher Levi
2011 Beath A, Bivard A, McElduff P, Parsons MW, Levi CR, 'Clinical predictors of outcome in acute ischaemic stroke patients treated with intravenous tissue plasminogen activator (tPA)', International Journal of Stroke (2011) [E3]
Co-authors Patrick Mcelduff, Mark Parsons, Andrew Bivard, Christopher Levi
2011 Cadilhac D, Lannin N, Anderson C, Kilkenny M, Lim J, Levi CR, et al., 'Australian Stroke Clinical Registry: Management and outcome of patients with transient ischaemic attack (TIA)', International Journal of Stroke (2011) [E3]
Co-authors Christopher Levi
2011 Campbell B, Christensen S, Levi CR, Desmond P, Donnan G, Davis G, Parsons MW, 'Comparison of CT perfusion to multimodal MRI in ischemic stroke', International Journal of Stroke (2011) [E3]
Co-authors Mark Parsons, Christopher Levi
2011 Dale S, Levi CR, D'Este CA, Griffiths R, Grimshaw J, Ward J, Middleton S, 'Maximising uptake of clinical protocols to manage fever, hyperglycaemia and swallowing in acute stroke: Assessing barriers and enablers', International Journal of Stroke (2011) [E3]
Co-authors Christopher Levi, Catherine Deste
2011 Fuentes S, Huang Y, Wang J, Sharma V, Nguyen HT, Pandian J, et al., 'The Enhanced Control of Hypertension ANd Thrombolysis strokE StuDy (ENCHANTED): Part A - Rationale for a trial of low dose rtPA', International Journal of Stroke (2011) [E3]
Co-authors Christopher Levi
2011 Fuentes S, Huang Y, Wang J, Sharma V, Nguyen HT, Pandian J, et al., 'The Enhanced Control of Hypertension ANd Thrombolysis strokE StuDy (ENCHANTED): Part B - Rationale for a trial of early intensive blood pressure lowering after use of rtPA', International Journal of Stroke (2011) [E3]
Co-authors Christopher Levi, Mark Parsons
2011 Sheedy R, Bernhardt J, Kilkenny M, Levi CR, Longworth M, Cadilhac D, 'Allied health assessments are more common for patients with acute ischaemic stroke compared to intracerebral haemorrhage', International Journal of Stroke (2011) [E3]
Co-authors Christopher Levi
2011 O'Brien W, Chung K, Levi CR, Spratt NJ, Parsons MW, 'Comparative study of Multimodal Computed Tomography (MdCT) and Magnetic resonance imaging (MRI) in Transient ischaemic attack and minor stroke patient', International Journal of Stroke (2011) [E3]
Co-authors Christopher Levi, Mark Parsons, Neil Spratt
2011 Menon B, O'Brien W, Bivard A, Levi CR, Spratt NJ, Parsons MW, 'Detailed anatomic and physiologic assessment of leptomeningeal collaterals in acute ischemic stroke patients using dynamic time resolved 320 slice CT angiography', International Journal of Stroke (2011) [E3]
Co-authors Christopher Levi, Neil Spratt, Andrew Bivard, Mark Parsons
2011 Lannin N, Cadilhac D, Anderson C, Lim J, Price C, Faux S, et al., 'Community follow-up of stroke survivors in the Australian Stroke Clinical Registry (AuSCR)', International Journal of Stroke (2011) [E3]
Co-authors Christopher Levi
2011 Hunter AJ, Snodgrass SN, Quain DA, Parsons MW, Levi CR, 'Orthostatic variation in transcranial Doppler measured cerebral blood flow velocity 24 hours post acute ischaemic stroke', International Journal of Stroke (2011) [E3]
Co-authors Mark Parsons, Suzanne Snodgrass, Christopher Levi
2011 Lillicrap T, Jyoti R, Levi CR, Parsons MW, Spratt NJ, Stanwell P, Lueck C, 'Temperature measurements using MR spectroscopy: Validation and calibration in healthy volunteers', International Journal of Stroke (2011) [E3]
Co-authors Neil Spratt, Mark Parsons, Christopher Levi
2011 Russell ML, Evans MK, Royan AT, Magin PJ, Lasserson D, Attia JR, et al., 'Referral and triage of patients with TIAs to an acute access clinic: Risk-stratification performance in an Australian setting', International Journal of Stroke (2011) [E3]
Co-authors Patrick Mcelduff, Mark Parsons, John Attia, Christopher Levi, Parker Magin, Neil Spratt
2011 Thomas L, Rivett DA, Levi CR, 'Risk factors and clinical presentation of craniocervical arterial dissection. A prospective study: Preliminary results', Physiotherapy: Abstracts, World Physical Therapy 2011 (2011) [E3]
Citations Scopus - 12Web of Science - 12
Co-authors Lucy Thomas, John Attia, Darren Rivett, Christopher Levi
2011 Thomas L, Rivett DA, Levi CR, 'Risk factors and clinical presentation of craniocervical arterial dissection: Preliminary results of a prospective study', APA Physiotherapy Conference 2011 (2011) [E3]
Co-authors Darren Rivett, Christopher Levi, Lucy Thomas
2011 Campbell BC, Christensen S, Levi CR, Desmond PM, Donnan GA, Davis SM, Parsons MW, 'Predicting infarct core using CT perfusion - comparison of CT perfusion parameters to concurrent diffusion MRI', Stroke (2011) [E3]
Co-authors Christopher Levi, Mark Parsons
2011 Middleton S, Dale S, Levi CR, Griffiths R, Grimshaw J, Ward J, D'Este CA, 'Barriers and enablers to implementing protocols for fever, hyperglycaemia and swallowing dysfunction in acute stroke', Stroke (2011) [E3]
Co-authors Christopher Levi, Catherine Deste
2011 Menon BK, O'Brien W, Bivard A, Levi CR, Spratt NJ, Parsons MW, 'Anatomic and physiologic assessment of leptomeningeal collaterals in acute ischemic stroke patients using dynamic time resolved 320 slice CT angiography', Stroke (2011) [E3]
Co-authors Mark Parsons, Christopher Levi, Andrew Bivard, Neil Spratt
2011 Middleton S, Ward J, Grimshaw J, Griffiths R, D'Este CA, Dale S, et al., 'Does a team base knowledge transfer intervention to manage fever, hyperglycaemia and swallowing dysfunction, improve 90-day outcomes following stroke?', Stroke (2011) [E3]
Co-authors Patrick Mcelduff, Catherine Deste, Christopher Levi
2011 Bivard A, Levi CR, Spratt NJ, Parsons MW, 'Delayed perfusion predicts the volume of the perfusion lesion', Stroke (2011) [E3]
Co-authors Neil Spratt, Mark Parsons, Andrew Bivard, Christopher Levi
2011 Christensen S, Campbell B, Parsons MW, De Silva DA, Ebinger M, Butcher K, et al., 'High tmax values on perfusion MRI often reflect low CBV - A pathophysiological link between the malignant perfusion profile and poor outcome?', Stroke (2011) [E3]
Citations Web of Science - 1
Co-authors Mark Parsons, Christopher Levi
2011 Campbell BC, Tu HT, Christensen S, Desmond PM, Levi CR, Bladin CF, et al., 'Diffusion imaging 24 hours after stroke onset accurately represents final infarct volume', Stroke (2011) [E3]
Co-authors Christopher Levi, Mark Parsons
2011 Lannin N, Cadilhac D, Anderson C, Lim J, Price C, Faux S, et al., 'Life after Stroke: Community follow-up of Australian survivors of stroke', Proceedings of the 24th Occupational Therapy Australia National Conference (2011) [E3]
Co-authors Christopher Levi
2011 Bivard A, Spratt NJ, Levi CR, Parsons MW, 'Perfusion CT predicts subsequent tissue and clinical outcome in hyperacute ischemic stroke', Cerebrovascular Diseases (2011) [E3]
Co-authors Mark Parsons, Neil Spratt, Andrew Bivard, Christopher Levi
2011 Cadilhac DA, Lannin NA, Anderson CS, Levi CR, Price C, Faux S, Donnan GA, 'Management and outcome of patients admitted with transient ischaemic attack (TIA): The Australian Stroke Clinical Registry Experience', Cerebrovascular Diseases (2011) [E3]
Co-authors Christopher Levi
2011 Campbell BCV, Christensen S, Levi CR, Desmond PM, Donnan GA, Davis SM, Parsons MW, 'Predicting infarct core using CT perfusion - Cerebral blood flow thresholds perform best', Cerebrovascular Diseases (2011) [E3]
Co-authors Mark Parsons, Christopher Levi
2011 Dale S, Middleton S, Levi CR, D'Este CA, Griffiths R, Grimshaw J, Ward J, 'Challenges of a large cluster randomised controlled trial: Barriers and enablers to implementing protocols for fever, hyperglycaemia and swallowing dysfunction in the quality in acute stroke (QASC) Project', Cerebrovascular Diseases (2011) [E3]
Co-authors Catherine Deste, Christopher Levi
2011 Drury P, Levi CR, D'Este CA, Dale S, Griffiths R, Grimshaw J, et al., 'The QASC cluster randomised controlled trial of an intervention to improve management of fever, hyperglycaemia and swallowing dysfunction in acute stroke: Did clinician behaviour change?', Cerebrovascular Diseases (2011) [E3]
Co-authors Patrick Mcelduff, Catherine Deste, Christopher Levi
2011 Marsden DL, Garnett AR, Watson T, McElduff P, Levi CR, Parsons MW, 'In the field stroke assessment tool for paramedics: The 'Hunter 8'', Cerebrovascular Diseases (2011) [E3]
Co-authors Patrick Mcelduff, Christopher Levi, Mark Parsons
2011 Parsons MW, Bivard A, Campbell B, Chong KK, Miteff F, Bladin C, et al., 'Tenecteplase versus alteplase for acute ischaemic stroke: An imaging based efficacy trial', Cerebrovascular Diseases (2011) [E3]
Co-authors Andrew Bivard, Mark Parsons, Christopher Levi
2011 Shiue I, Marsden DL, Spratt NJ, Matzarakis A, McElduff P, Anderson CS, Levi CR, 'Psychologically equivalent temperature and stroke attack rates', Cerebrovascular Diseases (2011) [E3]
Co-authors Neil Spratt, Patrick Mcelduff, Christopher Levi
2011 Middleton S, Levi C, D'Este C, Dale S, Drury P, Griffiths R, et al., 'THE QASC CLUSTER RANDOMISED CONTROLLED TRIAL OF A TEAM-BASED INTERVENTION TO IMPROVE MANAGEMENT OF FEVER, HYPERGLYCAEMIA AND SWALLOWING DYSFUNCTION IN ACUTE STROKE: PATIENT 90-DAY OUTCOMES', Cerebrovascular Diseases (2011)
DOI 10.1159/000329448
Co-authors Christopher Levi, Catherine Deste, Patrick Mcelduff
2010 Perez De La Ossa N, Chandra RV, Campbell BCV, Christensen S, Collins M, Parsons MW, et al., 'Leukoaraiosis is not an independent risk factor for parenchymal hemorrhage after thrombolysis', Cerebrovascular Diseases: European Stroke Conference (2010) [E3]
Co-authors Christopher Levi, Mark Parsons
2010 Middleton S, Levi CR, D'Este CA, Dale S, Griffiths R, Grimshaw J, et al., '90-Day mortality and morbidity post- acute stroke in New South Wales, Australia: pre-intervention results from the quality in acute stroke care (QASC) cluster trial', Cerebrovascular Diseases: European Stroke Conference (2010) [E3]
Co-authors Catherine Deste, Christopher Levi
2010 McVerry F, Levi CR, Muir KW, Parsons MW, 'Detection of penumbra and arterial occlusions using multimodal CT - where should therapy be targeted?', Cerebrovascular Diseases: European Stroke Conference (2010) [E3]
Co-authors Mark Parsons, Christopher Levi
2010 Levi CR, Chambers BR, Young D, Stork J, Abbott A, Wlodarczyk JH, et al., 'The efficacy and safety of 10% dextran 40 in the prevention of stroke complicating carotid endarterectomy - the dextran in carotid endarterectomy (DICE) trial', Cerebrovascular Diseases: European Stroke Conference (2010) [E3]
Co-authors Mark Parsons, Christopher Levi
2010 Hubbard IJ, Budd TW, Carey LM, McElduff P, Levi CR, Parsons MW, 'Intensive behavioural upper limb training in acute stroke: an RCT of functional outcomes and brain reorganisation', Cerebrovascular Diseases: European Stroke Conference (2010) [E3]
Co-authors Christopher Levi, Bill Budd, Isobel Hubbard, Patrick Mcelduff, Mark Parsons
2010 Campbell BCV, Costello C, Christensen S, Ebinger M, Parsons MW, Desmond PM, et al., 'Acute infarct hyperintensity is almost universal beyond 3 hours and does not predict hemorrhagic transformation', Cerebrovascular Diseases: European Stroke Conference (2010) [E3]
Co-authors Christopher Levi, Mark Parsons
2010 Campbell BCV, Christensen S, Tu H, Desmond PM, Levi CR, Bladin CF, et al., 'Diffusion imaging 24 hours after stroke onset accurately represents final infarct volume', Cerebrovascular Diseases: European Stroke Conference (2010) [E3]
Co-authors Mark Parsons, Christopher Levi
2010 Campbell BCV, Christensen S, Desmond PM, Parsons MW, Barber PA, De Silva DA, et al., 'Major infarct growth beyond 6 hours is associated with collateral circulation failure', Cerebrovascular Diseases: European Stroke Conference (2010) [E3]
Co-authors Christopher Levi, Mark Parsons
2010 Cadilhac DA, Lannin NA, Anderson CS, Levi CR, Faux S, Price C, et al., 'The Australian Stroke Clinical Registry: achievements in the first year', Cerebrovascular Diseases: European Stroke Conference (2010) [E3]
Co-authors Christopher Levi
2010 Cadilhac DA, Kilkenny MF, Longworth M, Pollack MR, Levi CR, 'The metropolitan-rural divide for stroke ourcomes and the impact of stroke units', Cerebrovascular Diseases: European Stroke Conference (2010) [E3]
Co-authors Christopher Levi
2010 Bivard A, McElduff P, Spratt NJ, Levi CR, Parsons MW, 'Validating perfusion-computed tomography in defining extent of irreversible brain ischemia', Circulation (2010) [E3]
Co-authors Mark Parsons, Christopher Levi, Neil Spratt, Andrew Bivard, Patrick Mcelduff
2010 Lillicrap T, Stanwell P, Parsons MW, Spratt NJ, Hudson S, Levi CR, 'MR spectroscopy in brain temperature measurement and application to induced hypothermia therapy', Circulation (2010) [E3]
Co-authors Peter Stanwell, Christopher Levi, Neil Spratt, Mark Parsons
2010 Maguire JM, Thakkinstian A, Levi CR, Lincz L, Bissett KE, Sturm J, et al., 'Genetic influences on ischemic stroke 90-day functional outcome: A novel association', Circulation (2010) [E3]
Co-authors Rodney Scott, Christopher Levi, Lisa Lincz, John Attia
2010 Tu HT, Campbell BC, Christensen S, Butcher KS, Collins M, Parsons MW, et al., 'The Effects of Atrial Fibrillation on Infarct Evolution and Outcome', STROKE (2010) [E3]
Citations Web of Science - 1
Co-authors Mark Parsons, Christopher Levi
2010 Christensen S, Parsons MW, De Silva DA, Ebinger M, Butcher K, Fink J, et al., 'Testing the mismatch hypothesis in the randomized EPITHET data set: The effect of treatment, mismatch and their interaction on infarct growth', Stroke (2010) [E3]
Citations Web of Science - 3
Co-authors Mark Parsons, Christopher Levi
2010 Bivard A, McElduff P, Levi CR, Spratt NJ, Parsons MW, 'Defining the extent of irreversible brain ischemia using perfusion computed tomography', Stroke (2010) [E3]
Citations Web of Science - 1
Co-authors Patrick Mcelduff, Mark Parsons, Neil Spratt, Andrew Bivard, Christopher Levi
2010 Campbell BC, Christensen S, Parsons MW, Desmond PM, Barber PA, Butcher KS, et al., 'Very low cerebral blood volume predicts hemorrhagic transformation better than diffusion lesion volume in acute ischemic stroke', Stroke (2010) [E3]
Citations Web of Science - 1
Co-authors Mark Parsons, Christopher Levi
2010 Lillicrap TP, Hudson S, Stanwell P, Parsons MW, Spratt NJ, Levi CR, 'MR spectroscopy and diffusion-weighted MRI can accurately measure both reduced and increased brain temperature', Stroke (2010) [E3]
Co-authors Mark Parsons, Christopher Levi, Peter Stanwell, Neil Spratt
2009 McLeod DD, Spratt NJ, Levi CR, Beautement S, Roworth B, Buxton D, et al., 'Experimental validation of perfusion computed tomography in acute middle cerebral artery occlusion', ACBRC 2009 Abstracts (2009) [E3]
Co-authors Neil Spratt, Mark Parsons, Christopher Levi, Damian Mcleod
2009 McLeod DD, Parsons MW, Levi CR, Beautement S, Roworth B, Buxton D, et al., 'An experimental model to investigate CT brain perfusion after stroke', ANS 2009 Abstracts: Posters (2009) [E3]
Co-authors Christopher Levi, Neil Spratt, Mark Parsons, Damian Mcleod
2009 Thomas L, Rivett DA, Levi CR, 'Risk factors and clinical features associated with craniocervical arterial dissection', APA Conference Week Abstracts (2009) [E3]
Co-authors Lucy Thomas, Darren Rivett, Christopher Levi
2009 Butcher K, Christensen S, Parsons MW, De Silva D, Ebinger M, Levi CR, et al., 'Post-treatment blood pressure control predicts thrombolysis related hemorrhagic transformation', Stroke (2009) [E3]
DOI 10.1161/strokeaha.108.000015
Citations Web of Science - 1
Co-authors Christopher Levi, Mark Parsons
2009 Christensen S, Parsons MW, De Silva D, Ebinger M, Butcher K, Fink J, et al., 'Optimising MR criteria for penumbral selection trials', Stroke (2009) [E3]
DOI 10.1161/strokeaha.108.000015
Citations Web of Science - 6
Co-authors Christopher Levi, Mark Parsons
2009 McLeod DD, Spratt NJ, Levi CR, Beautement S, Roworth B, Buxton D, et al., 'Perfusion computed tomography for acute stroke: A model for experimental validation', Cerebrovascular Diseases (2009) [E3]
DOI 10.1159/000221776
Co-authors Christopher Levi, Mark Parsons, Neil Spratt, Damian Mcleod
2009 Brekenfeld C, De Silva DA, Christensen S, Churilov L, Parsons MW, Levi CR, et al., 'Dual target (mismatch and vessel obstruction) at baseline MRI does not improve stroke patient selection for thrombolysis 3-6 h', Cerebrovascular Diseases (2009) [E3]
DOI 10.1159/000221772
Co-authors Mark Parsons, Christopher Levi
2009 Butcher K, Christensen S, Parsons MW, De Silva D, Ebinger M, Levi CR, et al., 'Hemorrhagic transformation in the echoplanar imaging thrombolysis evaluation trial (EPITHET) is predicted by post-treatment blood pressure control and infarct volume', Cerebrovascular Diseases (2009) [E3]
DOI 10.1159/000221772
Co-authors Christopher Levi, Mark Parsons
2009 Campbell BCV, Christensen S, Butcher KS, Gordon I, Parsons MW, Desmond PM, et al., 'Very low cerebral blood volume (VLCBV) predicts hemorrhagic transformation better than DWI volume in acute ischemic stroke', Cerebrovascular Diseases (2009) [E3]
DOI 10.1159/000221773
Co-authors Mark Parsons, Christopher Levi
2009 Maguire J, Thakkinstian A, Attia JR, Lincz L, Bisset L, Sturm J, et al., 'Impact of COX-2 RS5275, RS20417 and GPIIIA RS5918 polymorphisms on 90 day ischaemic stroke functional outcome: A novel association', Cerebrovascular Diseases (2009) [E3]
DOI 10.1159/000221772
Co-authors John Attia, Rodney Scott, Lisa Lincz, Christopher Levi
2009 Thomas L, Rivett DA, Levi CR, 'Factors affecting the safety of cervical manipulation', Manual Therapy (2009) [E3]
Co-authors Christopher Levi, Lucy Thomas, Darren Rivett
2008 Budd TW, Parsons MW, Hubbard IJ, Carey L, Levi CR, 'A longitudinal fMRI study of cortical sensorimotor reorganization in stroke recovery', NeuroImage (2008) [E3]
Co-authors Isobel Hubbard, Christopher Levi, Mark Parsons, Bill Budd
2008 Miteff F, Parsons MW, Bateman GA, Spratt NJ, Levi CR, 'Does collateral vessel status on CT angiography add to perfusion CT in the prediction of outcome after acute ischaemc stroke?', Internal Medicine Journal (2008) [E3]
DOI 10.1111/j.1445-5994.2008.01755_7.x
Co-authors Mark Parsons, Neil Spratt, Christopher Levi
2008 Christensen S, Parsons MW, De Silva DA, Ebinger M, Butcher K, Fink J, et al., 'Optimizing mismatch definitions in acute stroke MRI: An epithet post hoc study', Internal Medicine Journal (2008) [E3]
DOI 10.1111/j.1445-5994.2008.01755_7.x
Co-authors Mark Parsons, Christopher Levi
2008 Gill M, Marsden D, Pollack M, Levi CR, Longworth M, Cadilhac D, et al., 'From rhetoric to reality: Implementing organised stroke care in rural New South Wales (NSW): The NSW Rural Stroke Project', Internal Medicine Journal (2008) [E3]
DOI 10.1111/j.1445-5994.2008.01756.x
Co-authors Christopher Levi
2008 Selmes C, Levi CR, Parsons MW, Miteff F, 'The incidence of anterior cerebral artery flow reversal in high-grade internal carotid artery stenotic disease or occlusion', Internal Medicine Journal (2008) [E3]
DOI 10.1111/j.1445-5994.2008.01756.x
Co-authors Mark Parsons, Christopher Levi
2008 Thomas L, Levi C, Rivett DA, 'Risk factors and natural history of craniocervical arterial dissection. Interactive poster presented.', 9th International Conference of the International Federation of Orthopaedic Manipulative Therapists (IFOMT) Absracts CD. (2008) [E3]
Co-authors Lucy Thomas, Darren Rivett, Christopher Levi
2008 Desilva DA, Ebinger M, Christensen S, Levi CR, Parsons MW, Peeters A, et al., 'The impact of diabetes and admission in blood glucose on outcomes in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET)', Cerebrovascular Diseases (2008) [E3]
DOI 10.1159/000132093
Co-authors Mark Parsons, Christopher Levi
2008 Ebinger M, Christensen S, Desilva DA, Parsons MW, Levi CR, Peeters A, et al., 'Expediting MRI-based proof of concept stroke trials using an earlier primary endpoint', Cerebrovascular Diseases (2008) [E3]
DOI 10.1159/000132088
Co-authors Christopher Levi, Mark Parsons
2007 Maguire J, Sturm J, Attia JR, Whyte S, Bisset L, Lincz L, et al., 'A case-control genetic association study to examine platelet glycoprotein polymorphisms and ischaemic stroke risk', Internal Medicine Journal (2007) [E3]
Co-authors Lisa Lincz, John Attia, Christopher Levi, Mark Parsons
2005 Selmes C, Evans MK, Levi C, Parsons M, Royan A, Russell M, et al., 'PREVALENCE OF INTRACRANIAL LARGE ARTERY DISEASE IN THE HUNTER REGION', Internal Medicine Journal (2005)
Co-authors Mark Parsons, Christopher Levi
2005 Evans MK, russell M, royan A, moore A, parsons M, levi C, 'THE ACUTE STROKE NURSE: AN INTEGRAL PART OF THE STROKE TEAM', Internal Medicine Journal (2005)
Co-authors Mark Parsons, Christopher Levi
2005 Butcher KS, Lee SB, Parsons M, Levi C, Allport L, Prosser J, et al., 'Increased blood volume maintains viability in tissue with isolated focal swelling on CT in acute stroke', STROKE (2005)
Citations Web of Science - 4
Co-authors Christopher Levi, Mark Parsons
2004 Abbott AL, Chambers BR, Stork JL, Levi CR, Selmes CM, Bladin CF, Donnan GA, 'High-grade asymptomatic carotid stenosis: Is it benign?', STROKE (2004)
Co-authors Christopher Levi
2004 Butcher KS, Macgregor L, Parsons MW, Barber PA, Levi C, Chalk J, et al., 'Multiple definitions of PWI-DWI mismatch reliably predict infarct growth', STROKE (2004)
Citations Web of Science - 2
Co-authors Mark Parsons, Christopher Levi
2004 Butcher KS, Parsons M, Barber A, Newcastle HH, Levi C, Chalk J, et al., 'The frequency of perfusion-diffusion mismatch decreases with objective definition', STROKE (2004)
Citations Web of Science - 2
Co-authors Christopher Levi, Mark Parsons
2004 Abbott AL, Chambers BR, Stork JL, Levi CR, Selmes CM, Bladin CF, Donnan GA, 'Embolic Signal Detection and Prediction of Ipsilateral Ischaemic Symptoms in Patients with High-grade Asymptomatic Carotid Stenosis', Embolic Signal Detection and Prediction of Ipsilateral Ischaemic Symptoms in Patients with High-grade Asymptomatic Carotid Stenosis (2004) [E3]
Co-authors Christopher Levi
2004 Abbott AL, Chambers BR, Stork JL, Levi CR, Selmes CM, Bladin CF, Donnan GA, 'Plaque Features As Predictors Of Ischaemic Symptoms in Patients With High-grade Asymptomatic Carotid Stenosis', Plaque Features As Predictors Of Ischaemic Symptoms in Patients With High-grade Asymptomatic Carotid Stenosis (2004) [E3]
Co-authors Christopher Levi
2004 Wang Y, Levi CR, Parsons MW, Selmes CM, Evans M, Royan A, et al., 'Predictors of in-hospital Neurological Deterioration in Acute Ischaemic Stroke', Predictors of in-hospital Neurological Deterioration in Acute Ischaemic Stroke (2004) [E3]
Co-authors Mark Parsons, Christopher Levi
2003 Levi CR, Selmes CM, Bull N, Baker G, Hardy D, Evans M, 'Normal blood flow velocities in the intracranial large arteries as measured by transcranial colour-coded duplex', Internal Medicine Journal (2003) [E3]
Co-authors Christopher Levi
2003 Pollack M, Levi CR, Wang Y, O'Dea IP, 'Influence of timing of transfer to rehabilitation on stroke outcomes', Internal Medicine Journal (2003) [E3]
Co-authors Christopher Levi
2003 Evans M, Levi CR, Royan A, Wang Y, Selmes CM, 'The influence of stroke case management on patient outcomes', internal Medicine Journal (2003) [E3]
Co-authors Christopher Levi
2003 Wang Y, Levi CR, D'Este CA, Attia JR, Spratt N, Fisher J, 'Seasonal variation in stroke in the Hunter Region, Australia a five-year hospital-based study, 1995-2000', STROKE (2003)
Co-authors Neil Spratt, Christopher Levi, John Attia, Catherine Deste
2002 Wang Y, Ng K, Spratt N, Evans MK, Royan A, Fisher J, et al., 'A prospective study on predictors of prolonged hospital stay', Journal of Clinical Neuroscience (2002)
DOI 10.1054/jocn.2002.1124
Co-authors Christopher Levi
2002 Edwards J, Turner A, Mosgrove K, Hunter M, Hudson S, Selmes CM, Levi C, 'Processing of visual stimuli following coronary artery bypass grafting (CABG): an fMRI study', Brain-Dynamics Conference (2002) [E3]
Co-authors Christopher Levi, Mick Hunter
2002 Wang Y, Levi CR, D'Este CA, Pollack M, Fisher J, 'Stroke incidence variations in rural, semi-rural and urban areas of the Hunter Region, Australia, 1995-2000', Not known (2002) [E3]
Co-authors Catherine Deste, Christopher Levi
2002 Evans MK, Royan A, Wang Y, Levi C, 'The use of a case management model of care in the acute stroke unit', Stroke Society of Australasia Annual Scientific Meeting (2002)
DOI 10.1054/jocn.2002.1124
Co-authors Christopher Levi
2000 Kostulas K, Selmes C, Bull N, Evans MK, Levi C, 'Influence of Acute Carotid and Transcranial Color Coded Duplex on Assessment of Ischemic Stroke Mechanism', 4th World Stroke Congress (2000)
DOI 10.1161/01.str.31.11.2769
Co-authors Christopher Levi
1994 Donnan GA, Baird AE, Levi CR, 'Diagnosis and imaging of stroke', Journal of Hypertension (1994)

Background: Less than 20 years ago the diagnosis of stroke was almost entirely based on clinical features. Since the mid-1970s sophisticated ultrasonography, computed tomography, ... [more]

Background: Less than 20 years ago the diagnosis of stroke was almost entirely based on clinical features. Since the mid-1970s sophisticated ultrasonography, computed tomography, magnetic resonance imaging, angiography and spectroscopy, single-photon emission computed tomography and positron emission tomography have been developed in rapid succession. Current use of neuroimaging in stroke patients: By using a combination of imaging modalities it is now possible to show nearly all of the vascular tree from the left ventricle of the heart through to small arteries within the brain. Depending on clinical need, in most cases, it should be possible to define the location and mechanism of any given vascular event affecting the brain, and thus design appropriate management. The future: Neuroimaging, clinical diagnosis and therapy are closely linked. Neuroimaging will become even more important if potential neuroprotective or thrombolytic agents prove effective. Categorization of pathophysiological subtypes of haemorrhagic and ischaemic stroke will allow more precise management of patients. If the rate of development in neuroimaging of the previous 20 years is maintained, even more precise evaluation of stroke patients will become possible.

Citations Scopus - 1
Co-authors Christopher Levi
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Thesis / Dissertation (1 outputs)

Year Citation Altmetrics Link
2015 Gardner AJ, Concussion in Professional Rugby League, University of Newcastle (2015)
Co-authors Andrew Gardner
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Grants and Funding

Summary

Number of grants 86
Total funding $23,973,658

Click on a grant title below to expand the full details for that specific grant.


20179 grants / $5,432,742

Saving brain and changing practice in stroke (STEEPLE)$2,137,045

Funding body: NHMRC (National Health & Medical Research Council)

Funding body NHMRC (National Health & Medical Research Council)
Project Team Professor Stephen Davis, Professor Geoff Donnan, Professor Graeme Hankey, Professor Mark Parsons, Conjoint Professor Chris Levi, Dr Bruce Campbell
Scheme Program Grant
Role Investigator
Funding Start 2017
Funding Finish 2021
GNo G1700494
Type Of Funding Aust Competitive - Commonwealth
Category 1CS
UON Y

Subproject: Saving brain and changing practice in stroke (TACTICS)$2,137,045

Funding body: NHMRC (National Health & Medical Research Council)

Funding body NHMRC (National Health & Medical Research Council)
Project Team Conjoint Professor Chris Levi, Professor Mark Parsons
Scheme Program Grant
Role Lead
Funding Start 2017
Funding Finish 2021
GNo GS170003
Type Of Funding Aust Competitive - Commonwealth
Category 1CS
UON Y

Subproject:HMRI MRSP Infrastructure (17) Brain and Mental Health - PRC for Stroke and Brain Injury$356,551

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Professor Neil Spratt, Professor Mark Parsons, Professor Michael Nilsson, Associate Professor Rohan Walker, Associate Professor Sarah Johnson, Doctor Andrew Bivard, Doctor Andrew Gardner, Conjoint Professor Chris Levi, Doctor Coralie English, Associate Professor Frini Karayanidis, Aprof JANE Maguire
Scheme NSW MRSP Infrastructure Grant
Role Investigator
Funding Start 2017
Funding Finish 2017
GNo GS170009
Type Of Funding Other Public Sector - State
Category 2OPS
UON Y

A new treatment to help recovery from stroke, including fatigue and quality of life$319,200

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Doctor Andrew Bivard, Conjoint Professor Chris Levi
Scheme Project Grant
Role Investigator
Funding Start 2017
Funding Finish 2020
GNo G1701348
Type Of Funding Grant - Aust Non Government
Category 3AFG
UON Y

Research Assistant Support – TRANSIENT and GP Networks$62,000

Funding body: Hunter New England Local Health District

Funding body Hunter New England Local Health District
Project Team Conjoint Professor Chris Levi
Scheme Research Funds
Role Lead
Funding Start 2017
Funding Finish 2017
GNo G1701011
Type Of Funding Other Public Sector - State
Category 2OPS
UON Y

What type of leadership is required to improve the provision of evidenced-based best practice in acute stroke care?$50,000

Funding body: NSW Agency for Clinical Innovation (ACI)

Funding body NSW Agency for Clinical Innovation (ACI)
Project Team Associate Professor Christine Paul, Conjoint Professor Chris Levi, Professor Rebecca Mitchell, Doctor Andrew Bivard, Professor John Attia, Dr Martin Jude, Ms Annika Ryan
Scheme Research Project
Role Investigator
Funding Start 2017
Funding Finish 2018
GNo G1700672
Type Of Funding Other Public Sector - State
Category 2OPS
UON Y

Elicitation interviews as a contemplative intervention: insights form stroke into body ownership and agency$21,032

Funding body: Mind and Life Europe

Funding body Mind and Life Europe
Project Team Doctor Bryan Paton, Conjoint Professor Chris Levi, Professor Michael Nilsson, Mr Gabriel Axel Montes, Andreas Roepstorff
Scheme Research Award
Role Investigator
Funding Start 2017
Funding Finish 2017
GNo G1700691
Type Of Funding International - Competitive
Category 3IFA
UON Y

VR Rehab$4,545

Funding body: CSIRO - Commonwealth Scientific and Industrial Research Organisation

Funding body CSIRO - Commonwealth Scientific and Industrial Research Organisation
Project Team Doctor Bryan Paton, Conjoint Professor Chris Levi, Professor Michael Nilsson, Mr Gabriel Axel Montes
Scheme ON Prime
Role Investigator
Funding Start 2017
Funding Finish 2017
GNo G1701035
Type Of Funding Other Public Sector - Commonwealth
Category 2OPC
UON Y

20165 grants / $1,621,948

Telehealth and Advanced CT Imaging Combined Study (TACTICS)$992,098

Funding body: NHMRC (National Health & Medical Research Council)

Funding body NHMRC (National Health & Medical Research Council)
Project Team Conjoint Professor Chris Levi, Doctor Andrew Bivard, Professor John Attia, Professor Christopher Bladin, Professor Stephen Davis, Professor Geoff Donnan, Professor Craig Anderson, Dr Bruce Campbell, Professor Mark Parsons, Dr Rohan Grimley
Scheme Partnership Projects
Role Lead
Funding Start 2016
Funding Finish 2021
GNo G1600728
Type Of Funding Aust Competitive - Commonwealth
Category 1CS
UON Y

HMRI MRSP Infrastructure (12-16) Brain and Mental Health Program – Stroke and Brain Injury$325,297

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Professor Neil Spratt, Professor Mark Parsons, Associate Professor Rohan Walker, Doctor Coralie English, Professor Michael Nilsson, Conjoint Professor Chris Levi, Doctor Andrew Bivard, Aprof JANE Maguire, Conjoint Professor Parker Magin, Associate Professor Sarah Johnson, Professor John Attia
Scheme NSW MRSP Infrastructure Grant
Role Investigator
Funding Start 2016
Funding Finish 2016
GNo G1600733
Type Of Funding Other Public Sector - State
Category 2OPS
UON Y

A randomised controlled trial of the effectiveness of ‘Enable Me’: an e-health innovation for stroke survivors and support persons.$245,109

Funding body: NHMRC (National Health & Medical Research Council)

Funding body NHMRC (National Health & Medical Research Council)
Project Team Laureate Professor Robert Sanson-Fisher, Doctor Amy Waller, Associate Professor Mariko Carey, Conjoint Professor Chris Levi, Associate Professor Michael Pollack, Professor Chris Doran, Doctor Christopher Oldmeadow, Conjoint Associate Professor Frans Henskens
Scheme Partnership Projects
Role Investigator
Funding Start 2016
Funding Finish 2019
GNo G1500867
Type Of Funding Aust Competitive - Commonwealth
Category 1CS
UON Y

TEMPO-2$30,000

Funding body: University of Calgary

Funding body University of Calgary
Project Team Conjoint Professor Chris Levi
Scheme Research Project
Role Lead
Funding Start 2016
Funding Finish 2019
GNo G1600986
Type Of Funding International - Non Competitive
Category 3IFB
UON Y

A randomised controlled trial of the effectiveness of ‘Enable Me’: an e-health innovation for stroke survivors and support persons.$29,444

Funding body: National Stroke Foundation

Funding body National Stroke Foundation
Project Team Laureate Professor Robert Sanson-Fisher, Doctor Amy Waller, Associate Professor Mariko Carey, Conjoint Professor Chris Levi, Dr Michael Pollack, Professor Chris Doran, Doctor Christopher Oldmeadow, Conjoint Associate Professor Frans Henskens
Scheme Partnership Projects Partner Funding
Role Investigator
Funding Start 2016
Funding Finish 2019
GNo G1501095
Type Of Funding Grant - Aust Non Government
Category 3AFG
UON Y

20152 grants / $2,447,454

Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery$1,223,727

Funding body: NHMRC (National Health & Medical Research Council)

Funding body NHMRC (National Health & Medical Research Council)
Project Team Associate Professor Julie Bernhardt, Professor Michael Nilsson, Dr Leeanne Carey, Professor Paulette Van Vliet, Dr Dominique Cadilhac, Professor Christopher Bladin, Professor Sandy Middleton, Professor Geoff Donnan, Professor Mark Parsons, Conjoint Professor Chris Levi
Scheme Centres of Research Excellence (CRE) - Centres of Clinical Research Excellence
Role Investigator
Funding Start 2015
Funding Finish 2019
GNo G1401448
Type Of Funding Aust Competitive - Commonwealth
Category 1CS
UON Y

Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery$1,223,727

Funding body: NHMRC (National Health & Medical Research Council)

Funding body NHMRC (National Health & Medical Research Council)
Project Team Associate Professor Julie Bernhardt, Professor Michael Nilsson, Dr Leeanne Carey, Professor Paulette Van Vliet, Dr Dominique Cadilhac, Professor Christopher Bladin, Professor Sandy Middleton, Professor Geoff Donnan, Professor Mark Parsons, Conjoint Professor Chris Levi
Scheme Centres of Research Excellence (CRE) - Centres of Clinical Research Excellence
Role Investigator
Funding Start 2015
Funding Finish 2019
GNo G1401448
Type Of Funding Aust Competitive - Commonwealth
Category 1CS
UON Y

20149 grants / $2,279,613

Does pneumococcal vaccination protect against cardiovascular disease? $1,840,507

Funding body: NHMRC (National Health & Medical Research Council)

Funding body NHMRC (National Health & Medical Research Council)
Project Team Professor John Attia, Professor Catherine D'Este, Dr Walter Abhayaratna, Professor Andrew Tonkin, Conjoint Professor Chris Levi, Conjoint Professor David Durrheim, Professor Joseph Hung, Associate Professor Mark McEvoy, Doctor Alexis Hure
Scheme Project Grant
Role Investigator
Funding Start 2014
Funding Finish 2019
GNo G1300127
Type Of Funding Aust Competitive - Commonwealth
Category 1CS
UON Y

Altering the Rehabililtation Environment to Improve Stroke Survivor Activity (AREISSA): A Phase II Trial.$264,241

Funding body: National Heart Foundation of Australia

Funding body National Heart Foundation of Australia
Project Team Professor Neil Spratt, Associate Professor Louise Ada, Professor Michael Nilsson, Professor Sandy Middleton, Associate Professor Julie Bernhardt, Professor Leonid Churilov, Conjoint Professor Chris Levi, Conjoint Associate Professor Michael Pollack, Associate Professor Steven Faux, Professor Lin Perry, Dr Annie McCluskey
Scheme NSW Cardiovascular Research Network Research Development Project Grant
Role Investigator
Funding Start 2014
Funding Finish 2015
GNo G1301044
Type Of Funding Grant - Aust Non Government
Category 3AFG
UON Y

Neuroimaging Biomarkers of Recovery: Longitudinal Imaging Study in the rehabilitation Phase post-Acute Ischemic Stroke (NEUROLISS)$50,000

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Doctor Andrew Bivard, Professor Mark Parsons, Conjoint Professor Chris Levi
Scheme Project Grant
Role Investigator
Funding Start 2014
Funding Finish 2014
GNo G1401437
Type Of Funding Grant - Aust Non Government
Category 3AFG
UON Y

Mapping whole-brain metabolic networks$25,000

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Doctor Renate Thienel, Associate Professor Frini Karayanidis, Associate Professor Juanita Todd, Associate Professor Peter Stanwell, Professor Mark Parsons, Conjoint Professor Chris Levi
Scheme Project Grant
Role Investigator
Funding Start 2014
Funding Finish 2014
GNo G1301285
Type Of Funding Grant - Aust Non Government
Category 3AFG
UON Y

An Evaluation of Transitional Care for Stroke Patients$25,000

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Associate Professor Ashley Kable, Professor Amanda Baker, Professor Dimity Pond, Doctor Alyna Turner, Conjoint Professor Chris Levi
Scheme Project Grant
Role Investigator
Funding Start 2014
Funding Finish 2014
GNo G1301294
Type Of Funding Grant - Aust Non Government
Category 3AFG
UON Y

Biological characterisation of genetic associations for large artery atherosclerotic stroke$25,000

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Doctor Liz Holliday, Laureate Professor Rodney Scott, Conjoint Professor Chris Levi, Professor John Attia, Aprof JANE Maguire
Scheme Stroke Research Project Grant
Role Investigator
Funding Start 2014
Funding Finish 2014
GNo G1301340
Type Of Funding Grant - Aust Non Government
Category 3AFG
UON Y

Prevent 2nd Stroke: The development and pilot testing of an online lifestyle behaviours program for stroke and TIA survivors$20,000

Funding body: National Stroke Foundation

Funding body National Stroke Foundation
Project Team Professor Billie Bonevski, Dr Alyna Turner, Professor Amanda Baker, Conjoint Professor Chris Levi, Conjoint Associate Professor Michael Pollack, Doctor Timothy Regan
Scheme Research Grant
Role Investigator
Funding Start 2014
Funding Finish 2014
GNo G1301114
Type Of Funding Grant - Aust Non Government
Category 3AFG
UON Y

Seasonal variation in cervical arterial dissection$19,865

Funding body: National Stroke Foundation

Funding body National Stroke Foundation
Project Team Doctor Lucy Thomas, Conjoint Professor Chris Levi, Professor Darren Rivett
Scheme Research Grant
Role Investigator
Funding Start 2014
Funding Finish 2014
GNo G1301126
Type Of Funding Grant - Aust Non Government
Category 3AFG
UON Y

Tenecteplase versus Alteplase for Stroke Thrombolysis Evaluation (TASTE) Trial$10,000

Funding body: University of Newcastle

Funding body University of Newcastle
Project Team Professor Mark Parsons, Conjoint Professor Chris Levi, Doctor Patrick McElduff
Scheme Near Miss Grant
Role Investigator
Funding Start 2014
Funding Finish 2014
GNo G1301401
Type Of Funding Internal
Category INTE
UON Y

20137 grants / $2,143,813

HMRI MRSP Infrastructure (12-16) – Translational Neuroscience & Mental Health$1,649,691

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Conjoint Professor Chris Levi
Scheme NSW MRSP Infrastructure Grant
Role Lead
Funding Start 2013
Funding Finish 2016
GNo G1300587
Type Of Funding Other Public Sector - State
Category 2OPS
UON Y

Translational research program in stroke – from discovery to therapy to implementation and better patient outcomes$333,622

Funding body: NHMRC (National Health & Medical Research Council)

Funding body NHMRC (National Health & Medical Research Council)
Project Team Conjoint Professor Chris Levi
Scheme Practitioner Fellowships
Role Lead
Funding Start 2013
Funding Finish 2017
GNo G1200043
Type Of Funding Aust Competitive - Commonwealth
Category 1CS
UON Y

Greater Charitable Foundation Fellows in Stroke Research$100,000

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Professor Neil Spratt, Professor Mark Parsons, Conjoint Professor Chris Levi
Scheme Stroke Research Project Grant
Role Investigator
Funding Start 2013
Funding Finish 2013
GNo G1300508
Type Of Funding Contract - Aust Non Government
Category 3AFC
UON Y

Long term effect of sports-related concussion$38,500

Funding body: Brain Foundation (NSW Branch)

Funding body Brain Foundation (NSW Branch)
Project Team Conjoint Professor Chris Levi
Scheme Research Grant
Role Lead
Funding Start 2013
Funding Finish 2013
GNo G1201198
Type Of Funding Grant - Aust Non Government
Category 3AFG
UON Y

The genetic determinants of brain haemorrhage associated with stroke thrombolysis$10,000

Funding body: University of Newcastle

Funding body University of Newcastle
Project Team Conjoint Professor Chris Levi, Professor John Attia, Doctor Liz Holliday, Dr Simon Koblar, Laureate Professor Rodney Scott, Conjoint Associate Professor Jonathan Sturm, Associate Professor Jonathan Rosand, Doctor Lisa Lincz, Aprof JANE Maguire
Scheme Near Miss Grant
Role Lead
Funding Start 2013
Funding Finish 2013
GNo G1300475
Type Of Funding Internal
Category INTE
UON Y

The genetic determinants of brain haemorrhage associated with stroke thrombolysis$10,000

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Conjoint Professor Chris Levi, Professor John Attia, Doctor Liz Holliday, Dr Simon Koblar, Laureate Professor Rodney Scott, Conjoint Associate Professor Jonathan Sturm, Associate Professor Jonathan Rosand, Doctor Lisa Lincz, Aprof JANE Maguire
Scheme Near Miss
Role Lead
Funding Start 2013
Funding Finish 2013
GNo G1300704
Type Of Funding Grant - Aust Non Government
Category 3AFG
UON Y

2012 EIA Impact Trial travel grant$2,000

Funding body: University of Newcastle

Funding body University of Newcastle
Project Team Conjoint Professor Chris Levi
Scheme Travel Grant
Role Lead
Funding Start 2013
Funding Finish 2013
GNo G1300374
Type Of Funding Internal
Category INTE
UON Y

20129 grants / $1,879,766

An international comparison of systems of care, risk stratification and outcomes in TIA and minor stroke$1,189,791

Funding body: NHMRC (National Health & Medical Research Council)

Funding body NHMRC (National Health & Medical Research Council)
Project Team Conjoint Professor Chris Levi, Conjoint Professor Parker Magin, Dr Daniel Lasserson, Dr Jose Valderas, Associate Professor Helen Dewey, Professor Peter Barber, Professor Peter Rothwell, Professor Neil Spratt, Dr Dominique Cadilhac, Professor Valery Feigin
Scheme Project Grant
Role Lead
Funding Start 2012
Funding Finish 2016
GNo G1100258
Type Of Funding Aust Competitive - Commonwealth
Category 1CS
UON Y

Project EVA: an environmentally responsible facility for interdisciplinary supercomputing applications$263,000

Funding body: University of Newcastle

Funding body University of Newcastle
Project Team Professor Pablo Moscato, Laureate Professor Jon Borwein, Conjoint Professor Keith Jones, Conjoint Professor Chris Levi, Professor Mark Parsons, Professor Michael Ostwald, Professor Hugh Craig, Conjoint Professor Peter Greer, Associate Professor Stephan Chalup, Professor Regina Berretta
Scheme Equipment Grant
Role Investigator
Funding Start 2012
Funding Finish 2012
GNo G1100627
Type Of Funding Internal
Category INTE
UON Y

T3 Trial: Triage, Treatment and Transfer of patients with stroke in emergency departments$174,525

Funding body: NHMRC (National Health & Medical Research Council)

Funding body NHMRC (National Health & Medical Research Council)
Project Team Professor Sandy Middleton, Conjoint Professor Chris Levi, Associate Professor Mark Fitzgerald, Associate Professor Julie Considine, Professor Jeremy Grimshaw, Conjoint Professor Cate d'Este, Professor Richard Gerraty, Associate Professor Ngai Wah Cheung, Dr Dominique Cadilhac, Associate Professor Elizabeth McInnes
Scheme Project Grant
Role Lead
Funding Start 2012
Funding Finish 2015
GNo G1201067
Type Of Funding Aust Competitive - Commonwealth
Category 1CS
UON Y

Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED)$156,250

Funding body: NHMRC (National Health & Medical Research Council)

Funding body NHMRC (National Health & Medical Research Council)
Project Team Professor Craig Anderson, Professor John Chalmers, Professor Richard Lindley, Associate Professor Hisatomi Arima, Dr Jiguang Wang, Conjoint Professor Chris Levi
Scheme Project Grant
Role Lead
Funding Start 2012
Funding Finish 2016
GNo G1200702
Type Of Funding Aust Competitive - Commonwealth
Category 1CS
UON Y

Tomago Aluminium$26,000

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Associate Professor Frini Karayanidis, Conjoint Associate Professor Grant Bateman, Professor Mark Parsons, Emeritus Professor Patricia Michie, Mr Todd Jolly, Conjoint Professor Chris Levi, Miss Jaime Rennie
Scheme Project Grant
Role Investigator
Funding Start 2012
Funding Finish 2012
GNo G1200517
Type Of Funding Contract - Aust Non Government
Category 3AFC
UON Y

What causes unexplained encephalitis? A pilot adult encephalitis hospital-based surveillance system$20,200

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Conjoint Professor David Durrheim, Conjoint Professor Chris Levi, Doctor Beverley Paterson
Scheme Project Grant
Role Investigator
Funding Start 2012
Funding Finish 2012
GNo G1200219
Type Of Funding Contract - Aust Non Government
Category 3AFC
UON Y

Experimental brain imaging to investigate novel protective mechanisms of short duration body cooling after stroke$20,000

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Doctor Damian McLeod, Professor Neil Spratt, Professor Mark Parsons, Conjoint Professor Chris Levi
Scheme Project Grant
Role Investigator
Funding Start 2012
Funding Finish 2012
GNo G1101116
Type Of Funding Contract - Aust Non Government
Category 3AFC
UON Y

The genetic determinants of brain haemorrhage associated with stroke thrombolysis$20,000

Funding body: University of Newcastle

Funding body University of Newcastle
Project Team Conjoint Professor Chris Levi, Professor John Attia, Doctor Liz Holliday, Laureate Professor Rodney Scott, Conjoint Associate Professor Jonathan Sturm, Doctor Lisa Lincz
Scheme Near Miss Grant
Role Lead
Funding Start 2012
Funding Finish 2012
GNo G1200675
Type Of Funding Internal
Category INTE
UON Y

HMRI Exchange Visit Prize - Andrew Gardner$10,000

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Conjoint Professor Chris Levi, Dr Andrew Gardner
Scheme Research Grant
Role Lead
Funding Start 2012
Funding Finish 2012
GNo G1200014
Type Of Funding Contract - Aust Non Government
Category 3AFC
UON Y

20115 grants / $1,972,834

Implementation of quality use of advanced CT imaging in acute stroke$1,075,461

Funding body: NHMRC (National Health & Medical Research Council)

Funding body NHMRC (National Health & Medical Research Council)
Project Team Professor Mark Parsons, Conjoint Professor Chris Levi, Professor Geoff Donnan, Professor Stephen Davis, Professor John Attia, Professor Christopher Bladin, Mr Qing Yang, Associate Professor Peter Mitchell, Associate Professor Stacy Goergen, Professor Ramamohanarao Kotagiri
Scheme Partnership Projects
Role Investigator
Funding Start 2011
Funding Finish 2015
GNo G1000535
Type Of Funding Aust Competitive - Commonwealth
Category 1CS
UON Y

HMRI-MRSP Infrastructure (11-12) Centre for Brain and Mental Health Research$436,266

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Conjoint Professor Chris Levi
Scheme NSW MRSP Infrastructure Grant
Role Lead
Funding Start 2011
Funding Finish 2011
GNo G1101135
Type Of Funding Other Public Sector - State
Category 2OPS
UON Y

HMRI MRSP Infrastructure Grant (10-11) - Brain and Mental Health$400,244

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Conjoint Professor Chris Levi
Scheme NSW MRSP Infrastructure Grant
Role Lead
Funding Start 2011
Funding Finish 2011
GNo G1100285
Type Of Funding Other Public Sector - State
Category 2OPS
UON Y

Relationships between white matter lesions and cognitive and motor functioning in patients with minor ischaemic stroke: A structural and functional brain imaging study - RhD 2yr$40,000

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Mr Todd Jolly, Associate Professor Frini Karayanidis, Professor Mark Parsons, Conjoint Professor Chris Levi, Emeritus Professor Patricia Michie, Conjoint Associate Professor Grant Bateman, Conjoint Professor Peter Schofield
Scheme Research Higher Degree Support Grant
Role Investigator
Funding Start 2011
Funding Finish 2011
GNo G1100061
Type Of Funding Contract - Aust Non Government
Category 3AFC
UON Y

Exploring Chronic Traumatic Encephalopathy (CTE) amongst current and former professional rugby league players$20,863

Funding body: NSW Sporting Injuries Committee

Funding body NSW Sporting Injuries Committee
Project Team Associate Professor Frances Kay-Lambkin, Dr Andrew Gardner, Associate Professor Peter Stanwell, Conjoint Professor Chris Levi, Professor Mark Parsons
Scheme Research & Injury Prevention Scheme
Role Investigator
Funding Start 2011
Funding Finish 2012
GNo G1100822
Type Of Funding Other Public Sector - State
Category 2OPS
UON Y

201010 grants / $1,136,543

Evaluating the effectiveness of a strategy to increase the adoption of best evidence practice. A cluster randomised controlled trial in acute stroke care$800,532

Funding body: NHMRC (National Health & Medical Research Council)

Funding body NHMRC (National Health & Medical Research Council)
Project Team Laureate Professor Robert Sanson-Fisher, Conjoint Professor Chris Levi, Associate Professor Christine Paul, Conjoint Professor Cate d'Este, Professor Mark Parsons, Professor Christopher Bladin, Professor Richard Lindley, Professor John Attia
Scheme Partnership Projects
Role Investigator
Funding Start 2010
Funding Finish 2016
GNo G0189781
Type Of Funding Aust Competitive - Commonwealth
Category 1CS
UON Y

Testing stroke sonothrombolysis using an improved experimental model of thromboembolic stroke$81,386

Funding body: National Stroke Foundation

Funding body National Stroke Foundation
Project Team Professor Neil Spratt, Conjoint Professor Chris Levi
Scheme Postgraduate Biomedical Scholarship
Role Investigator
Funding Start 2010
Funding Finish 2013
GNo G0190597
Type Of Funding Grant - Aust Non Government
Category 3AFG
UON Y

Improving patient selection for acute stroke therapies - an experimental model of CT brain perfusion after stroke$50,000

Funding body: BellBerry Limited

Funding body BellBerry Limited
Project Team Professor Mark Parsons, Professor Neil Spratt, Conjoint Professor Chris Levi, Doctor Damian McLeod, Dr Peter Stanwell
Scheme Near Miss
Role Investigator
Funding Start 2010
Funding Finish 2012
GNo G0900222
Type Of Funding Grant - Aust Non Government
Category 3AFG
UON Y

Evaluating the effectiveness of a strategy to increase the adoption of best evidence practice. A cluster randomised controlled trial in acute stroke care $50,000

Funding body: Victorian Department of Health

Funding body Victorian Department of Health
Project Team Laureate Professor Robert Sanson-Fisher, Conjoint Professor Chris Levi, Associate Professor Christine Paul, Conjoint Professor Cate d'Este, Professor Mark Parsons, Professor Christopher Bladin, Professor Richard Lindley, Professor John Attia
Scheme Project Grant
Role Investigator
Funding Start 2010
Funding Finish 2014
GNo G1100824
Type Of Funding Other Public Sector - State
Category 2OPS
UON Y

Translational Doppler ultrasound markers of the ischaemic penumbra: A prospective observational study using CT Perfusion and angiography as comparators$40,000

Funding body: Hunter Children`s Research Foundation

Funding body Hunter Children`s Research Foundation
Project Team Conjoint Professor Chris Levi
Scheme Research Grant
Role Lead
Funding Start 2010
Funding Finish 2011
GNo G0900156
Type Of Funding Contract - Aust Non Government
Category 3AFC
UON Y

Implementation of thrombolytic therapy in acute stroke. A cluster randomised trial$30,000

Funding body: BellBerry Limited

Funding body BellBerry Limited
Project Team Conjoint Professor Chris Levi, Professor John Attia, Associate Professor Christine Paul, Professor Mark Parsons, Professor Christopher Bladin, Professor Richard Lindley, Conjoint Professor Cate d'Este
Scheme Near Miss
Role Lead
Funding Start 2010
Funding Finish 2014
GNo G0900221
Type Of Funding Grant - Aust Non Government
Category 3AFG
UON Y

A structural and functional brain imaging study of how white matter lesions in patients with minor ischaemic strike affect cognitive and motor control processes$24,600

Funding body: Hunter Children`s Research Foundation

Funding body Hunter Children`s Research Foundation
Project Team Associate Professor Frini Karayanidis, Professor Mark Parsons, Emeritus Professor Patricia Michie, Conjoint Professor Chris Levi, Ms Sharna Jamadar, Mr Matthew Hughes, Conjoint Professor Peter Schofield, Conjoint Associate Professor Grant Bateman
Scheme Research Grant
Role Investigator
Funding Start 2010
Funding Finish 2010
GNo G0900150
Type Of Funding Grant - Aust Non Government
Category 3AFG
UON Y

Minor stroke and Transient Ischaemic Attack pathways of care: a pilot of a cohort study based in general practice$23,025

Funding body: John Hunter Hospital Charitable Trust

Funding body John Hunter Hospital Charitable Trust
Project Team Professor Mark Parsons, Dr Daniel Lasserson, Conjoint Professor Parker Magin, Conjoint Professor Chris Levi
Scheme Research Grant
Role Investigator
Funding Start 2010
Funding Finish 2011
GNo G1000933
Type Of Funding Other Public Sector - State
Category 2OPS
UON Y

Sir Ronald Fisher GPU computing cluster $22,000

Funding body: NHMRC (National Health & Medical Research Council)

Funding body NHMRC (National Health & Medical Research Council)
Project Team Professor Pablo Moscato, Conjoint Professor Chris Levi, Professor Regina Berretta
Scheme Equipment Grant
Role Investigator
Funding Start 2010
Funding Finish 2010
GNo G1000054
Type Of Funding Other Public Sector - Commonwealth
Category 2OPC
UON Y

Sparke Helmore / NBN television triathlon award for research excellence$15,000

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Conjoint Professor Chris Levi
Scheme Sparke Helmore/NBN Television Corporate Triathlon Award for Research Excellence
Role Lead
Funding Start 2010
Funding Finish 2010
GNo G1000026
Type Of Funding Grant - Aust Non Government
Category 3AFG
UON Y

20097 grants / $1,734,567

Australian stroke genetics collaborative - Genome-wide association study in ischaemic stroke$1,108,000

Funding body: NHMRC (National Health & Medical Research Council)

Funding body NHMRC (National Health & Medical Research Council)
Project Team Conjoint Professor Chris Levi, Conjoint Associate Professor Jonathan Sturm, Professor John Attia, Laureate Professor Rodney Scott, Doctor Lisa Lincz, Dr Simon Koblar, Professor Pablo Moscato
Scheme Project Grant
Role Lead
Funding Start 2009
Funding Finish 2011
GNo G0188856
Type Of Funding Aust Competitive - Commonwealth
Category 1CS
UON Y

HMRI MRSP Infrastructure Grant (09-10) - Brain and Mental Health$327,892

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Conjoint Professor Chris Levi
Scheme NSW MRSP Infrastructure Grant
Role Lead
Funding Start 2009
Funding Finish 2009
GNo G1000661
Type Of Funding Other Public Sector - State
Category 2OPS
UON Y

China-Australia therapeutic hypothermia in stroke (CATHS) research program: identification of diagnostic molecular markers and therapeutic targets involved in re-warming related brain injury$230,275

Funding body: NSW Office for Science & Medical Research

Funding body NSW Office for Science & Medical Research
Project Team Conjoint Professor Chris Levi, Associate Professor Mark Baker, Professor Neil Spratt, Emeritus Professor John Rostas
Scheme China-NSW Collaborative Research Program
Role Lead
Funding Start 2009
Funding Finish 2009
GNo G0190392
Type Of Funding Other Public Sector - State
Category 2OPS
UON Y

Centre for Brain and Mental Health Research - International Visitors$25,000

Funding body: University of Newcastle

Funding body University of Newcastle
Project Team Conjoint Professor Chris Levi
Scheme Special Project Grant
Role Lead
Funding Start 2009
Funding Finish 2009
GNo G0190630
Type Of Funding Internal
Category INTE
UON Y

Establishing Computed Tomography Perfusion (CTP) imaging in an animal stroke model$20,000

Funding body: National Stroke Foundation

Funding body National Stroke Foundation
Project Team Doctor Damian McLeod, Professor Neil Spratt, Professor Mike Calford, Conjoint Professor Chris Levi, Professor Mark Parsons
Scheme Research Grant
Role Investigator
Funding Start 2009
Funding Finish 2009
GNo G0189942
Type Of Funding Contract - Aust Non Government
Category 3AFC
UON Y

Towards better early imaging in stroke: Use of an experimental model to investigate CT brain perfusion$13,000

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Professor Neil Spratt, Professor Mark Parsons, Doctor Damian McLeod, Conjoint Professor Chris Levi
Scheme Stroke Research Project Grant
Role Investigator
Funding Start 2009
Funding Finish 2009
GNo G0189810
Type Of Funding Contract - Aust Non Government
Category 3AFC
UON Y

Vascular Ischaemia Study$10,400

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Conjoint Professor Chris Levi, Professor John Attia, Laureate Professor Rodney Scott, Doctor Michael Seldon, Doctor Lisa Lincz, Conjoint Associate Professor Jonathan Sturm
Scheme Research Grant
Role Lead
Funding Start 2009
Funding Finish 2009
GNo G0900120
Type Of Funding Contract - Aust Non Government
Category 3AFC
UON Y

20084 grants / $566,094

Low-dose tenecteplase vs standard-dose alteplase for acute ischaemic stroke: An imaging based safety and efficacy study$335,500

Funding body: NHMRC (National Health & Medical Research Council)

Funding body NHMRC (National Health & Medical Research Council)
Project Team Professor Mark Parsons, Professor Stephen Davis, Professor Christopher Bladin, Dr Romesh Markus, Associate Professor Helen Dewey, Conjoint Professor Chris Levi
Scheme Project Grant
Role Investigator
Funding Start 2008
Funding Finish 2010
GNo G0187651
Type Of Funding Aust Competitive - Commonwealth
Category 1CS
UON Y

A randomised controlled trial of mild hypothermia in acute ischaemic stroke$117,176

Funding body: National Heart Foundation of Australia

Funding body National Heart Foundation of Australia
Project Team Conjoint Professor Chris Levi, Professor Mark Parsons, Professor Christopher Bladin, Professor Neil Spratt
Scheme Grant-In-Aid
Role Lead
Funding Start 2008
Funding Finish 2009
GNo G0187644
Type Of Funding Aust Competitive - Non Commonwealth
Category 1NS
UON Y

Health services research: a randomised controlled trial to evaluate a model of comprehensive stroke care$75,918

Funding body: NHMRC (National Health & Medical Research Council)

Funding body NHMRC (National Health & Medical Research Council)
Project Team Conjoint Professor Chris Levi, Associate Professor Michael Pollack
Scheme Project Grant
Role Lead
Funding Start 2008
Funding Finish 2010
GNo G0188529
Type Of Funding Aust Competitive - Commonwealth
Category 1CS
UON Y

A randomised controlled trial of mild hypothermia acute ischaemic stroke$37,500

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Conjoint Professor Chris Levi
Scheme Project Grant
Role Lead
Funding Start 2008
Funding Finish 2008
GNo G0188466
Type Of Funding Contract - Aust Non Government
Category 3AFC
UON Y

20073 grants / $29,539

A functional MRI and tractography study of the effect of early upper limb therapy on brain plasticity after stroke$19,039

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Doctor Bill Budd, Professor Mark Parsons, Conjoint Professor Chris Levi
Scheme Project Grant
Role Investigator
Funding Start 2007
Funding Finish 2007
GNo G0187254
Type Of Funding Contract - Aust Non Government
Category 3AFC
UON Y

A functional MRI study of upper limb therapy in acute stroke.$5,500

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Professor Mark Parsons, Doctor Bill Budd, Conjoint Professor Chris Levi
Scheme Research Grant
Role Investigator
Funding Start 2007
Funding Finish 2007
GNo G0187321
Type Of Funding Contract - Aust Non Government
Category 3AFC
UON Y

Genetic polymorphisms in the native thrombolytic systems as risk factors for ischaemic stroke.$5,000

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Conjoint Professor Chris Levi, Professor John Attia, Laureate Professor Rodney Scott, Dr Amanda Thrift
Scheme Research Grant
Role Lead
Funding Start 2007
Funding Finish 2007
GNo G0187320
Type Of Funding Contract - Aust Non Government
Category 3AFC
UON Y

20068 grants / $2,047,653

PRC - Priority Research Centre for Gender health & Ageing$543,772

Funding body: University of Newcastle

Funding body University of Newcastle
Project Team Professor Julie Byles, Professor Sandra Capra, Associate Professor Pauline Chiarelli, Conjoint Professor David Henry, Professor Tina Koch, Ms Chris Landorf, Conjoint Professor Chris Levi, Professor Deb Loxton, Associate Professor Liz Milward, Conjoint Associate Professor Lynne Parkinson, Professor Dimity Pond, Conjoint Professor David Sibbritt, Associate Professor Anne Young
Scheme Priority Research Centre
Role Investigator
Funding Start 2006
Funding Finish 2013
GNo G0186949
Type Of Funding Internal
Category INTE
UON Y

PRC - Priority Research Centre for Brain & Mental Health Research (CBMHR)$524,282

Funding body: University of Newcastle

Funding body University of Newcastle
Project Team Conjoint Professor Chris Levi, Professor Amanda Baker, Professor Mike Calford, Professor Trevor Day, Emeritus Professor Peter Dunkley, Professor Michael Hazelton, Professor Andrew Heathcote, Professor Brian Kelly, Conjoint Professor Vaughan Carr, Emeritus Professor Patricia Michie, Professor David Pow, Emeritus Professor John Rostas, Professor Ulli Schall, Professor Alistair Sim, Professor Mike Startup
Scheme Priority Research Centre
Role Lead
Funding Start 2006
Funding Finish 2013
GNo G0186947
Type Of Funding Internal
Category INTE
UON Y

Keeping Brain Cells alive in Stroke Treatment$180,000

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Conjoint Professor Chris Levi
Scheme Project Grant
Role Lead
Funding Start 2006
Funding Finish 2009
GNo G0186983
Type Of Funding Contract - Aust Non Government
Category 3AFC
UON Y

A functional MRI study of upper limb therapy in acute stroke$122,474

Funding body: National Heart Foundation of Australia

Funding body National Heart Foundation of Australia
Project Team Professor Mark Parsons, Doctor Bill Budd, Conjoint Professor Chris Levi, Doctor Isobel Hubbard
Scheme Grant-In-Aid
Role Investigator
Funding Start 2006
Funding Finish 2007
GNo G0186201
Type Of Funding Aust Competitive - Non Commonwealth
Category 1NS
UON Y

Harmful or protective? Low dose COX-2 inhibitors and coronary or cerebrovascular occlusion$20,000

Funding body: University of Newcastle

Funding body University of Newcastle
Project Team Conjoint Professor David Henry, Dr Patricia McGettigan, Conjoint Professor Chris Levi
Scheme Near Miss Grant
Role Investigator
Funding Start 2006
Funding Finish 2006
GNo G0186057
Type Of Funding Internal
Category INTE
UON Y

Supplementary oxygen for acute ischaemic stroke: an imaging-based efficacy trial (SOS trial)$19,982

Funding body: University of Newcastle

Funding body University of Newcastle
Project Team Professor Mark Parsons, Conjoint Professor Chris Levi
Scheme Pilot Grant
Role Investigator
Funding Start 2006
Funding Finish 2006
GNo G0186701
Type Of Funding Internal
Category INTE
UON Y

The visual form and motion test as a measure of post-cardiac surgery cognitive impairment$16,000

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Doctor Neva Bull, Conjoint Professor Chris Levi, Conjoint Associate Professor Mick Hunter
Scheme Project Grant
Role Investigator
Funding Start 2006
Funding Finish 2006
GNo G0186099
Type Of Funding Contract - Aust Non Government
Category 3AFC
UON Y

20053 grants / $361,583

Acute Stroke: Imaging the Ischaemic Penumbra with Perfusion CT$239,250

Funding body: NHMRC (National Health & Medical Research Council)

Funding body NHMRC (National Health & Medical Research Council)
Project Team Professor Mark Parsons, Professor Stephen Davis, Professor Brian Tress, Dr Romesh Markus, Dr Stephen Read, Conjoint Professor Chris Levi
Scheme Project Grant
Role Investigator
Funding Start 2005
Funding Finish 2007
GNo G0183962
Type Of Funding Aust Competitive - Commonwealth
Category 1CS
UON Y

Genetic polymorphisms in the native thrombolytic and thrombotic systems as risk factors for ischaemic stroke$106,488

Funding body: National Heart Foundation of Australia

Funding body National Heart Foundation of Australia
Project Team Conjoint Professor Chris Levi, Professor John Attia, Laureate Professor Rodney Scott, Dr Amanda Thrift
Scheme Grant-In-Aid
Role Lead
Funding Start 2005
Funding Finish 2006
GNo G0184034
Type Of Funding Aust Competitive - Non Commonwealth
Category 1NS
UON Y

2005 RIBG allocation$15,845

Funding body: University of Newcastle

Funding body University of Newcastle
Project Team Conjoint Professor Chris Levi
Scheme Research Infrastructure Block Grant (RIBG)
Role Lead
Funding Start 2005
Funding Finish 2005
GNo G0185798
Type Of Funding Internal
Category INTE
UON Y

20041 grants / $28,000

Novel genetic and environmental risk factors in atherothrombosis: The role of variation in Cox-2, tpA and PAI-1 activity$28,000

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Conjoint Professor Chris Levi, Conjoint Professor David Henry, Dr Patricia McGettigan, Professor John Attia, Professor Mark Parsons, Dr Michael Seldon, Laureate Professor Rodney Scott
Scheme Research Grant
Role Lead
Funding Start 2004
Funding Finish 2004
GNo G0183749
Type Of Funding Contract - Aust Non Government
Category 3AFC
UON Y

20011 grants / $60,000

Influence of Glycemic Control on Outcome after Acute Ischaemic Stroke in Diabetic Patients.$60,000

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Conjoint Professor Chris Levi
Scheme Research Grant
Role Lead
Funding Start 2001
Funding Finish 2003
GNo G0180578
Type Of Funding Contract - Aust Non Government
Category 3AFC
UON Y

20002 grants / $211,509

A randomised, controlled trial of 10% Dextran 40 in the prevention of stroke complicating Carotid Endarterectomy.$197,509

Funding body: NHMRC (National Health & Medical Research Council)

Funding body NHMRC (National Health & Medical Research Council)
Project Team Conjoint Professor Chris Levi, Professor Geoff Donnan, Dr B Chambers, Professor Christopher Bladin, Professor Stephen Davis, Dr John Wlodarczyk
Scheme Project Grant
Role Lead
Funding Start 2000
Funding Finish 2002
GNo G0178440
Type Of Funding Aust Competitive - Commonwealth
Category 1CS
UON Y

Brain Impairment after Cardiac Surgery.$14,000

Funding body: Brain Foundation (NSW Branch)

Funding body Brain Foundation (NSW Branch)
Project Team Conjoint Associate Professor Mick Hunter, Conjoint Professor Chris Levi
Scheme Research Grant
Role Investigator
Funding Start 2000
Funding Finish 2000
GNo G0180157
Type Of Funding Donation - Aust Non Government
Category 3AFD
UON Y

19991 grants / $20,000

10% Dextran 40 in the prevention of stroke complicating carotoid endarterectomy$20,000

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Conjoint Professor Chris Levi
Scheme Research Grant
Role Lead
Funding Start 1999
Funding Finish 1999
GNo G0178614
Type Of Funding Contract - Aust Non Government
Category 3AFC
UON Y
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Research Supervision

Number of supervisions

Completed12
Current8

Total current UON EFTSL

Masters0.6
PhD2.4

Current Supervision

Commenced Level of Study Research Title Program Supervisor Type
2017 PhD An MRI Registry of Clinical and Radiological Outcomes Following Initiation of Anticoagulation After Ischaemic Stroke or Transient Ischaemic Attack in Patients with Atrial Fibrillation PhD (Medicine), Faculty of Health and Medicine, The University of Newcastle Co-Supervisor
2017 PhD Lacunar Ischemic Strokes: Acute Imaging and Management PhD (Medicine), Faculty of Health and Medicine, The University of Newcastle Principal Supervisor
2017 PhD The cognitive neuroscience of multisensory processing and agency in stroke survivors: from theory to rehabilitation PhD (Medicine), Faculty of Health and Medicine, The University of Newcastle Principal Supervisor
2016 PhD Intervention for better thrombolysis implementation: Impact on patient outcome and staff perception PhD (CommunityMed & ClinEpid), Faculty of Health and Medicine, The University of Newcastle Co-Supervisor
2016 PhD TIA as a model for secondary neurodegeneration PhD (Medicine), Faculty of Health and Medicine, The University of Newcastle Principal Supervisor
2015 PhD Patient Profiling Using Advanced Imaging and Biomarkers in Acute Ischemic Stroke PhD (Medicine), Faculty of Health and Medicine, The University of Newcastle Principal Supervisor
2015 Masters Prognosis of Transient Ischaemic Attack in Modern Health Care Settings M Philosophy (Medicine), Faculty of Health and Medicine, The University of Newcastle Principal Supervisor
2013 PhD Economic Evaluation of Stroke Interventions in Selected Hospitals in Australia PhD (CommunityMed & ClinEpid), Faculty of Health and Medicine, The University of Newcastle Principal Supervisor

Past Supervision

Year Level of Study Research Title Program Supervisor Type
2017 PhD Individual Patient Profiling Using Clinical and Neuroradiological Biomarkers in Acute Ischemic Stroke: Application of Advanced Multimodal Neuroimaging PhD (Medicine), Faculty of Health and Medicine, The University of Newcastle Co-Supervisor
2016 PhD Making Clots and Breaking Clots: Modelling Arterial Occlusion to Test Stroke Sonothrombolysis PhD (Human Physiology), Faculty of Health and Medicine, The University of Newcastle Co-Supervisor
2016 PhD Unlocking the Puzzle: A Narrative Inquiry into the Experiences of People with Transient Ischaemic Attack or Minor Stroke PhD (Nursing), Faculty of Health and Medicine, The University of Newcastle Co-Supervisor
2016 PhD Assessing and Training Cardiorespiratory Fitness After Stroke PhD (Medicine), Faculty of Health and Medicine, The University of Newcastle Co-Supervisor
2016 PhD The Provision of Best-Practice Care: Examining Modifiable Barriers Along the Care Pathway for Stroke PhD (Behavioural Science), Faculty of Health and Medicine, The University of Newcastle Co-Supervisor
2015 PhD Concussion in Professional Rugby League PhD (Medicine), Faculty of Health and Medicine, The University of Newcastle Principal Supervisor
2015 PhD Whole-Brain CTP in Acute Ischemic Stroke PhD (Medicine), Faculty of Health and Medicine, The University of Newcastle Co-Supervisor
2013 PhD Minimising Risk Factors for Cervical Spine Manipulation PhD (Physiotherapy), Faculty of Health and Medicine, The University of Newcastle Co-Supervisor
2013 PhD Perfusion Imaging in Acute and Evolving Brain Ischemia PhD (Medicine), Faculty of Health and Medicine, The University of Newcastle Co-Supervisor
2010 PhD Genetic Polymorphisms of Platelet Glycoprotein and Cyclooxygenase-2 Genes and Their Influence on Risk of Ischaemic Stroke, 90 Day Post-Stroke Outcome, and Gene-Environment Interactions PhD (Medicine), Faculty of Health and Medicine, The University of Newcastle Co-Supervisor
2002 PhD Public Knowledge and Perception of Stroke in the Newcastle Urban Area PhD (CommunityMed & ClinEpid), Faculty of Health and Medicine, The University of Newcastle Co-Supervisor
2002 PhD Prediction of Mortality in Patients with Acute Stroke PhD (CommunityMed & ClinEpid), Faculty of Health and Medicine, The University of Newcastle Principal Supervisor
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Research Collaborations

The map is a representation of a researchers co-authorship with collaborators across the globe. The map displays the number of publications against a country, where there is at least one co-author based in that country. Data is sourced from the University of Newcastle research publication management system (NURO) and may not fully represent the authors complete body of work.

Country Count of Publications
Australia 454
United Kingdom 82
United States 74
Canada 64
Germany 44
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News

Strokefinder

Hunter to test stroke detector

March 2, 2017

With an acute stroke occurring every 10 minutes in Australia, a revolutionary timesaving diagnostic device called the Stroke Finder helmet is being trialled by the Hunter Medical Research Institute for the first time.

Chris Levi

Research boost to improve stroke management in regional Australia

February 6, 2017

Almost $2 million has been awarded to the University of Newcastle (UON) to support four new research projects, as part of the National Health and Medical Research Council’s (NHMRC) funding outcomes.

UON Stroke researchers share in $13.7m grant

March 9, 2016

A prestigious National Health and Medical Research Centre (NHMRC) Program Grant has been awarded to two University of Newcastle researchers to support stroke research.

Professor Chris Levi

Study of ‘minor strokes’ to prevent major impact

April 1, 2014

A community-based clinical trial that monitors people who have experienced a transient ischaemic attack (TIA) – colloquially known as a 'minor stroke' or 'funny turn' – is being expanded by researchers from the HMRI Stroke Group.

Professors Mark Parsons

International stroke trial

December 3, 2013

A Hunter stroke drug trial that yielded rapid treatment benefits for patients will expand nationally and internationally.

Conjoint Professor Chris Levi

Position

Conjoint Professor
School of Medicine and Public Health
Faculty of Health and Medicine

Contact Details

Email chris.levi@newcastle.edu.au
Phone (02) 4921 3490
Fax (02) 4921 3488

Office

Room JHH
Building John Hunter Hospital
Location Other

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