It is headed by the Controller General of Accounts (CGA), functions through Indian Civil Accounts Organization. ICAS was created in 1976 to provide auditing and accounting services to the Government of India. MRI contraindications (pacemaker, etc.The Indian Civil Accounts Service (ICAS) is ‘Group A’ services functioning under the Department of Expenditure in the Union Ministry of Finance.Documented allergy to MR contrast agent.Creatinine clearance Any pre-existing illness resulting in a modified Rankin Scale Score of 2 or higher prior to the qualifying stroke.Intra-arterial thrombectomy can be started within 90 minutes of completion of the MR perfusion scan and within 24 hours of symptom onset (Start of IA therapy is defined as the time of insertion of the femoral artery sheath Time of brain scan is defined as the time that the scan is completed).Planned to undergo or has undergone an MR brain scan including MR perfusion imaging (ASL & bolus PWI) and MR angiography of the circle of Willis prior to IA therapy.(Either as primary therapy or as adjuvant therapy following intravenous tPA treatment) Planned to undergo (or has undergone) intra-arterial (IA) thrombectomy and/or thrombolysis for acute hemispheric stroke.Clinical diagnosis of ischemic stroke and an associated score on the NIHSS of 5 or more points.The investigators hope to learn if these new MRI techniques can help identify which patients are most likely to benefit from mechanical clot removal after receiving tPA. In particular, this study will assess whether a new non-contrast MR imaging method, arterial spin labeling (ASL), which measures cerebral blood flow and can give insight into collateral flow, is effective at predicting who will benefit most from treatment. We hypothesize that the response to mechanical clot retrieval can be predicted based on characteristics of an MRI scan obtained just prior to the retrieval procedure. In order to avoid harm and maximize benefit it is important to know, prior to initiation of the mechanical clot retrieval procedure, if the procedure is likely to result in a clinical improvement. Whereas some patients benefit, others experience no effect, and yet others are likely harmed by mechanical clot retrieval. Although effective at removing blood-clots, it appears that mechanical clot retrieval is not beneficial for all patients. However it is unclear for which stroke patients mechanical thrombectomy is most suitable. Mechanical clot removal increases the percentage of stroke patients who achieve recanalization, and as a result may increase the proportion of patients who have good clinical outcomes. Patients with persistent blood vessel occlusions and no improvement in their clinical condition after receiving tPA or those arriving at the hospital outside the 3 hour time window routinely undergo mechanical clot removal to open an occluded blood vessel in the brain. Second, stroke patients who receive tPA do not always benefit because the treatment does not restore blood flow in all patients. Most stroke patients, however, arrive at the hospital after the three-hour time-window and are therefore excluded from tPA treatment. Because of the narrow three hour time-window during which tPA is effective, only patients who arrive to the hospital early on can be treated with tPA. This is the result of two main limitations of tPA therapy.įirst, the proportion of patients that can be treated with iv tPA is small. Unfortunately, only a very small fraction of stroke patients is treated with tPA, and benefits from tPA. Intravenous tissue plasminogen activator (IV tPA) is the standard of care treatment for stroke patients when treatment can be initiated within 3 hours after symptom onset. Why Should I Register and Submit Results?.
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