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Patient characteristics (13)
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Age at procedure characteristics |
Weight (kg) |
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Gender |
Living Status |
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Race |
Zip/Postal Code |
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Primary Insurer |
Ambulatory Status |
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Height (inches) |
Smoking |
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Height (cm) |
Quit Smoking Date |
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Weight (lbs) |
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Medical History (14)
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Chronic obstructive pulmonary disease |
Prior Coronary Artery Bypass Graft |
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Diabetes |
Prior Percutaneous Coronary Intervention |
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Dialysis |
Prior Carotid Endarterectomy/Carotid Artery Stenting |
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Hypertension |
Major surgery |
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Atrial Fibrillation |
Major Brain surgery |
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Hyperlipidemia |
Major cardiac Procedure Characteristics |
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Prior Congestive Heart Failure |
Major vascular Procedure Characteristics |
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Pre-Procedural Characteristics (36)
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Admit Date |
Time at IV tPA Given |
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Visit Code |
Other IV Thrombolytic Given |
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Transferred From? |
Time at other IV Thrombolytic |
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CAD Symptoms |
Pre-Stroke Modified Rankin Score (mRS) |
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Prior Stroke Event |
National Institute of Health Stroke Score |
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Pre-op Haemoglobin (g/dl) |
CT Angiography |
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Pre-op Haemoglobin (g/L) |
MRI |
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Creatinine (mg/dl) |
CT Perfusion |
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Creatinine (umol/L) |
Magnetic Resonance Perfusion |
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Blood Pressure On Arrival - Systolic |
CT |
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Diastolic |
Alberta Stroke Programme Early CT Score |
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International Normalised Ratio |
Core Infarct Volume (DWI Volume) |
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Glucose |
Stroke Onset Witnessed |
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Pre-Op American Society of Anesthesiologists Physical Status Classification |
Time Last Known Well |
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Pre-Op P2Y12 Antagonist |
Time at First Emergency Department Arrival |
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Pre-Op Statin |
Time at Second ED Arrival |
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Pre-Op Chronic Anticoagulant |
Time at Most Recent Imaging Done |
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IV Tissue Plasminogen Activator (tPA) Given |
Time at Image Interpretation |
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Procedure Characteristics (102)
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Procedure Characteristics Date |
Final Pass Stent Ret Dia |
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Primary Physician |
Pass 1 Stent Ret Len |
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Assistant |
Pass 2 Stent Ret Len |
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Medicare Health Insurance Claim Number |
Final Pass Stent Ret Len |
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Hypercoagulable State |
Pass 1 Asp Catheter |
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Ipsilateral |
Pass 2 Asp Catheter |
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Contralateral |
Final Pass Asp Catheter |
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Initial Location of Occlusion |
Pass 1 Asp Cath Other |
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Side of Occlusion |
Pass 2 Asp Cath Other |
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Location of Additional Occlusion |
Final Pass Asp Cath Other |
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Side of Additional Occlusion |
Pass 1 Separator Used |
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Expanded Thrombolysis In Cerebral Infarction Grade |
Pass 2 Separator Used |
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Trial Enrollment |
Final Pass Separator Used |
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American Society of Anesthesiologists Class |
Pass 1 Asp Type |
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Anaesthesia |
Pass 2 Asp Type |
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Intubated Prior to Angio Suite Arrival |
Final Pass Asp Type |
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Time at Arrival to Angio Suite |
Additional Treatment |
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Time at Groin Puncture |
Extra Cranial Angioplasty |
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Stroke Onset to Groin Puncture |
Side of Extra Cranial Angioplasty |
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ED Arrival to Groin Puncture |
Extra Cranial Stent |
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Number of Passes |
Side of Extra Cranial Stent |
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Pass 1 Intervention Type |
Intra-arterial Thrombolytic Given |
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Pass 2 Intervention Type |
Thrombolytic Dosage |
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Final Pass Intervention Type |
IIb/IIIa Inhibitor Given |
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Pass 1 Clot Location |
Heparin Given |
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Pass 2 Clot Location |
Total Heparin Units |
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Final Pass Clot Location |
Activated Clotting Time |
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Pass 1 Guide Cath Balloon |
Angiomax Given |
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Pass 2 Guide Cath Balloon |
ASA Given Intra-procedurally |
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Final Pass Guide Cath Balloon |
ASA Dosage |
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Pass 1 Guide Cath Asp |
Route |
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Pass 2 Guide Cath Asp |
P2Y12 Antagonist Given |
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Final Pass Guide Cath Asp |
P2Y12 Antagonist Dosage |
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Pass 1 Inter Cath Asp |
Other intraarterial medication (antispasm) |
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Pass 2 Inter Cath Asp |
Route |
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Final Pass Inter Cath Asp |
Total Fluoro Time |
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Pass 1 Inter Cath Used |
Total Radiation |
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Pass 2 Inter Cath Used |
Contrast Volume |
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Final Pass Inter Cath Used |
Final eTICI Grade |
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Pass 1 Int Cath Other: |
Time at Recanalisation |
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Pass 2 Int Cath Other: |
Intra-Procedural Complication |
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Final Pass Int Cath Other: |
Embolization to Non-target Vessel |
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Pass 1 Distal Dev Trtmt App |
Location of Vessel Perforation |
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Pass 2 Distal Dev Trtmt App |
Required Additional Treatment |
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Final Pass Distal Dev Trtmt App |
Technical Failure |
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Pass 1 DD Treat App Other |
Please Specify: |
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Pass 2 DD Treat App Other |
Procedure Characteristics Time |
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Final Pass DD Treat App Other |
Time to Recanalisation |
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Pass 1 Stent Retriever |
Access artery issues and complications (including but not limited to) |
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Pass 2 Stent Retriever |
Dissection |
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Final Pass Stent Retriever |
Occlusion |
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Pass 1 Stent Rtrvr Other |
Device issues: |
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Pass 2 Stent Rtrvr Other |
Dissection |
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Final Pass Stent Rtrvr Other |
Device failure, breakage, or foreign body embolization |
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Pass 1 Stent Ret Dia |
Device related emboli |
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Pass 2 Stent Ret Dia |
Vessel perforation/rupture/extravasation (intracranial) |
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Post-Procedural Characteristics (29)
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Haemorrhagic Infarction (HI) 1 |
Groin Puncture Complication Requiring Intervention |
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HI2 |
Time Point of Occurrence |
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Parenchymal hematoma (PH) 1 Type Haemorrhagic Transformation |
Check All That Apply: |
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PH2 Type Haemorrhagic Transformation |
Final Infarct Volume defined using imaging type and timepoint |
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Parenchymal hematoma remote from infarcted brain tissue |
Final Infarct Volume NA |
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Intraventricular haemorrhage |
Intensive Care Unit Stay |
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Subarachnoid haemorrhage |
Discharge NIHSS |
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Subdural haemorrhage |
Discharge NIHSS NA |
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Please Specify: |
NIHSS Score Change (Timepoint - Pre-Stroke) >= 4 |
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Discharge Date |
Suspected Cause of Neurologic Deterioration |
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Discharge Status |
Need for access site arterial repair |
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Date of Death |
Artery Type |
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Post-Operative Length of Stay |
Type of complication |
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Alive at 24 Hours? |
Subsequent complications |
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24 Hour National Institute of Health Stroke Score |
Retroperitoneal haemorrhage |
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24 Hour CT |
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Imaging Data (3)
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All Head and Neck CT /CT Angiography/CT Perfusion |
All cerebral angiography - Digital Subtraction Angiography |
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All head and Neck Magnetic Resonance- MRI/ Angiography/ Perfusion-weighted MRI |
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Follow-Up (26)
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Date of Contact |
1 Year NIHSS |
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Contact By |
Re-admission within 1 year |
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Current Living Status; (Rehab, Nursing Facility, Hospice, Home, Dead) |
Antiplatelet or Dual Antiplatelet Therapy type and duration of therapy |
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Date of Death |
Cerebral target (treated) vessel re-occlusion |
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Cause of Death |
Death within 90 days |
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Current Smoking |
Death within 1 year |
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30 Day Modified Rankin Score |
New cerebral infarct within 30 days |
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30 Day National Institute of Health Stroke Score |
New cerebral infarct within 90 days |
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Re-admission within 30 days |
New cerebral infarct within 1 year |
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90 Day mRS |
Discharge Disposition; (Rehab, Nursing Facility, Hospice, Home) |
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90 Day NIHSS |
mRS 2 years |
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Re-admission within 90 days |
mRS 3 years |
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1 Year mRS |
mRS 5 years |