2022
Acute Ischemic Stroke, Depressed Left Ventricular Ejection Fraction, and Sinus Rhythm: Prevalence and Practice Patterns
Baker AD, Schwamm LH, Sanborn DY, Furie K, Stretz C, Mac Grory B, Yaghi S, Kleindorfer D, Sucharew H, Mackey J, Walsh K, Flaherty M, Kissela B, Alwell K, Khoury J, Khatri P, Adeoye O, Ferioli S, Woo D, Martini S, La Rosa F, Demel SL, Madsen T, Star M, Coleman E, Slavin S, Jasne A, Mistry EA, Haverbusch M, Merkler AE, Kamel H, Schindler J, Sansing LH, Faridi KF, Sugeng L, Sheth KN, Sharma R. Acute Ischemic Stroke, Depressed Left Ventricular Ejection Fraction, and Sinus Rhythm: Prevalence and Practice Patterns. Stroke 2022, 53: 1883-1891. PMID: 35086361, PMCID: PMC10214981, DOI: 10.1161/strokeaha.121.036706.Peer-Reviewed Original ResearchConceptsLeft ventricular ejection fractionAcute ischemic strokeDepressed left ventricular ejection fractionVentricular ejection fractionSinus rhythmIschemic strokeEjection fractionPooled prevalenceHealth Stroke Severity ScaleSecondary stroke prevention strategiesMultivariable logistic regression modelAntithrombotic treatment regimensHospital-based cohortRetrospective cohort studySecondary stroke preventionStroke prevention strategiesMulti-center cohortStroke Severity ScaleLogistic regression modelsEchocardiographic characteristicsHospitalization dischargeAntiplatelet therapyStroke preventionCardiac thrombusCohort study
2021
Expedited and Comprehensive Management of Low-Risk TIA Patients in the Emergency Department is Safe and Less Costly
Garg A, Maran I, Amin H, Vlieks K, Neuschatz K, Coppola A, Poskus K, Johnson J, Davis M, Minja F, Schindler J, Sansing LH, Malhotra A, Jasne AS, Sharma R. Expedited and Comprehensive Management of Low-Risk TIA Patients in the Emergency Department is Safe and Less Costly. Journal Of Stroke And Cerebrovascular Diseases 2021, 30: 106016. PMID: 34325273, DOI: 10.1016/j.jstrokecerebrovasdis.2021.106016.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overClinical ProtocolsCost SavingsCost-Benefit AnalysisDecision Support TechniquesDelivery of Health Care, IntegratedEmergency Service, HospitalFeasibility StudiesFemaleHospital CostsHumansIschemic Attack, TransientLength of StayMaleMiddle AgedOutcome and Process Assessment, Health CarePredictive Value of TestsRetrospective StudiesRisk AssessmentRisk FactorsTime FactorsTreatment OutcomeTriageConceptsLow-risk TIA patientsTransient ischemic attackTIA patientsEmergency roomAcademic comprehensive stroke centerSingle-center cohort studyPre-pathway groupComprehensive stroke centerClinical practice recommendationsLength of stayOutcomes of interestImpending strokeIschemic attackOutpatient echocardiogramRapid outpatientTIA admissionsEchocardiogram findingsEchocardiographic findingsStroke clinicCohort studyStroke centersNeurovascular eventsEmergency departmentFinal diagnosisHospital costsIschemic Stroke, Inflammation, and Endotheliopathy in COVID-19 Patients
McAlpine LS, Zubair AS, Maran I, Chojecka P, Lleva P, Jasne AS, Navaratnam D, Matouk C, Schindler J, Sheth KN, Chun H, Lee AI, Spudich S, Sharma R, Sansing LH. Ischemic Stroke, Inflammation, and Endotheliopathy in COVID-19 Patients. Stroke 2021, 52: e233-e238. PMID: 33966492, PMCID: PMC8140646, DOI: 10.1161/strokeaha.120.031971.Peer-Reviewed Original Research
2020
Effects of Collateral Status on Infarct Distribution Following Endovascular Therapy in Large Vessel Occlusion Stroke
Al-Dasuqi K, Payabvash S, Torres-Flores GA, Strander SM, Nguyen CK, Peshwe KU, Kodali S, Silverman A, Malhotra A, Johnson MH, Matouk CC, Schindler JL, Sansing LH, Falcone GJ, Sheth KN, Petersen NH. Effects of Collateral Status on Infarct Distribution Following Endovascular Therapy in Large Vessel Occlusion Stroke. Stroke 2020, 51: e193-e202. PMID: 32781941, PMCID: PMC7484023, DOI: 10.1161/strokeaha.120.029892.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overArterial Occlusive DiseasesCerebral InfarctionCohort StudiesCollateral CirculationComputed Tomography AngiographyEndovascular ProceduresFemaleHumansInfarction, Middle Cerebral ArteryLinear ModelsMagnetic Resonance AngiographyMaleMiddle AgedReperfusionRetrospective StudiesStrokeThrombectomyTreatment OutcomeWhite MatterConceptsLarge vessel occlusion strokeFinal infarct volumeCollateral statusPoor collateral statusFavorable outcomeInfarct distributionInfarct volumeReperfusion successIndependent predictorsOcclusion strokeInternal capsuleAnterior circulation large vessel occlusion ischemic strokeLarge vessel occlusion ischemic strokeDeep white matter tractsBaseline collateral statusBorder-zone infarctionEarly favorable outcomeEarly functional outcomesRankin Scale scoreCohort of patientsDegree of reperfusionLarge vessel occlusionComputed tomography angiographyDeep white matterMagnetic resonance imagingStroke Code Presentations, Interventions, and Outcomes Before and During the COVID-19 Pandemic
Jasne AS, Chojecka P, Maran I, Mageid R, Eldokmak M, Zhang Q, Nystrom K, Vlieks K, Askenase M, Petersen N, Falcone GJ, Wira CR, Lleva P, Zeevi N, Narula R, Amin H, Navaratnam D, Loomis C, Hwang DY, Schindler J, Hebert R, Matouk C, Krumholz HM, Spudich S, Sheth KN, Sansing LH, Sharma R. Stroke Code Presentations, Interventions, and Outcomes Before and During the COVID-19 Pandemic. Stroke 2020, 51: 2664-2673. PMID: 32755347, PMCID: PMC7446978, DOI: 10.1161/str.0000000000000347.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBetacoronavirusBrain IschemiaCohort StudiesComorbidityConnecticutCoronary Artery DiseaseCoronavirus InfectionsCOVID-19DyslipidemiasEmergency Medical ServicesEthnicityFemaleHumansHypertensionIncomeInsurance, HealthIntracranial HemorrhagesMaleMedically UninsuredMiddle AgedOutcome and Process Assessment, Health CarePandemicsPneumonia, ViralRetrospective StudiesSARS-CoV-2Severity of Illness IndexStrokeSubstance-Related DisordersTelemedicineThrombectomyThrombolytic TherapyTime-to-TreatmentConceptsComprehensive stroke centerStroke codePatient characteristicsStroke severityStroke code patientsHistory of hypertensionStroke-like symptomsCoronary artery diseaseCoronavirus disease 2019 (COVID-19) pandemicPatient-level dataLower median household incomePublic health initiativesDisease 2019 pandemicCOVID-19 pandemicRace/ethnicityCode patientsHospital presentationPublic health insuranceRankin ScaleStroke centersArtery diseaseReperfusion timeStroke symptomsEarly outcomesConnecticut hospitals
2019
Decreases in Blood Pressure During Thrombectomy Are Associated With Larger Infarct Volumes and Worse Functional Outcome
Petersen NH, Ortega-Gutierrez S, Wang A, Lopez GV, Strander S, Kodali S, Silverman A, Zheng-Lin B, Dandapat S, Sansing LH, Schindler JL, Falcone GJ, Gilmore EJ, Amin H, Cord B, Hebert RM, Matouk C, Sheth KN. Decreases in Blood Pressure During Thrombectomy Are Associated With Larger Infarct Volumes and Worse Functional Outcome. Stroke 2019, 50: 1797-1804. PMID: 31159701, PMCID: PMC6787912, DOI: 10.1161/strokeaha.118.024286.Peer-Reviewed Original ResearchConceptsFinal infarct volumeWorse functional outcomeInfarct volumeEndovascular thrombectomyFunctional outcomeOcclusion strokeCerebral infarction 2b/3 reperfusionPressure reductionLarge vessel intracranial occlusionsGreater infarct growthBlood pressure reductionComprehensive stroke centerPercent of patientsBlood pressure managementLarger infarct volumesModified Rankin ScaleRankin Scale scoreMultivariable logistic regressionRelative hypotensionSustained hypotensionInfarct progressionNinety patientsInfarct growthIschemic penumbraIschemic stroke
2016
Cerebral Microhemorrhages and Meningeal Siderosis in Infective Endocarditis
Malhotra A, Schindler J, Grory B, Chu SY, Youn TS, Matouk C, Greer DM, Schrag M. Cerebral Microhemorrhages and Meningeal Siderosis in Infective Endocarditis. Cerebrovascular Diseases 2016, 43: 59-67. PMID: 27871078, DOI: 10.1159/000452718.Peer-Reviewed Original ResearchConceptsCerebral amyloid angiopathyInfective endocarditisSusceptibility-weighted imaging (SWI) sequencesSmall subarachnoid hemorrhageGradient-echo T2Sensitive diagnostic techniquesSWI MRIMycotic aneurysmSevere hypertensionGroups of subjectsAmyloid angiopathyCerebral insultCerebral microhemorrhagesNeurological involvementWorse prognosisSubarachnoid hemorrhageSWI findingsAcademic hospitalSignificant predilectionMicrohemorrhagesPatientsGRE T2HypertensionSiderosisEndocarditisRisk rtPA: An iOS mobile application based on TURN for predicting 90-day outcome after IV thrombolysis
Asuzu D, Nystrӧm K, Schindler J, Wira C, Greer D, Halliday J, Sheth KN. Risk rtPA: An iOS mobile application based on TURN for predicting 90-day outcome after IV thrombolysis. Clinical Neurology And Neurosurgery 2016, 142: 148-152. PMID: 26875069, DOI: 10.1016/j.clineuro.2016.01.030.Peer-Reviewed Original ResearchMissed Ischemic Stroke Diagnosis in the Emergency Department by Emergency Medicine and Neurology Services
Arch AE, Weisman DC, Coca S, Nystrom KV, Wira CR, Schindler JL. Missed Ischemic Stroke Diagnosis in the Emergency Department by Emergency Medicine and Neurology Services. Stroke 2016, 47: 668-673. PMID: 26846858, DOI: 10.1161/strokeaha.115.010613.Peer-Reviewed Original ResearchMeSH KeywordsAgedBrain IschemiaDiagnostic ErrorsEmergency Medical ServicesEmergency MedicineFemaleHumansMaleNeurologyRetrospective StudiesStrokeConceptsEmergency departmentLarge community hospitalCommunity hospitalIschemic strokeStroke diagnosisAcademic hospitalNausea/vomitingSecondary prevention therapiesAcute ischemic strokeRetrospective chart reviewIschemic stroke diagnosisAcademic teaching hospitalEndovascular considerationsChart reviewPrompt treatmentSymptom onsetPosterior circulationPrevention therapyNeurology serviceAcute interventionAnterior strokeAtypical symptomsStroke historyPosterior strokeTeaching hospital
2015
TURN Score Predicts 24-Hour Cerebral Edema After IV Thrombolysis
Asuzu D, Nyström K, Sreekrishnan A, Schindler J, Wira C, Greer D, Halliday J, Kimberly WT, Sheth KN. TURN Score Predicts 24-Hour Cerebral Edema After IV Thrombolysis. Neurocritical Care 2015, 24: 381-388. PMID: 26341364, DOI: 10.1007/s12028-015-0198-6.Peer-Reviewed Original ResearchConceptsSymptomatic intracerebral hemorrhageBrain swellingIntracerebral hemorrhageCerebral edemaPoor outcomeSevere outcomesOdds ratioLogistic regression reporting odds ratiosNINDS rt-PA trialIschemic stroke patientsReporting odds ratioNew brainNew onsetMidline shiftStroke patientsRt-PAEdemaThrombolysisMortalityOutcomesMass effectCharacteristic curveHemorrhagePatientsStatistical associationCohort-Based Identification of Predictors of Symptomatic Intracerebral Hemorrhage After IV Thrombolysis
Asuzu D, Nyström K, Amin H, Schindler J, Wira C, Greer D, Chi NF, Halliday J, Sheth KN. Cohort-Based Identification of Predictors of Symptomatic Intracerebral Hemorrhage After IV Thrombolysis. Neurocritical Care 2015, 23: 394-400. PMID: 25691004, DOI: 10.1007/s12028-015-0121-1.Peer-Reviewed Original ResearchConceptsRt-PA therapyEarly CT hypodensityHyperdense MCA signCT hypodensityIschemic strokeIndependent predictorsRisk of sICHSymptomatic intracerebral hemorrhageAcute ischemic strokeVisual field deficitsNew independent predictorAdditional independent predictorsCase-control studyIdentification of predictorsLevel of consciousnessTwo-sample t-testMann-Whitney testAntithrombolytic therapyStroke centersField deficitsSerious complicationsIntracerebral hemorrhageClinical parametersIntracranial hemorrhageTherapy
2014
Modest Association between the Discharge Modified Rankin Scale Score and Symptomatic Intracerebral Hemorrhage after Intravenous Thrombolysis
Asuzu D, Nystrom K, Amin H, Schindler J, Wira C, Greer D, Chi NF, Halliday J, Sheth KN. Modest Association between the Discharge Modified Rankin Scale Score and Symptomatic Intracerebral Hemorrhage after Intravenous Thrombolysis. Journal Of Stroke And Cerebrovascular Diseases 2014, 24: 548-553. PMID: 25540072, DOI: 10.1016/j.jstrokecerebrovasdis.2014.09.034.Peer-Reviewed Original ResearchMeSH KeywordsAdministration, IntravenousArea Under CurveBrain IschemiaCerebral HemorrhageChi-Square DistributionConnecticutDecision Support TechniquesDisability EvaluationFemaleFibrinolytic AgentsHumansLogistic ModelsMaleOdds RatioPatient DischargePredictive Value of TestsRetrospective StudiesRisk AssessmentRisk FactorsROC CurveStrokeThrombolytic TherapyTime FactorsTreatment OutcomeConceptsDischarge mRS scoreSymptomatic intracerebral hemorrhageRankin Scale scoreMRS scoreClinical scoresAdverse outcomesIntracerebral hemorrhageScale scoreModified Rankin Scale scoreLong-term adverse outcomesYale-New Haven HospitalIntravenous thrombolytic therapyIschemic stroke patientsUnivariate logistic regressionHosmer-Lemeshow statisticNew Haven HospitalMRS dataIntravenous thrombolysisThrombolytic therapyStroke patientsClinical benefitModest agreementClinical dataLogistic regressionModest associationComparison of 8 Scores for predicting Symptomatic Intracerebral Hemorrhage after IV Thrombolysis
Asuzu D, Nystrom K, Amin H, Schindler J, Wira C, Greer D, Chi NF, Halliday J, Sheth KN. Comparison of 8 Scores for predicting Symptomatic Intracerebral Hemorrhage after IV Thrombolysis. Neurocritical Care 2014, 22: 229-233. PMID: 25168743, DOI: 10.1007/s12028-014-0060-2.Peer-Reviewed Original ResearchConceptsSymptomatic intracerebral hemorrhageRt-PA therapyStroke-TPIThrombolytic therapyClinical scoresIntracerebral hemorrhageOdds ratioPredictors of sICHAcute ischemic stroke patientsYale-New Haven HospitalRt-PA treatmentIschemic stroke patientsHosmer-Lemeshow statisticBackgroundIntracerebral hemorrhageConsecutive patientsFeared complicationMethodsClinical dataStroke patientsAdverse outcomesStudy criteriaPatientsTherapyHemorrhageLogistic regressionSPAN-100
2012
Missed Opportunities for Recognition of Ischemic Stroke in the Emergency Department
Lever NM, Nyström KV, Schindler JL, Halliday J, Wira C, Funk M. Missed Opportunities for Recognition of Ischemic Stroke in the Emergency Department. Journal Of Emergency Nursing 2012, 39: 434-439. PMID: 22633790, DOI: 10.1016/j.jen.2012.02.011.Peer-Reviewed Original ResearchConceptsNontraditional symptomsIschemic strokeEmergency departmentSymptom presentationDiagnostic accuracyYale-New Haven HospitalComprehensive neurological evaluationGeneralized weaknessNeurological evaluationStroke symptomsMedical recordsMental statusEmergency nursesPatientsAppropriate managementSymptomsStrokeDiagnosisStrong associationSymptom typeHospitalPresentationMissed opportunityDescriptive statisticsAssociation