2022
Outcomes After Endovascular Thrombectomy With or Without Alteplase in Routine Clinical Practice
Smith E, Zerna C, Solomon N, Matsouaka R, Mac Grory B, Saver J, Hill M, Fonarow G, Schwamm L, Messé S, Xian Y. Outcomes After Endovascular Thrombectomy With or Without Alteplase in Routine Clinical Practice. JAMA Neurology 2022, 79: 768-776. PMID: 35696198, PMCID: PMC9194745, DOI: 10.1001/jamaneurol.2022.1413.Peer-Reviewed Original ResearchConceptsSymptomatic intracranial hemorrhageAcute ischemic strokeEndovascular thrombectomyObservational cohort studyRoutine clinical practiceAlteplase treatmentIschemic strokeIntravenous alteplaseCohort studyDischarge destinationPrespecified outcomesHigh riskClinical practiceCerebral Infarction grade 2bHealth Stroke Severity scoreCerebral infarction (TICI) gradeIntravenous alteplase treatmentLarge nationwide registryStroke severity scoresRandomized clinical trialsEmergency medical servicesGood reperfusionGuidelines-StrokeHospital strokeCertain comorbidities
2021
Thrombolysis in Mild Stroke
Asdaghi N, Romano J, Gardener H, Campo-Bustillo I, Purdon B, Khan Y, Gulati D, Broderick J, Schwamm L, Smith E, Saver J, Sacco R, Khatri P. Thrombolysis in Mild Stroke. Stroke 2021, 52: e586-e589. PMID: 34496619, DOI: 10.1161/strokeaha.120.033466.Peer-Reviewed Original ResearchConceptsNIHSS scoreClinical practiceHealth Stroke Scale scoreMild ischemic stroke patientsMedian NIHSS scoreTrial of thrombolysisStroke Scale scoreIschemic stroke patientsProportion of patientsBroad clinical practiceRoutine clinical practiceSyndromic severityTrial cohortStroke patientsMild strokeMild patientsNeurological syndromeAlteplasePatientsScale scoreLess severityMaRISSComparable deficitsNational InstituteSeverityFrequency, Characteristics, and Outcomes of Endovascular Thrombectomy in Patients With Stroke Beyond 6 Hours of Onset in US Clinical Practice
Zachrison K, Schwamm L, Xu H, Matsouaka R, Shah S, Smith E, Xian Y, Fonarow G, Saver J. Frequency, Characteristics, and Outcomes of Endovascular Thrombectomy in Patients With Stroke Beyond 6 Hours of Onset in US Clinical Practice. Stroke 2021, 52: 3805-3814. PMID: 34470490, DOI: 10.1161/strokeaha.121.034069.Peer-Reviewed Original ResearchConceptsAcute ischemic stroke patientsEndovascular thrombectomyIschemic stroke patientsStroke patientsEVT casesGuidelines-Stroke hospitalsUS clinical practiceLower stroke severityClinical practice settingEVT outcomesEVT timesHospital mortalityNontrial settingDischarge dispositionIschemic strokePatient characteristicsStroke severityAtrial fibrillationFunctional outcomeClinical registryHospital characteristicsPatientsClinical practicePractice settingsStudy period
2019
Association Between Time to Treatment With Endovascular Reperfusion Therapy and Outcomes in Patients With Acute Ischemic Stroke Treated in Clinical Practice
Jahan R, Saver J, Schwamm L, Fonarow G, Liang L, Matsouaka R, Xian Y, Holmes D, Peterson E, Yavagal D, Smith E. Association Between Time to Treatment With Endovascular Reperfusion Therapy and Outcomes in Patients With Acute Ischemic Stroke Treated in Clinical Practice. JAMA 2019, 322: 252-263. PMID: 31310296, PMCID: PMC6635908, DOI: 10.1001/jama.2019.8286.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeEndovascular reperfusion therapySymptomatic intracranial hemorrhageLarge vessel occlusionRoutine clinical practiceHospice dischargePuncture timeClinical practiceSubstantial reperfusionIschemic strokeArterial punctureVessel occlusionLarge vessel occlusion acute ischemic strokeMedian pretreatment scoreHealth Stroke ScaleRetrospective cohort studyRandomized clinical trialsHigher likelihoodAssociation of speedAmbulatory statusReperfusion therapyStroke ScaleAdverse eventsCohort studyHospital arrival
2018
Evidence-Based Performance Measures and Outcomes in Patients With Acute Ischemic Stroke
Wang Y, Li Z, Zhao X, Liu L, Wang C, Wang C, Peterson E, Schwamm L, Fonarow G, Smith S, Bettger J, Wang D, Li H, Xian Y, Wang Y. Evidence-Based Performance Measures and Outcomes in Patients With Acute Ischemic Stroke. Circulation Cardiovascular Quality And Outcomes 2018, 11: e001968. PMID: 30557048, DOI: 10.1161/circoutcomes.115.001968.Peer-Reviewed Original ResearchMeSH KeywordsAgedBrain IschemiaChinaClinical CompetenceDisability EvaluationEvidence-Based MedicineFemaleFibrinolytic AgentsGuideline AdherenceHumansMaleMiddle AgedOutcome and Process Assessment, Health CarePractice Guidelines as TopicPractice Patterns, Physicians'Prospective StudiesQuality ImprovementQuality Indicators, Health CareRecovery of FunctionRegistriesRisk FactorsSmoking CessationStrokeStroke RehabilitationThrombolytic TherapyTime FactorsTime-to-TreatmentTreatment OutcomeConceptsAcute ischemic strokeIschemic strokeOptimal complianceStroke careChina National Stroke RegistryEvidence-based performance measuresMultivariable Cox modelNational Stroke RegistryFavorable functional outcomeProspective cohort studyEvidence-based guidelinesRoutine clinical practiceCause of deathIntravenous tPAStroke recurrenceStroke RegistryCohort studyNationwide registryClinical outcomesFunctional outcomeCare measuresImproved outcomesHospital measuresCox modelClinical practice
2017
Increase in Endovascular Therapy in Get With The Guidelines-Stroke After the Publication of Pivotal Trials
Smith E, Saver J, Cox M, Liang L, Matsouaka R, Xian Y, Bhatt D, Fonarow G, Schwamm L. Increase in Endovascular Therapy in Get With The Guidelines-Stroke After the Publication of Pivotal Trials. Circulation 2017, 136: 2303-2310. PMID: 28982689, DOI: 10.1161/circulationaha.117.031097.Peer-Reviewed Original ResearchConceptsEndovascular thrombectomyEVT useEligible patientsIschemic strokePivotal trialsCase volumeStroke systemsHealth Stroke Scale scoreGuidelines-Stroke programStroke Scale scoreMean case volumeGuidelines-StrokeEndovascular therapyMore patientsPatient eligibilityPatientsClinical practiceScale scoreHospitalStrokeTrialsNational InstituteStroke durationLinear regressionThrombectomyAmerican Telemedicine Association: Telestroke Guidelines
Demaerschalk BM, Berg J, Chong BW, Gross H, Nystrom K, Adeoye O, Schwamm L, Wechsler L, Whitchurch S. American Telemedicine Association: Telestroke Guidelines. Telemedicine Journal And E-Health 2017, 23: 376-389. PMID: 28384077, PMCID: PMC5802246, DOI: 10.1089/tmj.2017.0006.Peer-Reviewed Original ResearchConceptsAcute stroke syndromeStroke patient careAcute care facilitiesTelestroke modelStroke syndromeHemorrhagic strokeNeurologic emergencyAcute phaseHospital encountersNeurological emergencyStroke careTelestroke servicesCare facilitiesClinical practiceClinical protocolsPatient careClinical servicesRemote careHealthcare practitionersCarePatientsStrokeQuality outcomesEntire continuumGuidelinesUse of Strategies to Improve Door-to-Needle Times With Tissue-Type Plasminogen Activator in Acute Ischemic Stroke in Clinical Practice
Xian Y, Xu H, Lytle B, Blevins J, Peterson E, Hernandez A, Smith E, Saver J, Messé S, Paulsen M, Suter R, Reeves M, Jauch E, Schwamm L, Fonarow G. Use of Strategies to Improve Door-to-Needle Times With Tissue-Type Plasminogen Activator in Acute Ischemic Stroke in Clinical Practice. Circulation Cardiovascular Quality And Outcomes 2017, 10: e003227. PMID: 28096207, DOI: 10.1161/circoutcomes.116.003227.Peer-Reviewed Original ResearchMeSH KeywordsBrain IschemiaCross-Sectional StudiesFibrinolytic AgentsGuideline AdherenceHealth Care SurveysHumansInfusions, IntravenousPractice Guidelines as TopicQuality ImprovementQuality Indicators, Health CareStrokeThrombolytic TherapyTime FactorsTime-to-TreatmentTissue Plasminogen ActivatorTreatment OutcomeConceptsNational quality improvement initiativeGuidelines-Stroke hospitalsAcute ischemic strokeDTN timeIntravenous tPAIschemic strokeNeedle timeTissue-type plasminogen activator administrationMedian DTN timeIschemic stroke patientsEmergency medical services (EMS) providersQuality improvement initiativesTissue-type plasminogen activatorHospital arrivalSymptom onsetStroke patientsMedical service providersClinical practiceHospitalPatientsMost hospitalsPlasminogen activatorPhase IStrokeImprovement initiatives
2013
Time to Treatment With Intravenous Tissue Plasminogen Activator and Outcome From Acute Ischemic Stroke
Saver J, Fonarow G, Smith E, Reeves M, Grau-Sepulveda M, Pan W, Olson D, Hernandez A, Peterson E, Schwamm L. Time to Treatment With Intravenous Tissue Plasminogen Activator and Outcome From Acute Ischemic Stroke. JAMA 2013, 309: 2480-2488. PMID: 23780461, DOI: 10.1001/jama.2013.6959.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeSymptomatic intracranial hemorrhageTissue-type plasminogen activatorIschemic strokeIntracranial hemorrhageIndependent ambulationHospital mortalityThrombolytic treatmentClinical practiceIntravenous tissue-type plasminogen activatorMedian pretreatment National InstitutesIntravenous tissue plasminogen activatorPlasminogen activatorGreater stroke severityGuidelines-Stroke programPretreatment National InstitutesHealth Stroke ScaleUS clinical practiceRandomized clinical trialsTissue plasminogen activatorHospital presentationShorter OTTAmbulatory statusHospital deathStroke Scale
2012
Use of Tissue-Type Plasminogen Activator Before and After Publication of the European Cooperative Acute Stroke Study III in Get With The Guidelines-Stroke
Messé S, Fonarow G, Smith E, Kaltenbach L, Olson D, Kasner S, Schwamm L. Use of Tissue-Type Plasminogen Activator Before and After Publication of the European Cooperative Acute Stroke Study III in Get With The Guidelines-Stroke. Circulation Cardiovascular Quality And Outcomes 2012, 5: 321-326. PMID: 22550132, DOI: 10.1161/circoutcomes.111.964064.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overEuropeFemaleFibrinolytic AgentsGuideline AdherenceHumansInfusions, IntravenousLinear ModelsMaleMiddle AgedMultivariate AnalysisOdds RatioOutcome and Process Assessment, Health CarePractice Guidelines as TopicStrokeThrombolytic TherapyTime FactorsTissue Plasminogen ActivatorTreatment OutcomeUnited StatesConceptsAcute ischemic strokeEuropean Cooperative Acute Stroke Study (ECASS) IIIECASS IIITreatment of patientsUse of tPAEligible patientsHours of AISProportion of patientsStudy IIITissue-type plasminogen activatorGuidelines-StrokeIschemic strokeMedian doorNeedle timePatientsClinical practiceTreatment ratesPlasminogen activatorSignificant increaseHoursLater time windowAdverse affectsTPATreatmentProportion
2011
Improving Door-to-Needle Times in Acute Ischemic Stroke
Fonarow G, Smith E, Saver J, Reeves M, Hernandez A, Peterson E, Sacco R, Schwamm L. Improving Door-to-Needle Times in Acute Ischemic Stroke. Stroke 2011, 42: 2983-2989. PMID: 21885841, DOI: 10.1161/strokeaha.111.621342.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeAcute ischemic stroke patientsTissue-type plasminogen activatorIschemic stroke patientsNeedle timeIschemic strokeStroke patientsAmerican Heart Association/American Stroke AssociationIntravenous tissue-type plasminogen activatorAmerican Stroke AssociationUnited States hospitalsEmergency medical services prenotificationInitial program goalsTeam-based approachImproving DoorStroke teamTPA administrationFaster doorStroke AssociationClinical practiceHospital participationState HospitalStrokePatientsPlasminogen activator
2010
Recent Nationwide Trends in Discharge Statin Treatment of Hospitalized Patients With Stroke
Ovbiagele B, Schwamm L, Smith E, Hernandez A, Olson D, Pan W, Fonarow G, Saver J. Recent Nationwide Trends in Discharge Statin Treatment of Hospitalized Patients With Stroke. Stroke 2010, 41: 1508-1513. PMID: 20508182, DOI: 10.1161/strokeaha.109.573618.Peer-Reviewed Original ResearchConceptsTransient ischemic attackDischarge statin prescriptionIschemic attackStatin treatmentStatin useStatin prescriptionRecent nationwide trendsNationwide trendsCholesterol Levels (SPARCL) trialEligible patientsGuidelines-StrokeStroke preventionAcute strokeIschemic strokeVascular riskHospitalized patientsAtherosclerotic strokeFemale sexNonsignificant increasePatientsClinical practiceStrokeStudy periodAggressive reductionTreatment
2009
A score to predict early risk of recurrence after ischemic strokeSYMBOLSYMBOL
Ay H, Gungor L, Arsava E, Rosand J, Vangel M, Benner T, Schwamm L, Furie K, Koroshetz W, Sorensen A. A score to predict early risk of recurrence after ischemic strokeSYMBOLSYMBOL. Neurology 2009, 74: 128-135. PMID: 20018608, PMCID: PMC2809031, DOI: 10.1212/wnl.0b013e3181ca9cff.Peer-Reviewed Original ResearchConceptsRecurrent strokeEarly riskPrognostic scoreConsecutive ischemic stroke patientsComprehensive prognostic scoreTIA/strokeAcute stroke careIschemic stroke patientsPredictors of recurrenceRisk of recurrenceCox regression modelEtiologic stroke subtypesPatient management algorithmsBrain infarctsAcute settingIschemic strokeStroke subtypesIndependent predictorsStroke careStroke patientsImaging featuresPrior historySeparate cohortClinical practiceStrokeNumber Needed to Treat to Benefit and to Harm for Intravenous Tissue Plasminogen Activator Therapy in the 3- to 4.5-Hour Window
Saver J, Gornbein J, Grotta J, Liebeskind D, Lutsep H, Schwamm L, Scott P, Starkman S. Number Needed to Treat to Benefit and to Harm for Intravenous Tissue Plasminogen Activator Therapy in the 3- to 4.5-Hour Window. Stroke 2009, 40: 2433-2437. PMID: 19498197, PMCID: PMC2724988, DOI: 10.1161/strokeaha.108.543561.Peer-Reviewed Original ResearchConceptsTissue plasminogen activatorRankin ScaleIntravenous tissue plasminogen activator therapyIntravenous tissue plasminogen activatorTissue plasminogen activator therapyPlasminogen activatorAcute cerebral ischemiaModified Rankin ScalePlasminogen activator therapyResults of therapyEffect sizeCerebral ischemiaPoststroke disabilityAdditional patientsActivator therapyWorse outcomesGlobal disabilityTreatment decisionsBetter outcomesClinical practicePatientsNNTBLikelihood of helpEffect size estimatesTable analysis