2023
Distinguishing Distinct Neural Systems for Proximal vs Distal Upper Extremity Motor Control After Acute Stroke
Lin D, Hardstone R, DiCarlo J, Mckiernan S, Snider S, Jacobs H, Erler K, Rishe K, Boyne P, Goldsmith J, Ranford J, Finklestein S, Schwamm L, Hochberg L, Cramer S. Distinguishing Distinct Neural Systems for Proximal vs Distal Upper Extremity Motor Control After Acute Stroke. Neurology 2023, 101: e347-e357. PMID: 37268437, PMCID: PMC10435065, DOI: 10.1212/wnl.0000000000207417.Peer-Reviewed Original ResearchConceptsDistal motor controlUpper extremity motor deficitsAcute strokeBarthel IndexMotor deficitsMotor controlAcute stroke patientsUpper extremity hemiparesisUpper extremity motor controlRegion of injuryLesion-symptom mappingMotor systemHealthy CNSDays poststrokeDistal injuriesRankin ScaleStroke onsetConsecutive patientsStroke patientsMotor scoresClinical syndromeFunctional outcomeIntact CNSPosterior aspectPrecentral gyrusShorter Door-to-Needle Times Are Associated With Better Outcomes After Intravenous Thrombolytic Therapy and Endovascular Thrombectomy for Acute Ischemic Stroke
Man S, Solomon N, Mac Grory B, Alhanti B, Uchino K, Saver J, Smith E, Xian Y, Bhatt D, Schwamm L, Hussain M, Fonarow G. Shorter Door-to-Needle Times Are Associated With Better Outcomes After Intravenous Thrombolytic Therapy and Endovascular Thrombectomy for Acute Ischemic Stroke. Circulation 2023, 148: 20-34. PMID: 37199147, PMCID: PMC10356148, DOI: 10.1161/circulationaha.123.064053.Peer-Reviewed Original ResearchConceptsIntravenous thrombolytic therapyAcute ischemic strokeGood long-term functional outcomeLong-term functional outcomeShorter DTN timesEndovascular thrombectomyFunctional outcomeDTN timeIschemic strokeCause mortalityNeedle timeThrombolytic therapyCox proportional hazards modelModified Rankin Scale (mRS) 0Older US patientsRankin Scale 0Multivariate logistic regressionProportional hazards modelLongitudinal functional outcomesHome timeEligible patientsEVT candidatesEVT timesGuidelines-StrokeThrombolytic administrationSMS-text messaging for collecting outcome measures after acute stroke
DiCarlo J, Erler K, Petrilli M, Emerson K, Gochyyev P, Schwamm L, Lin D. SMS-text messaging for collecting outcome measures after acute stroke. Frontiers In Digital Health 2023, 5: 1043806. PMID: 36910572, PMCID: PMC9996089, DOI: 10.3389/fdgth.2023.1043806.Peer-Reviewed Original ResearchModified Rankin ScaleAcute strokeOutcomes Measurement Information System (PROMIS) Global-10Acute stroke treatmentText messaging programsNIH Stroke ScaleOutcome data collectionHospitalization dischargeSMS text messagingHospital stayStroke ScaleMRS scoreRankin ScaleStroke treatmentFunctional outcomePROM scoresOutcome measuresWeighted Cohen's kappaPatientsSignificant associationStrokeTraditional followSMS textOutcomesParticipant satisfaction
2022
Association of Modified Rankin Scale With Recovery Phenotypes in Patients With Upper Extremity Weakness After Stroke
Erler K, Wu R, DiCarlo J, Petrilli M, Gochyyev P, Hochberg L, Kautz S, Schwamm L, Cramer S, Finklestein S, Lin D. Association of Modified Rankin Scale With Recovery Phenotypes in Patients With Upper Extremity Weakness After Stroke. Neurology 2022, 98: e1877-e1885. PMID: 35277444, PMCID: PMC9109148, DOI: 10.1212/wnl.0000000000200154.Peer-Reviewed Original ResearchConceptsModified Rankin ScaleUpper extremity weaknessMRS scoreStroke trialsFunctional outcomeOutcome measuresMRS levelsExtremity weaknessRankin ScaleMRS outcomesMotor impairmentFuture stroke trialsDaily living statusUpper extremity impairmentMeaningful changeGlobal outcome measuresMeaningful clinical changeIschemic strokeFugl-MeyerGrip strengthMotor phenotypeClinical changesClinical careDaily livingPatientsTemporal Trends in Racial and Ethnic Disparities in Endovascular Therapy in Acute Ischemic Stroke
Sheriff F, Xu H, Maud A, Gupta V, Vellipuram A, Fonarow G, Matsouaka R, Xian Y, Reeves M, Smith E, Saver J, Rodriguez G, Cruz‐Flores S, Schwamm L. Temporal Trends in Racial and Ethnic Disparities in Endovascular Therapy in Acute Ischemic Stroke. Journal Of The American Heart Association 2022, 11: e023212. PMID: 35229659, PMCID: PMC9075329, DOI: 10.1161/jaha.121.023212.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeEndovascular therapyEVT useIschemic strokeNon-Hispanic white patientsGuidelines-Stroke databaseHealth Stroke ScaleMortality/dischargeClinical trial publicationsPatient disparitiesDischarge homeEligible patientsNHW patientsStroke ScaleWhite patientsBlack patientsAsian patientsFunctional outcomeLarge cohortTrial publicationsPatientsFunctional independenceEthnic disparitiesRelated outcomesNational InstituteAssociation of Recent Use of Non–Vitamin K Antagonist Oral Anticoagulants With Intracranial Hemorrhage Among Patients With Acute Ischemic Stroke Treated With Alteplase
Kam W, Holmes D, Hernandez A, Saver J, Fonarow G, Smith E, Bhatt D, Schwamm L, Reeves M, Matsouaka R, Khan Y, Unverdorben M, Birmingham M, Lyden P, Asimos A, Altschul D, Schoonover T, Jumaa M, Nomura J, Suri M, Moore S, Lafranchise E, Olson D, Peterson E, Xian Y. Association of Recent Use of Non–Vitamin K Antagonist Oral Anticoagulants With Intracranial Hemorrhage Among Patients With Acute Ischemic Stroke Treated With Alteplase. JAMA 2022, 327: 760-771. PMID: 35143601, PMCID: PMC8832308, DOI: 10.1001/jama.2022.0948.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeSymptomatic intracranial hemorrhageSecondary functional outcomesSecondary safety outcomesProportion of patientsIntravenous alteplaseIntracranial hemorrhageIschemic strokeFunctional outcomeOral anticoagulantsInpatient mortalitySafety outcomesNon-Vitamin K Antagonist Oral AnticoagulantsK Antagonist Oral AnticoagulantsBaseline clinical factorsGuidelines-Stroke programIntravenous alteplase administrationLong-term anticoagulantsUse of NOACsRetrospective cohort studyUse of anticoagulantsSignificant differencesAlteplase administrationCardiovascular comorbiditiesNOAC group
2021
Exploring the Unmet Need in Acute Ischemic Stroke Patients Not Treated With Intravenous Alteplase: The Get With The Guidelines‐Stroke Registry
Mac Grory B, Xian Y, Solomon N, Matsouaka R, Decker‐Palmer M, Fonarow G, Smith E, Schwamm L. Exploring the Unmet Need in Acute Ischemic Stroke Patients Not Treated With Intravenous Alteplase: The Get With The Guidelines‐Stroke Registry. Stroke Vascular And Interventional Neurology 2021, 2 DOI: 10.1161/svin.121.000226.Peer-Reviewed Original ResearchGuidelines-Stroke registryAcute ischemic strokeIschemic strokePatient populationCommon reasonUnmet needAcute ischemic stroke patientsIntravenous tissue plasminogen activatorAcute ischemic stroke careGuidelines-Stroke hospitalsIschemic stroke patientsIschemic stroke careLong-term outcomesTissue plasminogen activatorAlteplase deliveryHospital mortalityIntravenous alteplaseClinical characteristicsConclusions PatientsReadmission ratesEarly administrationPostdischarge costsStroke careStroke patientsFunctional outcomeFrequency, 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 periodTenecteplase Reperfusion therapy in Acute ischaemic Cerebrovascular Events-II (TRACE II): rationale and design
Li S, Campbell B, Schwamm L, Fisher M, Parsons M, Li H, Pan Y, Wang Y, . Tenecteplase Reperfusion therapy in Acute ischaemic Cerebrovascular Events-II (TRACE II): rationale and design. Stroke And Vascular Neurology 2021, 7: 71-76. PMID: 34446531, PMCID: PMC8899655, DOI: 10.1136/svn-2021-001074.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeExcellent functional outcomeFunctional outcomeReperfusion therapyRt-PAAcute ischemic cerebrovascular eventsIntravenous thrombolysis therapyMajor neurological improvementSecondary efficacy outcomesHealth Stroke ScaleIschemic cerebrovascular eventsSymptomatic intracranial hemorrhageFavorable functional outcomeIschemic stroke onsetPrimary study outcomeRankin Scale 0Non-inferiority studyTissue-type plasminogen activatorCerebrovascular eventsNeurological improvementStroke ScaleEfficacy outcomesIschemic strokeStroke onsetThrombolysis therapy
2020
Trends in Reperfusion Therapy for In-Hospital Ischemic Stroke in the Endovascular Therapy Era
Akbik F, Xu H, Xian Y, Shah S, Smith E, Bhatt D, Matsouaka R, Fonarow G, Schwamm L. Trends in Reperfusion Therapy for In-Hospital Ischemic Stroke in the Endovascular Therapy Era. JAMA Neurology 2020, 77: 1486-1495. PMID: 32955582, PMCID: PMC7506601, DOI: 10.1001/jamaneurol.2020.3362.Peer-Reviewed Original ResearchConceptsHospital stroke onsetHospital onsetIntravenous thrombolysisStroke onsetEndovascular therapyReperfusion therapyHospital strokeCohort studyIschemic strokeFunctional outcomeNational registryIn-Hospital Ischemic StrokeIntravenous thrombolysis treatmentLimited contemporary dataRetrospective cohort studyAcute ischemic strokeVascular risk factorsWorse functional outcomeEndovascular reperfusion therapyLonger median timeKey patient characteristicsTherapy eraThrombolysis treatmentHospital dischargePatient characteristicsAssociation Between Thrombolytic Door-to-Needle Time and 1-Year Mortality and Readmission in Patients With Acute Ischemic Stroke
Man S, Xian Y, Holmes D, Matsouaka R, Saver J, Smith E, Bhatt D, Schwamm L, Fonarow G. Association Between Thrombolytic Door-to-Needle Time and 1-Year Mortality and Readmission in Patients With Acute Ischemic Stroke. JAMA 2020, 323: 2170-2184. PMID: 32484532, PMCID: PMC7267850, DOI: 10.1001/jama.2020.5697.Peer-Reviewed Original ResearchConceptsIntravenous tissue plasminogen activatorAcute ischemic strokeTissue plasminogen activatorCause mortalityNeedle timeCause readmissionIschemic strokeLong-term outcomesShorter doorBetter long-term outcomesImproved long-term outcomesPlasminogen activatorRetrospective cohort studyGood functional outcomeGuidelines-StrokeCohort studyHospital arrivalHospital dischargeMedian doorEarly administrationMedian agePrimary outcomeThrombolytic therapyFunctional outcomeReadmissionSafety and Outcomes of Intravenous tPA in Acute Ischemic Stroke Patients With Prior Stroke Within 3 Months
Shah S, Liang L, Kosinski A, Hernandez A, Schwamm L, Smith E, Fonarow G, Bhatt D, Feng W, Peterson E, Xian Y. Safety and Outcomes of Intravenous tPA in Acute Ischemic Stroke Patients With Prior Stroke Within 3 Months. Circulation Cardiovascular Quality And Outcomes 2020, 13: e006031. PMID: 31903770, DOI: 10.1161/circoutcomes.119.006031.Peer-Reviewed Original ResearchMeSH KeywordsAdministrative Claims, HealthcareAgedAged, 80 and overBrain IschemiaDatabases, FactualFemaleFibrinolytic AgentsHospital MortalityHumansInfusions, IntravenousIntracranial HemorrhagesMaleMedicareRecurrenceRegistriesRetrospective StudiesRisk AssessmentRisk FactorsStrokeThrombolytic TherapyTime FactorsTissue Plasminogen ActivatorTreatment OutcomeUnited StatesConceptsAcute ischemic stroke patientsPrior ischemic strokeSymptomatic intracranial hemorrhageIschemic stroke patientsPrior strokeHospital mortalityIntravenous tPAIschemic strokeIntracranial hemorrhageStroke patientsGuidelines-Stroke hospitalsHigher stroke severityGood functional outcomeHistory of strokeRetrospective observational studyYears of ageCardiovascular comorbiditiesStroke providersStroke severityUnadjusted riskFunctional outcomeHigh prevalenceObservational studyMedicare claimsElevated risk
2019
DEFUSE 3 Non-DAWN Patients
Leslie-Mazwi T, Hamilton S, Mlynash M, Patel A, Schwamm L, Lansberg M, Marks M, Hirsch J, Albers G. DEFUSE 3 Non-DAWN Patients. Stroke 2019, 50: 618-625. PMID: 30727856, PMCID: PMC6768068, DOI: 10.1161/strokeaha.118.023310.Peer-Reviewed Original ResearchConceptsRankin Scale scoreNIHSS 6DEFUSE 3Functional outcomeInfarct volumeLarger patientsDAWN criteriaScale scoreEmergent large vessel occlusionRankin Scale score 0DEFUSE 3 patientsEffect of thrombectomyHealth Stroke ScaleLarge vessel occlusionBenefit of thrombectomyCore infarct volumeBeneficial treatment effectMethods Eligibility criteriaNIHSS scoreStroke ScaleConclusions PatientsEndovascular therapySymptom onsetDAWN trialVessel occlusion
2018
Protocols for Endovascular Stroke Treatment Diminish the Weekend Effect Through Improvements in Off-Hours Care
Raymond S, Akbik F, Stapleton C, Mehta B, Chandra R, Gonzalez R, Rabinov J, Schwamm L, Patel A, Hirsch J, Leslie-Mazwi T. Protocols for Endovascular Stroke Treatment Diminish the Weekend Effect Through Improvements in Off-Hours Care. Frontiers In Neurology 2018, 9: 1106. PMID: 30619062, PMCID: PMC6305592, DOI: 10.3389/fneur.2018.01106.Peer-Reviewed Original ResearchTime of presentationTreatment latencyTreatment intervalEndovascular stroke treatmentProspective observational cohortOff-hour careAcute strokeMedian doorObservational cohortConsecutive patientsEndovascular therapyStroke treatmentStroke carePuncture timeFunctional outcomeProtocol adherenceThrombolysis candidatesInstitutional protocolPatient outcomesWeekend effectProtocol experienceStudy periodOutcomesPatientsRegular work hoursEvidence-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 practicePrestroke selective serotonin reuptake inhibitor use and functional outcomes after ischaemic stroke
Etherton M, Siddiqui K, Schwamm L. Prestroke selective serotonin reuptake inhibitor use and functional outcomes after ischaemic stroke. Stroke And Vascular Neurology 2018, 3: 9. PMID: 29600002, PMCID: PMC5870643, DOI: 10.1136/svn-2017-000119.Peer-Reviewed Original ResearchConceptsSelective serotonin reuptake inhibitorsAcute ischemic strokeIschemic strokeLength of staySSRI useFunctional outcomeSelective serotonin reuptake inhibitor useSerotonin reuptake inhibitor useGuidelines-Stroke registrySerotonin reuptake inhibitorsMultivariate regression analysisAmbulatory statusSymptomatic hemorrhageConsecutive patientsInhibitor useMotor recoveryReuptake inhibitorsFunctional recoveryStroke recoveryUnivariate analysisData registryDrug listMultivariate analysisStrokeLower likelihood
2016
Use and Outcomes of Intravenous Thrombolysis for Acute Ischemic Stroke in Patients ≥90 Years of Age
Arora R, Salamon E, Katz J, Cox M, Saver J, Bhatt D, Fonarow G, Peterson E, Smith E, Schwamm L, Xian Y, Libman R. Use and Outcomes of Intravenous Thrombolysis for Acute Ischemic Stroke in Patients ≥90 Years of Age. Stroke 2016, 47: 2347-2354. PMID: 27491734, DOI: 10.1161/strokeaha.116.012241.Peer-Reviewed Original ResearchMeSH KeywordsAdministration, IntravenousAdolescentAdultAge FactorsAgedAged, 80 and overBrain IschemiaFemaleFibrinolytic AgentsHospital MortalityHumansIntracranial HemorrhagesMaleMiddle AgedPractice Patterns, Physicians'PrognosisRegistriesRetrospective StudiesStrokeThrombolytic TherapyTissue Plasminogen ActivatorTreatment OutcomeYoung AdultConceptsIntravenous tissue-type plasminogen activatorTissue-type plasminogen activatorAcute ischemic strokeSymptomatic hemorrhageTPA useIschemic strokeYounger patientsFunctional outcomeQuality improvement registryGood functional outcomeYears of ageYounger age groupsIntravenous thrombolysisHospital mortalityFibrinolytic therapyAcute rehabilitationIndependent ambulationDischarge outcomesMultivariable analysisHospice dischargePatientsAge groupsHemorrhagePlasminogen activatorMortalityPrior Antithrombotic Use Is Associated With Favorable Mortality and Functional Outcomes in Acute Ischemic Stroke
Myint P, Hellkamp A, Fonarow G, Reeves M, Schwamm L, Schulte P, Xian Y, Suter R, Bhatt D, Saver J, Peterson E, Smith E. Prior Antithrombotic Use Is Associated With Favorable Mortality and Functional Outcomes in Acute Ischemic Stroke. Stroke 2016, 47: 2066-2074. PMID: 27435402, DOI: 10.1161/strokeaha.115.012414.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeIschemic strokeAntithrombotic useClinical outcomesVascular indicationsBetter outcomesPrevious antithrombotic therapyUse of antithromboticsMainstay of treatmentRankin Scale scoreImproved clinical outcomesAppropriate patient populationIndependent ambulatory statusGuidelines-StrokeHospital mortalityAmbulatory statusAntithrombotic therapyStroke preventionDischarge destinationHospital factorsSecondary preventionFavorable mortalityStroke patientsAcute eventFunctional outcomeAssociation of Get With The Guidelines-Stroke Program Participation and Clinical Outcomes for Medicare Beneficiaries With Ischemic Stroke
Song S, Fonarow G, Olson D, Liang L, Schulte P, Hernandez A, Peterson E, Reeves M, Smith E, Schwamm L, Saver J. Association of Get With The Guidelines-Stroke Program Participation and Clinical Outcomes for Medicare Beneficiaries With Ischemic Stroke. Stroke 2016, 47: 1294-1302. PMID: 27079809, PMCID: PMC4975426, DOI: 10.1161/strokeaha.115.011874.Peer-Reviewed Original ResearchConceptsAcute ischemic stroke admissionsGWTG-Stroke programIschemic stroke admissionsClinical outcomesStroke admissionsMedicare beneficiariesAcute care US hospitalsHospital-based quality improvement programsGWTG-Stroke hospitalsImproved functional outcomesAmerican Heart AssociationQuality Improvement ProgramGWTG-StrokePostdischarge mortalityAcute strokeIschemic strokeFunctional outcomeHeart AssociationNonparticipating hospitalsStroke hospitalsHospital participationUS hospitalsHospitalPre periodSimilar hospitalsRisks and Benefits Associated With Prestroke Antiplatelet Therapy Among Patients With Acute Ischemic Stroke Treated With Intravenous Tissue Plasminogen Activator
Xian Y, Federspiel J, Grau-Sepulveda M, Hernandez A, Schwamm L, Bhatt D, Smith E, Reeves M, Thomas L, Webb L, Bettger J, Laskowitz D, Fonarow G, Peterson E. Risks and Benefits Associated With Prestroke Antiplatelet Therapy Among Patients With Acute Ischemic Stroke Treated With Intravenous Tissue Plasminogen Activator. JAMA Neurology 2016, 73: 1-10. PMID: 26551916, DOI: 10.1001/jamaneurol.2015.3106.Peer-Reviewed Original ResearchConceptsIntravenous tissue plasminogen activatorSymptomatic intracranial hemorrhageAcute ischemic strokePrestroke antiplatelet therapyTissue plasminogen activatorAntiplatelet therapyIschemic strokeGood functional outcomeHospital mortalityFunctional outcomeHigher oddsPlasminogen activatorDual antiplatelet treatmentGuidelines-Stroke registryRisk-adjusted likelihoodCardiovascular risk factorsRankin Scale scoreAmerican Heart AssociationAntiplatelet treatmentRegistry hospitalsRegistry patientsAmbulatory statusTPA administrationAdult patientsAntiplatelet agents