2023
Tenecteplase versus alteplase in acute ischaemic cerebrovascular events (TRACE-2): a phase 3, multicentre, open-label, randomised controlled, non-inferiority trial
Wang Y, Li S, Pan Y, Li H, Parsons M, Campbell B, Schwamm L, Fisher M, Che F, Dai H, Li D, Li R, Wang J, Wang Y, Zhao X, Li Z, Zheng H, Xiong Y, Meng X, Investigators T, Li R, Wang D, Wang Y, Chen S, Deng D, Zhang H, Wang J, Chen H, Zhang H, Wu Y, Liu H, Lu G, Zhao L, Zhu R, Liu Y, Yi F, Gao J, Dai H, Hao J, Che F, Cai X, Duan Z, Yu H, Wei T, Tang Y, Peng Z, Zhang B, Song Y, Chen X, Liu Y, Liu J, Li D, Zhao W, Wei X, Xue Q, Liu X, Yang Y, zhao C, Chen J, Sui Y, Sheng G, Zhang Y, Liu J, Zhang L, Wang W, Guo Z, Li H, Hu R, Chen G, Liang Z, Chen J, Xia L, Long Z. Tenecteplase versus alteplase in acute ischaemic cerebrovascular events (TRACE-2): a phase 3, multicentre, open-label, randomised controlled, non-inferiority trial. The Lancet 2023, 401: 645-654. PMID: 36774935, DOI: 10.1016/s0140-6736(22)02600-9.Peer-Reviewed Original ResearchConceptsSymptomatic intracranial hemorrhageAcute ischemic strokeAlteplase groupTenecteplase groupNon-inferiority marginNon-inferiority trialIschemic strokeModified intentionTreat populationEndovascular thrombectomyIntracranial hemorrhageRisk ratioScale scoreAcute ischemic cerebrovascular eventsHealth Stroke Scale scoreMedical Sciences (CAMS) Innovation FundStandard intravenous thrombolysisIschemic cerebrovascular eventsPrimary efficacy outcomePrimary safety outcomeStroke Scale scoreRankin Scale scoreProportion of participantsIntravenous tenecteplaseIntravenous thrombolysis
2022
Sex Differences in Endovascular Therapy for Ischemic Stroke: Results From the Get With The Guidelines–Stroke Registry
Demel S, Reeves M, Xu H, Xian Y, Mac Grory B, Fonarow G, Matsouaka R, Smith E, Saver J, Schwamm L. Sex Differences in Endovascular Therapy for Ischemic Stroke: Results From the Get With The Guidelines–Stroke Registry. Stroke 2022, 53: 3099-3106. PMID: 35880521, DOI: 10.1161/strokeaha.122.038491.Peer-Reviewed Original ResearchConceptsEndovascular therapyIschemic strokeHealth Stroke Scale scoreTreatment ratesGuidelines-Stroke hospitalsGuidelines-Stroke registryStroke Scale scoreAcute ischemic strokeSex differencesLarge vessel occlusionMultivariable regression analysisIschemic stroke dischargesEVT useHospital deathHospital mortalityASA guidelinesVessel occlusionOdds ratioScale scoreStroke dischargesSignificant sex differencesWomenNational InstituteMenStatistical adjustmentA Phase III, prospective, double-blind, randomized, placebo-controlled trial of thrombolysis in imaging-eligible, late-window patients to assess the efficacy and safety of tenecteplase (TIMELESS): Rationale and design
Albers G, Campbell B, Lansberg M, Broderick J, Butcher K, Froehler M, Schwamm L, Nouh A, Liebeskind D, Toy F, Yang M, Massaro L, Schoeffler M, Purdon B. A Phase III, prospective, double-blind, randomized, placebo-controlled trial of thrombolysis in imaging-eligible, late-window patients to assess the efficacy and safety of tenecteplase (TIMELESS): Rationale and design. International Journal Of Stroke 2022, 18: 237-241. PMID: 35262424, DOI: 10.1177/17474930221088400.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeInternal carotid arteryPlacebo-controlled trialRankin Scale scoreSymptom onsetDay 90Scale scoreMiddle cerebral artery occlusionEfficacy of tenecteplaseLate-window patientsSafety of tenecteplaseSymptomatic intracranial hemorrhageCerebral artery occlusionLarge vessel occlusionPhase IIIPrimary efficacy objectiveBetter clinical outcomesAdverse eventsArtery occlusionEndovascular thrombectomyIschemic strokeMCA occlusionClinical outcomesIntracranial hemorrhageSalvageable tissue
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 InstituteSeverityCTA Protocols in a Telestroke Network Improve Efficiency for Both Spoke and Hub Hospitals
Yu A, Regenhardt R, Whitney C, Schwamm L, Patel A, Stapleton C, Viswanathan A, Hirsch J, Lev M, Leslie-Mazwi T. CTA Protocols in a Telestroke Network Improve Efficiency for Both Spoke and Hub Hospitals. American Journal Of Neuroradiology 2021, 42: 435-440. PMID: 33541900, PMCID: PMC7959422, DOI: 10.3174/ajnr.a6950.Peer-Reviewed Original ResearchConceptsEndovascular thrombectomySpoke hospitalsTelestroke networkHub hospitalCTA protocolHealth Stroke Scale scoreEmergent large vessel occlusionStroke Scale scoreRate of patientsLarge vessel occlusionCTA utilizationThrombectomy ratesStroke triageThrombectomyNonsignificant increasePatientsScale scoreHospitalTriage processNational InstituteOverall rateCTAExtended windowHigher numberRetention rate
2019
Frequency of early rapid improvement in stroke severity during interfacility transfer.
Zachrison K, Leslie-Mazwi T, Boulouis G, Goldstein J, Regenhardt R, Viswanathan A, Lauer A, Siddiqui K, Charidimou A, Rost N, Schwamm L. Frequency of early rapid improvement in stroke severity during interfacility transfer. Neurology Clinical Practice 2019, 9: 373-380. PMID: 31750022, PMCID: PMC6814428, DOI: 10.1212/cpj.0000000000000667.Peer-Reviewed Original ResearchNIHSS scoreInterfacility transferMedian initial NIHSS scoreNIH Stroke Scale scoreHigher initial NIHSSInitial NIHSS scoreNIHSS score changeStroke Scale scoreRapid improvementCSC arrivalInitial NIHSSIndex strokeStroke severityPatient characteristicsMedian changeMultivariable modelingScale scoreScore changeLogistic regressionStrokePatientsScoresDEFUSE 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
Safety and Efficacy of a 3-Dimensional Stent Retriever With Aspiration-Based Thrombectomy vs Aspiration-Based Thrombectomy Alone in Acute Ischemic Stroke Intervention: A Randomized Clinical Trial
Nogueira R, Frei D, Kirmani J, Zaidat O, Lopes D, Turk A, Heck D, Mason B, Haussen D, Levy E, Mehta S, Lazzaro M, Chen M, Dörfler A, Yoo A, Derdeyn C, Schwamm L, Langer D, Siddiqui A. Safety and Efficacy of a 3-Dimensional Stent Retriever With Aspiration-Based Thrombectomy vs Aspiration-Based Thrombectomy Alone in Acute Ischemic Stroke Intervention: A Randomized Clinical Trial. JAMA Neurology 2018, 75: 304-311. PMID: 29296999, PMCID: PMC5885851, DOI: 10.1001/jamaneurol.2017.3967.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeSerious adverse eventsProcedure-related serious adverse eventsStent retrieverMechanical thrombectomy devicesAspiration groupAdverse eventsEnd pointClinical trialsThrombectomy devicesLarge vessel acute ischemic strokeDevice-related serious adverse eventsScale scoreHealth Stroke Scale scoreMedian baseline NIHSS scorePrimary effectiveness end pointPrimary safety end pointAcute ischemic stroke interventionCerebral infarction (TICI) gradeEffectiveness end pointBaseline NIHSS scorePrimary end pointSafety end pointStroke Scale scoreHours of onset
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 regressionThrombectomy
2015
Safety and efficacy of desmoteplase given 3–9 h after ischaemic stroke in patients with occlusion or high-grade stenosis in major cerebral arteries (DIAS-3): a double-blind, randomised, placebo-controlled phase 3 trial
Albers G, von Kummer R, Truelsen T, Jensen J, Ravn G, Grønning B, Chabriat H, Chang K, Davalos A, Ford G, Grotta J, Kaste M, Schwamm L, Shuaib A, Investigators D. Safety and efficacy of desmoteplase given 3–9 h after ischaemic stroke in patients with occlusion or high-grade stenosis in major cerebral arteries (DIAS-3): a double-blind, randomised, placebo-controlled phase 3 trial. The Lancet Neurology 2015, 14: 575-584. PMID: 25937443, DOI: 10.1016/s1474-4422(15)00047-2.Peer-Reviewed Original ResearchConceptsMajor cerebral arteriesHigh-grade stenosisRankin Scale scoreIschemic strokeSymptom onsetCerebral arteryDay 90Scale scorePlacebo-controlled phase 3 trialComputer-generated randomisation listMajor cerebral artery occlusionModified Rankin Scale scoreSymptomatic cerebral edemaSymptomatic intracranial hemorrhageBaseline National InstitutesHealth Stroke ScaleSerious adverse eventsCerebral artery occlusionPhase 3 trialModified Rankin ScaleRandomisation listStroke ScaleStudy drugAdverse eventsArtery occlusionOutcomes in Mild Acute Ischemic Stroke Treated With Intravenous Thrombolysis: A Retrospective Analysis of the Get With the Guidelines–Stroke Registry
Romano J, Smith E, Liang L, Gardener H, Camp S, Shuey L, Cook A, Campo-Bustillo I, Khatri P, Bhatt D, Fonarow G, Sacco R, Schwamm L. Outcomes in Mild Acute Ischemic Stroke Treated With Intravenous Thrombolysis: A Retrospective Analysis of the Get With the Guidelines–Stroke Registry. JAMA Neurology 2015, 72: 423-431. PMID: 25642650, DOI: 10.1001/jamaneurol.2014.4354.Peer-Reviewed Original ResearchConceptsRecombinant tissue plasminogen activatorHealth Stroke Scale scoreStroke Scale scoreSymptomatic intracranial hemorrhageShort-term outcomesIntravenous recombinant tissue plasminogen activatorGuidelines-Stroke registrySerious systemic hemorrhageAcute ischemic strokeLength of stayMild strokeTreatment complicationsIschemic strokeIntracranial hemorrhageScale scoreSymptom onsetSerious complicationsRetrospective analysisSystemic hemorrhageMild acute ischemic strokeNational InstituteWorse short-term outcomesBaseline National InstitutesHigher National InstitutesQuality improvement registry
2013
Impact of macroeconomic status on prehospital management, in-hospital care and functional outcome of acute stroke in China
Ji R, Wang D, Liu G, Shen H, Wang Y, Li H, Schwamm L, Wang Y. Impact of macroeconomic status on prehospital management, in-hospital care and functional outcome of acute stroke in China. Journal Of Clinical Practice 2013, 10: 701-712. DOI: 10.2217/cpr.13.68.Peer-Reviewed Original ResearchPrehospital managementFunctional outcomeChina National Stroke RegistryModified Rankin Scale scoreOpportunity-based scoreNational Stroke RegistryRankin Scale scoreGood functional outcomeGeneralized estimation equationsStroke RegistryIschemic strokeHospital careScale scoreHospital qualityStrokeComposite measureCareOutcomesScoresDysphagia Screening and Hospital-acquired Pneumonia in Patients with Acute Ischemic Stroke: Findings from Get with the Guidelines–Stroke
Masrur S, Smith E, Saver J, Reeves M, Bhatt D, Zhao X, Olson D, Pan W, Hernandez A, Fonarow G, Schwamm L. Dysphagia Screening and Hospital-acquired Pneumonia in Patients with Acute Ischemic Stroke: Findings from Get with the Guidelines–Stroke. Journal Of Stroke And Cerebrovascular Diseases 2013, 22: e301-e309. PMID: 23305674, DOI: 10.1016/j.jstrokecerebrovasdis.2012.11.013.Peer-Reviewed Original ResearchConceptsHospital-acquired pneumoniaDysphagia screeningStroke patientsGuidelines-StrokeNIHSS scoreIschemic strokeOral intakeMultivariable analysisHealth Stroke Scale scoreAdmission National InstitutesGuidelines-Stroke hospitalsStroke Scale scoreAcute ischemic strokeIschemic stroke patientsLength of stayEligible patientsHospital mortalitySevere strokeFemale genderNational guidelinesLower riskPatientsScale scorePneumoniaStroke
2012
Implementation of a patient selection protocol for intra-arterial therapy increases treatment rates in patients with acute ischemic stroke
Rost N, Smith E, Nogueira R, Fitzpatrick K, Yoo A, Hirsch J, Schwamm L. Implementation of a patient selection protocol for intra-arterial therapy increases treatment rates in patients with acute ischemic stroke. Journal Of NeuroInterventional Surgery 2012, 5: i44. PMID: 22611045, PMCID: PMC3777532, DOI: 10.1136/neurintsurg-2011-010240.Peer-Reviewed Original ResearchConceptsIntra-arterial therapyAcute ischemic strokePatient selection protocolLTB patientsIschemic strokeIntravenous tissue plasminogen activatorNIH Stroke Scale scoreTreatment ratesProximal artery occlusionStroke Scale scoreTissue plasminogen activatorProtocol adoptionStroke durationInfarct volumeArtery occlusionMost patientsMultivariable adjustmentIndependent predictorsPatient selectionStroke databasePatientsScale scorePlasminogen activatorStudy periodBrain imagingInfarct Volume Is a Pivotal Biomarker After Intra-Arterial Stroke Therapy
Yoo A, Chaudhry Z, Nogueira R, Lev M, Schaefer P, Schwamm L, Hirsch J, González R. Infarct Volume Is a Pivotal Biomarker After Intra-Arterial Stroke Therapy. Stroke 2012, 43: 1323-1330. PMID: 22426317, DOI: 10.1161/strokeaha.111.639401.Peer-Reviewed Original ResearchMeSH KeywordsAge FactorsAgedAged, 80 and overBiomarkersBrain InfarctionCohort StudiesDatabases, FactualFemaleFibrinolytic AgentsHumansInfusions, IntravenousMagnetic Resonance ImagingMaleMiddle AgedNeuroimagingPredictive Value of TestsProspective StudiesRetrospective StudiesStrokeThrombolytic TherapyTissue Plasminogen ActivatorTomography, X-Ray ComputedTreatment OutcomeConceptsFinal infarct volumeIntra-arterial therapyAcute ischemic strokeInfarct volumeFunctional outcomeBetter outcomesIschemic strokePoor outcomeAnterior circulation acute ischemic strokeScale scoreHealth Stroke Scale scoreMedian admission National InstitutesMedian final infarct volumesLong-term functional outcomeIntra-arterial stroke therapyAdmission National InstitutesProximal artery occlusionStroke Scale scoreOnly independent predictorRankin Scale scoreArtery occlusionProspective cohortRankin ScaleIndependent predictorsClinical outcomes
2011
Outcomes in Mild or Rapidly Improving Stroke Not Treated With Intravenous Recombinant Tissue-Type Plasminogen Activator
Smith E, Fonarow G, Reeves M, Cox M, Olson D, Hernandez A, Schwamm L. Outcomes in Mild or Rapidly Improving Stroke Not Treated With Intravenous Recombinant Tissue-Type Plasminogen Activator. Stroke 2011, 42: 3110-3115. PMID: 21903949, DOI: 10.1161/strokeaha.111.613208.Peer-Reviewed Original ResearchConceptsRecombinant tissue-type plasminogen activatorIntravenous recombinant tissue-type plasminogen activatorHealth Stroke Scale scoreStroke Scale scoreTissue-type plasminogen activatorHospital dischargePoor outcomeRisk factorsNationwide studyScale scorePoor short-term outcomePlasminogen activatorInitial National InstitutesHigher National InstitutesIschemic stroke patientsLipid-lowering medicationsVascular risk factorsMultivariable-adjusted analysesShort-term outcomesStroke-related disabilityLarge nationwide studyNational InstituteReperfusion therapyHome dischargeIndependent predictors
2010
Management of Thrombolysis-Associated Symptomatic Intracerebral Hemorrhage
Goldstein J, Marrero M, Masrur S, Pervez M, Barrocas A, Abdullah A, Oleinik A, Rosand J, Smith E, Dzik W, Schwamm L. Management of Thrombolysis-Associated Symptomatic Intracerebral Hemorrhage. JAMA Neurology 2010, 67: 965-969. PMID: 20697046, PMCID: PMC3690951, DOI: 10.1001/archneurol.2010.175.Peer-Reviewed Original ResearchConceptsSymptomatic intracerebral hemorrhageIntra-arterial thrombolysisHospital mortalityIntracerebral hemorrhageHealth Stroke Scale scoreIntravenous tissue plasminogen activatorGuidelines-Stroke databaseStroke Scale scoreAcute ischemic strokeMultivariable logistic regressionFresh frozen plasmaTissue plasminogen activatorMulticenter registryAcute strokeDevastating complicationIschemic strokeIndependent predictorsThrombolytic therapyFrozen plasmaAppropriate treatmentRetrospective analysisPatientsScale scoreCoagulopathyThrombolysis
2008
Intravenous desmoteplase in patients with acute ischaemic stroke selected by MRI perfusion–diffusion weighted imaging or perfusion CT (DIAS-2): a prospective, randomised, double-blind, placebo-controlled study
Hacke W, Furlan A, Al-Rawi Y, Davalos A, Fiebach J, Gruber F, Kaste M, Lipka L, Pedraza S, Ringleb P, Rowley H, Schneider D, Schwamm L, Leal J, Söhngen M, Teal P, Wilhelm-Ogunbiyi K, Wintermark M, Warach S. Intravenous desmoteplase in patients with acute ischaemic stroke selected by MRI perfusion–diffusion weighted imaging or perfusion CT (DIAS-2): a prospective, randomised, double-blind, placebo-controlled study. The Lancet Neurology 2008, 8: 141-150. PMID: 19097942, PMCID: PMC2730486, DOI: 10.1016/s1474-4422(08)70267-9.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overBrain IschemiaCerebral HemorrhageDouble-Blind MethodFemaleFibrinolytic AgentsHumansInjections, IntravenousMagnetic Resonance ImagingMaleMiddle AgedPerfusionPlasminogen ActivatorsProspective StudiesSample SizeStrokeTomography, X-Ray ComputedTreatment FailureYoung AdultConceptsSymptomatic intracranial hemorrhageClinical response rateAcute ischemic strokeDiffusion-weighted imagingResponse rateNIHSS scoreIschemic strokeIntracranial hemorrhageLesion volumeDay 90Mortality ratePerfusion imagingScale scoreHealth Stroke Scale scoreMedian baseline NIHSS scoreModified Rankin Scale scoreMagnetic resonance perfusion imagingComposite of improvementBaseline NIHSS scorePlacebo-controlled studyStroke Scale scoreDose-ranging studyRankin Scale scoreSymptoms of strokeOnset of stroke
2005
Poor Outcomes in Patients Who Do Not Receive Intravenous Tissue Plasminogen Activator Because of Mild or Improving Ischemic Stroke
Smith E, Abdullah A, Petkovska I, Rosenthal E, Koroshetz W, Schwamm L. Poor Outcomes in Patients Who Do Not Receive Intravenous Tissue Plasminogen Activator Because of Mild or Improving Ischemic Stroke. Stroke 2005, 36: 2497-2499. PMID: 16210552, DOI: 10.1161/01.str.0000185798.78817.f3.Peer-Reviewed Original ResearchConceptsIntravenous tissue plasminogen activatorTissue plasminogen activatorNeurological worseningPoor outcomeHealth Stroke Scale scoreProspective single-center studyPlasminogen activatorStroke Scale scoreSingle-center studyIschemic stroke symptomsTPA eligibilityHome dischargeIschemic strokeNeurological deficitsSymptom onsetStroke symptomsSeverity criteriaPatientsScale scoreNational InstituteSubstantial minoritySymptomsStrokeWorseningOutcomes
2001
Utility of Perfusion-Weighted CT Imaging in Acute Middle Cerebral Artery Stroke Treated With Intra-Arterial Thrombolysis:
Lev M, Segal A, Farkas J, Hossain S, Putman C, Hunter G, Budzik R, Harris G, Buonanno F, Ezzeddine M, Chang Y, Koroshetz W, Gonzalez R, Schwamm L. Utility of Perfusion-Weighted CT Imaging in Acute Middle Cerebral Artery Stroke Treated With Intra-Arterial Thrombolysis:. Stroke 2001, 32: 2021-2028. PMID: 11546891, DOI: 10.1161/hs0901.095680.Peer-Reviewed Original ResearchConceptsFinal infarct volumeAcute middle cerebral artery strokeNIH Stroke Scale scoreMiddle cerebral artery strokeMCA stem occlusionIntra-arterial thrombolysisStroke Scale scoreComplete recanalizationClinical outcomesInfarct volumeLesion volumeArtery strokeOutcome groupAdmission NIH Stroke Scale scoreInitial NIH Stroke Scale scoreScale scoreEarly complete recanalizationFinal lesion volumeUtility of perfusionPoor outcome groupModified Rankin ScalePoor clinical outcomeRankin ScaleStroke onsetConsecutive patients