2024
Tenecteplase for Stroke at 4.5 to 24 Hours with Perfusion-Imaging Selection
Albers G, Jumaa M, Purdon B, Zaidi S, Streib C, Shuaib A, Sangha N, Kim M, Froehler M, Schwartz N, Clark W, Kircher C, Yang M, Massaro L, Lu X, Rippon G, Broderick J, Butcher K, Lansberg M, Liebeskind D, Nouh A, Schwamm L, Campbell B. Tenecteplase for Stroke at 4.5 to 24 Hours with Perfusion-Imaging Selection. New England Journal Of Medicine 2024, 390: 701-711. PMID: 38329148, DOI: 10.1056/nejmoa2310392.Peer-Reviewed Original ResearchConceptsModified Rankin ScaleSymptomatic intracranial hemorrhageInternal carotid arteryMiddle cerebral arteryRankin ScalePlacebo groupTenecteplase groupIntracranial hemorrhageIncidence of symptomatic intracranial hemorrhageCerebral arteryIncidence of symptomatic intracerebral hemorrhageCarotid arteryPlacebo-controlled trialSymptomatic intracerebral hemorrhageEvidence of occlusionSafety populationDouble-blindPerfusion-imagingMedian timeClinical outcomesIntracerebral hemorrhagePlaceboPerfusion imagingPrimary outcomeOdds ratio
2023
Most Promising Approaches to Improve Stroke Outcomes: The Stroke Treatment Academic Industry Roundtable XII Workshop
Wechsler L, Adeoye O, Alemseged F, Bahr-Hosseini M, Deljkich E, Favilla C, Fisher M, Grotta J, Hill M, Kamel H, Khatri P, Lyden P, Mirza M, Nguyen T, Samaniego E, Schwamm L, Selim M, Silva G, Yavagal D, Yenari M, Zachrison K, Boltze J, Yaghi S, Roundtable O. Most Promising Approaches to Improve Stroke Outcomes: The Stroke Treatment Academic Industry Roundtable XII Workshop. Stroke 2023, 54: 3202-3213. PMID: 37886850, DOI: 10.1161/strokeaha.123.044279.Peer-Reviewed Original ResearchPerformance of Thrombectomy-Capable, Comprehensive, and Primary Stroke Centers in Reperfusion Therapies for Acute Ischemic Stroke: Report From the Get With The Guidelines–Stroke Registry
Raychev R, Sun J, Schwamm L, Smith E, Fonarow G, Messé S, Xian Y, Chiswell K, Blanco R, Mac Grory B, Saver J. Performance of Thrombectomy-Capable, Comprehensive, and Primary Stroke Centers in Reperfusion Therapies for Acute Ischemic Stroke: Report From the Get With The Guidelines–Stroke Registry. Circulation 2023, 148: 2019-2028. PMID: 37855118, DOI: 10.1161/circulationaha.123.066114.Peer-Reviewed Original ResearchConceptsComprehensive stroke centerPrimary stroke centerThrombectomy-capable stroke centersAcute ischemic strokeGuidelines-Stroke registryEndovascular thrombectomyStroke centersReperfusion therapyIschemic strokeClinical outcomesHealth Stroke Scale scoreClinical efficacy outcomesStroke Scale scoreHigher National InstitutesOdds of dischargeGoal doorEVT proceduresHospital mortalityIntravenous thrombolysisEfficacy outcomesSuccessful reperfusionCohort studyDischarge destinationNeedle timePuncture timeRecent Vitamin K Antagonist Use and Intracranial Hemorrhage After Endovascular Thrombectomy for Acute Ischemic Stroke
Mac Grory B, Holmes D, Matsouaka R, Shah S, Chang C, Rison R, Jindal J, Holmstedt C, Logan W, Corral C, Mackey J, Gee J, Bonovich D, Walker J, Gropen T, Benesch C, Dissin J, Pandey H, Wang D, Unverdorben M, Hernandez A, Reeves M, Smith E, Schwamm L, Bhatt D, Saver J, Fonarow G, Peterson E, Xian Y. Recent Vitamin K Antagonist Use and Intracranial Hemorrhage After Endovascular Thrombectomy for Acute Ischemic Stroke. JAMA 2023, 329: 2038-2049. PMID: 37338878, PMCID: PMC10282891, DOI: 10.1001/jama.2023.8073.Peer-Reviewed Original ResearchConceptsRisk of sICHSymptomatic intracranial hemorrhageVitamin K antagonistsAcute ischemic strokeSecondary end pointsEndovascular thrombectomyVKA useIschemic strokeHospital mortalityEnd pointIntracranial hemorrhageOral vitamin K antagonistsVitamin K antagonist useGuidelines-Stroke programPrior VKA usePrimary end pointObservational cohort studyLarge vessel occlusionRisk of complicationsAmerican Heart AssociationUse of anticoagulantsSignificant differencesHospital presentationSICH riskAntagonist useShorter 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 administration
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 comorbiditiesSex 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 adjustmentTrends in Use, Outcomes, and Disparities in Endovascular Thrombectomy in US Patients With Stroke Aged 80 Years and Older Compared With Younger Patients
Adcock A, Schwamm L, Smith E, Fonarow G, Reeves M, Xu H, Matsouaka R, Xian Y, Saver J. Trends in Use, Outcomes, and Disparities in Endovascular Thrombectomy in US Patients With Stroke Aged 80 Years and Older Compared With Younger Patients. JAMA Network Open 2022, 5: e2215869. PMID: 35671055, PMCID: PMC9175073, DOI: 10.1001/jamanetworkopen.2022.15869.Peer-Reviewed Original ResearchConceptsSymptomatic intracranial hemorrhageAcute ischemic strokeYounger patientsHospital mortalityCohort studyIschemic strokeOlder patientsIntracranial hemorrhageAmerican Heart Association/American Stroke AssociationFunctional independenceHealth Stroke Scale scoreSymptomatic intracranial hemorrhage rateNationwide retrospective cohort studyGuidelines-Stroke programGWTG-Stroke hospitalsIntracranial hemorrhage rateStroke Scale scoreFavorable functional outcomeRetrospective cohort studyAmerican Stroke AssociationQuality improvement registryMeeting study criteriaEVT rateEVT useThrombectomy trialsRationale and design of a stepped wedge cluster randomised trial to improve acute reperfusion treatment quality for stroke: IMPROVE stroke care in China
Li Z, Wang C, Zhang X, Zong L, Zhou H, Gu H, Jiang Y, Pan Y, Meng X, Zhou Q, Zhao H, Yang X, Wang M, Xiong Y, Zhao X, Wang Y, Liu L, Ma X, Morgan L, Xian Y, Schwamm L, Wang Y. Rationale and design of a stepped wedge cluster randomised trial to improve acute reperfusion treatment quality for stroke: IMPROVE stroke care in China. Stroke And Vascular Neurology 2022, 7: 451-456. PMID: 35354662, PMCID: PMC9614172, DOI: 10.1136/svn-2021-001461.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeIntravenous thrombolysisReperfusion therapyEndovascular thrombectomyEligible patientsPrimary outcomeWedge clusterQuality improvement interventionsMixed-effects logistic regressionTreatment qualityIntraclass correlation coefficientReperfusion treatmentHospital delayIschemic strokeStroke centersTreat principleStroke careEfficacy analysisChina trialEffective treatmentNumber of casesImprovement interventionsPatientsComprehensive interventionLogistic regressionIn a hub-and-spoke network, spoke-administered thrombolysis reduces mechanical thrombectomy procedure time and number of passes
Kraft A, Awad A, Rosenthal J, Dmytriw A, Vranic J, Bonkhoff A, Bretzner M, Hirsch J, Rabinov J, Stapleton C, Schwamm L, Rost N, Leslie-Mazwi T, Patel A, Regenhardt R. In a hub-and-spoke network, spoke-administered thrombolysis reduces mechanical thrombectomy procedure time and number of passes. Interventional Neuroradiology 2022, 29: 315-320. PMID: 35317663, PMCID: PMC10369105, DOI: 10.1177/15910199221087498.Peer-Reviewed Original ResearchConceptsLarge vessel occlusion strokeIntravenous thrombolysisIVT-treated patientsMechanical thrombectomyProcedure timePuncture timeImproved reperfusionBaseline characteristicsTICI 2bIVT patientsOcclusion strokeOperative reportsProcedural characteristicsTelestroke networkPatientsReperfusionIncreased proportionThrombolysisTechnical difficultiesNIHSSThrombectomyHospitalStrokeMinAssociation Between Endovascular Therapy Time to Treatment and Outcomes in Patients With Basilar Artery Occlusion
Joundi R, Sun J, Xian Y, Alhanti B, Nogueira R, Bhatt D, Fonarow G, Saver J, Schwamm L, Smith E. Association Between Endovascular Therapy Time to Treatment and Outcomes in Patients With Basilar Artery Occlusion. Circulation 2022, 145: 896-905. PMID: 35050693, DOI: 10.1161/circulationaha.121.056554.Peer-Reviewed Original ResearchConceptsBasilar artery occlusionSymptomatic intracranial hemorrhageEndovascular therapySymptom onsetEVT timesHospital mortalityArtery occlusionMedian onsetIntracranial hemorrhageBetter outcomesHealth Stroke Scale scoreIndividual-level patient dataMedian National InstitutesStroke Scale scoreHospital-level factorsProportion of patientsLogistic regression modelsSubstantial reperfusionAnterior circulationPrimary outcomeUS registryMean ageDevastating conditionImproved outcomesTherapy time
2021
Outcomes of Endovascular Therapy in Patients With Prestroke Mobility Impairment
Beekman R, Sun JL, Alhanti B, Schwamm LH, Smith EE, Bhatt DL, Xian Y, Shah S, Lytle BL, Fonarow GC, Sheth KN. Outcomes of Endovascular Therapy in Patients With Prestroke Mobility Impairment. Stroke 2021, 52: e725-e728. PMID: 34517771, DOI: 10.1161/strokeaha.121.034464.Peer-Reviewed Original ResearchConceptsEndovascular thrombectomyGuidelines-Stroke registrySymptomatic intracranial hemorrhageMobility impairmentsLogistic regression modelsHospital deathEndovascular therapyClinical benefitIntracranial hemorrhageAdverse outcomesClinical trialsThrombectomyPatientsOutcomesFurther studiesImpairmentRegression modelsNational data setsSafetyHemorrhageRegistryTherapyPopulationHospiceTrialsFrequency, 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'Drip-and-ship' intravenous thrombolysis and outcomes for large vessel occlusion thrombectomy candidates in a hub-and-spoke telestroke model
Regenhardt R, Rosenthal J, Awad A, Martinez-Gutierrez J, Nolan N, McIntyre J, Whitney C, Alotaibi N, Dmytriw A, Vranic J, Stapleton C, Patel A, Rost N, Schwamm L, Leslie-Mazwi T. 'Drip-and-ship' intravenous thrombolysis and outcomes for large vessel occlusion thrombectomy candidates in a hub-and-spoke telestroke model. Journal Of NeuroInterventional Surgery 2021, 14: 650-653. PMID: 34326197, PMCID: PMC8799754, DOI: 10.1136/neurintsurg-2021-017819.Peer-Reviewed Original ResearchConceptsEndovascular thrombectomyIntravenous thrombolysisIntracerebral hemorrhageDay mRSEVT candidatesFunctional independenceHealth Stroke Scale scoreEmergent large vessel occlusionRisk of ICHMedian National InstitutesStroke Scale scoreLarge vessel occlusionOutcomes of interestAlteplase useDischarge mRSTelestroke modelThrombectomy candidatesEligible patientsIntravenous alteplaseTICI 2bAdequate reperfusionMedian ageSpoke hospitalsCT scoreVessel occlusionAccess to Mechanical Thrombectomy for Ischemic Stroke in the United States
Kamel H, Parikh N, Chatterjee A, Kim L, Saver J, Schwamm L, Zachrison K, Nogueira R, Adeoye O, Díaz I, Ryan A, Pandya A, Navi B. Access to Mechanical Thrombectomy for Ischemic Stroke in the United States. Stroke 2021, 52: 2554-2561. PMID: 33980045, PMCID: PMC8316281, DOI: 10.1161/strokeaha.120.033485.Peer-Reviewed Original ResearchConceptsIschemic strokeMechanical thrombectomyUnadjusted logistic regression modelsNonfederal emergency departmentsAcute ischemic strokeLarge cerebral vesselsAcute care hospitalsMultiple sensitivity analysesLogistic regression modelsStandard descriptive statisticsIntravenous thrombolysisStroke severityUrban patientsCare hospitalSuch patientsInterhospital transferRural patientsStroke careEmergency departmentPopulation-wide dataCerebral vesselsThrombectomyCalendar year 2016PatientsPrimary analysisCTA 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
2020
Strategy for reliable identification of ischaemic stroke, thrombolytics and thrombectomy in large administrative databases
Zachrison K, Li S, Reeves M, Adeoye O, Camargo C, Schwamm L, Hsia R. Strategy for reliable identification of ischaemic stroke, thrombolytics and thrombectomy in large administrative databases. Stroke And Vascular Neurology 2020, 6: 194-200. PMID: 33177162, PMCID: PMC8258073, DOI: 10.1136/svn-2020-000533.Peer-Reviewed Original ResearchConceptsICD-9/ICDMS-DRG codesCurrent Procedural TerminologyEndovascular thrombectomyICD-10 codesLarge administrative databaseIschemic strokeICD codesDischarge codesEmergency departmentAdministrative databasesICD-9CPT codesThrombolytic-treated patientsMedicare severity diagnosisAdministrative dataInpatient hospitalisationThrombolytic treatmentED patientsInterhospital transferDiagnosis codesStroke researchInternational ClassificationPatientsProcedural TerminologyDetermining the Need for Thrombectomy-Capable Stroke Centers Based on Travel Time to the Nearest Comprehensive Stroke Center
Baker D, Tschurtz B, Aliaga A, Williams S, Jauch E, Schwamm L. Determining the Need for Thrombectomy-Capable Stroke Centers Based on Travel Time to the Nearest Comprehensive Stroke Center. The Joint Commission Journal On Quality And Patient Safety 2020, 46: 501-505. PMID: 32736996, DOI: 10.1016/j.jcjq.2020.06.005.Peer-Reviewed Original ResearchShort cuts make long delays: Getting it right from the start in prehospital stroke triage.
Schwamm L, Ntaios G. Short cuts make long delays: Getting it right from the start in prehospital stroke triage. Neurology 2020, 94: 341-342. PMID: 31980583, DOI: 10.1212/wnl.0000000000008994.Peer-Reviewed Original Research
2019
A Network Approach to Stroke Systems of Care
Zachrison K, Dhand A, Schwamm L, Onnela J. A Network Approach to Stroke Systems of Care. Circulation Cardiovascular Quality And Outcomes 2019, 12: e005526. PMID: 31405293, PMCID: PMC6822608, DOI: 10.1161/circoutcomes.119.005526.Peer-Reviewed Original Research