2023
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
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 ResearchMeSH KeywordsBrain IschemiaCohort StudiesEndovascular ProceduresHumansIschemic StrokeRegistriesReperfusionRetrospective StudiesStrokeThrombectomyTreatment OutcomeConceptsComprehensive 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 trialsTemporal 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 ResearchMeSH KeywordsEndovascular ProceduresEthnicityHispanic or LatinoHumansIschemic StrokeStrokeTreatment OutcomeConceptsAcute 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 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 ResearchMeSH KeywordsAgedArterial Occlusive DiseasesBasilar ArteryEndovascular ProceduresFemaleHumansIntracranial HemorrhagesMaleRetrospective StudiesStrokeThrombectomyTreatment OutcomeConceptsBasilar 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 ResearchMeSH KeywordsAgedAged, 80 and overEndovascular ProceduresFemaleHumansMaleMiddle AgedMobility LimitationRegistriesStrokeThrombectomyTreatment OutcomeConceptsEndovascular 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 periodAssociation Between Hospital Volumes and Clinical Outcomes for Patients With Nontraumatic Subarachnoid Hemorrhage
Leifer D, Fonarow G, Hellkamp A, Baker D, Hoh B, Prabhakaran S, Schoeberl M, Suter R, Washington C, Williams S, Xian Y, Schwamm L. Association Between Hospital Volumes and Clinical Outcomes for Patients With Nontraumatic Subarachnoid Hemorrhage. Journal Of The American Heart Association 2021, 10: e018373. PMID: 34325522, PMCID: PMC8475679, DOI: 10.1161/jaha.120.018373.Peer-Reviewed Original ResearchConceptsAnnual case volumeComprehensive Stroke Center (CSC) certificationStroke center certificationNational Inpatient SampleSubarachnoid hemorrhageNontraumatic subarachnoid hemorrhageCase volumeHospital mortalityClinical outcomesPoor outcomeCenter certificationSAH casesBetter outcomesVolume thresholdHospital annual case volumeHospital case volumeCases/yearBackground Previous studiesLogistic regression modelsSAH hospitalizationsHospital volumeAneurysm obliterationInpatient SampleOdds ratioImproved outcomes'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 occlusionCTA 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
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 ResearchMeSH KeywordsAgedAged, 80 and overCohort StudiesEndovascular ProceduresFemaleHospitalizationHumansIschemic StrokeMaleMiddle AgedReperfusionRetrospective StudiesThrombolytic TherapyConceptsHospital 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 characteristics
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 arrivalUse, Temporal Trends, and Outcomes of Endovascular Therapy After Interhospital Transfer in the United States
Shah S, Xian Y, Sheng S, Zachrison KS, Saver JL, Sheth KN, Fonarow GC, Schwamm LH, Smith EE. Use, Temporal Trends, and Outcomes of Endovascular Therapy After Interhospital Transfer in the United States. Circulation 2019, 139: 1568-1577. PMID: 30700144, PMCID: PMC6816244, DOI: 10.1161/circulationaha.118.036509.Peer-Reviewed Original ResearchConceptsEndovascular therapyInterhospital transferHospital outcomesIschemic strokeMultivariable logistic regression modelSymptomatic intracranial hemorrhageAcute ischemic strokeComprehensive stroke centerLarge vessel occlusionRisk-adjusted modelsLogistic regression modelsEVT outcomesGuidelines-StrokeHospital mortalityStroke centersIndependent ambulationPivotal trialsStroke careIntracranial hemorrhageVessel occlusionEVT casesStroke systemsWhite racePatientsFurther evaluationComponents and Trends in Door to Treatment Times for Endovascular Therapy in Get With The Guidelines-Stroke Hospitals
Menon B, Xu H, Cox M, Saver J, Goyal M, Peterson E, Xian Y, Matsuoka R, Jehan R, Yavagal D, Gupta R, Mehta B, Bhatt D, Fonarow G, Schwamm L, Smith E. Components and Trends in Door to Treatment Times for Endovascular Therapy in Get With The Guidelines-Stroke Hospitals. Circulation 2019, 139: 169-179. PMID: 30586703, DOI: 10.1161/circulationaha.118.036701.Peer-Reviewed Original ResearchConceptsGuidelines-Stroke hospitalsEndovascular therapyHospital-level variablesShorter doorArterial accessCase volumeFirst pass timeArterial puncture timeComprehensive stroke centerLarge vessel occlusionCalendar year quarterWorkflow timesSignificant linear time trendsIschemic strokeLonger doorMedian doorStroke centersArterial punctureDiabetes mellitusMultivariable analysisPuncture timeFaster doorEmergency departmentClinical trialsMultivariable modeling
2018
STAIR X
Liebeskind D, Derdeyn C, Wechsler L, Albers G, Ankerud E, Boltze J, Broderick J, Campbell B, Elkind M, En’Wezoh D, Furlan A, Gorelick P, Grotta J, Hess D, Hancock A, Hill M, Holt W, Hutchison R, Kim W, Lansberg M, LaScalza S, Latour L, Liberman M, Luby M, Lyden P, Majidi S, Mansi C, Nogueira R, Saver J, Savitz S, Schwamm L, Selim M, Sheth K, Simpkins A, Singhal A, Solberg Y, Steinberg G, Taylor T, Tymianski M, Yoo A. STAIR X. Stroke 2018, 49: 2241-2247. PMID: 30355006, DOI: 10.1161/strokeaha.118.021424.Peer-Reviewed Original ResearchBiomarkersCerebral AngiographyDevice ApprovalEducationEndovascular ProceduresGuidelines as TopicHumansIntracranial HemorrhagesPrecision MedicineRandomized Controlled Trials as TopicRegistriesResearch DesignStrokeThrombectomyThrombolytic TherapyTreatment OutcomeUnited StatesUnited States Food and Drug AdministrationComparison of Acute Ischemic Stroke Care and Outcomes Between Comprehensive Stroke Centers and Primary Stroke Centers in the United States
Man S, Zhao X, Uchino K, Hussain M, Smith E, Bhatt D, Xian Y, Schwamm L, Shah S, Khan Y, Fonarow G. Comparison of Acute Ischemic Stroke Care and Outcomes Between Comprehensive Stroke Centers and Primary Stroke Centers in the United States. Circulation Cardiovascular Quality And Outcomes 2018, 11: e004512. PMID: 29794035, PMCID: PMC5978771, DOI: 10.1161/circoutcomes.117.004512.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBrain IschemiaCertificationComprehensive Health CareDelivery of Health Care, IntegratedEmergency Service, HospitalEndovascular ProceduresFemaleHospital MortalityHospitalsHumansMaleMiddle AgedOutcome and Process Assessment, Health CarePatient AdmissionPatient TransferQuality ImprovementQuality Indicators, Health CareRecovery of FunctionRegistriesRisk AssessmentRisk FactorsStrokeThrombolytic TherapyTime FactorsTime-to-TreatmentTreatment OutcomeUnited StatesConceptsPrimary stroke centerEmergency department admissionsStroke center certificationAcute ischemic strokeIschemic stroke careStroke centersStroke careDepartment admissionsHospital mortalityHospital outcomesIntravenous tPAIschemic strokeCenter certificationTPA timeComprehensive Stroke Center (CSC) certificationAcute ischemic stroke careMultivariable logistic regression modelAcute reperfusion therapyAcute stroke triageBrain Attack CoalitionDefect-free careComprehensive stroke centerOverall care qualityLogistic regression modelsGuidelines-StrokeSafety 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