2019
Intravenous Tissue-Type Plasminogen Activator in Acute Ischemic Stroke Patients With History of Stroke Plus Diabetes Mellitus
Ehrlich M, Liang L, Xu H, Kosinski A, Hernandez A, Schwamm L, Smith E, Fonarow G, Bhatt D, Peterson E, Xian Y. Intravenous Tissue-Type Plasminogen Activator in Acute Ischemic Stroke Patients With History of Stroke Plus Diabetes Mellitus. Stroke 2019, 50: 1497-1503. PMID: 31035901, PMCID: PMC6538420, DOI: 10.1161/strokeaha.118.024172.Peer-Reviewed Original ResearchConceptsIntravenous tissue-type plasminogen activatorSymptomatic intracerebral hemorrhageAcute ischemic strokeHistory of strokeTissue-type plasminogen activatorIschemic stroke patientsDiabetes mellitusIschemic strokeIntracerebral hemorrhagePlasminogen activatorStroke patientsUnadjusted ratesAcute ischemic stroke patientsBaseline clinical factorsConcomitant diabetes mellitusECASS III trialGuidelines-Stroke registryPrior ischemic strokeCardiovascular risk factorsHospital mortalityPrior strokeSevere strokeIII trialsClinical factorsRisk factors
2016
Baseline Predictors of Poor Outcome in Patients Too Good to Treat With Intravenous Thrombolysis
Ali S, Siddiqui K, Ay H, Silverman S, Singhal A, Viswanathan A, Rost N, Lev M, Schwamm L. Baseline Predictors of Poor Outcome in Patients Too Good to Treat With Intravenous Thrombolysis. Stroke 2016, 47: 2986-2992. PMID: 27834750, DOI: 10.1161/strokeaha.116.014871.Peer-Reviewed Original ResearchConceptsIntravenous tissue-type plasminogen activatorHealth Stroke ScaleTissue-type plasminogen activatorPoor outcomeIntravenous thrombolysisStroke ScaleMultivariable analysisPlasminogen activatorHigher median National InstitutesConsecutive stroke admissionsCurrent safety profileGuidelines-Stroke databaseInitial National InstitutesMedian National InstitutesThird of patientsVascular risk factorsNational InstituteSkilled nursing facilitiesMultifocal infarctionPoor collateralsStroke admissionsImaging predictorsInpatient rehabilitationSafety profileImaging featuresUse 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 activatorMortality
2015
Endovascular Clot Retrieval Therapy
Smith E, Schwamm L. Endovascular Clot Retrieval Therapy. Stroke 2015, 46: 1462-1467. PMID: 25944330, DOI: 10.1161/strokeaha.115.008385.Peer-Reviewed Original ResearchConceptsStroke systemsEndovascular acute ischemic stroke therapyIntravenous tissue-type plasminogen activatorAcute ischemic stroke therapyIschemic stroke therapyTissue-type plasminogen activatorCapable centersAppropriate patientsStroke therapyEffective therapyRetrieval therapyMeaningful benefitCommunity settingsTherapyPlasminogen activatorEquitable accessInitial recommendationsData entryPatientsRegistryHospitalTrialsDrip and Ship Thrombolytic Therapy for Acute Ischemic Stroke
Sheth KN, Smith EE, Grau-Sepulveda MV, Kleindorfer D, Fonarow GC, Schwamm LH. Drip and Ship Thrombolytic Therapy for Acute Ischemic Stroke. Stroke 2015, 46: 732-739. PMID: 25672784, DOI: 10.1161/strokeaha.114.007506.Peer-Reviewed Original ResearchConceptsIntravenous tissue-type plasminogen activatorTissue-type plasminogen activatorSymptomatic intracranial hemorrhageTPA useAcute strokeIschemic strokeIntracranial hemorrhageHealth Stroke Scale scoreReal-world practice patternsGuidelines-Stroke programStroke Scale scoreAcute ischemic strokeCharacteristics of patientsLower National InstitutesPatient selection biasConventional thrombolysisHospital mortalityHospital outcomesSymptom onsetInterhospital transferThrombolytic therapyHospital characteristicsPractice patternsShip paradigmMAIN OUTCOME
2014
Chronic Kidney Disease and Bleeding Complications After Intravenous Thrombolytic Therapy for Acute Ischemic Stroke
Ovbiagele B, Smith E, Schwamm L, Grau-Sepulveda M, Saver J, Bhatt D, Hernandez A, Peterson E, Fonarow G. Chronic Kidney Disease and Bleeding Complications After Intravenous Thrombolytic Therapy for Acute Ischemic Stroke. Circulation Cardiovascular Quality And Outcomes 2014, 7: 929-935. PMID: 25249561, DOI: 10.1161/circoutcomes.114.001144.Peer-Reviewed Original ResearchMeSH KeywordsAcute DiseaseAgedBrain IschemiaFemaleFibrinolytic AgentsFollow-Up StudiesGlomerular Filtration RateHemorrhageHospital MortalityHumansIncidenceInjections, IntravenousMaleOdds RatioRegistriesRenal Insufficiency, ChronicRetrospective StudiesThrombolytic TherapyTime FactorsTissue Plasminogen ActivatorUnited StatesConceptsChronic kidney diseaseSerious systemic hemorrhageSymptomatic intracranial hemorrhagePresence of CKDIntravenous tissue-type plasminogen activatorIntracranial hemorrhageSystemic hemorrhageTissue-type plasminogen activatorKidney diseaseFunctional statusTissue-type plasminogen activator administrationPlasminogen activatorAdmission serum creatinineGuidelines-Stroke programIndependent functional statusIntravenous thrombolytic therapyPrimary end pointAcute ischemic strokeIschemic stroke patientsGlomerular filtration rateNormal kidney functionDischarge functional statusHigher unadjusted oddsTissue-type plasminogenHospital mortalityTime and Diffusion Lesion Size in Major Anterior Circulation Ischemic Strokes
Hakimelahi R, Vachha B, Copen W, Papini G, He J, Higazi M, Lev M, Schaefer P, Yoo A, Schwamm L, González R. Time and Diffusion Lesion Size in Major Anterior Circulation Ischemic Strokes. Stroke 2014, 45: 2936-2941. PMID: 25190444, DOI: 10.1161/strokeaha.114.005644.Peer-Reviewed Original ResearchConceptsAnterior circulation ischemic strokeMiddle cerebral artery occlusionDiffusion-weighted imagingCerebral artery occlusionStroke onsetIschemic strokeInfarct sizeDWI lesionsInfarct volumeArtery occlusionIntravenous tissue-type plasminogen activatorProximal middle cerebral arteryDistal internal carotid arteryAcute infarct volumeDWI lesion volumeMajority of patientsMiddle cerebral arteryInternal carotid arteryAcute infarct sizeSame inclusion criteriaTraditional time windowTissue-type plasminogen activatorCerebral perfusionConsecutive patientsInfarct growthStrategies Used by Hospitals to Improve Speed of Tissue-Type Plasminogen Activator Treatment in Acute Ischemic Stroke
Xian Y, Smith E, Zhao X, Peterson E, Olson D, Hernandez A, Bhatt D, Saver J, Schwamm L, Fonarow G. Strategies Used by Hospitals to Improve Speed of Tissue-Type Plasminogen Activator Treatment in Acute Ischemic Stroke. Stroke 2014, 45: 1387-1395. PMID: 24713527, DOI: 10.1161/strokeaha.113.003898.Peer-Reviewed Original ResearchConceptsShorter DTN timesAcute ischemic strokeTissue-type plasminogen activatorDTN timeIschemic strokePlasminogen activatorIntravenous tissue-type plasminogen activatorTissue-type plasminogen activator treatmentTissue-type plasminogen activator administrationGuidelines-Stroke hospitalsMedian DTN timePlasminogen activator treatmentHospital strategiesNeedle timeSymptom onsetMultivariable analysisBaseline useEmergency departmentRapid doorActivator treatmentHospitalStrokeActivation systemAssociationActivatorImproving Door-to-Needle Times
Ruff I, Ali S, Goldstein J, Lev M, Copen W, McIntyre J, Rost N, Schwamm L. Improving Door-to-Needle Times. Stroke 2014, 45: 504-508. PMID: 24399372, DOI: 10.1161/strokeaha.113.004073.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overClinical ProtocolsComorbidityData Interpretation, StatisticalEarly DiagnosisEmergency Medical ServicesFemaleFibrinolytic AgentsHumansInternational Classification of DiseasesMaleMiddle AgedProspective StudiesQuality ImprovementRetrospective StudiesSocioeconomic FactorsStrokeThrombolytic TherapyTissue Plasminogen ActivatorTomography, X-Ray ComputedTreatment OutcomeConceptsIntravenous tissue-type plasminogen activatorEmergency department arrivalTissue-type plasminogen activatorAcute strokeDTN timeNeedle timeHealth Stroke Scale scorePlasminogen activatorAcute ischemic strokePercentage of patientsStroke Scale scoreAmerican Heart AssociationStroke care modelWilcoxon signed-rank testImproving DoorIschemic strokeStroke guidelinesHeart AssociationPostintervention periodSigned-rank testPre interventionCare modelNational guidelinesPost interventionPatients
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
Risk Score for Intracranial Hemorrhage in Patients With Acute Ischemic Stroke Treated With Intravenous Tissue-Type Plasminogen Activator
Menon B, Saver J, Prabhakaran S, Reeves M, Liang L, Olson D, Peterson E, Hernandez A, Fonarow G, Schwamm L, Smith E. Risk Score for Intracranial Hemorrhage in Patients With Acute Ischemic Stroke Treated With Intravenous Tissue-Type Plasminogen Activator. Stroke 2012, 43: 2293-2299. PMID: 22811458, DOI: 10.1161/strokeaha.112.660415.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBlood PressureCerebral HemorrhageCohort StudiesData Interpretation, StatisticalEthnicityFemaleFibrinolytic AgentsHospitalsHumansLogistic ModelsMaleMiddle AgedMultivariate AnalysisPredictive Value of TestsRisk AssessmentRisk FactorsStrokeTissue Plasminogen ActivatorTreatment OutcomeConceptsIntravenous tissue-type plasminogen activatorSymptomatic intracranial hemorrhageTissue-type plasminogen activatorSICH riskIschemic strokeSymptom onsetIntracranial hemorrhageValidation cohortC-statisticPlasminogen activatorIntravenous tissue-type plasminogen activator treatmentRisk of sICHTissue-type plasminogen activator treatmentHigher baseline National InstitutesHigher systolic blood pressureDerivation sampleBaseline National InstitutesHealth Stroke ScaleStroke symptom onsetAcute ischemic strokeSystolic blood pressurePlasminogen activator treatmentMultivariable logistic regressionHigh blood glucoseNational InstituteRegional Variation in Recommended Treatments for Ischemic Stroke and TIA
Allen NB, Kaltenbach L, Goldstein LB, Olson DM, Smith EE, Peterson ED, Schwamm L, Lichtman JH. Regional Variation in Recommended Treatments for Ischemic Stroke and TIA. Stroke 2012, 43: 1858-1864. PMID: 22588262, DOI: 10.1161/strokeaha.112.652305.Peer-Reviewed Original ResearchConceptsDefect-free careLipid-lowering medicationsTissue-type plasminogen activatorLower oddsIschemic strokeIntravenous tissue-type plasminogen activatorSecondary stroke prevention treatmentDeep vein thrombosis prophylaxisTissue-type plasminogen activator administrationNational quality improvement programPlasminogen activatorGuideline-recommended treatmentGuidelines-Stroke hospitalsTransient ischemic attackQuarter of patientsStroke prevention treatmentBetter patient outcomesWeight loss educationQuality Improvement ProgramEligible patientsIschemic attackThrombosis prophylaxisPatient demographicsStroke treatmentMedical historyTimes From Symptom Onset to Hospital Arrival in the Get With The Guidelines–Stroke Program 2002 to 2009
Tong D, Reeves M, Hernandez A, Zhao X, Olson D, Fonarow G, Schwamm L, Smith E. Times From Symptom Onset to Hospital Arrival in the Get With The Guidelines–Stroke Program 2002 to 2009. Stroke 2012, 43: 1912-1917. PMID: 22539544, DOI: 10.1161/strokeaha.111.644963.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeIschemic strokeSymptom onsetDoor timeHospital arrivalIntravenous tissue-type plasminogen activatorAcute ischemic stroke therapyEmergency medical services transportFourth of patientsGuidelines-Stroke programProportion of patientsHospital arrival timeIschemic stroke therapyPlasminogen activator therapyPortion of patientsTissue-type plasminogen activatorEligible patientsStroke therapyActivator therapyAcute interventionNationwide studyTreatment windowPatientsEarly onsetStroke
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 activatorTimeliness of Tissue-Type Plasminogen Activator Therapy in Acute Ischemic Stroke
Fonarow G, Smith E, Saver J, Reeves M, Bhatt D, Grau-Sepulveda M, Olson D, Hernandez A, Peterson E, Schwamm L. Timeliness of Tissue-Type Plasminogen Activator Therapy in Acute Ischemic Stroke. Circulation 2011, 123: 750-758. PMID: 21311083, DOI: 10.1161/circulationaha.110.974675.Peer-Reviewed Original ResearchMeSH KeywordsAcute DiseaseAgedAged, 80 and overAmerican Heart AssociationBrain IschemiaEmergency Medical ServicesFemaleFibrinolytic AgentsGuideline AdherenceHumansMaleMiddle AgedOutcome Assessment, Health CarePractice Guidelines as TopicRisk FactorsStrokeTime FactorsTissue Plasminogen ActivatorUnited StatesConceptsAcute ischemic strokeIntravenous tissue-type plasminogen activatorTissue-type plasminogen activatorIschemic stroke patientsNeedle timeIschemic strokeStroke patientsAcute ischemic stroke patientsGuidelines-Stroke programSimilar stroke severitySymptomatic intracranial hemorrhageTimeliness of reperfusionProportion of patientsPlasminogen activator therapyTreatment initiation timeMinute doorPrior strokeHospital mortalityHospital factorsStroke severitySymptom onsetPatient factorsActivator therapyIntracranial hemorrhageHospital characteristics
2005
Arterial occlusion revealed by CT angiography predicts NIH stroke score and acute outcomes after IV tPA treatment.
Sims J, Rordorf G, Smith E, Koroshetz W, Lev M, Buonanno F, Schwamm L. Arterial occlusion revealed by CT angiography predicts NIH stroke score and acute outcomes after IV tPA treatment. American Journal Of Neuroradiology 2005, 26: 246-51. PMID: 15709120, PMCID: PMC7974096.Peer-Reviewed Original ResearchConceptsCT angiographyLocation of occlusionEarly improvementInitial NIHSSArterial occlusionIntravenous tissue-type plasminogen activatorNIH stroke scoreProspective stroke databaseHealth Stroke ScaleAcute stroke patientsMiddle cerebral arteryPatent vasculatureSite of occlusionTissue-type plasminogen activatorLower NIHSSStroke ScaleStroke ScoreSymptomatic hemorrhageRankin ScaleAcute outcomesHemorrhagic riskCerebral arteryClinical outcomesStroke databaseStroke patients