2024
Contemporary Prestroke Dual Antiplatelet Use and Symptomatic Intracerebral Hemorrhage Risk After Thrombolysis
Peng T, Schwamm L, Fonarow G, Hassan A, Hill M, Messé S, Coronado F, Falcone G, Sharma R. Contemporary Prestroke Dual Antiplatelet Use and Symptomatic Intracerebral Hemorrhage Risk After Thrombolysis. JAMA Neurology 2024, 81: 722-731. PMID: 38767894, PMCID: PMC11106713, DOI: 10.1001/jamaneurol.2024.1312.Peer-Reviewed Original ResearchRisk of symptomatic intracerebral hemorrhageSymptomatic intracerebral hemorrhageTreated with IV-tPAAcute ischemic strokeIV-tPAAmerican Heart Association and American Stroke AssociationAssociated with lower oddsIschemic strokeDual antiplatelet therapyAssociated with increased riskPropensity score subclassificationAmerican Stroke AssociationIntracerebral hemorrhage riskGWTG-StrokeSymptomatic intracerebral hemorrhage riskGuidelines-StrokeDischarge modified Rankin Scale scoreIn-hospital deathStroke AssociationLower oddsRate of symptomatic intracerebral hemorrhageAntiplatelet therapyCohort studyAssociated with symptomatic intracerebral hemorrhagePrestrokeCost-effectiveness of atrial fibrillation detection with insertable cardiac monitors in large-artery or small-vessel disease stroke in the United Kingdom
Witte K, Schwamm L, Bernstein R, Reynolds M, Rose D, Lip G, Ozturk E, Villinger J, Rosemas S, Ziegler P, Yaghi S. Cost-effectiveness of atrial fibrillation detection with insertable cardiac monitors in large-artery or small-vessel disease stroke in the United Kingdom. EP Europace 2024, 26: euae102.603. PMCID: PMC11120381, DOI: 10.1093/europace/euae102.603.Peer-Reviewed Original ResearchQuality-adjusted life yearsInsertable cardiac monitorCHA2DS2-VASc scoreContinuous cardiac monitoringStroke eventsAtrial fibrillationCardiac monitoringNational Health Service (NHSBase case incremental cost-effectiveness ratioCHA2DS2-VAScInsertable cardiac monitor implantationDetection of AFHealth-related benefitsRisk of AFUnited KingdomCost-effectiveLarge-arteryRisk of cerebrovascular eventsIschemic strokeWillingness-to-pay thresholdsDetect atrial fibrillationIncremental cost-effectiveness ratioCost-effectiveness analysisProbabilistic sensitivity analysesSmall vessel disease strokeTrends in the Use of Medications for Secondary Ischemic Stroke Prevention in Denmark, 2005-2021.
Skajaa N, Laugesen K, Lauffenburger J, Schwamm L, Sørensen H, Patorno E. Trends in the Use of Medications for Secondary Ischemic Stroke Prevention in Denmark, 2005-2021. Neurology 2024, 102: e209309. PMID: 38648572, PMCID: PMC11226314, DOI: 10.1212/wnl.0000000000209309.Peer-Reviewed Original ResearchConceptsMedication useOral anticoagulant medicationsGlucose-lowering medication useFactors associated with medication useLipid-lowering medication useSevere strokeIschemic stroke hospitalizationsAntihypertensive medication useAnticoagulant medicationOlder patientsCare of patientsSodium-glucose cotransporter-2 inhibitorsGlucagon-like peptide-1 receptor agonistsStroke preventionAnticoagulant medication useLipid-loweringPeptide-1 receptor agonistsGlucose-loweringReduced life expectancyIschemic strokeCotransporter-2 inhibitorsStroke careCohort of patientsStroke hospitalizationsSecondary ischemic stroke preventionTrends in Stroke Thrombolysis Care Metrics and Outcomes by Race and Ethnicity, 2003-2021
Man S, Solomon N, Mac Grory B, Alhanti B, Saver J, Smith E, Xian Y, Bhatt D, Schwamm L, Uchino K, Fonarow G. Trends in Stroke Thrombolysis Care Metrics and Outcomes by Race and Ethnicity, 2003-2021. JAMA Network Open 2024, 7: e2352927. PMID: 38324315, PMCID: PMC10851100, DOI: 10.1001/jamanetworkopen.2023.52927.Peer-Reviewed Original ResearchConceptsDoor-to-needleDoor-to-needle timeHispanic patientsWhite patientsAssociated with improvementsThrombolysis rateCohort studyEthnic groupsQuality InitiativeCohort study of patientsCare qualityCare metricsPre-testIschemic strokeEthnic disparitiesRetrospective cohort studyMain OutcomesPatient functionIschemic stroke onsetSecondary outcomesPrimary outcomeStudy of patientsOddsAcute ischemic strokeStroke onset
2023
Hospital‐Level Variability in Reporting of Ischemic Stroke Subtypes and Supporting Diagnostic Evaluation in GWTG‐Stroke Registry
Mullen M, Gurol M, Prabhakaran S, Messé S, Kleindorfer D, Smith E, Fonarow G, Xu H, Zhao X, Cigarroa J, Schwamm L. Hospital‐Level Variability in Reporting of Ischemic Stroke Subtypes and Supporting Diagnostic Evaluation in GWTG‐Stroke Registry. Journal Of The American Heart Association 2023, 12: e031303. PMID: 38108258, PMCID: PMC10863791, DOI: 10.1161/jaha.123.031303.Peer-Reviewed Original ResearchConceptsHospital-level variabilityDiagnostic evaluationIschemic strokeDiagnostic testingStroke pathogenesisCryptogenic strokeSecondary preventionEtiologic subtypesRisk factorsLarge nationwide registryIschemic stroke subtypesLong-term cardiac rhythm monitoringCardiac rhythm monitoringAdequate diagnostic evaluationIntracranial vascular imagingEvidence-based interventionsNationwide registryStroke subtypesIS subtypesDocumentation ratesRhythm monitoringPatientsCardiac monitoringSubtypesStrokeHigher Procedural Volumes Are Associated with Faster Treatment Times, Better Functional Outcomes, and Lower Mortality in Patients Undergoing Endovascular Treatment for Acute Ischemic Stroke
Nogueira R, Haussen D, Smith E, Sun J, Xian Y, Alhanti B, Blanco R, Mac Grory B, Doheim M, Bhatt D, Fonarow G, Hassan A, Joundi R, Mocco J, Frankel M, Schwamm L. Higher Procedural Volumes Are Associated with Faster Treatment Times, Better Functional Outcomes, and Lower Mortality in Patients Undergoing Endovascular Treatment for Acute Ischemic Stroke. Annals Of Neurology 2023, 95: 146-155. PMID: 37731004, DOI: 10.1002/ana.26803.Peer-Reviewed Original ResearchHigh procedural volumeProcedural volumeEndovascular therapyHospital mortalityPrimary cohortAIS patientsFaster treatment timesAcute ischemic stroke patientsGood discharge outcomeGuidelines-Stroke registryPretreatment National InstitutesHealth Stroke ScaleAcute ischemic strokeIschemic stroke patientsObservational cohort studyHospital procedural volumeLower ratesStroke ScaleCohort studyIschemic strokeArterial punctureDischarge outcomesEndovascular treatmentInterhospital transferStroke patientsPerformance 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 timeRationale and design of the GOLDEN BRIDGE II: a cluster-randomised multifaceted intervention trial of an artificial intelligence-based cerebrovascular disease clinical decision support system to improve stroke outcomes and care quality in China
Li Z, Zhang X, Ding L, Jing J, Gu H, Jiang Y, Meng X, Du C, Wang C, Wang M, Xu M, Zhang Y, Hu M, Li H, Gong X, Dong K, Zhao X, Wang Y, Liu L, Xian Y, Peterson E, Fonarow G, Schwamm L, Wang Y. Rationale and design of the GOLDEN BRIDGE II: a cluster-randomised multifaceted intervention trial of an artificial intelligence-based cerebrovascular disease clinical decision support system to improve stroke outcomes and care quality in China. Stroke And Vascular Neurology 2023, svn-2023-002411. PMID: 37699726, DOI: 10.1136/svn-2023-002411.Peer-Reviewed Original ResearchClinical decision support systemVascular eventsIntervention trialsIntervention groupControl groupGuideline-based treatment recommendationsCare qualityNew vascular eventsStroke care qualityAcute ischemic strokeComposite vascular eventsII trialUsual careIschemic strokeStroke etiologyStroke onsetStroke outcomePrimary outcomeTreat principleClinical outcomesStroke careCerebrovascular diseaseEligible participantsTreatment recommendationsIntervention studiesRecent 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 useOutcomes of recurrent stroke in patients with atrial fibrillation according to presumed etiology
Pedreira B, Zachrison K, Singhal A, Yan Z, Oliveira-Filho J, Schwamm L. Outcomes of recurrent stroke in patients with atrial fibrillation according to presumed etiology. Arquivos De Neuro-Psiquiatria 2023, 81: 616-623. PMID: 37336506, PMCID: PMC10371407, DOI: 10.1055/s-0043-1769124.Peer-Reviewed Original ResearchConceptsUndetermined stroke etiologyAtrial fibrillationRecurrent strokeStroke etiologyAF patientsFavorable outcomeAcademic comprehensive stroke centerHealth Stroke Scale scoreMedian National InstitutesSingle-center sampleComprehensive stroke centerRecurrent ischemic strokeStroke Scale scoreHistory of strokePotent risk factorDifferent treatment strategiesHospital mortalitySecondary prophylaxisReperfusion therapyCardioembolic strokeIschemic strokeStroke centersDischarge outcomesRisk factorsTreatment strategiesEffectiveness of a Quality Improvement Intervention on Reperfusion Treatment for Patients With Acute Ischemic Stroke
Wang C, Gu H, Zong L, Zhang X, Zhou Q, Jiang Y, Li H, Meng X, Yang X, Wang M, Huo X, Wangqin R, Bei Y, Qi X, Liu X, Hu S, Wang Z, Zhao X, Wang Y, Liu L, Ma X, Morgan L, Xian Y, Schwamm L, Wang Y, Li Z, Yang Q, Chen G, Ma Q, Li X, Chen J, Zhao X, Wang H, Niu X, Xu J, Zhao L, Wang Z, Huang D, Jin X, Chen S, Li J, Yu J, Liu P, Li G, Hao Y, Yang G, Huang X, Zhou C, Yang J, Gu J, Sun P, Guo Z, Ma G, Chen G, Tang M, Wang N, Chen L, Li J, Li A, Li S, Cao M, Guo J, Ren Y, Li T, Zhang L, Xie Z, Dong J, Kong X, Liang H, Zhang Y. Effectiveness of a Quality Improvement Intervention on Reperfusion Treatment for Patients With Acute Ischemic Stroke. JAMA Network Open 2023, 6: e2316465. PMID: 37266940, PMCID: PMC10238948, DOI: 10.1001/jamanetworkopen.2023.16465.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeQuality improvement interventionsTargeted quality improvement interventionsReperfusion therapy ratesProportion of patientsIschemic strokeEligible patientsStepped-wedge clusterSymptom onsetReperfusion therapyEndovascular thrombectomyImprovement interventionsTherapy ratesUsual careSecondary outcomesPrimary outcomeSecondary hospitalsClinical trialsIntravenous recombinant tissue plasminogen activatorModified Rankin Scale scoreRecombinant tissue plasminogen activatorRankin Scale scoreTissue plasminogen activatorEVT rateHospital mortalityRationale and design of Tenecteplase Reperfusion Therapy in Acute Ischaemic Cerebrovascular Events III (TRACE III): a randomised, phase III, open-label, controlled trial
Xiong Y, Campbell B, Fisher M, Schwamm L, Parsons M, Li H, Pan Y, Meng X, Zhao X, Wang Y. Rationale and design of Tenecteplase Reperfusion Therapy in Acute Ischaemic Cerebrovascular Events III (TRACE III): a randomised, phase III, open-label, controlled trial. Stroke And Vascular Neurology 2023, 9: 82-89. PMID: 37247876, PMCID: PMC10956103, DOI: 10.1136/svn-2023-002310.Peer-Reviewed Original ResearchLarge vessel occlusionAnterior circulation large vessel occlusionIschemic strokePerfusion-weighted imagingEfficacy outcomesReperfusion therapyMajor neurological improvementSecondary efficacy outcomesStandard medical therapyHealth Stroke ScalePrimary efficacy outcomeSymptomatic intracerebral hemorrhageRankin Scale scoreTissue-type plasminogen activatorDirect thrombectomyNeurological improvementStroke ScaleAnterior circulationMedical therapyMRS scoreIntracerebral hemorrhageSalvageable tissueVessel occlusionCT perfusionClinical trialsShorter 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 administrationTenecteplase 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
No short-term mortality from benzodiazepine use post-acute ischemic stroke after accounting for bias
Moura L, Yan Z, Donahue M, Smith L, Schwamm L, Hsu J, Newhouse J, Haneuse S, Blacker D, Hernandez-Diaz S. No short-term mortality from benzodiazepine use post-acute ischemic stroke after accounting for bias. Journal Of Clinical Epidemiology 2022, 154: 136-145. PMID: 36572369, PMCID: PMC10033385, DOI: 10.1016/j.jclinepi.2022.12.013.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeRisk differenceIschemic strokeBenzodiazepine useShort-term mortalityImmortal time biasElectronic health recordsAIS admissionsBenzodiazepine initiationStroke RegistryPoststroke mortalityTreatment initiationMortality riskPatientsFurther adjustmentMortalityBenzodiazepinesOlder adultsTime biasHealth recordsImmortal timeStrokeRiskDaysContraindicationsComparative Effectiveness and Safety of Seizure Prophylaxis Among Adults After Acute Ischemic Stroke
Moura L, Donahue M, Yan Z, Smith L, Hsu J, Newhouse J, Schwamm L, Haneuse S, Hernandez-Diaz S, Blacker D. Comparative Effectiveness and Safety of Seizure Prophylaxis Among Adults After Acute Ischemic Stroke. Stroke 2022, 54: 527-536. PMID: 36544249, PMCID: PMC9870933, DOI: 10.1161/strokeaha.122.039946.Peer-Reviewed Original ResearchConceptsSeizure prophylaxisRisk differenceAntiseizure drugsEarly seizure prophylaxisSevere AIS patientsAcute ischemic strokePrespecified subgroup analysisHealth care factorsInverse probability weightsElectronic health recordsAIS admissionsPoststroke mortalityStroke RegistryIschemic strokeAIS patientsStroke settingsCare factorsSubgroup analysisProphylaxisMortality riskHigh riskPatientsComparative effectivenessExcess deathsTrial dataThe promise of tenecteplase in acute stroke: Within reach or beyond approval?
Zachrison K, Schwamm L. The promise of tenecteplase in acute stroke: Within reach or beyond approval? Med 2022, 3: 651-655. PMID: 36202099, DOI: 10.1016/j.medj.2022.09.005.Peer-Reviewed Original ResearchClinical and neuroimaging risk factors associated with the development of intracerebral hemorrhage while taking direct oral anticoagulants
Das A, Gökçal E, Regenhardt R, Warren A, Biffi A, Goldstein J, Kimberly W, Viswanathan A, Schwamm L, Rosand J, Greenberg S, Gurol M. Clinical and neuroimaging risk factors associated with the development of intracerebral hemorrhage while taking direct oral anticoagulants. Journal Of Neurology 2022, 269: 6589-6596. PMID: 35997817, PMCID: PMC10947801, DOI: 10.1007/s00415-022-11333-2.Peer-Reviewed Original ResearchConceptsCortical superficial siderosisPrior ischemic strokeDOAC usersCerebral microbleedsWhite matter hyperintensitiesIschemic strokeSevere white matter hyperintensitiesOral anticoagulant usageDirect oral anticoagulantsSingle referral centerHigh hemorrhagic riskCoronary artery diseaseAge-matched controlsMultivariable regression modelsDOAC therapyICH cohortPrior strokeOral anticoagulantsSuperficial siderosisBaseline demographicsReferral centerSmoking historyArtery diseaseConclusionsRisk factorsHemorrhage riskTemporal trends and rural–urban disparities in cerebrovascular risk factors, in-hospital management and outcomes in ischaemic strokes in China from 2005 to 2015: a nationwide serial cross-sectional survey
Wang C, Gu H, Zhang X, Jiang Y, Li H, Bettger J, Meng X, Dong K, Wangqin R, Yang X, Wang M, Liu C, Liu L, Tang B, Li G, Xu Y, He Z, Yang Y, Yip W, Fonarow G, Schwamm L, Xian Y, Zhao X, Wang Y, Wang Y, Li Z. Temporal trends and rural–urban disparities in cerebrovascular risk factors, in-hospital management and outcomes in ischaemic strokes in China from 2005 to 2015: a nationwide serial cross-sectional survey. Stroke And Vascular Neurology 2022, 8: 34-50. PMID: 35985768, PMCID: PMC9985802, DOI: 10.1136/svn-2022-001552.Peer-Reviewed Original ResearchConceptsCerebrovascular risk factorsHospital mortalityIschemic strokeRisk factorsComposite outcomeRural-urban disparitiesUrban hospitalHospital managementSecondary prevention treatmentSerial cross-sectional surveysHospital admission ratesIschemic stroke admissionsTwo-stage random sampling surveyCause of mortalityCross-sectional surveyHospital outcomesStroke admissionsCurrent smokingHospital admissionHospital burdenAdmission ratesMedical advicePrevention treatmentTemporal improvementHospitalOutcomes 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 comorbidities