2023
Higher 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 patients
2022
The relationship between stroke system organization and disparities in access to stroke center care in California
Zachrison K, Samuels‐Kalow M, Li S, Yan Z, Reeves M, Hsia R, Schwamm L, Camargo C. The relationship between stroke system organization and disparities in access to stroke center care in California. Journal Of The American College Of Emergency Physicians Open 2022, 3: e12706. PMID: 35316966, PMCID: PMC8921441, DOI: 10.1002/emp2.12706.Peer-Reviewed Original ResearchIschemic stroke patientsInterhospital transferStroke patientsReperfusion interventionsCenter careEthnic disparitiesAcute ischemic stroke patientsNon-Hispanic black patientsAsian/Pacific Islander patientsAcute ischemic strokeComprehensive stroke centerOdds of dischargeHospital-level characteristicsPacific Islander patientsNon-Hispanic Asian/Pacific IslandersNon-Hispanic blacksAsian/Pacific IslandersInterhospital patient transfersOutcomes of interestNon-Hispanic whitesHierarchical logistic regressionReperfusion therapyHospital dischargeIschemic strokeStroke centers
2021
Exploring the Unmet Need in Acute Ischemic Stroke Patients Not Treated With Intravenous Alteplase: The Get With The Guidelines‐Stroke Registry
Mac Grory B, Xian Y, Solomon N, Matsouaka R, Decker‐Palmer M, Fonarow G, Smith E, Schwamm L. Exploring the Unmet Need in Acute Ischemic Stroke Patients Not Treated With Intravenous Alteplase: The Get With The Guidelines‐Stroke Registry. Stroke Vascular And Interventional Neurology 2021, 2 DOI: 10.1161/svin.121.000226.Peer-Reviewed Original ResearchGuidelines-Stroke registryAcute ischemic strokeIschemic strokePatient populationCommon reasonUnmet needAcute ischemic stroke patientsIntravenous tissue plasminogen activatorAcute ischemic stroke careGuidelines-Stroke hospitalsIschemic stroke patientsIschemic stroke careLong-term outcomesTissue plasminogen activatorAlteplase deliveryHospital mortalityIntravenous alteplaseClinical characteristicsConclusions PatientsReadmission ratesEarly administrationPostdischarge costsStroke careStroke patientsFunctional outcomeThrombolysis 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 InstituteSeverityFrequency, 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 periodNational Trends in Telestroke Utilization in a US Commercial Platform Prior to the COVID-19 Pandemic
Zachrison KS, Sharma R, Wang Y, Mehrotra A, Schwamm LH. National Trends in Telestroke Utilization in a US Commercial Platform Prior to the COVID-19 Pandemic. Journal Of Stroke And Cerebrovascular Diseases 2021, 30: 106035. PMID: 34419836, PMCID: PMC8494566, DOI: 10.1016/j.jstrokecerebrovasdis.2021.106035.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overCOVID-19Databases, FactualFemaleFibrinolytic AgentsHumansMaleMiddle AgedPractice Patterns, Physicians'Quality ImprovementQuality Indicators, Health CareRemote ConsultationStrokeThrombolytic TherapyTime FactorsTime-to-TreatmentTissue Plasminogen ActivatorTreatment OutcomeUnited StatesConceptsIschemic stroke patientsTelestroke consultationAlteplase deliveryStroke patientsNumber of patientsNumber of consultsCOVID-19 public health emergencyPublic health emergencyAlteplase useMedian doorNeedle timeStroke severityED arrivalEmergency departmentImaging reviewHospital characteristicsTelestroke networkCT scanHospital participationSpoke sitesProvider groupsPatientsHospital sizeStudy periodHealth emergencyAnticonvulsant Primary and Secondary Prophylaxis for Acute Ischemic Stroke Patients
Jones F, Sanches P, Smith J, Zafar S, Hernandez-Diaz S, Blacker D, Hsu J, Schwamm L, Westover M, Moura L. Anticonvulsant Primary and Secondary Prophylaxis for Acute Ischemic Stroke Patients. Stroke 2021, 52: 2782-2791. PMID: 34126758, PMCID: PMC8384723, DOI: 10.1161/strokeaha.120.033299.Peer-Reviewed Original ResearchConceptsQuality-adjusted life expectancySecondary prophylaxisAdverse drug reactionsADR riskLate seizuresPrimary prophylaxisMale patientsFemale patientsLifetime riskLS riskAcute ischemic stroke hospitalizationsLong-term secondary prophylaxisAcute ischemic stroke patientsHigher ADR risksAcute ischemic strokeIschemic stroke patientsIschemic stroke hospitalizationsCommon clinical scenariosShort-term therapyAnticonvulsant prophylaxisLifetime prophylaxisPersistent seizuresSeizure prophylaxisEarly seizuresIschemic stroke
2020
Impact of Emergency Department Crowding on Delays in Acute Stroke Care
Jaffe T, Goldstein J, Yun B, Etherton M, Leslie-Mazwi T, Schwamm L, Zachrison K. Impact of Emergency Department Crowding on Delays in Acute Stroke Care. Western Journal Of Emergency Medicine 2020, 21: 892-899. PMID: 32726261, PMCID: PMC7390586, DOI: 10.5811/westjem.2020.5.45873.Peer-Reviewed Original ResearchConceptsAcute stroke careStroke careED crowdingEndovascular therapyConsecutive acute ischemic stroke patientsCare deliveryAcute ischemic stroke patientsGroin puncture timeGuidelines-Stroke registryStroke care deliveryHealth Stroke ScaleIschemic stroke patientsMultiple clinical factorsUrban academic EDInitial stroke severityHigh ED utilizationSingle-institution analysisAcute care deliveryEmergency stroke careOutcomes of interestWilcoxon rank sum testEmergency department (ED) crowdingRank sum testAlteplase deliveryDTN timeThrombolysis beyond 4.5 h in Acute Ischemic Stroke
Etherton M, Gadhia R, Schwamm L. Thrombolysis beyond 4.5 h in Acute Ischemic Stroke. Current Neurology And Neuroscience Reports 2020, 20: 35. PMID: 32607627, DOI: 10.1007/s11910-020-01055-1.Peer-Reviewed Original ResearchConceptsUnknown symptom onsetSymptom onsetAcute ischemic stroke patientsImproved long-term outcomesSalvageable brain tissueIntravenous thrombolytic therapyPlacebo-controlled trialAcute ischemic strokeIschemic stroke patientsLong-term outcomesDWI-FLAIR mismatchAlteplase treatmentSummaryIn patientsIschemic strokeStroke onsetAcute settingRecent FindingsIn recent yearsStroke patientsThrombolytic therapySalvageable tissueReviewThe purposeIndividualized approachStroke lesionsPatientsBrain tissueAcute ischemic stroke: improving access to intravenous tissue plasminogen activator
Turner A, Schwamm L, Etherton M. Acute ischemic stroke: improving access to intravenous tissue plasminogen activator. Expert Review Of Cardiovascular Therapy 2020, 18: 277-287. PMID: 32323590, DOI: 10.1080/14779072.2020.1759422.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeIschemic stroke patientsIschemic strokeStroke patientsTreatment windowAcute ischemic stroke patientsIntravenous tissue plasminogen activatorTreatment ratesUnknown symptom onsetAcute stroke careTissue plasminogen activatorQuality improvement initiativesHealth care resourcesUnited States FoodStroke outcomeSymptom onsetStroke careStroke specialistsStroke systemsTelestroke networkDrug AdministrationAlteplasePatientsPlasminogen activatorStates FoodMissing outcome data management in acute stroke trials testing iv thrombolytics. Is there risk of bias?
Fernandez-Ferro J, Schwamm L, Descalzo M, MacIsaac R, Lyden P, Lees K. Missing outcome data management in acute stroke trials testing iv thrombolytics. Is there risk of bias? European Stroke Journal 2020, 5: 148-154. PMID: 32637648, PMCID: PMC7313360, DOI: 10.1177/2396987320905457.Peer-Reviewed Original ResearchAcute stroke trialsStroke trialsOdds ratioOutcome dataRankin ScaleNon-thrombolysed patientsRankin Scale 90Ischemic stroke patientsInternational Stroke TrialRisk of biasMultiple imputationLast observationOdds ratio estimatesTreatment odds ratiosStroke patientsClinical trialsOutcome comparisonsPatientsTrialsSafety and Outcomes of Intravenous tPA in Acute Ischemic Stroke Patients With Prior Stroke Within 3 Months
Shah S, Liang L, Kosinski A, Hernandez A, Schwamm L, Smith E, Fonarow G, Bhatt D, Feng W, Peterson E, Xian Y. Safety and Outcomes of Intravenous tPA in Acute Ischemic Stroke Patients With Prior Stroke Within 3 Months. Circulation Cardiovascular Quality And Outcomes 2020, 13: e006031. PMID: 31903770, DOI: 10.1161/circoutcomes.119.006031.Peer-Reviewed Original ResearchMeSH KeywordsAdministrative Claims, HealthcareAgedAged, 80 and overBrain IschemiaDatabases, FactualFemaleFibrinolytic AgentsHospital MortalityHumansInfusions, IntravenousIntracranial HemorrhagesMaleMedicareRecurrenceRegistriesRetrospective StudiesRisk AssessmentRisk FactorsStrokeThrombolytic TherapyTime FactorsTissue Plasminogen ActivatorTreatment OutcomeUnited StatesConceptsAcute ischemic stroke patientsPrior ischemic strokeSymptomatic intracranial hemorrhageIschemic stroke patientsPrior strokeHospital mortalityIntravenous tPAIschemic strokeIntracranial hemorrhageStroke patientsGuidelines-Stroke hospitalsHigher stroke severityGood functional outcomeHistory of strokeRetrospective observational studyYears of ageCardiovascular comorbiditiesStroke providersStroke severityUnadjusted riskFunctional outcomeHigh prevalenceObservational studyMedicare claimsElevated risk
2019
Thrombolytic therapy in older acute ischemic stroke patients with gastrointestinal malignancy or recent bleeding
Inohara T, Liang L, Kosinski A, Smith E, Schwamm L, Hernandez A, Bhatt D, Fonarow G, Peterson E, Xian Y. Thrombolytic therapy in older acute ischemic stroke patients with gastrointestinal malignancy or recent bleeding. European Stroke Journal 2019, 5: 47-55. PMID: 32232169, PMCID: PMC7092738, DOI: 10.1177/2396987319871784.Peer-Reviewed Original ResearchRecombinant tissue plasminogen activatorRecent gastrointestinal bleedingAcute ischemic strokeGastrointestinal malignanciesIschemic strokeGastrointestinal bleedingHospital mortalityIntravenous recombinant tissue plasminogen activatorOlder acute ischemic stroke patientsAcute ischemic stroke patientsRtPA-treated patientsIschemic stroke patientsTissue plasminogen activatorOutcomes of interestGuidelines-StrokeIndex strokeRecent bleedingSevere strokeObservational cohortClinical outcomesStroke patientsThrombolytic therapyBleedingSystemic hemorrhagePatientsThe Medicare Shared Savings Program and Outcomes for Ischemic Stroke Patients: a Retrospective Cohort Study
Kaufman B, O’Brien E, Stearns S, Matsouaka R, Holmes G, Weinberger M, Song P, Schwamm L, Smith E, Fonarow G, Xian Y. The Medicare Shared Savings Program and Outcomes for Ischemic Stroke Patients: a Retrospective Cohort Study. Journal Of General Internal Medicine 2019, 34: 2740-2748. PMID: 31452032, PMCID: PMC6854149, DOI: 10.1007/s11606-019-05283-1.Peer-Reviewed Original ResearchConceptsAccountable care organizationsIschemic strokeRecurrent strokeMSSP accountable care organizationsIndex hospital stayIncident ischemic strokeRetrospective cohort studyAcute care utilizationIschemic stroke patientsMedicare Shared Savings Program Accountable Care OrganizationsModerate ischemic strokeConclusionsAmong patientsMain MeasuresOutcomesCause readmissionHospital stayCohort studyHome dischargeCare utilizationStroke patientsTransitional careProbability of dischargeCare coordinationPatient outcomesMedicare claimsService beneficiariesIntravenous 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 factorsMedicare Shared Savings ACOs and Hospice Care for Ischemic Stroke Patients
Kaufman B, O'Brien E, Stearns S, Matsouaka R, Holmes G, Weinberger M, Schwamm L, Smith E, Fonarow G, Xian Y, Taylor D. Medicare Shared Savings ACOs and Hospice Care for Ischemic Stroke Patients. Journal Of The American Geriatrics Society 2019, 67: 1402-1409. PMID: 30835818, DOI: 10.1111/jgs.15852.Peer-Reviewed Original ResearchConceptsIschemic stroke patientsHigher mortality riskHospice enrollmentStroke patientsAccountable care organizationsMortality riskMedicare Shared Savings ProgramComfort measuresLife careIncident ischemic stroke patientsLow-mortality risk groupsGWTG-Stroke hospitalsIncident ischemic strokeMortality risk groupsPalliative care servicesService Medicare beneficiariesQuality of endMedicare hospice benefitSevere strokeIschemic strokePoor prognosisNational registryReduced oddsRisk groupsHospice care
2018
Ischemic Stroke Transfer Patterns in the Northeast United States
Zachrison K, Onnela J, Hernandez A, Reeves M, Camargo C, Cox M, Matsouaka R, Metlay J, Goldstein J, Schwamm L. Ischemic Stroke Transfer Patterns in the Northeast United States. Journal Of Stroke And Cerebrovascular Diseases 2018, 28: 295-304. PMID: 30389376, DOI: 10.1016/j.jstrokecerebrovasdis.2018.09.048.Peer-Reviewed Original ResearchConceptsGuidelines-Stroke registryRegional stroke systemIschemic stroke patientsHospital connectionsTissue plasminogen activatorSevere strokeMore patientsStroke patientsIS patientsReceiving HospitalPatient dischargeStroke systemsPatient transferPatientsHospitalNortheast hospitalsMost hospitalsPlasminogen activatorCareUnited StatesFurther characterizationAdmissionRegistryStrokeQuality of care for ischemic stroke in China vs India: Findings from national clinical registries.
Li Z, Pandian J, Sylaja P, Wang Y, Zhao X, Liu L, Wang C, Khurana D, Srivastava M, Kaul S, Arora D, Schwamm L, Wang Y, Singhal A. Quality of care for ischemic stroke in China vs India: Findings from national clinical registries. Neurology 2018, 91: e1348-e1354. PMID: 30158158, PMCID: PMC6177271, DOI: 10.1212/wnl.0000000000006291.Peer-Reviewed Original ResearchConceptsChina National Stroke Registry IIGreater stroke severityStroke risk factorsRisk factorsStroke severityClinical outcomesStroke careIndian patientsAcademic stroke centerNational clinical registryIschemic stroke patientsBurden of strokeIschemic stroke careDifferent risk factorsQuality of careHospital mortalityIschemic strokeStroke centersAcute managementStroke patientsStroke ProjectChinese patientsClinical registryWorse outcomesAcademic hospitalIntravenous thrombolysis in unwitnessed stroke onset: MR WITNESS trial results
Schwamm L, Wu O, Song S, Latour L, Ford A, Hsia A, Muzikansky A, Betensky R, Yoo A, Lev M, Boulouis G, Lauer A, Cougo P, Copen W, Harris G, Warach S, Investigators O. Intravenous thrombolysis in unwitnessed stroke onset: MR WITNESS trial results. Annals Of Neurology 2018, 83: 980-993. PMID: 29689135, PMCID: PMC6095471, DOI: 10.1002/ana.25235.Peer-Reviewed Original ResearchConceptsMagnetic resonance imagingSymptomatic intracranial hemorrhageLarge vessel occlusionIntravenous thrombolysisSymptom discoveryVessel occlusionAcute ischemic stroke patientsFluid-attenuated inversion recovery magnetic resonance imagingInversion recovery magnetic resonance imagingDiffusion-weighted magnetic resonance imagingIschemic stroke patientsStroke durationAnn NeurolSymptomatic edemaUnwitnessed onsetUnwitnessed strokeIntravenous alteplaseRankin ScaleSecondary outcomesStroke onsetSymptom onsetPrimary outcomeIntracranial hemorrhageProspective studyStroke patients
2017
Frequent Hub–Spoke Contact Is Associated with Improved Spoke Hospital Performance: Results from the Massachusetts General Hospital Telestroke Network
Moreno A, Schwamm L, Siddiqui K, Viswanathan A, Whitney C, Rost N, Zachrison K. Frequent Hub–Spoke Contact Is Associated with Improved Spoke Hospital Performance: Results from the Massachusetts General Hospital Telestroke Network. Telemedicine Journal And E-Health 2017, 24: 678-683. PMID: 29271703, PMCID: PMC6014912, DOI: 10.1089/tmj.2017.0252.Peer-Reviewed Original ResearchConceptsDTN timePatient presentationTelestroke consultsTelestroke networkPatient-level regression analysesAcute ischemic stroke patientsShorter DTN timesIschemic stroke patientsFrequent contactPrimary predictor variableMedian DTNTPA administrationNeedle timeTPA useSpoke hospitalsStroke patientsMore frequent contactsHub hospitalImproved outcomesMedian numberTPA deliveryPatientsHospitalRegression analysisTelestroke