2024
Mapping the Ecological Terrain of Stroke Prehospital Delay: A Nationwide Registry Study
Dhand A, Reeves M, Mu Y, Rosner B, Rothfeld-Wehrwein Z, Nieves A, Dhongade V, Jarman M, Bergmark R, Semco R, Ader J, Marshall B, Goedel W, Fonarow G, Smith E, Saver J, Schwamm L, Sheth K. Mapping the Ecological Terrain of Stroke Prehospital Delay: A Nationwide Registry Study. Stroke 2024, 55: 1507-1516. PMID: 38787926, PMCID: PMC11299104, DOI: 10.1161/strokeaha.123.045521.Peer-Reviewed Original ResearchConceptsSocial Vulnerability IndexPrehospital delayHospital arrivalZIP Code Tabulation AreasEmergency medical servicesCommunity-level social vulnerabilityGuidelines-Stroke registryCommunity socioeconomic statusCommunity-level factorsPatient-level factorsNationwide registry studyAmerican Heart AssociationSocial vulnerabilityCox proportional hazards modelsSocially vulnerable areasAssociated with delaySocial determinantsProportional hazards modelAcute stroke treatmentGeospatial mappingSocioeconomic statusMedical servicesIncreased social vulnerabilityPrimary exposureQuartile 3Trends 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 preventionThrombolysis for Wake-Up Stroke Versus Non–Wake-Up Unwitnessed Stroke: EOS Individual Patient Data Meta-Analysis
Kamogawa N, Miwa K, Toyoda K, Jensen M, Inoue M, Yoshimura S, Fukuda-Doi M, Kitazono T, Boutitie F, Ma H, Ringleb P, Wu O, Schwamm L, Warach S, Hacke W, Davis S, Donnan G, Gerloff C, Thomalla G, Koga M, Investigators O. Thrombolysis for Wake-Up Stroke Versus Non–Wake-Up Unwitnessed Stroke: EOS Individual Patient Data Meta-Analysis. Stroke 2024, 55: 895-904. PMID: 38456303, PMCID: PMC10978262, DOI: 10.1161/strokeaha.123.043358.Peer-Reviewed Original ResearchConceptsSymptomatic intracranial hemorrhageIntracranial hemorrhageIntravenous thrombolysisFavorable outcomeUnwitnessed strokeNon-WUSFrequency of favorable outcomesIndividual patient-data meta-analysisMultivariate logistic regression analysisModified Rankin Scale scoreSafety of intravenous thrombolysisRankin Scale scoreEffect of intravenous thrombolysisIntravenous thrombolysis groupLogistic regression analysisUnknown-onset strokeRandomized controlled trialsNo significant differencePatient-level dataData meta-analysisStandard treatmentInsufficient statistical powerPatientsSafety outcomesControlled trialsTenecteplase 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 ratioTrends 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 monitoringSubtypesStrokePerformance 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 timeInsurance-Based Disparities in Stroke Center Access in California: A Network Science Approach
Zachrison K, Hsia R, Schwamm L, Yan Z, Samuels-Kalow M, Reeves M, Camargo C, Onnela J. Insurance-Based Disparities in Stroke Center Access in California: A Network Science Approach. Circulation Cardiovascular Quality And Outcomes 2023, 16: e009868. PMID: 37746725, PMCID: PMC10592016, DOI: 10.1161/circoutcomes.122.009868.Peer-Reviewed Original ResearchConceptsInsurance-based disparitiesStroke centersEmergency departmentHospital clustersInitial emergency departmentIschemic stroke admissionsHospital emergency departmentClusters of hospitalsLogistic regression modelsStroke admissionsUninsured patientsPatient insuranceLower oddsPatientsLess strokeCenter accessOddsCenter transferHospitalLikelihood of transferInsurance groupsRegression modelsLower proportionDepartmentAssociationRecent 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 useEffectiveness 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 ResearchMeSH KeywordsAgedHumansIschemic StrokeMaleQuality ImprovementReperfusionStrokeTissue Plasminogen ActivatorConceptsAcute 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 mortalityShorter 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 dataClinical 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 ResearchMeSH KeywordsBrain IschemiaCross-Sectional StudiesHospitals, UrbanHumansIschemic StrokeRisk FactorsStrokeConceptsCerebrovascular 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 comorbiditiesTrends in characteristics of neurologists who provide stroke consultations in the USA, 2008–2021
Nakamoto C, Wilcock A, Schwamm L, Majersik J, Zachrison K, Mehrotra A. Trends in characteristics of neurologists who provide stroke consultations in the USA, 2008–2021. Stroke And Vascular Neurology 2022, 8: 86-88. PMID: 35902139, PMCID: PMC9985800, DOI: 10.1136/svn-2022-001662.Peer-Reviewed Original ResearchMeSH KeywordsAgedHumansIschemic Attack, TransientIschemic StrokeMedicareNeurologistsNeurologyReferral and ConsultationStrokeUnited StatesConceptsAcute ischemic strokeTransient ischemic attackVascular neurologistsPatient's homeAIS/transient ischemic attackHigh-volume providersNeurologist consultationTIA episodesIschemic attackIschemic strokeStroke consultationsNeurologistsService MedicarePhysician practicesStudy periodConsultsPatientsEpisodesConsultationHomeHospitalStrokeProportionSex 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 adjustmentAnalysis of Prescriptions for Dual Antiplatelet Therapy After Acute Ischemic Stroke
Xian Y, Xu H, Matsouaka R, Laskowitz D, Maisch L, Hannah D, Smith E, Fonarow G, Bhatt D, Schwamm L, Mac Grory B, Feng W, Fosbøl E, Peterson E, Johnson M. Analysis of Prescriptions for Dual Antiplatelet Therapy After Acute Ischemic Stroke. JAMA Network Open 2022, 5: e2224157. PMID: 35900761, PMCID: PMC9335137, DOI: 10.1001/jamanetworkopen.2022.24157.Peer-Reviewed Original ResearchConceptsAHA/ASA guidelinesAcute ischemic strokeMinor ischemic strokeUse of DAPTDual antiplatelet therapyIschemic strokeMinor strokeHospital-level variationAntiplatelet therapyASA guidelinesDAPT useCohort studySecondary preventionOdds ratioAmerican Heart Association/American Stroke AssociationMinor acute ischemic strokeMulticenter retrospective cohort studyMultivariable logistic regression analysisSubstantial hospital-level variationAHA/ASAGuidelines-Stroke programIdentical clinical featuresRetrospective cohort studyAmerican Stroke AssociationEvidence-based guidelines