2024
Automated detection of early signs of irreversible ischemic change on CTA source images in patients with large vessel occlusion
Mak A, Matouk C, Avery E, Behland J, Haider S, Frey D, Madai V, Vajkoczy P, Griessenauer C, Zand R, Hendrix P, Abedi V, Sanelli P, Falcone G, Petersen N, Sansing L, Sheth K, Payabvash S, Malhotra A. Automated detection of early signs of irreversible ischemic change on CTA source images in patients with large vessel occlusion. PLOS ONE 2024, 19: e0304962. PMID: 38870240, PMCID: PMC11175522, DOI: 10.1371/journal.pone.0304962.Peer-Reviewed Original ResearchConceptsDiffusion-weighted imagingLarge vessel occlusionIrreversible ischemic changesPoor functional outcomeFunctional outcomesIschemic changesInfarct volumeAlberta Stroke Program Early CT ScorePredicting poor functional outcomeVessel occlusionFollow-up diffusion-weighted imagingAnterior circulation LVO strokeCTA source imagesReceiver operating characteristic curveExpert human readersPredicting final infarctionASPECTS regionsAdmission CTANon-inferior performanceBaseline CTACT scoreFinal infarctEndovascular therapyHU attenuationValidation cohortThrombectomy vs Medical Management for Posterior Cerebral Artery Stroke: Systematic Review, Meta-Analysis, and Real-World Data.
Chen H, Khunte M, Colasurdo M, Malhotra A, Gandhi D. Thrombectomy vs Medical Management for Posterior Cerebral Artery Stroke: Systematic Review, Meta-Analysis, and Real-World Data. Neurology 2024, 102: e209315. PMID: 38626383, PMCID: PMC11175628, DOI: 10.1212/wnl.0000000000209315.Peer-Reviewed Original ResearchConceptsSymptomatic intracranial hemorrhagePosterior cerebral arteryAssociated with higher oddsNational Inpatient SampleEndovascular thrombectomyHigher oddsMedical managementCohort studyFunctional independencePosterior cerebral artery strokeSafety of endovascular thrombectomyOdds of symptomatic intracranial hemorrhageAssociated with significantly higher ratesOxford Centre for Evidence-Based Medicine criteriaRates of in-hospital mortalityCentre for Evidence-Based Medicine criteriaMeta-analysisRate of ICHAssociated with different oddsHigher odds of deathRate of subarachnoid hemorrhageIn-hospital mortalityAssociated with lower ratesClass III evidenceLevel of evidence
2023
Trends in Use of Intravenous Thrombolysis and Endovascular Thrombectomy in Patients With Acute Stroke With Large Vessel Occlusion 2016 to 2020 and Impact of COVID‐19 Pandemic
Khunte M, Chen H, Khunte A, Payabvash S, Gandhi D, Malhotra A. Trends in Use of Intravenous Thrombolysis and Endovascular Thrombectomy in Patients With Acute Stroke With Large Vessel Occlusion 2016 to 2020 and Impact of COVID‐19 Pandemic. Journal Of The American Heart Association 2023, 12: e029579. PMID: 37889182, PMCID: PMC10727381, DOI: 10.1161/jaha.122.029579.Peer-Reviewed Original ResearchIntravenous thrombolysis prior to endovascular thrombectomy in elderly stroke patients: An analysis of the National Inpatient Sample database
Chen H, Khunte M, Colasurdo M, Malhotra A, Gandhi D. Intravenous thrombolysis prior to endovascular thrombectomy in elderly stroke patients: An analysis of the National Inpatient Sample database. Journal Of The Neurological Sciences 2023, 454: 120842. PMID: 37856997, DOI: 10.1016/j.jns.2023.120842.Peer-Reviewed Original ResearchConceptsNational Inpatient Sample databaseHospital mortalityHemorrhagic complicationsIntravenous thrombolysisEndovascular thrombectomyEVT patientsIVT treatmentThrombectomy centreElderly patientsMultivariable logistic regression modelSample databaseStroke risk factorsElderly stroke patientsCross-sectional studyLarge-scale cross-sectional studyOutcomes of interestHigh rateLogistic regression modelsPatients 80Medical comorbiditiesOnly patientsPatient demographicsStroke etiologyThrombolytic treatmentHemorrhagic riskCT With CTA Versus MRI in Patients Presenting to the Emergency Department With Dizziness: Analysis Using Propensity Score Matching.
Tu L, Navaratnam D, Melnick E, Forman H, Venkatesh A, Malhotra A, Yaesoubi R, Sureshanand S, Sheth K, Mahajan A. CT With CTA Versus MRI in Patients Presenting to the Emergency Department With Dizziness: Analysis Using Propensity Score Matching. American Journal Of Roentgenology 2023, 221: 836-845. PMID: 37404082, DOI: 10.2214/ajr.23.29617.Peer-Reviewed Original ResearchConceptsSecondary stroke prevention medicationsStroke prevention medicationsEmergency departmentPrevention medicationsEchocardiography evaluationPosterior circulation strokeProportion of patientsGroup of patientsPhysical examination findingsNeuroimaging resultsUse of MRIReview of systemsGreater frequencyPropensity-score matchingExamination findingsRetrospective studyED readmissionMedical historyHead CTClinical impactMRI examinationsBrain MRINeck CTADizzinessPatientsFactors associated with door-in-door-out times in large vessel occlusion stroke patients undergoing endovascular therapy
Radmard M, Wu X, Khunte M, Malhotra A. Factors associated with door-in-door-out times in large vessel occlusion stroke patients undergoing endovascular therapy. The American Journal Of Emergency Medicine 2023, 70: 192-193. PMID: 37393131, DOI: 10.1016/j.ajem.2023.06.020.Peer-Reviewed Original ResearchClinical criteria to exclude acute vascular pathology on CT angiogram in patients with dizziness
Tu L, Malhotra A, Venkatesh A, Taylor R, Sheth K, Yaesoubi R, Forman H, Sureshanand S, Navaratnam D. Clinical criteria to exclude acute vascular pathology on CT angiogram in patients with dizziness. PLOS ONE 2023, 18: e0280752. PMID: 36893103, PMCID: PMC9997874, DOI: 10.1371/journal.pone.0280752.Peer-Reviewed Original ResearchConceptsAcute vascular pathologyEmergency departmentVascular pathologyNegative predictive valueDizzy patientsStroke codeCTA headPredictive valueAdult ED encountersTransient ischemic attackHalf of patientsLong-term smokersLarge vessel occlusionCoronary artery diseasePast medical historySeparate validation cohortCross-sectional analysisIschemic attackAnalysis cohortArterial dissectionArtery diseaseClinical factorsED encountersMedication useChief complaintLetter to the Editor Regarding “Drip and Ship versus Mothership Model in the MCA Stroke: A Propensity-Matched Real World Analysis Through NIS Data”
Malhotra A, Khunte M, Wu X, Radmard M. Letter to the Editor Regarding “Drip and Ship versus Mothership Model in the MCA Stroke: A Propensity-Matched Real World Analysis Through NIS Data”. World Neurosurgery 2023, 170: 266. PMID: 36782423, DOI: 10.1016/j.wneu.2022.09.098.Peer-Reviewed Original ResearchLetter to the Editor Re “Endovascular thrombectomy or bridging therapy in minor ischemic stroke with large vessel occlusion”
Malhotra A, Khunte M, Wu X, Radmard M. Letter to the Editor Re “Endovascular thrombectomy or bridging therapy in minor ischemic stroke with large vessel occlusion”. Thrombosis Research 2023, 232: 145. PMID: 36739257, DOI: 10.1016/j.thromres.2023.01.008.Peer-Reviewed Original Research
2022
Associations of Osteoarthritis With Thrombectomy Utilization and Outcomes for Large Vessel Acute Ischemic Stroke
Chen H, Khunte M, Colasurdo M, Jindal G, Malhotra A, Gandhi D, Chaturvedi S. Associations of Osteoarthritis With Thrombectomy Utilization and Outcomes for Large Vessel Acute Ischemic Stroke. Stroke 2022, 54: 518-526. PMID: 36541211, DOI: 10.1161/strokeaha.122.041749.Peer-Reviewed Original ResearchConceptsMultivariable logistic regression modelEndovascular thrombectomyAssociation of osteoarthritisLogistic regression modelsHospital mortalityMedical comorbiditiesIschemic strokeRisk factorsLower oddsLarge vessel acute ischemic strokeNational Inpatient Sample databaseMultivariable logistic regression analysisLarge-vessel ischemic strokeIntravenous thrombolysis treatmentStroke risk factorsAcute ischemic strokeIschemic stroke patientsPresence of osteoarthritisCause of disabilityCross-sectional studyLogistic regression analysisPatient selection practicesLarge-scale cross-sectional studyDirect risk factorEVT treatmentLetter to the editor re “Minor stroke in large vessel occlusion: A matched analysis of patients from the German Stroke Registry—Endovascular Treatment and patients from the Safe Implementation of Treatments in Stroke—International Stroke Thrombolysis Register”
Malhotra A, Khunte M, Wu X, Radmard M. Letter to the editor re “Minor stroke in large vessel occlusion: A matched analysis of patients from the German Stroke Registry—Endovascular Treatment and patients from the Safe Implementation of Treatments in Stroke—International Stroke Thrombolysis Register”. European Journal Of Neurology 2022, 30: 290-291. PMID: 36260371, DOI: 10.1111/ene.15598.Commentaries, Editorials and LettersCost-effectiveness of endovascular thrombectomy in acute stroke patients with large ischemic core
Sanmartin M, Katz J, Wang J, Malhotra A, Sangha K, Bastani M, Martinez G, Sanelli P. Cost-effectiveness of endovascular thrombectomy in acute stroke patients with large ischemic core. Journal Of NeuroInterventional Surgery 2022, 15: e166-e171. PMID: 36175016, DOI: 10.1136/jnis-2022-019460.Peer-Reviewed Original ResearchConceptsQuality-adjusted life yearsIncremental cost-effectiveness ratioNet monetary benefitProbabilistic sensitivity analysesEconomic evaluation studiesCost-effectiveness analysisCost-effectiveness ratioSensitivity analysisTwo-way sensitivity analysesLifetime healthcare costsMonetary benefitsLife yearsLifetime costsLifetime benefitsLarge ischemic coreStandard careCost-effective strategyEVTIschemic coreStroke patientsAIS patientsPatient's lifetimeAcute ischemic stroke patientsCostEndovascular thrombectomy treatment
2020
Effects of Collateral Status on Infarct Distribution Following Endovascular Therapy in Large Vessel Occlusion Stroke
Al-Dasuqi K, Payabvash S, Torres-Flores GA, Strander SM, Nguyen CK, Peshwe KU, Kodali S, Silverman A, Malhotra A, Johnson MH, Matouk CC, Schindler JL, Sansing LH, Falcone GJ, Sheth KN, Petersen NH. Effects of Collateral Status on Infarct Distribution Following Endovascular Therapy in Large Vessel Occlusion Stroke. Stroke 2020, 51: e193-e202. PMID: 32781941, PMCID: PMC7484023, DOI: 10.1161/strokeaha.120.029892.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overArterial Occlusive DiseasesCerebral InfarctionCohort StudiesCollateral CirculationComputed Tomography AngiographyEndovascular ProceduresFemaleHumansInfarction, Middle Cerebral ArteryLinear ModelsMagnetic Resonance AngiographyMaleMiddle AgedReperfusionRetrospective StudiesStrokeThrombectomyTreatment OutcomeWhite MatterConceptsLarge vessel occlusion strokeFinal infarct volumeCollateral statusPoor collateral statusFavorable outcomeInfarct distributionInfarct volumeReperfusion successIndependent predictorsOcclusion strokeInternal capsuleAnterior circulation large vessel occlusion ischemic strokeLarge vessel occlusion ischemic strokeDeep white matter tractsBaseline collateral statusBorder-zone infarctionEarly favorable outcomeEarly functional outcomesRankin Scale scoreCohort of patientsDegree of reperfusionLarge vessel occlusionComputed tomography angiographyDeep white matterMagnetic resonance imagingEndovascular Contact Aspiration versus Stent Retriever for Revascularization in Patients with Acute Ischemic Stroke and Large Vessel Occlusion: A Cost-Minimization Analysis
Malhotra A, Boltyenkov A, Wu X, Matouk CC, Forman HP, Gandhi D, Sanelli P. Endovascular Contact Aspiration versus Stent Retriever for Revascularization in Patients with Acute Ischemic Stroke and Large Vessel Occlusion: A Cost-Minimization Analysis. World Neurosurgery 2020, 139: e23-e31. PMID: 32105871, DOI: 10.1016/j.wneu.2020.02.078.Peer-Reviewed Original ResearchCT Angiography for Triage of Patients with Acute Minor Stroke: A Cost-effectiveness Analysis.
Wu X, Hughes DR, Gandhi D, Matouk CC, Sheth K, Schindler J, Wira C, Wintermark M, Sanelli P, Malhotra A. CT Angiography for Triage of Patients with Acute Minor Stroke: A Cost-effectiveness Analysis. Radiology 2020, 294: 580-588. PMID: 31934828, DOI: 10.1148/radiol.2019191238.Peer-Reviewed Original ResearchConceptsLarge vessel occlusionAcute minor strokeBest medical managementMinor strokeCT angiographyMedical managementProbabilistic sensitivity analysesLower health benefitsImmediate thrombectomyHealth benefitsHealth outcomesVascular imagingAcute ischemic strokeMarkov decision-analytic modelWorse health outcomesImproved health outcomesDecision analytic modelNet monetary benefitIntravenous thrombolysisIschemic strokeYounger patientsThrombectomy strategyPatientsAngiographyStroke
2019
Higher Plaque Burden of Middle Cerebral Artery Is Associated With Recurrent Ischemic Stroke
Ran Y, Wang Y, Zhu M, Wu X, Malhotra A, Lei X, Zhang F, Wang X, Xie S, Zhou J, Zhu J, Cheng J, Zhu C. Higher Plaque Burden of Middle Cerebral Artery Is Associated With Recurrent Ischemic Stroke. Stroke 2019, 51: 659-662. PMID: 31856694, DOI: 10.1161/strokeaha.119.028405.Peer-Reviewed Original ResearchConceptsRecurrent ischemic strokeMiddle cerebral arteryMagnetic resonance vessel wall imagingPlaque burdenIschemic strokeVessel wall imagingAcute strokeCerebral arteryRecurrent strokeChronic strokeStroke patientsPlaque characteristicsMiddle cerebral artery plaqueRecurrent acute strokeRecurrent stroke groupRecurrent stroke patientsAcute stroke patientsHigher plaque burdenMethods One hundredDegree of stenosisClinical factorsStroke groupArtery plaquesFemale sexImaging featuresA comparison of benign positional vertigo and stroke patients presenting to the emergency department with vertigo or dizziness
Hanna J, Malhotra A, Brauer PR, Luryi A, Michaelides E. A comparison of benign positional vertigo and stroke patients presenting to the emergency department with vertigo or dizziness. American Journal Of Otolaryngology 2019, 40: 102263. PMID: 31358317, DOI: 10.1016/j.amjoto.2019.07.007.Peer-Reviewed Original ResearchConceptsBenign paroxysmal positional vertigoStroke risk factorsCT/CTAEmergency departmentBPPV patientsNeurologic symptomsStroke patientsRisk factorsPositional vertigoCT headExam findingsNeurologic exam findingsPosterior circulation strokeProfile of patientsBenign positional vertigoParoxysmal positional vertigoCommon imaging modalityAcute strokeNeurologic examInitial imagingMRI brainDischarge diagnosisComputed tomographyPatientsVertigoLetter by Malhotra and Wu Regarding Article, “Advanced Neuroimaging in Stroke Patient Selection for Mechanical Thrombectomy”
Malhotra A, Wu X. Letter by Malhotra and Wu Regarding Article, “Advanced Neuroimaging in Stroke Patient Selection for Mechanical Thrombectomy”. Stroke 2019, 50: e130. PMID: 30896370, DOI: 10.1161/strokeaha.119.024825.Peer-Reviewed Original ResearchComparative Effectiveness of Endovascular Thrombectomy in Elderly Stroke Patients
Malhotra A, Wu X, Payabvash S, Matouk CC, Forman HP, Gandhi D, Sanelli P, Schindler J. Comparative Effectiveness of Endovascular Thrombectomy in Elderly Stroke Patients. Stroke 2019, 50: 963-969. PMID: 30908156, DOI: 10.1161/strokeaha.119.025031.Peer-Reviewed Original ResearchConceptsQuality-adjusted life yearsIntravenous thrombolysisEndovascular thrombectomyLarge vessel occlusionAge 80 yearsEVT strategyVessel occlusionModified Rankin Scale scorePoststroke functional outcomeAcute ischemic strokeRankin Scale scoreElderly stroke patientsMarkov decision-analytic modelYears of ageDecision analytic modelMultiple sensitivity analysesPurpose- StrokeAcute strokeBaseline disabilityElderly patientsIschemic strokeStroke patientsFunctional outcomeHealthy patientsAdvanced ageNeuroimaging of Pediatric Arteriopathies
Goyal P, Malhotra A, Almast J, Sapire J, Gupta S, Mangla M, Mangla R. Neuroimaging of Pediatric Arteriopathies. Journal Of Neuroimaging 2019, 29: 287-308. PMID: 30920080, DOI: 10.1111/jon.12614.Peer-Reviewed Original ResearchConceptsIschemic strokeMajor prognostic implicationsPediatric ischemic strokeSecondary stroke preventionAcute ischemic strokeFocal neurologic deficitsAdult stroke populationSmall vessel arteriopathyNoninflammatory etiologiesRecurrent strokeStroke preventionSystemic complicationsCerebral arteriopathyNeurologic deficitsStroke etiologyAcute managementPrompt diagnosisStroke populationNeuropsychiatric symptomsClinical manifestationsClinical symptomsPrognostic implicationsPredominant vesselRisk factorsSchool-aged children