2022
Portable, low-field magnetic resonance imaging enables highly accessible and dynamic bedside evaluation of ischemic stroke
Yuen MM, Prabhat AM, Mazurek MH, Chavva IR, Crawford A, Cahn BA, Beekman R, Kim JA, Gobeske KT, Petersen NH, Falcone GJ, Gilmore EJ, Hwang DY, Jasne AS, Amin H, Sharma R, Matouk C, Ward A, Schindler J, Sansing L, de Havenon A, Aydin A, Wira C, Sze G, Rosen MS, Kimberly WT, Sheth KN. Portable, low-field magnetic resonance imaging enables highly accessible and dynamic bedside evaluation of ischemic stroke. Science Advances 2022, 8: eabm3952. PMID: 35442729, PMCID: PMC9020661, DOI: 10.1126/sciadv.abm3952.Peer-Reviewed Original ResearchIschemic strokeMagnetic resonance imagingResonance imagingFluid-attenuated inversion recoveryDiffusion-weighted imaging sequencesStroke volume measurementsStroke pathwayStroke severityFunctional outcomeLow-field magnetic resonance imagingBedside evaluationClinical managementStroke volumeMRI studiesStrokePatientsBrain imagingCerebellar structuresHigh-field MRI studiesHyperintense regionsInversion recoveryInfarctsUseful imagingVolume measurementsBedside detection of intracranial midline shift using portable magnetic resonance imaging
Sheth KN, Yuen MM, Mazurek MH, Cahn BA, Prabhat AM, Salehi S, Shah JT, By S, Welch EB, Sofka M, Sacolick LI, Kim JA, Payabvash S, Falcone GJ, Gilmore EJ, Hwang DY, Matouk C, Gordon-Kundu B, RN AW, Petersen N, Schindler J, Gobeske KT, Sansing LH, Sze G, Rosen MS, Kimberly WT, Kundu P. Bedside detection of intracranial midline shift using portable magnetic resonance imaging. Scientific Reports 2022, 12: 67. PMID: 34996970, PMCID: PMC8742125, DOI: 10.1038/s41598-021-03892-7.Peer-Reviewed Original ResearchConceptsMidline shiftNeuroscience intensive care unitCare measurementYale-New Haven HospitalValuable bedside toolIntensive care unitPoor clinical outcomeBrain-injured patientsMass effectNew Haven HospitalMagnetic resonance imagingClinical outcomesIll patientsCare unitStroke patientsFunctional outcomeBedside toolObservational studyBedside detectionImaging examsPatientsResonance imagingPortable MRIImaging suiteSignificant concordance
2020
Direct carotid puncture for mechanical thrombectomy in acute ischemic stroke patients with prohibitive vascular access.
Cord BJ, Kodali S, Strander S, Silverman A, Wang A, Chouairi F, Koo AB, Nguyen CK, Peshwe K, Kimmel A, Porto CM, Hebert RM, Falcone GJ, Sheth KN, Sansing LH, Schindler JL, Matouk CC, Petersen NH. Direct carotid puncture for mechanical thrombectomy in acute ischemic stroke patients with prohibitive vascular access. Journal Of Neurosurgery 2020, 135: 53-63. PMID: 32796146, PMCID: PMC9491727, DOI: 10.3171/2020.5.jns192737.Peer-Reviewed Original ResearchDirect carotid punctureSmaller infarct volumesMechanical thrombectomyVascular accessFunctional outcomeAIS-LVONIHSS scoreDCP groupInfarct volumeTransfemoral accessNeck hematomaStroke patientsCarotid punctureABMT groupAnterior circulation acute ischemic strokeCommon carotid artery dissectionAcute ischemic stroke patientsDirect carotid accessEmergency mechanical thrombectomyAcute ischemic strokeAdmission NIHSS scoreCarotid artery dissectionIschemic stroke patientsGood functional outcomeLarge vessel occlusionBlood Pressure Decreases Occur Throughout Endovascular Thrombectomy and Are Associated with Poor Functional Outcome (4872)
Kimmel A, Silverman A, Kodali S, Strander S, Nguyen C, Peshwe K, Wang A, Cardenas G, Holcombe A, Zevallos C, Dandapat S, Sansing L, Schindler J, Falcone G, Matouk C, Sheth K, Ortega-Gutierrez S, Petersen N. Blood Pressure Decreases Occur Throughout Endovascular Thrombectomy and Are Associated with Poor Functional Outcome (4872). Neurology 2020, 94 DOI: 10.1212/wnl.94.15_supplement.4872.Peer-Reviewed Original ResearchFixed Compared With Autoregulation-Oriented Blood Pressure Thresholds After Mechanical Thrombectomy for Ischemic Stroke
Petersen NH, Silverman A, Strander SM, Kodali S, Wang A, Sansing LH, Schindler JL, Falcone GJ, Gilmore EJ, Jasne AS, Cord B, Hebert RM, Johnson M, Matouk CC, Sheth KN. Fixed Compared With Autoregulation-Oriented Blood Pressure Thresholds After Mechanical Thrombectomy for Ischemic Stroke. Stroke 2020, 51: 914-921. PMID: 32078493, PMCID: PMC7050651, DOI: 10.1161/strokeaha.119.026596.Peer-Reviewed Original ResearchConceptsSystolic BP thresholdMean arterial pressureArterial pressureEndovascular thrombectomyIschemic strokeSystolic BPFunctional outcomePercent timeFurther brain injuryModified Rankin ScaleBlood pressure changesPoor functional outcomeBP thresholdAutoregulatory indexHemorrhagic transformationMechanical thrombectomyRankin ScaleBlood pressureBP targetsHemodynamic managementAcute phaseBP managementStroke patientsCerebral autoregulationWorse outcomes
2019
Decreases in Blood Pressure During Thrombectomy Are Associated With Larger Infarct Volumes and Worse Functional Outcome
Petersen NH, Ortega-Gutierrez S, Wang A, Lopez GV, Strander S, Kodali S, Silverman A, Zheng-Lin B, Dandapat S, Sansing LH, Schindler JL, Falcone GJ, Gilmore EJ, Amin H, Cord B, Hebert RM, Matouk C, Sheth KN. Decreases in Blood Pressure During Thrombectomy Are Associated With Larger Infarct Volumes and Worse Functional Outcome. Stroke 2019, 50: 1797-1804. PMID: 31159701, PMCID: PMC6787912, DOI: 10.1161/strokeaha.118.024286.Peer-Reviewed Original ResearchConceptsFinal infarct volumeWorse functional outcomeInfarct volumeEndovascular thrombectomyFunctional outcomeOcclusion strokeCerebral infarction 2b/3 reperfusionPressure reductionLarge vessel intracranial occlusionsGreater infarct growthBlood pressure reductionComprehensive stroke centerPercent of patientsBlood pressure managementLarger infarct volumesModified Rankin ScaleRankin Scale scoreMultivariable logistic regressionRelative hypotensionSustained hypotensionInfarct progressionNinety patientsInfarct growthIschemic penumbraIschemic strokePatients with Parenchymal Hemorrhagic Transformation and Poor Functional Outcome Have Distinct Systolic Blood Pressure Trajectories 72 hours After Mechanical Thrombectomy (P5.3-007)
Kodali S, Strander S, Silverman A, Agarwal T, Stretz C, Wang A, Sansing L, Schindler J, Sheth K, Petersen N. Patients with Parenchymal Hemorrhagic Transformation and Poor Functional Outcome Have Distinct Systolic Blood Pressure Trajectories 72 hours After Mechanical Thrombectomy (P5.3-007). Neurology 2019, 92 DOI: 10.1212/wnl.92.15_supplement.p5.3-007.Peer-Reviewed Original ResearchBlood Pressure Management Outside Individualized Limits of Autoregulation is Associated with Neurologic Deterioration and Worse Functional Outcomes in Patients with Large-Vessel Occlusion (LVO) Ischemic Stroke (S52.002)
Silverman A, Wang A, Strander S, Kodali S, Sansing L, Schindler J, Gilmore E, Sheth K, Petersen N. Blood Pressure Management Outside Individualized Limits of Autoregulation is Associated with Neurologic Deterioration and Worse Functional Outcomes in Patients with Large-Vessel Occlusion (LVO) Ischemic Stroke (S52.002). Neurology 2019, 92 DOI: 10.1212/wnl.92.15_supplement.s52.002.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 age