2024
Deep learning for prediction of post-thrombectomy outcomes based on admission CT angiography in large vessel occlusion stroke
Sommer J, Dierksen F, Zeevi T, Tran A, Avery E, Mak A, Malhotra A, Matouk C, Falcone G, Torres-Lopez V, Aneja S, Duncan J, Sansing L, Sheth K, Payabvash S. Deep learning for prediction of post-thrombectomy outcomes based on admission CT angiography in large vessel occlusion stroke. Frontiers In Artificial Intelligence 2024, 7: 1369702. PMID: 39149161, PMCID: PMC11324606, DOI: 10.3389/frai.2024.1369702.Peer-Reviewed Original ResearchEnd-to-endComputed tomography angiographyLarge vessel occlusionConvolutional neural networkDeep learning pipelineTrain separate modelsLogistic regression modelsResNet-50Deep learningAdmission computed tomography angiographyNeural networkLearning pipelineAdmission CT angiographyPreprocessing stepDiagnosis of large vessel occlusionsLarge vessel occlusion strokeReceiver operating characteristic areaEnsemble modelAutomated modelPre-existing morbidityCT angiographyReperfusion successNeurological examCross-validationOcclusion strokeAutomated 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 cohortRadiomics-Based Prediction of Collateral Status from CT Angiography of Patients Following a Large Vessel Occlusion Stroke
Avery E, Abou-Karam A, Abi-Fadel S, Behland J, Mak A, Haider S, Zeevi T, Sanelli P, Filippi C, Malhotra A, Matouk C, Falcone G, Petersen N, Sansing L, Sheth K, Payabvash S. Radiomics-Based Prediction of Collateral Status from CT Angiography of Patients Following a Large Vessel Occlusion Stroke. Diagnostics 2024, 14: 485. PMID: 38472957, PMCID: PMC10930945, DOI: 10.3390/diagnostics14050485.Peer-Reviewed Original ResearchCollateral statusCollateral scoreLarge vessel occlusionAcute LVO strokeRadiomics modelTest cohortCT angiography of patientsAdmission computed tomography angiographyAnterior circulation territoryAngiography of patientsLong-term outcomesReceiver operating characteristic areaRadiomics-based predictionCollateral arterial circulationOperating characteristics areaAdmission CTACirculation territoryCT angiographyClinical outcomesRadiomic featuresTreatment triageOcclusion strokeVessel occlusionPatientsArterial circulation
2022
Impact of collateral flow on cost-effectiveness of endovascular thrombectomy.
Khunte M, Wu X, Avery EW, Gandhi D, Payabvash S, Matouk C, Heit JJ, Wintermark M, Albers GW, Sanelli P, Malhotra A. Impact of collateral flow on cost-effectiveness of endovascular thrombectomy. Journal Of Neurosurgery 2022, 137: 1801-1810. PMID: 35535841, DOI: 10.3171/2022.2.jns212887.Peer-Reviewed Original ResearchConceptsIncremental cost-effectiveness ratioEndovascular thrombectomyIschemic stroke patientsCollateral statusPoor collateral statusBetter outcomesPoor collateralsCollateral circulationStroke patientsAcute ischemic stroke patientsModified Rankin Scale scorePoor collateral circulationRankin Scale scoreLarge vessel occlusionCollateral blood flowGood collateral blood flowCost-effectiveness ratioBase-case analysisProbabilistic sensitivity analysesEVT strategyEVT treatmentIschemic strokeMedical therapyMore patientsCollateral flowCost-effectiveness of thrombectomy in patients with minor stroke and large vessel occlusion: effect of thrombus location on cost-effectiveness and outcomes
Khunte M, Wu X, Koo A, Payabvash S, Matouk C, Heit JJ, Wintermark M, Albers GW, Sanelli PC, Gandhi D, Malhotra A. Cost-effectiveness of thrombectomy in patients with minor stroke and large vessel occlusion: effect of thrombus location on cost-effectiveness and outcomes. Journal Of NeuroInterventional Surgery 2022, 15: 39-45. PMID: 35022300, DOI: 10.1136/neurintsurg-2021-018375.Peer-Reviewed Original ResearchConceptsLarge vessel occlusionProximal M1 occlusionEndovascular thrombectomyMinor strokeM2 occlusionsIntravenous thrombolysisM1 occlusionMedical managementVessel occlusionRankin score 0Markov decision-analytic modelBase-case analysisDecision analytic modelProbabilistic sensitivity analysesProximal M1More patientsPoor outcomeThrombus locationDistal M1Occlusion siteObservational studyScore 0Significant disabilityBetter outcomesPatients
2021
Similar admission NIHSS may represent larger tissue-at-risk in patients with right-sided versus left-sided large vessel occlusion
Mak A, Matouk C, Avery EW, Behland J, Frey D, Madai VI, Vajkoczy P, Malhotra A, Karam A, Sanelli P, Falcone GJ, Petersen NH, Sansing L, Sheth KN, Payabvash S. Similar admission NIHSS may represent larger tissue-at-risk in patients with right-sided versus left-sided large vessel occlusion. Journal Of NeuroInterventional Surgery 2021, 14: 985-991. PMID: 34645705, DOI: 10.1136/neurintsurg-2021-017785.Peer-Reviewed Original ResearchConceptsLarge vessel occlusionFinal infarct volumeLarger final infarct volumeWorse discharge outcomesInfarct volumeAdmission NIHSSDischarge outcomesVessel occlusionScale scoreMultivariate analysisAnterior large vessel occlusionLower admission NIHSS scoreHealth Stroke Scale scoreAdmission National InstitutesAdmission stroke severityPoor discharge outcomeStroke Scale scoreLarger infarct volumesAdmission NIHSS scoreRankin Scale scoreVoxel-wise analysisIncomplete reperfusionInfarct distributionOcclusion sideNIHSS scoreCost-effectiveness of endovascular thrombectomy in patients with low Alberta Stroke Program Early CT Scores (< 6) at presentation.
Wu X, Payabvash S, Matouk CC, Lev MH, Wintermark M, Sanelli P, Gandhi D, Malhotra A. Cost-effectiveness of endovascular thrombectomy in patients with low Alberta Stroke Program Early CT Scores (< 6) at presentation. Journal Of Neurosurgery 2021, 135: 1645-1655. PMID: 33962378, DOI: 10.3171/2020.9.jns202965.Peer-Reviewed Original ResearchAlberta Stroke Program Early CT ScoreLow Alberta Stroke Program Early CT ScoreEndovascular thrombectomyLarge vessel occlusionMedical managementCT scoreBetter outcomesCost-effective strategyEVT-treated patientsIncremental cost-effectiveness ratioAcute ischemic strokeCost-effectiveness ratioDecision-analytical studyIschemic strokePoor outcomeVessel occlusionLifetime horizonSignificant disabilityPatientsHealth outcomesAge groupsPerfect healthSocietal perspectiveQALYHealth benefits
2020
Outcomes after Thrombectomy for Minor Stroke: A Meta-Analysis
Wu X, Khunte M, Payabvash S, Zhu C, Brackett A, Matouk CC, Gandhi D, Sanelli P, Malhotra A. Outcomes after Thrombectomy for Minor Stroke: A Meta-Analysis. World Neurosurgery 2020, 149: e1140-e1154. PMID: 33359881, DOI: 10.1016/j.wneu.2020.12.047.Peer-Reviewed Original ResearchConceptsSymptomatic intracranial hemorrhageBest medical managementMedical managementMechanical thrombectomyExcellent outcomesBetter outcomesImmediate thrombectomyMinor strokeIncidence of sICHLarge vessel occlusionSignificant selection biasStroke symptomatologyIntravenous thrombolysisBaseline characteristicsPooled proportionIntracranial hemorrhageOdds ratioThrombectomyMT outcomesMeta-AnalysisPatientsMortalityOutcomesStrokeSelection biasEffects 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 imaging
2019
Comparative 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
2011
CT Perfusion Mean Transit Time Maps Optimally Distinguish Benign Oligemia from True “At-Risk” Ischemic Penumbra, but Thresholds Vary by Postprocessing Technique
Kamalian S, Kamalian S, Konstas AA, Maas MB, Payabvash S, Pomerantz SR, Schaefer PW, Furie KL, González RG, Lev MH. CT Perfusion Mean Transit Time Maps Optimally Distinguish Benign Oligemia from True “At-Risk” Ischemic Penumbra, but Thresholds Vary by Postprocessing Technique. American Journal Of Neuroradiology 2011, 33: 545-549. PMID: 22194372, PMCID: PMC3746025, DOI: 10.3174/ajnr.a2809.Peer-Reviewed Original ResearchConceptsAcute stroke patientsLarge vessel occlusionBenign oligemiaStroke patientsIschemic penumbraCTP parametersRelative cerebral blood flowConsecutive stroke patientsHours of onsetCerebral blood flowMean transit time mapsCharacteristic curve analysisTransit time mapsUninvolved hemisphereRadiographic evidenceThrombolytic therapyFinal infarctVessel occlusionRelative MTTBlood flowCTP mapsPerfusion parametersOligemiaReperfusionPatients