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 cohort
2023
Suboptimal Sleep Duration Is Associated With Poorer Neuroimaging Brain Health Profiles in Middle‐Aged Individuals Without Stroke or Dementia
Clocchiatti‐Tuozzo S, Rivier C, Renedo D, Lopez V, Geer J, Miner B, Yaggi H, de Havenon A, Payabvash S, Sheth K, Gill T, Falcone G. Suboptimal Sleep Duration Is Associated With Poorer Neuroimaging Brain Health Profiles in Middle‐Aged Individuals Without Stroke or Dementia. Journal Of The American Heart Association 2023, 13: e031514. PMID: 38156552, PMCID: PMC10863828, DOI: 10.1161/jaha.123.031514.Peer-Reviewed Original ResearchConceptsSuboptimal sleep durationWhite matter hyperintensitiesMiddle-aged individualsLong sleep durationLarger WMH volumeSleep durationMiddle-aged adultsHealth profileWMH volumeAmerican Heart Association's LifeAsymptomatic middle-aged adultsWMH presenceVolume of WMHOptimal sleepSelf-reported sleep durationModifiable risk factorsWhite matter tractsProspective magnetic resonanceSimple 7Cardiovascular healthRisk factorsShort sleepMatter hyperintensitiesHigh riskEarly interventionAssociation of Poor Oral Health With Neuroimaging Markers of White Matter Injury in Middle-Aged Participants in the UK Biobank.
Rivier C, Renedo D, de Havenon A, Sunmonu N, Gill T, Payabvash S, Sheth K, Falcone G. Association of Poor Oral Health With Neuroimaging Markers of White Matter Injury in Middle-Aged Participants in the UK Biobank. Neurology 2023, 102: e208010. PMID: 38165331, PMCID: PMC10870735, DOI: 10.1212/wnl.0000000000208010.Peer-Reviewed Original ResearchConceptsPoor oral healthOral healthBrain healthRisk factorsNeuroimaging markerWMH volumeHealth profileMD scoreSelf-reported poor oral healthCross-sectional neuroimaging studiesFractional anisotropyWhite matter hyperintensity volumeModifiable risk factorsWhite matter injuryPresence of denturesMendelian randomizationMiddle-aged personsFA scoreMiddle-aged participantsLoose teethCardiovascular diseaseHyperintensity volumeBrain MRIModifiable processEarly interventionTrends 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 Research
2022
Deep Learning Applications for Acute Stroke Management
Chavva IR, Crawford AL, Mazurek MH, Yuen MM, Prabhat AM, Payabvash S, Sze G, Falcone GJ, Matouk CC, de Havenon A, Kim JA, Sharma R, Schiff SJ, Rosen MS, Kalpathy‐Cramer J, Gonzalez J, Kimberly WT, Sheth KN. Deep Learning Applications for Acute Stroke Management. Annals Of Neurology 2022, 92: 574-587. PMID: 35689531, DOI: 10.1002/ana.26435.Peer-Reviewed Original ResearchConceptsDeep machine learningDeep learning applicationsMedical image analysisDeep neural networksPixel-wise labelingAcute stroke managementReal-world examplesDL applicationsDL approachMachine learningLearning applicationsDL modelsNeural networkStroke managementLesion segmentationMaximal utilityImage analysisElectronic medical record dataInter-rater variabilityCause of disabilityMedical record dataRelevant clinical featuresStroke detectionAdvanced neuroimaging techniquesDecision makingCT angiographic radiomics signature for risk stratification in anterior large vessel occlusion stroke
Avery EW, Behland J, Mak A, Haider SP, Zeevi T, Sanelli PC, Filippi CG, Malhotra A, Matouk CC, Griessenauer CJ, Zand R, Hendrix P, Abedi V, Falcone GJ, Petersen N, Sansing LH, Sheth KN, Payabvash S. CT angiographic radiomics signature for risk stratification in anterior large vessel occlusion stroke. NeuroImage Clinical 2022, 34: 103034. PMID: 35550243, PMCID: PMC9108990, DOI: 10.1016/j.nicl.2022.103034.Peer-Reviewed Original ResearchConceptsLarge vessel occlusion strokeIndependent cohortPrognostication toolsMechanical thrombectomyRisk stratificationOcclusion strokeExternal cohortAnterior circulation large vessel occlusion strokeOutcome predictionAcute stroke triageAnterior circulation territoryRadiomic featuresTime of admissionGeisinger Medical CenterLVO stroke patientsReliable clinical informationSignificant differencesAdmission CTAStroke patientsPrognostic informationFavorable outcomeStroke triageTreatment decisionsMedical CenterRadiomics signatureAnalysis of Clinical Traits Associated With Cardiovascular Health, Genomic Profiles, and Neuroimaging Markers of Brain Health in Adults Without Stroke or Dementia
Acosta JN, Both CP, Rivier C, Szejko N, Leasure AC, Gill TM, Payabvash S, Sheth KN, Falcone GJ. Analysis of Clinical Traits Associated With Cardiovascular Health, Genomic Profiles, and Neuroimaging Markers of Brain Health in Adults Without Stroke or Dementia. JAMA Network Open 2022, 5: e2215328. PMID: 35622359, PMCID: PMC9142873, DOI: 10.1001/jamanetworkopen.2022.15328.Peer-Reviewed Original ResearchConceptsBrain healthBrain volumeMagnetic resonance imagingLower mean volumeLifestyle factorsCardiovascular healthLarge population-based cohort studyLife's Simple 7 (LS7) scoresPopulation-based cohort studyBrain magnetic resonance imagingMean volumeWhite matter hyperintensity volumeBrain health benefitsCommunity-dwelling personsImproved brain healthOutcomes of interestUK BiobankFinal analytical sampleAsymptomatic personsCohort studyLS7 scoreNeuroimaging markerHyperintensity volumeMAIN OUTCOMEGenetic predispositionImpact 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 outcomesPatientsBedside 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
2021
The coronal plane maximum diameter of deep intracerebral hemorrhage predicts functional outcome more accurately than hematoma volume
Haider SP, Qureshi AI, Jain A, Tharmaseelan H, Berson ER, Majidi S, Filippi CG, Mak A, Werring DJ, Acosta JN, Malhotra A, Kim JA, Sansing LH, Falcone G, Sheth K, Payabvash S. The coronal plane maximum diameter of deep intracerebral hemorrhage predicts functional outcome more accurately than hematoma volume. International Journal Of Stroke 2021, 17: 777-784. PMID: 34569877, PMCID: PMC9005571, DOI: 10.1177/17474930211050749.Peer-Reviewed Original ResearchSimilar 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 scoreRapid Assessment of Blood Pressure Variability and Outcome After Successful Thrombectomy
Castro P, Ferreira F, Nguyen CK, Payabvash S, Tan C, Sorond F, Azevedo E, Petersen N. Rapid Assessment of Blood Pressure Variability and Outcome After Successful Thrombectomy. Stroke 2021, 52: e531-e535. PMID: 34311565, PMCID: PMC8384685, DOI: 10.1161/strokeaha.121.034291.Peer-Reviewed Original ResearchConceptsBlood pressure variabilityEndovascular stroke therapyBP variabilityFunctional outcomeNeurological recoveryStroke therapyPressure variabilityAnterior circulation ischemic strokeHigh blood pressure variabilityLong-term functional outcomeBP variability measuresEarly clinical improvementEarly neurological recoveryPersonalized BP managementFavorable functional outcomeInitial clinical responsePoor functional outcomeRisk assessment toolSuccessful reperfusionClinical improvementClinical responseIschemic strokeRankin ScaleSuccessful thrombectomyPostreperfusion periodImaging of Spontaneous Intracerebral Hemorrhage
Jain A, Malhotra A, Payabvash S. Imaging of Spontaneous Intracerebral Hemorrhage. Neuroimaging Clinics Of North America 2021, 31: 193-203. PMID: 33902874, PMCID: PMC8820948, DOI: 10.1016/j.nic.2021.02.003.Peer-Reviewed Original ResearchConceptsIntracerebral hemorrhageSpontaneous intracerebral hemorrhageStroke incidenceLatest evidence-based guidelinesNontraumatic spontaneous intracerebral hemorrhageHemorrhagic stroke incidenceOverall stroke incidenceIdentification of patientsEvidence-based guidelinesClinical outcome predictionMorbidity rateHematoma expansionTreatment strategiesFirst monthOutcome predictionHemorrhageMortalityIncidenceFirst yearPatientsStrokeNeuroimagingMonths
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 biasCost-effectiveness of endovascular thrombectomy in patients with acute stroke and M2 occlusion
Khunte M, Wu X, Payabvash S, Zhu C, Matouk C, Schindler J, Sanelli P, Gandhi D, Malhotra A. Cost-effectiveness of endovascular thrombectomy in patients with acute stroke and M2 occlusion. Journal Of NeuroInterventional Surgery 2020, 13: 784-789. PMID: 33077578, DOI: 10.1136/neurintsurg-2020-016765.Peer-Reviewed Original ResearchConceptsEndovascular thrombectomyMedical managementProbabilistic sensitivity analysesM2 occlusionsAcute strokeBranch occlusionEVT-treated patientsAcute ischemic strokeQuality-adjusted life yearsLifetime quality-adjusted life yearsDecision analytic modelDecision analytic studyIschemic strokeReperfusion techniquesLifetime horizonBetter outcomesPatientsLife yearsAge groupsPerfect healthSocietal perspectiveCost-effective strategyStrokeHealth benefitsOcclusionEffects 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
2017
Multivariate Prognostic Model of Acute Stroke Combining Admission Infarct Location and Symptom Severity: A Proof-of-Concept Study
Payabvash S, Benson JC, Tyan AE, Taleb S, McKinney AM. Multivariate Prognostic Model of Acute Stroke Combining Admission Infarct Location and Symptom Severity: A Proof-of-Concept Study. Journal Of Stroke And Cerebrovascular Diseases 2017, 27: 936-944. PMID: 29198948, DOI: 10.1016/j.jstrokecerebrovasdis.2017.10.034.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overArea Under CurveBrainBrain IschemiaBrain MappingDatabases, FactualDecision Support TechniquesDiffusion Magnetic Resonance ImagingDisability EvaluationFemaleHumansLogistic ModelsMaleMesencephalonMiddle AgedMultivariate AnalysisOdds RatioPatient AdmissionPonsPredictive Value of TestsProof of Concept StudyReproducibility of ResultsRetrospective StudiesRisk FactorsROC CurveSeverity of Illness IndexStrokeTime FactorsTreatment OutcomeConceptsDisability/deathMidbrain/ponsAcute ischemic stroke patientsIschemic stroke patientsAdmission NIHSS scoreStroke patientsNIHSS scoreIndependent predictorsInfarct locationScale scoreHealth Stroke Scale scoreHigher admission NIHSS scoresModified Rankin Scale scoreSymptom severityAdmission stroke severityBaseline functional disabilityLarger infarct volumesStroke Scale scoreRankin Scale scoreHours of onsetAcute ischemic infarctMultivariate prognostic modelMajor arterial occlusionHypothesis-generating studyVoxel-based analysis
2016
The Effects of DWI‐Infarct Lesion Volume on DWI‐FLAIR Mismatch: Is There a Need for Size Stratification?
Payabvash S, Taleb S, Benson JC, Rykken JB, Oswood MC, McKinney AM, Hoffman B. The Effects of DWI‐Infarct Lesion Volume on DWI‐FLAIR Mismatch: Is There a Need for Size Stratification? Journal Of Neuroimaging 2016, 27: 392-396. PMID: 27878926, DOI: 10.1111/jon.12407.Peer-Reviewed Original ResearchConceptsDWI-FLAIR mismatchPositive predictive valueDWI lesion volumeLesion volumeNegative predictive valueStroke onsetAcute infarctsStroke patientsInfarct lesionsPredictive valueFluid-attenuated inversion recovery hyperintensityAcute ischemic stroke patientsInfarct lesion volumeIschemic stroke patientsHours of onsetInversion recovery hyperintensityContralateral normal sideIdentification of strokePotential imaging biomarkerMultivariate regression analysisIdentification of infarctionSymptom onsetTherapy timeNormal sideImaging biomarkers