2023
Shorter 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 administration
2020
Target: Stroke Was Associated With Faster Intravenous Thrombolysis and Improved One-Year Outcomes for Acute Ischemic Stroke in Medicare Beneficiaries
Man S, Xian Y, Holmes D, Matsouaka R, Saver J, Smith E, Bhatt D, Schwamm L, Fonarow G. Target: Stroke Was Associated With Faster Intravenous Thrombolysis and Improved One-Year Outcomes for Acute Ischemic Stroke in Medicare Beneficiaries. Circulation Cardiovascular Quality And Outcomes 2020, 13: e007150. PMID: 33302714, DOI: 10.1161/circoutcomes.120.007150.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overDatabases, FactualFemaleFibrinolytic AgentsHumansInfusions, IntravenousInsurance BenefitsIschemic StrokeMaleMedicarePatient ReadmissionQuality ImprovementQuality Indicators, Health CareRetrospective StudiesRisk AssessmentRisk FactorsThrombolytic TherapyTime FactorsTime-to-TreatmentTreatment OutcomeUnited StatesConceptsAcute ischemic strokeIschemic strokeNeedle timeIntravenous thrombolysisCardiovascular readmissionCause mortalityThrombolytic treatmentThrombolytic therapyMedicare beneficiariesGuidelines-Stroke hospitalsIntravenous thrombolytic therapyIntravenous thrombolytic treatmentOne-year outcomesProportion of patientsProportional hazards analysisAmerican Heart AssociationQuality InitiativeCause readmissionMedian doorHospital clusteringMedian ageHeart AssociationHospital characteristicsReadmissionImproved doorThrombolysis beyond 4.5 h in Acute Ischemic Stroke
Etherton M, Gadhia R, Schwamm L. Thrombolysis beyond 4.5 h in Acute Ischemic Stroke. Current Neurology And Neuroscience Reports 2020, 20: 35. PMID: 32607627, DOI: 10.1007/s11910-020-01055-1.Peer-Reviewed Original ResearchConceptsUnknown symptom onsetSymptom onsetAcute ischemic stroke patientsImproved long-term outcomesSalvageable brain tissueIntravenous thrombolytic therapyPlacebo-controlled trialAcute ischemic strokeIschemic stroke patientsLong-term outcomesDWI-FLAIR mismatchAlteplase treatmentSummaryIn patientsIschemic strokeStroke onsetAcute settingRecent FindingsIn recent yearsStroke patientsThrombolytic therapySalvageable tissueReviewThe purposeIndividualized approachStroke lesionsPatientsBrain tissue
2017
Treatment and Outcome of Hemorrhagic Transformation After Intravenous Alteplase in Acute Ischemic Stroke
Yaghi S, Willey JZ, Cucchiara B, Goldstein JN, Gonzales NR, Khatri P, Kim LJ, Mayer SA, Sheth KN, Schwamm LH. Treatment and Outcome of Hemorrhagic Transformation After Intravenous Alteplase in Acute Ischemic Stroke. Stroke 2017, 48: e343-e361. PMID: 29097489, DOI: 10.1161/str.0000000000000152.Peer-Reviewed Original ResearchConceptsSymptomatic intracranial hemorrhageAcute ischemic strokeIschemic strokeSystemic thrombolysisCase seriesIntravenous thrombolytic therapyMainstay of treatmentSmall case seriesTreatment of patientsBlood-brain barrierWriting group membersHemorrhagic transformationIntravenous alteplaseFeared complicationSevere complicationsPrompt diagnosisRandomized trialsThrombolytic therapyIntracranial hemorrhageRetrospective studyRisk factorsEarly correctionAlteplaseStrokeLiterature review
2016
Substantial Progress Yet Significant Opportunity for Improvement in Stroke Care in China
Li Z, Wang C, Zhao X, Liu L, Wang C, Li H, Shen H, Liang L, Bettger J, Yang Q, Wang D, Wang A, Pan Y, Jiang Y, Yang X, Zhang C, Fonarow G, Schwamm L, Hu B, Peterson E, Xian Y, Wang Y, Wang Y. Substantial Progress Yet Significant Opportunity for Improvement in Stroke Care in China. Stroke 2016, 47: 2843-2849. PMID: 27758941, DOI: 10.1161/strokeaha.116.014143.Peer-Reviewed Original ResearchConceptsChina National Stroke RegistryIntravenous thrombolytic therapyNational Stroke RegistryQuality Improvement ProgramHigher composite scoresStroke RegistryDysphagia screeningStroke careThrombolytic therapyAtrial fibrillationSmoking cessationLeading causeStroke educationMultivariate analysisStudy periodAdherenceComposite scoreHospitalPhase 2Phase 1CareRegression modelsOddsOverall qualitySignificant improvement
2014
Chronic Kidney Disease and Bleeding Complications After Intravenous Thrombolytic Therapy for Acute Ischemic Stroke
Ovbiagele B, Smith E, Schwamm L, Grau-Sepulveda M, Saver J, Bhatt D, Hernandez A, Peterson E, Fonarow G. Chronic Kidney Disease and Bleeding Complications After Intravenous Thrombolytic Therapy for Acute Ischemic Stroke. Circulation Cardiovascular Quality And Outcomes 2014, 7: 929-935. PMID: 25249561, DOI: 10.1161/circoutcomes.114.001144.Peer-Reviewed Original ResearchMeSH KeywordsAcute DiseaseAgedBrain IschemiaFemaleFibrinolytic AgentsFollow-Up StudiesGlomerular Filtration RateHemorrhageHospital MortalityHumansIncidenceInjections, IntravenousMaleOdds RatioRegistriesRenal Insufficiency, ChronicRetrospective StudiesThrombolytic TherapyTime FactorsTissue Plasminogen ActivatorUnited StatesConceptsChronic kidney diseaseSerious systemic hemorrhageSymptomatic intracranial hemorrhagePresence of CKDIntravenous tissue-type plasminogen activatorIntracranial hemorrhageSystemic hemorrhageTissue-type plasminogen activatorKidney diseaseFunctional statusTissue-type plasminogen activator administrationPlasminogen activatorAdmission serum creatinineGuidelines-Stroke programIndependent functional statusIntravenous thrombolytic therapyPrimary end pointAcute ischemic strokeIschemic stroke patientsGlomerular filtration rateNormal kidney functionDischarge functional statusHigher unadjusted oddsTissue-type plasminogenHospital mortality
2010
The “Golden Hour” and Acute Brain Ischemia
Saver J, Smith E, Fonarow G, Reeves M, Zhao X, Olson D, Schwamm L. The “Golden Hour” and Acute Brain Ischemia. Stroke 2010, 41: 1431-1439. PMID: 20522809, PMCID: PMC2909671, DOI: 10.1161/strokeaha.110.583815.Peer-Reviewed Original ResearchConceptsIschemic stroke patientsHospital emergency departmentIntravenous thrombolytic therapyAcute brain ischemiaNeedle timeThrombolytic therapyStroke patientsEmergency departmentGolden hourBrain ischemiaGreater stroke severityGuidelines-Stroke databaseQuarter of patientsHours of onsetHours patientsStroke severityDoor timeEarly presentationPatientsWell timeStudy periodTherapyIschemiaOnset timeMinutes
2005
The Evolving Role of Acute Stroke Imaging in Intravenous Thrombolytic Therapy: Patient Selection and Outcomes Assessment
Sims J, Schwamm L. The Evolving Role of Acute Stroke Imaging in Intravenous Thrombolytic Therapy: Patient Selection and Outcomes Assessment. Neuroimaging Clinics Of North America 2005, 15: 421-440. PMID: 16198950, DOI: 10.1016/j.nic.2005.06.001.Peer-Reviewed Original ResearchConceptsPatient selectionIntravenous thrombolytic therapyStroke pathophysiologyThrombolytic trialsPenumbral tissueAcute strokeLarge infarctionCerebral ischemiaRisk stratificationThrombolytic therapyCT perfusionStroke mechanismBrain hemorrhageTherapeutic successCT angiographyUnenhanced CTOutcome assessmentPotential future roleEarly signsEarly trialsMR imagingThrombolysisInfarctionTrialsEvolving role