2023
Performance of Thrombectomy-Capable, Comprehensive, and Primary Stroke Centers in Reperfusion Therapies for Acute Ischemic Stroke: Report From the Get With The Guidelines–Stroke Registry
Raychev R, Sun J, Schwamm L, Smith E, Fonarow G, Messé S, Xian Y, Chiswell K, Blanco R, Mac Grory B, Saver J. Performance of Thrombectomy-Capable, Comprehensive, and Primary Stroke Centers in Reperfusion Therapies for Acute Ischemic Stroke: Report From the Get With The Guidelines–Stroke Registry. Circulation 2023, 148: 2019-2028. PMID: 37855118, DOI: 10.1161/circulationaha.123.066114.Peer-Reviewed Original ResearchConceptsComprehensive stroke centerPrimary stroke centerThrombectomy-capable stroke centersAcute ischemic strokeGuidelines-Stroke registryEndovascular thrombectomyStroke centersReperfusion therapyIschemic strokeClinical outcomesHealth Stroke Scale scoreClinical efficacy outcomesStroke Scale scoreHigher National InstitutesOdds of dischargeGoal doorEVT proceduresHospital mortalityIntravenous thrombolysisEfficacy outcomesSuccessful reperfusionCohort studyDischarge destinationNeedle timePuncture timeOutcomes of recurrent stroke in patients with atrial fibrillation according to presumed etiology
Pedreira B, Zachrison K, Singhal A, Yan Z, Oliveira-Filho J, Schwamm L. Outcomes of recurrent stroke in patients with atrial fibrillation according to presumed etiology. Arquivos De Neuro-Psiquiatria 2023, 81: 616-623. PMID: 37336506, PMCID: PMC10371407, DOI: 10.1055/s-0043-1769124.Peer-Reviewed Original ResearchConceptsUndetermined stroke etiologyAtrial fibrillationRecurrent strokeStroke etiologyAF patientsFavorable outcomeAcademic comprehensive stroke centerHealth Stroke Scale scoreMedian National InstitutesSingle-center sampleComprehensive stroke centerRecurrent ischemic strokeStroke Scale scoreHistory of strokePotent risk factorDifferent treatment strategiesHospital mortalitySecondary prophylaxisReperfusion therapyCardioembolic strokeIschemic strokeStroke centersDischarge outcomesRisk factorsTreatment strategiesTenecteplase versus alteplase in acute ischaemic cerebrovascular events (TRACE-2): a phase 3, multicentre, open-label, randomised controlled, non-inferiority trial
Wang Y, Li S, Pan Y, Li H, Parsons M, Campbell B, Schwamm L, Fisher M, Che F, Dai H, Li D, Li R, Wang J, Wang Y, Zhao X, Li Z, Zheng H, Xiong Y, Meng X, Investigators T, Li R, Wang D, Wang Y, Chen S, Deng D, Zhang H, Wang J, Chen H, Zhang H, Wu Y, Liu H, Lu G, Zhao L, Zhu R, Liu Y, Yi F, Gao J, Dai H, Hao J, Che F, Cai X, Duan Z, Yu H, Wei T, Tang Y, Peng Z, Zhang B, Song Y, Chen X, Liu Y, Liu J, Li D, Zhao W, Wei X, Xue Q, Liu X, Yang Y, zhao C, Chen J, Sui Y, Sheng G, Zhang Y, Liu J, Zhang L, Wang W, Guo Z, Li H, Hu R, Chen G, Liang Z, Chen J, Xia L, Long Z. Tenecteplase versus alteplase in acute ischaemic cerebrovascular events (TRACE-2): a phase 3, multicentre, open-label, randomised controlled, non-inferiority trial. The Lancet 2023, 401: 645-654. PMID: 36774935, DOI: 10.1016/s0140-6736(22)02600-9.Peer-Reviewed Original ResearchConceptsSymptomatic intracranial hemorrhageAcute ischemic strokeAlteplase groupTenecteplase groupNon-inferiority marginNon-inferiority trialIschemic strokeModified intentionTreat populationEndovascular thrombectomyIntracranial hemorrhageRisk ratioScale scoreAcute ischemic cerebrovascular eventsHealth Stroke Scale scoreMedical Sciences (CAMS) Innovation FundStandard intravenous thrombolysisIschemic cerebrovascular eventsPrimary efficacy outcomePrimary safety outcomeStroke Scale scoreRankin Scale scoreProportion of participantsIntravenous tenecteplaseIntravenous thrombolysis
2022
Sex Differences in Endovascular Therapy for Ischemic Stroke: Results From the Get With The Guidelines–Stroke Registry
Demel S, Reeves M, Xu H, Xian Y, Mac Grory B, Fonarow G, Matsouaka R, Smith E, Saver J, Schwamm L. Sex Differences in Endovascular Therapy for Ischemic Stroke: Results From the Get With The Guidelines–Stroke Registry. Stroke 2022, 53: 3099-3106. PMID: 35880521, DOI: 10.1161/strokeaha.122.038491.Peer-Reviewed Original ResearchConceptsEndovascular therapyIschemic strokeHealth Stroke Scale scoreTreatment ratesGuidelines-Stroke hospitalsGuidelines-Stroke registryStroke Scale scoreAcute ischemic strokeSex differencesLarge vessel occlusionMultivariable regression analysisIschemic stroke dischargesEVT useHospital deathHospital mortalityASA guidelinesVessel occlusionOdds ratioScale scoreStroke dischargesSignificant sex differencesWomenNational InstituteMenStatistical adjustmentTrends in Use, Outcomes, and Disparities in Endovascular Thrombectomy in US Patients With Stroke Aged 80 Years and Older Compared With Younger Patients
Adcock A, Schwamm L, Smith E, Fonarow G, Reeves M, Xu H, Matsouaka R, Xian Y, Saver J. Trends in Use, Outcomes, and Disparities in Endovascular Thrombectomy in US Patients With Stroke Aged 80 Years and Older Compared With Younger Patients. JAMA Network Open 2022, 5: e2215869. PMID: 35671055, PMCID: PMC9175073, DOI: 10.1001/jamanetworkopen.2022.15869.Peer-Reviewed Original ResearchConceptsSymptomatic intracranial hemorrhageAcute ischemic strokeYounger patientsHospital mortalityCohort studyIschemic strokeOlder patientsIntracranial hemorrhageAmerican Heart Association/American Stroke AssociationFunctional independenceHealth Stroke Scale scoreSymptomatic intracranial hemorrhage rateNationwide retrospective cohort studyGuidelines-Stroke programGWTG-Stroke hospitalsIntracranial hemorrhage rateStroke Scale scoreFavorable functional outcomeRetrospective cohort studyAmerican Stroke AssociationQuality improvement registryMeeting study criteriaEVT rateEVT useThrombectomy trialsAssociation Between Endovascular Therapy Time to Treatment and Outcomes in Patients With Basilar Artery Occlusion
Joundi R, Sun J, Xian Y, Alhanti B, Nogueira R, Bhatt D, Fonarow G, Saver J, Schwamm L, Smith E. Association Between Endovascular Therapy Time to Treatment and Outcomes in Patients With Basilar Artery Occlusion. Circulation 2022, 145: 896-905. PMID: 35050693, DOI: 10.1161/circulationaha.121.056554.Peer-Reviewed Original ResearchConceptsBasilar artery occlusionSymptomatic intracranial hemorrhageEndovascular therapySymptom onsetEVT timesHospital mortalityArtery occlusionMedian onsetIntracranial hemorrhageBetter outcomesHealth Stroke Scale scoreIndividual-level patient dataMedian National InstitutesStroke Scale scoreHospital-level factorsProportion of patientsLogistic regression modelsSubstantial reperfusionAnterior circulationPrimary outcomeUS registryMean ageDevastating conditionImproved outcomesTherapy time
2021
Thrombolysis in Mild Stroke
Asdaghi N, Romano J, Gardener H, Campo-Bustillo I, Purdon B, Khan Y, Gulati D, Broderick J, Schwamm L, Smith E, Saver J, Sacco R, Khatri P. Thrombolysis in Mild Stroke. Stroke 2021, 52: e586-e589. PMID: 34496619, DOI: 10.1161/strokeaha.120.033466.Peer-Reviewed Original ResearchConceptsNIHSS scoreClinical practiceHealth Stroke Scale scoreMild ischemic stroke patientsMedian NIHSS scoreTrial of thrombolysisStroke Scale scoreIschemic stroke patientsProportion of patientsBroad clinical practiceRoutine clinical practiceSyndromic severityTrial cohortStroke patientsMild strokeMild patientsNeurological syndromeAlteplasePatientsScale scoreLess severityMaRISSComparable deficitsNational InstituteSeverity'Drip-and-ship' intravenous thrombolysis and outcomes for large vessel occlusion thrombectomy candidates in a hub-and-spoke telestroke model
Regenhardt R, Rosenthal J, Awad A, Martinez-Gutierrez J, Nolan N, McIntyre J, Whitney C, Alotaibi N, Dmytriw A, Vranic J, Stapleton C, Patel A, Rost N, Schwamm L, Leslie-Mazwi T. 'Drip-and-ship' intravenous thrombolysis and outcomes for large vessel occlusion thrombectomy candidates in a hub-and-spoke telestroke model. Journal Of NeuroInterventional Surgery 2021, 14: 650-653. PMID: 34326197, PMCID: PMC8799754, DOI: 10.1136/neurintsurg-2021-017819.Peer-Reviewed Original ResearchConceptsEndovascular thrombectomyIntravenous thrombolysisIntracerebral hemorrhageDay mRSEVT candidatesFunctional independenceHealth Stroke Scale scoreEmergent large vessel occlusionRisk of ICHMedian National InstitutesStroke Scale scoreLarge vessel occlusionOutcomes of interestAlteplase useDischarge mRSTelestroke modelThrombectomy candidatesEligible patientsIntravenous alteplaseTICI 2bAdequate reperfusionMedian ageSpoke hospitalsCT scoreVessel occlusionCTA Protocols in a Telestroke Network Improve Efficiency for Both Spoke and Hub Hospitals
Yu A, Regenhardt R, Whitney C, Schwamm L, Patel A, Stapleton C, Viswanathan A, Hirsch J, Lev M, Leslie-Mazwi T. CTA Protocols in a Telestroke Network Improve Efficiency for Both Spoke and Hub Hospitals. American Journal Of Neuroradiology 2021, 42: 435-440. PMID: 33541900, PMCID: PMC7959422, DOI: 10.3174/ajnr.a6950.Peer-Reviewed Original ResearchConceptsEndovascular thrombectomySpoke hospitalsTelestroke networkHub hospitalCTA protocolHealth Stroke Scale scoreEmergent large vessel occlusionStroke Scale scoreRate of patientsLarge vessel occlusionCTA utilizationThrombectomy ratesStroke triageThrombectomyNonsignificant increasePatientsScale scoreHospitalTriage processNational InstituteOverall rateCTAExtended windowHigher numberRetention ratePatterns of antidepressant therapy and clinical outcomes among ischaemic stroke survivors
Etherton M, Shah S, Haolin X, Xian Y, Maisch L, Hannah D, Lindholm B, Lytle B, Thomas L, Smith E, Fonarow G, Schwamm L, Bhatt D, Hernandez A, O'Brien E. Patterns of antidepressant therapy and clinical outcomes among ischaemic stroke survivors. Stroke And Vascular Neurology 2021, 6: 384-394. PMID: 33526632, PMCID: PMC8485250, DOI: 10.1136/svn-2020-000691.Peer-Reviewed Original ResearchConceptsAntidepressant medicationIschemic strokeCause mortalityClinical outcomesOutcome measuresAD useHealth Stroke Scale scoreHigher admission National InstitutesMajor adverse cardiac eventsAdmission National InstitutesGuidelines-Stroke hospitalsPrior ischemic strokeAdverse cardiac eventsIschemic stroke survivorsStroke Scale scorePoor prognostic signPoor clinical outcomeLogistic regression modelsFalsification endpointsAntidepressant therapyCause readmissionNaïve patientsCardiac eventsPoststroke depressionStroke severity
2019
Clinical Effectiveness of Direct Oral Anticoagulants vs Warfarin in Older Patients With Atrial Fibrillation and Ischemic Stroke
Xian Y, Xu H, O’Brien E, Shah S, Thomas L, Pencina M, Fonarow G, Olson D, Schwamm L, Bhatt D, Smith E, Hannah D, Maisch L, Lytle B, Peterson E, Hernandez A. Clinical Effectiveness of Direct Oral Anticoagulants vs Warfarin in Older Patients With Atrial Fibrillation and Ischemic Stroke. JAMA Neurology 2019, 76: 1192-1202. PMID: 31329212, PMCID: PMC6647003, DOI: 10.1001/jamaneurol.2019.2099.Peer-Reviewed Original ResearchDirect oral anticoagulantsAcute ischemic strokeMajor adverse cardiovascular eventsAdverse cardiovascular eventsIschemic strokeLong-term outcomesAtrial fibrillationCardiovascular eventsOral anticoagulantsClinical effectivenessHigh riskHealth Stroke Scale scoreBetter long-term outcomesFirst year postdischargeStroke Scale scorePatient-centered outcomesPatient-centered measuresDOAC useGuidelines-StrokeCardiovascular readmissionCause readmissionGastrointestinal bleedingStroke preventionWarfarin prescriptionBaseline characteristicsFrequency of early rapid improvement in stroke severity during interfacility transfer.
Zachrison K, Leslie-Mazwi T, Boulouis G, Goldstein J, Regenhardt R, Viswanathan A, Lauer A, Siddiqui K, Charidimou A, Rost N, Schwamm L. Frequency of early rapid improvement in stroke severity during interfacility transfer. Neurology Clinical Practice 2019, 9: 373-380. PMID: 31750022, PMCID: PMC6814428, DOI: 10.1212/cpj.0000000000000667.Peer-Reviewed Original ResearchNIHSS scoreInterfacility transferMedian initial NIHSS scoreNIH Stroke Scale scoreHigher initial NIHSSInitial NIHSS scoreNIHSS score changeStroke Scale scoreRapid improvementCSC arrivalInitial NIHSSIndex strokeStroke severityPatient characteristicsMedian changeMultivariable modelingScale scoreScore changeLogistic regressionStrokePatientsScores
2018
Rates, Characteristics, and Outcomes of Patients Transferred to Specialized Stroke Centers for Advanced Care
Ali S, Fonarow G, Liang L, Xian Y, Smith E, Bhatt D, Schwamm L. Rates, Characteristics, and Outcomes of Patients Transferred to Specialized Stroke Centers for Advanced Care. Circulation Cardiovascular Quality And Outcomes 2018, 11: e003359. PMID: 30354551, DOI: 10.1161/circoutcomes.116.003359.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overCentralized Hospital ServicesDisability EvaluationFemaleHealthcare DisparitiesHospital MortalityHumansMaleMiddle AgedPatient AdmissionPatient TransferRecovery of FunctionRegistriesRetrospective StudiesRisk AssessmentRisk FactorsStrokeTime FactorsTime-to-TreatmentTreatment OutcomeUnited StatesConceptsSpecialized stroke centersStroke centersHospital mortalityAIS casesPrevious stroke/transient ischemic attackStroke/transient ischemic attackHealth Stroke Scale scoreHigher median National InstitutesWorse short-term outcomesAcute ischemic stroke careGuidelines-Stroke registryMedian National InstitutesOutcomes of patientsStroke Scale scoreTransient ischemic attackShort-term outcomesIschemic stroke careTransfer of patientsMidwest teaching hospitalInstitutional mortality ratesIschemic attackMultivariable adjustmentBaseline characteristicsRankin ScaleClinical outcomesSafety and Efficacy of a 3-Dimensional Stent Retriever With Aspiration-Based Thrombectomy vs Aspiration-Based Thrombectomy Alone in Acute Ischemic Stroke Intervention: A Randomized Clinical Trial
Nogueira R, Frei D, Kirmani J, Zaidat O, Lopes D, Turk A, Heck D, Mason B, Haussen D, Levy E, Mehta S, Lazzaro M, Chen M, Dörfler A, Yoo A, Derdeyn C, Schwamm L, Langer D, Siddiqui A. Safety and Efficacy of a 3-Dimensional Stent Retriever With Aspiration-Based Thrombectomy vs Aspiration-Based Thrombectomy Alone in Acute Ischemic Stroke Intervention: A Randomized Clinical Trial. JAMA Neurology 2018, 75: 304-311. PMID: 29296999, PMCID: PMC5885851, DOI: 10.1001/jamaneurol.2017.3967.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeSerious adverse eventsProcedure-related serious adverse eventsStent retrieverMechanical thrombectomy devicesAspiration groupAdverse eventsEnd pointClinical trialsThrombectomy devicesLarge vessel acute ischemic strokeDevice-related serious adverse eventsScale scoreHealth Stroke Scale scoreMedian baseline NIHSS scorePrimary effectiveness end pointPrimary safety end pointAcute ischemic stroke interventionCerebral infarction (TICI) gradeEffectiveness end pointBaseline NIHSS scorePrimary end pointSafety end pointStroke Scale scoreHours of onset
2017
Ischemic Stroke Profile, Risk Factors, and Outcomes in India
Sylaja P, Pandian J, Kaul S, Srivastava M, Khurana D, Schwamm L, Kesav P, Arora D, Pannu A, Thankachan T, Singhal A. Ischemic Stroke Profile, Risk Factors, and Outcomes in India. Stroke 2017, 49: 219-222. PMID: 29167386, PMCID: PMC5742046, DOI: 10.1161/strokeaha.117.018700.Peer-Reviewed Original ResearchConceptsAdmission National InstitutesHealth Stroke ScaleStroke ScaleIschemic strokeDiabetes mellitusRisk factorsHealth Stroke Scale scoreLower admission National InstitutesMedian admission National InstitutesNational InstituteRankin Scale score 0Stroke etiologic subtypesIntra-arterial thrombolysisStroke Scale scoreAcademic tertiary hospitalCommon risk factorsMagnetic resonance imagingHospital mortalityEtiologic subtypesStroke careStroke ProjectTertiary hospitalAtrial fibrillationStroke guidelinesMean ageIncrease in Endovascular Therapy in Get With The Guidelines-Stroke After the Publication of Pivotal Trials
Smith E, Saver J, Cox M, Liang L, Matsouaka R, Xian Y, Bhatt D, Fonarow G, Schwamm L. Increase in Endovascular Therapy in Get With The Guidelines-Stroke After the Publication of Pivotal Trials. Circulation 2017, 136: 2303-2310. PMID: 28982689, DOI: 10.1161/circulationaha.117.031097.Peer-Reviewed Original ResearchConceptsEndovascular thrombectomyEVT useEligible patientsIschemic strokePivotal trialsCase volumeStroke systemsHealth Stroke Scale scoreGuidelines-Stroke programStroke Scale scoreMean case volumeGuidelines-StrokeEndovascular therapyMore patientsPatient eligibilityPatientsClinical practiceScale scoreHospitalStrokeTrialsNational InstituteStroke durationLinear regressionThrombectomyIncorporating Stroke Severity Into Hospital Measures of 30-Day Mortality After Ischemic Stroke Hospitalization
Schwartz J, Wang Y, Qin L, Schwamm LH, Fonarow GC, Cormier N, Dorsey K, McNamara RL, Suter LG, Krumholz HM, Bernheim SM. Incorporating Stroke Severity Into Hospital Measures of 30-Day Mortality After Ischemic Stroke Hospitalization. Stroke 2017, 48: 3101-3107. PMID: 28954922, DOI: 10.1161/strokeaha.117.017960.Peer-Reviewed Original ResearchConceptsRisk-standardized mortality ratesElectronic health record dataHealth record dataStroke severityClaims dataMortality rateAmerican Heart Association/American Stroke AssociationHealth Stroke Scale scoreRisk variablesMedicaid ServicesRisk adjustmentMedian risk-standardized mortality rateGuidelines-Stroke registryLow-mortality hospitalsStroke Scale scoreAcute ischemic strokeAmerican Stroke AssociationOdds of mortalityMortality measuresRecord dataIschemic stroke hospitalizationsHigh-mortality hospitalsService claims dataRisk-adjustment variablesHospital admissionRecrudescence of Deficits After Stroke: Clinical and Imaging Phenotype, Triggers, and Risk Factors
Topcuoglu M, Saka E, Silverman S, Schwamm L, Singhal A. Recrudescence of Deficits After Stroke: Clinical and Imaging Phenotype, Triggers, and Risk Factors. JAMA Neurology 2017, 74: 1048-1055. PMID: 28783808, PMCID: PMC5710180, DOI: 10.1001/jamaneurol.2017.1668.Peer-Reviewed Original ResearchConceptsTransient ischemic attackRisk factorsIschemic attackChronic strokeMean ageDiagnostic criteriaPSR groupHealth Stroke Scale scoreIntravenous tissue plasminogen activatorMiddle cerebral artery territoryResearch Patient Data RepositoryCrossover cohort studyHypertensive brain hemorrhagePatients' mean ageStroke Scale scoreFocal neurologic deficitsSmall vessel diseaseCase-control studyPreliminary diagnostic criteriaTissue plasminogen activatorStroke-related deficitsMagnetic resonance imagingWhite matter tractsDiffusion-weighted imagingPatient data repository
2016
Why are acute ischemic stroke patients not receiving IV tPA?
Messé S, Khatri P, Reeves M, Smith E, Saver J, Bhatt D, Grau-Sepulveda M, Cox M, Peterson E, Fonarow G, Schwamm L. Why are acute ischemic stroke patients not receiving IV tPA? Neurology 2016, 87: 1565-1574. PMID: 27629092, PMCID: PMC5067546, DOI: 10.1212/wnl.0000000000003198.Peer-Reviewed Original ResearchMeSH KeywordsAdministration, IntravenousAgedAged, 80 and overBrain IschemiaDatasets as TopicFemaleFibrinolytic AgentsHealthcare DisparitiesHumansLogistic ModelsMaleMultivariate AnalysisRegistriesRetrospective StudiesSeverity of Illness IndexStrokeThrombolytic TherapyTissue Plasminogen ActivatorUnited StatesConceptsAcute ischemic strokeTissue plasminogen activatorHours of onsetEligible patientsAcute ischemic stroke patientsNIH Stroke Scale scoreStroke center certificationRetrospective cohort studyStroke Scale scoreIschemic stroke patientsEarlier calendar yearsEquation logistic regressionProsthetic heart valvesEmergency medical servicesGuidelines-StrokePrior strokeCohort studyIschemic strokeOlder patientsStroke onsetStroke severityDiabetes mellitusCenter HospitalStroke patientsAtrial fibrillation
2015
Treatment and Outcome of Thrombolysis-Related Hemorrhage: A Multicenter Retrospective Study
Yaghi S, Boehme A, Dibu J, Guerrero C, Ali S, Martin-Schild S, Sands K, Noorian A, Blum C, Chaudhary S, Schwamm L, Liebeskind D, Marshall R, Willey J. Treatment and Outcome of Thrombolysis-Related Hemorrhage: A Multicenter Retrospective Study. JAMA Neurology 2015, 72: 1-7. PMID: 26501741, PMCID: PMC4845894, DOI: 10.1001/jamaneurol.2015.2371.Peer-Reviewed Original ResearchConceptsSymptomatic intracerebral hemorrhageRecombinant tissue plasminogen activatorMulticenter retrospective studyHematoma expansionHospital mortalityMedian timeRetrospective studyIntravenous recombinant tissue plasminogen activatorHealth Stroke Scale scoreParenchymal hematoma type 2Code status changeOutcome of thrombolysisStroke-Monitoring StudyComprehensive stroke centerHospital mortality rateOutcomes of patientsStroke Scale scoreTissue plasminogen activatorIschemic strokePrimary outcomeRtPA therapySecondary outcomesStroke centersSymptom onsetIntracerebral hemorrhage