2023
Hospital‐Level Variability in Reporting of Ischemic Stroke Subtypes and Supporting Diagnostic Evaluation in GWTG‐Stroke Registry
Mullen M, Gurol M, Prabhakaran S, Messé S, Kleindorfer D, Smith E, Fonarow G, Xu H, Zhao X, Cigarroa J, Schwamm L. Hospital‐Level Variability in Reporting of Ischemic Stroke Subtypes and Supporting Diagnostic Evaluation in GWTG‐Stroke Registry. Journal Of The American Heart Association 2023, 12: e031303. PMID: 38108258, PMCID: PMC10863791, DOI: 10.1161/jaha.123.031303.Peer-Reviewed Original ResearchConceptsHospital-level variabilityDiagnostic evaluationIschemic strokeDiagnostic testingStroke pathogenesisCryptogenic strokeSecondary preventionEtiologic subtypesRisk factorsLarge nationwide registryIschemic stroke subtypesLong-term cardiac rhythm monitoringCardiac rhythm monitoringAdequate diagnostic evaluationIntracranial vascular imagingEvidence-based interventionsNationwide registryStroke subtypesIS subtypesDocumentation ratesRhythm monitoringPatientsCardiac monitoringSubtypesStroke
2019
Ischaemic stroke
Campbell B, De Silva D, Macleod M, Coutts S, Schwamm L, Davis S, Donnan G. Ischaemic stroke. Nature Reviews Disease Primers 2019, 5: 70. PMID: 31601801, DOI: 10.1038/s41572-019-0118-8.Peer-Reviewed Original ResearchMeSH KeywordsBrain IschemiaComputed Tomography AngiographyHumansMagnetic Resonance ImagingStrokeThrombolytic TherapyTomography, X-Ray ComputedTreatment OutcomeConceptsIschemic strokeIntravenous thrombolysisEndovascular thrombectomyStroke onsetSevere symptomatic carotid artery stenosisSymptomatic carotid artery stenosisSalvageable brain tissueBlood pressure controlCardiovascular risk managementLarge vessel occlusionMajority of strokesMechanism of strokeOnset of strokeCarotid artery stenosisCause of disabilitySecond highest causeSystems of careAntithrombotic medicationRapid reperfusionReperfusion therapySecondary preventionStroke symptomsArterial occlusionArtery stenosisCarotid endarterectomy
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 ResearchMeSH KeywordsAdultAgedBrain IschemiaDiabetes MellitusDisease-Free SurvivalFemaleHumansHypertensionIndiaMaleMiddle AgedStrokeSurvival RateTobacco UseTomography, X-Ray ComputedUnited StatesConceptsAdmission 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 ageMultiparametric Magnetic Resonance Imaging for Prediction of Parenchymal Hemorrhage in Acute Ischemic Stroke After Reperfusion Therapy
Nael K, Knitter J, Jahan R, Gornbein J, Ajani Z, Feng L, Meyer B, Schwamm L, Yoo A, Marshall R, Meyers P, Yavagal D, Wintermark M, Liebeskind D, Guzy J, Starkman S, Saver J, Kidwell C. Multiparametric Magnetic Resonance Imaging for Prediction of Parenchymal Hemorrhage in Acute Ischemic Stroke After Reperfusion Therapy. Stroke 2017, 48: 664-670. PMID: 28138001, PMCID: PMC5325250, DOI: 10.1161/strokeaha.116.014343.Peer-Reviewed Original ResearchConceptsCerebral blood volumeAcute ischemic strokeParenchymal hemorrhageReperfusion therapyIschemic strokeReceiver-operating characteristic curve analysisApparent diffusion coefficientMultiparametric magnetic resonance imagingPretreatment magnetic resonanceMagnetic resonance perfusionValues of CBVCharacteristic curve analysisApparent diffusion coefficient (ADC) valuesMagnetic resonance imagingIndependent predictorsIschemic coreRisk stratificationUnivariate analysisClinical trialsMicrovascular permeabilityBlood volumeInfarction corePatientsResonance imagingDiagnostic accuracy
2014
Improving Door-to-Needle Times
Ruff I, Ali S, Goldstein J, Lev M, Copen W, McIntyre J, Rost N, Schwamm L. Improving Door-to-Needle Times. Stroke 2014, 45: 504-508. PMID: 24399372, DOI: 10.1161/strokeaha.113.004073.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overClinical ProtocolsComorbidityData Interpretation, StatisticalEarly DiagnosisEmergency Medical ServicesFemaleFibrinolytic AgentsHumansInternational Classification of DiseasesMaleMiddle AgedProspective StudiesQuality ImprovementRetrospective StudiesSocioeconomic FactorsStrokeThrombolytic TherapyTissue Plasminogen ActivatorTomography, X-Ray ComputedTreatment OutcomeConceptsIntravenous tissue-type plasminogen activatorEmergency department arrivalTissue-type plasminogen activatorAcute strokeDTN timeNeedle timeHealth Stroke Scale scorePlasminogen activatorAcute ischemic strokePercentage of patientsStroke Scale scoreAmerican Heart AssociationStroke care modelWilcoxon signed-rank testImproving DoorIschemic strokeStroke guidelinesHeart AssociationPostintervention periodSigned-rank testPre interventionCare modelNational guidelinesPost interventionPatients
2013
Variable Selection and Prediction Using a Nested, Matched Case-Control Study: Application to Hospital Acquired Pneumonia in Stroke Patients
Qian J, Payabvash S, Kemmling A, Lev MH, Schwamm LH, Betensky RA. Variable Selection and Prediction Using a Nested, Matched Case-Control Study: Application to Hospital Acquired Pneumonia in Stroke Patients. Biometrics 2013, 70: 153-163. PMID: 24320930, PMCID: PMC3954429, DOI: 10.1111/biom.12113.Peer-Reviewed Original ResearchConceptsMassachusetts General HospitalCase-control studyStroke patientsAcute ischemic stroke patientsBrain regionsMatched Case-Control StudyHospital-Acquired PneumoniaIschemic stroke patientsLarge prospective studiesUnconditional logistic regressionCase-control designSpecific brain regionsAcquired PneumoniaAcute infarctionClinical featuresProspective studyClinical variablesGeneral HospitalEpidemiologic studiesPatientsModern imagingLarger studyLogistic regressionAppropriate statistical analysisHAP studiesHospital Acquired Pneumonia Is Linked to Right Hemispheric Peri-Insular Stroke
Kemmling A, Lev MH, Payabvash S, Betensky RA, Qian J, Masrur S, Schwamm LH. Hospital Acquired Pneumonia Is Linked to Right Hemispheric Peri-Insular Stroke. PLOS ONE 2013, 8: e71141. PMID: 23951094, PMCID: PMC3737185, DOI: 10.1371/journal.pone.0071141.Peer-Reviewed Original ResearchConceptsHemispheric infarctsBrain regionsConsecutive acute stroke patientsConditional logistic regression modelsHospital-Acquired PneumoniaRight hemispheric infarctAcute stroke patientsInsular cortex volumeVolume-based variablesSpecific brain regionsLogistic regression modelsAcquired PneumoniaControl patientsMajor complicationsBrainstem strokeImmune suppressionInfarct sizeStroke patientsAutonomic modulationClinical variablesAdmission imagingInfarct locationUnivariate analysisImmune mechanismsCortex volumeA Trial of Imaging Selection and Endovascular Treatment for Ischemic Stroke
Kidwell C, Jahan R, Gornbein J, Alger J, Nenov V, Ajani Z, Feng L, Meyer B, Olson S, Schwamm L, Yoo A, Marshall R, Meyers P, Yavagal D, Wintermark M, Guzy J, Starkman S, Saver J. A Trial of Imaging Selection and Endovascular Treatment for Ischemic Stroke. New England Journal Of Medicine 2013, 368: 914-923. PMID: 23394476, PMCID: PMC3690785, DOI: 10.1056/nejmoa1212793.Peer-Reviewed Original ResearchConceptsFavorable penumbral patternAcute ischemic strokeStandard carePenumbral patternIschemic strokeRankin ScaleNinety-day mortalitySymptomatic intracranial hemorrhageAnterior circulation strokeModified Rankin ScaleMagnetic resonance imagingEligible patientsEmbolectomy groupMechanical embolectomyEndovascular thrombectomyEndovascular therapySuch patientsClinical outcomesEndovascular treatmentIntracranial hemorrhageMean ageImaging selectionImaging patternsEmbolectomyPatients
2012
Elderly Patients Are at Higher Risk for Poor Outcomes After Intra-Arterial Therapy
Chandra R, Leslie-Mazwi T, Oh D, Chaudhry Z, Mehta B, Rost N, Rabinov J, Hirsch J, González R, Schwamm L, Yoo A. Elderly Patients Are at Higher Risk for Poor Outcomes After Intra-Arterial Therapy. Stroke 2012, 43: 2356-2361. PMID: 22744644, DOI: 10.1161/strokeaha.112.650713.Peer-Reviewed Original ResearchMeSH KeywordsAge FactorsAgedAged, 80 and overAngioplasty, BalloonCerebral InfarctionCohort StudiesEndovascular ProceduresEndpoint DeterminationFemaleFibrinolytic AgentsHumansInjections, Intra-ArterialMagnetic Resonance ImagingMaleMiddle AgedProspective StudiesReperfusionRiskStentsStrokeThrombolytic TherapyTissue Plasminogen ActivatorTomography, X-Ray ComputedTreatment OutcomeConceptsIntra-arterial therapyParenchymal hematoma type 2Elderly patientsBaseline disabilityClinical outcomesBaseline healthType 2Cerebral infarction 2Worse baseline healthElderly stroke patientsRankin Scale scoreWorse clinical outcomesCoronary artery diseaseAngiographic reperfusionBaseline demographicsStroke severityArtery diseaseStroke patientsAtrial fibrillationPoor outcomeSignificant hemorrhageHigh riskReperfusionPatientsBetter outcomesEconomic Impact of Using Additional Diagnostic Tests to Better Select Patients With Stroke for Intravenous Thrombolysis in the United Kingdom
Earnshaw S, McDade C, Chapman A, Jackson D, Schwamm L. Economic Impact of Using Additional Diagnostic Tests to Better Select Patients With Stroke for Intravenous Thrombolysis in the United Kingdom. Clinical Therapeutics 2012, 34: 1544-1558. PMID: 22695225, DOI: 10.1016/j.clinthera.2012.05.004.Peer-Reviewed Original ResearchConceptsMagnetic resonance imagingMRI selectionUsual careDiagnostic testsFavorable outcomeIncremental cost-effectiveness ratioAcute stroke treatmentPreferred diagnostic testNumber of patientsAdditional diagnostic testsCost-effectiveness ratioDecision analytic modelCTP selectionIntravenous thrombolysisStroke onsetStroke treatmentPatient selectionUK patientsPenumbral patternPatient outcomesPerfusion CTPatient historyThrombolysisPatientsPerfusion imagingPredictors of Rapid Brain Imaging in Acute Stroke
Kelly A, Hellkamp A, Olson D, Smith E, Schwamm L. Predictors of Rapid Brain Imaging in Acute Stroke. Stroke 2012, 43: 1279-1284. PMID: 22442169, DOI: 10.1161/strokeaha.111.626374.Peer-Reviewed Original ResearchMeSH KeywordsAge FactorsAgedDiabetes MellitusEmergency Service, HospitalFemaleFibrinolytic AgentsGuideline AdherenceHumansMagnetic Resonance ImagingMaleMultivariate AnalysisNeuroimagingPractice Guidelines as TopicRacial GroupsRetrospective StudiesSex FactorsStrokeThrombolytic TherapyTime FactorsTissue Plasminogen ActivatorTomography, X-Ray ComputedConceptsEmergency department arrivalBrain imagingSymptom onsetHealth Stroke Scale scoreFuture quality improvement initiativesGuidelines-Stroke programStroke Scale scoreStroke symptom onsetAcute stroke symptomsHistory of diabetesPeripheral vascular diseaseMultivariable logistic regressionQuality improvement initiativesEffectiveness of thrombolysisOverall imaging rateProsthetic heart valvesPredictive variablesAcute strokeMost patientsHospital clusteringIndependent predictorsStroke symptomsNonwhite raceEmergency departmentVascular diseaseInfarct Volume Is a Pivotal Biomarker After Intra-Arterial Stroke Therapy
Yoo A, Chaudhry Z, Nogueira R, Lev M, Schaefer P, Schwamm L, Hirsch J, González R. Infarct Volume Is a Pivotal Biomarker After Intra-Arterial Stroke Therapy. Stroke 2012, 43: 1323-1330. PMID: 22426317, DOI: 10.1161/strokeaha.111.639401.Peer-Reviewed Original ResearchMeSH KeywordsAge FactorsAgedAged, 80 and overBiomarkersBrain InfarctionCohort StudiesDatabases, FactualFemaleFibrinolytic AgentsHumansInfusions, IntravenousMagnetic Resonance ImagingMaleMiddle AgedNeuroimagingPredictive Value of TestsProspective StudiesRetrospective StudiesStrokeThrombolytic TherapyTissue Plasminogen ActivatorTomography, X-Ray ComputedTreatment OutcomeConceptsFinal infarct volumeIntra-arterial therapyAcute ischemic strokeInfarct volumeFunctional outcomeBetter outcomesIschemic strokePoor outcomeAnterior circulation acute ischemic strokeScale scoreHealth Stroke Scale scoreMedian admission National InstitutesMedian final infarct volumesLong-term functional outcomeIntra-arterial stroke therapyAdmission National InstitutesProximal artery occlusionStroke Scale scoreOnly independent predictorRankin Scale scoreArtery occlusionProspective cohortRankin ScaleIndependent predictorsClinical outcomes
2010
LICORICE-ASSOCIATED REVERSIBLE CEREBRAL VASOCONSTRICTION WITH PRES(CME)
Chatterjee N, Domoto-Reilly K, Fecci P, Schwamm L, Singhal A. LICORICE-ASSOCIATED REVERSIBLE CEREBRAL VASOCONSTRICTION WITH PRES(CME). Neurology 2010, 75: 1939-1941. PMID: 21098410, PMCID: PMC2995386, DOI: 10.1212/wnl.0b013e3181feb299.Peer-Reviewed Original ResearchAdministration, OralBrainCerebral AngiographyCerebrovascular CirculationCerebrovascular DisordersFemaleGlycyrrhizaHeadache Disorders, PrimaryHumansHydrocortisoneHypertensionMagnetic Resonance ImagingMiddle AgedNimodipinePosterior Leukoencephalopathy SyndromeSeizuresTomography, X-Ray ComputedTreatment OutcomeVasoconstrictionVasodilator AgentsVerapamilVision DisordersCost-Effectiveness of CT Perfusion for Selecting Patients for Intravenous Thrombolysis: A US Hospital Perspective
Jackson D, Earnshaw S, Farkouh R, Schwamm L. Cost-Effectiveness of CT Perfusion for Selecting Patients for Intravenous Thrombolysis: A US Hospital Perspective. American Journal Of Neuroradiology 2010, 31: 1669-1674. PMID: 20538823, PMCID: PMC7965001, DOI: 10.3174/ajnr.a2138.Peer-Reviewed Original ResearchConceptsHospital perspectiveUnenhanced CTExtent of penumbraLife-year savedUS hospital perspectiveAcute stroke evaluationSelection of patientsCT-based methodClinical trial dataDecision analytic modelCTP selectionIntravenous thrombolysisIschemic strokeClinical outcomesStroke evaluationPatient populationCT perfusionFavorable outcomeRoutine CTClinical trialsPatientsTrial dataMultivariate sensitivity analysisHospitalTPA treatment
2009
False Positive CT Angiography in Brain Death
Greer DM, Strozyk D, Schwamm LH. False Positive CT Angiography in Brain Death. Neurocritical Care 2009, 11: 272-275. PMID: 19390993, DOI: 10.1007/s12028-009-9220-1.Peer-Reviewed Original ResearchMeSH KeywordsAdultBrain DeathBrain EdemaCerebral AngiographyCerebrovascular CirculationCircle of WillisDiagnosis, DifferentialElectroencephalographyFalse Positive ReactionsFemaleHeart ArrestHumansTechnetium Tc 99m ExametazimeTomography, Emission-Computed, Single-PhotonTomography, X-Ray ComputedUltrasonography, Doppler, TranscranialConceptsCerebral circulatory arrestBrain criteriaCirculatory arrestBrain deathPositive CT angiographyCerebral blood flowSingle photon emissionTranscranial DopplerNewer testsClinical examinationTomographic angiographyConventional angiographyCT angiographyBlood flowAncillary testsEase of performanceAngiographyDetermination of deathGold standardConfirmatory testDeathPhoton emissionAcceptable testArrestPatientsCost-Effectiveness of Patient Selection Using Penumbral-Based MRI for Intravenous Thrombolysis
Earnshaw S, Jackson D, Farkouh R, Schwamm L. Cost-Effectiveness of Patient Selection Using Penumbral-Based MRI for Intravenous Thrombolysis. Stroke 2009, 40: 1710-1720. PMID: 19286581, DOI: 10.1161/strokeaha.108.540138.Peer-Reviewed Original ResearchMeSH KeywordsAgedAlgorithmsCerebral HemorrhageCost-Benefit AnalysisDecision Support TechniquesFemaleFibrinolytic AgentsHumansImage Processing, Computer-AssistedInfusions, IntravenousMagnetic Resonance ImagingMalePatient SelectionProportional Hazards ModelsQuality-Adjusted Life YearsStrokeThrombolytic TherapyTomography, X-Ray ComputedTreatment OutcomeConceptsMRI selectionExistence of the Diffusion-Perfusion Mismatch within 24 Hours after Onset of Acute Stroke: Dependence on Proximal Arterial Occlusion
Copen W, Rezai Gharai L, Barak E, Schwamm L, Wu O, Kamalian S, Gonzalez R, Schaefer P. Existence of the Diffusion-Perfusion Mismatch within 24 Hours after Onset of Acute Stroke: Dependence on Proximal Arterial Occlusion. Radiology 2009, 250: 878-86. PMID: 19164120, DOI: 10.1148/radiol.2503080811.Peer-Reviewed Original ResearchConceptsProximal arterial occlusionAcute ischemic stroke trialsIschemic stroke trialsAcute strokeArterial occlusionStroke trialsLesion volumePerfusion-weighted magnetic resonance imagesDiffusion-perfusion mismatchMean transit time mapsTransit time mapsHIPAA-compliant studyPAO patientsAngiographic evidenceStroke onsetDose escalationTomographic angiographyEligibility criteriaPatientsInstitutional reviewMagnetic resonance imagesMR angiographyDesmoteplaseSignificant differencesAngiography
2008
Intravenous desmoteplase in patients with acute ischaemic stroke selected by MRI perfusion–diffusion weighted imaging or perfusion CT (DIAS-2): a prospective, randomised, double-blind, placebo-controlled study
Hacke W, Furlan A, Al-Rawi Y, Davalos A, Fiebach J, Gruber F, Kaste M, Lipka L, Pedraza S, Ringleb P, Rowley H, Schneider D, Schwamm L, Leal J, Söhngen M, Teal P, Wilhelm-Ogunbiyi K, Wintermark M, Warach S. Intravenous desmoteplase in patients with acute ischaemic stroke selected by MRI perfusion–diffusion weighted imaging or perfusion CT (DIAS-2): a prospective, randomised, double-blind, placebo-controlled study. The Lancet Neurology 2008, 8: 141-150. PMID: 19097942, PMCID: PMC2730486, DOI: 10.1016/s1474-4422(08)70267-9.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overBrain IschemiaCerebral HemorrhageDouble-Blind MethodFemaleFibrinolytic AgentsHumansInjections, IntravenousMagnetic Resonance ImagingMaleMiddle AgedPerfusionPlasminogen ActivatorsProspective StudiesSample SizeStrokeTomography, X-Ray ComputedTreatment FailureYoung AdultConceptsSymptomatic intracranial hemorrhageClinical response rateAcute ischemic strokeDiffusion-weighted imagingResponse rateNIHSS scoreIschemic strokeIntracranial hemorrhageLesion volumeDay 90Mortality ratePerfusion imagingScale scoreHealth Stroke Scale scoreMedian baseline NIHSS scoreModified Rankin Scale scoreMagnetic resonance perfusion imagingComposite of improvementBaseline NIHSS scorePlacebo-controlled studyStroke Scale scoreDose-ranging studyRankin Scale scoreSymptoms of strokeOnset of strokeQuantitative Assessment of Core/Penumbra Mismatch in Acute Stroke
Schaefer P, Barak E, Kamalian S, Gharai L, Schwamm L, Gonzalez R, Lev M. Quantitative Assessment of Core/Penumbra Mismatch in Acute Stroke. Stroke 2008, 39: 2986-2992. PMID: 18723425, DOI: 10.1161/strokeaha.107.513358.Peer-Reviewed Original ResearchConceptsCT perfusionPatient selectionInfarct coreAcute middle cerebral artery strokeMiddle cerebral artery strokePreferred imaging methodStroke clinical trialsAcute strokeArtery strokeStroke trialsTrial enrollmentClinical trialsLesion volumeMR perfusionIschemic regionBlood volumeTime abnormalitiesVolume thresholdLesion sizeQuantitative CTPerfusionAdvanced MRCT coverageLesionsMR diffusionRole of Recanalization in Acute Stroke Outcome: Rationale for a CT Angiogram-Based “Benefit of Recanalization” Model
Rosenthal E, Schwamm L, Roccatagliata L, Coutts S, Demchuk A, Schaefer P, Gonzalez R, Hill M, Halpern E, Lev M. Role of Recanalization in Acute Stroke Outcome: Rationale for a CT Angiogram-Based “Benefit of Recanalization” Model. American Journal Of Neuroradiology 2008, 29: 1471-1475. PMID: 18599577, PMCID: PMC8119059, DOI: 10.3174/ajnr.a1153.Peer-Reviewed Original ResearchConceptsOnly independent predictorLesion volumeComplete recanalizationRecanalization statusClinical outcomesNIHSS scoreIndependent predictorsIncomplete recanalizationCTA-SI Alberta Stroke Program Early CT ScoreAcute middle cerebral artery strokeAlberta Stroke Program Early CT ScoreHealth Stroke Scale scoreMedian admission NIHSS scoreMiddle cerebral artery strokeCT angiographic source imagesAcute stroke outcomeAdmission National InstitutesBenefit of recanalizationEarly successful recanalizationMCA M1 occlusionRole of recanalizationStroke Scale scoreAdmission NIHSS scoreMRS score 0CT/CTA