2022
Outcomes After Endovascular Thrombectomy With or Without Alteplase in Routine Clinical Practice
Smith E, Zerna C, Solomon N, Matsouaka R, Mac Grory B, Saver J, Hill M, Fonarow G, Schwamm L, Messé S, Xian Y. Outcomes After Endovascular Thrombectomy With or Without Alteplase in Routine Clinical Practice. JAMA Neurology 2022, 79: 768-776. PMID: 35696198, PMCID: PMC9194745, DOI: 10.1001/jamaneurol.2022.1413.Peer-Reviewed Original ResearchConceptsSymptomatic intracranial hemorrhageAcute ischemic strokeEndovascular thrombectomyObservational cohort studyRoutine clinical practiceAlteplase treatmentIschemic strokeIntravenous alteplaseCohort studyDischarge destinationPrespecified outcomesHigh riskClinical practiceCerebral Infarction grade 2bHealth Stroke Severity scoreCerebral infarction (TICI) gradeIntravenous alteplase treatmentLarge nationwide registryStroke severity scoresRandomized clinical trialsEmergency medical servicesGood reperfusionGuidelines-StrokeHospital strokeCertain comorbidities
2019
DEFUSE 3 Non-DAWN Patients
Leslie-Mazwi T, Hamilton S, Mlynash M, Patel A, Schwamm L, Lansberg M, Marks M, Hirsch J, Albers G. DEFUSE 3 Non-DAWN Patients. Stroke 2019, 50: 618-625. PMID: 30727856, PMCID: PMC6768068, DOI: 10.1161/strokeaha.118.023310.Peer-Reviewed Original ResearchConceptsRankin Scale scoreNIHSS 6DEFUSE 3Functional outcomeInfarct volumeLarger patientsDAWN criteriaScale scoreEmergent large vessel occlusionRankin Scale score 0DEFUSE 3 patientsEffect of thrombectomyHealth Stroke ScaleLarge vessel occlusionBenefit of thrombectomyCore infarct volumeBeneficial treatment effectMethods Eligibility criteriaNIHSS scoreStroke ScaleConclusions PatientsEndovascular therapySymptom onsetDAWN trialVessel occlusion
2017
Clinical Imaging Factors Associated With Infarct Progression in Patients With Ischemic Stroke During Transfer for Mechanical Thrombectomy
Boulouis G, Lauer A, Siddiqui A, Charidimou A, Regenhardt R, Viswanathan A, Rost N, Leslie-Mazwi T, Schwamm L. Clinical Imaging Factors Associated With Infarct Progression in Patients With Ischemic Stroke During Transfer for Mechanical Thrombectomy. JAMA Neurology 2017, 74: 1361-1367. PMID: 28973081, PMCID: PMC5710581, DOI: 10.1001/jamaneurol.2017.2149.Peer-Reviewed Original ResearchConceptsThrombectomy-capable stroke centersCollateral blood flowIschemic strokeInfarct progressionMechanical thrombectomyCT angiographyMAIN OUTCOMEVessel statusBlood flowImaging factorsHigher adjusted odds ratioVascular imagingFavorable imaging profileHealth Stroke ScoreAcute ischemic strokeHigher National InstitutesAdjusted odds ratioRegional stroke networkStroke care networksStroke centersStroke ScoreConsecutive patientsStroke NetworkClinical severityFutile transfers
2014
Combining MRI with NIHSS Thresholds to Predict Outcome in Acute Ischemic Stroke: Value for Patient Selection
Schaefer P, Pulli B, Copen W, Hirsch J, Leslie-Mazwi T, Schwamm L, Wu O, González R, Yoo A. Combining MRI with NIHSS Thresholds to Predict Outcome in Acute Ischemic Stroke: Value for Patient Selection. American Journal Of Neuroradiology 2014, 36: 259-264. PMID: 25258369, PMCID: PMC4462135, DOI: 10.3174/ajnr.a4103.Peer-Reviewed Original ResearchMeSH KeywordsAgedBrainBrain IschemiaCerebral InfarctionDiffusion Magnetic Resonance ImagingFemaleHumansImage Processing, Computer-AssistedMaleMiddle AgedNational Institutes of Health (U.S.)Patient SelectionPrognosisReperfusionROC CurveSensitivity and SpecificitySeverity of Illness IndexStrokeUnited StatesConceptsPositive predictive valueAcute ischemic strokeLarge patient cohortReperfusion therapyPoor outcomeStroke sidePredictive valueNIHSS scoreIschemic strokeClinical outcomesPatient cohortPrognostic yieldAnterior circulation acute ischemic strokeAcute ischemic stroke patientsImaging thresholdsBeneficial treatment responseDiffusion-perfusion mismatchHigh positive predictive valueIschemic stroke patientsRight-sided strokeLeft-sided strokeUntreated patientsStroke onsetConsecutive patientsPatient selectionDevelopment and Initial Testing of the Stroke Rapid-Treatment Readiness Tool
Olson D, Cox M, Constable M, Britz G, Lin C, Zimmer L, Fonarow G, Schwamm L, Peterson E. Development and Initial Testing of the Stroke Rapid-Treatment Readiness Tool. Journal Of Neuroscience Nursing 2014, 46: 267-273. PMID: 25099063, PMCID: PMC4165480, DOI: 10.1097/jnn.0000000000000082.Peer-Reviewed Original ResearchConceptsIntravenous tissue plasminogen activatorTissue plasminogen activatorPlasminogen activatorQuality Improvement ProgramGuidelines-StrokeEligible patientsHospital arrivalIschemic strokeNeedle timeHealth systemU.S. hospitalsHospitalReadiness ToolInitial testingLikert scale surveyPatientsActivatorImprovement programsStrokeAdministration
2013
Hospital 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 volume
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 outcomesM. D. Hammer et al.
Hammer M, Schwamm L, Starkman S, Schellinger P, Jovin T, Nogueira R, Burgin W, Sen S, Diener H, Watson T, Michel P, Shuaib A, Dillon W, Liebeskind D. M. D. Hammer et al. International Journal Of Stroke 2012, 7: 655-661. PMID: 22264202, PMCID: PMC4157918, DOI: 10.1111/j.1747-4949.2011.00719.x.Peer-Reviewed Original ResearchConceptsIschemic stroke patientsSymptom onsetPartial aortic occlusionStroke patientsAortic occlusionIntracranial hemorrhageEight hoursInternational academic medical centersAsymptomatic intracranial hemorrhageLower baseline NIHSSSymptomatic intracranial hemorrhageFavorable neurological outcomeHealth Stroke ScalePerfusion-diffusion mismatchSingle-arm trialAcademic medical centerMagnetic resonance imagingBaseline NIHSSNeurological outcomeParenchymal hematomaStroke ScaleAdverse eventsSecondary outcomesStroke severityAcute treatment
2006
Neuroanatomic correlates of stroke-related myocardial injury
Ay H, Koroshetz W, Benner T, Vangel M, Melinosky C, Arsava E, Ayata C, Zhu M, Schwamm L, Sorensen A. Neuroanatomic correlates of stroke-related myocardial injury. Neurology 2006, 66: 1325-1329. PMID: 16525122, DOI: 10.1212/01.wnl.0000206077.13705.6d.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBiomarkersBrain IschemiaCardiomyopathiesCase-Control StudiesCerebral CortexCerebral InfarctionDiffusion Magnetic Resonance ImagingFemaleHumansInfarction, Middle Cerebral ArteryMaleMiddle AgedMyocardial InfarctionMyocardiumNecrosisParietal LobeSingle-Blind MethodSympathetic Nervous SystemTroponin TConceptsCTnT elevationMyocardial injuryIschemic strokeRight middle cerebral artery infarctionSerum cardiac troponin T levelsCardiac troponin T elevationBrain regionsMiddle cerebral artery infarctionCardiac troponin T levelsPrimary cardiac causeTroponin T elevationAcute ischemic strokeTroponin T levelsCerebral artery infarctionCoronary artery diseaseSex-matched patientsRight inferior parietal lobuleSpecific brain regionsInferior parietal lobuleFrequency of rightBrain infarctionCardiac causesInfarction volumeSymptom onsetArtery diseaseFirst-pass quantitative CT perfusion identifies thresholds for salvageable penumbra in acute stroke patients treated with intra-arterial therapy.
Schaefer P, Roccatagliata L, Ledezma C, Hoh B, Schwamm L, Koroshetz W, Gonzalez R, Lev M. First-pass quantitative CT perfusion identifies thresholds for salvageable penumbra in acute stroke patients treated with intra-arterial therapy. American Journal Of Neuroradiology 2006, 27: 20-5. PMID: 16418350, PMCID: PMC7976067.Peer-Reviewed Original ResearchConceptsCerebral blood volumeAcute stroke patientsCT perfusionStroke patientsCBF ratioGray matterWhite matterAbsolute cerebral blood volumeCBV ratioIntra-arterial therapyIschemic brain tissueQuantitative CT perfusionDynamic CT perfusionIA therapyRecanalization therapyStroke onsetSalvageable penumbraInfarct coreIschemic tissueUninvolved regionsIschemic regionBlood volumeCBF valuesPatientsBrain tissue
2005
Hypoattenuation on CT angiographic source images predicts risk of intracerebral hemorrhage and outcome after intra-arterial reperfusion therapy.
Schwamm L, Rosenthal E, Swap C, Rosand J, Rordorf G, Buonanno F, Vangel M, Koroshetz W, Lev M. Hypoattenuation on CT angiographic source images predicts risk of intracerebral hemorrhage and outcome after intra-arterial reperfusion therapy. American Journal Of Neuroradiology 2005, 26: 1798-803. PMID: 16091532, PMCID: PMC7975152.Peer-Reviewed Original ResearchMeSH KeywordsAgedArterial Occlusive DiseasesBasilar ArteryCerebral AngiographyCerebral HemorrhageCerebral InfarctionFemaleFibrinolytic AgentsHematomaHumansMaleMiddle AgedMiddle Cerebral ArteryPredictive Value of TestsRetrospective StudiesRisk AssessmentTissue Plasminogen ActivatorTomography, X-Ray ComputedConceptsIntra-arterial reperfusion therapyHemorrhagic transformationPoor clinical outcomeCTA source imagesReperfusion therapyClinical outcomesCT angiographic source imagesCatheter-based reperfusionReal-time risk stratificationSymptomatic hemorrhagic transformationReceiver operator characteristic curveBlood glucose levelsOperator characteristic curveAxial source imagesNormal contralateral tissueConsecutive patientsVascular insufficiencyIntracerebral hemorrhageRisk stratificationStroke patientsPoor outcomeSignificant complicationsRisk factorsContralateral tissueLesion volumeTransient ischemic attack with infarction: A unique syndrome?
Ay H, Koroshetz W, Benner T, Vangel M, Wu O, Schwamm L, Sorensen A. Transient ischemic attack with infarction: A unique syndrome? Annals Of Neurology 2005, 57: 679-686. PMID: 15852402, DOI: 10.1002/ana.20465.Peer-Reviewed Original ResearchMeSH KeywordsAgedBrainCerebral InfarctionEcho-Planar ImagingFemaleHumansIschemic Attack, TransientMagnetic Resonance ImagingMalePhenotypePrognosisSyndromeConceptsTransient ischemic attackIschemic strokeIschemic attackSymptom durationDistinct prognostic featuresSeparate clinical syndromesRecurrent ischemic strokeMinor ischemic strokeUnderwent diffusion-weighted imagingDiffusion-weighted imagingInfarct volumeConsecutive patientsTIA ratePrognostic featuresTransient symptomsBrain syndromeClinical syndromeUnique syndromeInfarctionPatientsStrokeSyndromeSymptomsDurationInfarcts
2004
Case 5-2004 — A 57-Year-Old Man with Slurred Speech and Left Hemiparesis
Cabot R, Harris N, Shepard J, Ebeling S, Ellender S, Peters C, Carter B, Rabinov J, Pfannl R, Schwamm L. Case 5-2004 — A 57-Year-Old Man with Slurred Speech and Left Hemiparesis. New England Journal Of Medicine 2004, 350: 707-716. PMID: 14960747, DOI: 10.1056/nejmcpc030037.Peer-Reviewed Original Research
2003
Whole-Brain CT Perfusion Measurement of Perfused Cerebral Blood Volume in Acute Ischemic Stroke: Probability Curve for Regional Infarction
Hunter G, Silvennoinen H, Hamberg L, Koroshetz W, Buonanno F, Schwamm L, Rordorf G, Gonzalez R. Whole-Brain CT Perfusion Measurement of Perfused Cerebral Blood Volume in Acute Ischemic Stroke: Probability Curve for Regional Infarction. Radiology 2003, 227: 725-30. PMID: 12728181, DOI: 10.1148/radiol.2273012169.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeCerebral blood volumeIschemic strokeBlood volumeMajor arterial occlusionLikelihood of infarctionLogistic regression analysisPositive predictive valueCT perfusion measurementsAcute strokeCerebral infarctionArterial occlusionIntracranial hemorrhagePerfusion scanCore infarctionPCBVInfarctionPositive followProbability of survivalRegional infarctionPredictive valuePatientsStrokePerfusion measurementsRegression analysis
2002
‘Footprints’ of Transient Ischemic Attacks: A Diffusion-Weighted MRI Study
Ay H, Oliveira-Filho J, Buonanno F, Schaefer P, Furie K, Chang Y, Rordorf G, Schwamm L, Gonzalez R, Koroshetz W. ‘Footprints’ of Transient Ischemic Attacks: A Diffusion-Weighted MRI Study. Cerebrovascular Diseases 2002, 14: 177-186. PMID: 12403950, DOI: 10.1159/000065682.Peer-Reviewed Original ResearchConceptsTransient ischemic attackFast fluid attenuated inversion recoveryDiffusion-weighted imagingIschemic attackDWI lesionsFocal neurologic symptomsHalf of patientsDiffusion-weighted MRI studiesFluid attenuated inversion recoveryAttenuated inversion recoveryBrain infarctionClinical characteristicsNeurologic symptomsConsecutive patientsIndependent predictorsIschemic injuryMotor symptomsRecent infarctionCerebrovascular abnormalitiesClinical syndromeVascular territoriesStroke mechanismMRI studiesPatientsInfarctionPredicting cerebral ischemic infarct volume with diffusion and perfusion MR imaging.
Schaefer P, Hunter G, He J, Hamberg L, Sorensen A, Schwamm L, Koroshetz W, Gonzalez R. Predicting cerebral ischemic infarct volume with diffusion and perfusion MR imaging. American Journal Of Neuroradiology 2002, 23: 1785-94. PMID: 12427640, PMCID: PMC8185825.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAged, 80 and overBlood Flow VelocityBrain IschemiaCerebral InfarctionCerebrovascular CirculationDiffusion Magnetic Resonance ImagingFalse Positive ReactionsFemaleFollow-Up StudiesHumansIschemic Attack, TransientMagnetic Resonance AngiographyMaleMiddle AgedObserver VariationPredictive Value of TestsSensitivity and SpecificityTime FactorsConceptsCerebral blood flowCerebral blood volumeFinal infarct volumeInfarct volumeDW imagingLesion growthAcute ischemic stroke symptomsHemodynamic imagesAcute ischemic infarctionIschemic infarct volumeInitial clinical assessmentFinal discharge diagnosisFinal infarct sizeHours of onsetIschemic stroke symptomsPerfusion MR imagingPerfusion-weighted imagesAcute strokeIschemic infarctionStroke symptomsAcute infarctionAcute lesionsDischarge diagnosisInfarct sizeAltered perfusion
2001
Utility of Perfusion-Weighted CT Imaging in Acute Middle Cerebral Artery Stroke Treated With Intra-Arterial Thrombolysis:
Lev M, Segal A, Farkas J, Hossain S, Putman C, Hunter G, Budzik R, Harris G, Buonanno F, Ezzeddine M, Chang Y, Koroshetz W, Gonzalez R, Schwamm L. Utility of Perfusion-Weighted CT Imaging in Acute Middle Cerebral Artery Stroke Treated With Intra-Arterial Thrombolysis:. Stroke 2001, 32: 2021-2028. PMID: 11546891, DOI: 10.1161/hs0901.095680.Peer-Reviewed Original ResearchConceptsFinal infarct volumeAcute middle cerebral artery strokeNIH Stroke Scale scoreMiddle cerebral artery strokeMCA stem occlusionIntra-arterial thrombolysisStroke Scale scoreComplete recanalizationClinical outcomesInfarct volumeLesion volumeArtery strokeOutcome groupAdmission NIH Stroke Scale scoreInitial NIH Stroke Scale scoreScale scoreEarly complete recanalizationFinal lesion volumeUtility of perfusionPoor outcome groupModified Rankin ScalePoor clinical outcomeRankin ScaleStroke onsetConsecutive patients
1999
Diffusion-Weighted Imaging Identifies a Subset of Lacunar Infarction Associated With Embolic Source
Ay H, Oliveira-Filho J, Buonanno F, Ezzeddine M, Schaefer P, Rordorf G, Schwamm L, Gonzalez R, Koroshetz W. Diffusion-Weighted Imaging Identifies a Subset of Lacunar Infarction Associated With Embolic Source. Stroke 1999, 30: 2644-2650. PMID: 10582991, DOI: 10.1161/01.str.30.12.2644.Peer-Reviewed Original ResearchConceptsLacunar syndromeSmall infarctsIdentifiable causeClinical syndromeCareful pathological studyClassic lacunar syndromeDWI hyperintense lesionsSingle lacunar infarctionBrain stem lesionsDay of admissionDistinct clinical syndromeDiffusion-weighted imagingMultiple infarctionsEmbolic mechanismEmbolic sourceArtery territoryClinical characteristicsLacunar infarctionSecondary preventionConsecutive patientsAcute lesionsIndex lesionSuch infarctsEmergency roomPathological studies
1998
Regional Ischemia and Ischemic Injury in Patients With Acute Middle Cerebral Artery Stroke as Defined by Early Diffusion-Weighted and Perfusion-Weighted MRI
Rordorf G, Koroshetz W, Copen W, Cramer S, Schaefer P, Budzik R, Schwamm L, Buonanno F, Sorensen A, Gonzalez G. Regional Ischemia and Ischemic Injury in Patients With Acute Middle Cerebral Artery Stroke as Defined by Early Diffusion-Weighted and Perfusion-Weighted MRI. Stroke 1998, 29: 939-943. PMID: 9596239, DOI: 10.1161/01.str.29.5.939.Peer-Reviewed Original ResearchMeSH KeywordsAcute DiseaseAdultAgedAged, 80 and overArterial Occlusive DiseasesBrain IschemiaCerebral ArteriesCerebral InfarctionCerebrovascular CirculationCerebrovascular DisordersDiffusionFemaleHumansMagnetic Resonance AngiographyMagnetic Resonance ImagingMaleMiddle AgedPerfusionReperfusion InjuryConceptsPerfusion-weighted imagingMiddle cerebral artery strokeDiffusion-weighted imagingCerebral blood volumeMCA strokeArtery strokeMR angiographyCBV abnormalityRegional ischemiaAcute middle cerebral artery strokeInitial diffusion-weighted imagingAcute stroke syndromeDistal branch occlusionDWI lesion volumeInitial DWI lesionMCA stem occlusionGroup 2 patientsMRI techniquesFinal infarct sizeFinal infarct volumeHours of onsetIntravenous contrast bolusAbnormal tissue perfusionProgression of infarctionPerfusion-Weighted MRI
1997
Diffusion-weighted imaging discriminates between cytotoxic and vasogenic edema in a patient with eclampsia.
Schaefer P, Buonanno F, Gonzalez R, Schwamm L. Diffusion-weighted imaging discriminates between cytotoxic and vasogenic edema in a patient with eclampsia. Stroke 1997, 28: 1082-5. PMID: 9158653, DOI: 10.1161/01.str.28.5.1082.Peer-Reviewed Original ResearchConceptsT2 hyperintense signal abnormalityDiffusion-weighted imagingHyperintense signal abnormalitiesVasogenic edemaSignal abnormalitiesRoutine MRIMajority of patientsPermanent neurological impairmentReversible neurological deficitsSubcortical white matterAdjacent gray matterDifferent treatment protocolsPathophysiology of eclampsiaEcho-planar diffusion-weighted imagingEclamptic patientsIschemic encephalopathyNeurological deficitsPosterior predominancePatient groupDiffusion-weighted imagesCytotoxic edemaNeurological impairmentPremature twinsTreatment protocolEdema