2024
Endovascular thrombectomy versus medical management for patients with large vessel stroke and infective endocarditis
Chen H, Colasurdo M, Khunte M, Malhotra A, Gandhi D. Endovascular thrombectomy versus medical management for patients with large vessel stroke and infective endocarditis. Journal Of NeuroInterventional Surgery 2024, jnis-2024-022374. PMID: 39317440, DOI: 10.1136/jnis-2024-022374.Peer-Reviewed Original ResearchEfficacy of endovascular thrombectomyLarge vessel occlusionInfective endocarditisPropensity score matchingIntracerebral hemorrhageSubarachnoid hemorrhageMedical managementMultivariable adjustmentOdds of intracerebral hemorrhageEndovascular thrombectomyHome dischargeRate of intracerebral hemorrhageFavorable hospital outcomesRate of in-hospital deathAssociated with significantly higher oddsLarge vessel occlusion strokeIn-hospital mortalityRoutine home dischargeIn-hospital deathRate of subarachnoid hemorrhageRate of home dischargeSignificantly higher oddsRate of routine dischargePrimary outcomeSecondary outcomesDeep learning for prediction of post-thrombectomy outcomes based on admission CT angiography in large vessel occlusion stroke
Sommer J, Dierksen F, Zeevi T, Tran A, Avery E, Mak A, Malhotra A, Matouk C, Falcone G, Torres-Lopez V, Aneja S, Duncan J, Sansing L, Sheth K, Payabvash S. Deep learning for prediction of post-thrombectomy outcomes based on admission CT angiography in large vessel occlusion stroke. Frontiers In Artificial Intelligence 2024, 7: 1369702. PMID: 39149161, PMCID: PMC11324606, DOI: 10.3389/frai.2024.1369702.Peer-Reviewed Original ResearchEnd-to-endComputed tomography angiographyLarge vessel occlusionConvolutional neural networkDeep learning pipelineTrain separate modelsLogistic regression modelsResNet-50Deep learningAdmission computed tomography angiographyNeural networkLearning pipelineAdmission CT angiographyPreprocessing stepDiagnosis of large vessel occlusionsLarge vessel occlusion strokeReceiver operating characteristic areaEnsemble modelAutomated modelPre-existing morbidityCT angiographyReperfusion successNeurological examCross-validationOcclusion strokeAutomated 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 cohortRadiomics-Based Prediction of Collateral Status from CT Angiography of Patients Following a Large Vessel Occlusion Stroke
Avery E, Abou-Karam A, Abi-Fadel S, Behland J, Mak A, Haider S, Zeevi T, Sanelli P, Filippi C, Malhotra A, Matouk C, Falcone G, Petersen N, Sansing L, Sheth K, Payabvash S. Radiomics-Based Prediction of Collateral Status from CT Angiography of Patients Following a Large Vessel Occlusion Stroke. Diagnostics 2024, 14: 485. PMID: 38472957, PMCID: PMC10930945, DOI: 10.3390/diagnostics14050485.Peer-Reviewed Original ResearchCollateral statusCollateral scoreLarge vessel occlusionAcute LVO strokeRadiomics modelTest cohortCT angiography of patientsAdmission computed tomography angiographyAnterior circulation territoryAngiography of patientsLong-term outcomesReceiver operating characteristic areaRadiomics-based predictionCollateral arterial circulationOperating characteristics areaAdmission CTACirculation territoryCT angiographyClinical outcomesRadiomic featuresTreatment triageOcclusion strokeVessel occlusionPatientsArterial circulationTime-driven activity-based costing (TDABC) of direct-to-angiography pathway for acute ischemic stroke patients with suspected large vessel occlusion
Sangha K, White T, Boltyenkov A, Bastani M, Sanmartin M, Katz J, Malhotra A, Rula E, Naidich J, Sanelli P. Time-driven activity-based costing (TDABC) of direct-to-angiography pathway for acute ischemic stroke patients with suspected large vessel occlusion. Journal Of Stroke And Cerebrovascular Diseases 2024, 33: 107516. PMID: 38183964, DOI: 10.1016/j.jstrokecerebrovasdis.2023.107516.Peer-Reviewed Original ResearchAcute ischemic strokeEndovascular treatmentAcute ischemic stroke patientsAppropriate patient selection criteriaNovel care pathwayIschemic stroke patientsLarge vessel occlusionPatient selection criteriaInstitutional patient databaseTime-driven activity-based costingEligible patientsAnterior circulationIschemic strokeClinical outcomesPatient factorsStroke patientsAIS patientsVessel occlusionCare pathwayPatient costsMain cost driversPatientsPatient databaseAngiography suiteCT pathway
2023
Clinical criteria to exclude acute vascular pathology on CT angiogram in patients with dizziness
Tu L, Malhotra A, Venkatesh A, Taylor R, Sheth K, Yaesoubi R, Forman H, Sureshanand S, Navaratnam D. Clinical criteria to exclude acute vascular pathology on CT angiogram in patients with dizziness. PLOS ONE 2023, 18: e0280752. PMID: 36893103, PMCID: PMC9997874, DOI: 10.1371/journal.pone.0280752.Peer-Reviewed Original ResearchConceptsAcute vascular pathologyEmergency departmentVascular pathologyNegative predictive valueDizzy patientsStroke codeCTA headPredictive valueAdult ED encountersTransient ischemic attackHalf of patientsLong-term smokersLarge vessel occlusionCoronary artery diseasePast medical historySeparate validation cohortCross-sectional analysisIschemic attackAnalysis cohortArterial dissectionArtery diseaseClinical factorsED encountersMedication useChief complaintLetter to the Editor Re “Endovascular thrombectomy or bridging therapy in minor ischemic stroke with large vessel occlusion”
Malhotra A, Khunte M, Wu X, Radmard M. Letter to the Editor Re “Endovascular thrombectomy or bridging therapy in minor ischemic stroke with large vessel occlusion”. Thrombosis Research 2023, 232: 145. PMID: 36739257, DOI: 10.1016/j.thromres.2023.01.008.Peer-Reviewed Original Research
2022
Letter to the editor re “Minor stroke in large vessel occlusion: A matched analysis of patients from the German Stroke Registry—Endovascular Treatment and patients from the Safe Implementation of Treatments in Stroke—International Stroke Thrombolysis Register”
Malhotra A, Khunte M, Wu X, Radmard M. Letter to the editor re “Minor stroke in large vessel occlusion: A matched analysis of patients from the German Stroke Registry—Endovascular Treatment and patients from the Safe Implementation of Treatments in Stroke—International Stroke Thrombolysis Register”. European Journal Of Neurology 2022, 30: 290-291. PMID: 36260371, DOI: 10.1111/ene.15598.Commentaries, Editorials and Letters
2020
Effects 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 imagingImplications of achieving TICI 2b vs TICI 3 reperfusion in patients with ischemic stroke: a cost-effectiveness analysis
Wu X, Khunte M, Gandhi D, Matouk C, Hughes DR, Sanelli P, Malhotra A. Implications of achieving TICI 2b vs TICI 3 reperfusion in patients with ischemic stroke: a cost-effectiveness analysis. Journal Of NeuroInterventional Surgery 2020, 12: 1161-1165. PMID: 32457225, DOI: 10.1136/neurintsurg-2020-015873.Peer-Reviewed Original ResearchConceptsQuality-adjusted life yearsLarge vessel occlusionTICI 3 reperfusionEndovascular thrombectomyTICI 2bTICI 3Stroke patientsHealth benefitsAge groupsAcute stroke patientsDegree of recanalizationDegree of reperfusionLifetime quality-adjusted life yearsCost-effectiveness analysisDecision analytic studyUnited States settingsIncomplete reperfusionIschemic strokeComplete reperfusionPatient selectionReperfusionPatientsHealth outcomesLife yearsCost savingsCT Angiography for Triage of Patients with Acute Minor Stroke: A Cost-effectiveness Analysis.
Wu X, Hughes DR, Gandhi D, Matouk CC, Sheth K, Schindler J, Wira C, Wintermark M, Sanelli P, Malhotra A. CT Angiography for Triage of Patients with Acute Minor Stroke: A Cost-effectiveness Analysis. Radiology 2020, 294: 580-588. PMID: 31934828, DOI: 10.1148/radiol.2019191238.Peer-Reviewed Original ResearchConceptsLarge vessel occlusionAcute minor strokeBest medical managementMinor strokeCT angiographyMedical managementProbabilistic sensitivity analysesLower health benefitsImmediate thrombectomyHealth benefitsHealth outcomesVascular imagingAcute ischemic strokeMarkov decision-analytic modelWorse health outcomesImproved health outcomesDecision analytic modelNet monetary benefitIntravenous thrombolysisIschemic strokeYounger patientsThrombectomy strategyPatientsAngiographyStroke
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