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Moving Toward Elucidating Alternative Motor Pathway Structures Post-Stroke: The Value Of Spinal Cord Neuroimaging, Ramiro Oquita, Victoria Cuello, Sarvani Uppati, Sravani Mannuru, Daniel Salinas, Michael R. Dobbs, Kelsey Potter-Baker

School of Medicine Publications and Presentations

Stroke results in varying levels of motor and sensory disability that have been linked to the neurodegeneration and neuroinflammation that occur in the infarct and peri-infarct regions within the brain. Specifically, previous research has identified a key role of the corticospinal tract in motor dysfunction and motor recovery post-stroke. Of note, neuroimaging studies have utilized magnetic resonance imaging (MRI) of the brain to describe the timeline of neurodegeneration of the corticospinal tract in tandem with motor function following a stroke. However, research has suggested that alternate motor pathways may also underlie disease progression and the degree of functional recovery post-stroke. …

Brain Artery Diameters And Risk Of Dementia And Stroke, Jesus D. Melgarejo, Kursat Gurel, Cassidy Rose Compton, Minghua Liu, Vanessa Guzman, Stephanie Assuras, Bonnie E. Levin, Mitchell S. V. Elkind, M. Kamran Ikram, Maryam Kavousi

School of Medicine Publications and Presentations

Introduction: We tested the association of brain artery diameters with dementia and stroke risk in three distinct population-based studies using conventional T2-weighted brain magnetic resonance imaging (MRI) images.

Methods: We included 8420 adults > 40 years old from three longitudinal population-based studies with brain MRI scans. We estimated and meta-analyzed the hazard ratios (HRs) of the brain and carotids and basilar diameters associated with dementia and stroke.

Result: Overall and carotid artery diameters > 95th percentile increased the risk for dementia by 1.74 (95% confidence interval [CI], 1.13-2.68) and 1.48 (95% CI, 1.12-1.96) fold, respectively. For stroke, meta-analyses yielded HRs of 1.59 …

Time To Reperfusion Is Not Associated With Functional Outcomes In First‐Pass Reperfusion: Analysis Of The Stratis Registry, Nathan W. Manning, Ameer E. Hassan, David S. Liebeskind, Nils H. Mueller‐Kronast, Ashutosh P. Jadhav, Raul G. Nogueira, Dileep R. Yavagal, Andrew Cheung, Jason Wenderoth

School of Medicine Publications and Presentations

Background

Time is considered a fundamental driver of treatment success in ischemic stroke reperfusion therapy. First‐pass reperfusion (FPR) is associated with improved outcomes. We explored the association between time to reperfusion, FPR, and functional outcomes in an analysis of the STRATIS (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke) registry data.

Methods

Registry patients with anterior circulation stroke, treated with endovascular thrombectomy and achieving complete or near‐complete expanded Thrombolysis in Cerebral Infarction scale (eTICI) 2c/3 reperfusion per core laboratory assessment were included. FPR was considered eTICI 2c/3 reperfusion in a single device pass. Patients undergoing multipass …

Aspiration Thrombectomy Of M2 Middle Cerebral Artery Occlusion To Treat Acute Ischemic Stroke: A Core Lab–Adjudicated Subset Analysis From The Complete Registry And Literature Review, Johanna T. Fifi, Kurt Yaeger, Stavros Matsoukas, Ameer E. Hassan, Albert Yoo, Sunil A. Sheth, Osama O. Zaidat

School of Medicine Publications and Presentations

Background

Although the benefits of aspiration thrombectomy for treating acute ischemic stroke caused by proximal large vessel occlusion have been established, fewer data are available for evaluating aspiration thrombectomy of distal occlusion. The objective of this study was to evaluate, by means of prospectively collected data, the safety and efficacy of aspiration thrombectomy in patients with M2 middle cerebral artery (MCA) occlusion.

Methods

This study is a subset analysis of a global prospective multicenter observational registry that included patients who presented with either anterior or posterior large vessel occlusion and were eligible for mechanical thrombectomy using the Penumbra System including …

The Society Of Vascular And Interventional Neurology (Svin) Mechanical Thrombectomy Registry: Methods And Primary Results, Diogo C. Haussen, Alhamza R. Al-Bayati, Mahmoud H. Mohammaden, Sunil A. Sheth, Sergio Salazar-Marioni, Italo Linfante, Guilherme Dabus, Amy K. Starosciak, Ameer E. Hassan, Wondwossen G. Tekle

School of Medicine Publications and Presentations

Background

A better understanding of real‐world practice patterns in the endovascular treatment for large vessel occlusion acute ischemic stroke is needed. Here, we report the methods and initial results of the Society of Vascular and Interventional Neurology (SVIN) Registry.

Methods

The SVIN Registry is an ongoing prospective, multicenter, observational registry capturing patients with large vessel occlusion acute ischemic stroke undergoing endovascular treatment since November 2018. Participating sites also contributed pre‐SVIN Registry data collected per institutional prospective registries, and these data were combined with the SVIN Registry in the SVIN Registry+ cohort.

Results

There were 2088 patients treated across 11 US …

Endovascular Thrombectomy In Patients With Large Core Ischemic Stroke: A Cost-Effectiveness Analysis From The Select Study, Amrou Sarraj, Elena Pizzo, Kyriakos Lobotesis, James C. Grotta, Ameer E. Hassan, Michael G. Abraham, Spiros Blackburn, Arthur L. Day, Mark J. Dannenbaum, William Hicks

School of Medicine Publications and Presentations

Background It is unknown whether endovascular thrombectomy (EVT) is cost effective in large ischemic core infarcts.

Methods In the prospective, multicenter, cohort study of imaging selection study (SELECT), large core was defined as computed tomography (CT) ASPECTS(CTP) ischemic core volume (rCBF

Results From 361 patients enrolled in SELECT, 105 had large core on CT or CTP (EVT 62, MM 43). 19 (31%) EVT vs 6 (14%) MM patients achieved modified Rankin Scale (mRS) score 0–2 (OR 3.27, 95% CI 1.11 to 9.62, P=0.03) with a shift towards better mRS (cOR 2.12, 95% CI 1.05 to 4.31, P=0.04). Over the projected …

Utilization Of The Ballast Long Guiding Sheath For Neuroendovascular Procedures: Institutional Experience In 68 Cases, Ameer E. Hassan, Elizabeth M. Burke, Marlon Monayao, Wondwossen G. Tekle

School of Medicine Publications and Presentations

Background: The rise of neurointerventional devices has created a demand for guide systems capable of navigating to the carotid artery consistently regardless of tortuosity. The shift toward large distal access catheters (DACs) and desire for greater trackability have inspired the creation of flexible, supportive, large-lumen long guiding sheaths. Recently, the Ballast long guiding sheath was introduced to provide stability and flexibility while navigating neurointerventional devices through tortuous intracranial anatomy.

Objective: To report our experience using the Ballast long guiding sheath in a series of patients undergoing a variety of neuroendovascular procedures.

Methods: We retrospectively identified all patients who underwent neuroendovascular …

Endovascular Thrombectomy Time Metrics In The Era Of Covid-19: Observations From The Society Of Vascular And Interventional Neurology Multicenter Collaboration, Alexandra L. Czap, Alicia M. Zha, Jacob Sebaugh, Ameer E. Hassan

School of Medicine Publications and Presentations

Background Unprecedented workflow shifts during the coronavirus disease 2019 (COVID-19) pandemic have contributed to delays in acute care delivery, but whether it adversely affected endovascular thrombectomy metrics in acute large vessel occlusion (LVO) is unknown.

Methods We performed a retrospective review of observational data from 14 comprehensive stroke centers in nine US states with acute LVO. EVT metrics were compared between March to July 2019 against March to July 2020 (primary analysis), and between statespecific pre-peak and peak COVID-19 months (secondary analysis), with multivariable adjustment.

Results Of the 1364 patients included in the primary analysis (51% female, median NIHSS 14 …

Safety And Efficacy Of Balloon-Mounted Stent In The Treatment Of Symptomatic Intracranial Atherosclerotic Disease: A Multicenter Experience, Mahmoud H. Mohammaden, Raul G. Nogueira, Wondwossen G. Tekle, Santiago Ortega-Gutierrez, Mudassir Farooqui, Cynthia B. Zevallos, Ricardo Hanel, Gustavo M. Cortez, Amin Aghaebrahim, Ameer E. Hassan

School of Medicine Publications and Presentations

Background Randomized clinical trials have failed to prove that the safety and efficacy of endovascular treatment for symptomatic intracranial atherosclerotic disease (ICAD) is better than that of medical management. A recent study using a self-expandable stent showed acceptable lower rates of periprocedural complications.

Objective To study the safety and efficacy of a balloon-mounted stent (BMS) in the treatment of symptomatic ICAD.

Methods Prospectively maintained databases from 15 neuroendovascular centers between 2010 and 2020 were reviewed. Patients were included if they had severe symptomatic intracranial stenosis in the target artery, medical management had failed, and they underwent intracranial stenting with BMS …

Stroke Etiologies In Patients With Covid-19: The Svin Covid-19 Multinational Registry, María E. Ramos-Araque, James E. Siegler, Marc Ribo, Manuel Requena, Cristina López, Mercedes De Lera, Juan F. Arenillas, Isabel Hernández Pérez, Beatriz Gómez-Vicente, Ameer E. Hassan

School of Medicine Publications and Presentations

Background and purpose: Coronavirus disease 2019 (COVID-19) is associated with a small but clinically significant risk of stroke, the cause of which is frequently cryptogenic. In a large multinational cohort of consecutive COVID-19 patients with stroke, we evaluated clinical predictors of cryptogenic stroke, short-term functional outcomes and inhospital mortality among patients according to stroke etiology.

Methods: We explored clinical characteristics and short-term outcomes of consecutively evaluated patients 18 years of age or older with acute ischemic stroke (AIS) and laboratory-confirmed COVID-19 from 31 hospitals in 4 countries (3/1/20–6/16/20).

Results:Of the 14.483 laboratory-confirmed patients with COVID-19, 156 (1.1%) were diagnosed …

Effect Of Covid-19 Pandemic On Mechanical Thrombectomy For Acute Ischemic Stroke Treatment In United States, Adnan Qureshi, Farhan Siddiq, Brandi R. French, Camilo R. Gomez, Vishal Jani, Ameer E. Hassan, M.Fareed K. Suri

School of Medicine Publications and Presentations

There is accumulating data suggesting that the ischemic stroke may be increased in patients with corona virus disease 2019 (COVID-19) due to hyper coagulopathy. An increase in acute ischemic stroke patients who require mechanical thrombectomy is to be expected particularly in regions with high rates of COVID-19.

Stratifying Chronic Stroke Patients Based On The Influence Of Contralesional Motor Cortices: An Inter-Hemispheric Inhibition Study, Yin-Liang Lin, Kelsey A. Potter-Baker, David A. Cunningham, Manshi Li, Vishwanath Sankarasubramanian, John Lee, Stephen Jones, Ken Sakaie, Xiaofeng Wang, Andre G. Machado

School of Medicine Publications and Presentations

Objective:

A recent “bimodal-balance recovery” model suggests that contralesional influence varies based on the amount of ipsilesional reserve: inhibitory when there is a large reserve, but supportive when there is a low reserve. Here, we investigated the relationships between contralesional influence (inter-hemispheric inhibition, IHI) and ipsilesional reserve (corticospinal damage/impairment), and also defined a criterion separating subgroups based on the relationships.

Methods:

Twenty-four patients underwent assessment of IHI using Transcranial Magnetic Stimulation (ipsilateral silent period method), motor impairment using Upper Extremity Fugl-Meyer (UEFM), and corticospinal damage using Diffusion Tensor Imaging and active motor threshold. Assessments of UEFM and IHI were repeated …

Initial Experience With The Next-Generation Resolute Onyx Zotarolimus-Eluting Stent In Symptomatic Intracranial Atherosclerotic Disease, Ameer E. Hassan, Mahmoud H. Mohammaden, Rani R. Rabah, Wondwossen G. Tekle

School of Medicine Publications and Presentations

Background and Purpose: Intracranial atherosclerotic disease (ICAD) is a common cause of stroke worldwide. Although there are different endovascular options for the treatment of symptomatic ICAD (sICAD), it is still controversial. Herein, we aim to study the safety and efficacy of a new generation of drug-eluting balloon-mounted stent (DES); Resolute (R) onyx DES in the treatment of sICAD.

Methods:A prospectively maintained neuroendovascular procedures database in a high-volume comprehensive stroke center was reviewed from October 2019 through January 2020. Patients were included if they had sICAD (≥70% stenosis), failed medical management, and underwent intracranial stenting with R-onyx DES. Technical success …

The Professional And Personal Impact Of The Coronavirus Pandemic On Us Neurointerventional Practices: A Nationwide Survey, Kyle M. Fargen, Thabele M. Leslie-Mazwi, Richard P. Klucznik, Stacey Q. Wolfe, Patrick Brown, Sameer A. Ansari, Guilherme Dabus, Alejandro M. Spiotta, Maxim Mokin, Ameer E. Hassan, David Liebeskind, Babu G. Welch, Adnan H. Siddiqui, Joshua A. Hirsch

School of Medicine Publications and Presentations

Background Little is currently known about the effects of the coronavirus (COVID-19) pandemic on neurointerventional (NI) procedural volumes or its toll on physician wellness.

Methods A 37-question online survey was designed and distributed to physician members of three NI physician organizations.

Results A total of 151 individual survey responses were obtained. Reduced mechanical thrombectomy procedures compared with pre-pandemic were observed with 32% reporting a greater than 50% reduction in thrombectomy volumes. In concert with most (76%) reporting at least a 25% reduction in non-mechanical thrombectomy urgent NI procedures and a nearly unanimous (96%) cessation of non-urgent elective cases, 68% of …

Association Of Office And Ambulatory Blood Pressure With Mortality And Cardiovascular Outcomes, Wen-Yi Yang, Jesus D. Melgarejo, Lutgarde Thijs, Zhen-Yu Zhang, José Boggia, Fang-Fei Wei, Tine W. Hansen, Kei Asayama, Gladys E. Maestre, Takayoshi Ohkubo

School of Medicine Publications and Presentations

Importance Blood pressure (BP) is a known risk factor for overall mortality and cardiovascular (CV)-specific fatal and nonfatal outcomes. It is uncertain which BP index is most strongly associated with these outcomes.

Objective To evaluate the association of BP indexes with death and a composite CV event.

Design, Setting, and Participants Longitudinal population-based cohort study of 11 135 adults from Europe, Asia, and South America with baseline observations collected from May 1988 to May 2010 (last follow-ups, August 2006-October 2016).

Exposures Blood pressure measured by an observer or an automated office machine; measured for 24 hours, during the day or …