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Chen H, Colasurdo M, Phipps MS, Miller TR, Cherian J, Marino J, Cronin CA, Wozniak MA, Gandhi D, Chaturvedi S, Jindal G. The BAND score: A simple model for upfront prediction of poor outcomes despite successful stroke thrombectomy. J Stroke Cerebrovasc Dis 2024; 33:107608. [PMID: 38286159 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 01/13/2024] [Accepted: 01/26/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND While endovascular thrombectomy (EVT) is beneficial for patients with acute large vessel occlusion ischemic strokes, a significant portion of patients still do poorly despite successful recanalization. Identifying patients at high risk for poor outcomes can be helpful for future clinical trial design and optimizing acute stroke triage. METHODS Consecutive EVT patients were identified from 2016 to 2021 at a Comprehensive Stroke Center, and clinical information was recorded. Poor outcome was defined as a 90-day modified Rankin Scale (mRS) of 4 or greater despite achieving a modified thrombolysis in cerebral infarction (mTICI) score of 2b or greater. Multivariable regression analyses were used to identify risk factors for poor outcomes, and a scoring system was constructed. RESULTS 483 patients with successful recanalization were identified. From a randomly selected training cohort (n = 357), the 10-point BAND score was constructed from independent risk factors for poor outcomes: baseline disability (1 point: baseline mRS ≥ 2), age (1 point: 60-69 years, 2 points: 70-79 years, 3 points: 80-84 years, 4 points: 85 years or older), NIHSS (2 points: 13-17, 3 points: 18-22, and 4 points: ≥ 23), and delay from last known normal (1 point: ≥ 6 h). The BAND score was significantly associated with rates of poor outcomes (p < 0.001), and it achieved an area under the receiver-operating characteristic curve (AUC) of 0.80 (95 %CI 0.76-0.85) in our training cohort and 0.78 (95 %CI 0.70-0.86) in our validation cohort (n = 126). Overall, the BAND score had a significantly higher AUC value than the widely validated THRIVE score and the THRIVE-EVT calculation (p = 0.001 and 0.029, respectively). Among patients with high BAND scores (7 or higher), 88.2 % had poor outcomes. CONCLUSION The BAND score is a simple tool to predict poor outcomes despite successful recanalization. Future studies are needed to confirm the BAND score's external validity.
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Affiliation(s)
- Huanwen Chen
- Division of Interventional Neuroradiology, Department of Radiology, University of Maryland Medical Center, Baltimore MD 21201, USA; National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda MD 20814, USA; Department of Neurology, Georgetown University Hospital, Washington DC 20007, USA
| | - Marco Colasurdo
- Division of Interventional Neuroradiology, Department of Radiology, University of Maryland Medical Center, Baltimore MD 21201, USA
| | - Michael S Phipps
- Department of Neurology, University of Maryland Medical Center, Baltimore MD 21201, USA
| | - Timothy R Miller
- Division of Interventional Neuroradiology, Department of Radiology, University of Maryland Medical Center, Baltimore MD 21201, USA
| | - Jacob Cherian
- Department of Neurosurgery, University of Maryland Medical Center, Baltimore MD 21201, USA
| | - Jose Marino
- Division of Interventional Neuroradiology, Department of Radiology, University of Maryland Medical Center, Baltimore MD 21201, USA
| | - Carolyn A Cronin
- Department of Neurology, University of Maryland Medical Center, Baltimore MD 21201, USA
| | - Marcella A Wozniak
- Department of Neurology, University of Maryland Medical Center, Baltimore MD 21201, USA
| | - Dheeraj Gandhi
- Division of Interventional Neuroradiology, Department of Radiology, University of Maryland Medical Center, Baltimore MD 21201, USA
| | - Seemant Chaturvedi
- Department of Neurology, University of Maryland Medical Center, Baltimore MD 21201, USA
| | - Gaurav Jindal
- Division of Interventional Neuroradiology, Department of Radiology, University of Maryland Medical Center, Baltimore MD 21201, USA.
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Grimes K, Mehndiratta P, Chaturvedi S. The impact of sex on stroke care: From epidemiology to outcome. J Stroke Cerebrovasc Dis 2024; 33:107675. [PMID: 38467238 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Carotid stenosis and atrial fibrillation are key risk factors for development of hemispheric strokes. In this review we aim to identify sex-specific differences in the pathophysiology and treatment of these risk factors and areas for future study. KEY FINDINGS Women are underrepresented in research studies of stroke in patients with carotid disease and atrial fibrillation. However, key differences have been found between men and women that suggest that the development of carotid disease and atrial fibrillation occur at later stages of life and are associated with higher severity of stroke. Some treatments, including surgical treatment, seem to have different rates of efficacy and women and women are at higher risk of surgical complications. This suggests that treatment recommendations may need to be sex specific. CONCLUSION Efforts should be made to address research and treatment gaps in women with stroke risk factors. This may lead to the development of sex-specific recommendations for stroke prevention and treatment.
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Affiliation(s)
- Kathryn Grimes
- Department of Neurology & Stroke Program, University of Maryland School of Medicine
| | - Prachi Mehndiratta
- Department of Neurology & Stroke Program, University of Maryland School of Medicine
| | - Seemant Chaturvedi
- Department of Neurology & Stroke Program, University of Maryland School of Medicine.
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Bhagawati M, Paul S, Mantella L, Johri AM, Laird JR, Singh IM, Singh R, Garg D, Fouda MM, Khanna NN, Cau R, Abraham A, Al-Maini M, Isenovic ER, Sharma AM, Fernandes JFE, Chaturvedi S, Karla MK, Nicolaides A, Saba L, Suri JS. Deep learning approach for cardiovascular disease risk stratification and survival analysis on a Canadian cohort. Int J Cardiovasc Imaging 2024:10.1007/s10554-024-03100-3. [PMID: 38678144 DOI: 10.1007/s10554-024-03100-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/02/2024] [Indexed: 04/29/2024]
Abstract
The quantification of carotid plaque has been routinely used to predict cardiovascular risk in cardiovascular disease (CVD) and coronary artery disease (CAD). To determine how well carotid plaque features predict the likelihood of CAD and cardiovascular (CV) events using deep learning (DL) and compare against the machine learning (ML) paradigm. The participants in this study consisted of 459 individuals who had undergone coronary angiography, contrast-enhanced ultrasonography, and focused carotid B-mode ultrasound. Each patient was tracked for thirty days. The measurements on these patients consisted of maximum plaque height (MPH), total plaque area (TPA), carotid intima-media thickness (cIMT), and intraplaque neovascularization (IPN). CAD risk and CV event stratification were performed by applying eight types of DL-based models. Univariate and multivariate analysis was also conducted to predict the most significant risk predictors. The DL's model effectiveness was evaluated by the area-under-the-curve measurement while the CV event prediction was evaluated using the Cox proportional hazard model (CPHM) and compared against the DL-based concordance index (c-index). IPN showed a substantial ability to predict CV events (p < 0.0001). The best DL system improved by 21% (0.929 vs. 0.762) over the best ML system. DL-based CV event prediction showed a ~ 17% increase in DL-based c-index compared to the CPHM (0.86 vs. 0.73). CAD and CV incidents were linked to IPN and carotid imaging characteristics. For survival analysis and CAD prediction, the DL-based system performs superior to ML-based models.
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Affiliation(s)
- Mrinalini Bhagawati
- Department of Biomedical Engineering, North-Eastern Hill University, Shillong, India
| | - Sudip Paul
- Department of Biomedical Engineering, North-Eastern Hill University, Shillong, India
| | - Laura Mantella
- Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Amer M Johri
- Division of Cardiology, Department of Medicine, Queen's University, Kingston, Canada
| | - John R Laird
- Heart and Vascular Institute, Adventist Health St. Helena, St Helena, CA, 94574, USA
| | - Inder M Singh
- Stroke Diagnostic and Monitoring Division, AtheroPoint™, Roseville, CA, 95661, USA
| | - Rajesh Singh
- Division of Research and Innovation, UTI, Uttaranchal University, Dehradun, India
| | - Deepak Garg
- School of Cowereter Science and Artificial Intelligence, SR University, Warangal, Telangana, 506371, India
| | - Mostafa M Fouda
- Department of ECE, Idaho State University, Pocatello, ID, 83209, USA
| | | | - Riccardo Cau
- Department of Radiology, Azienda Ospedaliero Universitaria, 40138, Cagliari, Italy
| | | | - Mostafa Al-Maini
- Allergy, Clinical Immunology and Rheumatology Institute, Toronto, ON, Canada
| | - Esma R Isenovic
- Department of Radiobiology and Molecular Genetics, National Institute of The Republic of Serbia, University of Belgrade, 11001, Belgrade, Serbia
| | - Aditya M Sharma
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA, 22904, USA
| | | | - Seemant Chaturvedi
- Department of Neurology & Stroke Program, University of Maryland, Baltimore, MD, USA
| | - Mannudeep K Karla
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Andrew Nicolaides
- Vascular Screening and Diagnostic Centre, University of Nicosia Medical School, Nicosia, Cyprus
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria, 40138, Cagliari, Italy
| | - Jasjit S Suri
- Stroke Diagnostic and Monitoring Division, AtheroPoint™, Roseville, CA, 95661, USA.
- Department of ECE, Idaho State University, Pocatello, ID, 83209, USA.
- Department of CE, Graphic Era Deemed to be University, 248002, Dehradun, India.
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Anuforo A, Aneni E, Akintoye E, Anikpezie N, Patel SD, Soipe A, Olojakpoke E, Burke D, Latorre JG, Khandelwal P, Chaturvedi S, Ovbiagele B, Otite FO. Trends in Age, Sex, and Racial Differences in the Incidence of Infective Endocarditis in Florida and New York. Circulation 2024; 149:1391-1393. [PMID: 38648273 DOI: 10.1161/circulationaha.123.066921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Affiliation(s)
- Anderson Anuforo
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY (A.A., A.S., E.O.)
| | - Ehimen Aneni
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (E. Aneni, E. Akintoye)
| | - Emmanuel Akintoye
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (E. Aneni, E. Akintoye)
| | - Nnabuchi Anikpezie
- Department of Population Medicine, University of Mississippi Medical Center, Jackson, (N.A.)
| | - Smit D Patel
- Department of Neurosurgery, University of Connecticut, Hartford (S.D.P.)
| | - Ayorinde Soipe
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY (A.A., A.S., E.O.)
| | - Eloho Olojakpoke
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY (A.A., A.S., E.O.)
| | - Devin Burke
- Cerebrovascular and Neurocritical Care Division, Upstate Neurological Institute, Syracuse, NY (D.B., J.G.L., F.O.O.)
| | - Julius Gene Latorre
- Cerebrovascular and Neurocritical Care Division, Upstate Neurological Institute, Syracuse, NY (D.B., J.G.L., F.O.O.)
| | | | - Seemant Chaturvedi
- Department of Neurology, University of Maryland School of Medicine, Baltimore (S.C.)
| | - Bruce Ovbiagele
- Department of Neurology, University of California San Francisco Weill Institute for Neurosciences, San Francisco (B.O.)
| | - Fadar Oliver Otite
- Cerebrovascular and Neurocritical Care Division, Upstate Neurological Institute, Syracuse, NY (D.B., J.G.L., F.O.O.)
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Khunte M, Chen H, Colasurdo M, Chaturvedi S, Malhotra A, Gandhi D. Sex discrepancies in the population incidence of stroke and hemorrhage related to atrial fibrillation or flutter. Cerebrovasc Dis 2024:000538108. [PMID: 38432203 DOI: 10.1159/000538108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/26/2024] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION Atrial fibrillation or flutter (AF) is a well-known risk factor for ischemic stroke. While female sex has been associated with higher stroke risk among AF patients, overall sex-specific real-world burdens of AF-related strokes and hemorrhages are unknown. METHODS The 2016-2020 National Inpatient Sample was queried for hospitalizations, morbidity, and mortality due to AF-related ischemic strokes and bleeds. Patient demographic information, vascular risk factors, comorbidities, and stroke characteristics were extracted using ICD-10 codes. Overall incidences were calculated using total population estimates provided by the United States Census Bureau, and relative risk was calculated by comparing annual incidences between men and women. RESULTS 2,420,870 ischemic stroke hospitalizations were identified; 542,635 (22.4%) were associated with AF. Overall, women had similar risk of hospitalization due to AF-related ischemic strokes compared to men; however, women had a higher risk of morbidity and mortality (RR 1.13 and 1.17, respectively; both p<0.001). In contrast, women had lower incidences of hospitalization, morbidity, and mortality due to AF-related bleeds (RR 0.82, 0.94, and 0.74, respectively; all p<0.001). Among patients with AF-related ischemic strokes, women had lower rates of anticoagulation use, higher rates of large vessel occlusion, and higher stroke severity (all p<0.001). These trends persisted among patients 80 years or older (all p<0.001). CONCLUSION Women in the United States have higher incidences of morbidity and mortality from AF-related ischemic strokes than men. Future studies should investigate strategies to reduce morbidity and mortality due to AF-related strokes in women.
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Kamel H, Longstreth WT, Tirschwell DL, Kronmal RA, Marshall RS, Broderick JP, Aragón García R, Plummer P, Sabagha N, Pauls Q, Cassarly C, Dillon CR, Di Tullio MR, Hod EA, Soliman EZ, Gladstone DJ, Healey JS, Sharma M, Chaturvedi S, Janis LS, Krishnaiah B, Nahab F, Kasner SE, Stanton RJ, Kleindorfer DO, Starr M, Winder TR, Clark WM, Miller BR, Elkind MSV. Apixaban to Prevent Recurrence After Cryptogenic Stroke in Patients With Atrial Cardiopathy: The ARCADIA Randomized Clinical Trial. JAMA 2024; 331:573-581. [PMID: 38324415 PMCID: PMC10851142 DOI: 10.1001/jama.2023.27188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/13/2023] [Indexed: 02/09/2024]
Abstract
Importance Atrial cardiopathy is associated with stroke in the absence of clinically apparent atrial fibrillation. It is unknown whether anticoagulation, which has proven benefit in atrial fibrillation, prevents stroke in patients with atrial cardiopathy and no atrial fibrillation. Objective To compare anticoagulation vs antiplatelet therapy for secondary stroke prevention in patients with cryptogenic stroke and evidence of atrial cardiopathy. Design, Setting, and Participants Multicenter, double-blind, phase 3 randomized clinical trial of 1015 participants with cryptogenic stroke and evidence of atrial cardiopathy, defined as P-wave terminal force greater than 5000 μV × ms in electrocardiogram lead V1, serum N-terminal pro-B-type natriuretic peptide level greater than 250 pg/mL, or left atrial diameter index of 3 cm/m2 or greater on echocardiogram. Participants had no evidence of atrial fibrillation at the time of randomization. Enrollment and follow-up occurred from February 1, 2018, through February 28, 2023, at 185 sites in the National Institutes of Health StrokeNet and the Canadian Stroke Consortium. Interventions Apixaban, 5 mg or 2.5 mg, twice daily (n = 507) vs aspirin, 81 mg, once daily (n = 508). Main Outcomes and Measures The primary efficacy outcome in a time-to-event analysis was recurrent stroke. All participants, including those diagnosed with atrial fibrillation after randomization, were analyzed according to the groups to which they were randomized. The primary safety outcomes were symptomatic intracranial hemorrhage and other major hemorrhage. Results With 1015 of the target 1100 participants enrolled and mean follow-up of 1.8 years, the trial was stopped for futility after a planned interim analysis. The mean (SD) age of participants was 68.0 (11.0) years, 54.3% were female, and 87.5% completed the full duration of follow-up. Recurrent stroke occurred in 40 patients in the apixaban group (annualized rate, 4.4%) and 40 patients in the aspirin group (annualized rate, 4.4%) (hazard ratio, 1.00 [95% CI, 0.64-1.55]). Symptomatic intracranial hemorrhage occurred in 0 patients taking apixaban and 7 patients taking aspirin (annualized rate, 1.1%). Other major hemorrhages occurred in 5 patients taking apixaban (annualized rate, 0.7%) and 5 patients taking aspirin (annualized rate, 0.8%) (hazard ratio, 1.02 [95% CI, 0.29-3.52]). Conclusions and Relevance In patients with cryptogenic stroke and evidence of atrial cardiopathy without atrial fibrillation, apixaban did not significantly reduce recurrent stroke risk compared with aspirin. Trial Registration ClinicalTrials.gov Identifier: NCT03192215.
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Affiliation(s)
- Hooman Kamel
- Clinical and Translational Neuroscience Unit, Department of Neurology and Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York
| | - W. T. Longstreth
- Department of Neurology, University of Washington, Seattle
- Department of Medicine, University of Washington, Seattle
- Department of Epidemiology, University of Washington, Seattle
| | | | | | - Randolph S. Marshall
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Joseph P. Broderick
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Rebeca Aragón García
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Pamela Plummer
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Noor Sabagha
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Qi Pauls
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Christy Cassarly
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Catherine R. Dillon
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Marco R. Di Tullio
- Division of Cardiology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Eldad A. Hod
- Department of Pathology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Elsayed Z. Soliman
- Epidemiological Cardiology Research Center, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David J. Gladstone
- Sunnybrook Research Institute, Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, and Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jeff S. Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Mukul Sharma
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Seemant Chaturvedi
- Department of Neurology, University of Maryland, and Baltimore VA Hospital, Baltimore
| | - L. Scott Janis
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Balaji Krishnaiah
- Department of Neurology, University of Tennessee Health Sciences Center, Memphis
| | - Fadi Nahab
- Departments of Neurology and Pediatrics, Emory University, Atlanta, Georgia
| | - Scott E. Kasner
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Robert J. Stanton
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Matthew Starr
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Wayne M. Clark
- Department of Neurology, Oregon Health & Science University, Portland
| | | | - Mitchell S. V. Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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7
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Paraskevas KI, Mikhailidis DP, Ringleb PA, Brown MM, Dardik A, Poredos P, Gray WA, Nicolaides AN, Lal BK, Mansilha A, Antignani PL, de Borst GJ, Cambria RP, Loftus IM, Lavie CJ, Blinc A, Lyden SP, Matsumura JS, Jezovnik MK, Bacharach JM, Meschia JF, Clair DG, Zeebregts CJ, Lanza G, Capoccia L, Spinelli F, Liapis CD, Jawien A, Parikh SA, Svetlikov A, Menyhei G, Davies AH, Musialek P, Roubin G, Stilo F, Sultan S, Proczka RM, Faggioli G, Geroulakos G, Fernandes E Fernandes J, Ricco JB, Saba L, Secemsky EA, Pini R, Myrcha P, Rundek T, Martinelli O, Kakkos SK, Sachar R, Goudot G, Schlachetzki F, Lavenson GS, Ricci S, Topakian R, Millon A, Di Lazzaro V, Silvestrini M, Chaturvedi S, Eckstein HH, Gloviczki P, White CJ. An international, multispecialty, expert-based Delphi Consensus document on controversial issues in the management of patients with asymptomatic and symptomatic carotid stenosis. J Vasc Surg 2024; 79:420-435.e1. [PMID: 37944771 DOI: 10.1016/j.jvs.2023.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/25/2023] [Accepted: 09/25/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Despite the publication of various national/international guidelines, several questions concerning the management of patients with asymptomatic (AsxCS) and symptomatic (SxCS) carotid stenosis remain unanswered. The aim of this international, multi-specialty, expert-based Delphi Consensus document was to address these issues to help clinicians make decisions when guidelines are unclear. METHODS Fourteen controversial topics were identified. A three-round Delphi Consensus process was performed including 61 experts. The aim of Round 1 was to investigate the differing views and opinions regarding these unresolved topics. In Round 2, clarifications were asked from each participant. In Round 3, the questionnaire was resent to all participants for their final vote. Consensus was reached when ≥75% of experts agreed on a specific response. RESULTS Most experts agreed that: (1) the current periprocedural/in-hospital stroke/death thresholds for performing a carotid intervention should be lowered from 6% to 4% in patients with SxCS and from 3% to 2% in patients with AsxCS; (2) the time threshold for a patient being considered "recently symptomatic" should be reduced from the current definition of "6 months" to 3 months or less; (3) 80% to 99% AsxCS carries a higher risk of stroke compared with 60% to 79% AsxCS; (4) factors beyond the grade of stenosis and symptoms should be added to the indications for revascularization in AsxCS patients (eg, plaque features of vulnerability and silent infarctions on brain computed tomography scans); and (5) shunting should be used selectively, rather than always or never. Consensus could not be reached on the remaining topics due to conflicting, inadequate, or controversial evidence. CONCLUSIONS The present international, multi-specialty expert-based Delphi Consensus document attempted to provide responses to several unanswered/unresolved issues. However, consensus could not be achieved on some topics, highlighting areas requiring future research.
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Affiliation(s)
| | - Dimitri P Mikhailidis
- Division of Surgery and Interventional Science, Department of Surgical Biotechnology, University College London Medical School, University College London (UCL) and Department of Clinical Biochemistry, Royal Free Hospital Campus, UCL, London, United Kingdom
| | | | - Martin M Brown
- Department of Brain Repair and Rehabilitation, Stroke Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Alan Dardik
- Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Pavel Poredos
- Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Andrew N Nicolaides
- Vascular Screening and Diagnostic Center, Nicosia, Cyprus; University of Nicosia Medical School, Nicosia, Cyprus; Department of Vascular Surgery, Imperial College, London, United Kingdom
| | - Brajesh K Lal
- Department of Vascular Surgery, University of Maryland School of Medicine, Baltimore, MD; Department of Vascular Surgery, Baltimore VA Medical Center, Baltimore, MD; Department of Neurology, Mayo Clinic, Rochester, MN
| | - Armando Mansilha
- Faculty of Medicine of the University of Porto, Porto, Portugal; Department of Angiology and Vascular Surgery, Hospital de S. Joao, Porto, Portugal
| | | | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Richard P Cambria
- Division of Vascular and Endovascular Surgery, St. Elizabeth's Medical Center, Boston, MA
| | - Ian M Loftus
- St George's Vascular Institute, St George's University London, London, United Kingdom
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
| | - Ales Blinc
- Division of Internal Medicine, Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Sean P Lyden
- Department of Vascular Surgery, The Cleveland Clinic, Cleveland, OH
| | - Jon S Matsumura
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Mateja K Jezovnik
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Centre at Houston, Houston, TX
| | - J Michael Bacharach
- Department of Vascular Medicine and Endovascular Intervention, North Central Heart Institute and the Avera Heart Hospital, Sioux Falls, SD
| | | | - Daniel G Clair
- Department of Vascular Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Clark J Zeebregts
- Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gaetano Lanza
- Vascular Surgery Department, IRCSS Multimedica Hospital, Castellanza, Italy
| | - Laura Capoccia
- Vascular Surgery Division, Department of Surgery, SS. Filippo e Nicola Hospital, Avezzano, Italy
| | - Francesco Spinelli
- Vascular Surgery Division, Department of Medicine and Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | | | - Arkadiusz Jawien
- Department of Vascular Surgery and Angiology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Sahil A Parikh
- Division of Cardiology, Department of Medicine, New York-Presbyterian Hospital/ Columbia University Irving Medical Center, New York, NY; Center for Interventional Cardiovascular Care and Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Alexei Svetlikov
- Division of Vascular and Endovascular Surgery, North-Western Scientific Clinical Center of Federal Medical Biological Agency of Russia, St Petersburg, Russia
| | - Gabor Menyhei
- Department of Vascular Surgery, University of Pecs, Pecs, Hungary
| | - Alun H Davies
- Department of Surgery and Cancer, Section of Vascular Surgery, Imperial College London, Charing Cross Hospital, London, United Kingdom
| | - Piotr Musialek
- Jagiellonian University Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
| | - Gary Roubin
- Department of Cardiology, Cardiovascular Associates of the Southeast/ Brookwood, Baptist Medical Center, Birmingham, AL
| | - Francesco Stilo
- Vascular Surgery Division, Department of Medicine and Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Sherif Sultan
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, University Hospital Galway, University of Galway, Galway, Ireland
| | - Robert M Proczka
- First Department of Vascular Surgery, Medicover Hospital, Warsaw, Poland, Lazarski University Faculty of Medicine, Warsaw, Poland
| | - Gianluca Faggioli
- Vascular Surgery, University of Bologna "Alma Mater Studiorum", Policlinico S. Orsola Malpighi, Bologna, Italy
| | - George Geroulakos
- Department of Vascular Surgery, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Jose Fernandes E Fernandes
- Faculty of Medicine, Lisbon Academic Medical Center, University of Lisbon, Portugal, Hospital da Luz Torres de Lisboa, Lisbon, Portugal
| | - Jean-Baptiste Ricco
- Department of Vascular Surgery, University Hospital of Toulouse, Toulouse, France
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliera Universitaria Di Cagliari, Cagliari, Italy
| | - Eric A Secemsky
- Division of Cardiology, Department of Medicine, Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA
| | - Rodolfo Pini
- Vascular Surgery, University of Bologna "Alma Mater Studiorum", Policlinico S. Orsola Malpighi, Bologna, Italy
| | - Piotr Myrcha
- Department of General and Vascular Surgery, Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL
| | - Ombretta Martinelli
- Faculty of Medicine, Sapienza University of Rome, Rome, Italy; Vascular Surgery Unit, "Umberto I." Hospital, Rome, Italy
| | - Stavros K Kakkos
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - Ravish Sachar
- North Carolina Heart and Vascular Hospital, UNC-REX Healthcare, University of North Carolina, Raleigh, NC
| | - Guillaume Goudot
- Vascular Medicine Department, Georges Pompidou European Hospital, APHP, Université Paris Cité, Paris, France
| | - Felix Schlachetzki
- Department of Neurology, University Hospital of Regensburg, Regensburg, Germany
| | | | - Stefano Ricci
- Neurology Department-Stroke Unit, Gubbio-Gualdo Tadino and Citta di Castello Hospitals, USL Umbria 1, Perugia, Italy
| | - Raffi Topakian
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
| | - Antoine Millon
- Department of Vascular and Endovascular Surgery, Louis Pradel Hospital, Hospices Civil de Lyon, Bron, France
| | - Vincenzo Di Lazzaro
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Universita Campus Bio-Medico di Roma, Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Mauro Silvestrini
- Department of Experimental and Clinical Medicine, Neurological Clinic, Marche Polytechnic University, Ancona, Italy
| | - Seemant Chaturvedi
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Peter Gloviczki
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Christopher J White
- Department of Medicine and Cardiology, Ochsner Clinical School, University of Queensland, Brisbane, Australia; Department of Cardiology, The John Ochsner Heart and Vascular Institute, New Orleans, LA
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Ghannam M, AlMajali M, Khasiyev F, Dibas M, Al Qudah A, AlMajali F, Ghazaleh D, Shah A, Fayad FH, Joudi K, Zaidat B, Childs CA, Levy BR, Abouainain Y, Özdemir-van Brunschot DMD, Shu L, Goldstein ED, Baig AA, Roeder H, Henninger N, de Havenon A, Levy EI, Matouk C, Derdeyn CP, Leira EC, Chaturvedi S, Yaghi S. Transcarotid Arterial Revascularization of Symptomatic Internal Carotid Artery Disease: A Systematic Review and Study-Level Meta-Analysis. Stroke 2024. [PMID: 38299350 DOI: 10.1161/strokeaha.123.044246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
BACKGROUND Transcarotid artery revascularization (TCAR) is an interventional therapy for symptomatic internal carotid artery disease. Currently, the utilization of TCAR is contentious due to limited evidence. In this study, we evaluate the safety and efficacy of TCAR in patients with symptomatic internal carotid artery disease compared with carotid endarterectomy (CEA) and carotid artery stenting (CAS). METHODS A systematic review was conducted, spanning from January 2000 to February 2023, encompassing studies that used TCAR for the treatment of symptomatic internal carotid artery disease. The primary outcomes included a 30-day stroke or transient ischemic attack, myocardial infarction, and mortality. Secondary outcomes comprised cranial nerve injury and major bleeding. Pooled odds ratios (ORs) for each outcome were calculated to compare TCAR with CEA and CAS. Furthermore, subgroup analyses were performed based on age and degree of stenosis. In addition, a sensitivity analysis was conducted by excluding the vascular quality initiative registry population. RESULTS A total of 7 studies involving 24 246 patients were analyzed. Within this patient cohort, 4771 individuals underwent TCAR, 12 350 underwent CEA, and 7125 patients underwent CAS. Compared with CAS, TCAR was associated with a similar rate of stroke or transient ischemic attack (OR, 0.77 [95% CI, 0.33-1.82]) and myocardial infarction (OR, 1.29 [95% CI, 0.83-2.01]) but lower mortality (OR, 0.42 [95% CI, 0.22-0.81]). Compared with CEA, TCAR was associated with a higher rate of stroke or transient ischemic attack (OR, 1.26 [95% CI, 1.03-1.54]) but similar rates of myocardial infarction (OR, 0.9 [95% CI, 0.64-1.38]) and mortality (OR, 1.35 [95% CI, 0.87-2.10]). CONCLUSIONS Although CEA has traditionally been considered superior to stenting for symptomatic carotid stenosis, TCAR may have some advantages over CAS. Prospective randomized trials comparing the 3 modalities are needed.
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Affiliation(s)
- Malik Ghannam
- Department of Neurology, University of Iowa Carver College of Medicine (M.G., M.A., M.D., D.G., H.R., E.C.L.)
| | - Mohammad AlMajali
- Department of Neurology, University of Iowa Carver College of Medicine (M.G., M.A., M.D., D.G., H.R., E.C.L.)
| | - Farid Khasiyev
- Department of Neurology (F.K.), Saint Louis University, MO
| | - Mahmoud Dibas
- Department of Neurology, University of Iowa Carver College of Medicine (M.G., M.A., M.D., D.G., H.R., E.C.L.)
| | - Abdullah Al Qudah
- Department of Neurological Surgery, University of Pittsburgh Medical Center, PA (A.A.Q.)
| | - Fawaz AlMajali
- Department of General Surgery (F.A.), Saint Louis University, MO
| | - Dana Ghazaleh
- Department of Neurology, University of Iowa Carver College of Medicine (M.G., M.A., M.D., D.G., H.R., E.C.L.)
| | - Asghar Shah
- Brown University, Providence, RI (A.S., F.H.F., K.J., B.Z.)
| | - Fayez H Fayad
- Brown University, Providence, RI (A.S., F.H.F., K.J., B.Z.)
| | - Kareem Joudi
- Brown University, Providence, RI (A.S., F.H.F., K.J., B.Z.)
| | - Bashar Zaidat
- Brown University, Providence, RI (A.S., F.H.F., K.J., B.Z.)
| | | | - Bennett R Levy
- George Washington School of Medicine and Health Sciences, DC (B.R.L.)
| | | | | | - Liqi Shu
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (L.S., E.D.G., S.Y.)
| | - Eric D Goldstein
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (L.S., E.D.G., S.Y.)
| | - Ammad A Baig
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, NY (A.A.B., E.I.L.)
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY (A.A.B., E.I.L.)
| | - Hannah Roeder
- Department of Neurology, University of Iowa Carver College of Medicine (M.G., M.A., M.D., D.G., H.R., E.C.L.)
| | - Nils Henninger
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester (N.H.)
| | - Adam de Havenon
- Department of Neurology (A.d.H.), Yale University, New Haven, CT
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, NY (A.A.B., E.I.L.)
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY (A.A.B., E.I.L.)
| | - Charles Matouk
- Department of Neurosurgery (C.M.), Yale University, New Haven, CT
| | - Colin P Derdeyn
- Department of Radiology (C.P.D.) and Department of Neurosurgery (E.C.L.), University of Iowa College of Medicine
| | - Enrique C Leira
- Department of Neurology, University of Iowa Carver College of Medicine (M.G., M.A., M.D., D.G., H.R., E.C.L.)
- Department of Epidemiology, University of Iowa College of Public Health (E.C.L.)
| | | | - Shadi Yaghi
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (L.S., E.D.G., S.Y.)
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Chaturvedi S, De Marchis GM. Inflammatory Biomarkers and Stroke Subtype: An Important New Frontier. Neurology 2024; 102:e208098. [PMID: 38165352 DOI: 10.1212/wnl.0000000000208098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 10/27/2023] [Indexed: 01/03/2024] Open
Abstract
Inflammation is an established pathway in the formation, growth, and rupture of atherosclerotic plaques. Inflammation is thus essential to the pathogenesis of coronary heart disease and some types of ischemic stroke.1 The benefit of anti-inflammatory therapies, such as colchicine2 and the anti-IL1β canakinumab,3 is proven in patients with coronary heart disease, yet it remains unproven for patients with ischemic stroke. Compared with coronary heart disease, the etiology of stroke is more heterogeneous. Besides arterio-arterial atherogenic embolism, possible etiologies are penetrator artery occlusion, cardioembolism, and other mechanisms. Finding a stroke etiology remains elusive in up to 30%-40% of patients despite a full evaluation. Understanding whether the stroke etiology modifies the association between inflammatory markers and recurrence risk is an important step to improve selection of patients for randomized trials on anti-inflammatory agents. IL-6 and high-sensitive CRP (hs-CRP) have been implicated in a higher recurrence risk after ischemic stroke by both an individual participant data meta-analysis4 and a Mendelian randomization study,5 but granular, in vivo results stratified by stroke etiology are lacking.
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Affiliation(s)
- Seemant Chaturvedi
- From the Department of Neurology (S.C.), University of Maryland, Baltimore; and Department of Neurology & Stroke Center (G.M.D.M.), Kantonsspital St. Gallen, Switzerland
| | - Gian Marco De Marchis
- From the Department of Neurology (S.C.), University of Maryland, Baltimore; and Department of Neurology & Stroke Center (G.M.D.M.), Kantonsspital St. Gallen, Switzerland
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10
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Otite FO, Patel SD, Aneni E, Lamikanra O, Wee C, Albright KC, Burke D, Latorre JG, Morris NA, Anikpezie N, Singla A, Sonig A, Kamel H, Khandelwal P, Chaturvedi S. Plateauing atrial fibrillation burden in acute ischemic stroke admissions in the United States from 2010 to 2020. Int J Stroke 2024:17474930231222163. [PMID: 38086764 DOI: 10.1177/17474930231222163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Utilization of oral anticoagulants for acute ischemic stroke (AIS) prevention in patients with atrial fibrillation (AF) increased in the United States over the last decade. Whether this increase has been accompanied by any change in AF prevalence in AIS at the population level remains unknown. The aim of this study is to evaluate trends in AF prevalence in AIS hospitalizations in various age, sex, and racial subgroups over the last decade. METHODS We used data contained in the 2010-2020 National Inpatient Sample to conduct a serial cross-sectional study. Primary AIS hospitalizations with and without comorbid AF were identified using International Classification of Diseases Codes. Joinpoint regression was used to compute annualized percentage change (APC) in prevalence and to identify points of change in prevalence over time. RESULTS Of 5,190,148 weighted primary AIS hospitalizations over the study period, 25.1% had comorbid AF. The age- and sex-standardized prevalence of AF in AIS hospitalizations increased across the entire study period 2010-2020 (average APC: 1.3%, 95% confidence interval (CI): 0.8-1.7%). Joinpoint regression showed that prevalence increased in the period 2010-2015 (APC: 2.8%, 95% CI: 1.9-3.9%) but remained stable in the period 2015-2020 (APC: -0.3%, 95% CI: -1.0 to 1.9%). Upon stratification by age and sex, prevalence increased in all age/sex groups from 2010 to 2015 and continued to increase throughout the entire study period in hospitalizations in men 18-39 years (APC: 4.0%, 95% CI: 0.2-7.9%), men 40-59 years (APC: 3.4%, 95% CI: 1.9-4.9%) and women 40-59 years (APC: 4.4%, 95% CI: 2.0-6.8%). In contrast, prevalence declined in hospitalizations in women 60-79 (APC: -1.0%, 95% CI: -0.5 to -1.5%) and women ⩾ 80 years over the period 2015-2020 but plateaued in hospitalizations in similar-aged men over the same period. CONCLUSION AF prevalence in AIS hospitalizations in the United States increased over the period 2010-2015, then plateaued over the period 2015-2020 due to declining prevalence in hospitalizations in women ⩾ 60 years and plateauing prevalence in hospitalizations in men ⩾ 60 years.
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Affiliation(s)
- Fadar Oliver Otite
- Department of Neurology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Smit D Patel
- Department of Neurosurgery, University of Connecticut, Hartford, CT, USA
| | - Ehimen Aneni
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | - Claribel Wee
- Department of Neurology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Karen C Albright
- Department of Neurology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Devin Burke
- Department of Neurology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Julius Gene Latorre
- Department of Neurology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Nicholas Allen Morris
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nnabuchi Anikpezie
- Department of Population Health, University of Mississippi Medical Center, Jackson, MS, USA
| | - Amit Singla
- Department of Neurosurgery, Rutgers University, Newark, NJ, USA
| | - Ashish Sonig
- Department of Neurosurgery, Rutgers University, Newark, NJ, USA
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | | | - Seemant Chaturvedi
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
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11
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Yaghi S, Albin C, Chaturvedi S, Savitz SI. Roundtable of Academia and Industry for Stroke Prevention: Prevention and Treatment of Large-Vessel Disease. Stroke 2024; 55:226-235. [PMID: 38134259 DOI: 10.1161/strokeaha.123.043910] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Affiliation(s)
- Shadi Yaghi
- Alpert Medical School at Brown University, Providence, RI (S.Y.)
| | | | | | - Sean I Savitz
- Institute for Stroke and Cerebrovascular Disease, University of Texas Health Science Center, Houston (S.I.S.)
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12
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Saba L, Cau R, Murgia A, Nicolaides AN, Wintermark M, Castillo M, Staub D, Kakkos SK, Yang Q, Paraskevas KI, Yuan C, Edjlali M, Sanfilippo R, Hendrikse J, Johansson E, Mossa-Basha M, Balu N, Dichgans M, Saloner D, Bos D, Jager HR, Naylor R, Faa G, Suri JS, Costello J, Auer DP, Mcnally JS, Bonati LH, Nardi V, van der Lugt A, Griffin M, Wasserman BA, Kooi ME, Gillard J, Lanzino G, Mikhailidis DP, Mandell DM, Benson JC, van Dam-Nolen DHK, Kopczak A, Song JW, Gupta A, DeMarco JK, Chaturvedi S, Virmani R, Hatsukami TS, Brown M, Moody AR, Libby P, Schindler A, Saam T. Carotid Plaque-RADS: A Novel Stroke Risk Classification System. JACC Cardiovasc Imaging 2024; 17:62-75. [PMID: 37823860 DOI: 10.1016/j.jcmg.2023.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/06/2023] [Accepted: 09/12/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Carotid artery atherosclerosis is highly prevalent in the general population and is a well-established risk factor for acute ischemic stroke. Although the morphological characteristics of vulnerable plaques are well recognized, there is a lack of consensus in reporting and interpreting carotid plaque features. OBJECTIVES The aim of this paper is to establish a consistent and comprehensive approach for imaging and reporting carotid plaque by introducing the Plaque-RADS (Reporting and Data System) score. METHODS A panel of experts recognized the necessity to develop a classification system for carotid plaque and its defining characteristics. Using a multimodality analysis approach, the Plaque-RADS categories were established through consensus, drawing on existing published reports. RESULTS The authors present a universal classification that is applicable to both researchers and clinicians. The Plaque-RADS score offers a morphological assessment in addition to the prevailing quantitative parameter of "stenosis." The Plaque-RADS score spans from grade 1 (indicating complete absence of plaque) to grade 4 (representing complicated plaque). Accompanying visual examples are included to facilitate a clear understanding of the Plaque-RADS categories. CONCLUSIONS Plaque-RADS is a standardized and reliable system of reporting carotid plaque composition and morphology via different imaging modalities, such as ultrasound, computed tomography, and magnetic resonance imaging. This scoring system has the potential to help in the precise identification of patients who may benefit from exclusive medical intervention and those who require alternative treatments, thereby enhancing patient care. A standardized lexicon and structured reporting promise to enhance communication between radiologists, referring clinicians, and scientists.
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Affiliation(s)
- Luca Saba
- Department of Radiology, University of Cagliari, Cagliari, Italy.
| | - Riccardo Cau
- Department of Radiology, University of Cagliari, Cagliari, Italy
| | | | - Andrew N Nicolaides
- Vascular Screening and Diagnostic Centre, Nicosia, Cyprus; University of Nicosia Medical School, Nicosia, Cyprus; Department of Vascular Surgery, Imperial College, London, United Kingdom
| | - Max Wintermark
- Department of Neuroradiology, The University of Texas MD Anderson Center, Houston, Texas, USA
| | - Mauricio Castillo
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Daniel Staub
- Vascular Medicine/Angiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Stavros K Kakkos
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - Qi Yang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | | | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Myriam Edjlali
- Multimodal Biomedical Imaging Laboratory (BioMaps), Paris-Saclay University, CEA, CNRS, Inserm, Frédéric Joliot Hospital Department, Orsay, France; Department of Radiology, APHP, Paris, France
| | | | | | - Elias Johansson
- Clinical Science, Umeå University, Neurosciences, Umeå, Sweden
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Niranjan Balu
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany; German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - David Saloner
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, California, USA
| | - Daniel Bos
- Department of Radiology and Nuclear Medicine, Erasmus MC Rotterdam, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Clinical Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - H Rolf Jager
- Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, United Kingdom
| | - Ross Naylor
- The Leicester Vascular Institute, Glenfield Hospital, Leicester, United Kingdom
| | - Gavino Faa
- Department of Pathology, University of Cagliari, Cagliari, Italy
| | - Jasjit S Suri
- Stroke Monitoring and Diagnostic Division, AtheroPoin, Roseville, California, USA
| | - Justin Costello
- Department of Neuroradiology, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | - Dorothee P Auer
- Radiological Sciences, Division of Clinical Neuroscience, and NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom
| | - J Scott Mcnally
- Department of Radiology, University of Utah, Salt Lake City, Utah, USA
| | - Leo H Bonati
- Department of Neurology and Stroke Center, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Valentina Nardi
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus MC Rotterdam, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Maura Griffin
- Vascular Screening and Diagnostic Centre, Nicosia, Cyprus
| | - Bruce A Wasserman
- Department of Radiology, University of Maryland School of Medicine and Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - M Eline Kooi
- Department of Radiology and Nuclear Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Giuseppe Lanzino
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London School, University College London, London, United Kingdom
| | - Daniel M Mandell
- Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - John C Benson
- Department of Radiology Mayo Clinic, Rochester, Minnesota, USA
| | - Dianne H K van Dam-Nolen
- Department of Radiology and Nuclear Medicine, Erasmus MC Rotterdam, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Anna Kopczak
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
| | - Jae W Song
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ajay Gupta
- Department of Radiology Weill Cornell Medical College, New York, New York, USA
| | - J Kevin DeMarco
- Walter Reed National Military Medical Center and Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Seemant Chaturvedi
- Department of Neurology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Renu Virmani
- Department of Cardiovascular Pathology, CVPath Institute, Gaithersburg, Maryland, USA
| | | | - Martin Brown
- Department of Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom
| | - Alan R Moody
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Peter Libby
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Andreas Schindler
- Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - Tobias Saam
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany; Die Radiologie, Rosenheim, Germany
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13
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Khanna NN, Singh M, Maindarkar M, Kumar A, Johri AM, Mentella L, Laird JR, Paraskevas KI, Ruzsa Z, Singh N, Kalra MK, Fernandes JFE, Chaturvedi S, Nicolaides A, Rathore V, Singh I, Teji JS, Al-Maini M, Isenovic ER, Viswanathan V, Khanna P, Fouda MM, Saba L, Suri JS. Polygenic Risk Score for Cardiovascular Diseases in Artificial Intelligence Paradigm: A Review. J Korean Med Sci 2023; 38:e395. [PMID: 38013648 PMCID: PMC10681845 DOI: 10.3346/jkms.2023.38.e395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/15/2023] [Indexed: 11/29/2023] Open
Abstract
Cardiovascular disease (CVD) related mortality and morbidity heavily strain society. The relationship between external risk factors and our genetics have not been well established. It is widely acknowledged that environmental influence and individual behaviours play a significant role in CVD vulnerability, leading to the development of polygenic risk scores (PRS). We employed the PRISMA search method to locate pertinent research and literature to extensively review artificial intelligence (AI)-based PRS models for CVD risk prediction. Furthermore, we analyzed and compared conventional vs. AI-based solutions for PRS. We summarized the recent advances in our understanding of the use of AI-based PRS for risk prediction of CVD. Our study proposes three hypotheses: i) Multiple genetic variations and risk factors can be incorporated into AI-based PRS to improve the accuracy of CVD risk predicting. ii) AI-based PRS for CVD circumvents the drawbacks of conventional PRS calculators by incorporating a larger variety of genetic and non-genetic components, allowing for more precise and individualised risk estimations. iii) Using AI approaches, it is possible to significantly reduce the dimensionality of huge genomic datasets, resulting in more accurate and effective disease risk prediction models. Our study highlighted that the AI-PRS model outperformed traditional PRS calculators in predicting CVD risk. Furthermore, using AI-based methods to calculate PRS may increase the precision of risk predictions for CVD and have significant ramifications for individualized prevention and treatment plans.
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Affiliation(s)
- Narendra N Khanna
- Department of Cardiology, Indraprastha APOLLO Hospitals, New Delhi, India
- Asia Pacific Vascular Society, New Delhi, India
| | - Manasvi Singh
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA
- Bennett University, Greater Noida, India
| | - Mahesh Maindarkar
- Asia Pacific Vascular Society, New Delhi, India
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA
- School of Bioengineering Sciences and Research, Maharashtra Institute of Technology's Art, Design and Technology University, Pune, India
| | | | - Amer M Johri
- Department of Medicine, Division of Cardiology, Queen's University, Kingston, Canada
| | - Laura Mentella
- Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Canada
| | - John R Laird
- Heart and Vascular Institute, Adventist Health St. Helena, St. Helena, CA, USA
| | | | - Zoltan Ruzsa
- Invasive Cardiology Division, University of Szeged, Szeged, Hungary
| | - Narpinder Singh
- Department of Food Science and Technology, Graphic Era Deemed to be University, Dehradun, Uttarakhand, India
| | | | | | - Seemant Chaturvedi
- Department of Neurology & Stroke Program, University of Maryland, Baltimore, MD, USA
| | - Andrew Nicolaides
- Vascular Screening and Diagnostic Centre and University of Nicosia Medical School, Cyprus
| | - Vijay Rathore
- Nephrology Department, Kaiser Permanente, Sacramento, CA, USA
| | - Inder Singh
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA
| | - Jagjit S Teji
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Mostafa Al-Maini
- Allergy, Clinical Immunology and Rheumatology Institute, Toronto, ON, Canada
| | - Esma R Isenovic
- Department of Radiobiology and Molecular Genetics, National Institute of The Republic of Serbia, University of Belgrade, Beograd, Serbia
| | | | - Puneet Khanna
- Department of Anaesthesiology, AIIMS, New Delhi, India
| | - Mostafa M Fouda
- Department of Electrical and Computer Engineering, Idaho State University, Pocatello, ID, USA
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria, Cagliari, Italy
| | - Jasjit S Suri
- Asia Pacific Vascular Society, New Delhi, India
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA
- Department of Computer Engineering, Graphic Era Deemed to be University, Dehradun, India.
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14
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Saba L, Maindarkar M, Khanna NN, Johri AM, Mantella L, Laird JR, Paraskevas KI, Ruzsa Z, Kalra MK, Fernandes JFE, Chaturvedi S, Nicolaides A, Rathore V, Singh N, Fouda MM, Isenovic ER, Al-Maini M, Viswanathan V, Suri JS. A Pharmaceutical Paradigm for Cardiovascular Composite Risk Assessment Using Novel Radiogenomics Risk Predictors in Precision Explainable Artificial Intelligence Framework: Clinical Trial Tool. FRONT BIOSCI-LANDMRK 2023; 28:248. [PMID: 37919080 DOI: 10.31083/j.fbl2810248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/02/2023] [Accepted: 08/28/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) is challenging to diagnose and treat since symptoms appear late during the progression of atherosclerosis. Conventional risk factors alone are not always sufficient to properly categorize at-risk patients, and clinical risk scores are inadequate in predicting cardiac events. Integrating genomic-based biomarkers (GBBM) found in plasma/serum samples with novel non-invasive radiomics-based biomarkers (RBBM) such as plaque area, plaque burden, and maximum plaque height can improve composite CVD risk prediction in the pharmaceutical paradigm. These biomarkers consider several pathways involved in the pathophysiology of atherosclerosis disease leading to CVD. OBJECTIVE This review proposes two hypotheses: (i) The composite biomarkers are strongly correlated and can be used to detect the severity of CVD/Stroke precisely, and (ii) an explainable artificial intelligence (XAI)-based composite risk CVD/Stroke model with survival analysis using deep learning (DL) can predict in preventive, precision, and personalized (aiP3) framework benefiting the pharmaceutical paradigm. METHOD The PRISMA search technique resulted in 214 studies assessing composite biomarkers using radiogenomics for CVD/Stroke. The study presents a XAI model using AtheroEdgeTM 4.0 to determine the risk of CVD/Stroke in the pharmaceutical framework using the radiogenomics biomarkers. CONCLUSIONS Our observations suggest that the composite CVD risk biomarkers using radiogenomics provide a new dimension to CVD/Stroke risk assessment. The proposed review suggests a unique, unbiased, and XAI model based on AtheroEdgeTM 4.0 that can predict the composite risk of CVD/Stroke using radiogenomics in the pharmaceutical paradigm.
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Affiliation(s)
- Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria, 40138 Cagliari, Italy
| | - Mahesh Maindarkar
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA
- School of Bioengineering Research and Sciences, Maharashtra Institute of Technology's Art, Design and Technology University, 412021 Pune, India
| | - Narendra N Khanna
- Department of Cardiology, Indraprastha APOLLO Hospitals, 110001 New Delhi, India
| | - Amer M Johri
- Department of Medicine, Division of Cardiology, Queen's University, Kingston, ON K7L 1C2, Canada
| | - Laura Mantella
- Department of Medicine, Division of Cardiology, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - John R Laird
- Heart and Vascular Institute, Adventist Health St. Helena, St Helena, CA 94574, USA
| | - Kosmas I Paraskevas
- Department of Vascular Surgery, Central Clinic of Athens, 11526 Athens, Greece
| | - Zoltan Ruzsa
- Invasive Cardiology Division, University of Szeged, 6725 Szeged, Hungary
| | - Manudeep K Kalra
- Department of Radiology, Harvard Medical School, Boston, MA 02118, USA
| | | | - Seemant Chaturvedi
- Department of Neurology & Stroke Program, University of Maryland, Baltimore, MD 21201, USA
| | - Andrew Nicolaides
- Vascular Screening and Diagnostic Centre and University of Nicosia Medical School, 2368 Agios Dometios, Cyprus
| | - Vijay Rathore
- Nephrology Department, Kaiser Permanente, Sacramento, CA 95823, USA
| | - Narpinder Singh
- Department of Food Science and Technology, Graphic Era Deemed to be University, Dehradun, 248002 Uttarakhand, India
| | - Mostafa M Fouda
- Department of Electrical and Computer Engineering, Idaho State University, Pocatello, ID 83209, USA
| | - Esma R Isenovic
- Department of Radiobiology and Molecular Genetics, National Institute of The Republic of Serbia, University of Belgrade, 11001 Belgrade, Serbia
| | - Mustafa Al-Maini
- Allergy, Clinical Immunology and Rheumatology Institute, Toronto, ON L4Z 4C4, Canada
| | | | - Jasjit S Suri
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA
- Department of Computer Engineering, Graphic Era Deemed to be University, 248002 Dehradun, India
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15
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Otite FO, Patel SD, Anikpezie N, Hoffman H, Beutler T, Akano EO, Aneni E, Lamikanra O, Osondu C, Wee C, Burke D, Albright KC, Latorre JG, Mejico L, Khandelwal P, Chaturvedi S. Demographic Disparities in the Incidence, Clinical Characteristics, and Outcome of Posterior Reversible Encephalopathy Syndrome in the United States. Neurology 2023; 101:e1554-e1559. [PMID: 37487751 PMCID: PMC10585693 DOI: 10.1212/wnl.0000000000207604] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 05/16/2023] [Indexed: 07/26/2023] Open
Abstract
OBJECTIVES To estimate age-specific, sex-specific, and race-specific incidence of posterior reversible encephalopathy syndrome (PRES) in the United States. METHODS We conducted a retrospective cohort study using the State Inpatient Database of Florida (2016-2019), Maryland (2016-2019), and New York (2016-2018). All new cases of PRES in adults (18 years or older) were combined with Census data to compute incidence. We evaluated the generalizability of incident estimates to the entire country using the 2016-2019 National Readmissions Database (NRD). RESULTS Across the study period, there were 3,716 incident hospitalizations for PRES in the selected states. The age-standardized and sex-standardized incidence of PRES was 2.7 (95% CI 2.5-2.8) cases/100,000/y. Incidence in female patients was >2 times that of male patients (3.7 vs 1.6 cases/100,000/y, p < 0.001). Incidence increased with age in both sexes (p-trend <0.001). Similar demographic distribution of first hospitalization for PRES was also noted in the entire country using the NRD. Age-standardized and sex-standardized PRES incidence in Black patients (4.2/100,000/y) was significantly greater than in Non-Hispanic White (2.7/100,000/y) and Hispanic patients (1.2/100,000/y) (p < 0.001 for pairwise comparisons). DISCUSSION The incidence of PRES in the United States is approximately 3/100,000/y, but incidence in female patients is >2 times that of male patients. PRES incidence is higher in Black compared with non-Hispanic White and Hispanic patients.
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Affiliation(s)
- Fadar Oliver Otite
- From the Department of Neurology (F.O.O., C.W., D.B., K.C.A., J.G.L., L.M.), SUNY Upstate Medical University, Syracuse, NY; Department of Neurosurgery (S.D.P.), University of Connecticut, Hartford; Department of Population Health (N.A.), University of Mississippi Medical Center, Jackson, MS; Department of Neurosurgery (H.H., T.B.), SUNY Upstate Medical University, Syracuse, NY; Molecular Neuropharmacological Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Section of Cardiovascular Medicine (E.A.), Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Department of Critical Care (O.L.), Springfield Clinic, IL; Baptist Health South Florida (C.O.), Miami; Departments of Neurology and Neurosurgery (P.K.), Rutgers University, Newark, NJ; and Department of Neurology (S.C.), University of Maryland, Baltimore.
| | - Smit D Patel
- From the Department of Neurology (F.O.O., C.W., D.B., K.C.A., J.G.L., L.M.), SUNY Upstate Medical University, Syracuse, NY; Department of Neurosurgery (S.D.P.), University of Connecticut, Hartford; Department of Population Health (N.A.), University of Mississippi Medical Center, Jackson, MS; Department of Neurosurgery (H.H., T.B.), SUNY Upstate Medical University, Syracuse, NY; Molecular Neuropharmacological Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Section of Cardiovascular Medicine (E.A.), Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Department of Critical Care (O.L.), Springfield Clinic, IL; Baptist Health South Florida (C.O.), Miami; Departments of Neurology and Neurosurgery (P.K.), Rutgers University, Newark, NJ; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Nnabuchi Anikpezie
- From the Department of Neurology (F.O.O., C.W., D.B., K.C.A., J.G.L., L.M.), SUNY Upstate Medical University, Syracuse, NY; Department of Neurosurgery (S.D.P.), University of Connecticut, Hartford; Department of Population Health (N.A.), University of Mississippi Medical Center, Jackson, MS; Department of Neurosurgery (H.H., T.B.), SUNY Upstate Medical University, Syracuse, NY; Molecular Neuropharmacological Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Section of Cardiovascular Medicine (E.A.), Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Department of Critical Care (O.L.), Springfield Clinic, IL; Baptist Health South Florida (C.O.), Miami; Departments of Neurology and Neurosurgery (P.K.), Rutgers University, Newark, NJ; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Haydn Hoffman
- From the Department of Neurology (F.O.O., C.W., D.B., K.C.A., J.G.L., L.M.), SUNY Upstate Medical University, Syracuse, NY; Department of Neurosurgery (S.D.P.), University of Connecticut, Hartford; Department of Population Health (N.A.), University of Mississippi Medical Center, Jackson, MS; Department of Neurosurgery (H.H., T.B.), SUNY Upstate Medical University, Syracuse, NY; Molecular Neuropharmacological Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Section of Cardiovascular Medicine (E.A.), Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Department of Critical Care (O.L.), Springfield Clinic, IL; Baptist Health South Florida (C.O.), Miami; Departments of Neurology and Neurosurgery (P.K.), Rutgers University, Newark, NJ; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Timothy Beutler
- From the Department of Neurology (F.O.O., C.W., D.B., K.C.A., J.G.L., L.M.), SUNY Upstate Medical University, Syracuse, NY; Department of Neurosurgery (S.D.P.), University of Connecticut, Hartford; Department of Population Health (N.A.), University of Mississippi Medical Center, Jackson, MS; Department of Neurosurgery (H.H., T.B.), SUNY Upstate Medical University, Syracuse, NY; Molecular Neuropharmacological Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Section of Cardiovascular Medicine (E.A.), Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Department of Critical Care (O.L.), Springfield Clinic, IL; Baptist Health South Florida (C.O.), Miami; Departments of Neurology and Neurosurgery (P.K.), Rutgers University, Newark, NJ; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Emmanuel Oladele Akano
- From the Department of Neurology (F.O.O., C.W., D.B., K.C.A., J.G.L., L.M.), SUNY Upstate Medical University, Syracuse, NY; Department of Neurosurgery (S.D.P.), University of Connecticut, Hartford; Department of Population Health (N.A.), University of Mississippi Medical Center, Jackson, MS; Department of Neurosurgery (H.H., T.B.), SUNY Upstate Medical University, Syracuse, NY; Molecular Neuropharmacological Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Section of Cardiovascular Medicine (E.A.), Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Department of Critical Care (O.L.), Springfield Clinic, IL; Baptist Health South Florida (C.O.), Miami; Departments of Neurology and Neurosurgery (P.K.), Rutgers University, Newark, NJ; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Ehimen Aneni
- From the Department of Neurology (F.O.O., C.W., D.B., K.C.A., J.G.L., L.M.), SUNY Upstate Medical University, Syracuse, NY; Department of Neurosurgery (S.D.P.), University of Connecticut, Hartford; Department of Population Health (N.A.), University of Mississippi Medical Center, Jackson, MS; Department of Neurosurgery (H.H., T.B.), SUNY Upstate Medical University, Syracuse, NY; Molecular Neuropharmacological Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Section of Cardiovascular Medicine (E.A.), Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Department of Critical Care (O.L.), Springfield Clinic, IL; Baptist Health South Florida (C.O.), Miami; Departments of Neurology and Neurosurgery (P.K.), Rutgers University, Newark, NJ; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Oluwatomi Lamikanra
- From the Department of Neurology (F.O.O., C.W., D.B., K.C.A., J.G.L., L.M.), SUNY Upstate Medical University, Syracuse, NY; Department of Neurosurgery (S.D.P.), University of Connecticut, Hartford; Department of Population Health (N.A.), University of Mississippi Medical Center, Jackson, MS; Department of Neurosurgery (H.H., T.B.), SUNY Upstate Medical University, Syracuse, NY; Molecular Neuropharmacological Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Section of Cardiovascular Medicine (E.A.), Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Department of Critical Care (O.L.), Springfield Clinic, IL; Baptist Health South Florida (C.O.), Miami; Departments of Neurology and Neurosurgery (P.K.), Rutgers University, Newark, NJ; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Chukwuemeka Osondu
- From the Department of Neurology (F.O.O., C.W., D.B., K.C.A., J.G.L., L.M.), SUNY Upstate Medical University, Syracuse, NY; Department of Neurosurgery (S.D.P.), University of Connecticut, Hartford; Department of Population Health (N.A.), University of Mississippi Medical Center, Jackson, MS; Department of Neurosurgery (H.H., T.B.), SUNY Upstate Medical University, Syracuse, NY; Molecular Neuropharmacological Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Section of Cardiovascular Medicine (E.A.), Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Department of Critical Care (O.L.), Springfield Clinic, IL; Baptist Health South Florida (C.O.), Miami; Departments of Neurology and Neurosurgery (P.K.), Rutgers University, Newark, NJ; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Claribel Wee
- From the Department of Neurology (F.O.O., C.W., D.B., K.C.A., J.G.L., L.M.), SUNY Upstate Medical University, Syracuse, NY; Department of Neurosurgery (S.D.P.), University of Connecticut, Hartford; Department of Population Health (N.A.), University of Mississippi Medical Center, Jackson, MS; Department of Neurosurgery (H.H., T.B.), SUNY Upstate Medical University, Syracuse, NY; Molecular Neuropharmacological Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Section of Cardiovascular Medicine (E.A.), Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Department of Critical Care (O.L.), Springfield Clinic, IL; Baptist Health South Florida (C.O.), Miami; Departments of Neurology and Neurosurgery (P.K.), Rutgers University, Newark, NJ; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Devin Burke
- From the Department of Neurology (F.O.O., C.W., D.B., K.C.A., J.G.L., L.M.), SUNY Upstate Medical University, Syracuse, NY; Department of Neurosurgery (S.D.P.), University of Connecticut, Hartford; Department of Population Health (N.A.), University of Mississippi Medical Center, Jackson, MS; Department of Neurosurgery (H.H., T.B.), SUNY Upstate Medical University, Syracuse, NY; Molecular Neuropharmacological Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Section of Cardiovascular Medicine (E.A.), Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Department of Critical Care (O.L.), Springfield Clinic, IL; Baptist Health South Florida (C.O.), Miami; Departments of Neurology and Neurosurgery (P.K.), Rutgers University, Newark, NJ; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Karen C Albright
- From the Department of Neurology (F.O.O., C.W., D.B., K.C.A., J.G.L., L.M.), SUNY Upstate Medical University, Syracuse, NY; Department of Neurosurgery (S.D.P.), University of Connecticut, Hartford; Department of Population Health (N.A.), University of Mississippi Medical Center, Jackson, MS; Department of Neurosurgery (H.H., T.B.), SUNY Upstate Medical University, Syracuse, NY; Molecular Neuropharmacological Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Section of Cardiovascular Medicine (E.A.), Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Department of Critical Care (O.L.), Springfield Clinic, IL; Baptist Health South Florida (C.O.), Miami; Departments of Neurology and Neurosurgery (P.K.), Rutgers University, Newark, NJ; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Julius G Latorre
- From the Department of Neurology (F.O.O., C.W., D.B., K.C.A., J.G.L., L.M.), SUNY Upstate Medical University, Syracuse, NY; Department of Neurosurgery (S.D.P.), University of Connecticut, Hartford; Department of Population Health (N.A.), University of Mississippi Medical Center, Jackson, MS; Department of Neurosurgery (H.H., T.B.), SUNY Upstate Medical University, Syracuse, NY; Molecular Neuropharmacological Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Section of Cardiovascular Medicine (E.A.), Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Department of Critical Care (O.L.), Springfield Clinic, IL; Baptist Health South Florida (C.O.), Miami; Departments of Neurology and Neurosurgery (P.K.), Rutgers University, Newark, NJ; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Luis Mejico
- From the Department of Neurology (F.O.O., C.W., D.B., K.C.A., J.G.L., L.M.), SUNY Upstate Medical University, Syracuse, NY; Department of Neurosurgery (S.D.P.), University of Connecticut, Hartford; Department of Population Health (N.A.), University of Mississippi Medical Center, Jackson, MS; Department of Neurosurgery (H.H., T.B.), SUNY Upstate Medical University, Syracuse, NY; Molecular Neuropharmacological Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Section of Cardiovascular Medicine (E.A.), Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Department of Critical Care (O.L.), Springfield Clinic, IL; Baptist Health South Florida (C.O.), Miami; Departments of Neurology and Neurosurgery (P.K.), Rutgers University, Newark, NJ; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Priyank Khandelwal
- From the Department of Neurology (F.O.O., C.W., D.B., K.C.A., J.G.L., L.M.), SUNY Upstate Medical University, Syracuse, NY; Department of Neurosurgery (S.D.P.), University of Connecticut, Hartford; Department of Population Health (N.A.), University of Mississippi Medical Center, Jackson, MS; Department of Neurosurgery (H.H., T.B.), SUNY Upstate Medical University, Syracuse, NY; Molecular Neuropharmacological Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Section of Cardiovascular Medicine (E.A.), Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Department of Critical Care (O.L.), Springfield Clinic, IL; Baptist Health South Florida (C.O.), Miami; Departments of Neurology and Neurosurgery (P.K.), Rutgers University, Newark, NJ; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Seemant Chaturvedi
- From the Department of Neurology (F.O.O., C.W., D.B., K.C.A., J.G.L., L.M.), SUNY Upstate Medical University, Syracuse, NY; Department of Neurosurgery (S.D.P.), University of Connecticut, Hartford; Department of Population Health (N.A.), University of Mississippi Medical Center, Jackson, MS; Department of Neurosurgery (H.H., T.B.), SUNY Upstate Medical University, Syracuse, NY; Molecular Neuropharmacological Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Section of Cardiovascular Medicine (E.A.), Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Department of Critical Care (O.L.), Springfield Clinic, IL; Baptist Health South Florida (C.O.), Miami; Departments of Neurology and Neurosurgery (P.K.), Rutgers University, Newark, NJ; and Department of Neurology (S.C.), University of Maryland, Baltimore
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16
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Chen H, Ahmad G, Phipps MS, Colasurdo M, Miller TR, Cherian J, Wozniak MA, Tran QK, Gandhi D, Chaturvedi S, Jindal G. Peri-procedural decrease in hemoglobin following mechanical thrombectomy for ischemic stroke. Interv Neuroradiol 2023:15910199231205627. [PMID: 37796790 DOI: 10.1177/15910199231205627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Peri-procedural blood loss and hemodilution occur in patients undergoing mechanical thrombectomy (MT) for ischemic stroke; however, its relationships with thrombectomy passes, procedure times, and clinical outcomes are unknown. METHODS Consecutive patients undergoing MT for anterior circulation large-vessel occlusion ischemic strokes were identified at a Comprehensive Stroke Center. Clinical information, modified treatment in cerebral ischemia (mTICI) scores, and modified Rankin Scores (mRS) at 90 days were prospectively collected from 2012 to 2021. Hemoglobin measurements before and after MTs were collected retrospectively via chart review, and changes were quantified. Patients with new-onset severe anemia (defined as post-MT hemoglobin less than 10g/dL) were identified. Modified Rankin scale (mRS) at 90 days was used to measure clinical outcomes. RESULTS Four-hundred and forty-five patients were identified. Hemoglobin decreased 1.27 ± 1.05 g/dL after MT on average. Greater number of thrombectomy passes and longer procedure times were associated with larger decreases in hemoglobin (p < 0.001 and p = 0.002, respectively). 11.5% (51 of 445) of patients had new-onset severe anemia, and this incidence was significantly higher with more thrombectomy passes (6.4% for one pass, 11.9% for two passes, and 17.4% for three or more passes; p = 0.010). In multivariable analyses, new-onset severe anemia was associated with significantly higher odds of 90-day poor outcomes (mRS 3-6, OR 2.70 [95%CI 1.12-6.51], p = 0.027) and death (OR 2.73 [95%CI 1.06-7.04], p = 0.037) compared to mild post-MT anemia. CONCLUSIONS More thrombectomy passes and longer procedure times were significantly associated with larger peri-procedural decreases in hemoglobin. Patients with new-onset hemoglobin less than 10 g/dL are at risk of poor outcomes.
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Affiliation(s)
- Huanwen Chen
- Division of Interventional Neuroradiology, Department of Radiology, University of Maryland Medical Center, Baltimore, MD, USA
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Ghasan Ahmad
- Division of Interventional Neuroradiology, Department of Radiology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Michael S Phipps
- Department of Neurology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Marco Colasurdo
- Division of Interventional Neuroradiology, Department of Radiology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Timothy R Miller
- Division of Interventional Neuroradiology, Department of Radiology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Jacob Cherian
- Department of Neurosurgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Marcella A Wozniak
- Department of Neurology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Quincy K Tran
- Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Dheeraj Gandhi
- Division of Interventional Neuroradiology, Department of Radiology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Seemant Chaturvedi
- Department of Neurology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Gaurav Jindal
- Division of Interventional Neuroradiology, Department of Radiology, University of Maryland Medical Center, Baltimore, MD, USA
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17
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Chen H, Ahmad G, Colasurdo M, Yarbrough K, Schrier C, Phipps MS, Cronin CA, Mehndiratta P, Cole JW, Wozniak M, Miller TR, Gandhi D, Jindal G, Chaturvedi S. Mildly elevated INR is associated with worse outcomes following mechanical thrombectomy for acute ischemic stroke. J Neurointerv Surg 2023; 15:e117-e122. [PMID: 35961666 PMCID: PMC10593142 DOI: 10.1136/jnis-2022-019283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/01/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Elevated International Normalized Ratio (INR) is a marker of coagulopathy, but its impact on outcomes following mechanical thrombectomy (MT) in patients with stroke is unclear. This study investigates the impact of mild INR elevations on clinical outcomes following MT. METHODS In this retrospective cohort study, consecutive patients with stroke treated with MT were identified from 2015 to 2020 at a Comprehensive Stroke Center. Demographic information, past medical history, INR, National Institutes of Health Stroke Scale score, use of tissue plasminogen activator, and last known normal to arteriotomy time were recorded. Outcome measures included modified Thrombolysis in Cerebral Infarction (mTICI) score, modified Rankin Scale (mRS) score at 90 days, and intracerebral hemorrhage (ICH). Patients were divided into two groups: normal INR (0.8-1.1) and mildly elevated INR (1.2-1.7). RESULTS A total of 489 patients were included for analysis, of which 349 had normal INR and 140 had mildly elevated INR. After multivariable adjustments, mildly elevated INR was associated with lower odds of excellent outcomes (mRS 0-1, OR 0.24, p=0.009), lower odds of functional independence (mRS 0-2, OR 0.38, p=0.038), and higher odds of 90-day mortality (OR 3.45, p=0.018). Elevated INR was not associated with a higher likelihood of ICH, and there were no differences in rates of HI1, HI2, PH1, or PH2 hemorrhagic transformations; however, elevated INR was associated with significantly higher odds of 90-day mortality in patients with ICH (OR 6.22, p=0.024). This effect size was larger than in patients without ICH (OR 3.38, p<0.001). CONCLUSION In patients with stroke treated with MT, mildly elevated INR is associated with worse clinical outcomes after recanalization and may worsen the mortality risk of hemorrhagic transformations.
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Affiliation(s)
- Huanwen Chen
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
- Department of Neurology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Ghasan Ahmad
- Department of Radiology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Marco Colasurdo
- Department of Radiology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Karen Yarbrough
- Department of Neurology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Chad Schrier
- Department of Neurology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Michael S Phipps
- Department of Neurology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Carolyn A Cronin
- Department of Neurology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Prachi Mehndiratta
- Department of Neurology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - John W Cole
- Department of Neurology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Marcella Wozniak
- Department of Neurology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Timothy R Miller
- Department of Radiology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Dheeraj Gandhi
- Department of Radiology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Gaurav Jindal
- Department of Radiology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Seemant Chaturvedi
- Department of Neurology, University of Maryland Medical Center, Baltimore, Maryland, USA
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Khunte M, Chen H, Colasurdo M, Chaturvedi S, Malhotra A, Gandhi D. National Trends of Cerebral Venous Sinus Stenting for the Treatment of Idiopathic Intracranial Hypertension. Neurology 2023; 101:402-406. [PMID: 36990721 PMCID: PMC10501094 DOI: 10.1212/wnl.0000000000207245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/16/2023] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVES Cerebral venous sinus stenting (VSS) has emerged as a new surgical procedure for the treatment of severe idiopathic intracranial hypertension (IIH), and its popularity has been anecdotally on the rise. This study explores recent temporal trends of VSS and other surgical IIH treatments in the United States. METHODS Adult patients with IIH were identified from the 2016-2020 National Inpatient Sample databases, and surgical procedures and hospital characteristics were recorded. Temporal trends of procedure numbers for VSS, CSF shunts, and optic nerve sheath fenestrations (ONSFs) were assessed and compared. RESULTS A total of 46,065 (95% CI 44,710-47,420) patients with IIH were identified, of whom 7,535 patients (95% CI 6,982-8,088) received surgical IIH treatments. VSS procedures increased 80% (150 [95% CI 55-245] to 270 [95% CI 162-378] per year, p < 0.001). Concurrently, the number of CSF shunts decreased by 19% (1,365 [95% CI 1,126-1,604] to 1,105 [95% CI 900-1,310] per year, p < 0.001), and ONSF procedures decreased by 54% (65 [95% CI 20-110] to 30 [95% CI 6-54] per year, p < 0.001). DISCUSSION Practice patterns for surgical IIH treatment in the United States are rapidly evolving, and VSS is becoming increasingly common. These findings highlight the urgency of randomized controlled trials to investigate the comparative effectiveness and safety of VSS, CSF shunts, ONSF, and standard medical treatments.
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Affiliation(s)
- Mihir Khunte
- From the Warren Alpert Medical School (M.K.), Brown University, Providence, RI; Department of Radiology and Biomedical Imaging (M.K., A.M.), Yale University, New Haven, CT; National Institute of Neurological Disorders and Stroke (H.C.), NIH, Bethesda, MD; Division of Interventional Neuroradiology (H.C., M.C., D.G.), Department of Radiology, University of Maryland Medical Center, Baltimore; Department of Neurology (H.C.), Georgetown University Hospital, Washington, DC; and Department of Neurology (S.C., D.G.), and Department of Neurosurgery (D.G.), University of Maryland Medical Center, Baltimore
| | - Huanwen Chen
- From the Warren Alpert Medical School (M.K.), Brown University, Providence, RI; Department of Radiology and Biomedical Imaging (M.K., A.M.), Yale University, New Haven, CT; National Institute of Neurological Disorders and Stroke (H.C.), NIH, Bethesda, MD; Division of Interventional Neuroradiology (H.C., M.C., D.G.), Department of Radiology, University of Maryland Medical Center, Baltimore; Department of Neurology (H.C.), Georgetown University Hospital, Washington, DC; and Department of Neurology (S.C., D.G.), and Department of Neurosurgery (D.G.), University of Maryland Medical Center, Baltimore
| | - Marco Colasurdo
- From the Warren Alpert Medical School (M.K.), Brown University, Providence, RI; Department of Radiology and Biomedical Imaging (M.K., A.M.), Yale University, New Haven, CT; National Institute of Neurological Disorders and Stroke (H.C.), NIH, Bethesda, MD; Division of Interventional Neuroradiology (H.C., M.C., D.G.), Department of Radiology, University of Maryland Medical Center, Baltimore; Department of Neurology (H.C.), Georgetown University Hospital, Washington, DC; and Department of Neurology (S.C., D.G.), and Department of Neurosurgery (D.G.), University of Maryland Medical Center, Baltimore
| | - Seemant Chaturvedi
- From the Warren Alpert Medical School (M.K.), Brown University, Providence, RI; Department of Radiology and Biomedical Imaging (M.K., A.M.), Yale University, New Haven, CT; National Institute of Neurological Disorders and Stroke (H.C.), NIH, Bethesda, MD; Division of Interventional Neuroradiology (H.C., M.C., D.G.), Department of Radiology, University of Maryland Medical Center, Baltimore; Department of Neurology (H.C.), Georgetown University Hospital, Washington, DC; and Department of Neurology (S.C., D.G.), and Department of Neurosurgery (D.G.), University of Maryland Medical Center, Baltimore
| | - Ajay Malhotra
- From the Warren Alpert Medical School (M.K.), Brown University, Providence, RI; Department of Radiology and Biomedical Imaging (M.K., A.M.), Yale University, New Haven, CT; National Institute of Neurological Disorders and Stroke (H.C.), NIH, Bethesda, MD; Division of Interventional Neuroradiology (H.C., M.C., D.G.), Department of Radiology, University of Maryland Medical Center, Baltimore; Department of Neurology (H.C.), Georgetown University Hospital, Washington, DC; and Department of Neurology (S.C., D.G.), and Department of Neurosurgery (D.G.), University of Maryland Medical Center, Baltimore
| | - Dheeraj Gandhi
- From the Warren Alpert Medical School (M.K.), Brown University, Providence, RI; Department of Radiology and Biomedical Imaging (M.K., A.M.), Yale University, New Haven, CT; National Institute of Neurological Disorders and Stroke (H.C.), NIH, Bethesda, MD; Division of Interventional Neuroradiology (H.C., M.C., D.G.), Department of Radiology, University of Maryland Medical Center, Baltimore; Department of Neurology (H.C.), Georgetown University Hospital, Washington, DC; and Department of Neurology (S.C., D.G.), and Department of Neurosurgery (D.G.), University of Maryland Medical Center, Baltimore.
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19
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Chaturvedi S, Simard JM. Extracranial-Intracranial Bypass Surgery for Stroke Prevention. JAMA 2023; 330:697-698. [PMID: 37606685 DOI: 10.1001/jama.2023.11166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Affiliation(s)
- Seemant Chaturvedi
- Department of Neurology & Stroke Program, University of Maryland School of Medicine, Baltimore
| | - J Marc Simard
- Department of Neurological Surgery, University of Maryland School of Medicine, Baltimore
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20
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Bhagawati M, Paul S, Agarwal S, Protogeron A, Sfikakis PP, Kitas GD, Khanna NN, Ruzsa Z, Sharma AM, Tomazu O, Turk M, Faa G, Tsoulfas G, Laird JR, Rathore V, Johri AM, Viskovic K, Kalra M, Balestrieri A, Nicolaides A, Singh IM, Chaturvedi S, Paraskevas KI, Fouda MM, Saba L, Suri JS. Cardiovascular disease/stroke risk stratification in deep learning framework: a review. Cardiovasc Diagn Ther 2023; 13:557-598. [PMID: 37405023 PMCID: PMC10315429 DOI: 10.21037/cdt-22-438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 05/17/2023] [Indexed: 07/06/2023]
Abstract
The global mortality rate is known to be the highest due to cardiovascular disease (CVD). Thus, preventive, and early CVD risk identification in a non-invasive manner is vital as healthcare cost is increasing day by day. Conventional methods for risk prediction of CVD lack robustness due to the non-linear relationship between risk factors and cardiovascular events in multi-ethnic cohorts. Few recently proposed machine learning-based risk stratification reviews without deep learning (DL) integration. The proposed study focuses on CVD risk stratification by the use of techniques mainly solo deep learning (SDL) and hybrid deep learning (HDL). Using a PRISMA model, 286 DL-based CVD studies were selected and analyzed. The databases included were Science Direct, IEEE Xplore, PubMed, and Google Scholar. This review is focused on different SDL and HDL architectures, their characteristics, applications, scientific and clinical validation, along with plaque tissue characterization for CVD/stroke risk stratification. Since signal processing methods are also crucial, the study further briefly presented Electrocardiogram (ECG)-based solutions. Finally, the study presented the risk due to bias in AI systems. The risk of bias tools used were (I) ranking method (RBS), (II) region-based map (RBM), (III) radial bias area (RBA), (IV) prediction model risk of bias assessment tool (PROBAST), and (V) risk of bias in non-randomized studies-of interventions (ROBINS-I). The surrogate carotid ultrasound image was mostly used in the UNet-based DL framework for arterial wall segmentation. Ground truth (GT) selection is vital for reducing the risk of bias (RoB) for CVD risk stratification. It was observed that the convolutional neural network (CNN) algorithms were widely used since the feature extraction process was automated. The ensemble-based DL techniques for risk stratification in CVD are likely to supersede the SDL and HDL paradigms. Due to the reliability, high accuracy, and faster execution on dedicated hardware, these DL methods for CVD risk assessment are powerful and promising. The risk of bias in DL methods can be best reduced by considering multicentre data collection and clinical evaluation.
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Affiliation(s)
- Mrinalini Bhagawati
- Department of Biomedical Engineering, North-Eastern Hill University, Shillong, India
| | - Sudip Paul
- Department of Biomedical Engineering, North-Eastern Hill University, Shillong, India
| | - Sushant Agarwal
- Advanced Knowledge Engineering Centre, GBTI, Roseville, CA, USA
- Department of Computer Science Engineering, PSIT, Kanpur, India
| | - Athanasios Protogeron
- Department of Cardiovascular Prevention & Research Unit Clinic & Laboratory of Pathophysiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros P. Sfikakis
- Rheumatology Unit, National Kapodistrian University of Athens, Athens, Greece
| | - George D. Kitas
- Arthritis Research UK Centre for Epidemiology, Manchester University, Manchester, UK
| | - Narendra N. Khanna
- Department of Cardiology, Indraprastha APOLLO Hospitals, New Delhi, India
| | | | - Aditya M. Sharma
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA, USA
| | - Omerzu Tomazu
- Department of Neurology, University Medical Centre Maribor, Maribor, Slovenia
| | - Monika Turk
- The Hanse-Wissenschaftskolleg Institute for Advanced Study, Delmenhorst, Germany
| | - Gavino Faa
- Department of Pathology, A.O.U., di Cagliari -Polo di Monserrato s.s, Cagliari, Italy
| | - George Tsoulfas
- Aristoteleion University of Thessaloniki, Thessaloniki, Greece
| | - John R. Laird
- Cardiology Department, St. Helena Hospital, St. Helena, CA, USA
| | - Vijay Rathore
- Nephrology Department, Kaiser Permanente, Sacramento, CA, USA
| | - Amer M. Johri
- Department of Medicine, Division of Cardiology, Queen’s University, Kingston, Canada
| | | | - Manudeep Kalra
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Antonella Balestrieri
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), Cagliari, Italy
| | - Andrew Nicolaides
- Vascular Screening and Diagnostic Centre, University of Nicosia Medical School, Nicosia, Cyprus
| | - Inder M. Singh
- Stroke Diagnostic and Monitoring Division, AtheroPoint™, Roseville, CA, USA
| | - Seemant Chaturvedi
- Department of Neurology & Stroke Program, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kosmas I. Paraskevas
- Department of Vascular Surgery, Central Clinic of Athens, N. Iraklio, Athens, Greece
| | | | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), Cagliari, Italy
| | - Jasjit S. Suri
- Stroke Diagnostic and Monitoring Division, AtheroPoint™, Roseville, CA, USA
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21
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Nathani K, Ciriello J, Chaturvedi S. Rare Sighting: Enlarged Anterior Spinal Artery Providing Collateral Blood Flow to the Basilar Artery. J Clin Neurosci 2023; 114:89-92. [PMID: 37329665 DOI: 10.1016/j.jocn.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/05/2023] [Accepted: 06/09/2023] [Indexed: 06/19/2023]
Affiliation(s)
- Karan Nathani
- University of Maryland School of Medicine, Department of Neurology, 110 S. Paca St, Baltimore, MD 21201, United States.
| | - Jonathan Ciriello
- University of Maryland School of Medicine, Department of Neurology, 110 S. Paca St, Baltimore, MD 21201, United States
| | - Seemant Chaturvedi
- University of Maryland School of Medicine, Department of Neurology, 110 S. Paca St, Baltimore, MD 21201, United States
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22
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Kalasapudi L, Williamson S, Shipper A, Motta M, Esenwa C, Otite FO, Chaturvedi S, Morris N. Scoping Review of Racial, Ethnic, and Sex Disparities in the Diagnosis and Management of Hemorrhagic Stroke. Neurology 2023:WNL.0000000000207406. [PMID: 37202159 PMCID: PMC10382273 DOI: 10.1212/wnl.0000000000207406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 03/28/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND AND OBJECTIVES In the United States, Black, Hispanic, and Asian Americans suffer from excessively high incidence rates of hemorrhagic stroke compared to White Americans. Women suffer from higher rates of subarachnoid hemorrhage than men. Previous reviews detailing racial, ethnic, and sex disparities in stroke have focused on ischemic stroke. We performed a scoping review of disparities in the diagnosis and management of hemorrhagic stroke in the United States to identify areas of disparities, research gaps, and evidence to inform efforts aimed at health equity. METHODS We included studies published after 2010 that assessed racial and ethnic or sex disparities in the diagnosis or management of patients 18 years or older in the United States with a primary diagnosis of spontaneous intracerebral hemorrhage or aneurysmal subarachnoid hemorrhage. We did not include studies assessing disparities in incidence, risks, or mortality and functional outcomes of hemorrhagic stroke. RESULTS After reviewing 6161 abstracts and 441 full texts, 59 studies met our inclusion criteria. Four themes emerged. First, few data address disparities in acute hemorrhagic stroke. Second, racial and ethnic disparities in blood pressure control following intracerebral hemorrhage exist and likely contribute to disparities in recurrence rates. Third, racial and ethnic differences in end-of-life-care exist, but further work is required to understand whether these differences represent true disparities in care. Fourth, very few studies specifically address sex disparities in hemorrhagic stroke care. DISCUSSION Further efforts are necessary to delineate and correct racial, ethnic, and sex disparities in the diagnosis and management of hemorrhagic stroke.
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Affiliation(s)
- Lakshman Kalasapudi
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Stacey Williamson
- Department of Neurology, Henry Ford Health System, Detroit, Michigan, USA
| | - Andrea Shipper
- Health Sciences and Human Services Library, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Melissa Motta
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Program in Trauma, Shock Trauma Hospital, Baltimore, Maryland, USA
| | - Charles Esenwa
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Fadar Oliver Otite
- Department of Neurology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Seemant Chaturvedi
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Nicholas Morris
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
- Program in Trauma, Shock Trauma Hospital, Baltimore, Maryland, USA
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23
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Morris NA, Jindal G, Chaturvedi S. Intensive Blood Pressure Control After Mechanical Thrombectomy for Acute Ischemic Stroke. Stroke 2023; 54:1457-1461. [PMID: 37021566 DOI: 10.1161/strokeaha.122.041949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Optimal blood pressure targets following successful mechanical thrombectomy remain uncertain. While some observational studies suggest that the relationship between blood pressure and outcomes follows a U-shaped curve, others suggest a linear relationship where lower is better. The recent BP-TARGET study (Blood Pressure Target in Acute Stroke to Reduce Hemorrhage After Endovascular Therapy) did not find a benefit to intensive blood pressure lowering regarding the risk of symptomatic intracranial hemorrhage, but it was not sufficiently powered to detect differences in functional outcomes. On its heels arrived the ENCHANTED2 (Enhanced Control of Hypertension and Thrombectomy Stroke Study)/mechanical thrombectomy trial, the first trial of intensive blood pressure lowering in patients with hypertension following successful mechanical thrombectomy powered to detect a difference in functional outcomes. The trial randomized patients to either a systolic blood pressure less than 120 or 140 to 180 mm Hg. The trial was terminated early due to safety concerns in the more intensive blood pressure-lowering group. In this emerging therapy critique, we explore concerns regarding the generalizability of ENCHANTED2/mechanical thrombectomy, including the high prevalence of intracranial atherosclerosis in the studied population. We survey mechanisms for poor outcomes in patients who receive overly aggressive blood pressure reduction following successful thrombectomy, such as poststroke autoregulatory compromise and persistent microcirculatory hypoperfusion. Finally, we advocate for a more moderate approach, pending further research.
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Affiliation(s)
- Nicholas A Morris
- Department of Neurology (N.A.M., S.C.), University of Maryland School of Medicine, Baltimore
- Program in Trauma, R Adams Cowley Shock Trauma Hospital, Baltimore, MD (N.A.M.)
| | - Gaurav Jindal
- Department of Radiology, Division of Interventional Neuroradiology (G.J.), University of Maryland School of Medicine, Baltimore
| | - Seemant Chaturvedi
- Department of Neurology (N.A.M., S.C.), University of Maryland School of Medicine, Baltimore
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24
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Kaur N, Patel S, Ayanbadejo MO, Hoffman H, Akano E, Anikpezie N, Aneni E, Lamikanra O, Wee C, Albright K, Khandelwal P, Latorre JG, Chaturvedi S, Otite FO. Age-specific trends in intravenous thrombolysis and mechanical thrombectomy utilization in acute ischemic stroke in children under age 18. Int J Stroke 2023; 18:469-476. [PMID: 36250237 DOI: 10.1177/17474930221127538] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate current trends in the utilization of intravenous thrombolysis (IV-tPA) and mechanical thrombectomy (MT) in acute ischemic stroke (AIS) in various age groups of children in the United States. METHODS We conducted a serial cross-sectional study using primary AIS admissions in children ⩽ 17 years (weighted n = 2807) contained in the 2009-2019 KIDS Inpatient Database. Age-specific utilization frequency of IV-tPA and MT were calculated. Multivariable-adjusted models were used to evaluate demographic predictors of treatment. RESULTS From 2009 to 2019, there were 2807 AIS admissions in children in the KID of which 55.9% were in boys and 29.9% were 15-17 years old.128 (4.6%) received IV-tPA. IV-tPA utilization differed by age (5-9 years: 3.1%, 15-17 years 8.1% p value < 0.001). Overall MT usage was 2.3% and this also varied by age (1-4 years: 0.9% and 15-17years 4.0%, p value = 0.006). IV-tPA utilization almost tripled across the study period (2.5% 2009 to 6.5% in 2019, p value = 0.001) while MT use more than doubled over time (1.2% in 2009 and 3.0% in 2019, p value = 0.048). Increased IV-tPA utilization was seen primarily in children 10-14 years (0.8% in 2009 to 7.2% 2019, p value = 0.005) and 15-17 years (5.4% in 2009 to 10.4% in 2019, p value = 0.045). Utilization in younger age groups remained unchanged over time. MT usage was very variable across various age groups over time. IV-tPA and MT utilization increased over time in nonchildren's hospitals (both p values < 0.05) but usage in designated children's hospitals did not change significantly over time. In multivariable models, there was no significant difference in odds of IV-tPA and MT use by sex, race or insurance status. CONCLUSION IV-tPA and MT utilization in pediatric AIS increased in the United States over the past decade mainly in older children 10-17 years. Utilization increased mainly in patients hospitalized in nonchildren's hospitals. Usage in children's hospitals did not change significantly over time.
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Affiliation(s)
- Navreet Kaur
- Department of Neurology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Smit Patel
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Haydn Hoffman
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Emmanuel Akano
- Molecular Neuropharmacology Unit, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Nnabuchi Anikpezie
- Department of Population Health, University of Mississippi, Jackson, MS, USA
| | - Ehimen Aneni
- Department of Cardiology, Yale University, New Haven, CT, USA
| | | | - Claribel Wee
- Department of Neurology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Karen Albright
- Department of Neurology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Priyank Khandelwal
- Departments of Neurology and Neurosurgery, Rutgers University New Jersey, Newark, NJ, USA
| | | | | | - Fadar Oliver Otite
- Department of Neurology, SUNY Upstate Medical University, Syracuse, NY, USA
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Chaturvedi S. Diagnosis and Management of Large Artery Atherosclerosis. Continuum (Minneap Minn) 2023; 29:486-500. [PMID: 37039406 DOI: 10.1212/con.0000000000001212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVE Ischemic stroke due to large vessel atherosclerosis is a significant cause of stroke globally. With the aging population, the number of people with atherosclerotic stroke will increase in the coming decades. This article reviews the recent developments in the assessment and treatment of extracranial and intracranial atherosclerotic disease. LATEST DEVELOPMENTS More intensive dual antiplatelet therapy can now be recommended for patients with transient ischemic attack or stroke. More stringent blood pressure and lipid control is also advised. The need for carotid revascularization will likely decrease in the coming decades because of advances in multimodal medical therapy; in particular, the role of revascularization for treating asymptomatic carotid stenosis is controversial. Patients with symptomatic intracranial stenosis should receive intensive medical therapy. Interest in high-resolution carotid plaque imaging is growing. ESSENTIAL POINTS The prevention of stroke due to large vessel atherosclerosis has improved owing to advances in medical therapies. The role of carotid revascularization is unclear for many patient subgroups.
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Ahmed R, Mhina C, Philip K, Patel SD, Aneni E, Osondu C, Lamikanra O, Akano EO, Anikpezie N, Albright KC, Latorre JG, Chaturvedi S, Otite FO. Age- and Sex-Specific Trends in Medical Complications After Acute Ischemic Stroke in the United States. Neurology 2023; 100:e1282-e1295. [PMID: 36599695 PMCID: PMC10033158 DOI: 10.1212/wnl.0000000000206749] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/15/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To test the hypothesis that the age and sex-specific prevalence of infectious (pneumonia, sepsis, and urinary tract infection [UTI]) and noninfectious (deep venous thrombosis [DVT], pulmonary embolism [PE], acute renal failure [ARF], acute myocardial infarction [AMI], and gastrointestinal bleeding [GIB]) complications increased after acute ischemic stroke (AIS) hospitalization in the United States from 2007 to 2019. METHODS We conducted a serial cross-sectional study using the 2007-2019 National Inpatient Sample. Primary AIS admissions in adults (aged 18 years or older) with and without complications were identified using International Classification of Diseases codes. We quantified the age/sex-specific prevalence of complications and used negative binomial regression models to evaluate trends over time. RESULTS Of 5,751,601 weighted admissions, 51.4% were women. 25.1% had at least 1 complication. UTI (11.8%), ARF (10.1%), pneumonia (3.2%), and AMI (2.5%) were the most common complications, while sepsis (1.7%), GIB (1.1%), DVT (1.2%), and PE (0.5%) were the least prevalent. Marked disparity in complication risk existed by age/sex (UTI: men 18-39 years 2.1%; women 80 years or older 22.5%). Prevalence of UTI (12.9%-9.7%) and pneumonia (3.8%-2.7%) declined, but that of ARF increased by ≈3-fold (4.8%-14%) over the period 2007-2019 (all p < 0.001). AMI (1.9%-3.1%), DVT (1.0%-1.4%), and PE (0.3%-0.8%) prevalence also increased (p < 0.001), but that of sepsis and GIB remained unchanged over time. After multivariable adjustment, risk of all complications increased with increasing NIH Stroke Scale (pneumonia: prevalence rate ratio [PRR] 1.03, 95% CI 1.03-1.04, for each unit increase), but IV thrombolysis was associated with a reduced risk of all complications (pneumonia: PRR 0.80, 85% CI 0.73-0.88; AMI: PRR 0.85, 95% CI 0.78-0.92; and DVT PRR 0.87, 95% CI 0.78-0.98). Mechanical thrombectomy was associated with a reduced risk of UTI, sepsis, and ARF, but DVT and PE were more prevalent in MT hospitalizations compared with those without. All complications except UTI were associated with an increased risk of in-hospital mortality (sepsis: PRR 1.97, 95% CI 1.78-2.19). DISCUSSION Infectious complications declined, but noninfectious complications increased after AIS admissions in the United States in the last decade. Utilization of IV thrombolysis is associated with a reduced risk of all complications.
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Affiliation(s)
- Rashid Ahmed
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Carl Mhina
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Karan Philip
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Smit D Patel
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Ehimen Aneni
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Chukwuemeka Osondu
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Oluwatomi Lamikanra
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Emmanuel Oladele Akano
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Nnabuchi Anikpezie
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Karen C Albright
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Julius G Latorre
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Seemant Chaturvedi
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Fadar Oliver Otite
- From the Department of Neurology (R.A.), Massachusetts General Hospital/Harvard Medical School, Boston; Department of Population Health Sciences (C.M.), Duke University, Raleigh, NC; Department of Neurology (K.P., K.C.A., J.G.L., F.O.O.), SUNY Upstate Medical University, Syracuse; Department of Neurology (S.D.P.), University of California Los Angeles; Department of Cardiology (E.A.), Yale University, New Haven, CT; Baptist Health South Florida (C.O.), Miami; Department of Critical Care (O.L.), Springfield Clinic, Springfield, IL; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; and Department of Neurology (S.C.), University of Maryland, Baltimore.
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Chaturvedi S. Transcarotid Artery Revascularization for Stroke Prevention-Multiple Elephants in the Room. JAMA Neurol 2023; 80:435-436. [PMID: 36939735 DOI: 10.1001/jamaneurol.2023.0293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Affiliation(s)
- Seemant Chaturvedi
- Department of Neurology and Stroke Program, University of Maryland School of Medicine, Baltimore
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Solomonow J, Marks JR, Yarbrough KL, Mehndiratta P, Chaturvedi S. Abstract 43: Is Dual Antiplatelet Therapy Underutilized Following TIA And Minor Stroke? Stroke 2023. [DOI: 10.1161/str.54.suppl_1.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background:
Initiation of dual antiplatelet therapy (DAPT) with aspirin and clopidogrel plays a significant role in the secondary prevention of recurrent acute ischemic events following high risk transient ischemic attack (TIA) and minor acute ischemic stroke (AIS). However, some patients do not receive the same targeted therapy on discharge and are only maintained on single antiplatelet therapy. Our aim was to identify the variations in single vs dual antiplatelet prescribing practices at the time of discharge within a Stroke Clinical Network consisting of nine stroke centers located in rural, suburban, and urban geographical regions.
Methods:
The GWTG registry was queried for all patients >18 years old with a TIA or a minor AIS (admission NIHSS ≤5), who were admitted to a single hospital network between January 2018 and December 2021. Demographics collected including age, race, gender, and BMI. Patients on concurrent anticoagulation were excluded. We evaluated antiplatelet discharge practices at the tertiary stroke center vs the entire network, among men vs. women, African Americans (AA) vs whites, age 18-70 vs >70 years, and across BMI. Chi squared and generalized linear models were used to test significant relationships between subgroups.
Results:
Among 2953 patients with a TIA or minor AIS, the mean age was 67.3 (SD +/- 13.8 years), with 42% >70 years of age. 47.8% were women; 37% were AA and 60% were white. DAPT was prescribed at the time of discharge to 40% of patients overall. Gender was a significant factor with men (43%) more likely to get prescribed DAPT than females (37%) (p=.002). While BMI did not have a lone effect on number of antiplatelets (AP) prescribed, when it was included as a covariate, there was a significant effect on the number of AP prescribed; with the higher the BMI, the less likely patients were to receive DAPT. Differences according to age, race, and effect of whether the patient was discharged from a tertiary center were not significant.
Conclusion:
We identified underutilization of DAPT following TIA and minor stroke across a health system, especially in women. Targeted intervention to increase DAPT use could lead to reduced rate of short-term stroke recurrence.
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Kumar A, Sharma H, Chaturvedi S, Maheshwari R. Innovative technique of reducing rewarm ischemia time in robotic assisted kidney transplant with multiple vessels. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01348-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Chen H, Khunte M, Colasurdo M, Jindal G, Malhotra A, Gandhi D, Chaturvedi S. Associations of Osteoarthritis With Thrombectomy Utilization and Outcomes for Large Vessel Acute Ischemic Stroke. Stroke 2023; 54:518-526. [PMID: 36541211 DOI: 10.1161/strokeaha.122.041749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Osteoarthritis and other musculoskeletal disorders are the leading causes of disability in the United States. While osteoarthritis is not a direct risk factor for stroke, osteoarthritis may impact patient selection for endovascular thrombectomy (EVT) due to prestroke disability. This study investigates associations of osteoarthritis with EVT utilization and outcomes. METHODS This was a large-scale cross-sectional study of the 2016 to 2019 National Inpatient Sample database. Adult patients with anterior large vessel ischemic strokes were identified. Patient demographics, stroke risk factors, stroke etiology, presence of osteoarthritis, medical comorbidities, EVT, intravenous thrombolysis treatments, and discharge destinations were recorded. Primary outcome was the rate of EVT treatment. Secondary outcomes include rates of discharge to home and in-hospital mortality. Propensity score matching and multivariable logistic regression models were used to account for possible confounders. RESULTS Two hundred fifty-two thousand five hundred five patients were identified, of whom 8.5% (21 500 patients) had osteoarthritis. After propensity score matching for 32 clinical variables, osteoarthritis patients were found to be 17.3% less likely to receive EVT than non-osteoarthritis patients (14.4% versus 17.3%, respectively; P<0.001). In multivariable logistic regression analysis, osteoarthritis was associated with 22.6% lower odds of receiving EVT (OR, 0.77 [95% CI, 0.70-0.86]; P<0.001), an effect size larger than any medical comorbidity captured in this study other than dementia and nonstroke neurological disease. Among those treated with EVT, multivariable logistic regression models showed that osteoarthritis was not associated with different odds of being discharged home (OR, 0.99 [95% CI, 0.81-1.21]; P=0.93); however, osteoarthritis was marginally associated with lower odds of in-hospital mortality (OR, 0.74 [95% CI, 0.54-1.01]; P=0.054). CONCLUSIONS Large vessel ischemic stroke patients with osteoarthritis were significantly less likely to receive EVT therapy despite similar post-EVT outcomes. These results warrant further investigation and prompt a critical review of current patient selection practices for stroke EVT therapy, specifically for patients with baseline disability due to musculoskeletal conditions such as osteoarthritis.
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Affiliation(s)
- Huanwen Chen
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda (H.C.).,Department of Neurology, MedStar Georgetown University Hospital, Washington DC (H.C.).,Division of Interventional Neuroradiology, Department of Radiology (H.C., M.C., G.J., D.G.), University of Maryland Medical Center, Baltimore
| | - Mihir Khunte
- Warren Alpert Medical School, Brown University, Providence, RI (M.K.).,Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT (M.K., A.M.)
| | - Marco Colasurdo
- Division of Interventional Neuroradiology, Department of Radiology (H.C., M.C., G.J., D.G.), University of Maryland Medical Center, Baltimore
| | - Gaurav Jindal
- Division of Interventional Neuroradiology, Department of Radiology (H.C., M.C., G.J., D.G.), University of Maryland Medical Center, Baltimore
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT (M.K., A.M.)
| | - Dheeraj Gandhi
- Division of Interventional Neuroradiology, Department of Radiology (H.C., M.C., G.J., D.G.), University of Maryland Medical Center, Baltimore
| | - Seemant Chaturvedi
- Department of Neurology (S.C.), University of Maryland Medical Center, Baltimore
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Arons D, Grimes K, Mehndiratta P, Chaturvedi S. Abstract TP196: Real Life Utility Of PCSK9 Inhibitors Following Ischemic Stroke. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.tp196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Introduction:
Hyperlipidemia is a modifiable risk factor for stroke, with the magnitude of LDL-C reduction correlating to risk of recurrent ischemic stroke. A high-intensity statin is considered standard of care in addition to dietary modification. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are used if the LDL-C target is not achieved despite maximally tolerated statins with ezetimibe. We investigated the role for PCSK9 inhibitors in our ischemic stroke population.
Methods:
An IRB approved retrospective review of patients admitted for acute ischemic stroke between 2019 – 2020 was performed. We estimated the probability of benefit from PCSK9 treatment with the following criteria: LDL > 190 regardless of treatment, LDL 161-190 on any dose statin therapy, and LDL 131-160 on high intensity statin therapy.
Results:
774 patients with ischemic stroke were admitted during this time frame. Mean age 62.8 +/- 13.2 with 57% male (52% Black, 42% White). 584 (75%) of these patients had LDL above goal. One patient was on PCSK9 therapy on admission. Although the majority of our patients had uncontrolled cholesterol, only one additional patient would meet the strict prescription criteria for PCSK9 therapy of being adherent to maximal tolerated statin dose and ezetimibe with LDL above goal. Other potential patients with estimated benefit include LDL >190 (20 patients), LDL 161-190 (16 patients), LDL 131-160 (13 patients). In total this amounts to 6.7% of stroke patients who we would expect to need PCSK9 inhibitors in the future.
Conclusion:
Using conservative projections, we estimate that about 1 in 14 patients with ischemic stroke could benefit from PCSK9 therapy. Achieving LDL targets more consistently is a promising approach to decreasing the recurrent stroke rate. Further prospective data evaluating outcomes after initiating PCSK9 inhibitor treatment are needed to validate these findings.
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Xia C, Hoffman H, Anikpezie N, Philip K, Wee C, Choudhry R, Albright KC, Masoud H, Beutler T, Schmidt E, Gould G, Patel SD, Akano EO, Morris N, Chaturvedi S, Aneni E, Lamikanra O, Chin L, Latorre JG, Otite FO. Trends in the Incidence of Spontaneous Subarachnoid Hemorrhages in the United States, 2007-2017. Neurology 2023; 100:e123-e132. [PMID: 36289004 PMCID: PMC10499430 DOI: 10.1212/wnl.0000000000201340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVE To test the hypothesis that age-specific, sex-specific, and race-specific and ethnicity-specific incidence of nontraumatic subarachnoid hemorrhage (SAH) increased in the United States over the last decade. METHODS In this retrospective cohort study, validated International Classification of Diseases codes were used to identify all new cases of SAH (n = 39,475) in the State Inpatients Databases of New York and Florida (2007-2017). SAH counts were combined with Census data to calculate incidence. Joinpoint regression was used to compute the annual percentage change (APC) in incidence and to compare trends over time between demographic subgroups. RESULTS Across the study period, the average annual age-standardized/sex-standardized incidence of SAH in cases per 100,000 population was 11.4, but incidence was significantly higher in women (13.1) compared with that in men (9.6), p < 0.001. Incidence also increased with age in both sexes (men aged 20-44 years: 3.6; men aged 65 years or older: 22.0). Age-standardized and sex-standardized incidence was greater in Black patients (15.4) compared with that in non-Hispanic White (NHW) patients (9.9) and other races and ethnicities, p < 0.001. On joinpoint regression, incidence increased over time (APC 0.7%, p < 0.001), but most of this increase occurred in men aged 45-64 years (APC 1.1%, p = 0.006), men aged 65 years or older (APC 2.3%, p < 0.001), and women aged 65 years or older (APC 0.7%, p = 0.009). Incidence in women aged 20-44 years declined (APC -0.7%, p = 0.017), while those in other age/sex groups remained unchanged over time. Incidence increased in Black patients (APC 1.8%, p = 0.014), whereas that in Asian, Hispanic, and NHW patients did not change significantly over time. DISCUSSION Nontraumatic SAH incidence in the United States increased over the last decade predominantly in middle-aged men and elderly men and women. Incidence is disproportionately higher and increasing in Black patients, whereas that in other races and ethnicities did not change significantly over time.
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Affiliation(s)
- Christina Xia
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL
| | - Haydn Hoffman
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL
| | - Nnabuchi Anikpezie
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL
| | - Karan Philip
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL
| | - Claribel Wee
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL
| | - Reema Choudhry
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL
| | - Karen C Albright
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL
| | - Hesham Masoud
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL
| | - Timothy Beutler
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL
| | - Elena Schmidt
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL
| | - Grahame Gould
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL
| | - Smit D Patel
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL
| | - Emmanuel Oladele Akano
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL
| | - Nicholas Morris
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL
| | - Seemant Chaturvedi
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL
| | - Ehimen Aneni
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL
| | - Oluwatomi Lamikanra
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL
| | - Lawrence Chin
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL
| | - Julius G Latorre
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL
| | - Fadar Oliver Otite
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL.
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Otite FO, Vanguru H, Anikpezie N, Patel SD, Chaturvedi S. Contemporary Incidence and Burden of Cerebral Venous Sinus Thrombosis in Children of the United States. Stroke 2022; 53:e496-e499. [DOI: 10.1161/strokeaha.122.039822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background:
The incidence of cerebral venous thrombosis (CVT) in children of the United States is unknown, and it is uncertain how the burden of CVT hospitalizations in children changed over the last decade.
Methods:
We conducted a retrospective cohort study using the State Inpatient Database and Kid’s inpatient database. All new CVT cases in children (0–19 years) in the New York 2006 to 2018 State Inpatient Database (n=705), and all cases of CVT in the entire US contained in the 2006 to 2019 Kid’s inpatient database (weighted n=6115) were identified using validated
International Classification of Diseases (ICDs
) codes. Incident counts were combined with census data to compute incidence. Between-group differences in incidence were tested using 2-proportions
Z
-test, and Joinpoint regression was used to trend incidence over time.
Results:
Across the study period, 48.2% of all incident CVT cases and 44.6% of all CVT admissions nationally were in girls. Of all incident cases, 27.2% were infants and 65.8% of these infants were neonates. Average incidence across the study period was (1.1/100 000/year, SE:0.04) but incidence in infants (6.4/100 000/year) was at least 5 times the incidence in other age groups (1–4 years: 0.7/100 000/year, 15–19 years: 1.2/100 000/year). Incidence and national burden of CVT admissions was higher in girls in adolescents 15 to 19 years, but overall burden was higher in boys in other age groups. Age- and sex-standardized CVT incidence increased by 3.8% annually (95% CI, 0.2%–7.6%), while the overall burden of admissions increased by 4.9% annually (95% CI, 3.6%–6.2%).
Conclusions:
CVT incidence in New York and national burden of CVT increased significantly over the last decade.
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Affiliation(s)
- Fadar Oliver Otite
- Department of Neurology, Upstate Medical University, Syracuse, NY (F.O.O.)
| | - Husitha Vanguru
- Department of Neurology, University of Kansas Medical Center, Kansas City (H.V.)
| | - Nnabuchi Anikpezie
- Department of Population Health Science, University of Mississippi Medical Center, Jackson (N.A.)
| | - Smit D. Patel
- Department of Neurology, University of Connecticut (S.D.P.)
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Otite FO, Somani S, Aneni E, Akano E, Patel SD, Anikpezie N, Lamikanra O, Masoud H, Latorre JG, Chaturvedi S, Mehndiratta P. Trends in age and sex-specific prevalence of cancer and cancer subtypes in acute ischemic stroke from 2007-2019. J Stroke Cerebrovasc Dis 2022; 31:106818. [PMID: 36323171 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/29/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To describe age and sex-specific prevalence of cancer in acute ischemic stroke (AIS) hospitalizations in the United States over the last decade. METHODS We conducted a retrospective serial cross-sectional study using all primary AIS discharges (weighted n=5,748,358) with and without cancer in the 2007-2019 National Inpatient Sample. Admissions with primary central nervous system cancers were excluded. Joinpoint regression was used to compute the average annualized percentage change (AAPC) in cancer prevalence over time. RESULTS Across the study period, 12.7% of AIS admissions had previous/active cancer, while 4.4% had active cancer. Of these, 18.8% were hematologic cancers, 47.2% were solid cancers without metastasis and 34.0% were metastatic cancers of any type. Age-adjusted active cancer prevalence differed by sex (males:4.8%; females:4.0%) and increased with age up to age 70-79 years (30-39 years 1.4%; 70-79 years:5.7%). Amongst cancer admissions, lung (18.7%) and prostate (17.8%) were the most common solid cancers in men, while lung (19.6%) and breast (13.7%) were the most prevalent in women. Active cancer prevalence increased over time (AAPC 1.7%, p<0.05) but the pace of increase was significantly faster in women (AAPC 2.8%) compared to men (AAPC 1.1%) (p-comparison =0.003). Fastest pace of increased prevalence was seen for genitourinary cancers in women and for gastrointestinal cancers in both sexes. Genitourinary cancers in men declined over time (AAPC -2.5%, p<0.05). Lung cancer prevalence increased in women (AAPC 1.8%, p<0.05) but remained constant in men. Prevalence of head/neck, skin/bone, gastrointestinal, hematological and metastatic cancers increased over time at similar pace in both sexes. CONCLUSION Prevalence of cancer in AIS admissions increased in the US over the last decade but the pace of this increase was faster in women compared to men. Gastrointestinal cancers in both sexes and genitourinary cancers in women are increasing at the fastest pace. Additional studies are needed to determine whether this increase is from co-occurrence or causation of AIS by cancer.
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Affiliation(s)
- Fadar Oliver Otite
- Department of Neurology, State University of New York, Upstate Medical University, Syracuse, NY, USA.
| | - Sana Somani
- Department of Neurology, Georgetown University School of Medicine, Washington, D.C., USA
| | - Ehimen Aneni
- Department of Cardiology, Yale University, New Haven, Connecticut, USA
| | - Emmanuel Akano
- Molecular Neuropharmacological Unit, National Institute of Neurological Diseases and Stroke, NINDS, Bethesda, Maryland, USA
| | - Smit D Patel
- Department of Neurosurgery, University of Connecticut, Hartford, Connecticut, USA
| | - Nnabuchi Anikpezie
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Hesham Masoud
- Department of Neurology, State University of New York, Upstate Medical University, Syracuse, NY, USA
| | - Julius Gene Latorre
- Department of Neurology, State University of New York, Upstate Medical University, Syracuse, NY, USA
| | - Seemant Chaturvedi
- Department of Neurology, University of Maryland School of Medicine, Baltimore, USA
| | - Prachi Mehndiratta
- Department of Neurology, University of Maryland School of Medicine, Baltimore, USA
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Macy M, Cash T, Pinto N, Pressey J, Szalontay L, Furman W, Bukowinski A, Foster J, Friedman G, HaDuong J, Fox E, Weigel B, Grevel J, Huang F, Phelps C, Childs B, Chung J, Chaturvedi S, Schulz A, DuBois S. Phase I dose-escalation study of the pan-PI3 K inhibitor copanlisib in children and adolescents with relapsed/refractory solid tumors. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)00878-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Kamtchum-Tatuene J, Saba L, Heldner M, Poorthuis MHF, Borst GD, Rundek T, Kakkos S, Chaturvedi S, Topakian R. Parallel Session 3: Acute/Vascular/Trauma| Wed 18 May, 1445 – 1600|4 Circulating Interleukin-6 predicts carotid study. J Neurol Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn2.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background and AimsInterleukin-6 (IL-6) has important roles in atherosclerosis pathophysiology. To determine if anti-IL-6 therapy could be an adjuvant stroke prevention strategy in patients with carotid atherosclerosis, we tested whether circulating IL-6 levels predict carotid plaque severity, vulnerability, and progression in the Cardiovascular Health Study.MethodsCarotid ultrasound was performed at baseline and 5 years. Plaque severity was scored 0 to 5 based on NASCET grade of stenosis. Plaque vulnerability at baseline was the presence of irregular, ulcerated or echolucent plaques. Plaque progression at 5 years was a ≥1 point increase in stenosis severity. Relationship of plasma IL-6 levels with plaque characteristics was modeled using multivariable linear (severity) or logistic (vulnerability and progression) regression. Risk factors of atherosclerosis were included as independent variables.ResultsIn 4334 participants with complete data (58.9% women, 72.7 ± 5.1 years). There were 1267 (29.2%) participants with vulnerable plaque and 1474 (34.0%) with plaque progression. Log IL-6 predicted plaque severity (β = 0.09, p=0.04), vulnerability (OR = 1.22, 95% CI: 1.06-1.40, p=0.006) and progression (OR = 1.44, 95% CI: 1.23-1.69, p<0.001). In participants with >50% probability of progression, mean log IL-6 was 0.54 corresponding to 2.0 pg/mL. Dichotomizing IL-6 levels did not affect performance of regression models.ConclusionsPlasma IL-6 predicts carotid plaque severity, vulnerability, and progression. The 2.0 pg/mL cut-off could help select individuals that would benefit from anti-IL-6 drugs for stroke prevention.
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Mehndiratta P, Ryan KA, Cronin C, Wozniak M, Cole JW, Chaturvedi S, Phipps MS, McArdle P, Kittner S. Differences in Multiple Risk Factors Between Black and White Individuals With Young-Onset Ischemic Stroke. Neurology 2022; 99:e560-e564. [PMID: 35613933 PMCID: PMC9442621 DOI: 10.1212/wnl.0000000000200706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 03/23/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Stroke in young adults constitutes 15%-18% of all ischemic stroke cases. Black individuals have an excess risk of ischemic stroke especially in young adults. Although it is known that Black patients have a higher prevalence of hypertension and diabetes, few studies have addressed the association of concurrent multiple vascular risk factors with the excess risk of early-onset stroke among Black individuals. METHODS A population-based case-control study of early-onset ischemic stroke, ages 15-49 years, was conducted in the Baltimore-Washington DC region between 1992 and 2007. Presence of the risk factors of obesity, hypertension, diabetes, and current smoking were obtained from both cases and controls by an in-person interview. Risk factor groups were defined as (1) 1 risk factor, (2) 2 risk factors, (3) 3 risk factors, and (4) 4 risk factors. Logistic regression analysis adjusting for age and sex was used to evaluate the association between each risk factor group and ischemic stroke compared with the reference group with no risk factors. RESULTS The study included 1,034 cases and 1,091 controls. Of the cases, 47% were Black, 54% were men, and the mean (±SD) age was 41.0 (±6.9) years. The odds of having a stroke increased exponentially as the number of risk factors increased, 2.1, 2.6, 7.6, 16.5, all p < 0.001, for groups 1-4, respectively. When stratified by race, Black individuals were approximately 6 times more likely to have all 4 risk factors. DISCUSSION The risk of stroke in young adults increased exponentially with the number of risk factors. Young Black patients with ischemic stroke were approximately 6 times more likely to have the co-occurrence of obesity, hypertension, diabetes, and smoking compared with their White counterparts. Targeting public health interventions to identify and improve care to Black young adults with multiple stroke risk factors may have substantial impact on lowering risk of stroke.
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Affiliation(s)
- Prachi Mehndiratta
- From the Department of Neurology (P. Mehndiratta, C.C., M.W., J.W.C., S.C., M.S.P., S.K.); Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (K.A.R., P. McArdle); and VA Maryland Health Care System (C.C., M.W., J.W.C., S.C., M.S.P., S.K.), Baltimore, MD.
| | - Kathleen A Ryan
- From the Department of Neurology (P. Mehndiratta, C.C., M.W., J.W.C., S.C., M.S.P., S.K.); Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (K.A.R., P. McArdle); and VA Maryland Health Care System (C.C., M.W., J.W.C., S.C., M.S.P., S.K.), Baltimore, MD
| | - Carolyn Cronin
- From the Department of Neurology (P. Mehndiratta, C.C., M.W., J.W.C., S.C., M.S.P., S.K.); Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (K.A.R., P. McArdle); and VA Maryland Health Care System (C.C., M.W., J.W.C., S.C., M.S.P., S.K.), Baltimore, MD
| | - Marcella Wozniak
- From the Department of Neurology (P. Mehndiratta, C.C., M.W., J.W.C., S.C., M.S.P., S.K.); Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (K.A.R., P. McArdle); and VA Maryland Health Care System (C.C., M.W., J.W.C., S.C., M.S.P., S.K.), Baltimore, MD
| | - John W Cole
- From the Department of Neurology (P. Mehndiratta, C.C., M.W., J.W.C., S.C., M.S.P., S.K.); Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (K.A.R., P. McArdle); and VA Maryland Health Care System (C.C., M.W., J.W.C., S.C., M.S.P., S.K.), Baltimore, MD
| | - Seemant Chaturvedi
- From the Department of Neurology (P. Mehndiratta, C.C., M.W., J.W.C., S.C., M.S.P., S.K.); Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (K.A.R., P. McArdle); and VA Maryland Health Care System (C.C., M.W., J.W.C., S.C., M.S.P., S.K.), Baltimore, MD
| | - Michael S Phipps
- From the Department of Neurology (P. Mehndiratta, C.C., M.W., J.W.C., S.C., M.S.P., S.K.); Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (K.A.R., P. McArdle); and VA Maryland Health Care System (C.C., M.W., J.W.C., S.C., M.S.P., S.K.), Baltimore, MD
| | - Patrick McArdle
- From the Department of Neurology (P. Mehndiratta, C.C., M.W., J.W.C., S.C., M.S.P., S.K.); Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (K.A.R., P. McArdle); and VA Maryland Health Care System (C.C., M.W., J.W.C., S.C., M.S.P., S.K.), Baltimore, MD
| | - Steven Kittner
- From the Department of Neurology (P. Mehndiratta, C.C., M.W., J.W.C., S.C., M.S.P., S.K.); Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (K.A.R., P. McArdle); and VA Maryland Health Care System (C.C., M.W., J.W.C., S.C., M.S.P., S.K.), Baltimore, MD
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Tatuene JK, Saba L, Heldner M, Poorthuis M, De Borst G, Rundek T, Kakkos S, Dichgans M, Chaturvedi S, Topakian R, Polak J, Jickling G. Plasma interleukin-6 predicts carotid plaque severity, vulnerability, and progression in the cardiovascular health study. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Kamtchum-Tatuene J, Saba L, Heldner MR, Poorthuis MHF, Borst GJD, Rundek T, Kakkos SK, Chaturvedi S, Topakian R, Polak JF, Jickling GC. Interleukin-6 Predicts Carotid Plaque Severity, Vulnerability, and Progression. Circ Res 2022; 131:e22-e33. [PMID: 35713008 DOI: 10.1161/circresaha.122.320877] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND IL-6 (interleukin-6) has important roles in atherosclerosis pathophysiology. To determine if anti-IL-6 therapy warrants evaluation as an adjuvant stroke prevention strategy in patients with carotid atherosclerosis, we tested whether circulating IL-6 levels predict carotid plaque severity, vulnerability, and progression in the prospective population-based CHS (Cardiovascular Health Study). METHODS Duplex carotid ultrasound was performed at baseline and 5 years. Baseline plaque severity was scored 0 to 5 based on North American Symptomatic Carotid Endarterectomy Trial grade of stenosis. Plaque vulnerability at baseline was the presence of markedly irregular, ulcerated, or echolucent plaques. Plaque progression at 5 years was a ≥1 point increase in stenosis severity. The relationship of baseline plasma IL-6 levels with plaque characteristics was modeled using multivariable linear (severity) or logistic (vulnerability and progression) regression. Risk factors of atherosclerosis were included as independent variables. Stepwise backward elimination was used with P>0.05 for variable removal. To assess model stability, we computed the E-value or minimum strength of association (odds ratio scale) that unmeasured confounders must have with log IL-6 and the outcome to suppress the association. We performed internal validation with 100 bootstrap samples. RESULTS There were 4334 participants with complete data (58.9% women, mean age: 72.7±5.1 years), including 1267 (29.2%) with vulnerable plaque and 1474 (34.0%) with plaque progression. Log IL-6 predicted plaque severity (β=0.09, P=1.3×10-3), vulnerability (OR, 1.21 [95% CI, 1.05-1.40]; P=7.4×10-3, E-value=1.71), and progression (OR, 1.44 [95% CI, 1.23-1.69], P=9.1×10-6, E-value 2.24). In participants with >50% predicted probability of progression, mean log IL-6 was 0.54 corresponding to 2.0 pg/mL. Dichotomizing IL-6 levels did not affect the performance of prediction models. CONCLUSIONS Circulating IL-6 predicts carotid plaque severity, vulnerability, and progression. The 2.0 pg/mL cutoff could facilitate the selection of individuals that would benefit from anti-IL-6 drugs for stroke prevention.
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Affiliation(s)
- Joseph Kamtchum-Tatuene
- Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. (J.K.-T.)
| | - Luca Saba
- Department of Radiology, University of Cagliari, Italy (L.S.)
| | - Mirjam R Heldner
- Department of Neurology, University Hospital Bern, Switzerland (M.R.H.)
| | - Michiel H F Poorthuis
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, the Netherlands. (M.H.F.P.)
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands. (G.J.d.B.)
| | | | - Stavros K Kakkos
- Department of Vascular Surgery, University of Patras Medical School, Greece (S.K.K.)
| | | | - Raffi Topakian
- Department of Neurology, University of Miami Miller School of Medicine (T.R.).,Academic Teaching Hospital Wels-Grieskirchen, Austria (R.T.)
| | - Joseph F Polak
- Department of Radiology, Tufts University School of Medicine and Boston University School of Medicine (J.F.P.)
| | - Glen C Jickling
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. (G.C.J.)
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Willey JZ, Chaturvedi S. Bleeding From Anti-Platelet Agents in Patients With Stroke and Transient Ischemic Attack: How Important Is It? Neurology 2022; 99:223-224. [PMID: 35654595 DOI: 10.1212/wnl.0000000000200863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/03/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Seemant Chaturvedi
- Department of Neurology & Stroke Program University of Maryland School of Medicine, College Park MD
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Saba L, Antignani PL, Gupta A, Cau R, Paraskevas KI, Poredos P, Wasserman B, Kamel H, Avgerinos ED, Salgado R, Caobelli F, Aluigi L, Savastano L, Brown M, Hatsukami T, Hussein E, Suri JS, Mansilha A, Wintermark M, Staub D, Montequin JF, Rodriguez RTT, Balu N, Pitha J, Kooi ME, Lal BK, Spence JD, Lanzino G, Marcus HS, Mancini M, Chaturvedi S, Blinc A. International Union of Angiology (IUA) consensus paper on imaging strategies in atherosclerotic carotid artery imaging: From basic strategies to advanced approaches. Atherosclerosis 2022; 354:23-40. [DOI: 10.1016/j.atherosclerosis.2022.06.1014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 12/24/2022]
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Shoukat U, Glick DR, Chaturvedi S, Diaz-Abad M. Images: polysomnographic findings of nystagmus caused by a midbrain hemorrhagic stroke. J Clin Sleep Med 2022; 18:1479-1482. [PMID: 35082024 PMCID: PMC9059607 DOI: 10.5664/jcsm.9896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/18/2021] [Accepted: 01/11/2022] [Indexed: 11/13/2022]
Abstract
Brainstem strokes can present with an array of ophthalmologic findings depending on the location of the lesion. Eye movements are recorded on electrooculogram during polysomnography for sleep staging. We present the case of a patient with a dorsal midbrain hemorrhagic stroke and nystagmus with distinct findings on the electrooculogram during polysomnography. These eye movements from nystagmus differed in many aspects (frequency and amplitude) from the classic findings of other eye movements recorded during different stages of sleep. These polysomnography findings have not been reported in the setting of midbrain stroke. Future studies comparing nystagmus in multiple sleep stages in stroke patients would be of interest. CITATION Shoukat U, Glick DR, Chaturvedi S, Diaz-Abad M. Images: Polysomnographic findings of nystagmus caused by a midbrain hemorrhagic stroke. J Clin Sleep Med. 2022;18(5):1479-1482.
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Affiliation(s)
- Umer Shoukat
- University of Maryland Sleep Disorders Center, University of Maryland Medical Center, Baltimore, Maryland
| | - Danielle R. Glick
- University of Maryland Sleep Disorders Center, University of Maryland Medical Center, Baltimore, Maryland
| | - Seemant Chaturvedi
- Department of Neurology and Stroke Program, University of Maryland School of Medicine, Baltimore, Maryland
| | - Montserrat Diaz-Abad
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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Abstract
The past decade has seen significant advances in stroke prevention. These advances include new antithrombotic agents, new options for dyslipidemia treatment, and novel techniques for surgical stroke prevention. In addition, there is greater recognition of the benefits of multifaceted interventions, including the role of physical activity and dietary modification. Despite these advances, the aging of the population and the high prevalence of key vascular risk factors pose challenges to reducing the burden of stroke. Using a cause-based framework, current approaches to prevention of cardioembolic, cryptogenic, atherosclerotic, and small vessel disease stroke are outlined in this paper. Special emphasis is given to recent trials of antithrombotic agents, including studies that have tested combination treatments and responses according to genetic factors.
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Affiliation(s)
| | | | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France
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Paraskevas KI, Mikhailidis DP, Antignani PL, Ascher E, Baradaran H, Bokkers RPH, Cambria RP, Comerota AJ, Dardik A, Davies AH, Eckstein HH, Faggioli G, Fernandes E Fernandes J, Fraedrich G, Geroulakos G, Gloviczki P, Golledge J, Gupta A, Jezovnik MK, Kakkos SK, Katsiki N, Knoflach M, Eline Kooi M, Lanza G, Lavenson GS, Liapis CD, Loftus IM, Mansilha A, Millon A, Nicolaides AN, Pini R, Poredos P, Proczka RM, Ricco JB, Riles TS, Ringleb PA, Rundek T, Saba L, Schlachetzki F, Silvestrini M, Spinelli F, Stilo F, Sultan S, Suri JS, Svetlikov AV, Zeebregts CJ, Chaturvedi S. Comparison of Recent Practice Guidelines for the Management of Patients With Asymptomatic Carotid Stenosis. Angiology 2022; 73:903-910. [PMID: 35412377 DOI: 10.1177/00033197221081914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Despite the publication of several national/international guidelines, the optimal management of patients with asymptomatic carotid stenosis (AsxCS) remains controversial. This article compares 3 recently released guidelines (the 2020 German-Austrian, the 2021 European Stroke Organization [ESO], and the 2021 Society for Vascular Surgery [SVS] guidelines) vs the 2017 European Society for Vascular Surgery (ESVS) guidelines regarding the optimal management of AsxCS patients.The 2017 ESVS guidelines defined specific imaging/clinical parameters that may identify patient subgroups at high future stroke risk and recommended that carotid endarterectomy (CEA) should or carotid artery stenting (CAS) may be considered for these individuals. The 2020 German-Austrian guidelines provided similar recommendations with the 2017 ESVS Guidelines. The 2021 ESO Guidelines also recommended CEA for AsxCS patients at high risk for stroke on best medical treatment (BMT), but recommended against routine use of CAS in these patients. Finally, the SVS guidelines provided a strong recommendation for CEA+BMT vs BMT alone for low-surgical risk patients with >70% AsxCS. Thus, the ESVS, German-Austrian, and ESO guidelines concurred that all AsxCS patients should receive risk factor modification and BMT, but CEA should or CAS may also be considered for certain AsxCS patient subgroups at high risk for future ipsilateral ischemic stroke.
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Affiliation(s)
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK
| | | | - Enrico Ascher
- Division of Vascular Surgery, 12297Vascular Institute of New York, Brooklyn, NY, USA
| | - Hediyeh Baradaran
- Department of Radiology, 14434University of Utah, Salt Lake City, UT, USA
| | - Reinoud P H Bokkers
- Department of Radiology, Medical Imaging Center, 10173University Medical Center Groningen, Groningen, The Netherlands
| | - Richard P Cambria
- Division of Vascular and Endovascular Surgery, St Elizabeth's Medical Center, Boston, MA, USA
| | - Anthony J Comerota
- Inova Heart and Vascular Institute, Inova Alexandria Hospital, Alexandria, VA, USA
| | - Alan Dardik
- Division of Vascular and Endovascular Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Alun H Davies
- Section of Vascular Surgery, Imperial College and Imperial Healthcare NHS Trust, London, UK
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Gianluca Faggioli
- Vascular Surgery, University of Bologna "Alma Mater Studiorum", Policlinico S. Orsola Malpighi, Bologna, Italy
| | | | - Gustav Fraedrich
- Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - George Geroulakos
- Department of Vascular Surgery, 69038"Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Peter Gloviczki
- Division of Vascular and Endovascular Surgery, 6915Mayo Clinic, Rochester, MN, USA
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, James Cook University and Townsville University Hospital, Townsville, Queensland, Australia
| | - Ajay Gupta
- Department of Radiology, 466371Weill Cornell Medicine, New York, NY, USA
| | - Mateja K Jezovnik
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Centre at Houston, Houston, TX, U.S.A
| | - Stavros K Kakkos
- Department of Vascular Surgery, 37795University of Patras Medical School, Patras, Greece
| | - Niki Katsiki
- First Department of Internal Medicine, 37782AHEPA University Hospital, Thessaloniki, Greece
| | - Michael Knoflach
- Department of Neurology, 27280Medical University of Innsbruck, Innsbruck, Austria
| | - M Eline Kooi
- CARIM School for Cardiovascular Disease, 46837Maastricht University, Maaastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, 46837Maastricht University Medical Center, Maastricht, The Netherlands
| | - Gaetano Lanza
- Vascular Surgery Department, 46837IRCSS MultiMedica Hospital, Castellanza, Italy
| | - George S Lavenson
- Department of Surgery, 1685Uniformed Services University, Bethesda, MD, USA
| | | | - Ian M Loftus
- St George's Vascular Institute, St George's University London, London, UK
| | - Armando Mansilha
- Faculty of Medicine of the University of Porto, Porto, Portugal.,Department of Angiology and Vascular Surgery, Hospital de S. Joao, Porto, Portugal
| | - Antoine Millon
- Department of Vascular and Endovascular Surgery, 26899Louis Pradel Hospital, Hospices Civils de Lyon, France
| | - Andrew N Nicolaides
- Department of Surgery, 121343University of Nicosia Medical School, Nicosia, Cyprus
| | - Rodolfo Pini
- Vascular Surgery, University of Bologna "Alma Mater Studiorum", Policlinico S. Orsola Malpighi, Bologna, Italy
| | - Pavel Poredos
- Department of Vascular Disease, University Medical Centre Ljubljana, Slovenia
| | - Robert M Proczka
- 1stDepartment of Vascular Surgery, Medicover Hospital, Warsaw, Poland
| | - Jean-Baptiste Ricco
- Department of Clinical Research, University of Poitiers, CHU de Poitiers, Poitiers, France
| | - Thomas S Riles
- Department of Surgery, Division of Vascular Surgery, 12297New York University Langone Medical Centre, New York, NY, USA
| | | | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, 12235University of Miami, Miami, FL, USA
| | - Luca Saba
- Department of Radiology, 97863Azienda Ospedaliera Universitaria Di Cagliari, Cagliari, Italy
| | - Felix Schlachetzki
- Department of Neurology, 210419University of Regensburg, Regensburg, Germany
| | - Mauro Silvestrini
- Neurological Clinic, Department of Experimental and Clinical Medicine, 9294Marche Polytechnic University, Ancona, Italy
| | - Francesco Spinelli
- Vascular Surgery Division, 9311Campus Bio-Medico University of Rome, Rome, Italy
| | - Francesco Stilo
- Vascular Surgery Division, 9311Campus Bio-Medico University of Rome, Rome, Italy
| | - Sherif Sultan
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland, Galway, Ireland
| | - Jasjit S Suri
- Stroke Diagnosis and Monitoring Division, AtheroPointTM, Roseville, USA
| | - Alexei V Svetlikov
- Division of Vascular and Endovascular Surgery, North-Western Scientific Clinical Center of Federal Medical Biological Agency of Russia, St Petersburgh, Russia
| | - Clark J Zeebregts
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Seemant Chaturvedi
- Department of Neurology & Stroke Program, 12264University of Maryland School of Medicine, Baltimore, MD, USA
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Ihle-Hansen H, Kelly P, Bladin C, Chaturvedi S. Editorial: Emerging Areas in Extracranial Carotid Stenosis Evaluation and Management. Front Neurol 2022; 13:891883. [PMID: 35463131 PMCID: PMC9020826 DOI: 10.3389/fneur.2022.891883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 03/15/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Hege Ihle-Hansen
- Stroke Unit, Department of Neurology, Oslo University Hospital, Oslo, Norway
- *Correspondence: Hege Ihle-Hansen
| | - Peter Kelly
- HRB Stroke Clinical Trials Network Ireland, University College Dublin, Dublin, Ireland
- Stroke Service, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Christopher Bladin
- Department of Neurosciences, Monash University, Melbourne, VIC, Australia
| | - Seemant Chaturvedi
- School of Medicine, University of Maryland, Baltimore, MD, United States
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Aradine EM, Ryan KA, Cronin CA, Wozniak MA, Cole JW, Chaturvedi S, Dutta TLM, Hou Y, Mehndiratta P, Motta M, Phipps MS, Yarbrough KL, McArdle PF, Kittner SJ. Black-White Differences in Ischemic Stroke Risk Factor Burden in Young Adults. Stroke 2022; 53:e66-e69. [PMID: 34802251 PMCID: PMC8885894 DOI: 10.1161/strokeaha.121.034314] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Although the US Black population has a higher incidence of stroke compared with the US White population, few studies have addressed Black-White differences in the contribution of vascular risk factors to the population burden of ischemic stroke in young adults. METHODS A population-based case-control study of early-onset ischemic stroke, ages 15 to 49 years, was conducted in the Baltimore-Washington DC region between 1992 and 2007. Risk factor data was obtained by in-person interview in both cases and controls. The prevalence, odds ratio, and population-attributable risk percent (PAR%) of smoking, diabetes, and hypertension was determined among Black patients and White patients, stratified by sex. RESULTS The study included 1044 cases and 1099 controls. Of the cases, 47% were Black patients, 54% were men, and the mean (±SD) age was 41.0 (±6.8) years. For smoking, the population-attributable risk percent were White men 19.7%, White women 32.5%, Black men 10.1%, and Black women 23.8%. For diabetes, the population-attributable risk percent were White men 10.5%, White women 7.4%, Black men 17.2%, and Black women 13.4%. For hypertension, the population-attributable risk percent were White men 17.2%, White women 19.3%, Black men 45.8%, and Black women 26.4%. CONCLUSIONS Modifiable vascular risk factors account for a large proportion of ischemic stroke in young adults. Cigarette smoking was the strongest contributor to stroke among White patients while hypertension was the strongest contributor to stroke among Black patients. These results support early primary prevention efforts focused on smoking cessation and hypertension detection and treatment.
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Affiliation(s)
- Elizabeth M. Aradine
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
| | - Kathleen A. Ryan
- VA Maryland Health Care System, Baltimore, MD,Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Carolyn A. Cronin
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD,VA Maryland Health Care System, Baltimore, MD
| | - Marcella A. Wozniak
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD,VA Maryland Health Care System, Baltimore, MD
| | - John W. Cole
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD,VA Maryland Health Care System, Baltimore, MD
| | - Seemant Chaturvedi
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD,VA Maryland Health Care System, Baltimore, MD
| | - Tara L. M. Dutta
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
| | - Yan Hou
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
| | - Prachi Mehndiratta
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
| | - Melissa Motta
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
| | - Michael S. Phipps
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD,VA Maryland Health Care System, Baltimore, MD
| | - Karen L. Yarbrough
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
| | - Patrick F. McArdle
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Steven J. Kittner
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD,VA Maryland Health Care System, Baltimore, MD,Corresponding Author: Steven J. Kittner, MD, MPH, 655 West Baltimore Street, Rm 12-006, Baltimore, MD 21201, Phone: 410-706-0414,
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Solomonow J, Yarbrough KL, Chaturvedi S, Mehndiratta P. Abstract WP227: Is Obesity Driving The Increase In Young Stroke? Stroke 2022. [DOI: 10.1161/str.53.suppl_1.wp227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Obesity is a known risk factor for acute ischemic stroke (AIS) in both the adult and young (<50 years) population. Prior studies suggest that this association is mediated through risk factors such as diabetes and hypertension; however, the extent of this association has not been reported. Our aim was to identify the association of obesity with young AIS, and the burden of lifestyle-related risk factors based on different body-mass-index (BMI) categories in patients with young AIS.
Methods:
All patients with AIS, younger than 50 years, admitted to the University of Maryland Medical System hospitals between Jan 2017 and December 2020, were included. Patients were categorized into 3 BMI categories - 1) Normal (18.5-24.9), 2) Overweight (25-29) and 3) Obese (≥30). Lifestyle-related risk factor (HTN, DM, DLD, and sleep apnea) burden and distribution was analyzed across the three groups using Chi-squared tests of association. One-way Welch’s ANOVA was utilized to test mean differences in number of risk factors across BMI categories.
Results:
We identified 1272 patients with young stroke. A total of 797/1272 (63%) of our young stroke patients were obese and 23.1% (n=294) were in the overweight category. In the obese category: mean age was 41.4 years (SD +/- 6.75), 49.4% were women and 53.4% were Black. Risk factor burden was significantly higher in the obese vs. the overweight and normal weight categories (Table 1)(p = <0.001). The proportion of patients with HTN, DM, DLD and sleep apnea was significantly higher in the obese category.
Conclusions:
A majority of young stroke patients were obese, and the obese and overweight patients were predominantly African American. Obese patients had the highest proportion of all medical risk factors, as well as a risk factor burden nearly twice as high as those with normal BMI. Efforts to reduce obesity hold promise in mitigating the burden of stroke in young adults.
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Otite F, Somani S, Chaturvedi S, Mehndiratta P. Abstract WP158: Trends In Utilization Of IV Thrombolysis And Mechanical Thrombectomy In Patients With Stroke And Malignancy. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.wp158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose:
Existing data shows that IV thrombolysis (tPA) and mechanical thrombectomy (MT) use in acute ischemic stroke (AIS) patients and malignancy is <2%. Our aim was to determine whether utilization of recanalization therapies has increased in AIS patients with cancer since publication of pivotal MT trials.
Methods:
All admissions with a primary diagnosis of AIS (weighted n=5,554,161) were identified from the 2007-2018 Nationwide Inpatient Sample. Cancer-associated strokes (CAS) were categorized into hematologic (hem), solid and metastatic (met) cancers. Joint point regression and multivariable-adjusted logistic regression models with interaction terms were used to evaluate rate of change in t-PA and MT use in CAS compared to non-CAS admissions.
Results:
Across this period, 4.0% of AIS admissions had comorbid CAS. The proportion of AIS hospitalizations with CAS increased from 3.8% in 2007 to 4.4% in 2018. Mean age of CAS was 72.9 (47.6% women) vs. 70.6 years (51.8% women) among non-CAS. CAS patients had fewer vascular risk factors. Highest t-PA usage was in non-CAS pts (7.8%) and lowest use in met-CAS pts (3.8%) and this difference was significant. In contrast MT usage was highest in met-CAS (2.0%) vs non-CAS (1.6%) and hem-CAS (1.2%). A race-by-time interaction revealed an increase in utilization of both therapies in all CAS groups. Pace of the increase was slower in met CAS (OR 0.97, 95%CI 0.95-0.99) per unit increase in year. MT use increased at a faster pace in met-CAS patients (OR 1.07, 95%CI 1.02-1.12) compared to non-CAS. Although overall mortality rates for patients with cancer has decreased for all cancer types, CAS had significantly higher in hospital mortality as compared to NCS (8.9% vs 4.4%, p <0.001).
Conclusions:
Utilization of both t-PA and MT has increased over the last decade. Contrary to prior studies, the current frequency and pace of increase in MT use is greater in met-CAS admissions compared to non-CAS. Patients with CAS have fewer traditional vascular risk factors and significantly higher in hospital mortality. Future studies should address longer term outcomes in CAS versus non-cancer strokes.
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Bansal A, Garg P, Kandhari P, Maheshwari R, Chaturvedi S, Garg H, Singh A, Kumar A. Comparative analysis of perioperative complications in kidney transplant patients with coronary artery disease on dual antiplatelet drugs. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01179-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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50
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Choi SG, Morawo AO, Solomonow J, Mehndiratta P, Yarbrough KL, Clark K, Cole JW, Cronin CA, Kittner SJ, Nunez J, Phipps MS, Schrier C, Wozniak MA, Williams D, Chaturvedi S. Abstract TP204: Discharge Statin Practices For Young Stroke Patients In A Stroke Clinical Network. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.tp204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Despite the association of statin use and lowered recurrent stroke and mortality, some studies suggest young stroke patients do not receive the same intense targeted treatment medical therapies for secondary stroke prevention as older patients. Our specific objective was to determine if there were differences in statin medication discharge practices provided to young ischemic stroke patients within a Stroke Clinical Network. The Stroke Clinical Network consists of nine stroke centers located in rural, suburban and urban geographical regions.
Methods:
The GWTG registry was queried (FY 2017-2021) to identify ischemic stroke patients to determine statin discharge practices using the following criteria: sex, race, age groups ≥18-39 and ≥40-49, LDL levels < 100, 101-129 and > 130, diabetes, HTN, and smoking status. Chi squared tests of proportions were used to evaluate significant relationships between subgroups.
Results:
Among 1,294 young ischemic stroke patients: 53% (682/1294) were Black and 38% (493/1294) White; mean age 40.9 years (SD +/-7.21years). Men, blacks, patients older than 40 and diabetics were more likely to be discharged on a statin. There was a direct correlation between sex, race, age, LDL level and diabetes with statin discharge practices. There was no difference in statin discharge practices between smokers and nonsmokers.
Conclusions:
Opportunities to improve compliance with obtaining LDL levels upon admission and prescribing statins at discharge exist. Increasing statin administration in the young stroke patient population reflects best practice and will decrease mortality and morbidity.
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Affiliation(s)
| | | | | | | | | | | | - John W Cole
- Univ of Maryland Sch of Medicine, Baltimore, MD
| | | | | | - Joel Nunez
- Univ of Maryland Sch of Medicine, Baltimore, MD
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