98 results on '"Merino JG"'
Search Results
2. Abstracts in Neurology ®: Refining the Original Short Form.
- Author
-
Baskin PK, Gottesman-Davis A, Pieper KM, Quimby SL, Rahkola A, and Merino JG
- Subjects
- Humans, Abstracting and Indexing, Periodicals as Topic, Neurology
- Published
- 2024
- Full Text
- View/download PDF
3. Open Peer Review Reports: A Pilot Project in Neurology ®.
- Author
-
Baskin PK, Barkhof F, Burch R, Callaghan BC, Ciccarelli O, Hedera P, Hershey LA, Jobst BC, Pieper KM, Quimby SL, Rahkola A, Schneider AL, Worrall BB, Wusthoff CJ, and Merino JG
- Subjects
- Humans, Pilot Projects, Neurology
- Published
- 2024
- Full Text
- View/download PDF
4. Stroke Prevention in Atrial Fibrillation: Our Current Failures and Required Research.
- Author
-
Gurol ME, Wright CB, Janis S, Smith EE, Gokcal E, Reddy VY, Merino JG, and Hsu JC
- Subjects
- Middle Aged, Humans, Aged, Anticoagulants therapeutic use, Treatment Outcome, Atrial Fibrillation complications, Atrial Fibrillation drug therapy, Stroke prevention & control, Stroke complications, Atrial Appendage, Embolism complications, Ischemic Stroke drug therapy
- Abstract
Nonvalvular atrial fibrillation is a common rhythm disorder of middle-aged to older adults that can cause ischemic strokes and systemic embolism. Lifelong use of oral anticoagulants reduces the risk of these ischemic events but increases the risk of major and clinically relevant hemorrhages. These medications also require strict compliance for efficacy, and they have nontrivial failure rates in higher-risk patients. Left atrial appendage closure is a nonpharmacological method to prevent ischemic strokes in atrial fibrillation without the need for lifelong anticoagulant use, but this procedure has the potential for complications and residual embolic events. This workshop of the Roundtable of Academia and Industry for Stroke Prevention discussed future research needed to further decrease the ischemic and hemorrhagic risks among patients with atrial fibrillation. A direct thrombin inhibitor, factor Xa inhibitors, and left atrial appendage closure are FDA-approved approaches whereas factor XIa inhibitors are currently being studied in phase 3 randomized controlled trials for stroke prevention. The benefits, risks, and shortcomings of these treatments and future research required in different high-risk patient populations are reviewed in this consensus statement., Competing Interests: Disclosures Dr Gurol receives research funding from National Institutes of Health. Dr Gurol’s hospital received research grants from Boston Scientific Corporation; research grants from Pfizer Canada Inc; and research grants from Avid Radiopharmaceuticals Inc. Dr Wright reports employment by National Institute of Neurological Disorders and Stroke. Dr Reddy reports compensation from Corvia Medical for consultant services; stock options in Focused Therapeutics; stock options in Heart Repair Technologies (HRT); stock options in Intershunt; stock options in East End Medical; stock options in Medlumics; stock holdings in Nyra Medical; compensation from W. L. Gore & Associates, Inc, for consultant services; compensation from Biotronik, Inc, for consultant services; stock options in Eximo; compensation from Philips for consultant services; stock options in Laminar; compensation from Biostar Ventures for consultant services; stock options in Axon Therapies; stock holdings in Vizaramed; stock options in Keystone Heart; compensation from CardioFocus, Inc, for consultant services; compensation from Biosense Webster, Inc, for consultant services; stock options in Impulse Dynamics (United States), Inc; stock options in Cardiacare. Israel; stock holdings in Affera; stock options in CardioNXT/AFTx; compensation from Cardionomic for consultant services; stock options in Atacor; compensation from Cardiac for consultant services; stock options in Field Medical; stock holdings in SoundCath; stock options in Oracle Health; compensation from AtriAN-Ireland for consultant services; stock options in Anumana; stock options in Acutus Medical, Inc; stock options in EP Frontiers; stock options in Nuvera; stock options in Javelin; stock options in Valcare; stock options in Middlepeak; stock options in Corisma; stock holdings in Surecor, Inc; stock options in Ablacon Inc; stock options in Atrian; stock options in Neutrace; stock options in Backbeat; compensation from Coremap for consultant services; stock options in Biosig; stock options in Dinova-Hangzhou DiNovA EP Technology; stock options in APN Health; compensation from Farapulse-Boston Scientific for consultant services; stock options in Kardium; compensation from Medtronic USA, Inc, for consultant services; compensation from Recor Medical for consultant services; stock options in Sirona Medical; stock holdings in Farapulse-BostonScientific; stock options in Epix Therapeutics; stock options in Aquaheart; stock options in Fire1; stock options in Pulse Biosciences; stock holdings in Manual Surgical Sciences; stock options in Autonomix; compensation from Abbott Vascular for consultant services; compensation from Abbott Vascular for consultant services; stock holdings in Newpace; compensation from Novo Nordisk for consultant services; stock options in EpiEP; compensation from BioTel Heart-Philips for consultant services; compensation from BOSTON SCIENTIFIC CORPORATION for consultant services; stock options in Restore Medical; stock options in EP Dynamics; stock options in LuxMed; stock options in Affera; stock options in Circa Scientific, Inc; stock holdings in Biostar Ventures; stock options in Cardiacare; compensation from Novartis for consultant services; and stock options in Anumana. Dr Merino reports compensation from American Academy of Neurology for other services and compensation from National Institute of Neurological Disorders and Stroke for data and safety monitoring services. Dr Hsu reports compensation from Biosense Webster, Inc, for consultant services; compensation from Abbott Laboratories for consultant services; compensation from Boston Scientific Corporation for consultant services; compensation from Sanofi US Services Inc for consultant services; compensation from Acutus Medical, Inc, for consultant services; compensation from iRhythm Technologies for consultant services; compensation from ZOLL Medical Corporation for consultant services; grants from Biotronik; compensation from Janssen Pharmaceuticals for consultant services; compensation from Pfizer for consultant services; compensation from Medtronic for consultant services; compensation from Biotronik for consultant services; stock options in Vektor Medical; compensation from AltaThera Pharmaceuticals LLC for consultant services; grants from Biosense Webster, Inc; and compensation from Bristol-Myers Squibb for consultant services.
- Published
- 2024
- Full Text
- View/download PDF
5. Ever Greener: Promoting More Timely and Ecofriendly Publication in Neurology ®.
- Author
-
Baskin PK, Rahkola A, and Merino JG
- Published
- 2023
- Full Text
- View/download PDF
6. Introducing a New Process for Methodologic and Statistical Review in Neurology .
- Author
-
Merino JG, Schneider ALC, and Ciccarelli O
- Subjects
- Neurology, Editorial Policies, Periodicals as Topic
- Published
- 2023
- Full Text
- View/download PDF
7. Modifications to the Short-Form Research Article in the Print Issue of Neurology .
- Author
-
Baskin PK, Swendsrud K, Rahkola A, and Merino JG
- Subjects
- Humans, Neurology
- Published
- 2023
- Full Text
- View/download PDF
8. Neurology ® Education : A New Journal in Neurology for Education Research.
- Author
-
Strowd RE, Baskin PK, and Merino JG
- Subjects
- Educational Status, Humans, Neurology education
- Published
- 2022
- Full Text
- View/download PDF
9. Association of Multiple Passes during Mechanical Thrombectomy with Incomplete Reperfusion and Lesion Growth.
- Author
-
Luby M, Merino JG, Davis R, Ansari S, Fisher M, Hsia AW, Kim Y, Latour LL, McCreedy ES, Sukhdeo Singh R, Wright CB, and Lynch JK
- Subjects
- Aged, Disease Progression, Female, Humans, Male, Reperfusion, Retrospective Studies, Thrombectomy adverse effects, Thrombectomy methods, Tissue Plasminogen Activator, Treatment Outcome, Brain Ischemia diagnostic imaging, Brain Ischemia therapy, Endovascular Procedures adverse effects, Endovascular Procedures methods, Ischemic Stroke, Reperfusion Injury
- Abstract
Introduction: Despite complete recanalization by mechanical thrombectomy, abnormal perfusion can be detected on MRI obtained post-endovascular therapy (EVT). The presence of residual perfusion abnormalities post-EVT may be associated with blood-brain barrier breakdown in response to mechanical disruption of the endothelium from multiple-pass thrombectomy. We hypothesize that multiple-pass versus single-pass thrombectomy is associated with a higher rate of residual hypoperfusion and increased lesion growth at 24 h., Materials and Methods: For this analysis, we included patients presenting to one of two stroke centers between January 2015 and February 2018 with an acute ischemic stroke within 12 h from symptom onset if they had a large vessel occlusion of the anterior circulation documented on magnetic resonance angiography or CTA, baseline MRI pre-EVT with imaging evidence of hypoperfusion, underwent EVT, and had a post-EVT MRI with qualitatively interpretable perfusion-weighted imaging data at 24 h. MRI Tmax maps using a time delay threshold of >6 s were used to quantitate hypoperfusion volumes. Residual hypoperfusion at 24 h was solely defined as Tmax volume >10 mL with >6 s delay. Complete recanalization was defined as modified treatment in cerebral infarction visualized on angiography at EVT completion. Hyperintense acute reperfusion injury marker was assessed on post-EVT pre-contrast fluid-attenuated inversion recovery at 24 h. Major early neurological improvement was defined as a reduction of the admission National Institutes of Health Stroke Scale by ≥8 points or a score of 0-1 at 24 h. Good functional outcome was defined as 0-2 on the modified Rankin Scale on day 30 or 90., Results: Fifty-five patients were included with median age 67 years, 58% female, 45% Black/African American, 36% White/Caucasian, median admission National Institutes of Health Stroke Scale 19, large vessel occlusion locations: 71% M1, 14.5% iICA, 14.5% M2, 69% treated with intravenous recombinant tissue plasminogen activator. Of these, 58% had multiple-pass thrombectomy, 39% had residual perfusion abnormalities at 24 h, and 64% had severe hyperintense acute reperfusion injury marker at 24 h. After adjusting for complete recanalization, only multiple-pass thrombectomy (odds ratio, 4.3 95% CI, 1.07-17.2; p = 0.04) was an independent predictor of residual hypoperfusion at 24 h. Patients with residual hypoperfusion had larger lesion growth on diffusion-weighted imaging (59 mL vs. 8 mL, p < 0.001), lower rate of major early neurological improvement (24% vs. 70%, p = 0.002) at 24 h, and worse long-term outcome based on the modified Rankin Scale at 30 or 90 days, 5 versus 2 (p < 0.001)., Conclusions: Our findings suggest that incomplete reperfusion on post-EVT MRI is present even in some patients with successful recanalization at the time of EVT and is associated with multiple-pass thrombectomy, lesion growth, and worse outcome. Future studies are needed to investigate whether patients with residual hypoperfusion may benefit from immediate adjunctive therapy to limit lesion growth and improve clinical outcome., (© 2021 S. Karger AG, Basel.)
- Published
- 2022
- Full Text
- View/download PDF
10. Neurology ®: Seventy Years of Change but Staying True to Our Roots.
- Author
-
Merino JG
- Subjects
- Humans, Neurology
- Published
- 2021
- Full Text
- View/download PDF
11. Climate Change.
- Author
-
Merino JG
- Published
- 2021
- Full Text
- View/download PDF
12. Career Development Program for Underrepresented in Medicine Scholars in Academic Neurology: TRANSCENDS.
- Author
-
Tagge R, Lackland DT, Gorelick PB, Litvan I, Cruz-Flores S, Merino JG, and Ovbiagele B
- Abstract
Background: The Training in Research for Academic Neurologists to Sustain Careers and Enhance the Numbers of Diverse Scholars (TRANSCENDS) program is a career advancement opportunity for individuals underrepresented in biomedical research funded by the National Institute of Neurologic Disorders and Stroke and American Academy of Neurology (AAN)., Objective: To report on qualitative and quantitative outcomes in TRANSCENDS., Design: Early career individuals (neurology fellows and junior faculty) from groups underrepresented in medicine (UIM) were competitively selected from a national pool of applicants (2016-2019). TRANSCENDS activities comprised an online Clinical Research degree program, monthly webinars, AAN meeting activities, and mentoring. Participants were surveyed during and after completion of TRANSCENDS to evaluate program components., Outcomes: Of 23 accepted scholars (comprising 4 successive cohorts), 56% were women, 61% Hispanic/Latinx, 30% Black/African American, and 30% assistant professors. To date, 48% have graduated the TRANSCENDS program and participants have published 180 peer-reviewed articles. Mentees' feedback noted that professional skills development (i.e., manuscript and grant writing), networking opportunities, and mentoring were the most beneficial elements of the program. Stated opportunities for improvement included incorporating a mentor-the-mentor workshop, providing more transitional support for mentees in the next stage of their careers, and requiring mentees to provide quarterly reports., Conclusions: TRANSCENDS is a feasible program for supporting UIM neurologists towards careers in research and faculty academic appointments attained thus far have been sustained. Although longer-term outcomes and process enhancements are warranted, programs like this may help increase the numbers of diverse academic neurologists and further drive neurologic innovation., (© 2021 American Academy of Neurology.)
- Published
- 2021
- Full Text
- View/download PDF
13. Neurology® in 2021: Progress Report.
- Author
-
Merino JG
- Published
- 2021
- Full Text
- View/download PDF
14. Neurology ®'s commitment to address gender bias in neurology journals.
- Author
-
Merino JG, Worrall BB, Baskin PK, and Ciccarelli O
- Subjects
- Female, Humans, Male, Neurology trends, Periodicals as Topic trends, Neurology standards, Periodicals as Topic standards, Sexism prevention & control
- Published
- 2020
- Full Text
- View/download PDF
15. Sickle Cell Trait and Risk of Ischemic Stroke in Young Adults.
- Author
-
Zhang RV, Ryan KA, Lopez H, Wozniak MA, Phipps MS, Cronin CA, Cole JW, Dutta TM, Mehndiratta P, Motta M, Merino JG, and Kittner SJ
- Subjects
- Adolescent, Adult, Black or African American, Age of Onset, Baltimore epidemiology, Case-Control Studies, Diabetes Complications epidemiology, District of Columbia epidemiology, Female, Genotype, Humans, Hypertension complications, Hypertension epidemiology, Male, Middle Aged, Myocardial Infarction epidemiology, Negative Results, Prevalence, Risk Assessment, Smoking adverse effects, Young Adult, Brain Ischemia epidemiology, Brain Ischemia genetics, Sickle Cell Trait epidemiology, Sickle Cell Trait genetics, Stroke epidemiology, Stroke genetics
- Abstract
Background and Purpose: Approximately 8% of Blacks have sickle cell trait (SCT), and there are conflicting reports from recent cohort studies on the association of SCT with ischemic stroke (IS). Most prior studies focused on older populations, with few data available in young adults., Methods: A population-based case-control study of early-onset IS was conducted in the Baltimore-Washington region between 1992 and 2007. From this study, 342 Black IS cases, ages 15 to 49, and 333 controls without IS were used to examine the association between SCT and IS. Each participant's SCT status was established by genotyping and imputation. For analysis, χ
2 tests and logistic regression models were performed with adjustment for potential confounding variables., Results: Participants with SCT (n=55) did not differ from those without SCT (n=620) in prevalence of hypertension, previous myocardial infarction, diabetes mellitus, and current smoking status. Stroke cases had increased prevalence in these risk factors compared with controls. We did not find an association between SCT and early-onset IS in our overall population (odds ratio=0.9 [95% CI, 0.5-1.7]) or stratified by sex in males (odds ratio=1.26 [95% CI, 0.56-2.80]) and females (odds ratio=0.67 [95% CI, 0.28-1.69])., Conclusions: Our data did not find evidence of increased risk of early-onset stroke with SCT.- Published
- 2020
- Full Text
- View/download PDF
16. The future of Neurology® : Building on a strong foundation.
- Author
-
Merino JG
- Published
- 2020
- Full Text
- View/download PDF
17. Reversible diffusion-weighted imaging lesions in acute ischemic stroke: A systematic review.
- Author
-
Nagaraja N, Forder JR, Warach S, and Merino JG
- Subjects
- Brain Ischemia diagnostic imaging, Brain Ischemia pathology, Diffusion Magnetic Resonance Imaging, Humans, Brain diagnostic imaging, Brain pathology, Stroke diagnostic imaging, Stroke pathology
- Abstract
Objectives: To systematically review the literature for reversible diffusion-weighted imaging (DWIR) lesions and to describe its prevalence, predictors, and clinical significance., Methods: Studies were included if the first DWI MRI was performed within 24 hours of stroke onset and follow-up DWI or fluid-attenuated inversion recovery (FLAIR)/T2 was performed within 7 or 90 days, respectively, to measure DWIR. We abstracted clinical, imaging, and outcomes data., Results: Twenty-three studies met the study criteria. The prevalence of DWIR was 26.5% in DWI-based studies and 6% in FLAIR/T2-based studies. DWIR was associated with recanalization or reperfusion of the ischemic tissue with or without the use of tissue plasminogen activator (t-PA) or endovascular therapy, earlier treatment with t-PA, shorter time to endovascular therapy after MRI, and absent or less severe perfusion deficit within the DWI lesion. DWIR was associated with early neurologic improvement in 5 of 6 studies (defined as improvement in the NIH Stroke Scale (NIHSS) score by 4 or 8 points from baseline or NIHSS score 0 to 2 at 24 hours after treatment or at discharge or median NIHSS score at 7 days) and long-term outcome in 6 of 7 studies (defined as NIHSS score ≤1, improvement in the NIHSS score ≥8 points, or modified Rankin Scale score up to ≤2 at 30 or 90 days) likely due to reperfusion., Conclusions: DWIR is seen in up to a quarter of patients with acute ischemic stroke, and it is associated with good clinical outcome following reperfusion. Our findings highlight the pitfalls of DWI to define ischemic core in the early hours of stroke., (© 2020 American Academy of Neurology.)
- Published
- 2020
- Full Text
- View/download PDF
18. Vascular variants and the evaluation of patients with acute stroke.
- Author
-
Merino JG and Tavarez T
- Published
- 2019
- Full Text
- View/download PDF
19. White Matter Hyperintensities on Magnetic Resonance Imaging: What Is a Clinician to Do?
- Author
-
Merino JG
- Subjects
- Florida, Humans, Magnetic Resonance Spectroscopy, Registries, Cerebrovascular Disorders, White Matter
- Published
- 2019
- Full Text
- View/download PDF
20. Neuroimaging evolution of ischemia in men and women: an observational study.
- Author
-
Dula AN, Luby M, King BT, Sheth SA, Magadán A, Davis LA, Gealogo GA, Merino JG, Hsia AW, Latour LL, and Warach SJ
- Subjects
- Aged, Aged, 80 and over, Arterial Occlusive Diseases, Biomarkers, Female, Gender Identity, Humans, Image Processing, Computer-Assisted, Magnetic Resonance Imaging, Male, Middle Aged, Neuroimaging, Time Factors, Brain Ischemia complications, Brain Ischemia diagnosis, Stroke complications, Stroke diagnosis, Stroke therapy
- Abstract
Objective: We present an exploratory study for identification of sex differences in imaging biomarkers that could further refine selection of patients for acute reperfusion therapy and trials based on sex and imaging targets., Methods: The Lesion Evolution in Stroke and Ischemia On Neuroimaging (LESION) study included consecutive acute stroke patients who underwent MRI within 24 h of time from last known well and prior to therapy. Those demonstrating a potential therapeutic target on imaging were identified by presence of: (1) arterial occlusion on angiography, (2) focal ischemic region on perfusion maps, or (3) a mismatch of perfusion versus diffusion imaging lesion size. The prevalence of imaging targets within clinically relevant time intervals was calculated for each patient and examined. The relationship of time from stroke onset to probability of detection of imaging targets was evaluated., Results: Of 7007 patients screened, of which 86.7% were scanned with MRI, 1092 patients (477/615 men/women) were included in LESION. The probability of imaging target detection was significantly different between men and women, with women more likely to present with all assessed imaging targets, odds ratios between 1.36 and 1.59, P < 0.02, adjusted for NIHSS, age, and time from last known well to MRI scan. This trend held for the entire 24-h studied., Interpretation: Women present more often with treatable ischemic stroke than men. The greater probability of potentially viable and/or treatable imaging targets in women at all time points suggests that tissue injury is slower to evolve in women., Competing Interests: Dula reports has nothing to disclose; Luby has nothing to disclose; King has nothing to disclose; Sheth has nothing to disclose; Magadan has nothing to disclose; Davis has nothing to disclose; Gealogo has nothing to disclose; Merino has nothing to disclose; Hsia has nothing to disclose; Merino has nothing to disclose; and Latour has nothing to disclose. Warach reports personal fees from Merck Sharp & Dohme Corporation, personal fees from Genentech, grants from Boehringer Ingelheim, grants from Valtari Bio, personal fees from AbbVie, outside the submitted work; In addition, Warach has a patent Biomarkers for acute ischemic stroke; US Patent number: 9200322 issued.
- Published
- 2019
- Full Text
- View/download PDF
21. Functional Independence After Stroke Thrombectomy Using Thrombolysis In Cerebral Infarction Grade 2c: A New Aim of Successful Revascularization.
- Author
-
Naragum V, Jindal G, Miller T, Kole M, Shivashankar R, Merino JG, Cole J, Chen R, Kohler N, and Gandhi D
- Subjects
- Activities of Daily Living, Female, Fibrinolytic Agents therapeutic use, Humans, Infarction, Middle Cerebral Artery complications, Infarction, Middle Cerebral Artery surgery, Length of Stay statistics & numerical data, Male, Middle Aged, Prospective Studies, Recovery of Function, Retrospective Studies, Stroke etiology, Stroke physiopathology, Tissue Plasminogen Activator therapeutic use, Treatment Outcome, Cerebral Revascularization methods, Stroke surgery, Thrombectomy methods
- Abstract
Background: Within the Thrombolysis In Cerebral Infarction (TICI) classification, TICI 2b has been historically considered successful recanalization. However, TICI 2b may result in worse functional outcomes compared with TICI 3 or a proposed TICI 2c revascularization grade. The aim of this study was to evaluate differences in functional independence at 90 days between TICI 2b, 2c, and 3 grades., Methods: A retrospective review of 185 consecutive patients with anterior cerebral circulation occlusions was performed; 33 patients who were treated >8 hours after onset were excluded. Patient angiograms were graded by 2 experienced neurointerventional physicians. Baseline demographics and functional independence at 90 days were compared., Results: Of 152 patients included in the study, 113 patients achieved TICI grade 2b (n = 37), 2c (n = 34), or 3 (n = 42). A significant difference in functional independence at 90 days was observed between TICI 2b and 2c/3 (P = 0.0008), between 2b and 2c (P = 0.0005), and between 2b and 3 (P = 0.01). There was no significant difference in functional independence between 2c and 3 (P = 0.24)., Conclusions: TICI 2c revascularization is associated with significantly improved outcomes compared with TICI 2b revascularization and similar outcomes compared with TICI 3 revascularization. Using a TICI grading system that includes an additional TICI 2c grade or expands the current definition of TICI 3 allows for refined prediction of functional independence. Achieving TICI 2c/3 reperfusion should be considered during stroke thrombectomy., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2018
- Full Text
- View/download PDF
22. Smoking and Risk of Ischemic Stroke in Young Men.
- Author
-
Markidan J, Cole JW, Cronin CA, Merino JG, Phipps MS, Wozniak MA, and Kittner SJ
- Subjects
- Adolescent, Adult, Angina Pectoris epidemiology, Case-Control Studies, Diabetes Mellitus epidemiology, Humans, Hypertension epidemiology, Logistic Models, Male, Middle Aged, Myocardial Infarction epidemiology, Obesity epidemiology, Odds Ratio, Risk Factors, Smoking epidemiology, Tobacco Products, United States epidemiology, Young Adult, Brain Ischemia epidemiology, Cigarette Smoking epidemiology, Stroke epidemiology
- Abstract
Background and Purpose: There is a strong dose-response relationship between smoking and risk of ischemic stroke in young women, but there are few data examining this association in young men. We examined the dose-response relationship between the quantity of cigarettes smoked and the odds of developing an ischemic stroke in men under age 50 years., Methods: The Stroke Prevention in Young Men Study is a population-based case-control study of risk factors for ischemic stroke in men ages 15 to 49 years. The χ
2 test was used to test categorical comparisons. Logistic regression models were used to calculate the odds ratio for ischemic stroke occurrence comparing current and former smokers to never smokers. In the first model, we adjusted solely for age. In the second model, we adjusted for potential confounding factors, including age, race, education, hypertension, myocardial infarction, angina, diabetes mellitus, and body mass index., Results: The study population consisted of 615 cases and 530 controls. The odds ratio for the current smoking group compared with never smokers was 1.88. Furthermore, when the current smoking group was stratified by number of cigarettes smoked, there was a dose-response relationship for the odds ratio, ranging from 1.46 for those smoking <11 cigarettes per day to 5.66 for those smoking 40+ cigarettes per day., Conclusions: We found a strong dose-response relationship between the number of cigarettes smoked daily and ischemic stroke among young men. Although complete smoking cessation is the goal, even smoking fewer cigarettes may reduce the risk of ischemic stroke in young men., (© 2018 American Heart Association, Inc.)- Published
- 2018
- Full Text
- View/download PDF
23. Selecting patients for endovascular treatment of acute stroke.
- Author
-
Merino JG
- Subjects
- Brain Ischemia, Endovascular Procedures, Humans, Treatment Outcome, Stroke, Thrombolytic Therapy
- Abstract
Competing Interests: Competing interests: I have read and understood the BMJ Group policy on declaration of interests and declare: I am the US research editor for The BMJ and receive salary support for that role. I am a stroke outcome adjudicator for the Women’s Health Initiative and I receive honorariums for my adjudications of each case. I am a vascular neurologist who treats patients with acute stroke and sometimes recommends endovascular thrombectomy.
- Published
- 2017
- Full Text
- View/download PDF
24. Standing up for science in the era of Trump.
- Author
-
Merino JG, Jha A, Loder E, and Abbasi K
- Subjects
- Culture, Government Regulation, Health Policy legislation & jurisprudence, Humans, United States, Federal Government, Politics, Science legislation & jurisprudence, Science organization & administration
- Published
- 2017
- Full Text
- View/download PDF
25. Stuttering lacunar infarction captured on serial MRIs.
- Author
-
Tahsili-Fahadan P, Simpkins AN, Leigh R, and Merino JG
- Published
- 2016
- Full Text
- View/download PDF
26. IDEAL-D: a rational framework for evaluating and regulating the use of medical devices.
- Author
-
Sedrakyan A, Campbell B, Merino JG, Kuntz R, Hirst A, and McCulloch P
- Subjects
- Humans, Medical Device Legislation, United Kingdom, United States, Device Approval legislation & jurisprudence, Device Approval standards, Equipment Design methods, Equipment Design standards, Equipment Safety methods, Equipment Safety standards
- Published
- 2016
- Full Text
- View/download PDF
27. Endovascular treatment for stroke.
- Author
-
Merino JG
- Subjects
- Brain Ischemia drug therapy, Endovascular Procedures, Humans, Thrombolytic Therapy, Treatment Outcome, Stroke therapy, Tissue Plasminogen Activator therapeutic use
- Published
- 2016
- Full Text
- View/download PDF
28. Embolic stroke secondary to spontaneous thrombosis of unruptured intracranial aneurysm: Report of three cases.
- Author
-
Arauz A, Patiño-Rodríguez HM, Chavarría-Medina M, Becerril M, Merino JG, and Zenteno M
- Subjects
- Adult, Cerebral Angiography, Cerebral Infarction complications, Cerebral Infarction pathology, Diffusion Magnetic Resonance Imaging, Female, Humans, Infarction, Middle Cerebral Artery pathology, Infarction, Middle Cerebral Artery therapy, Intracranial Aneurysm surgery, Intracranial Aneurysm therapy, Intracranial Thrombosis therapy, Magnetic Resonance Angiography, Male, Middle Aged, Neurosurgical Procedures, Recurrence, Stroke therapy, Treatment Outcome, Intracranial Aneurysm complications, Intracranial Thrombosis etiology, Stroke etiology
- Abstract
Intracranial aneurysms uncommonly present with ischemic stroke. Parent artery occlusion due to local extension of the luminal thrombus, aneurysms ejecting emboli to distal arteries, or increased mass effect have been described as possible pathogenic mechanisms. Guidelines for the management of these patients are absent. We present the clinical outcome and radiological characteristics of three patients with spontaneous thrombosis of intracranial aneurysms as a cause of ischemic stroke. This information is relevant given the possible benign history in terms of stroke recurrence and risk of bleeding., (© The Author(s) 2015.)
- Published
- 2016
- Full Text
- View/download PDF
29. The BMJ editors respond.
- Author
-
Loder E, Groves T, Schroter S, Merino JG, Weber W, and Godlee F
- Subjects
- Humans, Editorial Policies, Periodicals as Topic, Qualitative Research
- Published
- 2016
- Full Text
- View/download PDF
30. Time to recanalisation in patients with cerebral venous thrombosis under anticoagulation therapy.
- Author
-
Arauz A, Vargas-González JC, Arguelles-Morales N, Barboza MA, Calleja J, Martínez-Jurado E, Ruiz-Franco A, Quiroz-Compean A, and Merino JG
- Subjects
- Adult, Age Factors, Brain blood supply, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Neuroimaging, Retrospective Studies, Time Factors, Young Adult, Anticoagulants therapeutic use, Intracranial Thrombosis drug therapy, Phlebography drug effects, Venous Thrombosis drug therapy
- Abstract
Background and Purpose: Few studies have investigated the rates of recanalisation after cerebral venous thrombosis (CVT). Our objective was to investigate the recanalisation rate and to identify predictors of recanalisation in patients with CVT., Methods: We included 102 patients with confirmed first-ever, non-septic CVT. All patients received anticoagulation for 12 months or until complete recanalisation. To assess recanalisation, patients underwent MR venography every 3 months until partial or complete recanalisation or for 12 months after diagnosis. We conducted two parallel analyses of complete recanalisation versus partial and no recanalisation versus any recanalisation. As a secondary objective we explored the influence of recanalisation on outcome and recurrent events. We calculated the probability of recanalisation using Kaplan-Meier analysis and conducted multivariate analysis using a Cox model., Results: The mean age of patients was 33.5±11 years (80 (78.4%) women). Survival analysis indicated that 50% of the patients had any recanalisation (grades I, II and III) by 64 days and complete recanalisation (grade III) by 169 days. Adjusted Cox proportional model revealed that age <50 years (HR=11.5 95% CI=1.58 to 84.46, p=0.01) and isolated superior sagittal sinus thrombosis (HR=0.39, 95% CI=0.14 to 1.04, p=0.05) predict complete recanalisation, while age <50 years (HR=4.79; 95% CI=1.69 to 13.5, p=0.003) predicts any recanalisation. Patients with complete recanalisation had a greater chance of good functional outcome (HR=5.17; 95% CI=2.8 to 9.53, p<0.001)., Conclusions: We found that recanalisation occurs over time, until month 11. Complete recanalisation may influence functional outcome., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)
- Published
- 2016
- Full Text
- View/download PDF
31. Qualitative research and The BMJ.
- Author
-
Loder E, Groves T, Schroter S, Merino JG, and Weber W
- Subjects
- Humans, Editorial Policies, Periodicals as Topic, Qualitative Research
- Published
- 2016
- Full Text
- View/download PDF
32. Visualising childhood vaccination schedules across G8 countries.
- Author
-
Doshi P, Stahl-Timmins W, Merino JG, and Simpkins C
- Subjects
- Adolescent, Bacterial Infections prevention & control, Canada epidemiology, Child, Child, Preschool, Developed Countries statistics & numerical data, Developing Countries statistics & numerical data, European Union statistics & numerical data, Global Health, Humans, Infant, Infection Control methods, Japan epidemiology, Russia epidemiology, United States epidemiology, Vaccines, Conjugate administration & dosage, Virus Diseases prevention & control, Immunization Schedule, Immunologic Factors administration & dosage, Mass Vaccination statistics & numerical data, Vaccines administration & dosage
- Published
- 2015
- Full Text
- View/download PDF
33. Trial registration 10 years on.
- Author
-
Weber WE, Merino JG, and Loder E
- Subjects
- European Union, Humans, Randomized Controlled Trials as Topic, United States, Editorial Policies, Periodicals as Topic, Publication Bias
- Published
- 2015
- Full Text
- View/download PDF
34. Validation of the association between neurologic improvement with decline in blood pressure and recanalization in stroke--in reply.
- Author
-
Nagaraja N, Adams HP Jr, and Merino JG
- Subjects
- Female, Humans, Male, Blood Pressure drug effects, Cerebrovascular Circulation drug effects, Fibrinolytic Agents pharmacology, Infarction, Middle Cerebral Artery drug therapy, Registries, Thrombolytic Therapy statistics & numerical data, Tissue Plasminogen Activator pharmacology
- Published
- 2015
- Full Text
- View/download PDF
35. Association between neurologic improvement with decline in blood pressure and recanalization in stroke.
- Author
-
Nagaraja N, Warach S, Hsia AW, Adams HP Jr, Auh S, Latour LL, and Merino JG
- Subjects
- Aged, Aged, 80 and over, Female, Fibrinolytic Agents administration & dosage, Humans, Magnetic Resonance Angiography, Male, Middle Aged, Tissue Plasminogen Activator administration & dosage, Treatment Outcome, Blood Pressure drug effects, Cerebrovascular Circulation drug effects, Fibrinolytic Agents pharmacology, Infarction, Middle Cerebral Artery drug therapy, Registries, Thrombolytic Therapy statistics & numerical data, Tissue Plasminogen Activator pharmacology
- Abstract
Importance: Patients with stroke often have a decline in blood pressure after thrombolysis. Neurologic improvement could result from recanalization or better collateral flow despite persistent occlusion. We hypothesized that neurologic improvement with concurrent decline in blood pressure may be a clinical sign of recanalization after intravenous tissue plasminogen activator., Observations: Patients treated with intravenous tissue plasminogen activator at Suburban Hospital, Bethesda, Maryland, and MedStar Washington Hospital Center, Washington, DC, from 1999 to 2009 were included in the study if they had pretreatment and 24-hour magnetic resonance angiographic scans, National Institutes of Health Stroke Scale scores at those times, and proximal middle cerebral artery occlusion demonstrated prior to treatment. The recanalization status on 24-hour magnetic resonance angiography was classified as none, partial, or complete. Seventeen patients met study criteria. On 24-hour magnetic resonance angiography, 3 patients had no recanalization, 8 had partial recanalization, and 6 had complete recanalization. At 24 hours after thrombolysis, neurologic improvement with concurrent decline in systolic blood pressure of 20 mm Hg or greater was seen in 4 patients with partial recanalization, 4 patients with complete recanalization, and none of the patients with no recanalization., Conclusions and Relevance: Neurologic improvement with concurrent decline in systolic blood pressure of 20 mm Hg or greater after intravenous tissue plasminogen activator may be a clinical sign of recanalization. This observation needs confirmation in a larger cohort., Competing Interests: Disclosures No other disclosures were reported.
- Published
- 2014
- Full Text
- View/download PDF
36. Response to Ebola in the US: misinformation, fear, and new opportunities.
- Author
-
Merino JG
- Subjects
- Health Policy, Humans, Politics, Quarantine, United States, Communication, Fear, Hemorrhagic Fever, Ebola psychology, Hemorrhagic Fever, Ebola transmission
- Published
- 2014
- Full Text
- View/download PDF
37. Immediate changes in stroke lesion volumes post thrombolysis predict clinical outcome.
- Author
-
Luby M, Warach SJ, Nadareishvili Z, and Merino JG
- Subjects
- Aged, Aged, 80 and over, Diffusion Magnetic Resonance Imaging trends, Female, Follow-Up Studies, Humans, Male, Middle Aged, Predictive Value of Tests, Single-Blind Method, Time Factors, Treatment Outcome, Stroke diagnosis, Stroke drug therapy, Thrombolytic Therapy trends, Tissue Plasminogen Activator administration & dosage
- Abstract
Background and Purpose: We hypothesize that reversal in diffusion-weighted imaging (DWI) volume at 24 hours predicts favorable clinical outcome only if accompanied by immediate reperfusion. Our aim was to quantify the immediate DWI and mean transit time changes at 2 and 24 hours after intravenous tissue-type plasminogen activator to evaluate the effect of reperfusion and DWI change on outcome., Methods: Patients were selected from the Lesion Evolution in Stroke and Ischemia On Neuroimaging Project if they had an acute MRI with evaluable DWI and perfusion-weighted imaging, were treated with standard intravenous tissue-type plasminogen activator, had post-thrombolysis MRI with evaluable DWI and perfusion-weighted imaging at 2 and 24 hours and had follow-up fluid attenuated inversion recovery MRI at discharge through 90 days. A reader measured the DWI, mean transit time, and fluid attenuated inversion recovery volumes using a validated technique. A vascular neurologist scored the National Institutes of Health Stroke Scale at admit, 2, and 24 hours and the modified Rankin Scale at discharge, 5, 30, and 90 days. Favorable clinical outcome was defined as modified Rankin Scale of 0 or 1., Results: Seventy-one patients met the study criteria with mean (±SD) age of 71.6 (±16.4) years, 58% women, median admit National Institutes of Health Stroke Scale 9 (interquartile range, 4-18), median onset to triage 45 minutes (30-65), and median first MRI to intravenous tissue-type plasminogen activator 47 minutes (39-59). In binary multiple logistic regression analysis, younger age (odds ratio, 1.165; P=0.014; 95% confidence interval [CI], 1.031-1.316), lower admit National Institutes of Health Stroke Scale (odds ratio, 1.221; P=0.012; 95% confidence interval, 1.045-1.427), decrease in mean transit time volume at 2 hours (odds ratio, 1.021; P=0.031; 95% confidence interval, 1.002-1.040), and decrease in DWI volume at 24 hours (odds ratio, 1.173; P=0.027; 95% confidence interval, 1.018-1.351) were significant predictors of favorable clinical outcome., Conclusions: Reversal of the DWI volume at 24 hours because of immediate reperfusion in patients post thrombolysis is predictive of favorable clinical outcome., (© 2014 American Heart Association, Inc.)
- Published
- 2014
- Full Text
- View/download PDF
38. PCORI's ambitious efforts to promote transparency and dissemination of research findings.
- Author
-
Merino JG and Loder E
- Subjects
- Academies and Institutes, United States, Biomedical Research ethics, Biomedical Research standards, Information Dissemination, Patient Outcome Assessment
- Published
- 2014
- Full Text
- View/download PDF
39. Clinical stroke challenges: A practical approach.
- Author
-
Merino JG
- Published
- 2014
- Full Text
- View/download PDF
40. Assessing reperfusion with whole-brain arterial spin labeling: a noninvasive alternative to gadolinium.
- Author
-
Mirasol RV, Bokkers RP, Hernandez DA, Merino JG, Luby M, Warach S, and Latour LL
- Subjects
- Adult, Aged, Aged, 80 and over, Contrast Media, Data Interpretation, Statistical, Diffusion Magnetic Resonance Imaging, Female, Gadolinium, Humans, Image Processing, Computer-Assisted, Magnetic Resonance Imaging, Male, Middle Aged, Observer Variation, Prospective Studies, Radiography, Reproducibility of Results, Spin Labels, Brain Ischemia diagnostic imaging, Cerebral Arteries diagnostic imaging, Reperfusion methods, Stroke diagnostic imaging
- Abstract
Background and Purpose: Arterial spin labeling (ASL) is a perfusion imaging technique that does not require gadolinium. The study aimed to assess the reliability of ASL for evaluating reperfusion in acute ischemic stroke in comparison with dynamic susceptibility contrast (DSC) imaging., Methods: The study included 24 patients with acute ischemic stroke on admission and 24-hour follow-up ASL and DSC scans. Two readers rated images for interpretability and evidence of reperfusion. Cohen unweighted κ was used to assess (1) inter-rater reliability between readers for determining interpretability and the presence of reperfusion, (2) agreement between ASL and DSC for determining reperfusion for individual raters, and (3) agreement between ASL and DSC for determining reperfusion after consensus., Results: Inter-rater reliability for both ASL and DSC was moderate to good (κ of 0.67 versus 0.55, respectively). Reader 1 rated 16 patients as having interpretable ASL and DSC when compared with 15 patients for reader 2. The κ between ASL and DSC for determining reperfusion was 0.50 for reader 1 and 0.595 for reader 2. After consensus, 18 ASL and 17 DSC image sets were rated interpretable for reperfusion and 13 had both interpretable ASL and DSC scans, yielding a κ for assessment of reperfusion of 0.8., Conclusions: Inter-rater reliability of ASL and DSC was moderate to good. Agreement between ASL and DSC for determining reperfusion was moderate for each individual rater and increased substantially after consensus. ASL is a noninvasive and practical alternative to DSC for reperfusion assessments in patients with confirmed acute ischemic stroke.
- Published
- 2014
- Full Text
- View/download PDF
41. Predictors of acute stroke mimics in 8187 patients referred to a stroke service.
- Author
-
Merino JG, Luby M, Benson RT, Davis LA, Hsia AW, Latour LL, Lynch JK, and Warach S
- Subjects
- Black or African American, Age Factors, Aged, Chi-Square Distribution, Comorbidity, Diagnosis, Differential, Emergency Medical Services, Female, Humans, Logistic Models, Male, Odds Ratio, Patient Care Team, Predictive Value of Tests, Prognosis, Prospective Studies, Risk Factors, Sex Factors, Stroke ethnology, Time Factors, United States epidemiology, White People, National Institutes of Health (U.S.), Referral and Consultation, Stroke diagnosis
- Abstract
Background: Some patients seen by a stroke team do not have cerebrovascular disease but a condition that mimics stroke. The purpose of this study was to determine the rate and predictors of stroke mimics in a large sample., Methods: This is an analysis of data from consecutive patients seen by the National Institutes of Health Stroke Program over 10 years. Data were collected prospectively as a quality improvement initiative. Patients with a cerebrovascular event or a stroke mimic were compared with the Student t or Pearson chi-square test as appropriate, and logistic regression was done to identify independent predictors., Results: The analysis included 8187 patients: 30% had a stroke mimic. Patients with a stroke mimic were younger, and the proportion of patients with a stroke mimic was higher among women, patients without any risk factors, those seen as a code stroke or who arrived to the emergency department via personal vehicle, and those who had the onset of symptoms while inpatients. The proportion of patients with a stroke mimic was marginally higher among African-Americans than Caucasians. Factors associated with the greatest odds of having a stroke mimic in the logistic regression were lack of a history of hypertension, atrial fibrillation or hyperlipidemia., Conclusions: One third of the patients seen by a stroke team over 10 years had a stroke mimic. Factors associated with a stroke mimic may be ascertained by an emergency physician before calling the stroke team., (Copyright © 2013 National Stroke Association. All rights reserved.)
- Published
- 2013
- Full Text
- View/download PDF
42. Stroke mismatch volume with the use of ABC/2 is equivalent to planimetric stroke mismatch volume.
- Author
-
Luby M, Hong J, Merino JG, Lynch JK, Hsia AW, Magadán A, Song SS, Latour LL, and Warach S
- Subjects
- Aged, Aged, 80 and over, Female, Fibrinolytic Agents therapeutic use, Humans, Magnetic Resonance Imaging statistics & numerical data, Male, Middle Aged, Observer Variation, Predictive Value of Tests, Recovery of Function, Registries, Reproducibility of Results, Sensitivity and Specificity, Stroke drug therapy, Tissue Plasminogen Activator therapeutic use, Magnetic Resonance Imaging methods, Magnetic Resonance Imaging standards, Stroke pathology
- Abstract
Background and Purpose: In the clinical setting, there is a need to perform mismatch measurements quickly and easily on the MR imaging scanner to determine the specific amount of treatable penumbra. The objective of this study was to quantify the agreement of the ABC/2 method with the established planimetric method., Materials and Methods: Patients (n = 193) were selected from the NINDS Natural History Stroke Registry if they 1) were treated with standard intravenous rtPA, 2) had a pretreatment MR imaging with evaluable DWI and PWI, and 3) had an acute ischemic stroke lesion. A rater placed the linear diameters to measure the largest DWI and MTT lesion areas in 3 perpendicular axes-A, B, and C-and then used the ABC/2 formula to calculate lesion volumes. A separate rater measured the planimetric volumes. Multiple mismatch thresholds were used, including MTT volume - DWI volume ≥50 mL versus ≥60 mL and (MTT volume - DWI volume)/MTT volume ≥20% versus MTT/DWI = 1.8., Results: Compared with the planimetric method, the ABC/2 method had high sensitivity (0.91), specificity (0.90), accuracy (0.91), PPV (0.90), and NPV (0.91) to quantify mismatch by use of the ≥50 mL definition. The Spearman correlation coefficients were 0.846 and 0.876, respectively, for the DWI and MTT measurements. The inter-rater Bland-Altman plots demonstrated 95%, 95%, and 97% agreement for the DWI, MTT, and mismatch measurements., Conclusions: The ABC/2 method is highly reliable and accurate for quantifying the specific amount of MR imaging-determined mismatch and therefore is a potential tool to quickly calculate a treatable mismatch pattern.
- Published
- 2013
- Full Text
- View/download PDF
43. Physician payment sunshine act.
- Author
-
Merino JG
- Subjects
- Humans, Interprofessional Relations, Physicians economics, United States, Conflict of Interest legislation & jurisprudence, Disclosure legislation & jurisprudence, Drug Industry legislation & jurisprudence, Fees and Charges legislation & jurisprudence, Gift Giving
- Published
- 2013
- Full Text
- View/download PDF
44. Negative diffusion-weighted imaging after intravenous tissue-type plasminogen activator is rare and unlikely to indicate averted infarction.
- Author
-
Freeman JW, Luby M, Merino JG, Latour LL, Auh S, Song SS, Magadán A, Lynch JK, Warach S, and Hsia AW
- Subjects
- Adult, Aged, Aged, 80 and over, Cohort Studies, Diagnosis, Differential, Female, Fibrinolytic Agents administration & dosage, Follow-Up Studies, Humans, Injections, Intravenous, Male, Middle Aged, Retrospective Studies, Stroke diagnosis, Thrombolytic Therapy, Tissue Plasminogen Activator administration & dosage, Treatment Outcome, Diffusion Magnetic Resonance Imaging, Fibrinolytic Agents therapeutic use, Stroke pathology, Stroke prevention & control, Tissue Plasminogen Activator therapeutic use
- Abstract
Background and Purpose: Some patients treated with intravenous (IV) tissue-type plasminogen activator (tPA) have negative diffusion-weighted imaging (DWI) on follow-up imaging. Without a visible infarct, there may be uncertainty as to whether the patient was having a stroke that was averted by tPA or whether the symptoms had not been cerebrovascular in origin. We evaluated patients presenting with suspected acute stroke with a positive DWI lesion before IV tPA to determine the probability of finding a negative DWI up to 48 hours after treatment., Methods: We included patients from the Lesion Evolution in Stroke and Ischemia On Neuroimaging (LESION) project who had acute MRI screening with a positive DWI lesion before IV tPA treatment and had follow-up MRI up to 48 hours later. Experienced readers interpreted all acute and follow-up MRIs looking for ischemic lesions on DWI., Results: There were 231 patients who met study inclusion criteria, of which 225 patients (97.4%) had a persistent positive DWI corresponding to the acute stroke lesion on all follow-up imaging. Four patients (1.7%) had transient DWI lesion reversal with positive DWI on subsequent follow-up imaging. There were only 2 cases (0.9%) of complete DWI lesion reversal on all follow-up imaging., Conclusions: Averted infarction after IV tPA is rare, occurring in 0.9% of patients with pretreatment positive DWI evidence of acute ischemia. For IV tPA-treated patients who have a negative DWI on follow-up imaging, a cause other than acute stroke should be explored.
- Published
- 2013
- Full Text
- View/download PDF
45. Variability in the use of intravenous thrombolysis for mild stroke: experience across the SPOTRIAS network.
- Author
-
Willey JZ, Khatri P, Khoury JC, Merino JG, Ford AL, Rost NS, Gonzales NR, Ali LK, Meyer BC, and Broderick JP
- Subjects
- Academic Medical Centers, Administration, Intravenous, Aged, Aged, 80 and over, Chi-Square Distribution, Female, Fibrinolytic Agents adverse effects, Guideline Adherence, Hospital Mortality, Humans, Male, Middle Aged, Practice Guidelines as Topic, Predictive Value of Tests, Recombinant Proteins administration & dosage, Severity of Illness Index, Stroke diagnosis, Stroke mortality, Thrombolytic Therapy adverse effects, Thrombolytic Therapy mortality, Time Factors, Tissue Plasminogen Activator adverse effects, Treatment Outcome, United States epidemiology, Fibrinolytic Agents administration & dosage, Practice Patterns, Physicians' statistics & numerical data, Stroke drug therapy, Thrombolytic Therapy statistics & numerical data, Tissue Plasminogen Activator administration & dosage
- Abstract
Background: Current guidelines do not define the lower severity threshold for thrombolysis. In this study, we describe the variability of treatment of mild stroke patients across a network of academic stroke centers., Methods: Stroke centers within the Specialized Program of Translational Research in Acute Stroke (SPOTRIAS) prospectively collect data on patients treated with intravenous recombinant tissue plasminogen activator (IV rt-PA), including demographics, pretreatment National Institutes of Health Stroke Scale (NIHSS) scores, and in-hospital mortality. We examined the variability in proportion of total tissue plasminogen activator-treated patients in the NIHSS categories (0-3, 4-5, or ≥ 6) and associated outcomes., Results: A total of 2514 patients with reported NIHSS scores were treated with IV rt-PA between January 1, 2005 and December 31, 2009. The proportion of patients with mild stroke (NIHSS scores of 0-3) who were treated with IV rt-PA varied substantially across the centers (2.7-18.0%; P < .001). There were 5 deaths in the 256 treated with an NIHSS score of 0-3 (2.0%). The proportion of treated patients across the network with an NIHSS score of 0 to 3 increased from 4.8% in 2005 to 10.7% in 2009 (P = .001)., Conclusions: There is substantial variability in the proportion of treated patients who have mild stroke across the SPOTRIAS centers, reflecting a paucity of data on how to best treat patients with mild stroke. Randomized trial data for this group of patients are needed to clarify the use of rt-PA in patients with the mildest strokes., (Copyright © 2013 National Stroke Association. All rights reserved.)
- Published
- 2013
- Full Text
- View/download PDF
46. Profiling patients.
- Author
-
Merino JG
- Subjects
- Female, Humans, Male, Cocaine-Related Disorders diagnosis, Cocaine-Related Disorders urine, Emergency Medical Services methods, Ischemic Attack, Transient urine, Mass Screening methods, Stroke urine
- Published
- 2013
- Full Text
- View/download PDF
47. Publishing your research study in the BMJ.
- Author
-
Merino JG
- Subjects
- Humans, Information Dissemination, Journal Impact Factor, Peer Review, Research, Research Design, Periodicals as Topic, Publishing, Research
- Published
- 2013
- Full Text
- View/download PDF
48. Blood-brain barrier disruption after cardiac surgery.
- Author
-
Merino JG, Latour LL, Tso A, Lee KY, Kang DW, Davis LA, Lazar RM, Horvath KA, Corso PJ, and Warach S
- Subjects
- Aged, Female, Humans, Male, Reproducibility of Results, Sensitivity and Specificity, Treatment Outcome, Blood-Brain Barrier pathology, Cardiac Surgical Procedures adverse effects, Magnetic Resonance Imaging methods, Stroke etiology, Stroke pathology
- Abstract
Background and Purpose: CNS complications are often seen after heart surgery, and postsurgical disruption of the BBB may play an etiologic role. The objective of this study was to determine the prevalence of MR imaging-detected BBB disruption (HARM) and DWI lesions after cardiac surgery., Materials and Methods: All patients had an MRI after cardiac surgery. For half the patients (group 1), we administered gadolinium 24 hours after surgery and obtained high-resolution DWI and FLAIR images 24-48 hours later. We administered gadolinium to the other half (group 2) at the time of the postoperative scan, 2-4 days after surgery. Two stroke neurologists evaluated the images., Results: Of the 19 patients we studied, none had clinical evidence of a stroke or delirium at the time of the gadolinium administration or the scan, but 9 patients (47%) had HARM (67% in group 1; 30% in group 2; P = .18) and 14 patients (74%) had DWI lesions (70% in group 1; 78% in group 2; P = 1.0). Not all patients with DWI lesions had HARM, and not all patients with HARM had DWI lesions (P = .56)., Conclusions: Almost half the patients undergoing cardiac surgery have evidence of HARM, and three-quarters have acute lesions on DWI after surgery. BBB disruption is more prevalent in the first 24 hours after surgery. These findings suggest that MR imaging can be used as an imaging biomarker to assess therapies that may protect the BBB in patients undergoing heart surgery.
- Published
- 2013
- Full Text
- View/download PDF
49. Blogging about stroke: a new chapter for the journal.
- Author
-
Sanossian N and Merino JG
- Subjects
- Humans, Blogging trends, Neurology, Periodicals as Topic trends, Stroke
- Published
- 2012
- Full Text
- View/download PDF
50. Impact of acute ischemic stroke treatment in patients >80 years of age: the specialized program of translational research in acute stroke (SPOTRIAS) consortium experience.
- Author
-
Willey JZ, Ortega-Gutierrez S, Petersen N, Khatri P, Ford AL, Rost NS, Ali LK, Gonzales NR, Merino JG, Meyer BC, and Marshall RS
- Subjects
- Age Factors, Aged, Brain Ischemia mortality, Data Interpretation, Statistical, Endovascular Procedures, Fibrinolytic Agents administration & dosage, Fibrinolytic Agents therapeutic use, Hospital Mortality, Humans, Injections, Intra-Arterial, Injections, Intravenous, Middle Aged, Prospective Studies, Retrospective Studies, Risk, Stroke mortality, Thrombolytic Therapy adverse effects, Thrombolytic Therapy mortality, Tissue Plasminogen Activator administration & dosage, Tissue Plasminogen Activator therapeutic use, Translational Research, Biomedical, Aged, 80 and over statistics & numerical data, Brain Ischemia therapy, Stroke therapy
- Abstract
Background and Purpose: Few studies have addressed outcomes among patients ≥80 years treated with acute stroke therapy. In this study, we outline in-hospital outcomes in (1) patients ≥80 years compared with their younger counterparts; and (2) those over >80 years receiving intra-arterial therapy (IAT) compared with those treated with intravenous recombinant tissue-type plasminogen activator (IV rtPA)., Methods: Stroke centers within the Specialized Program of Translational Research in Acute Stroke (SPOTRIAS) prospectively collected data on all patients treated with IV rtPA or IAT from January 1, 2005, to December 31, 2010. IAT was defined as receiving any endovascular therapy; IAT was further divided into bridging therapy when the patient received both IAT and IV rtPA and endovascular therapy alone. In-hospital mortality was compared in (1) all patients aged ≥80 years versus younger counterparts; and (2) IAT, bridging therapy, and endovascular therapy alone versus IV rtPA only among those age ≥80 years using multivariable logistic regression. An age-stratified analysis was also performed., Results: A total of 3768 patients were included in the study; 3378 were treated with IV rtPA alone and 808 with IAT (383 with endovascular therapy alone and 425 with bridging therapy). Patients ≥80 years (n=1182) had a higher risk of in-hospital mortality compared with younger counterparts regardless of treatment modality (OR, 2.13; 95% CI, 1.60-2.84). When limited to those aged ≥80 years, IAT (OR, 0.95; 95% CI, 0.60-1.49), bridging therapy (OR, 0.82; 95% CI, 0.47-1.45), or endovascular therapy alone (OR, 1.15; 95% CI, 0.64-2.08) versus IV rtPA were not associated with increased in-hospital mortality., Conclusions: IAT does not appear to increase the risk of in-hospital mortality among those aged >80 years compared with IV thrombolysis alone.
- Published
- 2012
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.