29 results on '"Avadhani, Radhika"'
Search Results
2. Clinical Trial Protocol for BEACH: A Phase 2a Study of MW189 in Patients with Acute Nontraumatic Intracerebral Hemorrhage
- Author
-
Avadhani, Radhika, Ziai, Wendy C., Thompson, Richard E., Mould, W. Andrew, Lane, Karen, Nanni, Angeline, Iacobelli, Michael, Sharrock, Matthew F., Sansing, Lauren H., Van Eldik, Linda J., and Hanley, Daniel F.
- Published
- 2024
- Full Text
- View/download PDF
3. Association Between Neutrophil–Lymphocyte Ratio and 30-Day Infection and Thrombotic Outcomes After Intraventricular Hemorrhage: A CLEAR III Analysis
- Author
-
Kaleem, Safa, Zhang, Cenai, Gusdon, Aaron M., Oh, Stephanie, Merkler, Alexander E., Avadhani, Radhika, Awad, Isaam, Hanley, Daniel F., Kamel, Hooman, Ziai, Wendy C., and Murthy, Santosh B.
- Published
- 2024
- Full Text
- View/download PDF
4. Association Between Hematoma Volume and Risk of Subsequent Ischemic Stroke: A MISTIE III and ATACH-2 Analysis
- Author
-
Harris, William, Kaiser, Jed H., Liao, Vanessa, Avadhani, Radhika, Iadecola, Costantino, Falcone, Guido J., Sheth, Kevin N., Qureshi, Adnan I., Goldstein, Joshua N., Awad, Issam A., Hanley, Daniel F., Kamel, Hooman, Ziai, Wendy C., and Murthy, Santosh B.
- Published
- 2024
- Full Text
- View/download PDF
5. Who Determines the Quality of Life of Survivors of Severe Traumatic Brain Injury?
- Author
-
Carhuapoma, Lourdes R., Avadhani, Radhika, and Hanley, Daniel F.
- Published
- 2023
- Full Text
- View/download PDF
6. Post-Stroke Depression in Patients with Large Spontaneous Intracerebral Hemorrhage
- Author
-
Avadhani, Radhika, Thompson, Richard E., Carhuapoma, Lourdes, Yenokyan, Gayane, McBee, Nichol, Lane, Karen, Ostapkovich, Noeleen, Stadnik, Agnieszka, Awad, Issam A., Hanley, Daniel F., and Ziai, Wendy C.
- Published
- 2021
- Full Text
- View/download PDF
7. Intraventricular Hemorrhage Expansion in the CLEAR III Trial: A Post Hoc Exploratory Analysis
- Author
-
Roh, David J., Asonye, Ifeyinwa S., Carvalho Poyraz, Fernanda, Magid-Bernstein, Jessica R., Joiner, Evan F., Avadhani, Radhika, Awad, Issam, Hanley, Daniel F., Ziai, Wendy C., and Murthy, Santosh B.
- Published
- 2022
- Full Text
- View/download PDF
8. Cerebral Microbleeds and Acute Hematoma Characteristics in the ATACH-2 and MISTIE III Trials
- Author
-
Magid-Bernstein, Jessica R, Li, Yunke, Cho, Sung-Min, Piran, Pirouz J., Roh, David J., Gupta, Ajay, Shoamanesh, Ashkan, Merkler, Alexander, Zhang, Cenai, Avadhani, Radhika, Montano, Nataly, Iadecola, Constantino, Falcone, Guido, Sheth, Kevin, Qureshi, Adnan, Rosand, Jonathan, Goldstein, Joshua, Awad, Issam, Hanley, Daniel, Kamel, Hooman, Ziai, Wendy C., and Murthy, Santosh B.
- Published
- 2021
- Full Text
- View/download PDF
9. CSF and serum inflammatory response and association with outcomes in spontaneous intracerebral hemorrhage with intraventricular extension: an analysis of the CLEAR-III Trial
- Author
-
Gusdon, Aaron M., Thompson, Carol B., Quirk, Kendel, Mayasi, Yunis M., Avadhani, Radhika, Awad, Issam A., Hanley, Daniel F., and Ziai, Wendy C.
- Published
- 2021
- Full Text
- View/download PDF
10. Catheter Tract Hemorrhages and Intracerebral Hemorrhage Outcomes in the Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage Trial.
- Author
-
Garton, Andrew L. A., Oh, Stephanie E., Müller, Achim, Avadhani, Radhika, Cenai Zhang, Merkler, Alexander E., Awad, Issam, Hanley, Daniel, Kamel, Hooman, Ziai, Wendy C., and Murthy, Santosh B.
- Published
- 2024
- Full Text
- View/download PDF
11. Diffusion-Weighted Imaging Lesions After Intracerebral Hemorrhage and Risk of Stroke: A MISTIE III and ATACH-2 Analysis
- Author
-
Murthy, Santosh B., Zhang, Cenai, Gupta, Ajay, Cho, Sung-Min, Rivera-Lara, Lucia, Avadhani, Radhika, Gruber, Joshua, Iadecola, Costantino, Falcone, Guido J., Sheth, Kevin N., Qureshi, Adnan I., Goldstein, Joshua N., Hanley, Daniel F., Kamel, Hooman, and Ziai, Wendy C.
- Published
- 2021
- Full Text
- View/download PDF
12. Neonatal Survival After Serial Amnioinfusions for Bilateral Renal Agenesis: The Renal Anhydramnios Fetal Therapy Trial.
- Author
-
Miller, Jena L., Baschat, Ahmet A., Rosner, Mara, Blumenfeld, Yair J., Moldenhauer, Julie S., Johnson, Anthony, Schenone, Mauro H., Zaretsky, Michael V., Chmait, Ramen H., Gonzalez, Juan M., Miller, Russell S., Moon-Grady, Anita J., Bendel-Stenzel, Ellen, Keiser, Amaris M., Avadhani, Radhika, Jelin, Angie C., Davis, Jonathan M., Warren, Daniel S., Hanley, Daniel F., and Watkins, Joslynn A.
- Subjects
PULMONARY hypoplasia ,AMNIOTIC liquid ,PREGNANCY complications ,LUNG development ,BIRTH weight ,POLYHYDRAMNIOS ,AGENESIS of corpus callosum - Abstract
Key Points: Question: In pregnancies complicated by anhydramnios due to fetal bilateral renal agenesis, do serial amnioinfusions instituted before 26 weeks' gestation mitigate lethal pulmonary hypoplasia in neonates? Findings: In this nonrandomized clinical trial, 82% of live-born infants survived to 14 days of life or longer and placement of dialysis access, but longer-term neonatal survival was reduced. Serial amnioinfusions were not associated with severe maternal complications. Meaning: Prenatal serial amnioinfusions can mitigate neonatal lethal pulmonary hypoplasia in neonates with bilateral renal agenesis, but infants face substantial morbidity independent of lung function. Importance: Early anhydramnios during pregnancy, resulting from fetal bilateral renal agenesis, causes lethal pulmonary hypoplasia in neonates. Restoring amniotic fluid via serial amnioinfusions may promote lung development, enabling survival. Objective: To assess neonatal outcomes of serial amnioinfusions initiated before 26 weeks' gestation to mitigate lethal pulmonary hypoplasia. Design, Setting, and Participants: Prospective, nonrandomized clinical trial conducted at 9 US fetal therapy centers between December 2018 and July 2022. Outcomes are reported for 21 maternal-fetal pairs with confirmed anhydramnios due to isolated fetal bilateral renal agenesis without other identified congenital anomalies. Exposure: Enrolled participants initiated ultrasound-guided percutaneous amnioinfusions of isotonic fluid before 26 weeks' gestation, with frequency of infusions individualized to maintain normal amniotic fluid levels for gestational age. Main Outcomes and Measures: The primary end point was postnatal infant survival to 14 days of life or longer with dialysis access placement. Results: The trial was stopped early based on an interim analysis of 18 maternal-fetal pairs given concern about neonatal morbidity and mortality beyond the primary end point despite demonstration of the efficacy of the intervention. There were 17 live births (94%), with a median gestational age at delivery of 32 weeks, 4 days (IQR, 32-34 weeks). All participants delivered prior to 37 weeks' gestation. The primary outcome was achieved in 14 (82%) of 17 live-born infants (95% CI, 44%-99%). Factors associated with survival to the primary outcome included a higher number of amnioinfusions (P =.01), gestational age greater than 32 weeks (P =.005), and higher birth weight (P =.03). Only 6 (35%) of the 17 neonates born alive survived to hospital discharge while receiving peritoneal dialysis at a median age of 24 weeks of life (range, 12-32 weeks). Conclusions and Relevance: Serial amnioinfusions mitigated lethal pulmonary hypoplasia but were associated with preterm delivery. The lower rate of survival to discharge highlights the additional mortality burden independent of lung function. Additional long-term data are needed to fully characterize the outcomes in surviving neonates and assess the morbidity and mortality burden. Trial Registration: ClinicalTrials.gov Identifier: NCT03101891 This prospective, nonrandomized clinical trial assesses neonatal outcomes after serial amnioinfusions initiated before 26 weeks' gestation to mitigate lethal pulmonary hypoplasia in pregnancies complicated by bilateral renal agenesis. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
13. Glycemia and Cognitive Function in Metabolic Syndrome and Coronary Heart Disease
- Author
-
Avadhani, Radhika, Fowler, Kristen, Barbato, Corinne, Thomas, Sherine, Wong, Winnie, Paul, Camille, Aksakal, Mehmet, Hauser, Thomas H., Weinger, Katie, and Goldfine, Allison B.
- Published
- 2015
- Full Text
- View/download PDF
14. Association of Intraventricular Fibrinolysis With Clinical Outcomes in Intracerebral Hemorrhage: An Individual Participant Data Meta-Analysis.
- Author
-
Kuramatsu, Joji B., Gerner, Stefan T., Ziai, Wendy, Bardutzky, Jürgen, Sembill, Jochen A., Sprügel, Maximilian I., Mrochen, Anne, Kölbl, Kathrin, Ram, Malathi, Avadhani, Radhika, Falcone, Guido J., Selim, Magdy H., Lioutas, Vasileios-Arsenios, Endres, Matthias, Zweynert, Sarah, Vajkoczy, Peter, Ringleb, Peter A., Purrucker, Jan C., Volkmann, Jens, and Neugebauer, Hermann
- Published
- 2022
- Full Text
- View/download PDF
15. One-Year Outcome Trajectories and Factors Associated with Functional Recovery Among Survivors of Intracerebral and Intraventricular Hemorrhage With Initial Severe Disability.
- Author
-
Shah, Vishank A., Thompson, Richard E., Yenokyan, Gayane, Acosta, Julian N., Avadhani, Radhika, Dlugash, Rachel, McBee, Nichol, Li, Yunke, Hansen, Bjorn M., Ullman, Natalie, Falcone, Guido, Awad, Issam A., Hanley, Daniel F., and Ziai, Wendy C.
- Published
- 2022
- Full Text
- View/download PDF
16. Cerebral Microbleeds and Acute Hematoma Characteristics in the ATACH-2 and MISTIE III Trials.
- Author
-
Magid-Bernstein, Jessica R., Li, Yunke, Cho, Sung-Min DO, Piran, Pirouz J., Roh, David J., Gupta, Ajay MS, Shoamanesh, Ashkan, Merkler, Alexander MS, Zhang, Cenai MS, Avadhani, Radhika MS, Montano, Nataly, Iadecola, Constantino, Falcone, Guido J. ScD,, Sheth, Kevin N., Qureshi, Adnan I., Rosand, Jonathan, Goldstein, Joshua, Awad, Issam, Hanley, Daniel F., and Kamel, Hooman MS
- Published
- 2022
- Full Text
- View/download PDF
17. Neonatal survival after serial amnioinfusions for fetal bilateral renal agenesis: report from the raft trial
- Author
-
Miller, Jena L., Baschat, Ahmet A., Rosner, Mara, Blumenfeld, Yair J., Moldenhauer, Julie, Johnson, Anthony, Schenone, Mauro, Zaretsky, Michael V., Chmait, Ramen H., Velez, Juan Gonzalez, Miller, Russell S., Moon-Grady, Anita J., Bendel-Stenzel, Ellen M., Keiser, Amaris, Avadhani, Radhika, Jelin, Angie, Davis, Jonathan, Warren, Daniel, Hanley, Daniel, and Atkinson, Meredith
- Published
- 2023
- Full Text
- View/download PDF
18. Intracranial Pressure and Cerebral Perfusion Pressure in Large Spontaneous Intracranial Hemorrhage and Impact of Minimally Invasive Surgery.
- Author
-
Al-Kawaz, Mais N., Li, Yunke, Thompson, Richard E., Avadhani, Radhika, de Havenon, Adam, Gruber, Joshua, Awad, Issam, Hanley, Daniel F., and Ziai, Wendy
- Subjects
INTRACRANIAL hemorrhage ,MINIMALLY invasive procedures ,INTRACRANIAL pressure ,CEREBRAL hemorrhage ,PERFUSION - Abstract
Introduction: We investigated the effect of hematoma volume reduction with minimally invasive surgery (MIS) on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in patients with large spontaneous intracerebral hemorrhage (ICH). Methods: Post-hoc analysis of the Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation (MISTIE III) study, a clinical trial with blinded outcome assessments. The primary outcome was the proportion of ICP readings ≥20 and 30 mmHg, and CPP readings <70 and 60 mm Hg. Secondary outcomes included major disability (modified Rankin scale >3) and mortality at 30 and 365 days. We assessed the relationship between proportion of high ICP and low CPP events and MIS using binomial generalized linear models, and outcomes using multiple logistic regression. Results: Of 499 patients enrolled in MISTIE III, 72 patients had guideline based ICP monitors placed, 34 in the MIS group and 38 in control (no surgery) group. Threshold ICP and CPP events ≥20/ <70 mmHg occurred in 31 (43.1%) and 52 (72.2%) patients respectively. On adjusted analyses, proportion of ICP readings ≥20 and 30 mmHg were significantly lower in the MIS group vs. control group [Odds Ratio (OR) 0.27, 95% Confidence Interval [CI] 0.11–0.63 (p = 0.002); OR = 0.18, 0.04–0.75, p = 0.02], respectively. Proportion of CPP readings <70 and 60 mm Hg were also significantly lower in MIS patients [OR 0.31, 95% CI 0.15–0.63 (p = 0.001); OR 0.30, 95% CI 0.11–0.83 (p = 0.02)], respectively. Higher proportions of CPP readings <70 and 60 mm were significantly associated with short term mortality (p = 0.04), and (p = 0.006), respectively. Long term mortality was significantly associated with higher proportion of time with ICP ≥ 20 (p = 0.04), ICP ≥ 30 (p = 0.04), and CPP <70 mmHg (p = 0.01). Conclusion: Our results are consistent with the hypothesis that surgical reduction of ICH volume decreases proportion of high ICP and low CPP events and that these variables are associated with short- and long-term mortality. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
19. A Pooled Analysis of Diffusion-Weighted Imaging Lesions in Patients With Acute Intracerebral Hemorrhage.
- Author
-
Murthy, Santosh B., Cho, Sung-Min, Gupta, Ajay, Shoamanesh, Ashkan, Navi, Babak B., Avadhani, Radhika, Gruber, Joshua, Li, Yunke, Greige, Tatiana, Lioutas, Vasileios-Arsenios, Norton, Casey, Zhang, Cenai, Mandava, Pitchaiah, Iadecola, Costantino, Falcone, Guido J., Sheth, Kevin N., Biffi, Alessandro, Rosand, Jonathan, Qureshi, Adnan I., and Goldstein, Joshua N.
- Published
- 2020
- Full Text
- View/download PDF
20. Relationship of White Matter Lesions with Intracerebral Hemorrhage Expansion and Functional Outcome: MISTIE II and CLEAR III.
- Author
-
Hansen, Björn M., Ullman, Natalie, Muschelli, John, Norrving, Bo, Dlugash, Rachel, Avadhani, Radhika, Awad, Issam, Zuccarello, Mario, Ziai, Wendy C., Hanley, Daniel F., Thompson, Richard E., and Lindgren, Arne
- Subjects
CEREBRAL hemorrhage ,CLINICAL trial registries ,CEREBRAL small vessel diseases ,INTRAVENTRICULAR hemorrhage ,RANDOMIZED controlled trials - Abstract
Background/Objective: Intracerebral hemorrhage (ICH) patients commonly have concomitant white matter lesions (WML) which may be associated with poor outcome. We studied if WML affects hematoma expansion (HE) and post-stroke functional outcome in a post hoc analysis of patients from randomized controlled trials. Methods: In ICH patients from the clinical trials MISTIE II and CLEAR III, WML grade on diagnostic computed tomography (dCT) scan (dCT, < 24 h after ictus) was assessed using the van Swieten scale (vSS, range 0–4). The primary outcome for HE was > 33% or > 6 mL ICH volume increase from dCT to the last pre-randomization CT (< 72 h of dCT). Secondary HE outcomes were: absolute ICH expansion, > 10.4 mL total clot volume increase, and a subgroup analysis including patients with dCT < 6 h after ictus using the primary HE definition of > 33% or > 6 mL ICH volume increase. Poor functional outcome was assessed at 180 days and defined as modified Rankin Scale (mRS) ≥ 4, with ordinal mRS as a secondary endpoint. Results: Of 635 patients, 55% had WML grade 1–4 at dCT (median 2.2 h from ictus) and 13% had subsequent HE. WML at dCT did not increase the odds for primary or secondary HE endpoints (P ≥ 0.05) after adjustment for ICH volume, intraventricular hemorrhage volume, warfarin/INR > 1.5, ictus to dCT time in hours, age, diabetes mellitus, and thalamic ICH location. WML increased the odds for having poor functional outcome (mRS ≥ 4) in univariate analyses (vSS 4; OR 4.16; 95% CI 2.54–6.83; P < 0.001) which persisted in multivariable analyses after adjustment for HE and other outcome risk factors. Conclusions: Concomitant WML does not increase the odds for HE in patients with ICH but increases the odds for poor functional outcome. Clinical Trial Registration: http://www.clinicaltrials.gov trial-identifiers: NCT00224770 and NCT00784134. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
21. Developing a risk-based composite neurologic outcome for a trial of hydroxyurea in young children with sickle cell disease.
- Author
-
Casella, James F., Adams, Robert J., Brambilla, Donald J., Strouse, John J., Maier, Pia, Dlugash, Rachel, Avadhani, Radhika, Vermillion, Krista, Tonascia, James, Voeks, Jenifer H., Hanley, Daniel F., Thompson, Richard E., and Lehmann, Harold P.
- Subjects
DRUG therapy for sickle cell anemia ,NEUROLOGICAL disorder prevention ,HYDROXYUREA ,CLINICAL trials ,HEALTH attitudes ,MEDICAL research ,HEALTH outcome assessment ,SICKLE cell anemia ,EVIDENCE-based medicine ,DISEASE complications ,CHILDREN ,THERAPEUTICS - Abstract
Background Studies of interventions to prevent the many neurological complications of sickle cell disease must take into account multiple outcomes of variable severity, with limited sample size. The goals of the studies presented were to use investigator preferences across outcomes to determine an attitude-based weighting of relevant clinical outcomes and to establish a valid composite outcome for a clinical trial. Methods In Study 1, investigators were surveyed about their practice regarding hydroxyurea therapy and opinions about outcomes for the "Hydroxyurea to Prevent the Central Nervous System Complications of Sickle Cell Disease Trial" (HU Prevent), and their minimally acceptable relative risk reduction for the two outcome components, motor and neurocognitive deficits. In Study 2, HU Prevent investigators provided overall weights for these two components. In Study 3, they provided more granular rankings, ratings, and maximum number acceptable to harm. A weighted composite outcome, the Stroke Consequences Risk Score, was constructed that incorporates the major neurologic complications of sickle cell disease. The Stroke Consequences Risk Score represents the 3-year risk of suffering the adverse consequences of stroke. In Study 4, the results of the Optimizing Primary Stroke Prevention in Sickle Cell Anemia (STOP2) and Silent Infarct Transfusion Trials were reanalyzed in light of the composite outcome. Results In total, 22 to 27 investigators participated per study. In Study 1, across three samplings between 2009 and 2015, the average minimally acceptable relative risk reduction ranged from 0.36 to 0.50, at or below the target effect size of 0.50. In 2015, 21 (91%) reported that a placebo-controlled trial is reasonable; 23 (100%), that it is ethical; and 22 (96%), that they would change their practice, if the results of the trial were positive. In Studies 2 and 3, the weight elicited for a cognitive decline (of 10 IQ points) from the overall assessment was 0.67 (and for motor deficit, the complementary 0.33); from ranking, 0.6; from rating, 0.58; and from maximal number acceptable to harm, 0.5. Using data from two major clinical trials, Study 4 demonstrated the same conclusions as the original trials using the Stroke Consequences Risk Score, with smaller p-values for both reanalyses. An assessment of acceptability was performed as well. Conclusion This set of studies provides the rationale, justification, and validation for the use of a weighted composite outcome and confirms the need for the phase III HU Prevent study. Surveys of investigators in multi-center studies can provide the basis of clinically meaningful outcomes that foster the translation of study results into practice while increasing the efficiency of a study. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
22. Fibrinolytic for treatment of intraventricular hemorrhage: A meta-analysis and systematic review.
- Author
-
Baker, Alexandra Delaney, Perla, Krissia Margarita Rivera, Yu, Zhiyuan, Dlugash, Rachel, Avadhani, Radhika, Mould, William Andrew, Ziai, Wendy, Thompson, Richard E, Staykov, Dimitre, and Hanley, Daniel F
- Subjects
FIBRINOLYTIC agents ,INTRAVENTRICULAR hemorrhage ,META-analysis ,SYSTEMATIC reviews ,MORTALITY ,THERAPEUTICS - Abstract
Background: Intraventricular hemorrhage is a significant cause of mortality and morbidity worldwide. Treating intraventricular hemorrhage with intraventricular fibrinolytic therapy via a catheter is becoming an increasingly utilized intervention. Aims: This meta-analysis aimed to investigate the role of intraventricular fibrinolytic treatment in hypertensive intraventricular hemorrhage patients and evaluate the effect sizes for survival as well as level of function at differing time points. Summary of review: PubMed, CNKI, VIP, and Wanfang were searched using the terms "IVH" and "IVH and ICH" for human studies with adult patients published between January 1950 and July 2016. Seventeen publications were selected. Data analysis showed lower rates of mortality in the treatment group at 30 days (P<0.001), 180 days (P = 0.001), 365 days (P = 0.40), and overall (P<0.001). Pooling modified Rankin Scale and Glasgow outcome scale data, the treatment group had more good functional outcomes at 30 days (P = 0.38), 90 days (P = 0.04), 180 days (P = 0.31), 365 days (P = 0.76), and overall (P = 0.02). Good functional outcome was defined as modified Rankin Scale score of 0 to 3 or a Glasgow outcome scale score of 3 to 5. Conclusions: Intraventricular fibrinolytic for treatment of hypertensive intraventricular hemorrhage reduces mortality and potentially leads to an increased number of good functional outcomes. Different functional outcome scales (modified Rankin Scale or Glasgow outcome scale) produce different effect sizes. Intraventricular fibrinolytic treatment may offer intraventricular hemorrhage patients a targeted therapy that produces meaningful mortality benefit and possible functional outcome benefits. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
23. Asynchronous vascular consultation via electronic methods: A feasibility pilot.
- Author
-
Chittle, Melissa D., Rao, Sandhya K., Jaff, Michael R., Patel, Virendra I., Gallen, Kathleen M., Avadhani, Radhika, Ferris, Timothy G., and Wasfy, Jason H.
- Subjects
VASCULAR diseases ,ACCOUNTABLE care organizations ,CHRONIC disease treatment ,FEASIBILITY studies ,DUPLEX ultrasonography - Abstract
Management of chronic disease often requires multidisciplinary clinical efforts and specialist care. With the emergence of Accountable Care Organizations (ACOs), health care systems are incentivized to evaluate methods of information exchange between generalists and specialists in order to provide value while preserving quality. Our objective was to evaluate patient and referring provider satisfaction and outcomes of asynchronous electronic consultations in vascular care in a large tertiary academic medical center. Referring providers were offered a vascular ‘e-consult’ option through an electronic referral management system. We conducted chart review to understand the downstream effects and surveyed patients and referring providers to assess satisfaction. From 24 March 2014 to 1 March 2015, 54 e-consults were completed. Additional testing and recommendations were made in 49/54 (90.7%) e-consults, including lower-extremity venous duplex ultrasonography with reflux testing, duplex ultrasonography of the carotid artery, computed tomography, magnetic resonance imaging, non-invasive physiology arterial studies, laboratory tests, medications, compression stockings, and sequential lymphedema compression therapy. Referring providers were compliant with recommendations in 40/49 (81.6%) of e-consults. A total of 17/54 (31.5%) patients were surveyed with a median patient satisfaction score of 13.7/15 (91.3%) (SD ± 6.4). The program was associated with high referring provider satisfaction, with 87.0% finding the e-consult very helpful and 80.0% stating it averted the need for a traditional visit. Our experience suggests that e-consults are an effective way to provide vascular care in some patients and are associated with high patient and provider satisfaction. E-consults may therefore be an efficient method of care delivery for vascular patients within an ACO. [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
- View/download PDF
24. Association Between Intraventricular Alteplase Use and Parenchymal Hematoma Volume in Patients With Spontaneous Intracerebral Hemorrhage and Intraventricular Hemorrhage.
- Author
-
Witsch, Jens, Roh, David J., Avadhani, Radhika, Merkler, Alexander E., Kamel, Hooman, Awad, Issam, Hanley, Daniel F., Ziai, Wendy C., and Murthy, Santosh B.
- Published
- 2021
- Full Text
- View/download PDF
25. Does stereotactic thrombolysis with alteplase for intracerebral haemorrhage alter intraventricular haematoma volume? A secondary analysis of the MISTIE-III trial.
- Author
-
Sun P, Badihian S, Avadhani R, Walborn N, Yarava A, Alimoradi D, Awad I, Hanley D, Murthy S, and Ziai W
- Subjects
- Humans, Male, Female, Middle Aged, Aged, Treatment Outcome, Stereotaxic Techniques, Hematoma drug therapy, Tomography, X-Ray Computed, Cerebral Intraventricular Hemorrhage drug therapy, Tissue Plasminogen Activator therapeutic use, Tissue Plasminogen Activator administration & dosage, Fibrinolytic Agents therapeutic use, Fibrinolytic Agents administration & dosage, Cerebral Hemorrhage drug therapy, Thrombolytic Therapy methods
- Abstract
Background: Stereotactic thrombolysis reduces intracerebral haemorrhage (ICH) volume in patients with spontaneous ICH. Whether intrahaematomal alteplase administration is associated with a change in intraventricular haemorrhage volume (deltaIVH) and functional outcomes is unknown., Methods: Post hoc secondary analysis of the Minimally Invasive Surgery plus Alteplase for Intracerebral Hemorrhage Evacuation Phase III (MISTIE-III) trial in patients with IVH on the stability CT scan. Exposure was minimally invasive surgery plus alteplase (MIS+alteplase). Primary outcome was deltaIVH defined as IVH volume on end-of-treatment CT minus IVH volume on stability CT scan. Secondary outcomes were favourable functional outcome (modified Rankin Scale 0-3) and mortality at 365 days. We assessed the relationship between MIS+alteplase and deltaIVH in the primary analysis using multivariable linear regression, and between deltaIVH and functional outcomes in secondary analyses using multiple logistic regression., Results: Of 499 patients in MISTIE-III, 310 (62.1%) had IVH on stability scans; mean age (SD) was 61.2±12.3 years. A total of 146 (47.1%) received the MISTIE procedure and 164 (52.9%) standard medical care (SMC) only. The MIS+alteplase group had a greater mean reduction in IVH volume compared with the SMC group (deltaIVH: -2.35 (5.30) mL vs -1.15 (2.96) mL, p=0.02). While IVH volume decreased significantly in both treatment groups, in the primary analysis, MIS+alteplase was associated with greater deltaIVH in multivariable linear regression analysis adjusted for potential confounders (β -0.80; 95% CI -1.37 to -0.22, p=0.007). Secondary analysis demonstrated no associations between IVH reduction and functional outcomes (adjusted OR (aOR) for poor outcome 1.02; 95% CI 0.96 to 1.08, p=0.61; aOR for mortality 0.99; 95% CI 0.92 to 1.06, p=0.77)., Conclusions: Alteplase delivered into the ICH in MISTIE-III subjects with IVH was associated with a small reduction in IVH volume. This reduction did not translate into a significant benefit in mortality or functional outcomes at 365 days., Trial Registration Number: NCT01827046., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2024
- Full Text
- View/download PDF
26. Cerebral small vessel disease modifies outcomes after minimally invasive surgery for intracerebral haemorrhage.
- Author
-
Li Y, Cho SM, Avadhani R, Ali H, Hao Y, Murthy SB, Goldstein JN, Xia F, Hu X, Ullman NL, Awad I, Hanley D, and Ziai WC
- Subjects
- Humans, Male, Female, Treatment Outcome, Aged, Middle Aged, Time Factors, Risk Factors, Tissue Plasminogen Activator administration & dosage, Tissue Plasminogen Activator adverse effects, Recovery of Function, Minimally Invasive Surgical Procedures, Thrombolytic Therapy adverse effects, Neurosurgical Procedures adverse effects, Risk Assessment, Cerebral Small Vessel Diseases diagnostic imaging, Cerebral Small Vessel Diseases surgery, Cerebral Small Vessel Diseases physiopathology, Cerebral Hemorrhage surgery, Cerebral Hemorrhage diagnostic imaging, Magnetic Resonance Imaging, Predictive Value of Tests, Fibrinolytic Agents administration & dosage, Fibrinolytic Agents adverse effects, Functional Status
- Abstract
Background: Minimally invasive surgery (MIS) for spontaneous supratentorial intracerebral haemorrhage (ICH) is controversial but may be beneficial if end-of-treatment (EOT) haematoma volume is reduced to ≤15 mL. We explored whether MRI findings of cerebral small vessel disease (CSVD) modify the effect of MIS on long-term outcomes., Methods: Prespecified blinded subgroup analysis of 288 subjects with qualified imaging sequences from the phase 3 Minimally Invasive Surgery Plus Alteplase for Intracerebral Haemorrhage Evacuation (MISTIE) trial. We tested for heterogeneity in the effects of MIS and MIS+EOT volume ≤15 mL on the trial's primary outcome of good versus poor function at 1 year by the presence of single CSVD features and CSVD scores using multivariable models., Results: Of 499 patients enrolled in MISTIE III, 288 patients had MRI, 149 (51.7%) randomised to MIS and 139 (48.3%) to standard medical care (SMC). Median (IQR) ICH volume was 42 (30-53) mL. In the full MRI cohort, there was no statistically significant heterogeneity in the effects of MIS versus SMC on 1-year outcomes by any specific CSVD feature or by CSVD scores (all P
interaction >0.05). In 94 MIS patients with EOT ICH volume ≤15 mL, significant reduction in odds of poor outcome was found with cerebral amyloid angiopathy score <2 (OR, 0.14 (0.05-0.42); Pinteraction =0.006), absence of lacunes (OR, 0.37 (0.18-0.80); Pinteraction =0.02) and absence of severe white matter hyperintensities (WMHs) (OR, 0.22 (0.08-0.58); Pinteraction =0.03)., Conclusions: Following successful haematoma reduction by MIS, we found significantly lower odds of poor functional outcome with lower total burden of CSVD in addition to absence of lacunes and severe WMHs. CSVD features may have utility for prognostication and patient selection in clinical trials of MIS., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)- Published
- 2024
- Full Text
- View/download PDF
27. Hydroxyurea to prevent brain injury in children with sickle cell disease (HU Prevent)-A randomized, placebo-controlled phase II feasibility/pilot study.
- Author
-
Casella JF, Furstenau DK, Adams RJ, Brambilla DJ, Lebensburger JD, Fehr JJ, Jordan LC, King AA, Ichord RN, McKinstry RC, Kraut MA, Shaw DW, White DA, Whyte-Stewart DA, Avadhani R, Barron-Casella EA, Cannon AD, Eaton CK, Riekert KA, Shay JE, Smith-Seidel CA, Weiss DC, Ostapkovich ND, Vermillion K, Treine KE, Kingsbury CE, Strouse JJ, Thompson RE, and Hanley DF
- Abstract
Central nervous system (CNS) injury is common in sickle cell disease (SCD) and occurs early in life. Hydroxyurea is safe and efficacious for treatment of SCD, but high-quality evidence from randomized trials to estimate its neuroprotective effect is scant. HU Prevent was a randomized (1:1), double-blind, phase II feasibility/pilot trial of dose-escalated hydroxyurea vs. placebo for the primary prevention of CNS injury in children with HbSS or HbS-β
0 -thalassemia subtypes of SCD age 12-48 months with normal neurological examination, MRI of the brain, and cerebral blood flow velocity. We hypothesized that hydroxyurea would reduce by 50% the incidence of CNS injury. Two outcomes were compared: primary-a composite of silent cerebral infarction, elevated cerebral blood flow velocity, transient ischemic attack, or stroke; secondary-a weighted score estimating the risk of suffering the consequences of stroke (the Stroke Consequences Risk Score-SCRS), based on the same outcome events. Six participants were randomized to each group. One participant in the hydroxyurea group had a primary outcome vs. four in the placebo group (incidence rate ratio [90% CI] 0.216 [0.009, 1.66], p = .2914) (~80% reduction in the hydroxyurea group). The mean SCRS score was 0.078 (SD 0.174) in the hydroxyurea group, 0.312 (SD 0.174) in the placebo group, p = .072, below the p-value of .10 often used to justify subsequent phase III investigations. Serious adverse events related to study procedures occurred in 3/41 MRIs performed, all related to sedation. These results suggest that hydroxyurea may have profound neuroprotective effect in children with SCD and support a definitive phase III study to encourage the early use of hydroxyurea in all infants with SCD., (© 2024 Wiley Periodicals LLC.)- Published
- 2024
- Full Text
- View/download PDF
28. Efficacy and safety of minimally invasive surgery with thrombolysis in intracerebral haemorrhage evacuation (MISTIE III): a randomised, controlled, open-label, blinded endpoint phase 3 trial.
- Author
-
Hanley DF, Thompson RE, Rosenblum M, Yenokyan G, Lane K, McBee N, Mayo SW, Bistran-Hall AJ, Gandhi D, Mould WA, Ullman N, Ali H, Carhuapoma JR, Kase CS, Lees KR, Dawson J, Wilson A, Betz JF, Sugar EA, Hao Y, Avadhani R, Caron JL, Harrigan MR, Carlson AP, Bulters D, LeDoux D, Huang J, Cobb C, Gupta G, Kitagawa R, Chicoine MR, Patel H, Dodd R, Camarata PJ, Wolfe S, Stadnik A, Money PL, Mitchell P, Sarabia R, Harnof S, Barzo P, Unterberg A, Teitelbaum JS, Wang W, Anderson CS, Mendelow AD, Gregson B, Janis S, Vespa P, Ziai W, Zuccarello M, and Awad IA
- Subjects
- Aged, Female, Humans, Intention to Treat Analysis, Male, Middle Aged, Treatment Outcome, Cerebral Hemorrhage surgery, Minimally Invasive Surgical Procedures adverse effects, Minimally Invasive Surgical Procedures methods, Thrombolytic Therapy adverse effects, Thrombolytic Therapy methods
- Abstract
Background: Acute stroke due to supratentorial intracerebral haemorrhage is associated with high morbidity and mortality. Open craniotomy haematoma evacuation has not been found to have any benefit in large randomised trials. We assessed whether minimally invasive catheter evacuation followed by thrombolysis (MISTIE), with the aim of decreasing clot size to 15 mL or less, would improve functional outcome in patients with intracerebral haemorrhage., Methods: MISTIE III was an open-label, blinded endpoint, phase 3 trial done at 78 hospitals in the USA, Canada, Europe, Australia, and Asia. We enrolled patients aged 18 years or older with spontaneous, non-traumatic, supratentorial intracerebral haemorrhage of 30 mL or more. We used a computer-generated number sequence with a block size of four or six to centrally randomise patients to image-guided MISTIE treatment (1·0 mg alteplase every 8 h for up to nine doses) or standard medical care. Primary outcome was good functional outcome, defined as the proportion of patients who achieved a modified Rankin Scale (mRS) score of 0-3 at 365 days, adjusted for group differences in prespecified baseline covariates (stability intracerebral haemorrhage size, age, Glasgow Coma Scale, stability intraventricular haemorrhage size, and clot location). Analysis of the primary efficacy outcome was done in the modified intention-to-treat (mITT) population, which included all eligible, randomly assigned patients who were exposed to treatment. All randomly assigned patients were included in the safety analysis. This study is registered with ClinicalTrials.gov, number NCT01827046., Findings: Between Dec 30, 2013, and Aug 15, 2017, 506 patients were randomly allocated: 255 (50%) to the MISTIE group and 251 (50%) to standard medical care. 499 patients (n=250 in the MISTIE group; n=249 in the standard medical care group) received treatment and were included in the mITT analysis set. The mITT primary adjusted efficacy analysis estimated that 45% of patients in the MISTIE group and 41% patients in the standard medical care group had achieved an mRS score of 0-3 at 365 days (adjusted risk difference 4% [95% CI -4 to 12]; p=0·33). Sensitivity analyses of 365-day mRS using generalised ordered logistic regression models adjusted for baseline variables showed that the estimated odds ratios comparing MISTIE with standard medical care for mRS scores higher than 5 versus 5 or less, higher than 4 versus 4 or less, higher than 3 versus 3 or less, and higher than 2 versus 2 or less were 0·60 (p=0·03), 0·84 (p=0·42), 0·87 (p=0·49), and 0·82 (p=0·44), respectively. At 7 days, two (1%) of 255 patients in the MISTIE group and ten (4%) of 251 patients in the standard medical care group had died (p=0·02) and at 30 days, 24 (9%) patients in the MISTIE group and 37 (15%) patients in the standard medical care group had died (p=0·07). The number of patients with symptomatic bleeding and brain bacterial infections was similar between the MISTIE and standard medical care groups (six [2%] of 255 patients vs three [1%] of 251 patients; p=0·33 for symptomatic bleeding; two [1%] of 255 patients vs 0 [0%] of 251 patients; p=0·16 for brain bacterial infections). At 30 days, 76 (30%) of 255 patients in the MISTIE group and 84 (33%) of 251 patients in the standard medical care group had one or more serious adverse event, and the difference in number of serious adverse events between the groups was statistically significant (p=0·012)., Interpretation: For moderate to large intracerebral haemorrhage, MISTIE did not improve the proportion of patients who achieved a good response 365 days after intracerebral haemorrhage. The procedure was safely adopted by our sample of surgeons., Funding: National Institute of Neurological Disorders and Stroke and Genentech., (Copyright © 2019 Elsevier Ltd. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF
29. African American Screening and Enrollment in (Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage III) CLEAR III.
- Author
-
Lane K, Keita M, Avadhani R, Dlugash R, Mayo S, Thompson RE, Awad I, McBee N, Ziai W, and Hanley DF
- Abstract
Background: Under-enrolling minority patients in clinical trials reduces generalizability. CLEAR III, a randomized controlled trial, presented an opportunity to assess African American (AA) participation., Methods: AA enrollment was compared to U.S. population and NINDS trial data then stratified by region; census data for 42 recruitment cities were compared to screening and randomization percentages, using simple linear regression., Results: AAs were 25% of screens and 45.1% of enrollments (n=370), more than twice the 19.8% participation rate reported by the 2011 NINDS Advisory Panel on Health Disparities Research and triple the projected 13.9% 2014 U.S. population. Conversion rates were (AA vs. non-AA): overall (8.7% vs. 3.4%, p<0.001); Northeast (7.7% vs. 2.9%, p<0.001); South (8.2% vs. 4.0%, p<0.001); Midwest (10.3% vs. 3.6%, p<0.01); and West (8.9% vs. 3.8%, p=0.02). AA enrollments ranged from 0% to 100% (mean: 40.4%). AA screening ranged from 0% to 63.7% (mean: 23.2%). AA city census ranged from 1.3% to 82.7% (mean: 28.0%); higher census was associated with higher screening (p<0.0001) and enrollment (p=0.004)., Conclusions: AAs were willing to enroll in an acute stroke trial. AA city census rates should be considered when selecting enrollment centers and setting recruitment goals. Factors leading to successful AA recruitment should be further investigated, as population-based participation is a goal in all trials.
- Published
- 2018
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.