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1. Prolonged venous transit is associated with lower odds of excellent recovery after reperfusion in anterior large-vessel occlusion stroke.

Author

Salim, Hamza, Lakhani, Dhairya, Mei, Janet, Luna, Licia, Shahriari, Mona, Hyson, Nathan, Deng, Francis, Dmytriw, Adam, Guenego, Adrien, Urrutia, Victor, Marsh, Elisabeth, Lu, Hanzhang, Xu, Risheng, Leigh, Rich, Wolman, Dylan, Shah, Gaurang, Pulli, Benjamin, Albers, Gregory, Hillis, Argye, Llinas, Rafael, Nael, Kambiz, Wintermark, Max, Heit, Jeremy, Faizy, Tobias, and Yedavalli, Vivek

Subjects
Acute ischemic stroke (AIS), Computed tomography perfusion (CTP), Intravenous thrombolysis (IVT), Large‐vessel occlusion (LVO), Mechanical thrombectomy (MT), Prolonged venous transit (PVT), Venous outflow (VO), Humans, Male, Female, Aged, Middle Aged, Ischemic Stroke, Recovery of Function, Retrospective Studies, Reperfusion, Aged, 80 and over, Cerebrovascular Circulation, Treatment Outcome
Abstract

BACKGROUND AND PURPOSE: Acute ischemic stroke due to anterior circulation large-vessel occlusion (AIS-LVO) remains a leading cause of disability despite successful reperfusion therapies. Prolonged venous transit (PVT) has emerged as a potential prognostic imaging biomarker in AIS-LVO. We aimed to investigate whether PVT is associated with a decreased likelihood of excellent functional outcome (modified Rankin Scale [mRS] score of 0-1 at 90 days) after successful reperfusion. METHODS: In our prospectively collected, retrospectively reviewed database, we analyzed data from 104 patients with AIS-LVO who achieved successful reperfusion (modified Thrombolysis in Cerebral Infarction score of 2b/2c/3) between September 2017 and September 2022. PVT was defined as a time to maximum (Tmax) of ≥10 s in the superior sagittal sinus and/or torcula on computed tomography perfusion (CTP) imaging. Patients were categorized into PVT-positive (PVT+) and PVT-negative (PVT-) groups. The primary outcome was excellent functional recovery at 90 days. RESULTS: Of the 104 patients, 30 (29%) were PVT+. Excellent functional outcome was achieved in 38 patients (37%). PVT+ patients had a significantly lower rate of excellent recovery compared to PVT- patients (11% vs. 39%; p

Published
2025

2. Perfusion-Based Relative Cerebral Blood Volume Is Associated With Functional Dependence in Large-Vessel Occlusion Ischemic Stroke.

Author

Lakhani, Dhairya, Balar, Aneri, Koneru, Manisha, Wen, Sijin, Ozkara, Burak, Caplan, Justin, Dmytriw, Adam, Wang, Richard, Lu, Hanzhang, Hoseinyazdi, Meisam, Nabi, Mehreen, Mazumdar, Ishan, Cho, Andrew, Chen, Kevin, Sepehri, Sadra, Hyson, Nathan, Xu, Risheng, Urrutia, Victor, Luna, Licia, Hillis, Argye, Heit, Jeremy, Albers, Greg, Rai, Ansaar, Faizy, Tobias, Wintermark, Max, Nael, Kambiz, and Yedavalli, Vivek

Subjects
poor functional outcome, rCBV, relative cerebral blood volume, Humans, Male, Female, Cerebral Blood Volume, Aged, Retrospective Studies, Ischemic Stroke, Computed Tomography Angiography, Cerebrovascular Circulation, Middle Aged, Perfusion Imaging, Aged, 80 and over, Cerebral Angiography, Predictive Value of Tests, Prognosis, Recovery of Function, Functional Status
Abstract

BACKGROUND: Pretreatment computed tomography perfusion parameter relative cerebral blood volume (rCBV) lesion volume has been shown to predict 90-day modified Rankin Scale score in small-core strokes with Alberta Stroke Program Early Computed Tomography Score ≥5, including those with medium-vessel occlusions (mid and distal M2 segment occlusions). Hence, in this study we aim to assess the performance of different rCBV lesion volume thresholds (rCBV

Published
2024

3. Outcomes of mechanical thrombectomy in anticoagulated patients with acute distal and medium vessel stroke.

Author

Salim, Hamza, Musmar, Basel, Adeeb, Nimer, Yedavalli, Vivek, Lakhani, Dhairya, Grewal, Sahibjot, El Naamani, Kareem, Henninger, Nils, Sundararajan, Sri, Kühn, Anna, Khalife, Jane, Ghozy, Sherief, Scarcia, Luca, Tan, Benjamin, Regenhardt, Robert, Heit, Jeremy, Cancelliere, Nicole, Bernstock, Joshua, Rouchaud, Aymeric, Fiehler, Jens, Sheth, Sunil, Puri, Ajit, Dyzmann, Christian, Colasurdo, Marco, Barreau, Xavier, Renieri, Leonardo, Filipe, João, Harker, Pablo, Radu, Răzvan, Abdalkader, Mohamad, Klein, Piers, Marotta, Thomas, Spears, Julian, Ota, Takahiro, Mowla, Ashkan, Jabbour, Pascal, Biswas, Arundhati, Clarençon, Frédéric, Siegler, James, Nguyen, Thanh, Varela, Ricardo, Baker, Amanda, Essibayi, Muhammed, Altschul, David, Gonzalez, Nestor, Möhlenbruch, Markus, Costalat, Vincent, Gory, Benjamin, Stracke, Christian, Aziz-Sultan, Mohammad, Hecker, Constantin, Shaikh, Hamza, Liebeskind, David, Pedicelli, Alessandro, Alexandre, Andrea, Tancredi, Illario, Faizy, Tobias, Kalsoum, Erwah, Lubicz, Boris, Patel, Aman, Pereira, Vitor, Guenego, Adrien, and Dmytriw, Adam

Subjects
Stroke, anticoagulation, thrombectomy, Humans, Aged, Male, Female, Anticoagulants, Retrospective Studies, Ischemic Stroke, Aged, 80 and over, Thrombectomy, Treatment Outcome, Middle Aged, Stroke
Abstract

BACKGROUND: Stroke remains a major health concern globally, with oral anticoagulants widely prescribed for stroke prevention. The efficacy and safety of mechanical thrombectomy (MT) in anticoagulated patients with distal medium vessel occlusions (DMVO) are not well understood. METHODS: This retrospective analysis involved 1282 acute ischemic stroke (AIS) patients who underwent MT in 37 centers across North America, Asia, and Europe from September 2017 to July 2023. Data on demographics, clinical presentation, treatment specifics, and outcomes were collected. The primary outcomes were functional outcomes at 90 days post-MT, measured by modified Rankin Scale (mRS) scores. Secondary outcomes included reperfusion rates, mortality, and hemorrhagic complications. RESULTS: Of the patients, 223 (34%) were on anticoagulation therapy. Anticoagulated patients were older (median age 78 vs 74 years; p

Published
2024

4. Endovascular therapy versus medical management in isolated posterior cerebral artery acute ischemic stroke: A multinational multicenter propensity score-weighted study.

Author

Salim, Hamza, Pulli, Benjamin, Yedavalli, Vivek, Musmar, Basel, Adeeb, Nimer, Lakhani, Dhairya, Essibayi, Muhammed, El Naamani, Kareem, Henninger, Nils, Sundararajan, Sri, Kühn, Anna, Khalife, Jane, Ghozy, Sherief, Scarcia, Luca, Grewal, Inayat, Tan, Benjamin, Regenhardt, Robert, Heit, Jeremy, Cancelliere, Nicole, Bernstock, Joshua, Rouchaud, Aymeric, Fiehler, Jens, Sheth, Sunil, Puri, Ajit, Dyzmann, Christian, Colasurdo, Marco, Barreau, Xavier, Renieri, Leonardo, Filipe, João, Harker, Pablo, Radu, Răzvan, Abdalkader, Mohamad, Klein, Piers, Marotta, Thomas, Spears, Julian, Ota, Takahiro, Mowla, Ashkan, Jabbour, Pascal, Biswas, Arundhati, Clarençon, Frédéric, Siegler, James, Nguyen, Thanh, Varela, Ricardo, Baker, Amanda, Altschul, David, Gonzalez, Nestor, Möhlenbruch, Markus, Costalat, Vincent, Gory, Benjamin, Stracke, Christian, Aziz-Sultan, Mohammad, Hecker, Constantin, Shaikh, Hamza, Griessenauer, Christoph, Liebeskind, David, Pedicelli, Alessandro, Alexandre, Andrea, Tancredi, Illario, Faizy, Tobias, Kalsoum, Erwah, Lubicz, Boris, Patel, Aman, Pereira, Vitor, Wintermark, Max, Guenego, Adrien, and Dmytriw, Adam

Subjects
Acute ischemic stroke, endovascular therapy, medical management, posterior cerebral artery, propensity score analysis
Abstract

BACKGROUND: Despite the proven effectiveness of endovascular therapy (EVT) in acute ischemic strokes (AIS) involving anterior circulation large vessel occlusions, isolated posterior cerebral artery (PCA) occlusions (iPCAo) remain underexplored in clinical trials. This study investigates the comparative effectiveness and safety of EVT against medical management (MM) in patients with iPCAo. METHODS: This multinational, multicenter propensity score-weighted study analyzed data from the Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy (MAD-MT) registry, involving 37 centers across North America, Asia, and Europe. We included iPCAo patients treated with either EVT or MM. The primary outcome was the modified Rankin Scale (mRS) at 90 days, with secondary outcomes including functional independence, mortality, and safety profiles such as hemorrhagic complications. RESULTS: A total of 177 patients were analyzed (88 MM and 89 EVT). EVT showed a statistically significant improvement in 90-day mRS scores (OR = 0.55, 95% CI = 0.30-1.00, p = 0.048), functional independence (OR = 2.52, 95% CI = 1.02-6.20, p = 0.045), and a reduction in 90-day mortality (OR = 0.12, 95% CI = 0.03-0.54, p = 0.006) compared to MM. Hemorrhagic complications were not significantly different between the groups. CONCLUSION: EVT for iPCAo is associated with better neurological outcomes and lower mortality compared to MM, without an increased risk of hemorrhagic complications. Nevertheless, these results should be interpreted with caution due to the studys observational design. The findings are hypothesis-generating and highlight the need for future randomized controlled trials to confirm these observations and establish definitive treatment guidelines for this patient population.

Published
2024

5. Predictive value of follow-up infarct volume on functional outcomes in middle cerebral artery M2 segment vessel occlusion stroke treated with mechanical thrombectomy.

Author

Yedavalli, Vivek, Salim, Hamza, Musmar, Basel, Adeeb, Nimer, El Naamani, Kareem, Henninger, Nils, Sundararajan, Sri, Kühn, Anna, Khalife, Jane, Ghozy, Sherief, Scarcia, Luca, Tan, Benjamin, Regenhardt, Robert, Heit, Jeremy, Cancelliere, Nicole, Bernstock, Joshua, Rouchaud, Aymeric, Fiehler, Jens, Sheth, Sunil, Puri, Ajit, Dyzmann, Christian, Colasurdo, Marco, Barreau, Xavier, Renieri, Leonardo, Filipe, João, Harker, Pablo, Radu, Răzvan, Abdalkader, Mohamad, Klein, Piers, Marotta, Thomas, Spears, Julian, Ota, Takahiro, Mowla, Ashkan, Jabbour, Pascal, Biswas, Arundhati, Clarençon, Frédéric, Siegler, James, Nguyen, Thanh, Varela, Ricardo, Baker, Amanda, Essibayi, Muhammed, Altschul, David, Gonzalez, Nestor, Möhlenbruch, Markus, Costalat, Vincent, Gory, Benjamin, Stracke, Christian, Aziz-Sultan, Mohammad, Hecker, Constantin, Shaikh, Hamza, Liebeskind, David, Pedicelli, Alessandro, Alexandre, Andrea, Tancredi, Illario, Faizy, Tobias, Kalsoum, Erwah, Lubicz, Boris, Patel, Aman, Pereira, Vitor, Guenego, Adrien, and Dmytriw, Adam

Subjects
Stroke, follow-up infarct volume, mechanical thrombectomy, medium vessel occlusion
Abstract

BACKGROUND: Medium vessel occlusion (MeVO) strokes, particularly affecting the M2 segment of the middle cerebral artery, represent a critical proportion of acute ischemic strokes, posing significant challenges in management and outcome prediction. The efficacy of mechanical thrombectomy (MT) in MeVO stroke may warrant reliable predictors of functional outcomes. This study aimed to investigate the prognostic value of follow-up infarct volume (FIV) for predicting 90-day functional outcomes in MeVO stroke patients undergoing MT. METHODS: This multicenter, retrospective cohort study analyzed data from the Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy (MAD-MT) registry, covering patients with acute ischemic stroke due to M2 segment occlusion treated with MT. We examined the relationship between 90-day functional outcomes, measured by the modified Rankin Scale (mRS), and follow-up infarct volume (FIV), assessed through CT or MRI within 12-36 h post-MT. RESULTS: Among 130 participants, specific FIV thresholds were identified with high specificity and sensitivity for predicting outcomes. A FIV ⩽5 ml was highly specific for predicting favorable and excellent outcomes. The optimal cut-off for both prognostications was identified at ⩽15 ml by the Youden Index, with significant reductions in the likelihood of favorable outcomes observed above a 40 ml threshold. Receiver Operator Curve (ROC) analyses confirmed FIV as a superior predictor of functional outcomes compared to traditional recanalization scores, such as final modified thrombolysis in cerebral infarction score (mTICI). Multivariable analysis further highlighted the inverse relationship between FIV and positive functional outcomes. CONCLUSIONS: FIV within 36 h post-MT serves as a potent predictor of 90-day functional outcomes in patients with M2 segment MeVO strokes. Establishing FIV thresholds may aid in the prognostication of stroke outcomes, suggesting a role for FIV in guiding post intervention treatment decisions and informing clinical practice. Future research should focus on validating these findings across diverse patient populations and exploring the integration of FIV measurements with other clinical and imaging markers to enhance outcome prediction accuracy.

Published
2024

6. Milli-spinner thrombectomy

Author

Chang, Yilong, Li, Qi, Wu, Shuai, Pulli, Benjamin, Samli, Darren, Yock, Paul, Heit, Jeremy J., and Zhao, Ruike Renee

Subjects
Physics - Applied Physics
Abstract

Blockage of blood flow in arteries or veins by blood clots can lead to serious medical conditions. Mechanical thrombectomy (MT), minimally invasive endovascular procedures that utilize aspiration, stent retriever, or cutting mechanisms for clot removal have emerged as an effective treatment modality for ischemic stroke, myocardial infarction, pulmonary embolism, and peripheral vascular disease. However, state-of-the-art MT technologies still fail to remove clots in approximately 10% to 30% of patients, especially when treating large-size clots with high fibrin content. In addition, the working mechanism of most current MT techniques results in rupturing or cutting of clots which could lead to clot fragmentation and distal emboli. Here, we report a new MT technology based on an unprecedented mechanism, in which a milli-spinner mechanically debulks the clot by densifying its fibrin fiber network and discharging red blood cells to significantly reduce the clot volume for complete clot removal. This mechanism is achieved by the spin-induced compression and shearing of the clot. We demonstrate its effective clot-debulking performance with clot volumetric reduction of up to 90% on various sizes of clots with diverse clot compositions. Milli-spinner MT in both in-vitro pulmonary and cerebral artery flow models and in-vivo swine models demonstrate high-fidelity revascularization. The milli-spinner MT is the first reported mechanism that directly modifies the clot microstructure to facilitate clot removal, which also results in markedly improved MT efficacy compared to the existing MT mechanisms that are based on clot rupturing and cutting. This technology introduces a unique mechanical way of debulking and removing clots for future MT device development, especially for the treatment of ischemic stroke, pulmonary emboli, and peripheral thrombosis.

Published
2024

7. Outcomes with General Anesthesia Compared to Conscious Sedation for Endovascular Treatment of Medium Vessel Occlusions: Results of an International Multicentric Study

Author

Radu, Răzvan Alexandru, Costalat, Vincent, Romoli, Michele, Musmar, Basel, Siegler, James E., Ghozy, Sherief, Khalife, Jane, Salim, Hamza, Shaikh, Hamza, Adeeb, Nimer, Cuellar-Saenz, Hugo H., Thomas, Ajith J., Kadirvel, Ramanathan, Abdalkader, Mohamad, Klein, Piers, Nguyen, Thanh N., Heit, Jeremy J., Regenhardt, Robert W., Bernstock, Joshua D., Patel, Aman B., Rabinov, James D., Stapleton, Christopher J., Cancelliere, Nicole M., Marotta, Thomas R., Mendes Pereira, Vitor, El Naamani, Kareem, Amllay, Abdelaziz, Tjoumakaris, Stavropoula I., Jabbour, Pascal, Meyer, Lukas, Fiehler, Jens, Faizy, Tobias D., Guerreiro, Helena, Dusart, Anne, Bellante, Flavio, Forestier, Géraud, Rouchaud, Aymeric, Mounayer, Charbel, Kühn, Anna Luisa, Puri, Ajit S., Dyzmann, Christian, Kan, Peter T., Colasurdo, Marco, Marnat, Gaultier, Berge, Jérôme, Barreau, Xavier, Sibon, Igor, Nedelcu, Simona, Henninger, Nils, Ota, Takahiro, Dofuku, Shogo, Yeo, Leonard L. L., Tan, Benjamin YQ, Gopinathan, Anil, Martinez-Gutierrez, Juan Carlos, Salazar-Marioni, Sergio, Sheth, Sunil, Renieri, Leonardo, Capirossi, Carolina, Mowla, Ashkan, Chervak, Lina M., Vagal, Achala, Khandelwal, Priyank, Biswas, Arundhati, Clarençon, Frédéric, Elhorany, Mahmoud, Premat, Kevin, Valente, Iacopo, Pedicelli, Alessandro, Alexandre, Andrea M., Filipe, João Pedro, Varela, Ricardo, Quintero-Consuegra, Miguel, Gonzalez, Nestor R., YMD, Markus A., Jesser, Jessica, Weyland, Charlotte, ter Schiphorst, Adrien, Yedavalli, Vivek, Harker, Pablo, Aziz, Yasmin, Gory, Benjamin, Paul Stracke, Christian, Hecker, Constantin, Killer-Oberpfalzer, Monika, Griessenauer, Christoph J., Hsieh, Cheng-Yang, Liebeskind, David S., Tancredi, Illario, Fahed, Robert, Lubicz, Boris, Essibayi, Muhammed Amir, Baker, Amanda, Altschul, David, Scarcia, Luca, Kalsoum, Erwah, Dmytriw, Adam A., and Guenego, Adrien

Published
2024
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8. Mismatch Vs No Mismatch in Large Core—A Matter of Definition

Author

Yedavalli, Vivek, Salim, Hamza Adel, Lakhani, Dhairya A., Mei, Janet, Balar, Aneri, Musmar, Basel, Adeeb, Nimer, Hoseinyazdi, Meisam, Luna, Licia, Deng, Francis, Hyson, Nathan Z., Dmytriw, Adam A., Guenego, Adrien, Lu, Hanzhang, Urrutia, Victor C., Nael, Kambiz, Marsh, Elisabeth B., Llinas, Raf, Hillis, Argye E., Wintermark, Max, Faizy, Tobias D., Heit, Jeremy J., and Albers, Gregory W.

Published
2024
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9. Incidence and clinical outcomes of perforations during mechanical thrombectomy for medium vessel occlusion in acute ischemic stroke: A retrospective, multicenter, and multinational study.

Author

Dmytriw, Adam, Musmar, Basel, Salim, Hamza, Ghozy, Sherief, Siegler, James, Kobeissi, Hassan, Shaikh, Hamza, Khalife, Jane, Abdalkader, Mohamad, Klein, Piers, Nguyen, Thanh, Heit, Jeremy, Regenhardt, Robert, Cancelliere, Nicole, Bernstock, Joshua, Naamani, Kareem, Amllay, Abdelaziz, Meyer, Lukas, Dusart, Anne, Bellante, Flavio, Forestier, Géraud, Rouchaud, Aymeric, Saleme, Suzana, Mounayer, Charbel, Fiehler, Jens, Kühn, Anna, Puri, Ajit, Dyzmann, Christian, Kan, Peter, Colasurdo, Marco, Marnat, Gaultier, Berge, Jérôme, Barreau, Xavier, Sibon, Igor, Nedelcu, Simona, Henninger, Nils, Marotta, Thomas, Stapleton, Christopher, Rabinov, James, Ota, Takahiro, Dofuku, Shogo, Yeo, Leonard, Tan, Benjamin, Gopinathan, Anil, Martinez-Gutierrez, Juan, Salazar-Marioni, Sergio, Sheth, Sunil, Renieri, Leonardo, Capirossi, Carolina, Mowla, Ashkan, Chervak, Lina, Vagal, Achala, Adeeb, Nimer, Cuellar-Saenz, Hugo, Tjoumakaris, Stavropoula, Jabbour, Pascal, Khandelwal, Priyank, Biswas, Arundhati, Clarençon, Frédéric, Elhorany, Mahmoud, Premat, Kevin, Valente, Iacopo, Pedicelli, Alessandro, Filipe, João, Varela, Ricardo, Quintero-Consuegra, Miguel, Gonzalez, Nestor, Möhlenbruch, Markus, Jesser, Jessica, Costalat, Vincent, Ter Schiphorst, Adrien, Yedavalli, Vivek, Harker, Pablo, Aziz, Yasmin, Gory, Benjamin, Stracke, Christian, Hecker, Constantin, Kadirvel, Ramanathan, Killer-Oberpfalzer, Monika, Griessenauer, Christoph, Thomas, Ajith, Hsieh, Cheng-Yang, Liebeskind, David, Alexandru Radu, Răzvan, Alexandre, Andrea, Tancredi, Illario, Faizy, Tobias, Fahed, Robert, Weyland, Charlotte, Lubicz, Boris, Patel, Aman, Pereira, Vitor, and Guenego, Adrien

Subjects
AIS, MT, MeVo, Stroke, mechanical thrombectomy, perforation, Humans, Ischemic Stroke, Male, Retrospective Studies, Female, Aged, Middle Aged, Incidence, Thrombectomy, Treatment Outcome, Aged, 80 and over
Abstract

BACKGROUND: Mechanical thrombectomy (MT) has revolutionized the treatment of acute ischemic stroke (AIS) due to large vessel occlusion (LVO), but its efficacy and safety in medium vessel occlusion (MeVO) remain less explored. This multicenter, retrospective study aims to investigate the incidence and clinical outcomes of vessel perforations (confirmed by extravasation during an angiographic series) during MT for AIS caused by MeVO. METHODS: Data were collected from 37 academic centers across North America, Asia, and Europe between September 2017 and July 2021. A total of 1373 AIS patients with MeVO underwent MT. Baseline characteristics, procedural details, and clinical outcomes were analyzed. RESULTS: The incidence of vessel perforation was 4.8% (66/1373). Notably, our analysis indicates variations in perforation rates across different arterial segments: 8.9% in M3 segments, 4.3% in M2 segments, and 8.3% in A2 segments (p = 0.612). Patients with perforation had significantly worse outcomes, with lower rates of favorable angiographic outcomes (TICI 2c-3: 23% vs 58.9%, p

Published
2024

11. Multicenter evaluation of mechanical thrombectomy for distal medium vessel occlusions with National Institute of Health Stroke Scale Scores ≥ 6 and ≤ 6

Author

Kühn, Anna Luisa, Puri, Ajit S., Salim, Hamza Adel, Musmar, Basel, Ghozy, Sherief, Siegler, James, Shaikh, Hamza, Khalife, Jane, Abdalkader, Mohamad, Klein, Piers, Nguyen, Thanh N., Heit, Jeremy J., Regenhardt, Robert W., Diestro, Jose Danilo Bengzon, Cancelliere, Nicole M., Sweid, Ahmad, Naamani, Kareem El, Hasan, Zuha, Gopinathan, Anil, Amllay, Abdelaziz, Meyer, Lukas, Dusart, Anne, Bellante, Flavio, Forestier, Géraud, Rouchaud, Aymeric, Saleme, Suzana, Mounayer, Charbel, Fiehler, Jens, Dyzmann, Christian, Kan, Peter T., Singh, Jasmeet, Colasurdo, Marco, Marnat, Gaultier, Berge, Jérôme, Barreau, Xavier, Sibon, Igor, Nedelcu, Simona, Henninger, Nils, Marotta, Thomas R., Stapleton, Christopher J., Rabinov, James D., Ota, Takahiro, Dofuku, Shogo, Yeo, Leonard LL., Tan, Benjamin Y. Q., Martinez-Gutierrez, Juan Carlos, Salazar-Marioni, Sergio, Sheth, Sunil, Renieri, Leonardo, Capirossi, Carolina, Mowla, Ashkan, Tjoumakaris, Stavropoula I., Jabbour, Pascal, Khandelwal, Priyank, Biswas, Arundhati, Clarençon, Frédéric, Elhorany, Mahmoud, Premat, Kevin, Valente, Iacopo, Pedicelli, Alessandro, Filipe, João Pedro, Varela, Ricardo, Quintero-Consuegra, Miguel, Gonzalez, Nestor R., Möhlenbruch, Markus A., Jesser, Jessica, Costalat, Vincent, ter Schiphorst, Adrien, Yedavalli, Vivek, Harker, Pablo, Chervak, Lina, Aziz, Yasmin, Gory, Benjamin, Stracke, Christian Paul, Hecker, Constantin, Killer-Oberpfalzer, Monika, Griessenauer, Christoph J., Thomas, Ajith, Hsieh, Cheng-Yang, Liebeskind, David S., Radu, Răzvan Alexandru, Alexandre, Andrea M., Fahed, Robert, Tancredi, Illario, Faizy, Tobias D., Weyland, Charlotte, Lubicz, Boris, Patel, Aman B., Pereira, Vitor Mendes, Guenego, Adrien, and Dmytriw, Adam A.

Published
2024
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12. CT Perfusion Derived rCBV < 42% Lesion Volume Is Independently Associated with Followup FLAIR Infarct Volume in Anterior Circulation Large Vessel Occlusion.

Author

Lakhani, Dhairya, Balar, Aneri, Salim, Hamza, Koneru, Manisha, Wen, Sijin, Ozkara, Burak, Lu, Hanzhang, Wang, Richard, Hoseinyazdi, Meisam, Xu, Risheng, Nabi, Mehreen, Mazumdar, Ishan, Cho, Andrew, Chen, Kevin, Sepehri, Sadra, Hyson, Nathan, Urrutia, Victor, Luna, Licia, Hillis, Argye, Heit, Jeremy, Albers, Greg, Rai, Ansaar, Dmytriw, Adam, Faizy, Tobias, Wintermark, Max, Nael, Kambiz, and Yedavalli, Vivek

Subjects
infarct volume, rCBV < 42%, relative cerebral blood volume
Abstract

Pretreatment CT Perfusion (CTP) parameter rCBV < 42% lesion volume has recently been shown to predict 90-day mRS. In this study, we aim to assess the relationship between rCBV < 42% and a radiographic follow-up infarct volume delineated on FLAIR images. In this retrospective evaluation of our prospectively collected database, we included acute stroke patients triaged by multimodal CT imaging, including CT angiography and perfusion imaging, with confirmed anterior circulation large vessel occlusion between 9 January 2017 and 10 January 2023. Follow-up FLAIR imaging was used to determine the final infarct volume. Student t, Mann-Whitney-U, and Chi-Square tests were used to assess differences. Spearmans rank correlation and linear regression analysis were used to assess associations between rCBV < 42% and follow-up infarct volume on FLAIR. In total, 158 patients (median age: 68 years, 52.5% female) met our inclusion criteria. rCBV < 42% (ρ = 0.56, p < 0.001) significantly correlated with follow-up-FLAIR infarct volume. On multivariable linear regression analysis, rCBV < 42% lesion volume (beta = 0.60, p < 0.001), ASPECTS (beta = -0.214, p < 0.01), mTICI (beta = -0.277, p < 0.001), and diabetes (beta = 0.16, p < 0.05) were independently associated with follow-up infarct volume. The rCBV < 42% lesion volume is independently associated with FLAIR follow-up infarct volume.

Published
2024

13. The Relative Cerebral Blood Volume (rCBV) < 42% Is Independently Associated with Collateral Status in Anterior Circulation Large Vessel Occlusion.

Author

Lakhani, Dhairya, Balar, Aneri, Koneru, Manisha, Wen, Sijin, Ozkara, Burak, Lu, Hanzhang, Wang, Richard, Hoseinyazdi, Meisam, Mei, Janet, Xu, Risheng, Nabi, Mehreen, Mazumdar, Ishan, Cho, Andrew, Chen, Kevin, Sepehri, Sadra, Hyson, Nathan, Urrutia, Victor, Luna, Licia, Hillis, Argye, Heit, Jeremy, Albers, Greg, Rai, Ansaar, Dmytriw, Adam, Faizy, Tobias, Wintermark, Max, Yedavalli, Vivek, and Nael, Kambiz

Subjects
ASITN collateral score, rCBV < 42%, relative cerebral blood volume
Abstract

Background: The pretreatment CT perfusion (CTP) marker the relative cerebral blood volume (rCBV) < 42% lesion volume has recently been shown to predict 90-day functional outcomes; however, studies assessing correlations of the rCBV < 42% lesion volume with other outcomes remain sparse. Here, we aim to assess the relationship between the rCBV < 42% lesion volume and the reference standard digital subtraction angiography (DSA)-derived American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN) collateral score, hereby referred as the DSA CS. Methods: In this retrospective evaluation of our prospectively collected database, we included acute stroke patients triaged by multimodal CT imaging, including CT angiography and perfusion imaging, with confirmed anterior circulation large vessel occlusion between 1 September 2017 and 1 October 2023. Group differences were assessed using the Students t test, Mann-Whitney U test and Chi-Square test. Spearmans rank correlation and logistic regression analyses were used to assess associations between rCBV < 42% and DSA CS. Results: In total, 222 patients (median age: 69 years, 56.3% female) met our inclusion criteria. In the multivariable logistic regression analysis, taking into account age, sex, race, hypertension, hyperlipidemia, diabetes, atrial fibrillation, prior stroke or transient ischemic attack, the admission National Institute of Health stroke scale, the premorbid modified Rankin score, the Alberta stroke program early CT score (ASPECTS), and segment occlusion, the rCBV < 42% lesion volume (adjusted OR: 0.98, p < 0.05) was independently associated with the DSA CS. Conclusion: The rCBV < 42% lesion volume is independently associated with the DSA CS.

Published
2024

14. First pass effect as an independent predictor of functional outcomes in medium vessel occlusions: An analysis of an international multicenter study.

Author

Radu, Răzvan, Costalat, Vincent, Fahed, Robert, Ghozy, Sherief, Siegler, James, Shaikh, Hamza, Khalife, Jane, Abdalkader, Mohamad, Klein, Piers, Nguyen, Thanh, Heit, Jeremy, Sweid, Ahmad, El Naamani, Kareem, Regenhardt, Robert, Diestro, Jose, Cancelliere, Nicole, Amllay, Abdelaziz, Meyer, Lukas, Dusart, Anne, Bellante, Flavio, Forestier, Géraud, Rouchaud, Aymeric, Saleme, Suzana, Mounayer, Charbel, Fiehler, Jens, Kühn, Anna, Puri, Ajit, Dyzmann, Christian, Kan, Peter, Colasurdo, Marco, Marnat, Gaultier, Berge, Jérôme, Barreau, Xavier, Sibon, Igor, Nedelcu, Simona, Henninger, Nils, Kyheng, Maéva, Marotta, Thomas, Stapleton, Christopher, Rabinov, James, Ota, Takahiro, Dofuku, Shogo, Yeo, Leonard, Tan, Benjamin, Martinez-Gutierrez, Juan, Salazar-Marioni, Sergio, Sheth, Sunil, Renieri, Leonardo, Capirossi, Carolina, Mowla, Ashkan, Tjoumakaris, Stavropoula, Jabbour, Pascal, Khandelwal, Priyank, Biswas, Arundhati, Clarençon, Frédéric, Elhorany, Mahmoud, Premat, Kevin, Valente, Iacopo, Pedicelli, Alessandro, Pedro Filipe, João, Varela, Ricardo, Quintero-Consuegra, Miguel, Gonzalez, Nestor, Möhlenbruch, Markus, Jesser, Jessica, Tancredi, Illario, Ter Schiphorst, Adrien, Yedavalli, Vivek, Harker, Pablo, Chervak, Lina, Aziz, Yasmin, Gory, Benjamin, Paul Stracke, Christian, Hecker, Constantin, Killer-Oberpfalzer, Monika, Griessenauer, Christoph, Thomas, Ajith, Hsieh, Cheng-Yang, Liebeskind, David, Alexandre, Andrea, Faizy, Tobias, Weyland, Charlotte, Patel, Aman, Pereira, Vitor, Lubicz, Boris, Dmytriw, Adam, and Guenego, Adrien

Subjects
MeVO, Stroke, outcomes research, reperfusion, thrombectomy, Humans, Stroke, Brain Ischemia, Retrospective Studies, Thrombectomy, Treatment Outcome, Intracranial Hemorrhages
Abstract

INTRODUCTION: First pass effect (FPE), achievement of complete recanalization (mTICI 2c/3) with a single pass, is a significant predictor of favorable outcomes for endovascular treatment (EVT) in large vessel occlusion stroke (LVO). However, data concerning the impact on functional outcomes and predictors of FPE in medium vessel occlusions (MeVO) are scarce. PATIENTS AND METHODS: We conducted an international retrospective study on MeVO cases. Multivariable logistic modeling was used to establish independent predictors of FPE. Clinical and safety outcomes were compared between the two study groups (FPE vs non-FPE) using logistic regression models. Good outcome was defined as modified Rankin Scale 0-2 at 3 months. RESULTS: Eight hundred thirty-six patients with a final mTICI ⩾ 2b were included in this analysis. FPE was observed in 302 patients (36.1%). In multivariable analysis, hypertension (aOR 1.55, 95% CI 1.10-2.20) and lower baseline NIHSS score (aOR 0.95, 95% CI 0.93-0.97) were independently associated with an FPE. Good outcomes were more common in the FPE versus non-FPE group (72.8% vs 52.8%), and FPE was independently associated with favorable outcome (aOR 2.20, 95% CI 1.59-3.05). 90-day mortality and intracranial hemorrhage (ICH) were significantly lower in the FPE group, 0.43 (95% CI, 0.25-0.72) and 0.55 (95% CI, 0.39-0.77), respectively. CONCLUSION: Over 2/3 of patients with MeVOs and FPE in our cohort had a favorable outcome at 90 days. FPE is independently associated with favorable outcomes, it may reduce the risk of any intracranial hemorrhage, and 3-month mortality.

Published
2024

15. Random Expert Sampling for Deep Learning Segmentation of Acute Ischemic Stroke on Non-contrast CT

Author

Ostmeier, Sophie, Axelrod, Brian, Pulli, Benjamin, Verhaaren, Benjamin F. J., Mahammedi, Abdelkader, Liu, Yongkai, Federau, Christian, Zaharchuk, Greg, and Heit, Jeremy J.

Subjects
Computer Science - Computer Vision and Pattern Recognition
Abstract

Purpose: Multi-expert deep learning training methods to automatically quantify ischemic brain tissue on Non-Contrast CT Materials and Methods: The data set consisted of 260 Non-Contrast CTs from 233 patients of acute ischemic stroke patients recruited in the DEFUSE 3 trial. A benchmark U-Net was trained on the reference annotations of three experienced neuroradiologists to segment ischemic brain tissue using majority vote and random expert sampling training schemes. We used a one-sided Wilcoxon signed-rank test on a set of segmentation metrics to compare bootstrapped point estimates of the training schemes with the inter-expert agreement and ratio of variance for consistency analysis. We further compare volumes with the 24h-follow-up DWI (final infarct core) in the patient subgroup with full reperfusion and we test volumes for correlation to the clinical outcome (mRS after 30 and 90 days) with the Spearman method. Results: Random expert sampling leads to a model that shows better agreement with experts than experts agree among themselves and better agreement than the agreement between experts and a majority-vote model performance (Surface Dice at Tolerance 5mm improvement of 61% to 0.70 +- 0.03 and Dice improvement of 25% to 0.50 +- 0.04). The model-based predicted volume similarly estimated the final infarct volume and correlated better to the clinical outcome than CT perfusion. Conclusion: A model trained on random expert sampling can identify the presence and location of acute ischemic brain tissue on Non-Contrast CT similar to CT perfusion and with better consistency than experts. This may further secure the selection of patients eligible for endovascular treatment in less specialized hospitals.

Published
2023
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16. The Compensation Index Is Better Associated with DSA ASITN Collateral Score Compared to the Cerebral Blood Volume Index and Hypoperfusion Intensity Ratio.

Author

Lakhani, Dhairya, Balar, Aneri, Koneru, Manisha, Wen, Sijin, Hoseinyazdi, Meisam, Greene, Cynthia, Xu, Risheng, Luna, Licia, Caplan, Justin, Dmytriw, Adam, Guenego, Adrien, Wintermark, Max, Gonzalez, Fernando, Urrutia, Victor, Huang, Judy, Rai, Ansaar, Albers, Gregory, Heit, Jeremy, Yedavalli, Vivek, and Nael, Kambiz

Subjects
CBV index, HIR, acute ischemic stroke, collateral status, compensation index, hypoperfusion intensity ratio
Abstract

BACKGROUND: Pretreatment CT Perfusion (CTP) parameters serve as reliable surrogates of collateral status (CS). In this study, we aim to assess the relationship between the novel compensation index (CI, Tmax > 4 s/Tmax > 6 s) and already established CTP collateral markers, namely cerebral blood volume (CBV) index and Hypoperfusion Intensity Ratio (HIR), with the reference standard American Society of Interventional and Therapeutic Neuroradiology (ASITN) collateral score (CS) on DSA. METHODS: In this retrospective study, inclusion criteria were the following: (a) CT angiography confirmed anterior circulation large vessel occlusion from 9 January 2017 to 10 January 2023; (b) diagnostic CT perfusion; and (c) underwent mechanical thrombectomy with documented DSA-CS. Student t-test, Mann-Whitney-U-test and Chi-square test were used to assess differences. Spearmans rank correlation and logistic regression analysis were used to assess associations. p ≤ 0.05 was considered significant. RESULTS: In total, 223 patients (mean age: 67.8 ± 15.8, 56% female) met our inclusion criteria. The CI (ρ = 0.37, p < 0.001) and HIR (ρ = -0.29, p < 0.001) significantly correlated with DSA-CS. Whereas the CBV Index (ρ = 0.1, p > 0.05) did not correlate with DSA-CS. On multivariate logistic regression analysis taking into account age, sex, ASPECTS, tPA, premorbid mRS, NIH stroke scale, prior history of TIA, stroke, atrial fibrillation, diabetes mellitus, hyperlipidemia, heart disease and hypertension, only CI was not found to be independently associated with DSA-CS (adjusted OR = 1.387, 95% CI: 1.09-1.77, p < 0.01). CONCLUSION: CI demonstrates a stronger correlation with DSA-CS compared to both the HIR and CBV Index where it may show promise as an additional quantitative pretreatment CS biomarker.

Published
2023

17. Combined near infrared photoacoustic imaging and ultrasound detects vulnerable atherosclerotic plaque.

Author

Schneider, Martin, Wang, James, Kare, Aris, Adkar, Shaunak, Salmi, Darren, Bell, Caitlin, Alsaigh, Tom, Wagh, Dhananjay, Coller, John, Mayer, Aaron, Snyder, Sarah, Borowsky, Alexander, Long, Steven, Lansberg, Maarten, Steinberg, Gary, Heit, Jeremy, Leeper, Nicholas, and Ferrara, Katherine

Subjects
Atherosclerosis, NIR biomarker, Photoacoustic imaging, Spatial transcriptomics, Vulnerable plaque, Humans, Plaque, Atherosclerotic, Photoacoustic Techniques, Proteomics, Atherosclerosis, Ultrasonography
Abstract

Atherosclerosis is an inflammatory process resulting in the deposition of cholesterol and cellular debris, narrowing of the vessel lumen and clot formation. Characterization of the morphology and vulnerability of the lesion is essential for effective clinical management. Here, near-infrared auto-photoacoustic (NIRAPA) imaging is shown to detect plaque components and, when combined with ultrasound imaging, to differentiate stable and vulnerable plaque. In an ex vivo study of photoacoustic imaging of excised plaque from 25 patients, 88.2% sensitivity and 71.4% specificity were achieved using a clinically-relevant protocol. In order to determine the origin of the NIRAPA signal, immunohistochemistry, spatial transcriptomics and spatial proteomics were co-registered with imaging and applied to adjacent plaque sections. The highest NIRAPA signal was spatially correlated with bilirubin and associated blood-based residue and with the cytoplasmic contents of inflammatory macrophages bearing CD74, HLA-DR, CD14 and CD163 markers. In summary, we establish the potential to apply the NIRAPA-ultrasound imaging combination to detect vulnerable carotid plaque and a methodology for fusing molecular imaging with spatial transcriptomic and proteomic methods.

Published
2023

18. Follow-up infarct volume on fluid attenuated inversion recovery (FLAIR) imaging in distal medium vessel occlusions: the role of cerebral blood volume index

Author

Salim, Hamza, Lakhani, Dhairya A., Balar, Aneri, Musmar, Basel, Adeeb, Nimer, Hoseinyazdi, Meisam, Luna, Licia, Deng, Francis, Hyson, Nathan Z., Mei, Janet, Dmytriw, Adam A., Guenego, Adrien, Faizy, Tobias D., Heit, Jeremy J., Albers, Gregory W., Urrutia, Victor C., Llinas, Raf, Marsh, Elisabeth B., Hillis, Argye E., Nael, Kambiz, and Yedavalli, Vivek

Published
2024
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20. Pretreatment CTP Collateral Parameters Predict Good Outcomes in Successfully Recanalized Middle Cerebral Artery Distal Medium Vessel Occlusions

Author

Yedavalli, Vivek, Koneru, Manisha, Hamam, Omar, Hoseinyazdi, Meisam, Marsh, Elisabeth Breese, Llinas, Raf, Urrutia, Victor, Leigh, Richard, Gonzalez, Fernando, Xu, Risheng, Caplan, Justin, Huang, Judy, Lu, Hanzhang, Wintermark, Max, Heit, Jeremy, Guenego, Adrien, Albers, Greg, Nael, Kambiz, and Hillis, Argye

Published
2024
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21. Non-inferiority of Deep Learning Acute Ischemic Stroke Segmentation on Non-Contrast CT Compared to Expert Neuroradiologists

Author

Ostmeier, Sophie, Axelrod, Brian, Verhaaren, Benjamin F. J., Christensen, Soren, Mahammedi, Abdelkader, Liu, Yongkai, Pulli, Benjamin, Li, Li-Jia, Zaharchuk, Greg, and Heit, Jeremy J.

Subjects
Electrical Engineering and Systems Science - Image and Video Processing, Computer Science - Computer Vision and Pattern Recognition, Computer Science - Machine Learning
Abstract

To determine if a convolutional neural network (CNN) deep learning model can accurately segment acute ischemic changes on non-contrast CT compared to neuroradiologists. Non-contrast CT (NCCT) examinations from 232 acute ischemic stroke patients who were enrolled in the DEFUSE 3 trial were included in this study. Three experienced neuroradiologists independently segmented hypodensity that reflected the ischemic core on each scan. The neuroradiologist with the most experience (expert A) served as the ground truth for deep learning model training. Two additional neuroradiologists (experts B and C) segmentations were used for data testing. The 232 studies were randomly split into training and test sets. The training set was further randomly divided into 5 folds with training and validation sets. A 3-dimensional CNN architecture was trained and optimized to predict the segmentations of expert A from NCCT. The performance of the model was assessed using a set of volume, overlap, and distance metrics using non-inferiority thresholds of 20%, 3ml, and 3mm. The optimized model trained on expert A was compared to test experts B and C. We used a one-sided Wilcoxon signed-rank test to test for the non-inferiority of the model-expert compared to the inter-expert agreement. The final model performance for the ischemic core segmentation task reached a performance of 0.46+-0.09 Surface Dice at Tolerance 5mm and 0.47+-0.13 Dice when trained on expert A. Compared to the two test neuroradiologists the model-expert agreement was non-inferior to the inter-expert agreement, p < 0.05. The CNN accurately delineates the hypodense ischemic core on NCCT in acute ischemic stroke patients with an accuracy comparable to neuroradiologists.

Published
2022
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22. Use of the pRESET LITE thrombectomy device in combined approach for medium vessel occlusions: A multicenter evaluation

Author

Wang, Maud, Henkes, Hans, Ghozy, Sherief, Siegler, James E., Shaikh, Hamza, Khalife, Jane, Abdalkader, Mohamad, Klein, Piers, Nguyen, Thanh N., Heit, Jeremy J., Sweid, Ahmad, Naamani, Kareem El, Regenhardt, Robert W., Diestro, Jose Danilo Bengzon, Cancelliere, Nicole M., Amllay, Abdelaziz, Meyer, Lukas, Dusart, Anne, Bellante, Flavio, Forestier, Géraud, Rouchaud, Aymeric, Saleme, Suzana, Mounayer, Charbel, Fiehler, Jens, Kühn, Anna Luisa, Puri, Ajit S., Dyzmann, Christian, Kan, Peter T., Colasurdo, Marco, Marnat, Gaultier, Berge, Jérôme, Barreau, Xavier, Sibon, Igor, Nedelcu, Simona, Henninger, Nils, Weyland, Charlotte, Marotta, Thomas R., Stapleton, Christopher J., Rabinov, James D., Ota, Takahiro, Dofuku, Shogo, Yeo, Leonard LL., Tan, Benjamin Y. Q., Martinez-Gutierrez, Juan Carlos, Salazar-Marioni, Sergio, Sheth, Sunil, Renieri, Leonardo, Capirossi, Carolina, Mowla, Ashkan, Tjoumakaris, Stavropoula I., Jabbour, Pascal, Khandelwal, Priyank, Biswas, Arundhati, Clarençon, Frédéric, Elhorany, Mahmoud, Premat, Kevin, Valente, Iacopo, Pedicelli, Alessandro, Filipe, João Pedro, Varela, Ricardo, Quintero-Consuegra, Miguel, Gonzalez, Nestor R., Möhlenbruch, Markus A., Jesser, Jessica, Costalat, Vincent, ter Schiphorst, Adrien, Yedavalli, Vivek, Harker, Pablo, Chervak, Lina M., Aziz, Yasmin, Gory, Benjamin, Stracke, Christian Paul, Hecker, Constantin, Killer-Oberpfalzer, Monika, Griessenauer, Christoph J., Thomas, Ajith J., Hsieh, Cheng-Yang, Liebeskind, David S., Radu, Răzvan Alexandru, Alexandre, Andrea M., Tancredi, Illario, Faizy, Tobias D., Patel, Aman B., Pereira, Vitor Mendes, Fahed, Robert, Lubicz, Boris, Dmytriw, Adam A., and Guenego, Adrien

Published
2024
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23. Pretreatment parameters associated with hemorrhagic transformation among successfully recanalized medium vessel occlusions

Author

Koneru, Manisha, Hoseinyazdi, Meisam, Wang, Richard, Ozkara, Burak Berksu, Hyson, Nathan Z., Marsh, Elisabeth Breese, Llinas, Rafael H., Urrutia, Victor C., Leigh, Richard, Gonzalez, Luis Fernando, Xu, Risheng, Caplan, Justin M., Huang, Judy, Lu, Hanzhang, Luna, Licia, Wintermark, Max, Dmytriw, Adam A., Guenego, Adrien, Albers, Gregory W., Heit, Jeremy J., Nael, Kambiz, Hillis, Argye E., and Yedavalli, Vivek S.

Published
2024
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24. USE-Evaluator: Performance Metrics for Medical Image Segmentation Models with Uncertain, Small or Empty Reference Annotations

Author

Ostmeier, Sophie, Axelrod, Brian, Bertels, Jeroen, Isensee, Fabian, Lansberg, Maarten G., Christensen, Soren, Albers, Gregory W., Li, Li-Jia, and Heit, Jeremy J.

Subjects
Electrical Engineering and Systems Science - Image and Video Processing, Computer Science - Computer Vision and Pattern Recognition, Computer Science - Machine Learning
Abstract

Performance metrics for medical image segmentation models are used to measure the agreement between the reference annotation and the predicted segmentation. Usually, overlap metrics, such as the Dice, are used as a metric to evaluate the performance of these models in order for results to be comparable. However, there is a mismatch between the distributions of cases and difficulty level of segmentation tasks in public data sets compared to clinical practice. Common metrics fail to measure the impact of this mismatch, especially for clinical data sets that include low signal pathologies, a difficult segmentation task, and uncertain, small, or empty reference annotations. This limitation may result in ineffective research of machine learning practitioners in designing and optimizing models. Dimensions of evaluating clinical value include consideration of the uncertainty of reference annotations, independence from reference annotation volume size, and evaluation of classification of empty reference annotations. We study how uncertain, small, and empty reference annotations influence the value of metrics for medical image segmentation on an in-house data set regardless of the model. We examine metrics behavior on the predictions of a standard deep learning framework in order to identify metrics with clinical value. We compare to a public benchmark data set (BraTS 2019) with a high-signal pathology and certain, larger, and no empty reference annotations. We may show machine learning practitioners, how uncertain, small, or empty reference annotations require a rethinking of the evaluation and optimizing procedures. The evaluation code was released to encourage further analysis of this topic. https://github.com/SophieOstmeier/UncertainSmallEmpty.git, Comment: 16 pages, 10 figures, Published in Medical Image Analysis

Published
2022
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28. CT perfusion derived relative cerebral blood volume

Author

Lakhani, Dhairya A., Balar, Aneri B., Vagal, Vaibhav, Salim, Hamza, Mei, Janet, Koneru, Manisha, Wen, Sijin, Berksu Ozkara, Burak, Lu, Hanzhang, Wang, Richard, Xu, Risheng, Nabi, Mehreen, Mazumdar, Ishan, Cho, Andrew, Chen, Kevin, Sepehri, Sadra, Deng, Francis, Hyson, Nathan, Urrutia, Victor, Luna, Licia P., Sriwastwa, Aakanksha, Hillis, Argye E., Heit, Jeremy J., Albers, Greg W., Rai, Ansaar T., Dmytriw, Adam A., Faizy, Tobias D., Wintermark, Max, Nael, Kambiz, and Yedavalli, Vivek S.

Published
2024
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32. The Los Angeles motor scale (LAMS) is independently associated with CT perfusion collateral status markers

Author

Lakhani, Dhairya A., Mehta, Tejas R., Balar, Aneri B., Koneru, Manisha, Wen, Sijin, Ozkara, Burak Berksu, Caplan, Justin, Dmytriw, Adam A., Wang, Richard, Lu, Hanzhang, Hoseinyazdi, Meisam, Nabi, Mehreen, Mazumdar, Ishan, Cho, Andrew, Chen, Kevin, Sepehri, Sadra, Hyson, Nathan, Xu, Risheng, Urrutia, Victor, Luna, Licia, Hillis, Argye H, Heit, Jeremy J, Albers, Greg W., Rai, Ansaar T., Faizy, Tobias D, Wintermark, Max, Nael, Kambiz, and Yedavalli, Vivek S.

Published
2024
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34. Can Artificial Intelligence Effectively Predict Delayed Cerebral Ischemia After Cerebral Aneurysm Rupture?

Author

Moein Taghavi, Reza, Zhu, Guangming, Wintermark, Max, and Heit, Jeremy J

Abstract

Aneurysmal subarachnoid hemorrhage (aSAH) results in significant mortality and disability. Delayed Cerebral Ischemia (DCI) is the leading cause of poor outcome after aSAH among those who survive the initial hemorrhage event. Significant effort is expended to identify patients at risk of DCI, but existing tests, such as trans-cranial Doppler, suffer from relatively poor sensitivity. Tests to identify patients with DCI prospectively are of high interest.

Published
2022

36. Diffusion-Weighted Magnetic Resonance Brain Images Generation with Generative Adversarial Networks and Variational Autoencoders: A Comparison Study

Author

Hirte, Alejandro Ungría, Platscher, Moritz, Joyce, Thomas, Heit, Jeremy J., Tranvinh, Eric, and Federau, Christian

Subjects
Computer Science - Computer Vision and Pattern Recognition, Computer Science - Machine Learning, Electrical Engineering and Systems Science - Image and Video Processing
Abstract

We show that high quality, diverse and realistic-looking diffusion-weighted magnetic resonance images can be synthesized using deep generative models. Based on professional neuroradiologists' evaluations and diverse metrics with respect to quality and diversity of the generated synthetic brain images, we present two networks, the Introspective Variational Autoencoder and the Style-Based GAN, that qualify for data augmentation in the medical field, where information is saved in a dispatched and inhomogeneous way and access to it is in many aspects restricted., Comment: 20 pages, 5 figures, 2 tables

Published
2020

39. VINE Catheter for Endovascular Surgery

Author

Li, Mingyuan, Obregon, Rosario, Heit, Jeremy J, Norbash, Alexander, Hawkes, Elliot W, and Morimoto, Tania K

Subjects
Bioengineering, Cardiovascular, Medical robotics, soft robotics, surgical instruments
Published
2021

40. Excellent Recanalization and Small Core Volumes Are Associated With Favorable AM-PAC Score in Patients With Acute Ischemic Stroke Secondary to Large Vessel Occlusion

Author

Yedavalli, Vivek, Koneru, Manisha, Hoseinyazdi, Meisam, Copeland, Karen, Xu, Risheng, Luna, Licia, Caplan, Justin, Dmytriw, Adam, Guenego, Adrien, Heit, Jeremy, Albers, Gregory, Wintermark, Max, Gonzalez, Fernando, Urrutia, Victor, Huang, Judy, Leigh, Richard, Marsh, Elisabeth, Llinas, Rafael, Hernandez, Marlis Gonzalez, and Hillis, Argye

Published
2023
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45. The charlotte large artery occlusion endovascular therapy outcome score compares favorably to the critical area perfusion score for prognostication before basilar thrombectomy

Author

Karamchandani, Rahul R., Satyanarayana, Sagar, Yang, Hongmei, Rhoten, Jeremy B., Strong, Dale, Singh, Sam, Clemente, Jonathan D., Defilipp, Gary, Hazim, Manuel, Patel, Nikhil M., Bernard, Joe, Stetler, William R., Parish, Jonathan M., Blackwell, Thomas A., Heit, Jeremy J., Albers, Gregory W., Saba, Kasser, Guzik, Amy K., Wolfe, Stacey Q., and Asimos, Andrew W.

Published
2023
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48. Priorities for Advancements in Neuroimaging in the Diagnostic Workup of Acute Stroke

Author

Samaniego, Edgar A., Boltze, Johannes, Lyden, Patrick D., Hill, Michael D., Campbell, Bruce C.V., Silva, Gisele Sampaio, Sheth, Kevin N., Fisher, Marc, Hillis, Argye E., Nguyen, Thanh N., Carone, Davide, Favilla, Christopher G., Deljkich, Emir, Albers, Gregory W., Heit, Jeremy J., Lansberg, Maarten G., Aksoy, Didem, Broderick, Joe, Castonguay, Alicia C., Ghosh, Supurna, Grotta, James C., Harston, George, Houser, Gary R., Kuchenbecker, Kristopher, Latour, Lawrence L., Liebeskind, David S., Kylan Lynch, John, Maier, Carolina, Mistry, Eva, Mocco, J., Nogueira, Raul G., Saver, Jeffrey L., van Vlimmeren, Marijke, Wakhloo, Ajay K., and Wechsler, Lawrence

Published
2023
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