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1. 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

2. Mismatch Vs No Mismatch in Large Core—A Matter of Definition

Author

Yedavalli, Vivek, Adel Salim, Hamza, 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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4. 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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5. 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

6. 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

7. 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

8. 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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9. 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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10. 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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11. Multiparametric Radiogenomic Model to Predict Survival in Patients with Glioblastoma.

Author

Mahmoudi, Keon, Kim, Daniel, Tavakkol, Elham, Kihira, Shingo, Bauer, Adam, Tsankova, Nadejda, Khan, Fahad, Hormigo, Adilia, Yedavalli, Vivek, and Nael, Kambiz

Subjects
MGMT, MRI, glioma, multiparametric, radiogenomics, texture analysis, tumor segmentation
Abstract

BACKGROUND: Clinical, histopathological, and imaging variables have been associated with prognosis in patients with glioblastoma (GBM). We aimed to develop a multiparametric radiogenomic model incorporating MRI texture features, demographic data, and histopathological tumor biomarkers to predict prognosis in patients with GBM. METHODS: In this retrospective study, patients were included if they had confirmed diagnosis of GBM with histopathological biomarkers and pre-operative MRI. Tumor segmentation was performed, and texture features were extracted to develop a predictive radiomic model of survival (

Published
2024

12. 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

15. 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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16. 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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17. Automatic comprehensive radiological reports for clinical acute stroke MRIs.

Author

Liu, Chin-Fu, Zhao, Yi, Yedavalli, Vivek, Leigh, Richard, Falcao, Vitor, Miller, Michael, Hillis, Argye, and Faria, Andreia

Abstract

BACKGROUND: Although artificial intelligence systems that diagnosis among different conditions from medical images are long term aims, specific goals for automation of human-labor, time-consuming tasks are not only feasible but equally important. Acute conditions that require quantitative metrics, such as acute ischemic strokes, can greatly benefit by the consistency, objectiveness, and accessibility of automated radiological reports. METHODS: We used 1,878 annotated brain MRIs to generate a fully automated system that outputs radiological reports in addition to the infarct volume, 3D digital infarct mask, and the feature vector of anatomical regions affected by the acute infarct. This system is associated to a deep-learning algorithm for segmentation of the ischemic core and to parcellation schemes defining arterial territories and classically-identified anatomical brain structures. RESULTS: Here we show that the performance of our system to generate radiological reports was comparable to that of an expert evaluator. The weight of the components of the feature vectors that supported the prediction of the reports, as well as the prediction probabilities are outputted, making the pre-trained models behind our system interpretable. The system is publicly available, runs in real time, in local computers, with minimal computational requirements, and it is readily useful for non-expert users. It supports large-scale processing of new and legacy data, enabling clinical and translational research. CONCLUSION: The generation of reports indicates that our fully automated system is able to extract quantitative, objective, structured, and personalized information from stroke MRIs.

Published
2023

18. Umbrella review and network meta-analysis of diagnostic imaging test accuracy studies in differentiating between brain tumor progression versus pseudoprogression and radionecrosis

Author

Dagher, Richard, Gad, Mona, da Silva de Santana, Paloma, Sadeghi, Mohammad Amin, Yewedalsew, Selome F., Gujar, Sachin K., Yedavalli, Vivek, Köhler, Cristiano André, Khan, Majid, Tavora, Daniel Gurgel Fernandes, Kamson, David Olayinka, Sair, Haris I., and Luna, Licia P.

Published
2024
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20. Assessing the Efficacy of Mechanical Thrombectomy in Patients with an NIHSS < 6 Presenting with Proximal Middle Cerebral Artery Vessel Occlusion as Compared to Best Medical Management

Author

Yedavalli, Vivek Srikar, Hamam, Omar, Gudenkauf, Julie, Wang, Richard, Llinas, Rafael, Marsh, Elisabeth Breese, Caplan, Justin, Nael, Kambiz, and Urrutia, Victor

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Brain Disorders, Neurosciences, Clinical Research, Stroke, acute ischemic stroke, large vessel occlusion, mechanical thrombectomy, minor stroke, stroke care, Psychology, Cognitive Sciences, Applied and developmental psychology, Biological psychology
Abstract

Background and purposeMinor acute ischemic stroke (AIS) patients-defined by an NIHSS score < 6-presenting with proximal middle cerebral artery large vessel occlusions (MCA-LVO) is a subgroup for which treatment is still debated. Although these patients present with minor symptoms initially, studies have shown that several patients afflicted with MCA-LVO in this subgroup experience cognitive and functional decline. Although mechanical thrombectomy (MT) is the standard of care for patients with an NIHSS score of 6 or higher, treatment in the minor stroke subgroup is still being explored. The purpose of this preliminary study is to report our center's experience in evaluating the potential benefit of mechanical thrombectomy (MT) in minor stroke patients when compared to medical management (MM).MethodsWe performed a retrospective study with two comprehensive stroke centers within our hospital enterprise of consecutive patients presenting with minor AIS secondary to MCA-LVO (defined as M1 or proximal M2 segments of MCA). We subsequently evaluated patients who received MT versus those who received MM.ResultsBetween January 2017 and July 2021, we identified 46 AIS patients (11 treated with MT and 35 treated with MM) who presented with an NIHSS score < 6 secondary to MCA-LVO (47.8% 22/46 female, mean age 62.3 years, range 49-75 years). MT was associated with a significantly lower mRS at 90 days (median: 1.0 [IQR 0.0-2.0] versus 3.0 [IQR 1.0-4.0], p =

Published
2023

21. Correction to: Umbrella review and network meta-analysis of diagnostic imaging test accuracy studies in differentiating between brain tumor progression versus pseudoprogression and radionecrosis

Author

Dagher, Richard, Gad, Mona, da Silva de Santana, Paloma, Sadeghi, Mohammad Amin, Yewedalsew, Selome F., Gujar, Sachin K., Yedavalli, Vivek, Köhler, Cristiano André, Khan, Majid, Fernandes Tavora, Daniel Gurgel, Olayinka Kamson, David, Sair, Haris I., and Luna, Licia P.

Published
2024
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24. 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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26. 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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33. 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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39. Racial disparities in functional outcomes following mechanical thrombectomy in a cohort of patients with ischemic stroke.

Author

Srinivas, Tara, Ran, Kathleen, Nair, Sumil K., Hung, Alice, Young, Christopher C., Tamargo, Rafael J., Huang, Judy, Marsh, Elizabeth, Hillis, Argye, Yedavalli, Vivek, Urrutia, Victor, Gailloud, Philippe, Caplan, Justin M., Gonzalez, L. Fernando, and Risheng Xu

Subjects
RISK assessment, SELF-evaluation, NIH Stroke Scale, FUNCTIONAL assessment, MULTIPLE regression analysis, RETROSPECTIVE studies, DESCRIPTIVE statistics, MULTIVARIATE analysis, RACE, LONGITUDINAL method, ODDS ratio, ISCHEMIC stroke, STATISTICS, HEALTH equity, THROMBECTOMY, PATIENTS' attitudes, DISEASE risk factors
Abstract

Background Non-Hispanic Black (NHB) patients experience increased prevalence of stroke risk factors and stroke incidence compared with non-Hispanic White (NHW) patients. However, little is known about >90-day post-stroke functional outcomes following mechanical thrombectomy. Objective To describe patient characteristics, evaluate stroke risk factors, and analyze the adjusted impact of race on long-term functional outcomes to better identify and limit sources of disparity in post-stroke care. Methods We retrospectively reviewed 326 patients with ischemic stroke who underwent thrombectomy at two centers between 2019 and 2022. Race was selfreported as NHB, NHW, or non-Hispanic Other. Stroke risk factors, insurance status, procedural parameters, and post-stroke functional outcomes were collected. Good outcomes were defined as modified Rankin Scale score ≤2 and/or discharge disposition to home/self-care. To assess the impact of race on outcomes at 3-, 6-, and 12-months' follow-up, we performed univariate and multivariate logistic regression. Results Patients self-identified as NHB (42%), NHW (53%), or Other (5%). 177 (54.3%) patients were female; the median (IQR) age was 67.5 (59-77) years. The median (IQR) National Institutes of Health Stroke Scale score was 15 (10-20). On univariate analysis, NHB patients were more likely to have poor short-and long-term functional outcomes, which persisted on multivariate analysis as significant at 3 and 6 months but not at 12 months (3 months: OR=2.115, P=0.04; 6 months: OR=2.423, P=0.048; 12 months: OR=2.187, P=0.15). NHB patients were also more likely to be discharged to rehabilitation or hospice/death than NHW patients after adjusting for confounders (OR=1.940, P=0.04). Conclusions NHB patients undergoing thrombectomy for ischemic stroke experience worse 3-and 6-month functional outcomes than NHW patients after adjusting for confounders. Interestingly, this disparity was not detected at 12 months. Future research should focus on identifying social determinants in the shortterm post-stroke recovery period to improve parity in stroke care. [ABSTRACT FROM AUTHOR]

Published
2024
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40. Edited magnetic resonance spectroscopy in the neonatal brain

Author

Song, Yulu, Lally, Peter J., Yanez Lopez, Maria, Oeltzschner, Georg, Nebel, Mary Beth, Gagoski, Borjan, Kecskemeti, Steven, Hui, Steve C. N., Zöllner, Helge J., Shukla, Deepika, Arichi, Tomoki, De Vita, Enrico, Yedavalli, Vivek, Thayyil, Sudhin, Fallin, Daniele, Dean, III, Douglas C., Grant, P. Ellen, Wisnowski, Jessica L., and Edden, Richard A. E.

Published
2022
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41. Beyond the embolus: “do not miss” diffusion abnormalities of ischaemic and non-ischaemic neurological disease

Author

Yedavalli, Vivek, Nyberg, Eric M, Chow, Daniel S, and Thaker, Ashesh A

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Clinical Research, Neurosciences, Brain Disorders, Stroke, Cardiovascular, Diffusion magnetic resonance imaging, Neuroimaging, Hypoxia-ischaemia, Brain, Neurotoxicity syndromes, Clinical sciences
Abstract

Given the rapid evolution and technological advances in the diagnosis and treatment of acute ischaemic stroke (AIS), including the proliferation of comprehensive stroke centres and increasing emphasis on interventional stroke therapies, the need for prompt recognition of stroke due to acute large vessel occlusion has received significant attention in the recent literature. Diffusion-weighted imaging (DWI) is the gold standard for the diagnosis of acute ischaemic stroke, as images appear positive within minutes of ischaemic injury, and a high signal-to-noise ratio enables even punctate infarcts to be readily detected. DWI lesions resulting from a single arterial embolic occlusion or steno-occlusive lesion classically lateralise and conform to a specific arterial territory. When there is a central embolic source (e.g. left atrial thrombus), embolic infarcts are often found in multiple vascular territories. However, ischaemic disease arising from aetiologies other than arterial occlusion will often not conform to an arterial territory. Furthermore, there are several important entities unrelated to ischaemic disease that can present with abnormal DWI and which should not be confused with infarct. This pictorial review explores the scope and typical DWI findings of select neurologic conditions beyond acute arterial occlusion, which should not be missed or misinterpreted.Teaching points• DWI abnormalities due to acute arterial occlusion must be promptly identified. • DWI abnormalities not due to arterial occlusion will often not conform to an arterial territory. • Several important non-ischaemic entities can present on DWI and should not be confused with infarct.

Published
2017

42. Lower admission stroke severity is associated with good collateral status in distal medium vessel occlusion stroke

Author

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

Published
2024
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43. Outcomes of mechanical thrombectomy in anticoagulated patients with acute distal and medium vessel stroke

Author

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

Published
2024
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44. Hemoglobin Drop is Associated with Early Post-operative Stroke Following Revascularization Surgery for Moyamoya Disease

Author

Ran, Kathleen R., primary, Nair, Sumil K., additional, Srinivas, Tara, additional, Xie, Michael E., additional, Kilgore, Collin B., additional, Ye, Xiaobu, additional, Yedavalli, Vivek S., additional, Sun, Lisa R., additional, Jackson, Christopher M., additional, Caplan, Justin M., additional, Gonzalez, L. Fernando, additional, Tamargo, Rafael J., additional, Huang, Judy, additional, and Xu, Risheng, additional

Published
2024
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46. Prolonged venous transit on perfusion imaging is associated with higher odds of mortality in successfully reperfused patients with large vessel occlusion stroke

Author

Yedavalli, Vivek S, primary, Koneru, Manisha, additional, Hoseinyazdi, Meisam, additional, Greene, Cynthia, additional, Lakhani, Dhairya A, additional, Xu, Risheng, additional, Luna, Licia P, additional, Caplan, Justin M, additional, Dmytriw, Adam A, additional, Guenego, Adrien, additional, Heit, Jeremy J, additional, Albers, Gregory W, additional, Wintermark, Max, additional, Gonzalez, L Fernando, additional, Urrutia, Victor C, additional, Huang, Judy, additional, Nael, Kambiz, additional, Leigh, Richard, additional, Marsh, Elisabeth B, additional, Hillis, Argye E, additional, and Llinas, Rafael H, additional

Published
2024
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49. Relative Cerebral Blood Flow as an Indirect Imaging Surrogate in Patients With Anterior Circulation Large Vessel Occlusion and Association of Baseline Characteristics With Poor Collateral Status.

Author

Salim, Hamza Adel, Hamam, Omar, Parilday, Goksu, Moustafa, Rawan A., Ghandour, Samir, Rutgers, Moustafa, Sharara, Muhanned, Cho, Andrew, Mazumdar, Ishan, Radmard, Mahla, Shin, Christopher, Montes, Daniel, Malhotra, Ajay, Romero, Javier M., and Yedavalli, Vivek

Published
2024
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50. Hypoperfusion Intensity Ratio as an Indirect Imaging Surrogate in Patients With Anterior Circulation Large-Vessel Occlusion and Association of Baseline Characteristics With Poor Collateral Status.

Author

Hamam, Omar, Gudenkauf, Julie, Moustafa, Rawan, Cho, Andrew, Montes, Daniel, Sharara, Muhannad, Moustafa, Abdallah, Radmard, Mahla, Nabi, Mehreen, Chen, Kevin, Sepehri, Sadra, Shin, Christopher, Mazumdar, Ishan, Minsoo Kim, Mohseni, Alireza, Malhotra, Ajay, Romero, Javier, and Yedavalli, Vivek

Published
2024
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