1
|
Yedavalli V, Kihira S, Shahrouki P, Hamam O, Tavakkol E, McArthur M, Qiao J, Johanna F, Doshi A, Vagal A, Khatri P, Srinivasan A, Chaudhary N, Bahr-Hosseini M, Colby GP, Nour M, Jahan R, Duckwiler G, Arnold C, Saver JL, Mocco J, Liebeskind DS, Nael K. CTP-based estimated ischemic core: A comparative multicenter study between Olea and RAPID software. J Stroke Cerebrovasc Dis 2023; 32:107297. [PMID: 37738915 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107297] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND AND PURPOSE CTP is increasingly used to assess eligibility for endovascular therapy (EVT) in patients with large vessel occlusions (LVO). There remain variability and inconsistencies between software packages for estimation of ischemic core. We aimed to use heterogenous data from four stroke centers to perform a comparative analysis for CTP-estimated ischemic core between RAPID (iSchemaView) and Olea (Olea Medical). METHODS In this retrospective multicenter study, patients with anterior circulation LVO who underwent pretreatment CTP, successful EVT (defined TICI ≥ 2b), and follow-up MRI included. Automated CTP analysis was performed using Olea platform [rCBF < 25% and differential time-to-peak (dTTP)>5s] and RAPID (rCBF < 30%). The CTP estimated core volumes were compared against the final infarct volume (FIV) on post treatment MRI-DWI. RESULTS A total of 151 patients included. The CTP-estimated ischemic core volumes (mean ± SD) were 18.7 ± 18.9 mL on Olea and 10.5 ± 17.9 mL on RAPID significantly different (p < 0.01). The correlation between CTP estimated core and MRI final infarct volume was r = 0.38, p < 0.01 for RAPID and r = 0.39, p < 0.01 for Olea. Both software platforms demonstrated a strong correlation with each other (r = 0.864, p < 0.001). Both software overestimated the ischemic core volume above 70 mL in 4 patients (2.6%). CONCLUSIONS Substantial variation between Olea and RAPID CTP-estimated core volumes exists, though rates of overcalling of large core were low and identical. Both showed comparable core volume correlation to MRI infarct volume.
Collapse
Affiliation(s)
- V Yedavalli
- Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - S Kihira
- David Geffen School of Medicine at the University of California - Los Angeles, United States
| | - P Shahrouki
- David Geffen School of Medicine at the University of California - Los Angeles, United States
| | - O Hamam
- Massachussetts General Hospital, Boston, MA, United States
| | - E Tavakkol
- David Geffen School of Medicine at the University of California - Los Angeles, United States
| | - M McArthur
- David Geffen School of Medicine at the University of California - Los Angeles, United States
| | - J Qiao
- David Geffen School of Medicine at the University of California - Los Angeles, United States
| | - Fifi Johanna
- Mount Sinai School of Medicine, New York, NY, United States
| | - A Doshi
- Mount Sinai School of Medicine, New York, NY, United States
| | - A Vagal
- University of Cincinnati School of Medicine, Cincinnati, OH, United States
| | - P Khatri
- University of Cincinnati School of Medicine, Cincinnati, OH, United States
| | - A Srinivasan
- University of Michigan School of Medicine, Ann Arbor, MI, United States
| | - N Chaudhary
- University of Michigan School of Medicine, Ann Arbor, MI, United States
| | - M Bahr-Hosseini
- David Geffen School of Medicine at the University of California - Los Angeles, United States
| | - G P Colby
- David Geffen School of Medicine at the University of California - Los Angeles, United States
| | - M Nour
- David Geffen School of Medicine at the University of California - Los Angeles, United States
| | - R Jahan
- David Geffen School of Medicine at the University of California - Los Angeles, United States
| | - G Duckwiler
- David Geffen School of Medicine at the University of California - Los Angeles, United States
| | - C Arnold
- David Geffen School of Medicine at the University of California - Los Angeles, United States
| | - J L Saver
- David Geffen School of Medicine at the University of California - Los Angeles, United States
| | - J Mocco
- Mount Sinai School of Medicine, New York, NY, United States
| | - D S Liebeskind
- David Geffen School of Medicine at the University of California - Los Angeles, United States
| | - K Nael
- David Geffen School of Medicine at the University of California - Los Angeles, United States
| |
Collapse
|
2
|
Walsh CJ, Batt J, Herridge MS, Mathur S, Bader GD, Hu P, Khatri P, Dos Santos CC. Comprehensive multi-cohort transcriptional meta-analysis of muscle diseases identifies a signature of disease severity. Sci Rep 2022; 12:11260. [PMID: 35789175 PMCID: PMC9253003 DOI: 10.1038/s41598-022-15003-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 05/03/2022] [Indexed: 11/09/2022] Open
Abstract
Muscle diseases share common pathological features suggesting common underlying mechanisms. We hypothesized there is a common set of genes dysregulated across muscle diseases compared to healthy muscle and that these genes correlate with severity of muscle disease. We performed meta-analysis of transcriptional profiles of muscle biopsies from human muscle diseases and healthy controls. Studies obtained from public microarray repositories fulfilling quality criteria were divided into six categories: (i) immobility, (ii) inflammatory myopathies, (iii) intensive care unit (ICU) acquired weakness (ICUAW), (iv) congenital muscle diseases, (v) chronic systemic diseases, (vi) motor neuron disease. Patient cohorts were separated in discovery and validation cohorts retaining roughly equal proportions of samples for the disease categories. To remove bias towards a specific muscle disease category we repeated the meta-analysis five times by removing data sets corresponding to one muscle disease class at a time in a "leave-one-disease-out" analysis. We used 636 muscle tissue samples from 30 independent cohorts to identify a 52 gene signature (36 up-regulated and 16 down-regulated genes). We validated the discriminatory power of this signature in 657 muscle biopsies from 12 additional patient cohorts encompassing five categories of muscle diseases with an area under the receiver operating characteristic curve of 0.91, 83% sensitivity, and 85.3% specificity. The expression score of the gene signature inversely correlated with quadriceps muscle mass (r = -0.50, p-value = 0.011) in ICUAW and shoulder abduction strength (r = -0.77, p-value = 0.014) in amyotrophic lateral sclerosis (ALS). The signature also positively correlated with histologic assessment of muscle atrophy in ALS (r = 0.88, p-value = 1.62 × 10-3) and fibrosis in muscular dystrophy (Jonckheere trend test p-value = 4.45 × 10-9). Our results identify a conserved transcriptional signature associated with clinical and histologic muscle disease severity. Several genes in this conserved signature have not been previously associated with muscle disease severity.
Collapse
Affiliation(s)
- C J Walsh
- Keenan Research Center for Biomedical Science, Saint Michael's Hospital, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - J Batt
- Keenan Research Center for Biomedical Science, Saint Michael's Hospital, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - M S Herridge
- Interdepartmental Division of Critical Care, University Health Network, University of Toronto, Toronto, ON, Canada
| | - S Mathur
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - G D Bader
- The Donnelly Center, University of Toronto, Toronto, ON, Canada
| | - P Hu
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, MB, Canada
| | - P Khatri
- Stanford Institute for Immunity, Transplantation and Infection (ITI), Stanford University School of Medicine, Stanford, CA, USA.,Department of Medicine, Stanford Center for Biomedical Informatics Research (BMIR), Stanford University, Stanford, CA, USA
| | - C C Dos Santos
- Keenan Research Center for Biomedical Science, Saint Michael's Hospital, Toronto, ON, Canada. .,Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
3
|
Mahammedi A, Wang LL, Williamson BJ, Khatri P, Kissela B, Sawyer RP, Shatz R, Khandwala V, Vagal A. Small Vessel Disease, a Marker of Brain Health: What the Radiologist Needs to Know. AJNR Am J Neuroradiol 2022; 43:650-660. [PMID: 34620594 PMCID: PMC9089248 DOI: 10.3174/ajnr.a7302] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 07/05/2021] [Indexed: 11/07/2022]
Abstract
Small vessel disease, a disorder of cerebral microvessels, is an expanding epidemic and a common cause of stroke and dementia. Despite being almost ubiquitous in brain imaging, the clinicoradiologic association of small vessel disease is weak, and the underlying pathogenesis is poorly understood. The STandards for ReportIng Vascular changes on nEuroimaging (STRIVE) criteria have standardized the nomenclature. These include white matter hyperintensities of presumed vascular origin, recent small subcortical infarcts, lacunes of presumed vascular origin, prominent perivascular spaces, cerebral microbleeds, superficial siderosis, cortical microinfarcts, and brain atrophy. Recently, the rigid categories among cognitive impairment, vascular dementia, stroke, and small vessel disease have become outdated, with a greater emphasis on brain health. Conventional and advanced small vessel disease imaging markers allow a comprehensive assessment of global brain heath. In this review, we discuss the pathophysiology of small vessel disease neuroimaging nomenclature by means of the STRIVE criteria, clinical implications, the role of advanced imaging, and future directions.
Collapse
Affiliation(s)
- A Mahammedi
- From the Departments of Neuroradiology (A.M., L.L.W., B.J.W., V.K., A.V.)
| | - L L Wang
- From the Departments of Neuroradiology (A.M., L.L.W., B.J.W., V.K., A.V.)
| | - B J Williamson
- From the Departments of Neuroradiology (A.M., L.L.W., B.J.W., V.K., A.V.)
| | - P Khatri
- Neurology (P.K., B.K., R.P.S., R.S.) University of Cincinnati Medical Center, Cincinnati, Ohio
| | - B Kissela
- Neurology (P.K., B.K., R.P.S., R.S.) University of Cincinnati Medical Center, Cincinnati, Ohio
| | - R P Sawyer
- Neurology (P.K., B.K., R.P.S., R.S.) University of Cincinnati Medical Center, Cincinnati, Ohio
| | - R Shatz
- Neurology (P.K., B.K., R.P.S., R.S.) University of Cincinnati Medical Center, Cincinnati, Ohio
| | - V Khandwala
- From the Departments of Neuroradiology (A.M., L.L.W., B.J.W., V.K., A.V.)
| | - A Vagal
- From the Departments of Neuroradiology (A.M., L.L.W., B.J.W., V.K., A.V.)
| |
Collapse
|
4
|
Steiner T, Dichgans M, Norrving B, Aamodt AH, Berge E, Christensen H, Fuentes B, Khatri P, Korompoki E, Martí-Fabregas J, Quinn T, Toni D, Zedde M, Sacco S, Turc G. European Stroke Organisation (ESO) standard operating procedure for the preparation and publishing of guidelines. Eur Stroke J 2021; 6:CXXII-CXXXIV. [PMID: 34746429 DOI: 10.1177/23969873211024143] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/10/2021] [Indexed: 11/17/2022] Open
Abstract
The first European Stroke Organization (ESO) standard operating procedure (SOP) published in 2015 aimed at the implementation the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology to provide evidence-based guidelines for stroke management. This second ESO-SOP is aiming at further increase of the practicability of ESO guidelines and its technical implications. Authors comprised of the members of the ESO guideline Board and ESO Executive Committee. The final document was agreed on by several internal reviews. The second SOP comprises of the following aspects: rational for the SOP, the introduction of expert consensus statements, types of guideline documents, structures involved and detailed description of the guideline preparation process, handling of financial and intellectual conflicts of interest (CoI), involvement of ESO members in the guideline process, review process, authorship and publication policy, updating of guidelines, cooperation with other societies, and dealing with falsified data. This second SOP supersedes the first SOP published in 2015.
Collapse
Affiliation(s)
- T Steiner
- Department of Neurology, Klinikum Frankfurt Höchst GmbH, Frankfurt am Main, Germany.,Department of Neurology Hospital, Heidelberg University, Heidelberg, Germany
| | - M Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE, Munich), Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - B Norrving
- Department of Clinical Sciences Lund University Hospital and Lund University Departmnet of Neurology, Skane University Hospital, Lund, Sweden
| | - A H Aamodt
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - E Berge
- Department of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - H Christensen
- Department of Neurology, Bispebjerg Hospital, University of Copenhagen, Kobenhavn, Denmark
| | - B Fuentes
- Department of Neurology, Hospital Universitario La Paz, Madrid, Spain
| | - P Khatri
- Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - E Korompoki
- Division of Brain Science, Imperial College London, London, UK.,Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | | | - T Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - D Toni
- Departments of Neurological Sciences and Emergency, Unità di Trattamento Neurovascolare, University of Rome La Sapienza, Rome, Italy
| | - M Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale - IRCCS, di Reggio Emilia, Reggio Emilia, Italy
| | - S Sacco
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - G Turc
- Neurology Department, GHU Paris Psychiatrie et Neurosciences, Université de Paris, Paris, France
| |
Collapse
|
5
|
Khatri P, Hayasaka T, Holben B, Tripathi SN, Misra P, Patra PK, Hayashida S, Dumka UC. Aerosol Loading and Radiation Budget Perturbations in Densely Populated and Highly Polluted Indo-Gangetic Plain by COVID-19: Influences on Cloud Properties and Air Temperature. Geophys Res Lett 2021; 48:e2021GL093796. [PMID: 34924636 PMCID: PMC8667642 DOI: 10.1029/2021gl093796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/18/2021] [Accepted: 10/02/2021] [Indexed: 06/14/2023]
Abstract
Aerosols emitted in densely populated and industrialized Indo-Gangetic Plain, one of the most polluted regions in the world, modulate regional climate, monsoon, and Himalayan glacier retreat. Thus, this region is important for understanding aerosol perturbations and their resulting impacts on atmospheric changes during COVID-19 lockdown period, a natural experimental condition created by the pandemic. By analyzing 5 years (2016-2020) data of aerosols and performing a radiative transfer calculation, we found that columnar and near-surface aerosol loadings decreased, leading to reductions in radiative cooling at the surface and top of the atmosphere and atmospheric warming during lockdown period. Further, satellite data analyses showed increases in cloud optical thickness and cloud-particle effective radius and decrease in lower tropospheric air temperature during lockdown period. These results indicate critical influences of COVID-19 lockdown on regional climate and water cycle over Indo-Gangetic Plain, emphasizing need for further studies from modeling perspectives.
Collapse
Affiliation(s)
- P. Khatri
- Graduate School of ScienceCenter for Atmospheric and Oceanic StudiesTohoku UniversitySendaiJapan
- Research Institute for Humanity and NatureKyotoJapan
| | - T. Hayasaka
- Graduate School of ScienceCenter for Atmospheric and Oceanic StudiesTohoku UniversitySendaiJapan
| | - B. Holben
- National Aeronautics and Space AdministrationGoddard Space Flight CenterGreenbeltMDUSA
| | - S. N. Tripathi
- Department of Civil EngineeringIndian Institute of Technology KanpurKanpurIndia
| | - P. Misra
- Research Institute for Humanity and NatureKyotoJapan
| | - P. K. Patra
- Graduate School of ScienceCenter for Atmospheric and Oceanic StudiesTohoku UniversitySendaiJapan
- Research Institute for Humanity and NatureKyotoJapan
- Research Institute for Global ChangeJAMSTECYokohamaJapan
| | - S. Hayashida
- Research Institute for Humanity and NatureKyotoJapan
| | - U. C. Dumka
- Aryabhatta Research Institute of Observational Sciences (ARIES)NainitalIndia
| |
Collapse
|
6
|
Mistry EA, Mistry AM, Mehta T, Arora N, Starosciak AK, La Rosa FDLR, Siegler JE, Kasner SE, Chitale R, Fusco M, Froehler M, Yaghi S, Schrag M, Khatri P. White Matter Disease and Outcomes of Mechanical Thrombectomy for Acute Ischemic Stroke. AJNR Am J Neuroradiol 2020; 41:639-644. [PMID: 32165366 DOI: 10.3174/ajnr.a6478] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 01/31/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE The increased severity of white matter disease is associated with worse outcomes and an increased rate of intracerebral hemorrhage in patients with ischemic stroke undergoing thrombolytic treatment. However, whether white matter disease is associated with outcomes in patients undergoing endovascular treatment remains unclear. MATERIALS AND METHODS In this prespecified exploratory analysis of our prospective multi-institutional study that enrolled consecutive adult patients with anterior circulation ischemic stroke undergoing endovascular treatment from November 2017 to September 2018, we compared the following outcomes between patients with none-to-minimal (van Swieten score, 0-2) and moderate-to-severe (van Swieten score, 3-4) white matter disease using logistic regression: 90-day mRS 3-6, death, intracerebral hemorrhage, successful recanalization, and early neurologic recovery. RESULTS Of the 485 patients enrolled in the Blood Pressure after Endovascular Stroke Therapy (BEST) study, 389 had white matter disease graded (50% women; median age, 68 years; range, 58-79 years). A van Swieten score of 3-4 (n = 74/389, 19%) was associated with a higher rate of 90-day mRS of 3-6 (45% versus 18%; adjusted OR, 2.73; 95% CI, 1.34-5.93; P = .008). Although the death rate was higher in patients with van Swieten scores of 3-4 (26% versus 15%), the adjusted likelihood was not significantly different (adjusted OR, 1.14; 95% CI, 0.56-2.26; P = .710). Ordered regression revealed a shift toward worse mRS scores with increasing van Swieten scores (adjusted common OR, 3.04; 95% CI, 1.93-4.84; P < .001). No associations between white matter disease severity and intracerebral hemorrhage, successful recanalization, and early neurologic recovery were observed. CONCLUSIONS Moderate-to-severe white matter disease is associated with worse outcomes in patients undergoing endovascular treatment without a significant increase in hemorrhagic complications. Studies comparing patients with and without endovascular treatment are necessary to determine whether the benefit of endovascular treatment is attenuated with greater white matter disease.
Collapse
Affiliation(s)
- E A Mistry
- From the Departments of Neurology (E.A.M., M.S.) and
| | - A M Mistry
- Neurosurgery (A.M.M., R.C., M. Fusco), and
| | - T Mehta
- Department of Neurology and Neurosurgery (T.M.), University of Minnesota, Minneapolis, Minnesota
| | - N Arora
- Department of Neurology (N.A.), University of Missouri, Columbia, Missouri
| | - A K Starosciak
- Baptist Health Neuroscience Center (A.K.S., F.D.L.R.L.R.), Miami, Florida
| | - F D L R La Rosa
- Baptist Health Neuroscience Center (A.K.S., F.D.L.R.L.R.), Miami, Florida
| | - J E Siegler
- Department of Neurology (J.E.S., S.E.K.), University of Pennsylvania, Philadelphia, Pennsylvania
| | - S E Kasner
- Department of Neurology (J.E.S., S.E.K.), University of Pennsylvania, Philadelphia, Pennsylvania
| | - R Chitale
- Neurosurgery (A.M.M., R.C., M. Fusco), and
| | - M Fusco
- Neurosurgery (A.M.M., R.C., M. Fusco), and
| | - M Froehler
- Cerebrovascular Program (M. Froehler), Vanderbilt University Medical Center, Nashville, Tennessee
| | - S Yaghi
- New York University Langone Health (S.Y.), Brooklyn, New York
| | - M Schrag
- From the Departments of Neurology (E.A.M., M.S.) and
| | | | | |
Collapse
|
7
|
Khatri P, Samdariya S, Kumari P. Prospective randomized comparison between 5-fluorouracil, leucovorin and etoposide plus best supportive care with best supportive care in advanced gastric cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
8
|
Khatri P, Kumari P, Samdariya S. 5-fluorouracil and cisplatin regulated with leucovorin for locally advanced esophageal cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
9
|
Nichols C, Carrozzella J, Yeatts S, Tomsick T, Broderick J, Khatri P. Is periprocedural sedation during acute stroke therapy associated with poorer functional outcomes? J Neurointerv Surg 2018; 10:i40-i43. [PMID: 30037954 DOI: 10.1136/jnis.2009.001768.rep] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Accepted: 10/15/2009] [Indexed: 11/04/2022]
Abstract
BACKGROUND To safely perform acute intra-arterial revascularization procedures, use of sedative medications and paralytics is often necessary. During the conduct of the Interventional Management of Stroke trials (I and II), the level of sedation used periprocedurally varied. At some institutions, patients were paralyzed and intubated as part of the procedural standard of care while at other institutions no routine sedation protocol was followed. The aim of this study was to identify patient characteristics that would correlate with the need for deeper sedation and to explore whether levels of sedation relate to patient outcome. METHODS 75 of 81 patients in the Interventional Management of Stroke II Study were studied. Patients had anterior circulation strokes and underwent angiography and/or intervention. Four sedation categories were defined and tested for factors potentially associated with the level of sedation. Clinical outcomes were also analyzed, including successful angiographic reperfusion and the occurrence of clinical complications. RESULTS Only baseline National Institutes of Health Stroke Scale varied significantly by sedation category (p=0.01). Patients that were in the lower sedation category fared better, having a higher rate of good outcomes (p<0.01), lower death rates (p=0.02) and higher successful angiographic reperfusion rates (p=0.01). There was a significantly higher infection rate in patients receiving heavy sedation or pharmacologic paralysis (p=0.02) and a trend towards fewer groin related complications. CONCLUSION In this small sample, patients not receiving sedation fared better, had higher rates of successful angiographic reperfusion and had fewer complications. Further examination of the indications for procedural sedation or paralysis and their effect on outcome is warranted.
Collapse
Affiliation(s)
- C Nichols
- South Denver Neurosurgery, Littleton Adventist Hospital, Colorado, USA
| | - J Carrozzella
- University of Cincinnati Academic Health Center, Cincinnati, Ohio, USA
| | - S Yeatts
- Medical University of South Carolina, South Carolina, USA
| | - T Tomsick
- University of Cincinnati Academic Health Center, Cincinnati, Ohio, USA
| | - J Broderick
- University of Cincinnati Academic Health Center, Cincinnati, Ohio, USA
| | - P Khatri
- University of Cincinnati Academic Health Center, Cincinnati, Ohio, USA
| |
Collapse
|
10
|
Vagal A, Sanelli P, Sucharew H, Alwell KA, Khoury JC, Khatri P, Woo D, Flaherty M, Kissela BM, Adeoye O, Ferioli S, De Los Rios La Rosa F, Martini S, Mackey J, Kleindorfer D. Age, Sex, and Racial Differences in Neuroimaging Use in Acute Stroke: A Population-Based Study. AJNR Am J Neuroradiol 2017; 38:1905-1910. [PMID: 28838913 DOI: 10.3174/ajnr.a5340] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 06/05/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Limited information is available regarding differences in neuroimaging use for acute stroke work-up. Our objective was to assess whether race, sex, or age differences exist in neuroimaging use and whether these differences depend on the care center type in a population-based study. MATERIALS AND METHODS Patients with stroke (ischemic and hemorrhagic) and transient ischemic attack were identified in a metropolitan, biracial population using the Greater Cincinnati/Northern Kentucky Stroke Study in 2005 and 2010. Multivariable regression was used to determine the odds of advanced imaging use (CT angiography/MR imaging/MR angiography) for race, sex, and age. RESULTS In 2005 and 2010, there were 3471 and 3431 stroke/TIA events, respectively. If one adjusted for covariates, the odds of advanced imaging were higher for younger (55 years or younger) compared with older patients, blacks compared with whites, and patients presenting to an academic center and those seen by a stroke team or neurologist. The observed association between race and advanced imaging depended on age; in the older age group, blacks had higher odds of advanced imaging compared with whites (odds ratio, 1.34; 95% CI, 1.12-1.61; P < .01), and in the younger group, the association between race and advanced imaging was not statistically significant. Age by race interaction persisted in the academic center subgroup (P < .01), but not in the nonacademic center subgroup (P = .58). No significant association was found between sex and advanced imaging. CONCLUSIONS Within a large, biracial stroke/TIA population, there is variation in the use of advanced neuroimaging by age and race, depending on the care center type.
Collapse
Affiliation(s)
- A Vagal
- From the Departments of Radiology (A.V.)
| | - P Sanelli
- Department of Radiology (P.S.), Hofstra Northwell School of Medicine, Hempstead, New York
| | - H Sucharew
- Department of Biostatistics and Epidemiology (H.S., J.C.K.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - K A Alwell
- Neurology (K.A.A., P.K., D.W., M.F., B.M.K., S.F., F.D.L.R.L.R., S.M., D.K.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | - J C Khoury
- Department of Biostatistics and Epidemiology (H.S., J.C.K.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - P Khatri
- Neurology (K.A.A., P.K., D.W., M.F., B.M.K., S.F., F.D.L.R.L.R., S.M., D.K.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | - D Woo
- Neurology (K.A.A., P.K., D.W., M.F., B.M.K., S.F., F.D.L.R.L.R., S.M., D.K.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | - M Flaherty
- Neurology (K.A.A., P.K., D.W., M.F., B.M.K., S.F., F.D.L.R.L.R., S.M., D.K.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | - B M Kissela
- Neurology (K.A.A., P.K., D.W., M.F., B.M.K., S.F., F.D.L.R.L.R., S.M., D.K.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | | | - S Ferioli
- Neurology (K.A.A., P.K., D.W., M.F., B.M.K., S.F., F.D.L.R.L.R., S.M., D.K.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | - F De Los Rios La Rosa
- Neurology (K.A.A., P.K., D.W., M.F., B.M.K., S.F., F.D.L.R.L.R., S.M., D.K.), University of Cincinnati Medical Center, Cincinnati, Ohio.,Baptist Health Neuroscience Center (F.D.L.R.L.R.), Miami, Florida.,University of New Mexico Health Sciences Center and Department of Neurology (F.D.L.R.L.R.), Albuquerque, New Mexico
| | - S Martini
- Neurology (K.A.A., P.K., D.W., M.F., B.M.K., S.F., F.D.L.R.L.R., S.M., D.K.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | - J Mackey
- Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis, Indiana
| | - D Kleindorfer
- Neurology (K.A.A., P.K., D.W., M.F., B.M.K., S.F., F.D.L.R.L.R., S.M., D.K.), University of Cincinnati Medical Center, Cincinnati, Ohio
| |
Collapse
|
11
|
Tomsick TA, Carrozzella J, Foster L, Hill MD, von Kummer R, Goyal M, Demchuk AM, Khatri P, Palesch Y, Broderick JP, Yeatts SD, Liebeskind DS. Endovascular Therapy of M2 Occlusion in IMS III: Role of M2 Segment Definition and Location on Clinical and Revascularization Outcomes. AJNR Am J Neuroradiol 2016; 38:84-89. [PMID: 27765740 DOI: 10.3174/ajnr.a4979] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 08/01/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Uncertainty persists regarding the safety and efficacy of endovascular therapy of M2 occlusions following IV tPA. We reviewed the impact of revascularization on clinical outcomes in 83 patients with M2 occlusions in the Interventional Management of Stroke III trial according to specific M1-M2 segment anatomic features. MATERIALS AND METHODS Perfusion of any M2 branch distinguished M2-versus-M1 occlusion. Prespecified modified TICI and arterial occlusive lesion revascularization and clinical mRS 0-2 end points at 90 days for endovascular therapy-treated M2 occlusions were analyzed. Post hoc analyses of the relationship of outcomes to multiple baseline angiographic M2 and M1 subgroup characteristics were performed. RESULTS Of 83 participants with M2 occlusion who underwent endovascular therapy, 41.0% achieved mRS 0-2 at 90 days, including 46.6% with modified TICI 2-3 reperfusion compared with 26.1% with modified TICI 0-1 reperfusion (risk difference, 20.6%; 95% CI, -1.4%-42.5%). mRS 0-2 outcome was associated with reperfusion for M2 trunk (n = 9) or M2 division (n = 42) occlusions, but not for M2 branch occlusions (n = 28). Of participants with trunk and division occlusions, 63.2% with modified TICI 2a and 42.9% with modified TICI 2b reperfusion achieved mRS 0-2 outcomes; mRS 0-2 outcomes for M2 trunk occlusions (33%) did not differ from distal (38.2%) and proximal (26.9%) M1 occlusions. CONCLUSIONS mRS 0-2 at 90 days was dependent on reperfusion for M2 trunk but not for M2 branch occlusions. For M2 division occlusions, good outcome with modified TICI 2b reperfusion did not differ from that in modified TICI 2a. M2 segment definition and occlusion location may contribute to differences in revascularization and good outcome between Interventional Management of Stroke III and other endovascular therapy studies.
Collapse
Affiliation(s)
- T A Tomsick
- From the Department of Radiology (T.A.T., J.C.), University of Cincinnati Academic Health Center, University Hospital, Cincinnati, Ohio
| | - J Carrozzella
- From the Department of Radiology (T.A.T., J.C.), University of Cincinnati Academic Health Center, University Hospital, Cincinnati, Ohio
| | - L Foster
- Department of Biostatistics, Bioinformatics, and Epidemiology (L.F., Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina
| | - M D Hill
- Calgary Stroke Program (M.D.H., A.M.D.), Department of Clinical Neurosciences, Medicine, Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Foothills Hospital, Calgary, Alberta, Canada
| | - R von Kummer
- Department of Neuroradiology (R.v.K.), Dresden University Stroke Center, Universitätsklinikum Carl Gustav Carusan deTechnischen Universität Dresden, Dresden, Germany
| | - M Goyal
- Department of Radiology and Clinical Neurosciences (M.G.), University of Calgary, Calgary, Alberta, Canada
| | - A M Demchuk
- Calgary Stroke Program (M.D.H., A.M.D.), Department of Clinical Neurosciences, Medicine, Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Foothills Hospital, Calgary, Alberta, Canada
| | - P Khatri
- Department of Neurology (P.K., J.P.B.), University of Cincinnati Academic Health Center, Cincinnati, Ohio
| | - Y Palesch
- Department of Biostatistics, Bioinformatics, and Epidemiology (L.F., Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina
| | - J P Broderick
- Department of Neurology (P.K., J.P.B.), University of Cincinnati Academic Health Center, Cincinnati, Ohio
| | - S D Yeatts
- Department of Biostatistics, Bioinformatics, and Epidemiology (L.F., Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina
| | - D S Liebeskind
- University of California Los Angeles Stroke Center (D.S.L.), Los Angeles, California
| | | |
Collapse
|
12
|
Turner B, Jiang D, Khatri P, Chang D, Koong A. Multicohort Analysis of Effect of Ionizing Radiation on Transcription Identifies Conserved Gene Signature and Clinically Relevant Novel Radiosensitizers. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.2106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
13
|
von Kummer R, Mocco J, Zaidat O, Khatri P, Gupta R, Frei D, Lopes D, Shownkeen H, Berkhemer O, Meyer D, Chauke M, Hak S, Kuo S, Buell H, Bose A, Sit S, Yoo A. O-025 The Superiority of Thrombectomy over IV rtPA Monotherapy May be Associated with Thrombus Length – Results of the THERAPY Trial. J Neurointerv Surg 2016. [DOI: 10.1136/neurintsurg-2016-012589.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
14
|
Zaidat O, Mehta B, Yoo A, von Kummer R, Khatri P, Gupta R, Lopes D, Frei D, Shownkeen H, Meyer D, Bach V, Buell H, Kuo S, Bose A, Sit S, Mocco J. O-003 Time to Stroke Intervention is Reduced When CT Angiography is Performed Immediately after Non-contrast CT. J Neurointerv Surg 2016. [DOI: 10.1136/neurintsurg-2016-012589.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
15
|
von Kummer R, Frei D, Yoo A, Zaidat O, Khatri P, Gupta R, Lopes D, Shownkeen H, Meyer D, Buell H, Bach V, Kuo S, Bose A, Sit S, Mocco J. O-011 Symptomatic Intracranial Hemorrhage After Reperfusion Therapy – Impact of Definition on its Frequency. J Neurointerv Surg 2016. [DOI: 10.1136/neurintsurg-2016-012589.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
16
|
Khatri P, Kumari P. RM-018 Precise selection of metastatic gastric cancer patients for first line, docetaxel based chemotherapy: a retrospective study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw201.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
17
|
Kumari P, Beniwal S, Khatri P, Singhal M, Saugat S. P-112 Weekly gemcitabine for the treatment of biliary tract and gallbladder cancer. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw199.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
18
|
Kumari P, Sharma S, Jhakhad S, Beniwal S, Khatri P, Kumar H, Sharma N, Sharma A. P-247 Young patients under 40 age with colorectal cancer have poor survival. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw199.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
19
|
Khatri P, Kumari P, Beniwal S, Samdariya S. RM-028 Gemcitabine in combination with capecitabine compared with gemcitabine combined with erlotinib in locally advanced or metastatic pancreatic cancer. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw201.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
20
|
Khatri P, Kumari P. RM-026 Palliative therapy in unresectable advanced gall bladder cancer A. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw201.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
21
|
Kumari P, Khatri P, Singhal M. RM-025 Chemoradiation for unresectable gall bladder cancer: regional cancer centre study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw201.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
22
|
Khatri P, Kumari P. P-116 In Gastrointestinal' cancers, patients perspectives on palliative chemotherapy: a prospective study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw199.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
23
|
Tomsick TA, Foster LD, Liebeskind DS, Hill MD, Carrozella J, Goyal M, von Kummer R, Demchuk AM, Dzialowski I, Puetz V, Jovin T, Morales H, Palesch YY, Broderick J, Khatri P, Yeatts SD. Outcome Differences between Intra-Arterial Iso- and Low-Osmolality Iodinated Radiographic Contrast Media in the Interventional Management of Stroke III Trial. AJNR Am J Neuroradiol 2015; 36:2074-81. [PMID: 26228892 DOI: 10.3174/ajnr.a4421] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 03/03/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Intracarotid arterial infusion of nonionic, low-osmolal iohexol contrast medium has been associated with increased intracranial hemorrhage in a rat middle cerebral artery occlusion model compared with saline infusion. Iso-osmolal iodixanol (290 mOsm/kg H2O) infusion demonstrated smaller infarcts and less intracranial hemorrhage compared with low-osmolal iopamidol and saline. No studies comparing iodinated radiographic contrast media in human stroke have been performed, to our knowledge. We hypothesized that low-osmolal contrast media may be associated with worse outcomes compared with iodixanol in the Interventional Management of Stroke III Trial (IMS III). MATERIALS AND METHODS We reviewed prospective iodinated radiographic contrast media data for 133 M1 occlusions treated with endovascular therapy. We compared 5 prespecified efficacy and safety end points (mRS 0-2 outcome, modified TICI 2b-3 reperfusion, asymptomatic and symptomatic intracranial hemorrhage, and mortality) between those receiving iodixanol (n = 31) or low-osmolal contrast media (n = 102). Variables imbalanced between iodinated radiographic contrast media types or associated with outcome were considered potential covariates for the adjusted models. In addition to the iodinated radiographic contrast media type, final covariates were those selected by using the stepwise method in a logistic regression model. Adjusted relative risks were then estimated by using a log-link regression model. RESULTS Of baseline or endovascular therapy variables potentially linked to outcome, prior antiplatelet agent use was more common and microcatheter iodinated radiographic contrast media injections were fewer with iodixanol. Relative risk point estimates are in favor of iodixanol for the 5 prespecified end points with M1 occlusion. The percentage of risk differences are numerically greater for microcatheter injections with iodixanol. CONCLUSIONS While data favoring the use of iso-osmolal iodixanol for reperfusion of M1 occlusion following IV rtPA are inconclusive, potential pathophysiologic mechanisms suggesting clinical benefit warrant further investigation.
Collapse
Affiliation(s)
- T A Tomsick
- From the Department of Radiology (T.A.T., J.C., H.M.), University of Cincinnati Academic Health Center, University Hospital, Cincinnati, Ohio
| | - L D Foster
- Department of Public Health Sciences (L.D.F., Y.Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina
| | - D S Liebeskind
- University of California, Los Angeles Stroke Center (D.S.L.), Los Angeles, California
| | - M D Hill
- Department of Radiology and Clinical Neurosciences (M.D.H., M.G.)
| | - J Carrozella
- From the Department of Radiology (T.A.T., J.C., H.M.), University of Cincinnati Academic Health Center, University Hospital, Cincinnati, Ohio
| | - M Goyal
- Department of Radiology and Clinical Neurosciences (M.D.H., M.G.)
| | | | - A M Demchuk
- Calgary Stroke Program (A.M.D.), Department of Clinical Neurosciences/Medicine/Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - I Dzialowski
- Department of Neurology (I.D.), Elblandklinikum Meissen, Academic Teaching Hospital of Universitätsklinikum, Carl Gustav Carus Technische Universität Dresden, Meißen, Germany
| | - V Puetz
- Neurology (V.P.), Dresden University Stroke Center, Universitätsklinikum Carl Gustav Carus Technischen Universität Dresden, Dresden, Germany
| | - T Jovin
- The Stroke Institute (T.J.), University of Pittsburgh Medical Center, Pittsburgh. Pennsylvania
| | - H Morales
- From the Department of Radiology (T.A.T., J.C., H.M.), University of Cincinnati Academic Health Center, University Hospital, Cincinnati, Ohio
| | - Y Y Palesch
- Department of Public Health Sciences (L.D.F., Y.Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina
| | - J Broderick
- Department of Neurology (J.B., P.K.), University of Cincinnati Academic Health Center, Cincinnati, Ohio
| | - P Khatri
- Department of Neurology (J.B., P.K.), University of Cincinnati Academic Health Center, Cincinnati, Ohio
| | - S D Yeatts
- Department of Public Health Sciences (L.D.F., Y.Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina
| |
Collapse
|
24
|
Khatri P, Hoffmann B, Schuler G. Androgen receptor is widely expressed in bovine placentomes and up-regulated during differentiation of bovine trophoblast giant cells. Placenta 2013; 34:416-23. [DOI: 10.1016/j.placenta.2013.01.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Revised: 01/28/2013] [Accepted: 01/30/2013] [Indexed: 10/27/2022]
|
25
|
Zaidat OO, Lazzaro MA, Liebeskind DS, Janjua N, Wechsler L, Nogueira RG, Edgell RC, Kalia JS, Badruddin A, English J, Yavagal D, Kirmani JF, Alexandrov AV, Khatri P. Revascularization grading in endovascular acute ischemic stroke therapy. Neurology 2012; 79:S110-6. [PMID: 23008384 DOI: 10.1212/wnl.0b013e3182695916] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Recanalization and angiographic reperfusion are key elements to successful endovascular and interventional acute ischemic stroke (AIS) therapy. Intravenous recombinant tissue plasminogen activator (rt-PA), the only established revascularization therapy approved by the US Food & Drug Administration for AIS, may be less effective for large artery occlusion. Thus, there is enthusiasm for endovascular revascularization therapies, which likely provide higher recanalization rates, and trials are ongoing to determine clinical efficacy and compare various methods. It is anticipated that clinical efficacy will be well correlated with revascularization of viable tissue in a timely manner. METHOD Reporting, interpretation, and comparison of the various revascularization grading methods require agreement on measurement criteria, reproducibility, ease of use, and correlation with clinical outcome. These parameters were reviewed by performing a Medline literature search from 1965 to 2011. This review critically evaluates current revascularization grading systems. RESULTS AND CONCLUSION The most commonly used revascularization grading methods in AIS interventional therapy trials are the thrombolysis in cerebral ischemia (TICI, pronounced "tissy") and thrombolysis in myocardial ischemia (TIMI) scores. Until further technical and imaging advances can incorporate real-time reliable perfusion studies in the angio-suite to delineate regional perfusion more accurately, the TICI grading system is the best defined and most widely used scheme. Other grading systems may be used for research and correlation purposes. A new scale that combines primary site occlusion, lesion location, and perfusion should be explored in the future.
Collapse
Affiliation(s)
- O O Zaidat
- Department of Neurology, Medical College of Wisconsin/Froedtert Hospital, Milwaukee, WI, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Khatri P. W159 PROSPECTIVE ANALYSIS TO STUDY THE ROLE OF HIGH DOSE OF CALCIUM IN REDUCING/ARRESTING PROGRESSION OF EARLY PREECLAMPSIA. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)61884-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
27
|
Mocco J, Zaidat S, Khatri P. E-036 The THERAPY Trial: a prospective, randomized, concurrent controlled trial to assess safety and effectiveness of the Penumbra System®as adjunctive treatment to IV rtPA in acute ischemic stroke. J Neurointerv Surg 2012. [DOI: 10.1136/neurintsurg-2012-010455c.36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
28
|
Green J, Khoury J, Rademacher E, Woo D, Khatri P, Flaherty M, Adeoye O, Ferioli S, Kissela B, Kleindorfer D. Sources of Knowledge for Stroke Warning Signs and Risk Factors within a Population (P07.051). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
29
|
Kissela B, Alwell K, Khoury J, Moomaw C, Embi P, Rademacher E, Lindsell C, Woo D, Flaherty M, Khatri P, Adeoye O, Ferioli S, Kleindorfer D. A Pilot Population-Based Outcomes Study Using a Health Information Exchange (HIE): Demographic Comparison of Groups (P07.047). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
30
|
Kelley B, Sucharew H, Alwell K, Moomaw C, Rademacher E, Embi P, Khoury J, Lindsell C, Woo D, Flaherty M, Khatri P, Adeoye O, Ferioli S, Kleindorfer D, Kissela B. Persistent Depression after Acute Stroke Predicts Dementia (P07.048). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
31
|
Khatri P, Meganathan K, Adeoye O, Hornung R, Kleindorfer D. Acute Ischemic Stroke Treatment with Mechanical Embolectomy Has Doubled in the US from 2008 to 2010 (S09.004). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
32
|
Khatri P, Meganathan K, Adeoye O, Hornung R, Kleindorfer D. Acute Ischemic Stroke Treatment with Mechanical Embolectomy Has Doubled in the US from 2008 to 2010 (IN2-1.005). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.in2-1.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
33
|
Kelley B, Sucharew H, Alwell K, Moomaw C, Rademacher E, Embi P, Khoury J, Lindsell C, Woo D, Flaherty M, Khatri P, Adeoye O, Ferioli S, Kleindorfer D, Kissela B. Cognitive Outcome after Acute Stroke Does Not Correlate with Functional Outcome on Modified Rankin Scale (S53.004). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s53.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
34
|
Kumar R, Misra M, Kumar R, Gupta D, Khatri P, Tak B, Meena S. Phase Change Materials: Technology Status and Potential Defence Applications. DEFENCE SCI J 2011. [DOI: 10.14429/dsj.61.363] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
35
|
Mackey J, Kleindorfer D, Sucharew H, Moomaw CJ, Kissela BM, Alwell K, Flaherty ML, Woo D, Khatri P, Adeoye O, Ferioli S, Khoury JC, Hornung R, Broderick JP. Population-based study of wake-up strokes. Neurology 2011; 76:1662-7. [PMID: 21555734 DOI: 10.1212/wnl.0b013e318219fb30] [Citation(s) in RCA: 169] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Previous studies have estimated that wake-up strokes comprise 8%to 28% of all ischemic strokes, but these studies were either small or not population-based. We sought to establish the proportion and event rate of wake-up strokes in a large population-based study and to compare patients who awoke with stroke symptoms with those who were awake at time of onset. METHODS First-time and recurrent ischemic strokes among residents of the Greater Cincinnati/Northern Kentucky region (population 1.3 million) in 2005 were identified using International Classification of Diseases-9 codes 430-436 and verified via study physician review. Ischemic strokes in patients aged 18 years and older presenting to an emergency department were included. Baseline characteristics were ascertained, along with discharge modified Rankin Scale scores and 90-day mortality. RESULTS We identified 1,854 ischemic strokes presenting to an emergency department, of which 273 (14.3%) were wake-up strokes. There were no differences between wake-up strokes and all other strokes with regard to clinical features or outcomes except for minor differences in age and baseline retrospective NIH Stroke Scale score. The adjusted wake-up stroke event rate was 26.0/100,000. Of the wake-up strokes, at least 98 (35.9%) would have been eligible for thrombolysis if arrival time were not a factor. CONCLUSIONS Within our population, approximately 14% of ischemic strokes presenting to an emergency department were wake-up strokes. Wake-up strokes cannot be distinguished from other strokes by clinical features or outcome. We estimate that approximately 58,000 patients with wake-up strokes presented to an emergency department in the United States in 2005.
Collapse
Affiliation(s)
- J Mackey
- University of Cincinnati, Department of Neurology, Cincinnati, OH 45219, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Khatri P, Frenette G, Sullivan R, Hoffmann B, Schuler G. Expression of SULT1E1 protein in bovine placentomes: Evidence for localization in uninucleated trophoblast cells. Placenta 2011; 32:431-40. [DOI: 10.1016/j.placenta.2011.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 03/04/2011] [Accepted: 03/07/2011] [Indexed: 11/16/2022]
|
37
|
Kim Y, Khatri P, Park K, Dudley J, Sage J, Butte A. Identification of serum protein biomarkers for small cell lung cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e21005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
38
|
Fields J, Khatri P, Nesbit G, Liu K, Barnwell S, Lutsep H, Clark W, Lansberg M. E-024 Meta-analysis of randomized intra-arterial thrombolytic trials in the treatment of acute stroke. J Neurointerv Surg 2010. [DOI: 10.1136/jnis.2010.003251.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
39
|
M. Pickering L, Constantinidou A, Larkin JM, Sohaib SA, Khatri P, Nathan PD, Vinayan A, Ferguson T, Rose SS, Gore ME. Sunitinib treatment for longer than 2 years for renal cell carcinoma. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e15099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
40
|
Tomsick TA, Khatri P, Jovin T, Demaerschalk B, Malisch T, Demchuk A, Hill MD, Jauch E, Spilker J, Broderick JP. Equipoise among recanalization strategies. Neurology 2010; 74:1069-76. [PMID: 20350981 DOI: 10.1212/wnl.0b013e3181d76b8f] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Modern acute ischemic stroke therapy is based on the premise that recanalization and subsequent reperfusion are essential for the preservation of brain tissue and favorable clinical outcomes. We outline key issues that we think underlie equipoise regarding the comparative clinical efficacy of IV recombinant tissue-type plasminogen activator (rt-PA) and intra-arterial (IA) reperfusion therapies for acute ischemic stroke. On the one hand, IV rt-PA therapy has the benefit of speed with presumed lower rates of recanalization of large artery occlusions as compared to IA methods. More recent reports of major arterial occlusions treated with IV rt-PA, as measured by transcranial Doppler and magnetic resonance angiography, demonstrate higher rates of recanalization. Conversely, IA therapies report higher recanalization rates, but are hampered by procedural delays and risks, even failing to be applied at all in occasional patients where time to reperfusion remains a critical factor. Higher rates of recanalization in IA trials using clot-removal devices have not translated into improved patient functional outcome as compared to trials of IV therapy. Combined IV-IA therapy promises to offer advantages of both, but perhaps only when applied in the timeliest of fashions, compared to IV therapy alone. Where equipoise exists, randomizing subjects to either IV rt-PA therapy or IV therapy followed by IA intervention, while incorporating new interventions into the study design, is a rational and appropriate research approach.
Collapse
Affiliation(s)
- T A Tomsick
- Department of Neurology, UC Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati, OH 45267-0525, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Khatri R, Khatri P, Khoury J, Broderick J, Carrozzella J, Tomsick T. Microcatheter contrast injections during intra-arterial thrombolysis increase intracranial hemorrhage risk. J Neurointerv Surg 2010; 2:115-9. [DOI: 10.1136/jnis.2009.000794] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
42
|
|
43
|
Nichols C, Carrozzella J, Yeatts S, Tomsick T, Broderick J, Khatri P. Is periprocedural sedation during acute stroke therapy associated with poorer functional outcomes? J Neurointerv Surg 2009; 2:67-70. [PMID: 20431708 DOI: 10.1136/jnis.2009.001768] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND To safely perform acute intra-arterial revascularization procedures, use of sedative medications and paralytics is often necessary. During the conduct of the Interventional Management of Stroke trials (I and II), the level of sedation used periprocedurally varied. At some institutions, patients were paralyzed and intubated as part of the procedural standard of care while at other institutions no routine sedation protocol was followed. The aim of this study was to identify patient characteristics that would correlate with the need for deeper sedation and to explore whether levels of sedation relate to patient outcome. METHODS 75 of 81 patients in the Interventional Management of Stroke II Study were studied. Patients had anterior circulation strokes and underwent angiography and/or intervention. Four sedation categories were defined and tested for factors potentially associated with the level of sedation. Clinical outcomes were also analyzed, including successful angiographic reperfusion and the occurrence of clinical complications. RESULTS Only baseline National Institutes of Health Stroke Scale varied significantly by sedation category (p=0.01). Patients that were in the lower sedation category fared better, having a higher rate of good outcomes (p<0.01), lower death rates (p=0.02) and higher successful angiographic reperfusion rates (p=0.01). There was a significantly higher infection rate in patients receiving heavy sedation or pharmacologic paralysis (p=0.02) and a trend towards fewer groin related complications. CONCLUSION In this small sample, patients not receiving sedation fared better, had higher rates of successful angiographic reperfusion and had fewer complications. Further examination of the indications for procedural sedation or paralysis and their effect on outcome is warranted.
Collapse
Affiliation(s)
- C Nichols
- South Denver Neurosurgery, Littleton Adventist Hospital, Colorado 80122, USA.
| | | | | | | | | | | |
Collapse
|
44
|
Khatri P, Abruzzo T, Yeatts SD, Nichols C, Broderick JP, Tomsick TA. Good clinical outcome after ischemic stroke with successful revascularization is time-dependent. Neurology 2009; 73:1066-72. [PMID: 19786699 DOI: 10.1212/wnl.0b013e3181b9c847] [Citation(s) in RCA: 380] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Trials of IV recombinant tissue plasminogen activator (rt-PA) have demonstrated that longer times from ischemic stroke symptom onset to initiation of treatment are associated with progressively lower likelihoods of clinical benefit, and likely no benefit beyond 4.5 hours. How the timing of IV rt-PA initiation relates to timing of restoration of blood flow has been unclear. An understanding of the relationship between timing of angiographic reperfusion and clinical outcome is needed to establish time parameters for intraarterial (IA) therapies. METHODS The Interventional Management of Stroke pilot trials tested combined IV/IA therapy for moderate-to-severe ischemic strokes within 3 hours from symptom onset. To isolate the effect of time to angiographic reperfusion on clinical outcome, we analyzed only middle cerebral artery and distal internal carotid artery occlusions with successful reperfusion (Thrombolysis in Cerebral Infarction 2-3) during the interventional procedure (<7 hours). Time to angiographic reperfusion was defined as time from stroke onset to procedure termination. Good clinical outcome was defined as modified Rankin Score 0-2 at 3 months. RESULTS Among the 54 cases, only time to angiographic reperfusion and age independently predicted good clinical outcome after angiographic reperfusion. The probability of good clinical outcome decreased as time to angiographic reperfusion increased (unadjusted p = 0.02, adjusted p = 0.01) and approached that of cases without angiographic reperfusion within 7 hours. CONCLUSIONS We provide evidence that good clinical outcome following angiographically successful reperfusion is significantly time-dependent. At later times, angiographic reperfusion may be associated with a poor risk-benefit ratio in unselected patients.
Collapse
Affiliation(s)
- P Khatri
- Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, OH 45267-0525, USA.
| | | | | | | | | | | | | |
Collapse
|
45
|
Flaherty ML, Tao H, Haverbusch M, Sekar P, Kleindorfer D, Kissela B, Khatri P, Stettler B, Adeoye O, Moomaw CJ, Broderick JP, Woo D. Warfarin use leads to larger intracerebral hematomas. Neurology 2008; 71:1084-9. [PMID: 18824672 DOI: 10.1212/01.wnl.0000326895.58992.27] [Citation(s) in RCA: 182] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Among patients with intracerebral hemorrhage (ICH), warfarin use before onset leads to greater mortality. In a retrospective study, we sought to determine whether warfarin use is associated with larger initial hematoma volume, one determinant of mortality after ICH. METHODS We identified all patients hospitalized with ICH in the Greater Cincinnati region from January through December 2005. ICH volumes were measured on the first available brain scan by using the abc/2 method. Univariable analyses and a multivariable generalized linear model were used to determine whether international normalized ratio (INR) influenced initial ICH volume after adjusting for other factors, including age, race, sex, antiplatelet use, hemorrhage location, and time from stroke onset to scan. RESULTS There were 258 patients with ICH, including 51 patients taking warfarin. In univariable comparison, when INR was stratified, there was a trend toward a difference in hematoma volume by INR category (INR <1.2, 13.4 mL; INR 1.2-2.0, 9.3 mL; INR 2.1-3.0, 14.0 mL; INR >3.0, 33.2 mL; p = 0.10). In the model, compared with patients with INR <1.2, there was no difference in hematoma size for patients with INR 1.2-2.0 (p = 0.25) or INR 2.1-3.0 (p = 0.36), but patients with INR >3.0 had greater hematoma volume (p = 0.02). Other predictors of larger hematoma size were ICH location (lobar compared with deep cerebral, p = 0.02) and shorter time from stroke onset to scan (p < 0.001). CONCLUSION Warfarin use was associated with larger initial intracerebral hemorrhage (ICH) volume, but this effect was only observed for INR values >3.0. Larger ICH volume among warfarin users likely accounts for part of the excess mortality in this group.
Collapse
Affiliation(s)
- M L Flaherty
- Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, OH 45267-0525, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Tomsick T, Broderick J, Carrozella J, Khatri P, Hill M, Palesch Y, Khoury J. Revascularization results in the Interventional Management of Stroke II trial. AJNR Am J Neuroradiol 2008; 29:582-7. [PMID: 18337393 DOI: 10.3174/ajnr.a0843] [Citation(s) in RCA: 290] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Our aim was to detail revascularization results, including impact on outcome and mortality, in the Interventional Management of Stroke (IMS) II trial. MATERIALS AND METHODS IMS II was designed to obtain estimates of the efficacy and safety of reduced-dose intravenous recombinant tissue plasminogen activator (rtPA) followed by additional intra-arterial rtPA and low-energy sonography via the EKOS Primo Micro-Infusion Catheter at the occlusion in selected patients with ischemic stroke treated within 3 hours of onset. Revascularization outcomes were detailed and compared with modified Rankin Scale scores 0-2, mortality outcomes, and results from IMS I. RESULTS Complete recanalization at 60 minutes occurred in 12 of 29 (41.4%) sonography microcatheter-treated occlusions. Complete recanalization was achieved at 2 hours or procedure end in 20/29 (68.9%) in the ultrasound catheter-treated group, and final thrombolysis in cerebral infarction (TICI) 2/3 reperfusion was achieved in 18/29 (62.0%) ultrasound-treated subjects. Fifteen-minute angiograms demonstrated some recanalization in 69/145 (46.7%) sonography microcatheter treatment intervals, compared with 39/111 (35.1%) in IMS I treatments in 23 subjects with reliable 15-minute angiograms (P = .046). Pooled IMS I-II data demonstrated that partial or complete recanalization occurred in 56/75 (74.6%) and good reperfusion (TICI 2/3) occurred in 46/75 (61.3%) of internal carotid artery T and M1 occlusions. Revascularization correlated with good outcome for TICI 2/3 reperfusion (P = .0004), TICI 2B/3 reperfusion (P = .0002), and arterial occlusive lesion 2/3 recanalization (P = .03). CONCLUSION IMS II provides evidence that the EKOS Primo sonography microcatheter exhibits a trend toward improved recanalization of the occlusion compared with a standard microcatheter and again confirms the correlation between recanalization and reperfusion with good clinical outcome and reduced mortality.
Collapse
Affiliation(s)
- T Tomsick
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio, USA.
| | | | | | | | | | | | | |
Collapse
|
47
|
King S, Khatri P, Carrozella J, Spilker J, Broderick J, Hill M, Tomsick T. Anterior cerebral artery emboli in combined intravenous and intra-arterial rtPA treatment of acute ischemic stroke in the IMS I and II trials. AJNR Am J Neuroradiol 2007; 28:1890-4. [PMID: 17898199 PMCID: PMC8134277 DOI: 10.3174/ajnr.a0702] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Anterior cerebral artery (ACA) emboli may occur before or during fibrinolytic revascularization of middle cerebral artery (MCA) and internal carotid artery (ICA) T occlusions. We sought to determine the incidence and effect of baseline and new embolic ACA occlusions in the Interventional Management of Stroke (IMS) studies. MATERIALS AND METHODS Case report forms, pretreatment and posttreatment arteriograms, and CTs from 142 subjects entered into IMS I & II were reviewed to identify subjects with baseline ACA occlusion, new ACA emboli occurring during fibrinolysis, subsequent CT-demonstrated infarction in the ACA distribution, and to evaluate global and lower extremity motor clinical outcome. RESULTS During M1/M2 thrombolysis procedures, new ACA embolus occurred in 1 of 60 (1.7%) subjects. Baseline distal emboli were identified in 3 of 20 (15%) T occlusions before intra-arterial (IA) treatment, and new posttreatment distal ACA emboli were identified in 3 subjects. At 24 hours, 8 (32%) T occlusions demonstrated CT-ACA infarct, typically of small volume. Infarcts were less common following sonography microcatheter-assisted thrombolysis compared with standard microcatheter thrombolysis (P = .05). Lower extremity weakness was present in 9 of 10 subjects with ACA embolus/infarct at 24 hours. The modified Rankin 0 to 2 outcomes were achieved in 4 of 25 (16%) subjects with T occlusion overall, but in 0 of 10 subjects with distal ACA emboli or ACA CT infarcts (P = .07). CONCLUSIONS With IV/IA recombinant tissue plasminogen activator treatment for MCA emboli, new ACA emboli are uncommon events. Distal ACA emboli during T-occlusion thrombolysis are not uncommon, typically lead to small ACA-distribution infarcts, and may limit neurologic recovery.
Collapse
Affiliation(s)
- S King
- Clinical Coordinating Center, IMS Studies, University of Cincinnati, Cincinnati, OH, USA
| | | | | | | | | | | | | |
Collapse
|
48
|
Khatri P, Abraham I, Pardasani P, Pardasani R, Mukherjee T. SYNTHESIS OF THIOPHENOACETYL-1,4-BENZOQUINONES. HETEROCYCL COMMUN 2006. [DOI: 10.1515/hc.2006.12.6.463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
49
|
Khatri P, Babyak M, Croughwell ND, Davis R, White WD, Newman MF, Reves JG, Mark DB, Blumenthal JA. Temperature during coronary artery bypass surgery affects quality of life. Ann Thorac Surg 2001; 71:110-6. [PMID: 11216728 DOI: 10.1016/s0003-4975(00)02350-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The objective of this study was to examine the effects of temperature on a variety of indices of psychologic adjustment and quality of life. METHODS A total of 209 patients randomly received normothermic (warm) or hypothermic (cold) conditions during coronary artery bypass surgery (CABS), and a number of physical, social, and psychologic measures were assessed before as well as 6 weeks and 6 months after CABS. RESULTS Repeated measures analyses of covariance revealed significant temperature group main effects for anxiety (p = 0.008) and depression (p = 0.039), with the normothermic group obtaining lower anxiety and depression levels than the hypothermic group at both 6 weeks and 6 months after surgery. Additionally, among patients who entered the study with higher depression levels, those in the hypothermic group tended to have higher depression scores at follow-up compared with patients in the normothermic condition (p = 0.012). No temperature group differences were observed on other quality of life indices. CONCLUSIONS The results of the present study indicate that hypothermic conditions during CABS are associated with higher levels of emotional distress after CABS than normothermic conditions, particularly for patients with greater stress to begin with.
Collapse
Affiliation(s)
- P Khatri
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Babyak M, Blumenthal JA, Herman S, Khatri P, Doraiswamy M, Moore K, Craighead WE, Baldewicz TT, Krishnan KR. Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months. Psychosom Med 2000; 62:633-8. [PMID: 11020092 DOI: 10.1097/00006842-200009000-00006] [Citation(s) in RCA: 507] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the status of 156 adult volunteers with major depressive disorder (MDD) 6 months after completion of a study in which they were randomly assigned to a 4-month course of aerobic exercise, sertraline therapy, or a combination of exercise and sertraline. METHODS The presence and severity of depression were assessed by clinical interview using the Diagnostic Interview Schedule and the Hamilton Rating Scale for Depression (HRSD) and by self-report using the Beck Depression Inventory. Assessments were performed at baseline, after 4 months of treatment, and 6 months after treatment was concluded (ie, after 10 months). RESULTS After 4 months patients in all three groups exhibited significant improvement; the proportion of remitted participants (ie, those who no longer met diagnostic criteria for MDD and had an HRSD score <8) was comparable across the three treatment conditions. After 10 months, however, remitted subjects in the exercise group had significantly lower relapse rates (p = .01) than subjects in the medication group. Exercising on one's own during the follow-up period was associated with a reduced probability of depression diagnosis at the end of that period (odds ratio = 0.49, p = .0009). CONCLUSIONS Among individuals with MDD, exercise therapy is feasible and is associated with significant therapeutic benefit, especially if exercise is continued over time.
Collapse
Affiliation(s)
- M Babyak
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA
| | | | | | | | | | | | | | | | | |
Collapse
|