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78


The Left Atrial Appendage Morphology Improves Prediction of Stagnant Flow and Stroke Risk in Atrial Fibrillation [Editorial]

Yaghi, Shadi; Chang, Andrew; Ignacio, Gian; Scher, Erica; Panda, Nikhil; Chu, Antony; Wu, Michael; Lord, Aaron; Mac Grory, Brian; Furie, Karen; Elkind, Mitchell S V; Atalay, Michael; Song, Christopher
The left atrial appendage (LAA) is the most common site of thrombus formation in patients with atrial fibrillation. Therefore, better knowledge of the morphology, physiology, and function of the LAA may provide a better estimate of stroke risk. The LAA morphology is currently classified into 4 categories: chicken-wing (CW), windsock, cauliflower, and cactus. Chicken-wing is the most common and carries lower risk. This classification system, however, lacks consistent inter-rater reliability and correlation with stroke risk.
PMID: 31986073
ISSN: 1941-3084
CID: 4298892

Etiologic Subtypes of Ischemic Stroke in SARS-CoV-2 Patients in a Cohort of New York City Hospitals

Tiwari, Ambooj; Berekashvili, Ketevan; Vulkanov, Volodomyr; Agarwal, Shashank; Khaneja, Amit; Turkel-Parella, David; Liff, Jeremy; Farkas, Jeffrey; Nandakumar, Thambirajah; Zhou, Ting; Frontera, Jennnifer; Kahn, David E; Kim, Sun; Humbert, Kelly A; Sanger, Matthew D; Yaghi, Shadi; Lord, Aaron; Arcot, Karthikeyan; Dmytriw, Adam A
Objective: To describe the ischemic stroke subtypes related to coronavirus disease 2019 (COVID-19) in a cohort of New York City hospitals and explore their etiopathogenesis. Background: Most neurological manifestations are non-focal, but few have reported the characteristics of ischemic strokes or investigated its pathophysiology. Methods: Data were collected prospectively April 1-April 15, 2020 from two centers in New York City to review possible ischemic stroke types seen in COVID-19-positive patients. Patient presentation, demographics, related vascular risk factors, associated laboratory markers, as well as imaging and outcomes were collected. Results: The age of patients ranged between 27 and 82 years. Approximately 81% of patients had known vascular risk factors, the commonest being hypertension (75%) followed by diabetes (50%) coronary disease or atrial fibrillation. Eight patients presented with large vessel occlusion (LVO) with median age 55 years (27-82) and all were male. Eight patients presented with non-LVO syndromes, with median age 65.5 years (59-82) and most were female (62.5%). Both groups were 50% African Americans and 37.5% South Asian. Both groups had similar D-dimer levels although other acute phase reactants/disease severity markers (Ferritin, CRP, procalcitonin) were higher in the LVO group. The LVO group also had a significantly higher mortality compared to the non-LVO group. The most common etiology was cryptogenic (6 patients) followed by small vessel occlusion (3 patients) and undetermined-unclassified (3 patients). For the remaining 4 patients, 2 were identified as cardioembolic and 2 with large artery atherosclerosis. Conclusion: COVID-19-related ischemic events can present as small vessel occlusions, branch emboli or large vessel occlusions. The most common etiology is cryptogenic. Patients with LVO syndromes tend to be younger, male and may have elevated acute inflammatory markers.
PMCID:7527497
PMID: 33041972
ISSN: 1664-2295
CID: 4632392

Border-zone Infarcts Predict Early Recurrence in Patients with Large Artery Atherosclerotic Subtype Despite Medical Treatment [Meeting Abstract]

Kvernland, Alexandra; Prabhakaran, Shyam; Khatri, Pooja; de Havenon, Adam; Yeatts, Sharon; Scher, Erica; Torres, Jose; Ishida, Koto; Frontera, Jennifer; Lord, Aaron; Liebeskind, David; Yaghi, Shadi
ISI:000536058005253
ISSN: 0028-3878
CID: 4561552

Poor Risk Factor Control And Lower Levels Of Physical Activity Predict Incident Major Cardiovascular Events In Patients With Symptomatic Vertebrobasilar Disease: A Post-hoc Analysis Of The SAMMPRIS Trial [Meeting Abstract]

Croll, Leah; Chang, Andrew; Scher, Erica; Ishida, Koto; Torres, Jose; Riina, Howard; Frontera, Jennifer; Lord, Aaron; Yaghi, Shadi
ISI:000536058001201
ISSN: 0028-3878
CID: 4561162

TIME IS BRAIN in mechanical thrombectomy Particularly in Those Arriving within 6 hours and have good ASPECTS score [Meeting Abstract]

Snyder, Thomas; Agarwal, Shashank; Flusty, Brent; Kim, Sun; Frontera, Jennifer; Lord, Aaron; Favate, Albert; Humbert, Kelley; Torres, Jose; Sanger, Matthew; Zhang, Cen; Ishida, Koto; Rostanski, Sara; Yaghi, Shadi
ISI:000536058003240
ISSN: 0028-3878
CID: 4561342

Association Between Functional Outcomes of Stroke Patients Receiving Mechanical Thrombectomy and CT Perfusion Imaging Acquisition [Meeting Abstract]

Agarwal, Shashank; Mistry, Eva; Scher, Erica; Kim, Sun; Sanger, Matthew; Humbert, Kelley; Ishida, Koto; Torres, Jose; Rostanski, Sara; Zhang, Cen; Arcot, Karthikeyan; Turkel-Parrella, David; Farkas, Jeffrey; Raz, Eytan; Gordon, David; Riina, Howard; Shapiro, Maksim; Tanweer, Omar; Nossek, Erez; Nelson, Peter; Lord, Aaron; Frontera, Jennifer; Yaghi, Shadi
ISI:000536058002105
ISSN: 0028-3878
CID: 4561212

Redefining Early Neurological Improvement After Reperfusion Therapy in Stroke

Agarwal, Shashank; Cutting, Shawna; Grory, Brian Mac; Burton, Tina; Jayaraman, Mahesh; McTaggart, Ryan; Reznik, Michael; Scher, Erica; Chang, Andrew D; Frontera, Jennifer; Lord, Aaron; Rostanski, Sara; Ishida, Koto; Torres, Jose; Furie, Karen; Yaghi, Shadi
BACKGROUND AND PURPOSE/OBJECTIVE:Early neurologic improvement (ENI) in patients treated with alteplase has been shown to correlate with functional outcome. However, the definition of ENI remains controversial and has varied across studies. We hypothesized that ENI defined as a percentage change in the National Institute of Health Stroke Scale (NIHSS) score (percent change NIHSS score) at 24-hours would better correlate with favorable outcomes at 3 months than ENI defined as the change in NIHSS score (delta NIHSS score) at 24 hours. METHODS:Retrospective analysis of prospectively collected single-center quality improvement data was performed of all acute ischemic stroke (AIS) patients treated with alteplase. We examined delta NIHSS score and percent change NIHSS score in unadjusted and adjusted logistic regression models as predictors of a favorable outcome at 3 months (defined as mRS 0-1). RESULTS:Among 586 patients who met the inclusion criteria, 194 (33.1%) had a favorable outcome at 3 months. In fully adjusted models, both delta NIHSS score (OR per point decrease 1.27; 95% confidence interval [CI] 1.19-1.36) and percent change NIHSS score (OR per 10 percent decrease 1.17; 95% CI 1.12-1.22) were associated with favorable functional outcome at 3 months. Receiver operating characteristic (ROC) curve comparison showed that the area under the ROC curve for percent change NIHSS score (.755) was greater than delta NIHSS score (.613) or admission NIHSS (.694). CONCLUSIONS:Percentage change in NIHSS score may be a better surrogate marker of ENI and functional outcome in AIS patients after receiving acute thrombolytic therapy. More studies are needed to confirm our findings.
PMID: 31836356
ISSN: 1532-8511
CID: 4241792

Management of Elevated Intracranial Pressure: a Review

Changa, Abhinav R; Czeisler, Barry M; Lord, Aaron S
PURPOSE OF REVIEW/OBJECTIVE:Principles of intracranial pressure (ICP) management continue to be an essential part of the neurointensivist's skillset as appropriate treatment decisions can prevent secondary injury to the central nervous system. This review of the literature aims to: discuss commonly encountered pathologies associated with increased ICP, summarize diagnostic approaches used in evaluating ICP, and present evidence-based treatment paradigms that drive clinical care in intensive care units. RECENT FINDINGS/RESULTS:Recent topics of discussion include invasive and non-invasive modalities of diagnosis and monitoring, recent developments in hypothermia, hyperosmolar therapy, pharmacological interventions, and surgical therapies. The authors also present an example of an algorithm used within our system of hospitals for managing patients with elevated ICP. Recent advances have shown the mortality benefits in appropriately recognizing and treating increased ICP. Multiple modalities of treatment have been explored, and evidence has shown benefit in some. Further work continues to provide clarity in the appropriate management of intracranial hypertension.
PMID: 31773291
ISSN: 1534-6293
CID: 4216022

Teaching NeuroImages: Hippocampal sclerosis in cerebral malaria

Lillemoe, Kaitlyn; Brewington, Danielle; Lord, Aaron; Czeisler, Barry; Lewis, Ariane; Kurzweil, Arielle
PMID: 31262996
ISSN: 1526-632x
CID: 3967982

How Does Preexisting Hypertension Affect Patients with Intracerebral Hemorrhage?

Valentine, David; Lord, Aaron S; Torres, Jose; Frontera, Jennifer; Ishida, Koto; Czeisler, Barry M; Lee, Fred; Rosenthal, Jonathan; Calahan, Thomas; Lewis, Ariane
BACKGROUND AND PURPOSE/OBJECTIVE:Patients with intracerebral hemorrhage (ICH) frequently present with hypertension, but it is unclear if this is due to pre-existing hypertension (prHTN) or to the bleed itself or associated pain. We sought to assess the relationship between prHTN and admission systolic blood pressure (aBP) and bleed severity. METHODS:We retrospectively assessed the relationship between prHTN and aBP and NIHSS in patients with ICH at 3 institutions. RESULTS:Of 251 patients, 170 (68%) had prHTN based on history of hypertension/antihypertensive use. Median aBP was significantly higher in those with prHTN (155 mm Hg (IQR 135-181) versus 139 mm Hg (IQR 124-158), P < .001). Patients with left ventricular hypertrophy (LVH) on electrocardiogram (ECG) or transthoracic echocardiogram (TTE) had significantly higher aBP than those without LVH (median aBP 195 mm Hg (IQR 155-216) for patients with LVH on ECG versus 147 mm Hg (IQR 129-163) for patients with no LVH on ECG, P < .001; median aBP 181 mm Hg (IQR 153-214) for patients with LVH on TTE versus 152 mm Hg (IQR 137-169) for patients with no LVH on TTE, P = .01). prHTN was associated with a higher median NIHSS (11 (IQR 3-20) for patients with history of hypertension/antihypertensive use versus 6 (IQR 1-14) for patients without this history (P = .02); 9 (IQR 3-19) versus 5 (IQR 2-13) for patients with/without LVH on ECG (P = .085); and 10 (IQR 5-18) versus 5 (IQR 1-13) for patients with/without LVH on TTE (P = .046). CONCLUSIONS:Patients with ICH who have prHTN have higher aBP and NIHSS, suggesting that prHTN may worsen reactive hypertension in the setting of ICH.
PMID: 30553645
ISSN: 1532-8511
CID: 3554632