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Use of carotid web angioarchitecture in stratification of stroke risk
Negash, Bruck; Wiggan, Daniel D; Grin, Eric A; Sangwon, Karl L; Chung, Charlotte; Gutstadt, Eleanor; Sharashidze, Vera; Raz, Eytan; Shapiro, Maksim; Ishida, Koto; Torres, Jose L; Zhang, Cen; Nakatsuka, Michelle A; Rostanski, Sara K; Rethana, Melissa J; Kvernland, Alexandra; Sanger, Matthew; Lillemoe, Kaitlyn; Allen, Alexander; Kelly, Sean; Baranoski, Jacob F; Rutledge, Caleb; Riina, Howard A; Nelson, Peter Kim; Nossek, Erez
OBJECTIVE:To validate the carotid web (CW) risk stratification assessment described in previous works within a larger cohort of patients with symptomatic and incidentally found asymptomatic CWs. METHODS:A retrospective analysis of our institution's electronic medical records identified all patients with a diagnosis of CW from 2017 to 2024. We included symptomatic patients and those with asymptomatic CWs, that is, incidentally found webs without history of stroke or transient ischemic attack. Patient charts were reviewed for demographics, imaging, comorbidities, and a diagnosis of stroke after diagnosis of asymptomatic CW. All angles were measured as described in previous work on a sagittal reconstruction of neck CT angiography in which the common carotid artery (CCA), external carotid artery, and internal carotid artery (ICA) were well visualized, together with the CW itself. Principal component analysis and logistic regression were performed to evaluate the association between high-risk angles and stroke risk. RESULTS: Twenty-six symptomatic and 26 asymptomatic patients were identified. Of note, the number of patients with hypertension, hyperlipidemia, and smoking history was 17 (65.0%), 16 (62.0%), and 8 (31.0%) for symptomatic patients and 18 (69.0%), 17 (65.0%), and 15 (58.0%) for asymptomatic patients. All angular measurements showed statistically significant associations with stroke status. The CCA-web-pouch angle showed the strongest association (p=2.07×10⁻⁴), followed by the CCA-pouch-tip angle (p=3.23×10⁻⁴), ICA-web-pouch angle (p=0.004), and ICA-pouch-tip angle (p=0.005). Each additional high-risk angle increased the odds of stroke by 9.47-fold (p<0.0001). The associated probability of stroke increased from 6.3% with no high-risk angles to 39.1% with one high-risk angle and further to 85.9% with two high-risk angles. The model demonstrated high sensitivity, correctly identifying 84.6% of positive cases, and high specificity, correctly identifying 88.5% of negative cases. The F1 score was 0.863, indicating good overall model performance. CONCLUSION: Given this successful stratification of CWs into high- and low-risk groups, the utilization of geometric CW parameters may play a role in improving patient selection for intervention in the setting of incidentally diagnosed CW. .
PMID: 40541402
ISSN: 1759-8486
CID: 5871372
Large Subcortical Intracerebral Hemorrhage Because of Reversible Cerebral Vasoconstriction Syndrome: A Case Study
Allen, Alexander; Raz, Eytan; Huang, Paul; Rostanski, Sara K
PMID: 32867598
ISSN: 1524-4628
CID: 4582912
Case-Control Study of Paresthesia Among World Trade Center-Exposed Community Members
Marmor, Michael; Thawani, Sujata; Cotrina, Maria Luisa; Shao, Yongzhao; Wong, Ericka S; Stecker, Mark M; Wang, Bin; Allen, Alexander; Wilkenfeld, Marc; Vinik, Etta J; Vinik, Aaron I; Reibman, Joan
OBJECTIVE:To investigate whether paresthesia of the lower extremities following exposure to the World Trade Center (WTC) disaster was associated with signs of neuropathy, metabolic abnormalities, or neurotoxin exposures. METHODS:Case-control study comparing WTC-exposed paresthesia cases with "clinic controls" (WTC-exposed subjects without paresthesias), and "community controls" (WTC-unexposed persons). RESULTS:Neurological histories and examination findings were significantly worse in cases than controls. Intraepidermal nerve fiber densities were below normal in 47% of cases and sural to radial sensory nerve amplitude ratios were less than 0.4 in 29.4%. Neurologic abnormalities were uncommon among WTC-unexposed community controls. Metabolic conditions and neurotoxin exposures did not differ among groups. CONCLUSIONS:Paresthesias among WTC-exposed individuals were associated with signs of neuropathy, small and large fiber disease. The data support WTC-related exposures as risk factors for neuropathy, and do not support non-WTC etiologies.
PMID: 32049876
ISSN: 1536-5948
CID: 4304452
Outcomes of a "Boot Camp" for incoming neurology residents [Meeting Abstract]
Valentine, David; Allen, Alexander; Mirasol, Raymond; Kurzweil, Arielle
ISI:000475965902094
ISSN: 0028-3878
CID: 4028952
Factors Associated With Outpatient Neurology Clinic Follow-Up After Acute Stroke Hospitalization at a Large Public City Hospital [Meeting Abstract]
Tiu, Jonathan; Allen, Alexander; Finamore, Jon Marc; Yang, Dixon; Rostanski, Sara K.
ISI:000475965902354
ISSN: 0028-3878
CID: 4029052
A protean case of neurolymphomatosis [Meeting Abstract]
Valentine, David; Neophytides, Andreas; Allen, Alexander; Lustbader, Ian; Kurzweil, Arielle
ISI:000475965901414
ISSN: 0028-3878
CID: 4028892
Impact of Neurological Follow-Up on Early Hospital Readmission Rates for Acute Ischemic Stroke
Allen, Alexander; Barron, Todd; Mo, Ashley; Tangel, Richard; Linde, Ruth; Grim, Rodney; Mingle, John; Deibert, Ellen
INTRODUCTION/BACKGROUND:Despite advances in stroke care, readmission rates for patients with ischemic stroke remain high. Although factors such as age, diabetes, and continuous use of antiplatelet agents have been found to predict readmission rates, the impact of after-hospital care has not been examined. METHODS:The present study reviewed the charts of 416 patients with acute ischemic stroke and recorded stroke-related comorbidities, neurology follow-up within 21 days, readmission at 0 to 30 days, readmission at 31 to 90 days, and any reasons for readmission. RESULTS:= .017). Patients with coronary artery disease and diabetes had a significantly higher likelihood of readmission within 0 to 30 days. CONCLUSION/CONCLUSIONS:The present study suggests that neurology follow-up at any point in time for patients with acute ischemic stroke may reduce short-term readmissions, but special attention to optimizing management of other underlying medical conditions, coronary artery disease, or diabetes may also help reduce overall readmissions. Patients with stroke, therefore, may benefit from a follow-up with both the primary care and neurology in a coordinated fashion to prevent early readmissions at 30 days.
PMCID:5467821
PMID: 28634502
ISSN: 1941-8744
CID: 4507402
Establishing a higher priority for chronic kidney disease in Peru
Francis, Elizabeth R; Allen, Alexander K; Herrera-AƱazco, Percy; Kuo, Chin-Chi; Cardenas, Maria K; Feldman, Harold I; Baral, Stefan D; Miranda, J Jaime
PMID: 26718798
ISSN: 2214-109x
CID: 4507392