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1. Milli-spinner thrombectomy

Author

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

Subjects
Physics - Applied Physics
Abstract

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

Published
2024

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

Author

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

Published
2024
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4. Follow-up infarct volume on fluid attenuated inversion recovery (FLAIR) imaging in distal medium vessel occlusions: the role of cerebral blood volume index

Author

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

Published
2024
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6. Random Expert Sampling for Deep Learning Segmentation of Acute Ischemic Stroke on Non-contrast CT

Author

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

Subjects
Computer Science - Computer Vision and Pattern Recognition
Abstract

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

Published
2023
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7. Outcomes with General Anesthesia Compared to Conscious Sedation for Endovascular Treatment of Medium Vessel Occlusions: Results of an International Multicentric Study

Author

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

Published
2024
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8. Use of the pRESET LITE thrombectomy device in combined approach for medium vessel occlusions: A multicenter evaluation

Author

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

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

Author

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

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

Author

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

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

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

Published
2022
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13. USE-Evaluator: Performance Metrics for Medical Image Segmentation Models with Uncertain, Small or Empty Reference Annotations

Author

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

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

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

Published
2022
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18. The Los Angeles motor scale (LAMS) is independently associated with CT perfusion collateral status markers

Author

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

Published
2024
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23. Diffusion-Weighted Magnetic Resonance Brain Images Generation with Generative Adversarial Networks and Variational Autoencoders: A Comparison Study

Author

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

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

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

Published
2020

24. VINE Catheter for Endovascular Surgery

Author

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

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

27. Priorities for Advancements in Neuroimaging in the Diagnostic Workup of Acute Stroke

Author

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

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

Author

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

Published
2023
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33. Infarct Core Growth During Interhospital Transfer For Thrombectomy Is Faster At Night

Author

Seners, Pierre, Mlynash, Michael, Sreekrishnan, Anirudh, Ter Schiphorst, Adrien, Arquizan, Caroline, Costalat, Vincent, Henon, Hilde, Bretzner, Martin, Heit, Jeremy J., Olivot, Jean-Marc, Lansberg, Maarten G., Albers, Gregory W., Schmitt, Perrine, Sablot, Denis, Lalu, Thibault, Bricout, Nicolas, Albucher, Jean-François, Cognard, Christophe, Cordonnier, Charlotte, Christensen, Soren, and Scheldeman, Lauranne

Published
2023
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35. Lower admission stroke severity is associated with good collateral status in distal medium vessel occlusion stroke

Author

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

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

Author

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

Published
2024
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39. CT perfusion to measure venous outflow in acute ischemic stroke in patients with a large vessel occlusion.

Author

Adusumilli, Gautam, Christensen, Soren, Yuen, Nicole, Mlynash, Michael, Faizy, Tobias D., Albers, Gregory W., Lansberg, Maarten G., Fiehler, Jens, and Heit, Jeremy J.

Subjects
CAROTID artery radiography, GRAPHICAL user interfaces, RESEARCH funding, CEREBRAL veins, BLOOD vessels, COMPUTED tomography, CRANIAL sinuses, MANN Whitney U Test, DESCRIPTIVE statistics, PERFUSION imaging, ISCHEMIC stroke, THROMBECTOMY, PERFUSION, AUTOMATION, CEREBRAL circulation, DATA analysis software, NEURORADIOLOGY, NONPARAMETRIC statistics
Abstract

Background Robust venous outflow (VO) profiles, measured by degree of venous opacification on pre-thrombectomy CT angiography (CTA) studies, are strongly correlated with favorable outcomes in patients with large vessel occlusion acute ischemic stroke treated by thrombectomy. However, VO measurements are laborious and require neuroimaging expertise. Objective To develop a semi-automated method to measure VO using CTA and CT perfusion imaging studies. Methods We developed a graphical interface using The Visualization Toolkit, allowing for voxel selection at the confluence and bilateral internal cerebral veins on CTA along with arterial input functions (AlFs) from both internal carotid arteries. We extracted concentration-time curves from the CT perfusion study at the corresponding locations associated with AIF and venous output function (VOF). Outcome analyses were primarily conducted by the Mann-Whitney U and Jonckheere-Terpstra tests. Results Segmentation at the pre-selected AIF and VOF locations was performed on a sample of 97 patients. 65 patients had favorable VO (VO+) and 32 patients had unfavorable VO (VO-). VO+ patients were found to have a significantly shorter VOF time to peak (8.26; 95% CI 7.07 to 10.34) than VO- patients (9.44; 95% CI 8.61 to 10.91), P=0.007. No significant difference was found in VOF curve width and the difference in time between AIF and VOF peaks. Conclusions Time to peak of VOF at the confluence of sinuses was significantly associated with manually scored venous outflow. Further studies should aim to understand better the association between arterial inflow and venous outflow, and capture quantitative metrics of venous outflow at other locations. [ABSTRACT FROM AUTHOR]

Published
2024
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41. Association between occlusion location, net water uptake and ischemic lesion growth in large vessel anterior circulation strokes.

Author

Winkelmeier, Laurens, Heit, Jeremy J, Broocks, Gabriel, Prüter, Julia, Heitkamp, Christian, Schell, Maximilian, Albers, Gregory W, Lansberg, Maarten G, Wintermark, Max, Kemmling, André, Stracke, Christian Paul, Guenego, Adrien, Paech, Daniel, Fiehler, Jens, and Faizy, Tobias D

Abstract

Ischemic lesion net water uptake (NWU) represents a quantitative imaging biomarker for cerebral edema in acute ischemic stroke. Data on NWU for distinct occlusion locations remain scarce, but might help to improve the prognostic value of NWU. In this retrospective multicenter cohort study, we compared NWU between patients with proximal large vessel occlusion (pLVO; ICA or proximal M1) and distal large vessel occlusion (dLVO; distal M1 or M2). NWU was quantified by densitometric measurements of the early ischemic region. Arterial collateral status was assessed using the Maas scale. Regression analysis was used to investigate the relationship between occlusion location, NWU and ischemic lesion growth. A total of 685 patients met inclusion criteria. Early ischemic lesion NWU was higher in patients with pLVO compared with dLVO (7.7% vs 3.9%, P <.001). The relationship between occlusion location and NWU was partially mediated by arterial collateral status. NWU was associated with absolute ischemic lesion growth between admission and follow-up imaging (β estimate, 5.50, 95% CI, 3.81–7.19, P <.001). This study establishes a framework for the relationship between occlusion location, arterial collateral status, early ischemic lesion NWU and ischemic lesion growth. Future prognostic thresholds for NWU might be optimized by adjusting for the occlusion location. [ABSTRACT FROM AUTHOR]

Published
2024
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42. Clinical change during inter-hospital transfer for thrombectomy: Incidence, associated factors, and relationship with outcome.

Author

Seners, Pierre, Ter Schiphorst, Adrien, Wouters, Anke, Yuen, Nicole, Mlynash, Michael, Arquizan, Caroline, Heit, Jeremy J, Kemp, Stephanie, Christensen, Soren, Sablot, Denis, Wacongne, Anne, Lalu, Thibault, Costalat, Vincent, Albers, Gregory W, and Lansberg, Maarten G

Abstract

Background: Patients with acute ischemic stroke with a large vessel occlusion (LVO) admitted to non endovascular-capable centers often require inter-hospital transfer for thrombectomy. We aimed to describe the incidence of substantial clinical change during transfer, the factors associated with clinical change, and its relationship with 3-month outcome. Methods: We analyzed data from two cohorts of acute stroke patients transferred for thrombectomy to a comprehensive center (Stanford, USA, November 2019 to January 2023; Montpellier, France, January 2015 to January 2017), regardless of whether thrombectomy was eventually attempted. Patients were included if they had evidence of an LVO at the referring hospital and had a National Institute of Health Stroke Scale (NIHSS) score documented before and immediately after transfer. Inter-hospital clinical change was categorized as improvement (⩾4 points and ⩾25% decrease between the NIHSS score in the referring hospital and upon comprehensive center arrival), deterioration (⩾4 points and ⩾25% increase), or stability (neither improvement nor deterioration). The stable group was considered as the reference and was compared to the improvement or deterioration groups separately. Results: A total of 504 patients were included, of whom 22% experienced inter-hospital improvement, 14% deterioration, and 64% were stable. Pre-transfer variables independently associated with clinical improvement were intravenous thrombolysis use, more distal occlusions, and lower serum glucose; variables associated with deterioration included more proximal occlusions and higher serum glucose. On post-transfer imaging, clinical improvement was associated with arterial recanalization and smaller infarct growth and deterioration with larger infarct growth. As compared to stable patients, those with clinical improvement had better 3-month functional outcome (adjusted common odds ratio (cOR) = 2.43; 95% confidence interval (CI) = 1.59–3.71; p < 0.001), while those with deterioration had worse outcome (adjusted cOR = 0.60; 95% CI = 0.37–0.98; p = 0.044). Conclusion: Substantial inter-hospital clinical changes are frequently observed in LVO-related ischemic strokes, with significant impact on functional outcome. There is a need to develop treatments that improves the clinical status during transfer. Data access statement: The data that support the findings of this study are available upon reasonable request. [ABSTRACT FROM AUTHOR]

Published
2024
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43. CT perfusion based rCBF <38% volume is independently and negatively associated with digital subtraction angiography collateral score in anterior circulation large vessel occlusions.

Author

Lakhani, Dhairya A, Balar, Aneri B, Koneru, Manisha, Wen, Sijin, Ozkara, Burak Berksu, Wang, Richard, Hoseinyazdi, Meisam, Nabi, Mehreen, Mazumdar, Ishan, Cho, Andrew, Chen, Kevin, Sepehri, Sadra, Hyson, Nathan, Xu, Risheng, Urrutia, Victor, Luna, Licia, Hillis, Argye E, Heit, Jeremy J, Albers, Greg W, and Rai, Ansaar T

Abstract

Background: Collateral status (CS) is an important biomarker of functional outcomes in patients with acute ischemic stroke secondary to large vessel occlusion (AIS-LVO). Pretreatment CT perfusion (CTP) parameters serve as reliable surrogates of collateral status (CS). In this study, we aim to assess the relationship between the relative cerebral blood flow less than 38% (rCBF <38%), with the reference standard American Society of Interventional and Therapeutic Neuroradiology (ASITN) collateral score (CS) on DSA. Methods: In this prospectively collected, retrospectively reviewed analysis, inclusion criteria were as follows: (a) CT angiography (CTA) confirmed anterior circulation large vessel occlusion from 9/1/2017 to 10/01/2023; (b) diagnostic CT perfusion; and (c) underwent mechanical thrombectomy with documented ASITN CS. The ratios of the CTP-derived CBF values were calculated by dividing the values of the ischemic lesion by the corresponding values of the contralateral normal region (which were defined as rCBF). Spearman's rank correlation and logistic regression analysis were performed to determine the relationship of rCBF <38% lesion volume with DSA ASITN CS. p ≤.05 was considered significant. Results: In total, 223 patients [mean age: 67.77 ± 15.76 years, 56.1% (n = 125) female] met our inclusion criteria. Significant negative correlation was noted between rCBF <38% volume and DSA CS (ρ = −0.37, p <.001). On multivariate logistic regression analysis, rCBF <38% volume was found to be independently associated with worse ASITN CS (unadjusted OR: 3.03, 95% CI: 1.60–5.69, p <.001, and adjusted OR: 2.73, 95% CI: 1.34–5.50, p <.01). Conclusion: Greater volume of tissue with rCBF <38% is independently associated with better DSA CS. rCBF <38% is a useful adjunct tool in collateralization-based prognostication. Future studies are needed to expand our understanding of the role of rCBF <38% within the decision-making in patients with AIS-LVO. [ABSTRACT FROM AUTHOR]

Published
2024
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44. Thrombectomy for anterior circulation stroke beyond 6 h from time last known well (AURORA): a systematic review and individual patient data meta-analysis

Author

Jovin, Tudor G, Nogueira, Raul G, Lansberg, Maarten G, Demchuk, Andrew M, Martins, Sheila O, Mocco, J, Ribo, Marc, Jadhav, Ashutosh P, Ortega-Gutierrez, Santiago, Hill, Michael D, Lima, Fabricio O, Haussen, Diogo C, Brown, Scott, Goyal, Mayank, Siddiqui, Adnan H, Heit, Jeremy J, Menon, Bijoy K, Kemp, Stephanie, Budzik, Ron, Urra, Xabier, Marks, Michael P, Costalat, Vincent, Liebeskind, David S, and Albers, Gregory W

Published
2022
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46. Consensus statement on current and emerging methods for the diagnosis and evaluation of cerebrovascular disease

Author

Donahue, Manus J, Achten, Eric, Cogswell, Petrice M, De Leeuw, Frank-Erik, Derdeyn, Colin P, Dijkhuizen, Rick M, Fan, Audrey P, Ghaznawi, Rashid, Heit, Jeremy J, Ikram, M Arfan, Jezzard, Peter, Jordan, Lori C, Jouvent, Eric, Knutsson, Linda, Leigh, Richard, Liebeskind, David S, Lin, Weili, Okell, Thomas W, Qureshi, Adnan I, Stagg, Charlotte J, van Osch, Matthias JP, van Zijl, Peter CM, Watchmaker, Jennifer M, Wintermark, Max, Wu, Ona, Zaharchuk, Greg, Zhou, Jinyuan, and Hendrikse, Jeroen

Subjects
Biomedical and Clinical Sciences, Neurosciences, Clinical Sciences, Stroke, Aging, Brain Disorders, Detection, screening and diagnosis, 4.1 Discovery and preclinical testing of markers and technologies, Good Health and Well Being, Cerebrovascular Disorders, Humans, hemodynamics, metabolism, imaging, cerebrovascular disease, Cardiorespiratory Medicine and Haematology, Neurology & Neurosurgery, Clinical sciences
Abstract

Cerebrovascular disease (CVD) remains a leading cause of death and the leading cause of adult disability in most developed countries. This work summarizes state-of-the-art, and possible future, diagnostic and evaluation approaches in multiple stages of CVD, including (i) visualization of sub-clinical disease processes, (ii) acute stroke theranostics, and (iii) characterization of post-stroke recovery mechanisms. Underlying pathophysiology as it relates to large vessel steno-occlusive disease and the impact of this macrovascular disease on tissue-level viability, hemodynamics (cerebral blood flow, cerebral blood volume, and mean transit time), and metabolism (cerebral metabolic rate of oxygen consumption and pH) are also discussed in the context of emerging neuroimaging protocols with sensitivity to these factors. The overall purpose is to highlight advancements in stroke care and diagnostics and to provide a general overview of emerging research topics that have potential for reducing morbidity in multiple areas of CVD.

Published
2018

47. Multicenter US clinical experience with the Scepter Mini balloon catheter

Author

Salem, Mohamed M., primary, Kelmer, Paz, additional, Sioutas, Georgios S., additional, Ostmeier, Sophie, additional, Hoang, Alex, additional, Cortez, Gustavo, additional, El Naamani, Kareem, additional, Abbas, Rawad, additional, Hanel, Ricardo, additional, Tanweer, Omar, additional, Srinivasan, Visish M., additional, Jabbour, Pascal, additional, Kan, Peter, additional, Jankowitz, Brian T., additional, Heit, Jeremy J., additional, and Burkhardt, Jan-Karl, additional

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

Author

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

Published
2024
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49. Abstract TP149: Pretreatment Parameters Predicting Excellent Recanalization of Large Vessel Occlusion in Patients With Acute Ischemic Stroke

Author

Koneru, Manisha, primary, Hoseinyazdi, Meisam, additional, Greene, Cynthia, additional, Dmytriw, Adam A, additional, Guenego, Adrien, additional, Heit, Jeremy J, additional, Albers, Greg W, additional, Nael, Kambiz, additional, Xu, Risheng, additional, Urrutia, Victor C, additional, Marsh, Elisabeth B, additional, Leigh, Richard, additional, Llinas, Rafael H, additional, Hillis, Argye E, additional, and Yedavalli, Vivek, additional

Published
2024
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50. Abstract TP146: Collateral Status-Based Model for Hemorrhagic Transformation in Successfully Recanalized Medium Vessel Occlusions

Author

Koneru, Manisha, primary, Hoseinyazdi, Meisam, additional, Greene, Cynthia, additional, Dmytriw, Adam A, additional, Guenego, Adrien, additional, Heit, Jeremy J, additional, Albers, Greg W, additional, Nael, Kambiz, additional, Xu, Risheng, additional, Urrutia, Victor C, additional, Marsh, Elisabeth B, additional, Leigh, Richard, additional, Llinas, Rafael H, additional, Hillis, Argye E, additional, and Yedavalli, Vivek, additional

Published
2024
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