Publications by authors named "Czap A"
Article Synopsis
- This study assesses the cost-effectiveness of mobile stroke units (MSUs) compared to standard emergency medical services (EMS) for administering thrombolytics in ischemic stroke patients.
- The analysis used the incremental cost-effectiveness ratio (ICER) method to evaluate healthcare costs and quality-adjusted life years (QALYs), highlighting considerable variations based on patient disability status and treatment costs.
- Overall, while MSUs show borderline cost-effectiveness for all eligible patients, they are more favorable for patients without pre-existing disabilities, particularly when focusing on lifetime costs and stroke-specific expenses.
Migraine and its Association with Stroke in Pregnancy: A National Examination.
J Womens Health (Larchmt)
November 2024
Article Synopsis
- Migraine prevalence during reproductive years can be as high as 25%, yet the connection between migraines and stroke is not well understood, particularly in pregnant women.
- This study analyzed data from over 19 million pregnant patients, finding that those with migraines were more likely to experience ischemic and hemorrhagic strokes compared to those without migraines.
- Pregnant women with migraines, especially those experiencing aura, have a significantly higher risk of stroke and should consult their healthcare providers to monitor for potential neurological issues.
Intravenous thrombolysis (IVT) may be administered to stroke patients requiring immediate treatment more quickly than emergency medical services if certain conditions are met. These conditions include the presence of mobile stroke units (MSUs) with on-site treatment teams and a computed tomography scanner. We compared clinical outcomes of MSU conventional therapy by emergency medical services through a systematic review and meta-analysis.
View Article and Find Full Text PDFObjective: This study was undertaken to examine averted stroke in optimized stroke systems.
Methods: This secondary analysis of a multicenter trial from 2014 to 2020 compared patients treated by mobile stroke unit (MSU) versus standard management. The analytical cohort consisted of participants with suspected stroke treated with intravenous thrombolysis.
Article Synopsis
- This study aimed to assess how cerebral microbleeds (CMBs) affect outcomes for stroke patients undergoing endovascular thrombectomy (EVT), focusing on functional independence and safety.
- Using a systematic review approach, researchers analyzed four studies with 1,514 patients and found that the presence of CMBs significantly reduced the chances of achieving positive functional outcomes after EVT.
- However, CMBs had no effect on successful revascularization rates, mortality, or the occurrence of various hemorrhagic complications, indicating a specific impact of CMBs on functional recovery rather than overall safety.
Background: Few data exist on acute stroke treatment in patients with pre-existing disability (PD) since they are usually excluded from clinical trials. A recent trial of mobile stroke units (MSUs) demonstrated faster treatment and improved outcomes, and included PD patients.
Aim: To determine outcomes with tissue plasminogen activator (tPA), and benefit of MSU versus management by emergency medical services (EMS), for PD patients.
Article Synopsis
- Over 1,000 unexplained pediatric hepatitis cases have been identified globally, with a study focusing on 38 cases and various control groups to understand potential viral causes.
- High levels of adeno-associated virus 2 (AAV2) DNA were found in most cases, while low levels of adenovirus and human herpesvirus 6B were also detected; however, AAV2 appeared infrequently in healthy controls even when they were immunocompromised.
- The study suggests that abnormal replication of AAV2, potentially influenced by other viruses like HAdV and HHV-6B, may be responsible for immune-related liver disease in susceptible children.
The prehospital phase is a critical component of delivering high-quality acute stroke care. This topical review discusses the current state of prehospital acute stroke screening and transport, as well as new and emerging advances in prehospital diagnosis and treatment of acute stroke. Topics include prehospital stroke screening, stroke severity screening, emerging technologies to aid in the identification and diagnosis of acute stroke in the prehospital setting, prenotification of receiving emergency departments, decision support for destination determination, and the capabilities and opportunities for prehospital stroke treatment in mobile stroke units.
View Article and Find Full Text PDFBackground And Objectives: Declines in stroke admission, IV thrombolysis (IVT), and mechanical thrombectomy volumes were reported during the first wave of the COVID-19 pandemic. There is a paucity of data on the longer-term effect of the pandemic on stroke volumes over the course of a year and through the second wave of the pandemic. We sought to measure the effect of the COVID-19 pandemic on the volumes of stroke admissions, intracranial hemorrhage (ICH), IVT, and mechanical thrombectomy over a 1-year period at the onset of the pandemic (March 1, 2020, to February 28, 2021) compared with the immediately preceding year (March 1, 2019, to February 29, 2020).
View Article and Find Full Text PDFArticle Synopsis
- Recent studies showed a rise in cerebral venous thrombosis (CVT) cases during the COVID-19 pandemic, prompting this evaluation of hospitalization and mortality rates comparing the pandemic year (2020) to the year prior (2019).
- A cross-sectional study analyzed data from 171 stroke centers worldwide, focusing on CVT admissions and associated mortality from January 2019 to May 2021, revealing no significant differences in overall CVT volume or mortality between 2019 and 2020.
- However, the first five months of 2021 saw a notable increase in CVT admissions compared to 2019 and 2020, with higher mortality rates linked to COVID-19-positive patients and instances of vaccine-induced immune
How Frequent is the One-Hour tPA Infusion Interrupted or Delayed?
J Stroke Cerebrovasc Dis
June 2022
Article Synopsis
- tPA is a medicine that helps treat strokes but needs to be given slowly over an hour, which can sometimes be delayed or interrupted.
- In a study with 497 stroke patients, about 8.3% had their tPA treatment delayed or stopped for various reasons, but only a few did so because of side effects.
- Using Tenecteplase (TNK) instead of tPA could mean faster and more effective treatment since it doesn't need that long infusion.
Background: Hematoma enlargement (HE) after intracerebral hemorrhage (ICH) is a therapeutic target for improving outcomes. Hemostatic therapies to prevent HE may be more effective the earlier they are attempted. An understanding of HE in first 1 to 2 hours specifically in the prehospital setting would help guide future treatment interventions in this time frame and setting.
View Article and Find Full Text PDFPurpose Of Review: Several approaches have been developed to optimize prehospital systems for acute stroke given poor access and significant delays to timely treatment. Specially equipped ambulances that directly initiate treatment, known as Mobile Stroke Units (MSUs), have rapidly proliferated across the world. This review provides a comprehensive summary on the efficacy of MSUs in acute stroke, its various applications beyond thrombolysis, as well as the establishment, optimal setting and cost-effectiveness of incorporating an MSU into healthcare systems.
View Article and Find Full Text PDFBackground: Prehospital automated large vessel occlusion (LVO) detection in Mobile Stroke Units (MSUs) could accelerate identification and treatment of patients with LVO acute ischemic stroke. Here, we evaluate the performance of a machine learning (ML) model on CT angiograms (CTAs) obtained from 2 MSUs to detect LVO.
Methods: Patients evaluated on MSUs in Houston and Los Angeles with out-of-hospital CTAs were identified.
Objectives: Studies face challenges with missing 5-level EQ-5D (EQ-5D-5L) data, often because of the need for longitudinal EQ-5D-5L data collection. There is a dearth of validated methodologies for dealing with missing EQ-5D-5L data in the literature. This study, for the first time, examined the possibility of using retrospectively collected EQ-5D-5L data as proxies for the missing data.
View Article and Find Full Text PDFPurpose Of The Review: This article reviews common imaging modalities used in diagnosis and management of acute stroke. Each modality is discussed individually and clinical scenarios are presented to demonstrate how to apply these modalities in decision-making.
Recent Findings: Advances in neuroimaging provide unprecedented accuracy in determining tissue viability as well as tissue fate in acute stroke.
Introduction: We have demonstrated in a multicenter cohort that the COVID-19 pandemic has led to a delay in intravenous thrombolysis (IVT) among stroke patients. Whether this delay contributes to meaningful short-term outcome differences in these patients warranted further exploration.
Methods: We conducted a nested observational cohort study of adult acute ischemic stroke patients receiving IVT from 9 comprehensive stroke centers across 7 U.
Objective: To measure the global impact of COVID-19 pandemic on volumes of IV thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with 2 control 4-month periods.
Methods: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases.
Utilization and Availability of Advanced Imaging in Patients With Acute Ischemic Stroke.
Circ Cardiovasc Qual Outcomes
April 2021
Article Synopsis
- Recent clinical trials show that advanced imaging methods, especially computed tomography perfusion (CTP), are effective for treating acute ischemic stroke (AIS) through endovascular therapy and thrombolysis.
- A study analyzed Medicare data from Texas and the national level between 2014 and 2017, revealing that most AIS cases were predominantly evaluated with noncontrast head CT, while CTP use was low at just 3%.
- The findings highlighted that CTP is mostly utilized in hospitals performing advanced treatments and is less accessible in rural areas, emphasizing a significant gap in available imaging resources for effective stroke management.
Background: Unprecedented workflow shifts during the coronavirus disease 2019 (COVID-19) pandemic have contributed to delays in acute care delivery, but whether it adversely affected endovascular thrombectomy metrics in acute large vessel occlusion (LVO) is unknown.
Methods: We performed a retrospective review of observational data from 14 comprehensive stroke centers in nine US states with acute LVO. EVT metrics were compared between March to July 2019 against March to July 2020 (primary analysis), and between state-specific pre-peak and peak COVID-19 months (secondary analysis), with multivariable adjustment.
Background And Purpose: The optimal endovascular stroke therapy (EVT) care delivery structure is unknown. Here, we present our experience in creating an integrated stroke system (ISS) to expand EVT availability throughout our region while maintaining hospital and physician quality standards.
Methods: We identified all consecutive patients with large vessel occlusion acute ischemic stroke treated with EVT from January 2014 to February 2019 in our health care system.
Background: The COVID-19 pandemic led to profound changes in the organization of health care systems worldwide.
Aims: We sought to measure the global impact of the COVID-19 pandemic on the volumes for mechanical thrombectomy, stroke, and intracranial hemorrhage hospitalizations over a three-month period at the height of the pandemic (1 March-31 May 2020) compared with two control three-month periods (immediately preceding and one year prior).
Methods: Retrospective, observational, international study, across 6 continents, 40 countries, and 187 comprehensive stroke centers.
Background: To evaluate overall ischemic stroke volumes and rates, specific subtypes, and clinical presentation during the COVID-19 pandemic in a multicenter observational study from eight states across US.
Methods: We compared all ischemic strokes admitted between January 2019 and May 2020, grouped as; March-May 2020 (COVID-19 period) and March-May 2019 (seasonal pre-COVID-19 period). Primary outcome was stroke severity at admission measured by NIHSS stratified as mild (0-7), moderate [8-14], and severe (>14).
Article Synopsis
- The COVID-19 pandemic has significantly impacted medical care, specifically leading to delays in acute stroke treatment at comprehensive stroke centers in the U.S.!* -
- A study evaluating stroke patients admitted during the pandemic showed lower odds of receiving timely thrombolysis treatment within the Target: Stroke goal of 60 minutes compared to the pre-COVID-19 period, with a median delay of 4 minutes noted.!* -
- The findings indicated that delays were primarily due to slower imaging to treatment times, although there were no significant delays in thrombectomy procedures during the same period.!*