Publications by authors named "Fawaz Al-Mufti"
Introduction: Acute large vessel occlusions (LVOs) account for up to one-third of acute ischemic strokes (AIS) and are associated with high mortality and severe functional deficits. Animal model research suggests that statins may have a protective effect on vessel wall injury during endovascular thrombectomy (EVT). We conducted a retrospective observational study to assess the impact of statin use on clinical outcomes post-EVT in AIS patients with LVOs.
View Article and Find Full Text PDFBackground: Pituitary apoplexy (PA) is a rare, life-threatening clinical syndrome that occurs in response to acute ischemic infarction or hemorrhage of a pituitary adenoma. We report two cases of sudden neurologic and visual decline in patients with pituitary region masses in coronavirus disease (COVID)-positive patients with a focus on potential pathophysiological mechanisms and a safe approach to treatment.
Case Description: Case one is a 58-year-old male presenting with sudden-onset headache and visual disturbance.
Background/objectives: Recent studies reveal an "obesity paradox", suggesting better clinical outcomes after intracranial hemorrhage for obese patients compared to patients with a healthy BMI. While this paradox indicates improved survival rates for obese individuals in stroke cases, it is unknown whether this trend remains true across all forms of intracranial hemorrhage. Therefore, the objective of our study was to investigate the incidence, characteristics, and outcomes of hospitalized obese patients with intracranial hemorrhage.
View Article and Find Full Text PDFBackground: Stroke is a leading cause of global mortality and disability, with a disproportionately high burden in low- and middle-income countries. Access to intravenous thrombolysis (IVT) and endovascular treatment (EVT) remains extremely limited.
Aims: We evaluated the spatial distribution and geographic accessibility of stroke centers in India.
Article Synopsis
- Endovascular thrombectomy (EVT) has proven safe and effective for patients suffering from large core strokes, but the effects of reperfusion quality and procedure details on outcomes are still unclear.
- In the SELECT2 trial, findings indicated that 80% of patients experienced successful reperfusion, which correlates with better clinical outcomes, particularly in those who achieved near-complete reperfusion.
- Longer procedure times negatively impacted patient outcomes, while the method of thrombectomy (aspiration vs stent-retriever) showed no significant differences in reperfusion success or functional recovery.
Objective: The aim of this study is to evaluate the 100 most highly cited articles assessing posterior communicating artery aneurysms.
Methods: In May 2024, a comprehensive search was conducted in the Scopus database using the keyword "posterior communicating artery aneurysm" The top-100 most impactful articles were ranked by citation count and analyzed for relevant factors. Citations per year were calculated to minimize the risk of bias.
Background: Early neurological deterioration (END) and recurrence of vessel blockage frequently complicate intravenous thrombolysis (IVT) for acute ischemic stroke (AIS). Several studies have indicated the potential effectiveness of the early initiation (within < 24 h) of antiplatelet therapy (APT) after IVT. However, conflicting results have been reported by other studies.
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- Mechanical thrombectomy (MT) access for acute ischemic stroke varies greatly across countries, prompting the need for a scoring system to evaluate and improve treatment accessibility worldwide.
- A systematic review and a modified Delphi method were used to identify key attributes affecting MT access, culminating in a final score of 0-36 based on 12 consensus attributes selected by international experts.
- The MT access score serves as a pioneering tool to identify barriers to MT access, aiming to enhance stroke care and outcomes globally by guiding public health interventions.
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.
Article Synopsis
- A systematic review and meta-analysis were conducted to explore the relationship between D-dimer levels and the outcomes of thrombectomy in patients with acute ischemic stroke (AIS).
- The analysis included 14 studies and found that patients with low D-dimer levels experienced significantly better outcomes, including higher rates of favorable functional results and successful recanalization compared to those with high levels.
- Although there is a noted association between D-dimer levels and thrombectomy outcomes, the evidence is inconsistent and calls for more targeted research to clarify these findings.
Article Synopsis
- * A multicenter analysis involved 269 patients, reporting a high success rate (100% effective distal penetration), a low complication rate (2.2%), and significant improvements in cSDH diameter and neurological function at 60-day follow-up.
- * The findings suggest that using MMA embolization with the n-BCA D5W push technique is a safe and viable option alongside or instead of traditional surgery, showing a reduction in recurrence
Background And Purpose: Cerebral venous thrombosis (CVT) is associated with a high degree of morbidity and mortality. Our objective is to elucidate characteristics, treatments, and outcomes of patients with cancer and CVT (CA-CVT).
Methods: The 2016-2019 National Inpatient Sample (NIS) database was queried for patients with a primary diagnosis of CVT.
Background And Objectives: Although ventriculoperitoneal (VP) shunts are a common treatment for hydrocephalus, there are complication risks including infections. Late complications such as ventriculitis from ascending abdominal infections can have severe consequences. However, the incidence of central nervous system (CNS) infections in VP shunt patients with abdominal infections is not well understood.
View Article and Find Full Text PDFAs the incidence of subdural hematoma is increasing, it is important to understand symptomatology and clinical variables associated with treatment outcomes and mortality in this population; patients with subdural hematoma were selected from the National Inpatient Sample (NIS) Database between 2016 and 2020 using International Classification of Disease 10th Edition (ICD10) codes. Moderate-to-severe subdural hematoma patients were identified using the Glasgow Coma Scale (GCS). Multivariate regression was first used to identify predictors of in-hospital mortality and then beta coefficients were used to create a weighted mortality score.
View Article and Find Full Text PDFEndovascular thrombectomy (EVT) safety and efficacy in patients with large core infarcts receiving oral anticoagulants (OAC) are unknown. In the SELECT2 trial (NCT03876457), 29 of 180 (16%; vitamin K antagonists 15, direct OACs 14) EVT, and 18 of 172 (10%; vitamin K antagonists 3, direct OACs 15) medical management (MM) patients reported OAC use at baseline. EVT was not associated with better clinical outcomes in the OAC group (EVT 6 [4-6] vs MM 5 [4-6], adjusted generalized odds ratio 0.
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- Spinal cord injury (SCI) causes significant health issues and financial strain, focusing management on minimizing secondary damage from ischemia and inflammation.* -
- Emerging treatments like neuroprotective agents and neuromodulation techniques show promise but need more research, while timely surgical intervention within 24 hours is crucial for better outcomes.* -
- Maintaining specific blood pressure targets after injury and providing comprehensive care can help reduce complications, with corticosteroids showing potential for improving motor recovery when given soon after the injury.*
Article Synopsis
- The study investigates the link between acute kidney injury (AKI) and outcomes in patients with spontaneous subarachnoid hemorrhage (SAH), a serious condition with a high risk of complications.
- An analysis of over 76,000 SAH patients from 2010 to 2019 shows that about 14% developed AKI, with these patients being older and more likely to be obese compared to those without AKI.
- Findings indicate that AKI is significantly associated with poorer functional outcomes, longer hospital stays, and higher in-hospital mortality, highlighting the need for early detection to improve recovery chances.
Atlantoaxial subluxation and Down syndrome: A cross-sectional analysis.
J Craniovertebr Junction Spine
May 2024
Background: Atlantoaxial subluxation (AAS) is a diagnosis describing misalignment of the C1 vertebra relative to C2. Excessive translation of this joint, located adjacent to the medullary brain stem, can lead to devastating neurological consequences. A higher prevalence of AAS within the Down syndrome (DS) population has been well-established.
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- The study analyzed the impact of various factors on mortality in elderly trauma patients (65+) with severe traumatic brain injury who had surgery (craniotomy).
- It found that having two or more types of intracranial hemorrhage and prior use of anticoagulants significantly increased the risk of mortality.
- The research indicated that frailty alone doesn't strongly predict mortality, but categorized frail patients showed higher mortality rates compared to non-frail patients.
Article Synopsis
- Postoperative intracranial hemorrhage (POH) occurs in about 1.4% of patients after brain surgery, and current guidelines recommend keeping blood pressure below 140 mm Hg, although this is not well-supported by research.
- A study reviewed data from 147 patients who underwent craniotomy to explore the safety of allowing a higher systolic blood pressure goal of less than 160 mm Hg in the immediate postoperative period.
- Results showed no significant differences in complications, hospital stays, or the use of blood pressure medications between the two groups, suggesting that the higher blood pressure threshold may be safe after such surgeries.
Central retinal artery occlusion (CRAO) is a rare and visually debilitating vascular condition characterized by sudden and severe vision loss. CRAO is a compelling target for intravenous alteplase (tPA) and endovascular mechanical thrombectomy (MT) due to pathophysiological similarities with acute ischemic stroke; however, the utility of these interventions in CRAO remains dubious due to limited sample sizes and potential risks. To assess usage and outcomes of tPA and MT in CRAO, we queried the National Inpatient Sample database using International Classification of Disease, Ninth and Tenth edition for patients with CRAO and acute ischemic stroke between 2010 and 2019.
View Article and Find Full Text PDFBackground: Owing to the relative rarity of unruptured intracranial aneurysms (UIAs) in the pediatric population, evidence regarding treatment modalities and clinical outcomes remains limited.
Objective: To characterize the use and clinical outcomes of endovascular therapy (EVT) and microsurgical clipping (MSC) for pediatric UIAs over a two-decade interval using a large national registry.
Methods: Pediatric (<18 years of age) UIA hospitalizations were identified in the National Inpatient Sample from 2002 to 2019.
Background: Despite renewed interest and recently demonstrated efficacy for endovascular thrombectomy (EVT) for treatment of acute ischemic stroke (AIS) of the posterior circulation, to date, no randomized clinical trials have been conducted to evaluate EVT for isolated occlusions of the posterior cerebral artery (IPCA).
Methods: Hospitalizations for adult patients with primary admission diagnoses of IPCA occlusion were identified in the National Inpatient Sample registry during the period of 2016-2020. The study exposure was treatment with EVT, and primary clinical endpoints included favorable functional outcome (defined as discharge disposition to home without services, previously shown to have high concordance with modified Rankin scale scores 0-2), in-hospital mortality, and any intracranial hemorrhage (ICH).
Background: Recent studies indicate endovascular thrombectomy (EVT) as a safe, effective treatment for acute ischemic stroke (AIS) with large ischemic regions. Our study updates an ongoing living systematic review and meta-analysis of randomized controlled trials (RCTs) comparing outcomes of EVT to medical management only.
Methods: We searched MEDLINE, EMBASE, and the Cochrane Library for RCTs comparing EVT to medical management in AIS patients with large ischemic areas.
Background And Objectives: Dual antiplatelet therapy (DAPT) is necessary to minimize the risk of periprocedural thromboembolic complications associated with aneurysm embolization using pipeline embolization device (PED). We aimed to assess the impact of platelet function testing (PFT) on reducing periprocedural thromboembolic complications associated with PED flow diversion in patients receiving aspirin and clopidogrel.
Methods: Patients with unruptured intracranial aneurysms requiring PED flow diversion were identified from 13 centers for retrospective evaluation.