Publications by authors named "Jeremy Heit"
The relative level of functional impairment in stroke patients is a significant determinant of post-acute care. The Activity Measure for Post Acute Care 6-Clicks (AM-PAC) scores for basic mobility and daily activity are rapid standardized assessments whose utilities in predicting long-term stroke outcomes have not yet been studied. We performed a retrospective analysis of acute ischemic stroke patients and their outcomes.
View Article and Find Full Text PDFBackground And Purpose: Acute ischemic stroke due to anterior circulation large-vessel occlusion (AIS-LVO) remains a leading cause of disability despite successful reperfusion therapies. Prolonged venous transit (PVT) has emerged as a potential prognostic imaging biomarker in AIS-LVO. We aimed to investigate whether PVT is associated with a decreased likelihood of excellent functional outcome (modified Rankin Scale [mRS] score of 0-1 at 90 days) after successful reperfusion.
View Article and Find Full Text PDFBackground: Isolated anterior cerebral artery occlusions (ACAo) in patients with acute ischemic stroke present significant challenges due to their rarity. The efficacy and safety of endovascular therapy (EVT) in comparison with best medical therapy (BMT) for ACAo remains unclear. This study aimed to assess the outcomes of these treatments.
View Article and Find Full Text PDFBackground And Purpose: Prolonged venous transit (PVT+) is a marker of venous outflow; it is defined as the presence or absence of time-to-maximum ≥10 seconds timing in either the superior sagittal sinus or torcula. This novel perfusion imaging-based metric has been associated with higher odds of mortality and lower odds of functional recovery. This study aims to assess the relationship between PVT on admission perfusion imaging and length of hospital stay in large vessel occlusion strokes successfully reperfused with mechanical thrombectomy.
View Article and Find Full Text PDF: Pretreatment CTA-based Cortical Vein Opacification Score (COVES) has been shown to predict good functional outcomes at 90 days in patients with acute ischemic stroke secondary to large vessel occlusion (AIS-LVO). This is thought to be related to its ability to measure collateral status (CS). However, its association with the reference standard test, the DSA-based American Society of Interventional and Therapeutic Neuroradiology (ASITN) collateral score, has yet to be established.
View Article and Find Full Text PDFArticle Synopsis
Background And Aim: Recent studies have shown that the CT Perfusion (CTP) parameter of rCBV < 42 % lesion volume can predict 90-day functional outcomes in stroke patients. However, its correlation with discharge outcomes, including functional dependence, has not been investigated. Our study aims to evaluate the relationship between rCBV < 42 % and poor functional outcomes at discharge, defined as a modified Rankin score (mRS) of 3 or higher.
View Article and Find Full Text PDFThe hypoperfusion intensity ratio (HIR) is a quantitative metric used in vascular occlusion imaging to evaluate the extent of brain tissue at risk due to hypoperfusion. Defined as the ratio of tissue volume with a time-to-maximum (Tmax) of >10 seconds to that of >6 seconds, HIR assists in differentiating between the salvageable penumbra and the irreversibly injured core infarct. This review explores the role of HIR in assessing clinical outcomes and guiding treatment strategies, including mechanical thrombectomy and thrombolytic therapy, for patients with large vessel occlusions (LVOs).
View Article and Find Full Text PDFBackground: While advances in endovascular thrombectomy (EVT) have led to high reperfusion rates, most patients treated with EVT do not avoid disability. Post-reperfusion hemorrhagic transformation (HT) is a potential target for improving outcomes. This study examined pretreatment blood-brain barrier (BBB) disruption in tissue that would subsequently become part of the final infarct to evaluate its role in post-EVT HT.
View Article and Find Full Text PDFArticle Synopsis
- - Distal medium vessel occlusions (DMVOs) are responsible for 25-40% of acute ischemic stroke cases, but predictive models specifically for DMVO outcomes are not yet available
- - A retrospective study developed a machine learning model using clinical, lab, imaging, and treatment data from 164 DMVO patients to predict unfavorable outcomes at 90 days, achieving good prediction accuracy and calibration
- - The model identified key predictive factors like NIHSS score and history of malignancy, and a web application was created for personalized patient outcome predictions, highlighting the potential for better stroke care and personalized medicine.
Background: Despite the proven effectiveness of endovascular therapy (EVT) in acute ischemic strokes (AIS) involving anterior circulation large vessel occlusions, isolated posterior cerebral artery (PCA) occlusions (iPCAo) remain underexplored in clinical trials. This study investigates the comparative effectiveness and safety of EVT against medical management (MM) in patients with iPCAo.
Methods: This multinational, multicenter propensity score-weighted study analyzed data from the Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy (MAD-MT) registry, involving 37 centers across North America, Asia, and Europe.
Cerebral vasospasm (CV) following aneurysmal subarachnoid hemorrhage (aSAH) may lead to morbidity and mortality. Endovascular mechanical angioplasty may be performed if symptomatic CV is refractory to noninvasive medical management. Compliant and noncompliant balloons and manually adjustable mesh may be used in this indication.
View Article and Find Full Text PDFArticle Synopsis
- The study aims to improve prediction of 90-day functional outcomes in ischemic stroke patients using a deep learning model that combines non-contrast CT images and clinical data, potentially aiding healthcare planning and clinical trials.
- The dataset included 1,335 patients from multiple trials and registries, and the model demonstrated superior accuracy in predicting outcomes compared to models using only imaging or clinical data alone.
- The fused model achieved a mean absolute error (MAE) of 0.94 for mRS score prediction and an AUC of 0.91 for identifying unfavorable outcomes, indicating it significantly outperforms existing methods.
Article Synopsis
- HARM is an indicator of blood-brain barrier damage linked to negative outcomes in patients suffering from acute ischemic stroke caused by blocked large blood vessels (AIS-LVO).
- The study investigated whether poor venous outflow (VO) is associated with higher rates of HARM in patients after thrombectomy, finding that patients with bad VO experienced significantly more HARM.
- Key findings showed that patients with poor VO had worse stroke severity scores, larger ischemic tissue damage, and a higher likelihood (31%) of developing HARM post-treatment compared to those with good VO (10%).
Background: Recent advances have highlighted the efficacy of endovascular thrombectomy (EVT) in patients with large ischemic core stroke, yet a significant portion still experience very poor outcomes, defined as a 90-day modified Rankin Score (mRS) of 5-6. This study aims to investigate the hypoperfusion intensity ratio (HIR) as a prognostic imaging parameter for these outcomes.
Methods: In a multicenter retrospective cohort study, data from consecutive patients undergoing EVT for acute ischemic stroke with large vessel occlusion (AIS-LVO) at two comprehensive stroke centers were analyzed.
Background: In patients with an acute ischemic stroke, the penumbra is defined as ischemic tissue that remains salvageable when reperfusion occurs. However, the expected clinical recovery congruent with penumbral salvage is not always observed.
Aims: We aimed to determine whether the magnetic resonance imaging (MRI)-defined penumbra includes irreversible neuronal loss that impedes expected clinical recovery after reperfusion.
Objectives: This study aimed to compare clinical and perfusion imaging profiles in acute ischemic stroke with large vessel occlusion (AIS-LVO) between patients with intracranial atherosclerotic disease (ICAD) and non-ICAD who underwent endovascular treatment (EVT).
Methods: Data from AIS-LVO patients over the anterior circulation undergoing EVT across two stroke centers were retrospectively analyzed. Clinical profiles and perfusion parameters from automated processing of perfusion imaging were compared between ICAD and non-ICAD groups.
Article Synopsis
- Medium vessel occlusion (MeVO) strokes, especially in the M2 segment of the middle cerebral artery, are a significant challenge in stroke management, necessitating effective prediction of patient outcomes after mechanical thrombectomy (MT).
- This study analyzed data from the MAD-MT registry to evaluate the relationship between follow-up infarct volume (FIV) and 90-day functional outcomes, using the modified Rankin Scale (mRS) as a measurement.
- Results showed that FIV is a strong predictor of outcomes, with specific volume thresholds indicating favorable prognosis; notably, an FIV of ≤15 ml had the best predictive capability, outperforming traditional recanalization scores.
Article Synopsis
- The study investigates the effectiveness and safety of two treatment methods for acute ischemic stroke (AIS) caused by distal medium vessel occlusion (DMVO): intravenous thrombolysis (IVT) with mechanical thrombectomy (MT) versus IVT alone.
- Data was collected from 37 centers worldwide, involving over 1,000 patients, with the primary focus on functional independence at 90 days and secondary outcomes including mortality and intracerebral hemorrhage.
- Findings suggest that both treatment options yield similar functional and mortality outcomes for DMVO patients, but the MT-IVT approach carries a higher risk of hemorrhagic complications, indicating that it may not provide significant advantages over IVT alone for every patient.
Article Synopsis
- Ischemic strokes from isolated posterior cerebral artery (PCA) occlusions, though representing only 5% of strokes, lead to severe quality of life issues due to vision problems and thalamic involvement, highlighting the need for better management guidelines.
- A study analyzed 32 patients with isolated PCA occlusions to assess the relationship between perfusion imaging parameters and clinical outcomes, using the NIH Stroke Scale (NIHSS) at discharge as the primary measure.
- Results indicated significant correlations between NIHSS scores and perfusion parameters, particularly time-to-maximum (Tmax) and cerebral blood volume (CBV), suggesting that advanced imaging may enhance PCA stroke management, necessitating further validated research in this area.
Article Synopsis
- * This study looked at how well doctors could tell if patients had DCI by looking at special brain images called perfusion maps, comparing those with patients who didn't have aSAH.
- * The results showed that the doctors were fairly good at diagnosing DCI, with around 65-78% accuracy, meaning they could spot problems pretty well most of the time.
Background: Deep venous outflow (VO) may be an important surrogate marker of collateral blood flow in acute ischemic stroke patients with a large vessel occlusion (AIS-LVO). Researchers have yet to determine the relationship between deep VO status in late-window patients and imaging measures of collaterals, which are key in preserving tissue.
Materials And Methods: We performed a multicenter retrospective cohort study on a subset of DEFUSE 3 patients recruited across 38 centers between May 2016 and May 2017 who underwent successful thrombectomy revascularization.