Publications by authors named "Messe S"
Article Synopsis
- This study analyzed decisions regarding decompressive hemicraniectomy (DHC) and early withdrawal of life-sustaining therapy (WLST) in patients with large vessel occlusion (LVO) and large ischemic strokes from the SELECT2 trial.* -
- Among 352 patients, DHC was utilized in 55 patients, and WLST was chosen for 81, showing no significant differences in usage between those receiving endovascular thrombectomy (EVT) and those treated medically.* -
- About 21% of DHC patients were able to walk independently after one year, indicating that DHC did not negatively impact the benefits of thrombectomy, while WLST generally resulted in poor outcomes.*
Background: Patients with premorbid dementia have been generally excluded from trials of stroke therapies, and their dementia diagnosis may affect the care received. There are few data on the quality of stroke care and outcomes in these patients.
Methods: We compared the quality of care and outcomes for acute ischemic stroke patients with versus without premorbid dementia using national data from the Get With The Guidelines-Stroke registry between July 1, 2020, and December 31, 2021.
Article Synopsis
- Clinical trials indicate that using a mobile stroke unit (MSU) for prehospital management can lead to better outcomes for acute ischemic stroke patients who may need thrombolysis, but real-world data is limited.
- This study aimed to compare the effects of prehospital MSU management versus standard emergency services (EMS) on patient disability levels at the time of hospital discharge.
- The analysis included over 19,000 patients treated across multiple hospitals, revealing that those managed in an MSU had improved functional outcomes compared to those receiving standard EMS care.*
Background: The Get With The Guidelines-Stroke program is a quality improvement initiative designed to enhance adherence to evidence-based stroke care. Since its inception in 2003, over 2800 hospitals in the United States have participated in the program.
Methods: We examined patient characteristics, adherence to performance measures, and in-hospital outcomes in patients hospitalized for acute ischemic stroke, subarachnoid hemorrhage, intracerebral hemorrhage, and transient ischemic attack in The Get With The Guidelines-Stroke hospitals from 2003 through 2022.
Importance: Stroke treatment is exquisitely time sensitive. The door-in-door-out (DIDO) time, defined as the total time spent in the emergency department (ED) at a transferring hospital, is an important quality metric for the care of acute stroke. However, little is known about the contributions of specific process steps to delays and disparities in DIDO time.
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- The study examines the connection between acute brain injuries detected by diffusion-weighted MRI and stroke outcomes in patients who undergo transcatheter aortic valve replacement (TAVR).
- A total of 495 patients were analyzed, revealing that 85% experienced brain injuries, with a significant link between the total lesion volume and the occurrence of clinical strokes.
- The findings suggest that measuring the extent of brain injury could be important for predicting stroke risk and recovery in TAVR patients, indicating potential for enhancing stroke prevention strategies.
Objectives: Endovascular thrombectomy (EVT) dramatically improves clinical outcomes, but the reduction in final infarct volume only accounts for 10-15 % of the treatment benefit. We aimed to develop a novel MRI-ADC-based metric that quantify the degree of tissue injury to test the hypothesis that it outperforms infarct volume in predicting long-term outcome.
Materials And Methods: A single-center cohort consisted of consecutive acute stroke patients with anterior circulation large vessel occlusion, successful recanalization via EVT (mTICI ≥2b), and MRI of the brain between 12 h and 7 days post-EVT.
Importance: Intravenous alteplase (IV-tPA) can be administered to patients with acute ischemic stroke but is associated with symptomatic intracerebral hemorrhage (sICH). It is unclear if patients taking prestroke dual antiplatelet therapy (DAPT) are at higher risk of sICH.
Objective: To determine the associated risk of sICH in patients taking prestroke dual antiplatelet therapy receiving alteplase for acute ischemic stroke using propensity score matching analysis.
Article Synopsis
- The Get With The Guidelines-Stroke program is a major U.S. disease registry that has been improving stroke care and patient outcomes for 20 years.
- This narrative review covers the program's history, key achievements, and significant impacts on stroke care.
- It also explores future challenges and opportunities for enhancing the program over the next two decades.
Article Synopsis
- Larger perihematomal edema (PHE) volumes were linked to worse outcomes after intracerebral hemorrhage (ICH), with early expansion being notably greater in men than in women.
- A study analyzing data from the FAST trial found that while men and women had similar ICH and PHE volumes at baseline, men exhibited significantly larger volumes at 24 and 72 hours post-event.
- The research suggests that while sex plays a role in the volume trajectories of PHE, it is the expansion of PHE itself, rather than sex, that is a key factor in determining patient outcomes.
Article Synopsis
- * In a study of 3789 AIS patients, 300 had cTn measurements; those with a rising pattern had a significantly higher risk of 7-day mortality and unfavorable discharge compared to those with falling or stable levels.
- * The findings suggest that monitoring cTn patterns in AIS patients can help predict mortality risk and guide clinical decision-making.
Article Synopsis
- Intracerebral hemorrhage (ICH) is a highly lethal form of stroke, especially in patients on anticoagulants, prompting the development of new reversal strategies for anticoagulation.
- This study analyzes data from nearly 10,000 ICH patients treated at US hospitals to see how the timing of treatment (door-to-treatment or DTT times) affects patient outcomes after receiving reversal interventions.
- Results showed that a large portion of patients received reversal therapy, and specific DTT times were correlated with inpatient mortality and functional status, highlighting the importance of timely intervention in improving outcomes.
Background: Long-term rhythm monitoring to detect atrial fibrillation (AF) following a cryptogenic stroke (CS) is well established. However, the burden of organized atrial arrhythmias in this population is not well defined.
Objective: The purpose of this study was to assess the incidence and risk factors for organized atrial arrhythmias in patients with CS.
Background: Patients with ischemic stroke and concomitant COVID-19 infection have worse outcomes than those without this infection, but the impact of COVID-19 on hemorrhagic stroke remains unclear. We aimed to assess if COVID-19 worsens outcomes in intracerebral hemorrhage (ICH).
Methods And Results: We conducted an observational study of ICH outcomes using Get With The Guidelines Stroke data.
Article Synopsis
- * Patients who experience perioperative strokes face worse outcomes compared to those who have strokes in the community, including higher mortality rates and increased long-term disability.
- * There is a need for tailored clinical guidelines for perioperative strokes, as existing recommendations are primarily based on community strokes and may not fully address the unique aspects of strokes that occur in the hospital setting.
Approval, Evidence, and "Off-Label" Device Utilization: The Patent Foramen Ovale Closure Story.
Circ Cardiovasc Qual Outcomes
January 2024
Article Synopsis
- - The study analyzed off-label use of patent foramen ovale (PFO) closure across various conditions, like migraines and strokes, among patients with insurance from 2006 to 2019, finding that the procedure's use increased over time.
- - Out of 5,315 patients who underwent PFO closure, the majority (58.6%) were for stroke/systemic embolism, while a significant portion (almost 50%) received the procedure for unapproved indications, highlighting a disconnect with regulatory guidelines.
- - The findings suggest that PFO closure rates did not meaningfully align with clinical trial advancements or regulatory approvals, indicating a need for better coordination between regulators and payers to prioritize patient safety by encouraging use for
Objective: Although acute brain infarcts are common after surgical aortic valve replacement (SAVR), they are often unassociated with clinical stroke symptoms. The relationship between clinically "silent" infarcts and in-hospital delirium remains uncertain; obscured, in part, by how infarcts have been traditionally summarized as global metrics, independent of location or structural consequence. We sought to determine if infarct location and related structural connectivity changes were associated with postoperative delirium after SAVR.
View Article and Find Full Text PDFBackground: Secondary prevention of ischemic stroke (IS) requires adequate diagnostic evaluation to identify the likely etiologic subtype. We describe hospital-level variability in diagnostic testing and IS subtyping in a large nationwide registry.
Methods And Results: We used the GWTG-Stroke (Get With The Guidelines-Stroke) registry to identify patients hospitalized with a diagnosis of acute IS at 1906 hospitals between January 1, 2016, and September 30, 2017.
Objectives: Thrombectomy improves outcomes in patients with basilar artery (BA) occlusion. We hypothesized that the anatomic configuration of the BA bifurcation, classified as T- or Y-shaped, may impact the outcome as a T-shaped BA would involve more deep penetrating arteries of the midbrain and thalamus.
Materials And Methods: In this 2-center retrospective cohort study, we included patients with stroke due to distal BA occlusion and performed blinded classification of their BA distal bifurcation as either T- or Y-shaped.
Article Synopsis
- - The study evaluated the relationship between cerebral blood flow (CBF) and outcomes after endovascular therapy (EVT) for acute stroke using diffuse correlation spectroscopy (DCS) to monitor CBF in 40 patients.
- - Results showed that while successful recanalization was achieved in most patients, the amount of microvascular reperfusion did not directly correlate with infarct volume or functional outcomes; instead, smaller persistent CBF deficits were linked to better outcomes.
- - The findings suggest that monitoring CBF during EVT could help identify patients with inadequate reperfusion, allowing for more tailored post-treatment care to improve recovery.
Article Synopsis
- This study evaluates the quality of care for acute ischemic stroke patients receiving reperfusion therapies at thrombectomy-capable stroke centers (TSCs), primary stroke centers (PSCs), and comprehensive stroke centers (CSCs) between 2018 and 2020.
- It analyzed data from almost 85,000 patients, noting that the majority (73%) received endovascular thrombectomy (EVT) at CSCs, with CSCs also showing higher success rates in timely treatments and better clinical outcomes than PSCs.
- Findings indicated that patients at CSCs and TSCs had better odds of being discharged home or to rehabilitation, alongside lower chances of in-hospital mortality compared to those treated
Background Cardiovascular complications after acute ischemic stroke (AIS) can be related to chronic/comorbid cardiac conditions or acute disruption of the brain-heart autonomic axis (stroke-heart syndrome). Women are known to be more vulnerable to certain stress-induced cardiac complications, such as Takotsubo cardiomyopathy. We investigated sex differences in cardiac troponin (cTn) elevation, cardiac events, and outcomes after AIS.
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