Publications by authors named "Mohammad R Afzal"
Background: With the increasing use of magnetic resonance imaging in the assessment of acute intracerebral hemorrhage, diffusion-weighted imaging hyperintense lesions have been recognized to occur at sites remote to the hematoma in up to 40% of patients. We investigated whether blood pressure reduction was associated with diffusion-weighted imaging hyperintense lesions in acute intracerebral hemorrhage and whether such lesions are associated with worse clinical outcomes by analyzing imaging data from a randomized trial.
Methods: We performed exploratory subgroup analyses in an open-label randomized trial that investigated acute blood pressure lowering in 1000 patients with intracerebral hemorrhage between May 2011 and September 2015.
Background: To determine the clinical outcome for intracerebral hemorrhage (ICH) patients with pre-existing renal failure in the United States.
Methods: We analyzed the data from Nationwide Inpatient Sample (2008-2012) for all ICH patients with or without pre-existing renal failure. Patients were identified using the International Classification of Disease, Ninth Revision, Clinical Modification codes.
Cerebral Microbleeds and the Effect of Intensive Blood Pressure Reduction on Hematoma Expansion and Functional Outcomes: A Secondary Analysis of the ATACH-2 Randomized Clinical Trial.
JAMA Neurol
July 2018
Importance: Response to intensive blood pressure (BP) lowering in acute intracerebral hemorrhage (ICH) might vary with the degree of underlying cerebral small vessel disease.
Objectives: To characterize cerebral microbleeds (CMBs) in acute ICH and to assess the potential for interaction between underlying small vessel disease (as indicated by CMB number and location) and assignment to acute intensive BP targeting for functional outcomes and hematoma expansion.
Design, Setting, And Participants: Preplanned subgroup analyses in the Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 (ATACH-2) trial were performed.
Vertebral Artery Origin Stent Placement Using the Dual Lumen Qureshi-Jiao Guidecatheter.
J Vasc Interv Neurol
December 2017
Objective: We report the first experience with a new dual lumen guide catheter with lumen A with curved tip designed for delivery of stent and angioplasty catheters and lumen B with side exit for coaxial placement of stiff 0.014 inch wire.
Methods: We prospectively determined technical success, intended procedure (stent delivery at target lesion and a final residual stenosis <30%) completed without a need for a different catheter, and technical ease, intended procedure completed without ≥3 unsuccessful attempts in patients with symptomatic vertebral artery origin stenosis.
Purpose: The CT angiography (CTA) spot sign is a strong predictor of hematoma expansion in intracerebral hemorrhage (ICH). However, CTA parameters vary widely across centers and may negatively impact spot sign accuracy in predicting ICH expansion. We developed a CT iodine calibration phantom that was scanned at different institutions in a large multicenter ICH clinical trial to determine the effect of image standardization on spot sign detection and performance.
View Article and Find Full Text PDFA Population-Based Study of the Incidence of Acute Spinal Cord Infarction.
J Vasc Interv Neurol
June 2017
Background: There is a paucity of reliable data regarding incidence of acute spinal cord infarction in population-based studies.
Objectives: To determine the incidence of acute spinal cord infarction using a population-based design.
Methods: Medical records and neuroimaging data of all patients with acute spinal cord infarction from Stearns and Benton Counties, Minnesota, between January 1, 2010 and May 31, 2014 were reviewed.
Objective: To validate various noncontrast CT (NCCT) predictors of hematoma expansion in a large international cohort of ICH patients and investigate whether intensive blood pressure (BP) treatment reduces ICH growth and improves outcome in patients with these markers.
Methods: We analyzed patients enrolled in the Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH-II) randomized controlled trial. Participants were assigned to intensive (systolic BP <140 mm Hg) vs standard (systolic BP <180 mm Hg) treatment within 4.
Importance: The computed tomographic angiography (CTA) spot sign is associated with intracerebral hemorrhage (ICH) expansion and may mark those patients most likely to benefit from intensive blood pressure (BP) reduction.
Objective: To investigate whether the spot sign is associated with ICH expansion across a wide range of centers and whether intensive BP reduction decreases hematoma expansion and improves outcome in patients with ICH and a spot sign.
Design, Setting, And Participants: SCORE-IT (Spot Sign Score in Restricting ICH Growth) is a preplanned prospective observational study nested in the Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH-II) randomized clinical trial.
Objective: To determine whether there is any differential benefit of albumin administration within 2 h of onset of ischemia and in settings (severe ischemia with reperfusion in cardioembolic strokes with National Institutes of Health Stroke Scale [NIHSS] ≥15), most representative of experimental models of cerebral ischemia in which albumin was effective in reducing neurological injury.
Background: High-dose intravenous (IV) albumin treatment for acute ischemic stroke (ALIAS) trial did not show overall clinical benefit in ischemic stroke patients in contrast to preclinical studies; however, models of preclinical studies were not completely followed.
Methods: A total of 1275 patients combined from ALIAS trials I and II were included in our analysis.
Importance: The risk of ischemic stroke during periods of warfarin discontinuation for surgical procedures is recognized but not well characterized.
Objective: The study aimed to quantitate the risk of ischemic stroke associated with high risk atrial fibrillation during periods of warfarin discontinuation.
Design, Setting And Participants: A cohort of 4,060 patients (mean follow-up period of 3.
Background: We developed and validated a new index to provide risk adjustment and to predict in-hospital patient mortality and other outcomes in patients undergoing carotid endarterectomy (CEA).
Methods: The primary endpoint was occurrence of stroke, cardiac complications, or death during hospitalization for CEA derived from the Nationwide Inpatient Sample. Multivariate logistic regression was performed to identify the effect of clinical and demographic factors on occurrence of the primary endpoint.
Background And Purpose: To identify the beneficial effects of primary stroke centers (PSCs) certification by Joint Commission (JC), we compared the rates of in-hospital adverse events and discharge outcomes among ischemic stroke patients admitted to PSCs and those admitted to non-PSC hospitals in the United States.
Methods: We obtained the data from the Nationwide Inpatient Sample from 2010 and 2011. The analysis was limited to states that publicly reported hospital identity.
Background: Lumbar catheter placement under fluoroscopic guidance may reduce the rate of technical failures and associated complications seen with insertion guided by manually palpable landmarks.
Methods: We reviewed our experience with 43 attempted lumbar catheter placements using paramedian approach under fluoroscopic guidance and ascertained rates of technical success, and clinical events.
Results: Among the 43 patients, 18, 1, and 1 patients were on aspirin (with dipyrimadole in 2), clopidogrel, and combination of both, respectively.
Background: There is a paucity of reliable recent data regarding epidemiology of intracerebral hemorrhage (ICH) of undetermined etiology in population-based studies.
Objectives: To determine the incidence and case fatality of ICH of undetermined etiology using a population-based design.
Methods: Medical records and neuroimaging data of all patients with ICH from Stearns and Benton Counties, Minnesota, between June 1st, 2012 and June 30th, 2014 were reviewed.
Objective: To determine the association between human immunodeficiency virus (HIV) infection and status epilepticus and compare the outcomes of patients with status epilepticus with or without underlying HIV infection.
Methods: Patients with primary diagnosis of status epilepticus (cases) and status asthmaticus (controls) were identified from the 2002-2009 Nationwide Inpatient Sample (NIS) which is representative of all admissions in the United States. We performed logistic regression analysis adjusting for age, gender, co-morbid conditions, including hypertension, diabetes mellitus (DM), renal failure, alcohol use, and opportunistic infections.
The past decade has witnessed a marked increase in the number of clinical trials of cardiac repair with adult bone marrow cells (BMCs). These trials included patients with acute myocardial infarction (MI) as well as chronic ischemic heart disease (IHD) and utilized different types of BMCs with variable numbers, routes of administration, and timings after MI. Given these differences in methods, the outcomes from these trials have been often disparate and controversial.
View Article and Find Full Text PDFBackground: The estimates of patients who present with transient ischemic attacks (TIA) in the emergency departments (EDs) of United States and their disposition and factors that determine hospital admission are not well understood.
Objective: We used a nationally representative database to determine the rate and predictors of admission in TIA patients presenting to EDs.
Methods: We analyzed data from the National Emergency Department Sample (2006-2008) for all patients presenting with a primary diagnosis of TIA in the United States.