A5010454283- Acute Ischemic Stroke Management
- Traumatic Brain Injury and Neurovascular Disturbances
- Cerebrovascular and Carotid Artery Diseases
- Intracranial Aneurysms: Treatment and Complications
- Venous Thromboembolism Diagnosis and Management
- Intracerebral and Subarachnoid Hemorrhage Research
- Peripheral Artery Disease Management
- Stroke Rehabilitation and Recovery
- Neurosurgical Procedures and Complications
- Blood Pressure and Hypertension Studies
- Optical Imaging and Spectroscopy Techniques
- Pregnancy and preeclampsia studies
- Neurological Disease Mechanisms and Treatments
- Advanced MRI Techniques and Applications
- Cardiac Arrest and Resuscitation
- Cerebrospinal fluid and hydrocephalus
- Heart Rate Variability and Autonomic Control
- Hemodynamic Monitoring and Therapy
- Augmented Reality Applications
- Cardiovascular Health and Risk Factors
- Cardiovascular Health and Disease Prevention
- Radiomics and Machine Learning in Medical Imaging
- Cardiac Valve Diseases and Treatments
- Cardiac, Anesthesia and Surgical Outcomes
- S100 Proteins and Annexins
Yale University
2016-2025
Yale New Haven Hospital
2016-2024
United Nations Economic and Social Commission for Asia and the Pacific
2021-2024
Universidad Científica del Sur
2024
University of Iowa Hospitals and Clinics
2024
Massachusetts General Hospital
2012-2023
Massachusetts Institute of Technology
2023
Athinoula A. Martinos Center for Biomedical Imaging
2023
University of Utah
2023
Brown University
2023
Neuroimaging is a key step in the clinical evaluation of brain injury. Conventional magnetic resonance imaging (MRI) systems operate at high-strength fields (1.5-3 T) that require strict, access-controlled environments. Limited access to timely neuroimaging remains structural barrier effectively monitor occurrence and progression neurological injury intensive care settings. Recent advances low-field MRI technology have allowed for acquisition clinically meaningful outside radiology suites...
Abstract Radiological examination of the brain is a critical determinant stroke care pathways. Accessible neuroimaging essential to detect presence intracerebral hemorrhage (ICH). Conventional magnetic resonance imaging (MRI) operates at high field strength (1.5–3 T), which requires an access-controlled environment, rendering MRI often inaccessible. We demonstrate use low-field (0.064 T) for ICH evaluation. Patients were imaged using conventional (non-contrast computerized tomography (CT) or...
Brain imaging is essential to the clinical management of patients with ischemic stroke. Timely and accessible neuroimaging, however, can be limited in stroke pathways. Here, portable magnetic resonance (pMRI) acquired at very low field strength (0.064 T) used obtain actionable bedside neuroimaging for 50 confirmed Low-field pMRI detected infarcts 45 (90%) across cortical, subcortical, cerebellar structures. Lesions as small 4 mm were captured. Infarcts appeared hyperintense regions on...
Approximately 10% to 20% of large vessel occlusion (LVO) strokes involve tandem lesions (TLs), defined as concomitant intracranial LVO and stenosis or the cervical internal carotid artery. Mechanical thrombectomy (MT) may benefit patients with TLs; however, optimal management procedural strategy lesion remain unclear.
Background and Purpose— Successful reperfusion can be achieved in more than two-thirds of patients treated with mechanical thrombectomy. Therefore, it is important to understand the effect blood pressure (BP) on clinical outcomes after successful reperfusion. In this study, we investigated relationship between BP admission during first 24 hours outcomes. Methods— This was a multicenter study from 10 comprehensive stroke centers. To ensure homogeneity studied cohort, included only anterior...
Background and Purpose— After large-vessel intracranial occlusion, the fate of ischemic penumbra, ultimately final infarct volume, largely depends on tissue perfusion. In this study, we evaluated whether blood pressure reduction sustained relative hypotension during endovascular thrombectomy are associated with progression functional outcome. Methods— We identified consecutive patients occlusion stroke who underwent mechanical at 2 comprehensive centers. Intraprocedural mean arterial (MAP)...
The mechanisms linking systemic inflammation to poor outcome in ischemic stroke are not fully understood. authors investigated if peripheral following reperfusion therapy leads an increase cerebral edema (CED), thus hindering the clinical recovery.We designed a single-center study conducted at Centro Hospitalar Universitário São João between 2017 and 2019. Inclusion criteria were being adult, having anterior circulation acute stroke, receiving therapy. Neutrophil-to-lymphocyte,...
Dynamic cerebral autoregulation (DCA) is the continuous counterregulation of blood flow to fluctuations in pressure. DCA can become impaired after acute stroke, but it remains unclear what extent and over interval this occurs.We included 28 patients (NIHSS = 12 ± 6.5, age 68.4 17.1, 16F) with large-vessel ischemic stroke middle artery territory 29 healthy controls (mean 54.9 9, 16F). was assessed by simultaneous measurement pressure together velocities using finger plethysmography/arterial...
Background: Anecdotal reports suggest fewer patients with stroke symptoms are presenting to hospitals during the coronavirus disease 2019 (COVID-19) pandemic. We quantify trends in code calls and treatments at 3 Connecticut local emergence of COVID-19 examine patient characteristics process measures a Comprehensive Stroke Center (CSC) before Methods: activity was analyzed from January 1 April 28, 2020, corresponding dates 2019. Piecewise linear regression spline models identified when codes...
Background and Purpose— Loss of cerebral autoregulation in the acute phase ischemic stroke leaves patients vulnerable to blood pressure (BP) changes. Effective BP management after endovascular thrombectomy may protect brain from hypoperfusion or hyperperfusion. In this observational study, we compared personalized, autoregulation-based targets static systolic thresholds. Methods— We prospectively enrolled 90 undergoing for stroke. Autoregulatory function was continuously measured by...
Hematoma expansion (HE) is a modifiable risk factor and potential treatment target in patients with intracerebral hemorrhage (ICH). We aimed to train validate deep-learning models for high-confidence prediction of supratentorial ICH expansion, based on admission non-contrast head Computed Tomography (CT). Applying Monte Carlo dropout entropy model predictions, we estimated the uncertainty identified at high HE confidence. Using receiver operating characteristics area under curve (AUC),...
Elevated systolic blood pressure (SBP) after successful revascularization (SR) via endovascular therapy (EVT) is a known predictor of poor outcome. However, the optimal SBP goal following EVT still unknown. Our objective was to compare functional and safety outcomes between different goals with SR.This international multicenter study included 8 comprehensive stroke centers patients anterior circulation large vessel occlusion who were treated achieved SR. SR defined as modified thrombolysis...
<h3>Objective:</h3> To understand the physiologic basis of impaired cerebral autoregulation in subarachnoid hemorrhage (SAH) and its relationship to neurologic outcomes. <h3>Methods:</h3> The cohort included 121 patients with nontraumatic SAH admitted a neurointensive critical care unit from March 2010 May 2015. Vasospasm was ascertained digital subtraction angiography delayed ischemia (DCI) defined as new infarction on high-resolution CT. Cerebral blood flow beat-by-beat pressure were...
We aimed to determine whether subjects aged ≤70 years who were treated with intravenous glyburide (RP-1127; BIIB093; glibenclamide) would have better long-term outcomes than those received placebo.GAMES-RP (Glyburide Advantage in Malignant Edema and Stroke-Remedy Pharmaceuticals) was a prospective, double-blind, randomized, placebo-controlled phase 2 clinical trial. Eighty-six participants, 18 80 years, presented centers large hemispheric infarction (baseline diffusion-weighted imaging...
We aim to examine effects of collateral status and post-thrombectomy reperfusion on final infarct distribution early functional outcome in patients with anterior circulation large vessel occlusion ischemic stroke.Patients who underwent endovascular intervention were included this study. All had baseline computed tomography angiography follow-up magnetic resonance imaging. Collateral was graded according the criteria proposed by Miteff et al assessed using modified Thrombolysis Cerebral...
Abstract Neuroimaging is crucial for assessing mass effect in brain-injured patients. Transport to an imaging suite, however, challenging critically ill We evaluated the use of a low magnetic field, portable MRI (pMRI) midline shift (MLS). In this observational study, 0.064 T pMRI exams were performed on stroke patients admitted neuroscience intensive care unit at Yale New Haven Hospital. Dichotomous (present or absent) and continuous MLS measurements obtained locally available accessible...
Surgical and catheter-based cardiovascular procedures adjunctive pharmacology have an inherent risk of neurological complications. The current diversity endpoint definitions ascertainment methods in clinical trials has led to uncertainties the attributable inconsistent evaluation therapies intended prevent or mitigate injury. Benefit-risk assessment such should be on basis well-defined outcomes that are ascertained with consistent capture full spectrum neurovascular injury its effect....
Background Elevated systolic blood pressure (SBP) after mechanical thrombectomy (MT) correlates with worse outcome. However, the association between SBP reduction (SBPr) and outcome successful reperfusion MT is not well established. Objective To investigate SBPr in first 24 hours functional safety outcomes of MT. Methods A multicenter retrospective study, which included 10 comprehensive stroke centers, was carried out. Patients acute ischemic anterior circulation large vessel occlusions who...