A5056911306- Acute Ischemic Stroke Management
- Cerebrovascular and Carotid Artery Diseases
- Stroke Rehabilitation and Recovery
- Venous Thromboembolism Diagnosis and Management
- Peripheral Artery Disease Management
- Retinal Imaging and Analysis
- Intracranial Aneurysms: Treatment and Complications
- Glioma Diagnosis and Treatment
- Intracerebral and Subarachnoid Hemorrhage Research
- Medical Image Segmentation Techniques
- Radiomics and Machine Learning in Medical Imaging
- Glaucoma and retinal disorders
- Health disparities and outcomes
- Long-Term Effects of COVID-19
- Brain Metastases and Treatment
- Retinal and Optic Conditions
- Traumatic Brain Injury and Neurovascular Disturbances
- Telemedicine and Telehealth Implementation
- Cardiovascular Health and Risk Factors
- Neurological Disease Mechanisms and Treatments
- Cerebral Venous Sinus Thrombosis
- Reconstructive Surgery and Microvascular Techniques
- Health, Environment, Cognitive Aging
- Retinal Diseases and Treatments
- Advanced Neural Network Applications
The University of Texas Health Science Center at Houston
2020-2024
TESLA (Czechia)
2024
Importance Recent large infarct thrombectomy trials used heterogeneous imaging modalities and time windows for patient selection. Noncontrast computed tomographic (CT) scan is the most common stroke approach. It remains uncertain whether effective patients with infarcts identified using noncontrast CT alone within 24 hours of onset. Objective To evaluate effect in a on Design, Setting, Participants Open-label, blinded–end point, bayesian-adaptive randomized trial interim analyses early...
The benefit of endovascular stroke therapy (EVT) in large vessel occlusion (LVO) ischemic is highly time dependent. Process improvements to accelerate in-hospital workflows are critical.
Recent clinical trials have established the efficacy of endovascular stroke therapy and intravenous thrombolysis using advanced imaging, particularly computed tomography perfusion (CTP). The availability utilization CTP for patients hospitals that treat acute ischemic (AIS), however, is uncertain. We performed a retrospective cross-sectional analysis 2 complementary Medicare datasets, full sample Texas 5% national fee-for-service data from 2014 to 2017. AIS cases were identified...
Noncontrast head CT and perfusion (CTP) are both used to screen for endovascular stroke therapy (EST), but the impact of imaging strategy on likelihood EST is undetermined. Here, we examine influence CTP utilization in patients with large vessel occlusion (LVO).We identified acute ischemic at 4 comprehensive centers. All hospitals had 24/7 capability were covered by a single physician group (Neurology, NeuroIntervention, NeuroICU). centers performed noncontrast angiography initial...
Endovascular therapy (EVT) is a very effective treatment but relies on specialized capabilities that are not available in every hospital where acute ischemic stroke treated. Here, we assess whether access to and utilization of this has extended uniformly across racial ethnic groups.We conducted retrospective, population-based study using the 2019 Texas Inpatient Public Use Data File. Acute cases EVT use were identified International Classification Diseases, Tenth Revision (ICD-10) diagnosis...
Acute cerebral stroke is a leading cause of disability and death, which could be reduced with prompt diagnosis during patient transportation to the hospital. A portable retina imaging system enable this by measuring vascular information blood perfusion in and, due homology between retinal vessels, infer if underway. However, feasibility strategy, features, modalities do are not clear. In work, we show initial evidence approach training machine learning models using feature engineering...
CT Perfusion (CTP) predictions of infarct core play an important role in the determination treatment eligibility large vessel occlusion (LVO) acute ischemic stroke (AIS). Prior studies have demonstrated that blood glucose can affect cerebral flow (CBF). Here we examine influence and chronic hyperglycemia on CTP estimations core.
Background Prior studies on rupture risk of brain arteriovenous malformations (AVMs) in women undergoing pregnancy and delivery have reported conflicting findings, but also not accounted for AVM morphology heterogeneity. Here, we assess the association between intracranial hemorrhage (ICH) with AVMs using a cohort-crossover design which each woman serves as her own control. Methods Women who underwent were identified DRG codes from Healthcare Cost Utilization Project State Inpatient...
Acute ischemic stroke is a leading cause of death and disability in the world. Treatment decisions, especially around emergent revascularization procedures, rely heavily on size location infarct core. Currently, accurate assessment this measure challenging. While MRI-DWI considered gold standard, its availability limited for most patients suffering from stroke. Another well-studied imaging modality CT-Perfusion (CTP) which much more common than acute care, but not as precise MRI-DWI, it...
Background Prehospital routing of patients with large vessel occlusion (LVO) acute ischemic stroke (AIS) to centers capable performing endovascular therapy may improve clinical outcomes. Here, we explore whether distance comprehensive (CSCs), severity, and sex are associated direct‐to‐CSC prehospital in LVO AIS. Methods Results In this cross‐sectional study, identified consecutive AIS from a prospectively collected multihospital registry throughout the greater Houston area January 2019 June...
Background: Coronavirus disease 2019 (COVID-19) has been associated with coagulopathy, and D-dimer levels have used to predict severity. However, the role of in predicting mortality COVID-19 patients acute ischemic stroke (AIS) remains incompletely characterized. Methods: We conducted a retrospective cohort study using Optum® de-identified Electronic Health Record dataset. Patients were included if they 18 or older, had hospitalized within 7 days confirmed positivity from March 1, 2020...
In patients with large-vessel occlusion (LVO) acute ischemic stroke (AIS), determinations of infarct size play a key role in the identification candidates for endovascular therapy (EVT). An accurate, automated method to quantify at time presentation using widely available imaging modalities would improve screening EVT. Here, authors aimed compare performance three measures core presentation, including an machine learning.Patients LVO AIS who underwent successful EVT four comprehensive...
Background: Prehospital automated large vessel occlusion (LVO) detection in Mobile Stroke Units (MSUs) could accelerate identification and treatment of patients with LVO acute ischemic stroke. Here, we evaluate the performance a machine learning (ML) model on CT angiograms (CTAs) obtained from 2 MSUs to detect LVO. Methods: Patients evaluated Houston Los Angeles out-of-hospital CTAs were identified. Anterior circulation was defined as an intracranial internal carotid artery, middle cerebral...
Vessel segmentation in fundus images permits understanding retinal diseases and computing image-based biomarkers. However, manual vessel is a time-consuming process. Optical coherence tomography angiography (OCT-A) allows direct, non-invasive estimation of vessels. Unfortunately, compared to images, OCT-A cameras are more expensive, less portable, have reduced field view. We present an automated strategy relying on generative adversarial networks create vascular maps from without training...
Background Accelerating door‐in‐door‐out (DIDO) times at primary stroke centers (PSCs) for patients with large vessel occlusion (LVO) acute ischemic transferred possible endovascular therapy (EVT) is important to optimize outcomes. Here, we assess whether automated LVO detection coupled secure communication non‐EVT performing PSCs improves DIDO time and increases the proportion of receiving EVT after transfer. Methods From our prospectively collected multicenter registry, identified that...
Background There is substantial interest in adding endovascular stroke therapy (EST) capabilities community hospitals. Here, we assess the effect of transitioning to an EST-performing hospital (EPH) on acute ischemic (AIS) admissions a large system including academic and Methods From our prospectively collected multi-institutional registry, data AIS at 10 hospitals greater Houston area from January 2014 December 2022: one longstanding EPH (group A), three that transitioned EPHs November 2017...
Pleomorphic xanthoastrocytomas (PXA) are circumscribed gliomas that typically have a favorable prognosis. Limited studies revealed factors affecting survival outcomes in PXA. Here, we analyzed the largest PXA dataset literature and identify associated with outcomes.Using Surveillance, Epidemiology, End Results (SEER) 18 Registries database, identified histologically confirmed patients between 1994 2016. Overall (OS) was using Kaplan-Meier multivariable Cox proportional hazard models.In...
The optimal endovascular stroke therapy (EVT) care delivery structure is unknown. Here, we present our experience in creating an integrated system (ISS) to expand EVT availability throughout region while maintaining hospital and physician quality standards.We identified all consecutive patients with large vessel occlusion acute ischemic treated from January 2014 February 2019 health system. In October 2017, implemented the ISS, which 3 additional hospitals (4 total) became EVT-performing...
Fundus Retinal imaging is an easy-to-acquire modality typically used for monitoring eye health. Current evidence indicates that the retina, and its vasculature in particular, associated with other disease processes making it ideal candidate biomarker discovery. The development of these biomarkers has relied on predefined measurements, which makes process slow. Recently, representation learning algorithms such as general purpose convolutional neural networks or embeddings have been proposed...
Background The relationship between pass number during endovascular stroke therapy (EST) and outcomes in anterior circulation large vessel occlusion (LVO) acute ischemic (AIS) has been well studied. However, the association EST attempts for patients with posterior LVO remains unclear. Methods From our prospectively maintained multicenter registry, we identified consecutive AIS who underwent EST. of thrombectomy passes per‐pass reperfusion grades (thrombolysis cerebral infarction) were...
Scarcity of labels for medical images is a significant barrier training representation learning approaches based on deep neural networks. This limitation also present when using imaging data collected during routine clinical care stored in picture archiving communication systems (PACS), as these rarely have attached the high-quality required image computing tasks. However, extracted from PACS are commonly coupled with descriptive radiology reports that contain information and could be...
Background Unruptured cerebral aneurysms (UCAs) have a relatively low prevalence of ≈3%, but detection can prevent devastating consequences subarachnoid hemorrhage. Here, we assess the performance machine learning algorithm to identify UCAs and determine whether routine use improves patient care. Methods From prospectively maintained multicenter registry across 8 certified stroke centers (1 comprehensive 7 primary), identified patients who underwent computed tomography angiography for...
Background: First pass complete or near reperfusion defined as a modified Thrombolysis in Cerebral Infarction (mTICI) 2c/3 is the target for endovascular thrombectomy (EVT). Here, we examine whether additional passes patients who achieve first mTICI 2b, order to attain 2c/3, improve clinical outcomes. Methods: From our prospectively maintained institutional registry at 4 comprehensive stroke centers, identified treated with EVT (11/2017-12/2021). Per-pass grades were recorded time of...