Bruce Ovbiagele

Rancho Los Amigos Rehabilitation Center, Downey, California, United States

Are you Bruce Ovbiagele?

Claim your profile

Publications (323)1701.72 Total impact

  • Bruce Ovbiagele
    09/2015; 1(1):10-11. DOI:10.1016/j.ensci.2015.08.003
  • [Show abstract] [Hide abstract]
    ABSTRACT: Endovascular treatment is increasingly being used in acute stroke care. However, although stent retrievers show improved flow restoration rates, their clinical benefits have been uncertain. To assess the incremental effect of using stent retrievers compared with intravenous tissue plasminogen activator (IV tPA; alteplase) alone or placebo/control. We conducted a pooled analysis of 4 studies using stent retrievers (Solitaire), IV tPA, or placebo/control. We applied the ischemic stroke risk score ( to each participant to adjust for differences in baseline characteristics. We used a shift analysis to account for the potential benefits across the entire modified Rankin scale score at 90 days, adjusting for time-to-treatment, baseline Alberta Stroke Program Early CT score, and ischemic stroke risk score. Of the 915 participants in this analysis, 312 (34.1%) patients received placebo, 312 (34.1%) received tPA alone, 131 (14.4%) received stent retrievers alone, and 160 (17.5) received combined therapy (IV tPA plus stent retrievers). The shift analysis revealed that more patients remained independent at 90 days if receiving stent retrievers alone (number needed to treat 3.5) or combined with tPA (number needed to treat 3.1) compared with tPA alone. After adjustment, participants receiving stent retrievers alone (odds ratio, 2.95; 95% confidence interval, 1.48-5.89) or combined with tPA (odds ratio, 4.45; 95% confidence interval, 2.40-8.27) were more likely to be independent at 90 days compared with tPA alone. Patients with acute ischemic stroke who received IV tPA or revascularization therapies had a higher likelihood of achieving independence at 3 months. Stent retriever technology combined with tPA was associated with the greatest benefit compared with placebo, tPA alone, or endovascular therapy alone. ASPECTS, the Alberta Stroke Program Early CT scoreESCAPE, The Endovascular Treatment for Small Core and Proximal Occlusion Ischemic StrokeiScore, ischemic stroke risk scoreIV, intravenousMR CLEAN, Multicenter Randomized Clinical trial of Endovascular treatment for Acute ischemic stroke in the NetherlandsmRS, modified Rankin scaleNIHSS, National Institutes of Health Stroke ScaleNINDS, National Institute of Neurological Diseases and StrokesICH, symptomatic intracerebral hemorrhageSTAR, the Solitaire Flow Restoration Thrombectomy for Acute RevascularizationSWIFT, Solitaire flow restoration device vs the Merci Retriever in patients with acute ischemic stroketPA, tissue plasminogen activator (alteplase)WHO, World Health Organization.
    Neurosurgery 09/2015; 77(3):454-61. DOI:10.1227/NEU.0000000000000826 · 3.62 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: As the second leading cause of death and the leading cause of adult-onset disability, stroke is a major public health concern particularly pertinent in Sub-Saharan Africa (SSA), where nearly 80% of all global stroke mortalities occur, and stroke burden is projected to increase in the coming decades. However, traditional and emerging risk factors for stroke in SSA have not been well characterized, thus limiting efforts at curbing its devastating toll. The Stroke Investigative Research and Education Network (SIREN) project is aimed at comprehensively evaluating the key environmental and genomic risk factors for stroke (and its subtypes) in SSA while simultaneously building capacities in phenomics, biobanking, genomics, biostatistics, and bioinformatics for brain research. SIREN is a transnational, multicentre, hospital and community-based study involving 3,000 cases and 3,000 controls recruited from 8 sites in Ghana and Nigeria. Cases will be hospital-based patients with first stroke within 10 days of onset in whom neurovascular imaging will be performed. Etiological and topographical stroke subtypes will be documented for all cases. Controls will be hospital- and community-based participants, matched to cases on the basis of gender, ethnicity, and age (±5 years). Information will be collected on known and proposed emerging risk factors for stroke. Study Significance: SIREN is the largest study of stroke in Africa to date. It is anticipated that it will shed light on the phenotypic characteristics and risk factors of stroke and ultimately provide evidence base for strategic interventions to curtail the burgeoning burden of stroke on the sub-continent. © 2015 S. Karger AG, Basel.
    Neuroepidemiology 08/2015; 45(2):73-82. DOI:10.1159/000437372 · 2.56 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Accumulating data based on model-derived estimates suggest rising rates of stroke in sub-Saharan Africa over the next several decades. Stroke is a leading cause of death, disability, and dementia worldwide. Directly enumerated hospital-based data on the longitudinal trajectory of stroke admissions and deaths in sub-Saharan Africa could help hospital administrators, public health officials, and government policy-makers with planning and utilization of scarce resources. To evaluate 30-year trends in stroke admission and mortality rates in central Ghana. We undertook a retrospective analysis of data on stroke admissions and mortality at a tertiary referral hospital in central Ghana between 1983 and 2013. Rates of stroke admissions and mortality were expressed as stroke admissions or deaths divided by total number of hospital admissions or deaths respectively. Yearly crude case fatality from stroke was calculated and predictors of stroke mortality were determined using Cox proportional hazards regression analysis. Over the period, there were 12,233 stroke admissions with equal gender distribution. The rate of stroke admissions increased progressively from 5.32/1000 admissions in 1983 to 13.85/1000 admissions in 2010 corresponding to a 260% rise over the period. Stroke mortality rates also increased from 3.40/1000 deaths to 6.66/1000 deaths over the 30-year period. The average 28-day mortality over the period was 41.1%. Predictors of in-patient mortality were increasing age-aHR of 1.31 (1.16-1.47) for age>80years compared with <40years and admissions in 2000's compared with 1980's; aHR of 1.32 (1.26-1.39). Of the 1132 stroke patients with neuroimaging data: 569 (50.3%) had intracerebral hemorrhage, 382 (33.7%) had ischemic stroke and 181 (16.0) had sub-arachnoid hemorrhage. Patients with ischemic stroke were significantly older than those with ICH and SAH respectively. Rates of stroke admission and mortality have increased steadily over the past three decades in central Ghana. More intensive risk modification and optimization of acute stroke care are urgently needed to stem these worrisome trends. Copyright © 2015. Published by Elsevier B.V.
    Journal of the neurological sciences 08/2015; DOI:10.1016/j.jns.2015.07.043 · 2.47 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this guideline is to provide a focused update of the current recommendations for the endovascular treatment of acute ischemic stroke. Where there is overlap, the recommendations made here supersede those of previous guidelines. This focused update analyzes results from 8 randomized clinical trials of endovascular treatment and other relevant data published since 2013. It is not intended to be a complete literature review from the date of the previous guideline publication but rather to include pivotal new evidence that justifies changes in current recommendations. Members of the writing committee were appointed by the American Heart Association/American Stroke Association Stroke Council's Scientific Statement Oversight Committee and the American Heart Association/American Stroke Association Manuscript Oversight Committee (MOC). Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Recommendations follow the American Heart Association/American Stroke Association methods of classifying the level of certainty of the treatment effect and the class of evidence. Prerelease review of the draft guideline was performed by 6 expert peer reviewers and by the members of the Stroke Council Scientific Statement Oversight Committee and Stroke Council Leadership Committee. Evidence-based guidelines are presented for the selection of patients with acute ischemic stroke for endovascular treatment, the endovascular procedure and for systems of care to facilitate endovascular treatment. Certain endovascular procedures have been demonstrated to provide clinical benefit in selected patients with acute ischemic stroke. Systems of care should be organized to facilitate the delivery of this care. © 2015 American Heart Association, Inc.
    Stroke 06/2015; DOI:10.1161/STR.0000000000000074 · 5.72 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Lack of insurance is a barrier to optimal stroke risk factor control but data on its long-term impact on stroke outcomes are sparse. We assessed the association between health insurance and long-term mortality after stroke. Using data from the National Health and Nutrition Examination Surveys 1999-2004 with follow-up mortality assessment through 2006, we examined the independent effect of health insurance on (1) stroke mortality among all adult participants (n = 15,049) and (2) vascular and all-cause mortality rates among participants with self-reported stroke (n = 563). Among individuals without a previous stroke, uninsured individuals aged less than 65 years were more likely to die of stroke than those with insurance (adjusted hazard ratio [HR], 3.13; 95% confidence interval [CI], .96-10.23); however, among those aged 65 years or older, those with private insurance, private plus Medicare, or Medicare plus Medicaid had similar risk of stroke mortality when compared to those with Medicare alone. Stroke survivors aged 65 years or older with private insurance were less likely to die from vascular causes (adjusted HR, .38; 95% CI, .23-.63) compared to those with Medicare alone. For stroke survivors aged less than 65 years, uninsured individuals had similar all-cause mortality rates compared to their counterparts with insurance. Insurance status influences risk of dying from a stroke in the general population, as well as long-term mortality rates among stroke survivors in the United States, but these relationships vary by age. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.
    Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 06/2015; 24(8). DOI:10.1016/j.jstrokecerebrovasdis.2015.05.007 · 1.67 Impact Factor
  • Jong-Ho Park · Bruce Ovbiagele
    [Show abstract] [Hide abstract]
    ABSTRACT: Optimal combination of secondary stroke prevention treatment including antihypertensives, antithrombotic agents, and lipid modifiers is associated with reduced recurrent vascular risk including stroke. It is unclear whether optimal combination treatment has a differential impact on stroke patients based on level of vascular risk. We analyzed a clinical trial dataset comprising 3680 recent non-cardioembolic stroke patients aged ≥35years and followed for 2years. Patients were categorized by appropriateness levels 0 to III depending on the number of the drugs prescribed divided by the number of drugs potentially indicated for each patient (0=none of the indicated medications prescribed and III=all indicated medications prescribed [optimal combination treatment]). High-risk was defined as having a history of stroke or coronary heart disease (CHD) prior to the index stroke event. Independent associations of medication appropriateness level with a major vascular event (stroke, CHD, or vascular death), ischemic stroke, and all-cause death were analyzed. Compared with level 0, for major vascular events, the HR of level III in the low-risk group was 0.51 (95% CI: 0.20-1.28) and 0.32 (0.14-0.70) in the high-risk group; for stroke, the HR of level III in the low-risk group was 0.54 (0.16-1.77) and 0.25 (0.08-0.85) in the high-risk group; and for all-cause death, the HR of level III in the low-risk group was 0.66 (0.09-5.00) and 0.22 (0.06-0.78) in the high-risk group. Optimal combination treatment is related to a significantly lower risk of future vascular events and death among high-risk patients after a recent non-cardioembolic stroke. Copyright © 2015 Elsevier B.V. All rights reserved.
    Journal of the neurological sciences 05/2015; 355(1-2). DOI:10.1016/j.jns.2015.05.028 · 2.47 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Elevated blood pressure is common in acute stage of ischemic stroke and the strategy to manage this situation is not well established. We therefore conducted a meta-analysis of randomized controlled trials comparing active blood pressure lowering and control groups in early ischemic stroke. Pubmed, EMBASE, and from January 1966 to March 2015 were searched to identify relevant studies. We included randomized controlled trials with blood pressure lowering started versus control within 3 days of ischemic stroke onset. The primary outcome was unfavorable outcome at 3 months or at trial end point, defined as dependency or death, and the key secondary outcome was recurrent vascular events. Pooled relative risks and 95% confidence intervals were calculated using random-effects model. The systematic search identified 13 randomized controlled trials with 12 703 participants comparing early blood pressure lowering and control. Pooling the results with the random-effects model showed that blood pressure lowering in early ischemic stroke did not affect the risk of death or dependency at 3 months or at trial end point (relative risk, 1.04; 95% confidence interval, 0.96-1.13; P=0.35). Also, blood pressure lowering also had neutral effect on recurrent vascular events, as well as on disability or death, all-cause mortality, recurrent stroke, and serious adverse events. This meta-analysis suggested blood pressure lowering in early ischemic stroke had a neutral effect on the prevention of death or dependency. © 2015 American Heart Association, Inc.
    Stroke 05/2015; 46(7). DOI:10.1161/STROKEAHA.115.009552 · 5.72 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Qualitative methods are becoming widely used and increasingly accepted in biomedical research involving teams formed by experts from developing and developed practice environments. Resources are rare in offering guidance on how to surmount challenges of team integration and resolution of complicated logistical issues in a global setting. In this article we present a critical reflection of lessons learned and necessary steps taken to achieve methodological coherence and international team synergy. A series of 10 pretest interviews were conducted to assess instrumentation rigor and formulate measures to address any limitations or threats to bias and management procedures before carrying out the formal phase of qualitative research, contributing to an evidence-based stroke-preventive care clinical trial study. The experience of pretesting notably helped to identify obstacles and thus increase the methodological and social reliability central to conducting credible qualitative research, while also ensuring both personal and professional fulfillment of our team members.
    The International Journal of Qualitative Methods 04/2015; 14(2015):53-64.
  • Journal of the American Society of Hypertension 04/2015; 9(4):e121. DOI:10.1016/j.jash.2015.03.280 · 2.61 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Few studies have examined the actual hospital arrival mode, emergency department (ED) care processes, and early outcomes in Hispanic vs non-Hispanic acute ischemic stroke (AIS) patients. We evaluated processes and prognosis by Hispanic ethnicity among AIS patients encountered in urban setting. We retrospectively reviewed prospectively-collected data on 1,117 AIS patients presenting within 12 hours of ictus to five hospitals in a tertiary-level stroke center network in San Diego, California. Variables of interest included pre-hospital factors, ED care processes, and favorable outcome (day-90 modified Rankin Scale [mRS] score of 0-1); all of which were adjusted for pre-specified covariates in a multivariable logistic regression model. There were 192 Hispanic AIS patients (17.2% of cohort) encountered from June 2004 to March 2011. Hispanic patients were significantly more likely to be younger, female, and diabetic. Hispanic patients arrived by ambulance (vs other arrival modes) less frequently (adjusted OR .56; 95% CI: .38-.81), trended toward a longer time of stroke onset to treatment decision (351.6 vs. 320.02 minutes, P=.07), and experienced a favorable day-90 outcome less often (adjusted OR .52, CI: .28-.96). However, for the day-90 outcome, there was no interaction between ambulance arrival and Hispanic ethnicity (P=.5614). Hispanic AIS patients in this study were less likely to arrive at the hospital by ambulance, and experienced half the odds of a favorable outcome compared to others. Strategies to boost ambulance utilization among Hispanic AIS patients and identify contributors to this worrisome outcome disparity are needed.
    Ethnicity & disease 03/2015; 25(1):19-23. · 1.00 Impact Factor
  • Jong-Ho Park · Bruce Ovbiagele
    [Show abstract] [Hide abstract]
    ABSTRACT: There is a well-established relation of symptom severity with functional status and mortality after an index stroke. However, little is known about the impact of symptom severity of a recent index stroke on risk of recurrent vascular events. We reviewed the data set of a multicenter trial involving 3680 recent noncardioembolic stroke patients aged 35 years or older and followed for 2 years. Independent associations of stroke severity (as measured by National Institutes of Health Stroke Scale [NIHSS] score) with recurrent stroke (primary outcome) and stroke/coronary heart disease (CHD)/vascular death (secondary outcome) were analyzed. NIHSS score was analyzed as a dichotomous (<4 versus ≥4) and a continuous variable. Among study subjects, 550 (15%) had NIHSS scores of 4 or more (overall scores ranged from 0 to 18, median score was 1 [25th-75th percentile 0-2]). NIHSS was measured at a median of 35 days after the index stroke. After adjusting for multiple covariates, NIHSS of 4 or more was independently linked to a higher risk of recurrent stroke (hazard ratio [HR], 1.37; 95% confidence interval [CI], 1.01-1.84) and risk of stroke/CHD/vascular death (HR, 1.32; 95% CI, 1.07-1.64). Analysis of NIHSS score as a continuous variable also showed a higher risk of recurrent stroke (HR, 1.06; 95% CI, 1.00-1.12) and stroke/CHD/vascular death (HR, 1.05; 95% CI, 1.01-1.09) with increasing index stroke symptom severity. Greater residual symptom severity after a recent stroke is associated with higher risk of recurrent vascular events. Future studies are needed to confirm this relationship and to clarify its underlying mechanisms. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.
    Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 03/2015; 24(5). DOI:10.1016/j.jstrokecerebrovasdis.2014.12.033 · 1.67 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Recent studies suggest a J-shaped association between systolic blood pressure (SBP) and cardiovascular events. The optimal SBP target after stroke remains unknown. We assessed the link between SBP and mortality after stroke. We included adults (≥20 years) with self-reported stroke who participated in the National Health and Nutrition Examination Surveys 1998 to 2004, with mortality assessment in 2006. Baseline SBP was categorized as low to normal (<120 mm Hg), normal (120-140 mm Hg), and high (≥140 mm Hg). Independent relationships between baseline SBP and all-cause and vascular mortality were assessed using Cox proportional hazards. Of 31 126 adult participants, 455 had self-reported stroke and baseline BP readings: 19% had low to normal, 31% had normal, and 50% had high SBP. Two years after assessment, the low to normal SBP group tended to have the highest cumulative all-cause mortality (11.5%), compared with mortality rates of 8.5% and 7.5% in the normal and high SBP groups, respectively. Similar patterns were seen with vascular mortality. After adjusting for covariates, compared with the high SBP group, the low to normal group had higher all-cause mortality (adjusted hazard ratio, 1.96; 95% confidence interval, 1.13-3.39; P=0.017) and trended toward higher vascular mortality (adjusted hazard ratio, 2.08; 95% confidence interval, 0.93-4.68; P=0.075). Compared with the normal BP group, the risk of all-cause and vascular mortality trended higher in low to normal BP group but did not achieve statistical significance. After stroke, compared with SBP in the high range, low to normal SBP is associated with poorer mortality outcomes. © 2015 American Heart Association, Inc.
    Stroke 03/2015; 46(5). DOI:10.1161/STROKEAHA.115.008821 · 5.72 Impact Factor
  • Walter N Kernan · Bruce Ovbiagele · Steven J Kittner
    Stroke 03/2015; 46(4). DOI:10.1161/STROKEAHA.115.008661 · 5.72 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Information on the current burden of stroke in Africa is limited. The aim of this review was to comprehensively examine the current and projected burden of stroke in Africa. We systematically reviewed the available literature (PubMed and AJOL) from January 1960 and June 2014 on stroke in Africa. Percentage change in age-adjusted stroke incidence, mortality and disability-adjusted life years (DALYs) for African countries between 1990 and 2010 were calculated from the Global Burden of Diseases (GBD) model-derived figures. Community-based studies revealed an age-standardised annual stroke incidence rate of up to 316 per 100 000 population, and age-standardised prevalence rates of up to 981 per 100 000. Model-based estimates showed significant mean increases in age-standardised stroke incidence. The peculiar factors responsible for the substantial disparities in incidence velocity, ischaemic stroke proportion, mean age and case fatality compared to high-income countries remain unknown. While the available study data and evidence are limited, the burden of stroke in Africa appears to be increasing.
    03/2015; 26(2 Suppl 1):S27-38. DOI:10.5830/CVJA-2015-038
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: One in six people worldwide will experience a stroke in his/her lifetime. While people in Africa carry a disproportionately higher burden of poor stroke outcomes, compared to the rest of the world, the exact contribution of genomic factors to this disparity is unknown. Despite noteworthy research into stroke genomics, studies exploring the genetic contribution to stroke among populations of African ancestry in the United States are few. Furthermore, genomics data in populations living in Africa are lacking. The wide genomic variation of African populations offers a unique opportunity to identify genomic variants with causal relationships to stroke across different ethnic groups. The Stroke Investigative Research and Educational Network (SIREN), a component of the Human Health and Heredity in Africa (H3Africa) Consortium, aims to explore genomic and environmental risk factors for stroke in populations of African ancestry in West Africa and the United States. In this article, we review the literature on the genomics of stroke with particular emphasis on populations of African origin.
    03/2015; 26(2 Suppl 1):S39-49. DOI:10.5830/CVJA-2015-039
  • Jong-Ho Park · Bruce Ovbiagele · Wuwei Feng
    [Show abstract] [Hide abstract]
    ABSTRACT: Sexual function is an essential part of quality of life in adults. However, sexual dysfunction (SD) in stroke survivors is a common but under-recognized complication after stroke. It is frequently neglected by patients and clinicians. The etiology of post-stroke SD, which is multifactorial includes anatomical, physical and psychological factors. Complete return of sexual function is an important target for functional recovery after stroke, so clinicians need to be aware of this issue and take a lead role in addressing this challenge in stroke survivors. Accurate diagnosis and prompt treatment of post-stroke SD should be routinely incorporated into comprehensive stroke rehabilitation. This narrative review article, outlines the anatomy and physiology of sexual function, discusses various factors contributing to post-stroke SD, and proposes directions for future research. Copyright © 2015 Elsevier B.V. All rights reserved.
    Journal of the Neurological Sciences 02/2015; 350(1-2). DOI:10.1016/j.jns.2015.02.001 · 2.47 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Although several randomized controlled trials failed to show a benefit of B vitamin therapy on composite outcomes of cardiovascular death, myocardial infarction, and stroke among individuals with elevated homocysteine, recent post hoc analyses have suggested that several factors may interact with the effects of vitamin treatment. One post hoc analysis revealed an interaction between B vitamin therapy and antiplatelet use; however, those results have not been replicated in other studies or populations. We conducted a post hoc analysis of the Vitamin Intervention for Stroke Prevention (VISP) trial, a randomized controlled trial evaluating treatment with high- versus low-dose B vitamin therapy for secondary prevention of vascular events among stroke survivors with elevated homocysteine. Cox regression models were used to assess primary (recurrent stroke) and secondary (stroke, myocardial infarction, or vascular death) outcomes among individuals on high- versus low-dose vitamin therapy, categorized by antiplatelet use, after adjusting for covariates. Among 3680 participants, 52% took antiplatelet medications. When compared with low-dose therapy, high-dose vitamin therapy was associated with higher stroke risk among individuals on antiplatelets (hazard ratio, 1.43; 95% confidence interval, 1.02-2.01), but trended toward lower risk among those not on antiplatelets (hazard ratio, 0.86; 95% confidence interval, 0.62-1.19). High-dose B vitamin therapy may be associated with a higher risk of recurrent stroke among stroke survivors taking antiplatelets, but does not have a significant effect on recurrent stroke risk in those who are not on antiplatelets. Future randomized controlled trials may consider evaluating the effect of homocysteine lowering among stroke survivors with elevated homocysteine who are not on antiplatelet therapy. © 2015 American Heart Association, Inc.
    Stroke 02/2015; 46(3). DOI:10.1161/STROKEAHA.114.006927 · 5.72 Impact Factor
  • P Krishnan · G Saposnik · B Ovbiagele · L Zhang · S Symons · R Aviv
    [Show abstract] [Hide abstract]
    ABSTRACT: Stroke Prognostication by Using Age and NIHSS score (SPAN-100 index) facilitates stroke outcomes. We assessed imaging markers associated with the SPAN-100 index and their additional impact on outcome determination. Of 273 consecutive patients with acute ischemic stroke (<4.5 hours), 55 were characterized as SPAN-100-positive (age +NIHSS score ≥ 100). A comprehensive imaging review evaluated differences, using the presence of the hyperattenuated vessel sign, ASPECTS, clot burden score, collateral score, CBV, CBF, and MTT. The primary outcome assessed was favorable outcome (mRS ≤ 2). Secondary outcomes included recanalization, lack of neurologic improvement, and hemorrhagic transformation. Uni- and multivariate analyses assessed factors associated with favorable outcome. Area under the curve evaluated predictors of favorable clinical outcome. Compared with the SPAN-100-negative group, the SPAN-100-positive group (55/273; 20%) demonstrated larger CBVs (<0.001), poorer collaterals (P < .001), and increased hemorrhagic transformation rates (56.0% versus 36%, P = .02) despite earlier time to rtPA (P = .03). Favorable outcome was less common among patients with SPAN-100-positive compared with SPAN-100-negative (10.9% versus 42.2%; P < .001). Multivariate regression revealed poorer outcome for SPAN-100-positive (OR = 0.17; 95% CI, 0.06-0.38; P = .001), clot burden score (OR = 1.14; 95% CI, 1.05-1.25; P < .001), and CBV (OR = 0.58; 95% CI, 0.46-0.72; P = .001). The addition of the clot burden score and CBV improved the predictive value of SPAN-100 alone for favorable outcome from 60% to 68% and 74%, respectively. SPAN-100-positivity predicts a lower likelihood of favorable outcome and increased hemorrhagic transformation. CBV and clot burden score contribute to poorer outcomes among high-risk patients and improve stroke-outcome prediction. © 2015 American Society of Neuroradiology.
    American Journal of Neuroradiology 01/2015; 36(4). DOI:10.3174/ajnr.A4195 · 3.59 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Urinary creatinine excretion rate (CER) is an established marker of muscle mass. Low CER has been linked to poor coronary artery disease outcomes, but a link between CER and acute stroke prognosis has not been previously explored. We prospectively collected data from patients with acute stroke (ischemic or hemorrhagic) within 24 hours from symptom onset in a Neurological and Neurosurgery Intensive Care Unit in Taiwan. Baseline CER (mg/d) was calculated by urine creatinine concentration in morning spot urine multiplies 24-hour urine volume on the second day of admission. Patients were divided into 3 tertiles with highest, middle, and lowest CER. Primary endpoint was poor outcome defined as modified Rankin Scale 3-6 at 6 months. Among 156 critically ill acute stroke patients meeting study entry criteria, average age was 67.9 years, and 83 (53.2%) patients had ischemic stroke. Patients with lowest CER (vs. highest CER) had a high risk of poor outcome at 6-month after adjustment (odds ratio 4.96, 95% confidence interval 1.22 to 20.15, p value = 0.025). In conclusion, low baseline CER, a marker of muscle mass, was independently associated with poor 6-month outcome among critically ill acute stroke patients. We speculate that preservation of muscle mass through exercise or protein-energy supplement might be helpful for improving prognosis in severe stroke patients.
    Current Neurovascular Research 01/2015; 12(1). DOI:10.2174/1567202612666150102151455 · 2.25 Impact Factor

Publication Stats

5k Citations
1,701.72 Total Impact Points


  • 2015
    • Rancho Los Amigos Rehabilitation Center
      Downey, California, United States
  • 2012–2015
    • Medical University of South Carolina
      Charleston, South Carolina, United States
  • 2014
    • Myongji Hospital
      Kōyō, Gyeonggi Province, South Korea
  • 2011–2013
    • University of California, San Diego
      • Department of Neurosciences
      San Diego, California, United States
  • 2003–2012
    • University of California, Los Angeles
      • • Center for Neurobiology of Stress
      • • Department of Neurology
      Los Ángeles, California, United States
    • Beth Israel Deaconess Medical Center
      • Department of Neurology
      Boston, MA, United States
  • 2006–2011
    • Harbor-UCLA Medical Center
      • Department of Emergency Medicine
      Torrance, California, United States
    • Bristol-Myers Squibb
      New York, New York, United States
  • 2010
    • Sir Charles Gairdner Hospital
      Perth City, Western Australia, Australia
  • 2003–2010
    • Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center
      Torrance, California, United States
  • 2008
    • Sungkyunkwan University
      • Samsung Medical Center
      Sŏul, Seoul, South Korea
  • 2006–2008
    • University of Southern California
      • • Department of Neurology
      • • Keck School of Medicine
      Los Ángeles, California, United States
  • 2007
    • University of Toronto
      • Division of Neurology
      Toronto, Ontario, Canada
    • Ajou University
      Sŏul, Seoul, South Korea
  • 2005
    • University of California, San Francisco
      San Francisco, California, United States