S Claiborne Johnston

University of Texas at Austin, Austin, Texas, United States

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Publications (299)2372.46 Total impact

  • C G McDougall, S C Johnston, A Gholkar, A S Turk
    AJNR. American journal of neuroradiology. 11/2014;
  • Jay Chol Choi, S Claiborne Johnston, Anthony S Kim
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    ABSTRACT: Despite the absence of definitive data from randomized clinical trials on the comparative effectiveness of carotid artery stenting (CAS) versus carotid endarterectomy (CEA) for asymptomatic carotid stenosis, the use of CAS has been expanding and seems to be displacing the use of CEA in some parts of the United States. We used comprehensive hospital discharge data from January 2010 to December 2012 to identify patients who had CEA or CAS for asymptomatic carotid stenosis at all academic medical centers that participate in the University HealthSystem Consortium. In-hospital death and postoperative stroke after CAS and after CEA were compared using multivariable logistic regression, propensity score matching, and a grouped-treatment approach using multilevel mixed-effects models to adjust for baseline characteristics of patients selected for these procedures. We identified 17 716 patients with asymptomatic carotid stenosis treated with CEA and 3962 treated with CAS at 186 University HealthSystem Consortium hospitals. Postoperative stroke or in-hospital death was more frequent after CAS (4.0% versus 1.5%; P<0.001), and patients with CAS were more likely to have these adverse outcomes even after adjusting for baseline characteristics using multivariable analysis (odds ratio [OR], 2.5; 95% confidence interval [CI], 2.1-3.1; P<0.001) and propensity score matching (OR, 2.5; 95% CI, 1.9-3.4; P<0.001). In a multilevel mixed-effects model, hospitals that performed a higher proportion of all carotid revascularization cases using CAS had significantly higher rates of adverse outcomes (OR, 3.7; 95% CI, 1.8-7.6; P<0.001) after adjusting for patient-level variables. For asymptomatic carotid stenosis, CAS is associated with a substantially higher risk of postoperative stroke or in-hospital death than CEA even after adjustment for baseline differences in hospital and patient characteristics. © 2014 American Heart Association, Inc.
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    ABSTRACT: To determine what the trends in stroke mortality have been over 2 decades in young adults.
    Neurology 10/2014; · 8.30 Impact Factor
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    ABSTRACT: Statin use during hospitalization is associated with improved survival and a better discharge disposition among patients with ischemic stroke. It is unclear whether inpatient statin use has a similar effect among patients with intracerebral hemorrhage (ICH).
    JAMA Neurology 09/2014; · 7.58 Impact Factor
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    ABSTRACT: AimsTo examine the health-related quality of life (HRQOL) in patients with transient ischemic attack (TIA) or minor stroke and assess the impact of recurrent stroke on HRQOL.Methods Health-related quality of life data on patients participated in the Clopidogrel in High-risk patients with Acute Nondisabling Cerebrovascular Events (CHANCE) trial were analyzed. The available 90-day EuroQoL data (EQ-5D) were used to calculate EQ-5D index score. Poor HRQOL was defined as an EQ-5D index score ≤0.5. The characteristics of HRQOL and factors predicting poor HRQOL in these patients were then explored.ResultsAmong the total 5170 patients enrolled, 90-day HRQOL data were obtained from 5104 patients for analysis. The mean EQ-5D index score at day 90 was 0.88 ± 0.21 for all patients, but only 0.42 ± 0.35 for those with recurrent strokes. Poor 90-day HRQOL was found in 294 (5.8%) patients. Patients with poor HRQOL had more strokes during follow-up than patients with good HRQOL (94.9 vs. 4.7%, P < 0.001). Age, history of hypertension and diabetes, and NIHSS at baseline were independent risk factors for predicting poor HRQOL. Stroke recurrence, NIHSS at baseline, age, and minor stroke on admission became independent risk factors once stroke recurrence was added into the model.Conclusions Stroke recurrence was associated with poor HRQOL in patients with TIA or minor strokes. Interventions focusing on controlling risk factors and prevention of worsening of neurological function may prevent poor HRQOL in these patients.
    CNS Neuroscience & Therapeutics 09/2014; · 4.46 Impact Factor
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    ABSTRACT: Background Medical devices are often introduced prior to randomized-trial evidence of efficacy and this slows completion of trials. Alternative regulatory approaches include restricting device use outside of trials prior to trial evidence of efficacy (like the drug approval process) or restricting out-of-trial use but permitting coverage within trials such as Medicare's Coverage with Study Participation (CSP).Methods We compared the financial impact to manufacturers and insurers of three regulatory alternatives: (1) limited regulation (current approach), (2) CSP, and (3) restrictive regulation (like the current drug approval process). Using data for patent foramen ovale closure devices, we modeled key parameters including recruitment time, probability of device efficacy, market adoption, and device cost/price to calculate profits to manufacturers, costs to insurers, and overall societal impact on health.ResultsFor manufacturers, profits were greatest under CSP—driven by faster market adoption of effective devices—followed by restrictive regulation. Societal health benefit in total quality-adjusted life years was greatest under CSP. Insurers’ expenditures for ineffective devices were greatest with limited regulation. Findings were robust over a reasonable range of probabilities of trial success.Conclusions Regulation restricting out-of-trial device use and extending limited insurance coverage to clinical trial participants may balance manufacturer and societal interests. Clin Trans Sci 2014; Volume #: 1–8
    Clinical and Translational Science 08/2014; · 2.33 Impact Factor
  • Jacob S Elkins, S Claiborne Johnston, Mitchell S V Elkind
  • Source
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    ABSTRACT: Objective. A better understanding of the manuscript peer-review process could improve the likelihood that research of the highest quality is funded and published. To this end, we aimed to assess consistency across reviewers’ recommendations; agreement between reviewers’ recommendations and editors’ final decisions; and reviewer- and editor-level factors influencing editorial decisions in STROKE Journal.Methods. We analyzed all initial original contributions submitted to STROKE from January 2004 through December 2011. All submissions were linked to the final editorial decision (accept vs. reject). We assessed the level of agreement between reviewers (intraclass correlation coefficient). We compared the initial editorial decision (accept, minor revision, major revision and reject) across reviewers’ recommendations. We performed a logistic regression analysis to identify reviewer- and editor-related factors related to acceptance as the final decision.Results. Of 12,902 original submissions to STROKE during the 8-year study period, the level of agreement between reviewers was between fair and moderate (intraclass correlation coefficient 0.55, 95%CI: 0.09-0.75). Likelihood of acceptance was less than 5% if at least one reviewer recommended a rejection. In the multivariable analysis, higher reviewer-assigned priority scores were related to greater odds of acceptance (OR 26.3, 95%CI: 23.2-29.8); while higher numbers of reviewers (OR 0.54 per additional reviewer, 95%CI: 0.50-0.59) and suggestions for reviewers by authors vs. no suggestions (OR 0.83, 95%CI: 0.73-0.94) had lesser odds of acceptance.Interpretation. This analysis of the peer-review process of STROKE identified several factors that might be targeted to improve the consistency and fairness of the overall process. ANN NEUROL 2014. © 2014 American Neurological Association
    Annals of Neurology 07/2014; · 11.19 Impact Factor
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    ABSTRACT: Clinical trials frequently spend considerable effort to collect data on patients who were assessed for eligibility but not enrolled. The Consolidated Standards of Reporting Trials (CONSORT) guidelines' recommended flow diagram for randomized clinical trials reinforces the belief that the collection of screening data is a necessary and worthwhile endeavor. The rationale for collecting screening data includes scientific, trial management, and ethno-socio-cultural reasons.
    Clinical trials (London, England). 06/2014;
  • 06/2014; 45(6):1862-8.
  • Gustavo Saposnik, S Claiborne Johnston
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    ABSTRACT: IMPORTANCE The Stroke Prognostication using Age and the NIH Stroke Scale index, created by combining age in years plus a National Institutes of Health (NIH) Stroke Scale score of 100 or higher (and hereafter referred to as the SPAN-100 index), is a simple risk score for estimating clinical outcomes for patients with acute ischemic stroke (AIS). The association between this index and response to intravenous thrombolysis for AIS has not been properly evaluated. OBJECTIVE To assess the relationship between SPAN-100 index status and outcome following treatment with intravenous thrombolysis for AIS. DESIGN, SETTING, AND PARTICIPANTS Using the Virtual International Stroke Trials Archive (VISTA) database, an international repository of clinical trials data, we assessed the SPAN-100 index among 7093 patients with AIS who participated in 4 clinical trials from 2000 to 2006. The SPAN-100 index is considered positive if the sum of the age and the NIH Stroke Scale (a 15-item neurological examination scale with scores ranging from 0 to 42, with higher scores indicating more severe strokes) score is greater than or equal to 100. Multivariable logistic regression analyses were used to determine the independent association between SPAN-100 index status and 90-day outcomes. MAIN OUTCOMES AND MEASURES The primary outcome was a composite of severe disability or death measured 90 days after stroke, and the secondary outcomes were death alone and a composite of no disability/modest disability. RESULTS Of 7093 patients, 743 (10.5%) were SPAN-100 positive, and 2731 (38.5%) received intravenous thrombolysis. Compared with SPAN-100-negative patients, SPAN-100-positive patients were more likely to experience a catastrophic outcome (adjusted odds ratio [AOR], 9.03 [95% CI, 6.68-12.21]) or death alone (AOR, 5.03 [95% CI, 4.06-6.23]) and less likely to experience a favorable outcome (AOR, 0.08 [95% CI, 0.06-0.13]). However, there was an interaction between SPAN-100 index status and thrombolysis treatment (P < .001) revealing a reduction in the likelihood of severe disability/death with thrombolytic treatment for SPAN-100-positive (AOR, 0.46 [95% CI, 0.29-0.71]) but not SPAN-100-negative patients (AOR, 0.96 [95% CI, 0.85-1.07]). Similar interactions between SPAN-100 index status and thrombolysis treatment were observed for the 2 secondary outcomes. CONCLUSION AND RELEVANCE Compared with the SPAN-100-negative patients with AIS, the SPAN-100-positive patients with AIS seem to have poorer 3-month outcomes but may derive greater benefit when treated with intravenous thrombolysis. The SPAN-100-positive patients are often excluded from AIS clinical trials but should probably not be denied thrombolysis treatment on the basis of such a profile alone.
    JAMA neurology. 05/2014;
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    ABSTRACT: The aim of this updated guideline is to provide comprehensive and timely evidence-based recommendations on the prevention of future stroke among survivors of ischemic stroke or transient ischemic attack. The guideline is addressed to all clinicians who manage secondary prevention for these patients. Evidence-based recommendations are provided for control of risk factors, intervention for vascular obstruction, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke. Recommendations are also provided for the prevention of recurrent stroke in a variety of specific circumstances, including aortic arch atherosclerosis, arterial dissection, patent foramen ovale, hyperhomocysteinemia, hypercoagulable states, antiphospholipid antibody syndrome, sickle cell disease, cerebral venous sinus thrombosis, and pregnancy. Special sections address use of antithrombotic and anticoagulation therapy after an intracranial hemorrhage and implementation of guidelines.
    Stroke 05/2014; · 6.16 Impact Factor
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    ABSTRACT: The ability of polymer-modified coils to promote stable aneurysm occlusion after endovascular treatment is not well-documented. Angiographic aneurysm recurrence is widely used as a surrogate for treatment failure, but studies documenting the correlation of angiographic recurrence with clinical failure are limited. This trial compares the effectiveness of Matrix(2) polyglycolic/polylactic acid biopolymer-modified coils with bare metal coils and correlates the angiographic findings with clinical failure (ie, target aneurysm recurrence), a composite end point that includes any incident of posttreatment aneurysm rupture, retreatment, or unexplained death. This was a multicenter randomized noninferiority trial with blinded end point adjudication. We enrolled 626 patients, divided between Matrix(2) and bare metal coil groups. The primary outcome was target aneurysm recurrence at 12 ± 3 months. At 455 days, at least 1 target aneurysm recurrence event had occurred in 14.6% of patients treated with bare metal coils and 13.3% of Matrix(2) (P = .76, log-rank test) patients; 92.8% of target aneurysm recurrence events were re-interventions for aneurysms that had not bled after treatment, and 5.8% of target aneurysm recurrence events resulted from hemorrhage or rehemorrhage, with or without retreatment. Symptomatic re-intervention occurred in only 4 (0.6%) patients. At 455 days, 95.8% of patients with unruptured aneurysms and 90.4% of those with ruptured aneurysms were independent (mRS ≤ 2). Target aneurysm recurrence was associated with incomplete initial angiographic aneurysm obliteration, presentation with rupture, and a larger aneurysmal dome and neck size. Tested Matrix(2) coils were not inferior to bare metal coils. Endovascular coiling of intracranial aneurysms was safe, and the rate of technical success was high. Target aneurysm recurrence is a promising clinical outcome measure that correlates well with established angiographic measurements.
    American Journal of Neuroradiology 01/2014; · 3.17 Impact Factor
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    ABSTRACT: Treatment with the combination of clopidogrel and aspirin taken soon after a transient ischemic attack (TIA) or minor stroke was shown to reduce the 90-day risk of stroke in a large trial in China, but the cost-effectiveness is unknown. This study sought to estimate the cost-effectiveness of the clopidogrel-aspirin regimen for acute TIA or minor stroke.
    Journal of the American Heart Association. 01/2014; 3(3).
  • Annals of Neurology 12/2013; 74(6):A5-7. · 11.19 Impact Factor
  • Annals of Neurology 11/2013; 74(5):A7-9. · 11.19 Impact Factor
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    ABSTRACT: BACKGROUND AND PURPOSE:Stent-assisted coiling may result in less aneurysm recanalization but more complications than coiling alone. We evaluated outcomes of coiling with and without stents in the multicenter Matrix and Platinum Science Trial.MATERIALS AND METHODS:All patients in the Matrix and Platinum Science Trial with unruptured intracranial aneurysms treated per protocol were included. Baseline patient and aneurysm characteristics, procedural details, neurologic outcomes, angiographic outcomes, and safety data were analyzed.RESULTS:Overall, 137 of 361 (38%) patients were treated with a stent. Stent-coiled aneurysms had wider necks (≥4 mm in 62% with stents versus 33% without, P < .0001) and lower dome-to-neck ratios (1.3 versus 1.8, P < .0001). Periprocedural serious adverse events occurred infrequently in those treated with and without stents (6.6% versus 4.5%, P = .39). At 1 year, total significant adverse events, mortality, and worsening of mRS were similar in treatment groups, but ischemic strokes were more common in stent-coiled patients than in coiled patients (8.8% versus 2.2%, P = .005). However, multivariate analysis confirmed that at 2 years after treatment, prior cerebrovascular accident (OR, 4.7; P = .0089) and aneurysm neck width ≥4 mm (OR, 4.5; P = .02) were the only independent predictors of ischemic stroke. Stent use was not an independent predictor of ischemic stroke at 2 years (OR, 1.1; P = .94). Stent use did not predict target aneurysm recurrence at 2 years, but aneurysm dome size ≥10 mm (OR, 9.94; P < .0001) did predict target aneurysm recurrence.CONCLUSIONS:Stent-coiling had similar outcomes as coiling despite stented aneurysms having more difficult morphology than coiled aneurysms. Increased ischemic events in stent-coiled aneurysms were attributable to baseline risk factors and aneurysm morphology.
    American Journal of Neuroradiology 11/2013; · 3.17 Impact Factor
  • Gustavo Saposnik, S Claiborne Johnston, Bruce Ovbiagele
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    ABSTRACT: The ischemic stroke risk score (iScore) is a validated tool developed to estimate the risk of death and functional outcomes early after an acute ischemic stroke. Our goal was to determine the ability of the iScore to estimate clinical outcomes after intravenous thrombolysis tissue-type plasminogen activator (tPA) in the Virtual International Stroke Trials Archive (VISTA). We applied the iScore (www.sorcan.ca/iscore) to patients with an acute ischemic stroke within the VISTA collaboration to examine the effect of tPA. We explored the association between the iScore (<200 and ≥200) and the primary outcome of favorable outcome at 3 months defined as a modified Rankin scale score of 0 to 2. Secondary outcomes included death at 3 months, catastrophic outcomes (modified Rankin scale, 4-6), and Barthel index >90 at 3 months. Among 7140 patients with an acute ischemic stroke, 2732 (38.5%) received tPA and 711 (10%) had an iScore ≥200. Overall, tPA treatment was associated with a significant improvement in the primary outcome among patients with an iScore <200 (38.9% non-tPA versus 47.5% tPA; P<0.001) but was not associated with a favorable outcome among patients with an iScore ≥200 (5.5% non-tPA versus 7.6% tPA; P=0.45). In the multivariable analysis after adjusting for age, baseline National Institutes of Health Stroke Scale, and onset-to-treatment time, there was a significant interaction between tPA administration and iScore; tPA administration was associated with 47% higher odds of a favorable outcome at 3 months among patients with an iScore <200 (odds ratio, 1.47; 95% confidence interval, 1.30-1.67), whereas the association between tPA and favorable outcome among those with an iScore ≥200 remained nonsignificant (odds ratio, 0.80; 95% confidence interval, 0.45-1.42). A similar pattern of benefit with tPA among patients with an iScore <200, but not ≥200, was observed for secondary outcomes including death. The iScore is a useful and validated tool that helps clinicians estimate stroke outcomes. In stroke patients participating in VISTA, an iScore <200 was associated with better outcomes at 3 months after tPA.
    Stroke 10/2013; · 6.16 Impact Factor
  • Stephen L Hauser, S Andrew Josephson, S Claiborne Johnston
    Annals of Neurology 10/2013; 74(4):A5-A25. · 11.19 Impact Factor

Publication Stats

8k Citations
2,372.46 Total Impact Points

Top Journals


  • 2014
    • University of Texas at Austin
      Austin, Texas, United States
    • St. Michael's Hospital
      Toronto, Ontario, Canada
  • 2002–2014
    • University of California, San Francisco
      • Department of Neurology
      San Francisco, California, United States
  • 2012–2013
    • Weill Cornell Medical College
      • Department of Neurology and Neuroscience
      New York City, NY, United States
    • University of Toronto
      • • Division of Neurology
      • • Department of Medicine
      Toronto, Ontario, Canada
    • Kaiser Permanente
      Oakland, California, United States
  • 2003–2013
    • CSU Mentor
      • Department of Neurology
      Long Beach, California, United States
  • 2006–2012
    • University of California, Los Angeles
      • • Department of Neurology
      • • Center for Neurobiology of Stress
      Los Angeles, CA, United States
    • University of Oxford
      • Nuffield Department of Clinical Neurosciences
      Oxford, ENG, United Kingdom
    • Cleveland Clinic
      Cleveland, Ohio, United States
  • 2011
    • Cornell University
      • Department of Neurology and Neuroscience
      Ithaca, NY, United States
  • 2010–2011
    • Royal Perth Hospital
      Perth City, Western Australia, Australia
    • Children's Hospital Oakland Research Institute
      Oakland, California, United States
    • Capital Medical University
      Peping, Beijing, China
  • 2009
    • University of Minnesota Twin Cities
      • Department of Neurology
      Minneapolis, MN, United States
  • 2008
    • McMaster University
      Hamilton, Ontario, Canada
    • Team Coordinating Agency
      Haverhill, Massachusetts, United States
    • Université de Montréal
      • Department of Radiology, Radiation Oncology and Nuclear Medicine
      Montréal, Quebec, Canada
    • Johns Hopkins University
      • Department of Neurology
      Baltimore, MD, United States
  • 2005–2006
    • Harbor-UCLA Medical Center
      Torrance, California, United States