Shadi Yaghi

Shadi Yaghi
Brown University · Department of Neurology

Doctor of Medicine

About

476
Publications
45,786
Reads
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6,083
Citations
Introduction
Skills and Expertise
Additional affiliations
July 2013 - June 2015
Columbia University
Position
  • Vascular Neurology Fellow

Publications

Publications (476)
Article
Objectives Understanding the link between markers of cardiac injury and atrial fibrillation (AF) detected after stroke (AFDAS) may help refine stroke risk stratification and therapeutic approaches in AFDAS. Materials and methods We retrospectively analyzed 988 adult patients admitted for acute ischemic stroke and transient ischemic attack, who pre...
Article
Background: Progression of white matter hyperintensities (WMHs), a radiographic marker of cerebral small vessel disease, occurs with uncontrolled conventional cerebrovascular risk factors. Less certain, however, is the influence of dyslipidemia and the impact of 3-hydroxy-3-methylglutaryl-coenzyme-A reductase inhibitors (statins) on WMH progressio...
Article
Background In patients with atrial fibrillation who suffered an ischemic stroke while on treatment with nonvitamin K antagonist oral anticoagulants, rates and determinants of recurrent ischemic events and major bleedings remain uncertain. Methods This prospective multicenter observational study aimed to estimate the rates of ischemic and bleeding...
Article
Background Treatment of uncontrolled arterial hypertension reduces the risk of cerebral small vessel disease (CSVD) progression, although it is unclear whether this reduction occurs due to blood pressure control or class-specific pleiotropic effects, such as improved beat-to-beat arterial pressure variability with calcium channel blockers. The goal...
Article
The past decade has seen significant advances in stroke prevention. These advances include new antithrombotic agents, new options for dyslipidemia treatment, and novel techniques for surgical stroke prevention. In addition, there is greater recognition of the benefits of multifaceted interventions, including the role of physical activity and dietar...
Article
Objective To investigate the aetiology, subsequent preventive strategies and outcomes of stroke despite anticoagulation in patients with atrial fibrillation (AF). Methods We analysed consecutive patients with AF with an index imaging-proven ischaemic stroke despite vitamin K-antagonist (VKA) or direct oral anticoagulant (DOAC) treatment across 11...
Article
Objective Chronic subdural hematoma (CSDH) is a serious problem with an incidence of 20.6/100,000/year in North America and is posited to grow as the population ages. Middle Meningeal Artery (MMA) embolization is an upcoming therapy for treatment of CSDH. Among patients with CSDH who undergo MMA embolization outcomes are no different in patients wh...
Article
Introduction White matter hyperintensity (WMH) is an abnormal T2 signal in the deep and subcortical white matter visualized on MRI associated with hypertension, cerebrovascular disease, and aging. The Fazekas (Fz) scoring system is a commonly used qualitative tool to assess the severity of WMH. While studies have compared Fazekas scores to other sc...
Article
Background/objectives: Little is known about trajectories of recovery 12-months after hospitalization for severe COVID. Methods: We conducted a prospective, longitudinal cohort study of patients with and without neurological complications during index hospitalization for COVID-19 from March 10, 2020-May 20, 2020. Phone follow-up batteries were p...
Article
Background Evidence regarding the utilization and outcomes of endovascular thrombectomy (EVT) for pediatric ischemic stroke is limited, and justification for its use is largely based on extrapolation from clinical benefits observed in adults. Methods Weighted discharge data from the National Inpatient Sample were queried to identify pediatric pati...
Article
Objective: Prolonged post-stroke cardiac rhythm monitoring (PCM) reveals a substantial proportion of ischemic stroke (IS) patients with atrial fibrillation (AF) not detected by conventional rhythm monitoring strategies. We aim to evaluate the association between PCM and the institution of stroke preventive strategies and stroke recurrence. Method...
Article
An 18-year-old woman with a history of Down syndrome (DS) presented with left upper extremity weakness. Neurological examination revealed moderate hypotonia throughout, with mild spasticity of the left ankle. She had 2/5 left upper and lower extremity strength, mild pronation with drift in the left arm and 3+ deep tendon reflexes in the left biceps...
Article
Background: Conflicting data exists surrounding whether or not the effect of clopidogrel on risk reduction of cardiovascular outcomes, including stroke, is more pronounced in smokers. The aim of this study was to determine the effect of smoking status on subsequent stroke risk in all patients with minor ischemic stroke or TIA, as well as subgroups...
Article
Objective To measure the global impact of COVID-19 pandemic on volumes of IV thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with 2 control 4-month periods. Methods We conducted a cross-sectional, observational, retrospective study across 6 continents, 70...
Article
Background A small randomized controlled trial suggested that dabigatran may be as effective as warfarin in the treatment of cerebral venous thrombosis (CVT). We aimed to compare direct oral anticoagulants (DOACs) to warfarin in a real-world CVT cohort. Methods This multicenter international retrospective study (United States, Europe, New Zealand)...
Article
Patent foramen ovale (PFO) describes a valve in the interatrial septum that permits shunting of blood or thrombotic material between the atria. PFOs are present in approximately 25% of the healthy population and are not associated with any pathology in the vast majority of cases. However, comparisons between patients with stroke and healthy control...
Preprint
Background/Objectives Little is known about trajectories of recovery 12-months after hospitalization for severe COVID. Methods We conducted a prospective, longitudinal cohort study of patients with and without neurological complications during index hospitalization for COVID-19 from March 10, 2020-May 20, 2020. Phone follow-up batteries were perfo...
Article
Full-text available
Background The “1-3-6-12-day rule” for starting direct oral anticoagulants (DOACs) in patients with nonvalvular atrial fibrillation after acute ischemic stroke or transient ischemic attack recommends timings that may be later than used in clinical practice. We investigated more practical optimal timing of DOAC initiation according to stroke severit...
Article
Introduction: Hematoma expansion (HE) in patients with intracerebral hemorrhage (ICH) is a key predictor of poor prognosis and potentially amenable to treatment. Current clinical scoring models, radiological markers, and labs have limited ability to predict HE. This study aimed to create a more robust classification model to predict HE in patients...
Article
Objective: Transient Ischemic Attack (TIA) observation units in the emergency department (ED) were developed to expedite medical evaluation and to reduce recurrent strokes. However, TIA remains a clinically challenging diagnosis due to its reliance on patient history and has multiple mimics including complex migraine, seizure, and peripheral vertig...
Article
Background: Randomized trials have shown that dual antiplatelet therapy (DAPT) reduces the risk of subsequent ischemic stroke in patients with minor stroke or high-risk TIA (MS-TIA). However, the 90 day risk remains elevated at 5-8%. In this exploratory study, we aimed to identify predictors of subsequent ischemic stroke in patients with MS-TIA tre...
Article
Background: Patients with symptomatic intracranial stenosis (ICAS) face elevated risks of recurrent cerebrovascular events (RCE) despite optimal medical therapy. Borderzone infarcts (BZI) indirectly correlate with impaired distal perfusion, a known mechanism of recurrence. Studies assessing associations between borderzone infarcts and recurrence ra...
Article
Introduction: Early neurological deterioration (END) in patients with acute stroke is associated with poorer outcomes. We aim to investigate whether higher acute phase reactants in blood are associated with END. Identifying predictors of END could help select patient at the highest risk of END for possible interventions. Methods: In this cross-sect...
Article
Introduction: White matter hyperintensity (WMH), a radiographic marker of cerebral small vessel disease, is typically treated by modification of conventional cerebrovascular risk factors. However, the influence of dyslipidemia and the impact of 3-hydroxy-3-methylglutaryl-coenzyme-A reductase inhibitors (statins) on WMH is less certain. The goal of...
Article
Background: Prior research has shown that increased blood pressure variability (BPV) after ischemic stroke is associated with lower odds of good functional outcome, but the number, intervals between, and epochs of blood pressure measurements have not been standardized. Methods: We include patients enrolled in the FAST-MAG trial with a final diagnos...
Article
Background: The optimal timing for the initiation of anticoagulation in patients with acute ischemic stroke (AIS) related to atrial fibrillation (AF) remains uncertain. Observational studies assessing early anticoagulant initiation (≤14 days after index AIS) have provided conflicting results from the early use of non-vitamin K oral anticoagulants (...
Article
Introduction: The faster IV Alteplase and mechanical thrombectomy is initiated in acute ischemic stroke, the better the outcome. Delays can significantly impact times to treatment. A mechanism to communicate time targets to code stroke teams can play an important role in providing knowledge about time sensitive metrics. The utilization of the ASA S...
Article
Introduction: Hypertension is a well-recognized risk factor for acute ischemic stroke (AIS) and intraparenchymal hemorrhagic (IPH). We performed a nationwide analysis to evaluate the rate of AIS and IPH readmission comparing patients with hypertension as a principal versus non-principal diagnosis. Methods: Using the Healthcare Cost and Utilization...
Article
Background: Guidelines support anticoagulation for primary stroke prevention in those with atrial fibrillation and additional risk factors. Primary endpoints in longitudinal studies such as mortality and morbidity over time are impacted by various forms of selection bias such as differential attrition and competing risks, as well as time-varying co...
Article
Introduction: Venous thromboembolism (VTE) is a frequent and potentially life-threatening complication of acute ischemic stroke (AIS). We performed a nationwide analysis to evaluate rate and risk factors for VTE readmission in patients with AIS. Methods: Using the Healthcare Cost and Utilization Project (HCUP) Nationwide Readmission Database, we in...
Article
Introduction: Approximately 30% of ischemic strokes are cryptogenic and 40-50% of these patients have a patent foramen ovale (PFO) detected during work up. While the risk of ischemic stroke attributed to PFO is 0.5-1% per year, the proportion of disabling ischemic strokes in the setting of PFO is unknown. In this study, we aim to determine differen...
Article
Introduction: Midlife hypertension is associated with an increased later-life ischemic stroke risk. However, temporal trends of blood pressure have not been fully explored. Methods: We performed a post hoc analysis of the ARIC study and included participants with four systolic blood pressures (SBP) at Visits 1-4 (1987-1999). Patients who had an isc...
Article
Background: Stroke and myocardial infarction (MI) prevalence varies by race/ethnicity, as do the risk factors. Methods: We included biyearly data from the 2011-2019 Behavioral Risk Factor Surveillance System (BRFSS) surveys of adults (age ≥18) in the United States. We describe survey-weighted prevalence of self-reported stroke and MI by race and et...
Article
Background: Prior research with the National Inpatient Sample (NIS) has shown that women are less likely than men to receive to receive intravenous Alteplase (tPA) for acute ischemic stroke, but more recent analyses have found conflicting results and patient age has not been taken into account, nor has stroke severity. Methods: We included patients...
Article
Background: Recent data suggest that in patients with acute myocardial infarction (MI), the effect of clopidogrel on risk reduction of cardiovascular outcomes is more pronounced in smokers. The aim of this study was to determine the effect of smoking status on subsequent stroke risk in patients with minor ischemic stroke or TIA and determine whethe...
Article
Introduction: High blood pressure variability (BPV) is associated with worse prognoses among critically ill stroke and non-stroke patients. It is unclear if higher BPV’s association with worse outcomes is a unique sequela of stroke or a modifiable risk factor among all critically-ill patients. Methods: Using data from 7,939 ICU patients hospitalize...
Article
Introduction: The effect of platelet count on hematoma expansion in patients with intracerebral hemorrhage (ICH) has not been sufficiently studied. We performed a secondary analysis of the ATACH 2 trial to examine the association between platelet count and hematoma expansion. Methods: We included patients with a baseline platelet count, volumetric...
Article
Introduction: Stroke is the fifth leading cause of death in the US and a major cause of disability. Atrial fibrillation (AF) increases the risk of ischemic stroke fivefold. Cardioembolic stroke in patients with AF is associated with high mortality. The association of elevated cardiac troponin with mortality in patients with acute ischemic stroke ha...
Article
Background: Although hospital admissions for stroke declined in 2020 during the COVID-19 pandemic, patients with comorbid COVID-19 and stroke had increased mortality. We explored stroke mortality in 2020 and its association with COVID-19 prevalence and state-level hospital capacities. Methods: We analyzed CDC National Vital Statistics System and CO...
Article
Introduction: Direct oral anticoagulants (DOACs) have emerged as a potential anticoagulant therapy for patients with cerebral venous thrombosis (CVT). We conducted a systematic review and meta-analysis comparing DOACs versus vitamin K antagonists (VKAs) for treatment of CVT. Methods: We registered the review in PROSPERO (registration number CRD4202...
Article
Background and Purpose: Cryptogenic stroke accounts for 30% of ischemic stroke and in such patients, cardiac monitoring leads to increased detection of AF, increased utilization of anticoagulation, and decreased risk of recurrent stroke. We aim to identify differences in inpatient utilization of implantable cardiac monitors (ICMs) in patients with...
Article
Introduction: Neurologic deterioration (ND) occurs in a quarter of acute lacunar infarcts and may lead to severe disability, but underlying pathophysiology of ND remains poorly understood. We sought to identify risk factors and clinical characteristics associated with ND. Methods: This retrospective observational study included consecutive patients...
Article
Background: Underuse of FDA-approved stroke prevention methods in atrial fibrillation (AF) remains a major problem. We aimed to explore the potential causes of oral anticoagulant (OAC) non-use and compare the frequency of these factors between AF patients with acute ischemic stroke (AIS) off and on oral anticoagulant (OAC). Methods: The Neuro-AFib...
Article
Background and Purpose: Prolonged cardiac rhythm monitoring can reveal a substantial proportion of ischemic stroke (IS) patients with atrial fibrillation (AF). We sought to evaluate the potential utility of available prolonged cardiac rhythm monitoring strategies with respect to secondary stroke prevention. Methods: We searched Medline and Scopus d...
Article
Full-text available
Background Guidelines recommend confirmed diagnosis of atrial fibrillation (AF) to initiate oral anticoagulation in cryptogenic stroke (CS) patients. However, the intermittent nature of AF can make detection challenging with intermittent short-term cardiac monitoring. Objective This retrospective cohort study examines post-CS utilization of cardia...
Article
Background There are limited data about the epidemiology and secondary stroke prevention strategies used for patients with depressed left ventricular ejection fraction (LVEF) and sinus rhythm following an acute ischemic stroke (AIS). We sought to describe the prevalence of LVEF ≤40% and sinus rhythm among patients with AIS and antithrombotic treatm...
Article
Background One‐quarter of all strokes are subsequent events. It is not known whether higher levels of blood glucose are associated with an increased risk of subsequent stroke after high‐risk transient ischemic attack or minor ischemic stroke. Methods and Results We performed a secondary analysis of the POINT (Platelet Oriented Inhibition in New TI...
Article
Importance In the Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) trial, acute treatment with clopidogrel-aspirin was associated with significantly reduced risk of recurrent stroke. There may be specific patient groups who are more likely to benefit from this treatment. Objective To investigate whether the association of...
Chapter
Cardioembolic stroke is a major etiology accounting for one-fifth of all ischemic strokes. Recent advances in technology have enabled us to monitor heart rhythm remotely and detect paroxysmal atrial fibrillation. Atrial cardiopathy is an area of further investigation as a risk factor for cardioembolic stroke, especially in patients with cryptogenic...
Article
Background and purpose: Cryptogenic stroke accounts for 30% of ischemic stroke and in such patients, cardiac monitoring leads to increased detection of AF, increased utilization of anticoagulation, and decreased risk of recurrent stroke. We aim to identify differences in inpatient utilization of implantable cardiac monitors (ICMs) in patients with...
Article
Background Vasospasm is a treatable cause of deterioration following aneurysmal subarachnoid hemorrhage. Cerebral computed tomography perfusion mean transit times have been proposed as a predictor of vasospasm but suffer from well‐known technical limitations. We evaluated fully automated, thresholded time‐to‐maxima of the tissue residue function (...
Article
Full-text available
BACKGROUND Early neurologic deterioration (END) occurs in a quarter of acute lacunar infarcts, but the underlying pathophysiological features are poorly understood. We sought to determine the association between luminal stenosis (<50%) of the parent artery and END. METHODS This observational study included consecutive patients with lacunar stroke...
Article
Background Obstructive sleep apnea (OSA) portends increased morbidity and mortality following acute ischemic stroke (AIS). Evaluation of OSA in the setting of AIS treated with endovascular mechanical thrombectomy (MT) has not yet been evaluated in the literature. Methods The National Inpatient Sample from 2010 to 2018 was utilized to identify adul...
Article
Background The association between race and ethnicity and microvascular disease in patients with intracerebral hemorrhage (ICH) is unclear. We hypothesized that social determinants of health (SDOHs) mediate the relationship between race and ethnicity and severity of white matter hyperintensities (WMHs) and microbleeds in patients with ICH.Methods W...
Article
Full-text available
Importance There is clinical equipoise for COVID-19 convalescent plasma (CCP) use in patients hospitalized with COVID-19. Objective To determine the safety and efficacy of CCP compared with placebo in hospitalized patients with COVID-19 receiving noninvasive supplemental oxygen. Design, Setting, and Participants CONTAIN COVID-19, a randomized, do...
Article
Full-text available
Purpose of Review Patent foramen ovale (PFO) is widely prevalent and studies have suggested an association with ischemic stroke. In this review, we aim to highlight current management of patients with ischemic stroke in the setting of PFO and discuss some areas of controversy. Recent Findings Upon reviewing the literature, we have found that the e...
Article
Background There are multiple tools available to visualize the retinal and choroidal vasculature of the posterior globe. However, there are currently no reliable in vivo imaging techniques that can visualize the entire retrobulbar course of the retinal and ciliary vessels. Purpose To identify and characterize the central retinal artery (CRA) using...
Article
Objective To explore the association between blood pressure (BP) levels after endovascular thrombectomy (EVT) and the clinical outcomes of acute ischemic stroke (AIS) patients with large vessel occlusion (LVO). Methods A study was eligible if it enrolled AIS patients older than 18 years, with an LVO treated with either successful or unsuccessful E...
Article
Background and Objectives In ischemic stroke (IS) patients, intravenous alteplase (tPA) and endovascular thrombectomy (EVT) reduce long-term disability, but their utilization has not been fully optimized. Prior research has also demonstrated disparities in the use of tPA and EVT specific to sex, race/ethnicity, socioeconomic status, and geographic...
Article
Background and purpose: Dual antiplatelet therapy has been shown to reduce the risk of recurrent stroke in patients with minor stroke or transient ischemic attack. However, whether the effect of dual antiplatelet therapy is modified by pretreatment antiplatelet status is unclear. Methods: This is a post hoc analysis of the POINT trial (Platelet-...
Article
Full-text available
Objectives: Our objective was to identify characteristics associated with having an acute ischemic stroke (AIS) among hospitalized COVID-19 patients and the subset of these patients with a neurologic symptom. Materials and Methods: Our derivation cohort consisted of COVID-19 patients admitted to Yale-New Haven Health between January 3, 2020 and Aug...
Article
Background: It is unknown if race/ethnicity modifies the response to blood pressure (BP) lowering treatment after intracerebral hemorrhage (ICH). We aimed to examine the race/ethnicity differences in the response to BP lowering treatment after ICH. Methods: This is a post hoc analysis of the Antihypertensive Treatment of Acute Cerebral Hemorrhag...
Article
Objectives: Routine implementation of protocol-driven stroke "codes" results in timelier and more effective acute stroke management. However, it is unclear if patient demographics contribute to disparities in stroke code activation. We aimed to explore these demographic factors in a retrospective cohort study of patients with intracerebral hemorrh...
Article
Prehospital triage is critically important in the care of patients with stroke caused by large vessel occlusion (LVO), both because of the time-sensitive nature of acute interventions and the need to appropriately use available resources.¹ However, it is unclear if standardized LVO-specific triage protocols exist among emergency medical services (E...
Article
Background Increased systolic blood pressure variability (BPV) is associated with stroke, cardiovascular disease, and dementia and mild cognitive impairment. However, prior studies assessing the relationship between BPV and dementia or mild cognitive impairment had infrequent measurement of blood pressure or suboptimal blood pressure control. Meth...
Article
Full-text available
Introduction The carotid web is a compelling potential mechanism of embolic ischemic stroke. In this study, we aim to determine the prevalence of ipsilateral carotid web in a cohort of ischemic stroke patients and to perform a systematic review and meta-analysis of similar cohorts. Patients & methods We performed a retrospective, observational, co...
Article
Anticoagulation substantially reduces the risk of stroke in patients with atrial fibrillation (AF). However, recent studies have shown that up to 22%-36% of patients on anticoagulation will suffer an ischaemic stroke (IS). In this narrative review, we provide an overview of risk factors, mechanisms, management of acute IS and strategies for seconda...
Article
Background and Purpose We sought to determine if biomarkers of inflammation and coagulation can help define coronavirus disease 2019 (COVID-19)–associated ischemic stroke as a novel acute ischemic stroke (AIS) subtype. Methods We performed a machine learning cluster analysis of common biomarkers in patients admitted with severe acute respiratory s...
Article
Background and Purpose We systematically evaluated the impact of the coronavirus 2019 (COVID-19) pandemic on stroke care across the world. Methods Observational studies comparing characteristics, acute treatment delivery, or hospitalization outcomes between patients with stroke admitted during the COVID-19 pandemic and those admitted before the pa...
Article
Objectives Systemic inflammatory response syndrome (SIRS) and hematoma expansion are independently associated with worse outcomes after intracerebral hemorrhage (ICH), but the relationship between SIRS and hematoma expansion remains unclear. Materials and methods We performed a retrospective review of patients admitted to our hospital from 2013 to...
Chapter
In this chapter, we will describe the management strategy in the large artery extracranial atherosclerotic disease of the neck, dissection of the extracranial arteries of the head and neck, as well as small vessel disease. The main mechanism of stroke in patients who have extracranial atherosclerosis and/or dissection is artery-to-artery embolism,...