Wondwossen G Tekle

University of Minnesota Twin Cities | UMN · Department of Neurology

Background: Symptomatic intracranial atherosclerotic disease (sICAD) is estimated to cause 10% of strokes annually in the United States. However, treatment remains a challenge with several different stenting options studied in the past with unfavorable results. Objective: To report the 30-day stroke and/or death rate associated with intracranial...

Background There is little data available to guide optimal anesthesia management during rescue intracranial angioplasty and stenting (ICAS) for failed mechanical thrombectomy (MT). We sought to compare the procedural safety and functional outcomes of patients undergoing rescue ICAS for failed MT under general anesthesia (GA) vs non-general anesthes...

Introduction: Reperfusion therapy is highly beneficial for ischemic stroke. Reduction in both infarct growth and edema are plausible mediators of clinical benefit with reperfusion. We aimed to quantify these mediators and their interrelationship. Methods: In a pooled, patient-level analysis of EXTEND-IA trials and SELECT study, we employed a med...

OBJECTIVE Middle meningeal artery (MMA) embolization and the Subdural Evacuation Port System (SEPS) are minimally invasive treatment paradigms for chronic subdural hematoma (cSDH). Although SEPS offers acute decom- pression of local mass effect from a cSDH, MMA embolization has been shown to reduce the rate of cSDH recurrence. In combination, these...

Introduction Viz LVO artificial intelligence (AI) software utilizes AI-powered large vessel occlusion (LVO) detection technology which automatically identifies suspected LVO through CT angiogram (CTA) imaging and alerts on-call stroke teams. This analysis was performed to determine whether AI software can reduce the door-in-door-out (DIDO) time int...

Background: Successful reperfusion is one of the strongest predictors of functional outcomes after mechanical thrombectomy (MT). Despite continuous advancements in MT technology and techniques, reperfusion failure still occurs in ≈15% to 30% of patients with large vessel occlusion strokes undergoing MT. We aim to evaluate the safety and efficacy o...

Chronic subdural hematoma in children can be pathognomonic of abusive head trauma. Treatment options for these range from observation to surgical evacuation depending on clinical circumstance and presenting features, which can include mental status changes, headaches, focal neurologic deficits, or asymptomatic presentation. Standalone endovascular...

Background and Purpose Angioplasty and stenting is a treatment option for patients with medically refractory symptomatic intracranial atherosclerotic disease (sICAD). Currently the Wingspan Stent System (WSS) is the only FDA approved device for this indication. We find the Resolute (R) Onyx Stent, a drug-eluting balloon mounted stent (DES), a bette...

Intracranial atherosclerotic disease (ICAD) is a common cause of acute ischemic stroke. ICAD has a high rate of recurrent ischemic stroke despite recommended adequate medical treatment. Endovascular treatment of ICAD has been controversial due to high periprocedural complication in historic randomized clinical trials (RCTs). Recently, a multicenter...

Background A better understanding of real‐world practice patterns in the endovascular treatment for large vessel occlusion acute ischemic stroke is needed. Here, we report the methods and initial results of the Society of Vascular and Interventional Neurology (SVIN) Registry. Methods The SVIN Registry is an ongoing prospective, multicenter, observ...

Background and Purpose: Angioplasty and stenting is a therapeutic option for patients with medically refractory intracranial atherosclerotic disease (ICAD). We previously demonstrated the feasibility of using Resolute (R) Onyx Stent, a drug-eluting balloon mounted coronary stent (DES), for ICAD patients. WEAVE (Wingspan Stent System Post Market Sur...

Background and Purpose: Angioplasty and stenting is a treatment option for patients with medically refractory symptomatic intracranial atherosclerotic disease (sICAD). Currently the Wingspan Stent System (WSS) is the only FDA approved device for that indication. Nonetheless, our group has shown the Resolute (R) Onyx Stent, a drug-eluting balloon mo...

Background and Purpose: Current evidence has shown that race and ethnicity impact the outcomes in acute ischemic stroke (AIS) patients secondary to large vessel occlusion. However, there is limited evidence concerning the utility of endovascular thrombectomy and AIS outcomes in Hispanic Americans. This study aims to compare the characteristics and...

Background: The effect of anesthesia choice on endovascular thrombectomy (EVT) outcomes is unclear. Collateral status on perfusion imaging may help identify the optimal anesthesia choice. Methods: In a pooled patient level analysis of EXTEND-IA, EXTEND-IA TNK, EXTEND-IA TNK part II and SELECT, EVT Functional outcomes (mRS distribution) were compare...

Purpose of the Review This article reviews the current concepts in intracranial atherosclerotic disease (ICAD) as a common etiology of ischemic stroke; pathophysiologic mechanisms of ischemic stroke; diagnostic evaluation; and therapeutic modalities, including maximal medical therapy (MMT), percutaneous transluminal angioplasty and stenting (PTAS),...

Background and Purpose The purpose of the COMPLETE (International Acute Ischemic Stroke Registry With the Penumbra System Aspiration Including the 3D Revascularization Device) registry was to evaluate the generalizability of the safety and efficacy of the Penumbra System (Penumbra, Inc, Alameda) in a real-world setting. Methods COMPLETE was a glob...

Objective To investigate whether significant differences exist in recanalization rates and primary outcomes between patients who undergo mechanical thrombectomy alone versus those who undergo mechanical thrombectomy with acute intracranial stenting. Methods Through the utilization of a prospectively collected endovascular database at a comprehensi...

Background/objective Elderly patients (≥ 80 years) were underrepresented in randomized trials that proved the efficacy and safety of mechanical thrombectomy (MT) in acute ischemic strokes (AIS) due to large vessel occlusion (LVO). Additionally, the impact of race and socioeconomics on AIS outcomes is well-reported. We sought to compare the MT clini...

Background Mechanical thrombectomy (MT) is a widely proven method to treat acute ischemic stroke (AIS) during mechanical thrombectomy and acute stenting and angioplasty is a topic discussed till this day regarding safety and efficacy. However, intravenous glycoprotein IIb/IIIa agents such as Tirofiban have become a more common thing. We report the...

Background and purpose First pass effect (FPE) is defined as achieving modified treatment in cerebral infarction (mTICI) grade 2c/3 reperfusion from the first pass and is associated with more favorable outcomes. We aimed to compare FPE and non-FPE using a large database and further compare first-pass mTICI 2b with multiple passes mTICI 3. Methods...

Background Randomized clinical trials have failed to prove that the safety and efficacy of endovascular treatment for symptomatic intracranial atherosclerotic disease (ICAD) is better than that of medical management. A recent study using a self-expandable stent showed acceptable lower rates of periprocedural complications. Objective To study the s...

Background Remote tele-proctoring has been conducted in neuro-endovascular surgery, however, evidence to support its use in the fellowship training is limited. We demonstrate a novel augmented reality tele-proctoring platform to enable a remote attending to guide a fellow. Methods A consecutive series of neuro-endovascular cases were performed by...

Importance A direct to angiography (DTA) treatment paradigm without repeated imaging for transferred patients with large vessel occlusion (LVO) may reduce time to endovascular thrombectomy (EVT). Whether DTA is safe and associated with better outcomes in the late (>6 hours) window is unknown. Also, DTA feasibility and effectiveness in reducing time...

Background: The rise of neurointerventional devices has created a demand for guide systems capable of navigating to the carotid artery consistently regardless of tortuosity. The shift toward large distal access catheters (DACs) and desire for greater trackability have inspired the creation of flexible, supportive, large-lumen long guiding sheaths....

Objective To evaluate the comparative safety and efficacy of direct endovascular thrombectomy(dEVT) compared to bridging therapy(BT:IV-tPA+EVT) and assess if BT potential benefit relates to stroke severity, size and initial presentation to EVT vs. non-EVT center. Methods In a prospective multicenter cohort-study of imaging selection for endovascul...

Background The incidence of intracranial atherosclerotic disease (ICAD) in acute ischemic stroke treated with mechanical thrombectomy (MT) is not well defined, and its description may lead to improved stroke devices and rates of first pass success. Methods A retrospective study was performed on MT patients from 2012 to 2019 at a comprehensive stro...

Background and purpose: The degree to which the coronavirus disease 2019 (COVID-19) pandemic has affected systems of care, in particular, those for time-sensitive conditions such as stroke, remains poorly quantified. We sought to evaluate the impact of COVID-19 in the overall screening for acute stroke utilizing a commercial clinical artificial in...

Background Glycoprotein IIb/IIIa inhibitor use in acute ischemic stroke (AIS) during mechanical thrombectomy (MT) and acute stenting and angioplasty is a topic consistently debated due to concerns over safety and efficacy. Tirofiban is a glycoprotein IIb/IIIa used throughout the world now more commonly used during MT. We report the analysis of all...

Background: The degree to which the COVID-19 pandemic has affected systems of care, in particular those for time-sensitive conditions such as stroke, remains poorly quantified. We sought to evaluate the impact of COVID-19 in the overall screening for acute stroke utilizing a commercial clinical artificial intelligence (AI) platform. Methods: Data w...

Introduction: Viz.ai artificial intelligence (AI) software utilizes AI powered large vessel occlusion (LVO) detection technology which automatically identifies suspected LVO through CT angiogram (CTA) imaging and alerts on-call stroke teams. We performed this analysis to determine if utilization of this AI software can reduce the door-in to groin p...

Introduction: Intracranial atherosclerotic disease (ICAD) is a common cause of refractory stroke. Randomized clinical trials failed to prove the safety and efficacy of the endovascular treatment options of symptomatic ICAD (sICAD). However, there are many concerns regarding inclusion criteria in these trials which made them less effective than stan...

Introduction: Viz.ai artificial intelligence (AI) software utilizes AI powered large vessel occlusion (LVO) detection technology which automatically identifies suspected LVO through CT angiogram (CTA) imaging and alerts on-call stroke teams. We performed this analysis to determine if utilization of AI software can reduce the door-in door-out (DIDO)...

Background: Mechanical thrombectomy (MT) has significantly improved outcomes of acute ischemic stroke (AIS) patients due to large vessel occlusion (LVO). The first-pass effect (FPE), defined as achieving complete reperfusion (mTICI3/2c) with a single pass, was reported to be associated with higher functional independence rates following EVT and has...

Background: Acute ischemic strokes outcomes may be less favorable in elderly patients. Whether transferring octogenarians with large vessel occlusion (LVO) for endovascular thrombectomy (EVT) results in similar outcomes to younger patients is uncertain. Methods: A pooled cohort from 6 centers (Europe, US) from 1/2014 to 5/2020 of pts with (ICA, M1,...

Background and Objective: Prompt and complete reperfusion with mechanical thrombectomy (MT) is essential to improve outcome in acute ischemic strokes (AIS) with large vessel occlusion (LVO). Recently, first-pass effect (FPE), defined as achieving complete reperfusion with a single pass, has been emphasized as a potentially important MT target. We a...

Introduction: Endovascular treatment (EVT) is a widely proven method to treat patients diagnosed with intracranial large vessel occlusion. In order to ensure patients safety prior to and during EVT, preprocedural intubation has been adopted in many centers as a means for airway protection and immobilization. However, the correlation between site of...

Background and objective: Elderly patients were underrepresented in RCTs that proved the efficacy and safety of mechanical thrombectomy (MT) in acute ischemic strokes (AIS) due to large vessel occlusion (LVO). Additionally, the impact of race and socio-economics in AIS outcomes is well-reported. We sought to assess MT clinical outcomes in Hispanic...

Introduction: Successful and fast reperfusion with endovascular thrombectomy (EVT) improves outcomes in acute ischemic strokes due to large vessel occlusion (LVO). While complete reperfusion (mTICI 3) is the ideal target, multiple passes could prolong EVT and increase complications likelihood without improving clinical outcomes. We hypothesized tha...

Introduction: Mechanical thrombectomy (MT) results in a marked improvement in outcomes of acute ischemic stroke (AIS) patients. First pass effect (FPE), which is defined as the achievement of complete recanalization (mTICI 3) from a single pass, appears to be associated with higher rates of good outcome. We seek to determine if dimensions of stentr...

Background: Direct To Angio (DTA) for transferred large vessel occlusions (LVO) lowers time to endovascular thrombectomy (EVT), reperfusion and potentially improves outcomes. Safety and efficacy of DTA in late time window and on-call hours is unknown. Methods: Pooled cohort from 6 centers (EU, US) from 1/14-5/20 (ICA, M1, M2) LVO pts transferred fo...

Background: Endovascular treatment (EVT) is a widely proven method to treat patients diagnosed with intracranial large vessel occlusion (LVO). Through this method of treatment, it has been hypothesized that a lower number of thrombectomy passes is an indicator of higher rates of modified Thrombolysis in Cerebral Infarction 2b-3 (mTICI) and favorabl...

Background Transradial access (TRA) for neuroendovascular procedures has several clear benefits compared to transfemoral access. In this study, we report our initial experience with neuroendovascular procedures performed via transradial access using the novel Ballast 088 long sheath. Methods We conducted a retrospective analysis and identified 91...

PurposeFlow diverters (FD) have poor radiopacity, challenging visualization of deployment and vessel wall apposition with conventional neuroimaging modalities. We evaluated a novel cone beam computed tomography (CT) imaging technique that allows virtual dilution (VD) of contrast media to facilitate workflow and ensure accurate assessment of FD wall...

BACKGROUND AND PURPOSE Radial artery catheterization has been newly incorporated into the field of endovascular surgical neuroradiology as a safer and more efficient method for Cerebral angiography as opposed to the femoral artery approach. The objective is to understand the relationship between cerebral angiography procedure times after an operato...

Background The use of compliant dual lumen balloon microcatheters (CDLB) for the endovascular treatment of vascular malformations, wide neck aneurysms, and intracranial angioplasty (for vasospasm) is well documented. Navigation of 4 mm or larger CDLB within tortuous and small distal intracranial vessels can be challenging. Recently, the lower profi...

Background and Purpose: Intracranial atherosclerotic disease (ICAD) is a common cause of stroke worldwide. Although there are different endovascular options for the treatment of symptomatic ICAD (sICAD), it is still controversial. Herein, we aim to study the safety and efficacy of a new generation of drug-eluting balloon-mounted stent (DES); Resolu...

Background Recently approved artificial intelligence (AI) software utilizes AI powered large vessel occlusion (LVO) detection technology which automatically identifies suspected LVO through CT angiogram (CTA) imaging and alerts on-call stroke teams. We performed this analysis to determine if utilization of AI software and workflow platform can redu...

Background Endovascular treatment (EVT) is a widely proved method to treat patients diagnosed with intracranial large vessel occlusions (LVOs); however, there has been controversy about the safety and efficacy of incorporating intravenous tissue plasminogen activator (IV tPA) as pretreatment for EVT. Objective To compare the outcomes of all patien...

Background: Early endovascular recanalization of occluded vessels in acute ischemic stroke (AIS) is a major contributor to good clinical outcome. We report the analysis of all AIS patients throughout a 6-year experience following the deployment of a quality initiative aiming at improving care, speed and maintaining quality for AIS treatment. Method...

Background: Endovascular treatment (EVT) is a widely proven method to treat patients diagnosed with intracranial large vessel occlusions (LVO); however, there has been controversy regarding the safety and efficacy of incorporating intravenous tissue plasminogen activator (IV tPA) as pretreatment for EVT. We compared the outcomes of all LVO patients...

Background: Mechanical thrombectomy (MT) is a proven method of treating patients with acute ischemic stroke (AIS) from a large vessel occlusion. However, there has been controversy regarding the safety and efficacy of incorporating acute intracranial stenting in addition to standard MT especially after the WEAVE trial results which showed a signifi...

A 44-year-old man was referred to the neurointerventionalist 6 hours after sustaining a shotgun wound to the left chest, shoulder, and neck from 4 feet away. Physical examination of the chest showed a 5 cm × 5 cm gunshot entry wound on the anterior-superior aspect of the chest involving the supraclavicular and infraclavicular region, with multiple...

A 44-year-old man was referred to the neurointerventionalist 6 hours after sustaining a shotgun wound to the left chest, shoulder, and neck from 4 feet away. Physical examination of the chest showed a 5 cm × 5 cm gunshot entry wound on the anterior-superior aspect of the chest involving the supraclavicular and infraclavicular region, with multiple...

Background and Purpose— Because of unique attributes of mechanical thrombectomy performed between 6 and 24 hours after symptom onset in acute ischemic stroke patients, it is not known if predictors of angiographic recanalization and favorable outcome in patients treated with thrombectomy in the late (6–24 hour) time window are similar to those trea...

Background: Previous research has focused on the association between hemorrhagic transformation (HT) incidence and pre-procedural variables (i.e., baseline variables) rather than the association between HT incidence and endovascular treatment (EVT) procedural variables (e.g., stent retriever passes). Objective: To assess the association, if any, th...

Objective To investigate whether significant differences exist in hospital bills and patient outcomes between patients who undergo endovascular thrombectomy (EVT) alone and those who undergo EVT with pretreatment intravenous tissue plasminogen activator (IV tPA). Methods We retrospectively grouped patients in an EVT database into those who underwe...

Background: Studies have shown a lack of agreement of computed tomography perfusion (CTP) in the selection of acute ischemic stroke (AIS) patients for endovascular treatment. Purpose: To demonstrate whether non-contrast computed tomography (CT) within 8 h of symptom onset is comparable to CTP imaging. Methods: Prospective study of consecutive...

Background: Although comprehensive 24/7 endovascular capability and neurocritical care have been effective in the treatment of Subarachnoid Hemorrhage (SAH), studies have shown that there exists a historically significant disparity in providing access to such care within border Hispanic populations. As such, the efficacy of endovascular and neurocr...

Background: Previous research has primarily investigated the association between hemorrhagic transformation (HT) incidence and baseline variables (i.e. pre-procedural variables) rather than the association between HT incidence and endovascular treatment (EVT) procedural variables (e.g. the number of passes with a stent retriever). Current stent ret...

Background: The efficacy of intravenous thrombolytics (IV TPA) administration in conjunction with endovascular treatment (EVT) has recently come into question. If IV TPA does not offer significant patient outcome benefits nor significantly reduce rates of endovascular complications, its additional cost may present as an unnecessary financial burden...

Background The effect of endovascular thrombectomy that is performed more than 6 hours after the onset of ischemic stroke is uncertain. Patients with a clinical deficit that is disproportionately severe relative to the infarct volume may benefit from late thrombectomy. Methods We enrolled patients with occlusion of the intracranial internal caroti...

Background: One-month dual antiplatelet treatment, with aspirin and clopidogrel, following internal carotid artery stent placement is the current standard of care to prevent in-stent thrombosis. Cilostazol, an antiplatelet drug, has been demonstrated to have a safety profile comparable to aspirin and clopidogrel. Objective: To evaluate the safet...

Background and purpose: Hospitalist directed care is associated with improved outcomes in several medical conditions. The hospitalist effect has not been studied in acute ischemic stroke (AIS) patients. We compare length of stay (LOS), outcome, and adherence to "Get with the Guidelines" (GWTG) stroke quality measures among AIS patients admitted un...

Background: Recent studies have found an underutilization of hospital in-patient care for coronary artery disease in Hispanics living in border states. Objective: To identify acute treatment disparities in acute ischemic stroke Hispanic patients and determine the effect of such disparity on patient outcomes. Methods: We identified Hispanic and...

Background: Ischemic strokes due to tandem occlusions (TOs) have poor outcomes if they have been treated with only medical interventions. Recent trials demonstrated the effectiveness of endovascular treatment of acute ischemic stroke due to intracranial occlusions; however, most studies excluded patients with TOs. Methods: Retrospective review o...

Background: Hospitalist directed care has shown significant association with improved lengths of stay with improvements in outcomes in several acute conditions. The hospitalist effect has not been studied in acute ischemic stroke management. Objective: To identify acute ischemic stroke patients admitted under a hospitalist, internist, family practi...

BACKGROUND AND PURPOSE: The purpose of this study was to evaluate the impact of our coordinated stroke education programs and establishment of comprehensive stroke care in South Texas border town on the utilization of and outcomes associated with thrombolytic use. Previous studies have identified prominent disparities in health care delivery in the...

Introduction: Cerebral vasospasm is a major cause of delayed ischemic cerebral injury, typically occurring 3-14 days after subarachnoid hemorrhage (SAH). Ultra-early vasospasm is defined as angiographic vasospasm observed within 48 h of SAH onset. Immediate vasospasm at the time of aneurysmal rupture has been suspected, but has not been previously...

Background: Long-term outcomes associated with endovascular and surgical treatments for unruptured intracranial aneurysms are not well studied to date. Objective: To determine the 5-year risk of new intracranial hemorrhage, second procedure, and all-cause mortality in elderly patients with unruptured intracranial aneurysms who underwent either s...

Background Presence of aphasia or severe neurologic deficits is considered an indication for preprocedural intubation (PPI) for endovascular treatment (ET) in acute ischemic stroke patients. We determined the feasibility, technical success rates, and outcomes of ET without PPI in 2 groups of patients: those with aphasia and those with an admission...

Background: Recent studies have found an underutilization of hospital in-patient care for coronary artery disease in Hispanics living in Border States. Objective: To identify acute treatment disparities in acute ischemic stroke Hispanic patients and determine the effect of such disparity on patient outcomes. Methods: We identified Hispanic and non-...

A 54-year-old woman is reported with severe pulsatile tinnitus. Digital subtraction angiography demonstrated dural arteriovenous fistula of the marginal sinus with feeders arising exclusively from bilateral vertebral arteries. Patient underwent successful transarterial Onyx embolization with complete angiographic and clinical cure.

To evaluate the variability of determining eligibility for intravenous thrombolysis (IV t-PA) by a stroke team interpretation of computed tomographic (CT) scan of the head versus review of the radiology interpretation (presented in final report) in patients with acute ischemic stroke. We compiled a database of all IV t-PA-treated ischemic stroke pa...

Background: There is controversy whether asymptomatic vasospasm in other arteries should be concurrently treated (global treatment) in patients receiving targeted endovascular treatment [percutaneous-transluminal-angioplasty (PTA) and/or intra-arterial (IA) vasodilators] for focal symptomatic vasospasm. Objective: To determine the rates of occur...

The MERCI Retrieval system (Concentric Medical, Mountain View, CA) was the first FDA -approved device for mechanical thrombectomy in patients with acute ischemic stroke. It remains one of the most commonly used devices today despite its failure to restore blood flow in approximately 50% of the occlusions after technically successful deployment and...

Background: Due to higher rates of poor outcomes in endovascular procedures under general anesthesia, it has been proposed that only stroke patients with a very high baseline NIHSS score undergo pre-procedural intubation. Objective: To determine if patients with very high NIHSS score (>20) can undergo endovascular procedure without pre-procedural i...

Objective: To determine the 5 year risk of new intracranial hemorrhage, second procedure, and all-cause mortality in elderly patients with unruptured intracranial aneurysms who underwent either surgical or endovascular treatment. Methods: The study included a representative sample of fee-for-service Medicare beneficiaries aged 65 years or older who...

Background: There is paucity of knowledge regarding the spectrum of neurothrombectomy(NT) device-related complications. Objective: To report the characteristics and proportions of reported adverse-events(AE) related to NT devices used in endovascular treatment of acute ischemic stroke (AIS). Methods: We identified NT device-related AE reported by v...

Background: One month dual antiplatelet therapy, with Aspirin and Clopidogrel, following intra- and/or extra-cranial stent placement is the standard of care to prevent in- stent thrombosis. Cilostazol, a novel antiplatelet drug, with vasodilatory effects and smooth muscle cell proliferation inhibition, has recently been demonstrated to be safe and...

Background and purpose: Neuroendovascular procedures are performed with the patient under conscious sedation (local anesthesia) in varying numbers of patients in different institutions, though the risk of unplanned conversion to general anesthesia is poorly characterized. Our aim was to ascertain the rate of failure of conscious sedation in patien...

Introduction About 37000 to 52400 people in the United States suffer from intracerebral hemorrhage (ICH) every year (1). Hypertension is the most important risk factor for spontaneous ICH accounting for about 60-70% of cases (2). Broderick et al. showed hypertension was the primary cause of ICH in 72% of the 188 patients evaluated in the study (3)....

Background: The American Heart Association and the American Stroke Association recommend intravenous (IV) thrombolysis up to 4.5 h from acute ischemic stroke symptom onset based on its proven benefit in improving patient outcomes. We analyzed data from the Minnesota Stroke Registry to assess the rates of IV thrombolytic utilization and the process...

Because several new devices for mechanical thrombectomy have become available, the outcomes of patients undergoing endovascular treatment for acute ischemic stroke are expected to improve in the United States. We performed this analysis to evaluate trends in utilization of endovascular treatment and associated rates of death and disability among ac...