Jeffrey L. Saver
Ronald Reagan UCLA Medical Center
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Featured researches published by Jeffrey L. Saver.
Stroke | 2017
Andreas Charidimou; Guillaume Turc; Catherine Oppenheim; Shenqiang Yan; Jan F. Scheitz; Hebun Erdur; Pascal P. Klinger-Gratz; Marwan El-Koussy; Wakoh Takahashi; Yusuke Moriya; Duncan Wilson; Chelsea S. Kidwell; Jeffrey L. Saver; Asma Sallem; Solene Moulin; Myriam Edjlali-Goujon; Vincent Thijs; Zoe Fox; Ashkan Shoamanesh; Gregory W. Albers; Heinrich P. Mattle; Oscar Benavente; H. Rolf Jäger; Gareth Ambler; Junya Aoki; Jean-Claude Baron; Kazumi Kimura; Wataru Kakuda; Shunya Takizawa; Simon Jung
Background and Purpose— We assessed whether the presence, number, and distribution of cerebral microbleeds (CMBs) on pre-intravenous thrombolysis MRI scans of acute ischemic stroke patients are associated with an increased risk of intracerebral hemorrhage (ICH) or poor functional outcome. Methods— We performed an individual patient data meta-analysis, including prospective and retrospective studies of acute ischemic stroke treated with intravenous tissue-type plasminogen activator. Using multilevel mixed-effects logistic regression, we investigated associations of pre-treatment CMB presence, burden (1, 2–4, ≥5, and >10), and presumed pathogenesis (cerebral amyloid angiopathy defined as strictly lobar CMBs and noncerebral amyloid angiopathy) with symptomatic ICH, parenchymal hematoma (within [parenchymal hemorrhage, PH] and remote from the ischemic area [remote parenchymal hemorrhage, PHr]), and poor 3- to 6-month functional outcome (modified Rankin score >2). Results— In 1973 patients from 8 centers, the crude prevalence of CMBs was 526 of 1973 (26.7%). A total of 77 of 1973 (3.9%) patients experienced symptomatic ICH, 210 of 1806 (11.6%) experienced PH, and 56 of 1720 (3.3%) experienced PHr. In adjusted analyses, patients with CMBs (compared with those without CMBs) had increased risk of PH (odds ratio: 1.50; 95% confidence interval: 1.09–2.07; P=0.013) and PHr (odds ratio: 3.04; 95% confidence interval: 1.73–5.35; P<0.001) but not symptomatic ICH. Both cerebral amyloid angiopathy and noncerebral amyloid angiopathy patterns of CMBs were associated with PH and PHr. Increasing CMB burden category was associated with the risk of symptomatic ICH (P=0.014), PH (P=0.013), and PHr (P<0.00001). Five or more and >10 CMBs independently predicted poor 3- to 6-month outcome (odds ratio: 1.85; 95% confidence interval: 1.10–3.12; P=0.020; and odds ratio: 3.99; 95% confidence interval: 1.55–10.22; P=0.004, respectively). Conclusions— Increasing CMB burden is associated with increased risk of ICH (including PHr) and poor 3- to 6-month functional outcome after intravenous thrombolysis for acute ischemic stroke.
Journal of Cerebral Blood Flow and Metabolism | 2017
Hannah Irvine; Ann Christin Ostwaldt; Matthew B. Bevers; Simone Dixon; Thomas W Battey; Bruce C.V. Campbell; Stephen M. Davis; Geoffrey A. Donnan; Kevin N. Sheth; Reza Jahan; Jeffrey L. Saver; Chelsea S. Kidwell; W. Taylor Kimberly
Rapid revascularization is highly effective for acute stroke, but animal studies suggest that reperfusion edema may attenuate its beneficial effects. We investigated the relationship between reperfusion and edema in patients from the Echoplanar Imaging Thrombolysis Evaluation Trial (EPITHET) and Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy (MR RESCUE) cohorts. Reperfusion percentage was measured as the difference in perfusion-weighted imaging lesion volume between baseline and follow-up (day 3–5 for EPITHET; day 6–8 for MR RESCUE). Midline shift (MLS) and swelling volume were quantified on follow-up MRI. We found that reperfusion was associated with less MLS (EPITHET: Spearman ρ = −0.46; P < 0.001, and MR RESCUE: Spearman ρ = −0.49; P < 0.001) and lower swelling volume (EPITHET: Spearman ρ = −0.56; P < 0.001, and MR RESCUE: Spearman ρ = −0.27; P = 0.026). Multivariable analyses performed in EPITHET and MR RESCUE demonstrated that reperfusion independently predicted both less MLS (ß coefficient = −0.056; P = 0.025, and ß coefficient = −0.38; P = 0.028, respectively) and lower swelling volumes (ß coefficient = −4.7; P = 0.007, and ß coefficient = −10.7; P = 0.009, respectively), after adjusting for age, sex, NIHSS, admission glucose and follow-up lesion size. Taken together, our data suggest that even modest improvement in perfusion is associated with less brain edema in EPITHET and MR RESCUE.
International Journal of Stroke | 2017
Kristina Shkirkova; Eftitan Y Akam; Josephine Huang; Sunil A Sheth; May Nour; Conrad W Liang; Michael L. McManus; Van Trinh; G Duckwiler; Jason Tarpley; Fernando Vinuela; Jeffrey L. Saver
Background Rapid dissemination and coordination of clinical and imaging data among multidisciplinary team members are essential for optimal acute stroke care. Aim To characterize the feasibility and utility of the Synapse Emergency Room mobile (Synapse ERm) informatics system. Methods We implemented the Synapse ERm system for integration of clinical data, computerized tomography, magnetic resonance, and catheter angiographic imaging, and real-time stroke team communications, in consecutive acute neurovascular patients at a Comprehensive Stroke Center. Results From May 2014 to October 2014, the Synapse ERm application was used by 33 stroke team members in 84 Code Stroke alerts. Patient age was 69.6 (±17.1), with 41.5% female. Final diagnosis was: ischemic stroke 64.6%, transient ischemic attack 7.3%, intracerebral hemorrhage 6.1%, and cerebrovascular-mimic 22.0%. Each patient Synapse ERm record was viewed by a median of 10 (interquartile range 6–18) times by a median of 3 (interquartile range 2–4) team members. The most used feature was computerized tomography, magnetic resonance, and catheter angiography image display. In-app tweet team, communications were sent by median 1 (interquartile range 0–1, range 0–13) users per case and viewed by median 1 (interquartile range 0–3, range 0–44) team members. Use of the system was associated with rapid treatment times, faster than national guidelines, including median door-to-needle 51.0 min (interquartile range 40.5–69.5) and median door-to-groin 94.5 min (interquartile range 85.5–121.3). In user surveys, the mobile information platform was judged easy to employ in 91% (95% confidence interval 65%–99%) of uses and of added help in stroke management in 50% (95% confidence interval 22%–78%). Conclusion The Synapse ERm mobile platform for stroke team distribution and integration of clinical and imaging data was feasible to implement, showed high ease of use, and moderate perceived added utility in therapeutic management.
Archive | 2005
Bruce Ovbiagele; Chelsea S. Kidwell; Jeffrey L. Saver
Stroke | 2007
S H Shah; Jeffrey L. Saver; Chelsea S. Kidwell; Gregory W. Albers; Peter M. Rothwell; Hakan Ay; W J Koroshetz; Y Inatomi; M Uchino; Andrew M. Demchuk; Shelagh B. Coutts; Francisco Purroy; J Alvarez-Sabin; K Sander; D Sander; L Restrepo; R J Wityk; J J Marx; J. D. Easton; Grp Mriitiac.
Archive | 2003
Jeffrey L. Saver; Chelsea S. Kidwell
Archive | 2011
Jeffrey L. Saver; Sidney Starkman
Stroke (Sixth Edition)#R##N#Pathophysiology, Diagnosis, and Management | 2016
Reza Jahan; Jeffrey L. Saver
Archive | 2014
L. Katzan; Jason Mackey; Elaine L. Miller; Lee H. Schwamm; Linda S. Williams; Eric Smith; Jeffrey L. Saver; David N. Alexander; Karen L. Furie; L. Nelson Hopkins
Archive | 2014
S. Kidwell; Helmi L. Lutsep; Elaine L. Miller; Edward Feldmann; Thomas S. Hatsukami; Randall T. Higashida; S. Claiborne Johnston; J. Donald Easton; Jeffrey L. Saver; Gregory W. Albers; Mark J. Alberts; Seemant Chaturvedi