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  • 1
    Online Resource
    Online Resource
    Machine Learning–Enabled Automated Determination of Acute Ischemic Core From Computed Tomography Angiography
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Stroke Vol. 50, No. 11 ( 2019-11), p. 3093-3100
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 50, No. 11 ( 2019-11), p. 3093-3100
    Abstract: The availability of and expertise to interpret advanced neuroimaging recommended in the guideline-based endovascular stroke therapy (EST) evaluation are limited. Here, we develop and validate an automated machine learning-based method that evaluates for large vessel occlusion (LVO) and ischemic core volume in patients using a widely available modality, computed tomography angiogram (CTA). Methods— From our prospectively maintained stroke registry and electronic medical record, we identified patients with acute ischemic stroke and stroke mimics with contemporaneous CTA and computed tomography perfusion (CTP) with RAPID (IschemaView) post-processing as a part of the emergent stroke workup. A novel convolutional neural network named DeepSymNet was created and trained to identify LVO as well as infarct core from CTA source images, against CTP-RAPID definitions. Model performance was measured using 10-fold cross validation and receiver-operative curve area under the curve (AUC) statistics. Results— Among the 297 included patients, 224 (75%) had acute ischemic stroke of which 179 (60%) had LVO. Mean CTP-RAPID ischemic core volume was 23±42 mL. LVO locations included internal carotid artery (13%), M1 (44%), and M2 (21%). The DeepSymNet algorithm autonomously learned to identify the intracerebral vasculature on CTA and detected LVO with AUC 0.88. The method was also able to determine infarct core as defined by CTP-RAPID from the CTA source images with AUC 0.88 and 0.90 (ischemic core ≤30 mL and ≤50 mL). These findings were maintained in patients presenting in early (0–6 hours) and late (6–24 hours) time windows (AUCs 0.90 and 0.91, ischemic core ≤50 mL). DeepSymNet probabilities from CTA images corresponded with CTP-RAPID ischemic core volumes as a continuous variable with r =0.7 (Pearson correlation, P 〈 0.001). Conclusions— These results demonstrate that the information needed to perform the neuroimaging evaluation for endovascular therapy with comparable accuracy to advanced imaging modalities may be present in CTA, and the ability of machine learning to automate the analysis.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.119.026189
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 1467823-8
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  • 2
    Online Resource
    Online Resource
    Embolization of carotid-cavernous fistulas: A technical note on simultaneous balloon protection of the internal carotid artery
    Elsevier BV ; 2020
    In:  Journal of Clinical Neuroscience Vol. 78 ( 2020-08), p. 389-392
    Details
    In: Journal of Clinical Neuroscience, Elsevier BV, Vol. 78 ( 2020-08), p. 389-392
    Type of Medium: Online Resource
    ISSN: 0967-5868
    URL: Article
    DOI: 10.1016/j.jocn.2020.04.015
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2020
    detail.hit.zdb_id: 2009190-4
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  • 3
    Online Resource
    Online Resource
    Abstract 45: Treatment Trends and Clinical Outcomes for Unruptured Cerebral Aneurysms in High vs Low Volume Centers
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Stroke Vol. 50, No. Suppl_1 ( 2019-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 50, No. Suppl_1 ( 2019-02)
    Abstract: Background: Prior studies have suggested that unruptured cerebral aneurysm (CA) treatments have spread from high-volume centers into lower-volume centers in the past decade, coinciding with the increase of endovascular coiling (EC) relative to surgical clipping (SC). Our understanding of outcomes from CA treatments by hospital treatment volumes is lacking. Methods: Using administrative data on all discharges from hospitals in New York (2005-2014) and Florida (2005-2015), we identified patients with treatments for unruptured CAs. Good outcome was defined as discharge home without intracerebral hemorrhage (ICH) and poor outcome as discharge to SNF or death. A composite weighted index of risk factors was calculated using the Charlson Comorbidity Index (CCI). Logistic regression adjusted for age, sex, smoking, diabetes and CCI were performed. Results are provided as median [IQR] or OR [95% CI] . Results: Among 14,064 patients with treated unruptured CAs, median age was 58 [49 - 66] and 75% were female. EC was performed in 9,417 (67%), and increased over time (56% vs. 74%, 2006 vs. 2014). Annual treatments increased over the study period, with 1125 CAs treated in 2006 versus 1517 in 2014, whereas the number of treating hospitals did not (66 vs. 64, 2006 vs. 2014). In adjusted logistic regression, there was no difference in likelihood of a good outcome over time (OR 0.94 [0.86 - 1.03] , 2012-2015 vs. 2005 - 2008). The likelihood of good outcome increased with annual hospital treatment volume ( Figure 1a ). This relationship was maintained for patients treated with SC and EC (ORs 1.7 [1.33 - 2.2] and 3.2 [2.5 -4.1] ). The likelihood of poor outcome conversely decreased consistently with increasing annual treatment volume ( Figure 1b ). Conclusion: In this large cohort study, we did not observe an increase in the number of hospitals performing CA treatments. However, for patients treated with both SC and EC, treatment at higher-volume centers was associated with improved outcomes.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.50.suppl_1.45
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 1467823-8
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  • 4
    Online Resource
    Online Resource
    Abstract WP77: Automated Accurate Determinations of Acute Infarct Core Volumes From CT Angiography Using Machine Learning
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Stroke Vol. 50, No. Suppl_1 ( 2019-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 50, No. Suppl_1 ( 2019-02)
    Abstract: Background: Guideline-based acute ischemic stroke (AIS) evaluations require the use of advanced parenchymal imaging including CT perfusion (CTP) to determine the presence of large vessel occlusion (LVOs) and infarct core. The availability of CTP in all hospitals that receive patients with possible AIS is limited. An accurate method to evaluate possible AIS patients that does not require CTP is urgently needed. Methods: Consecutive patients from 3/2018 - 5/2018 evaluated emergently for possible AIS within 24 hours of onset at our institution were identified. Patients were included if they underwent contemporaneous non-contrast CT, CT angiogram (CTA) and CT Perfusion (CTP) with RAPID (IschemaView) post-processing. A linear Support Vector Machine (SVM) was created using CTA data alone and trained against the CTP-RAPID infarct core volume determinations, which was used as the “gold standard.” Performance parameters were calculated using 10-fold cross-validation. Results: Among 139 subjects, median age was 64 [54-73], 48% were female, 40% were white and 34% were African-American. From this population, 16 subjects (12%) were ultimately diagnosed with AIS. Median time from onset to imaging was 3.9 hours [1.7-10.1], NIHSS 16.5 [8-24] , and RAPID infarct core and “at risk” volumes were 35.5 mL [13-72] and 128.5 mL [80-165] . The CTA-based SVM classified AIS versus stroke mimic with excellent discrimination (AUC 0.95 ± 0.08) and accuracy of 89% ± 3%. In patients with AIS, CTA-based SVM estimation of infarct core correlated well with the CTP-RAPID (Spearman's rho 0.82 (p 〈 0.001) and Figure ). Conclusion: Our machine learning algorithm was able to accurately discriminate AIS versus stroke-mimic, and reproduce CTP-based infarct core measurements from CTA imaging alone. A complete AIS neuroimaging evaluation, for LVO as well as infarct core, may be obtainable from CTA, an imaging modality with much broader availability than CTP.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.50.suppl_1.WP77
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 1467823-8
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  • 5
    Online Resource
    Online Resource
    Handling of the Covid-19 Pandemic and Its Effects on Bariatric Surgical Practice: Analysis of GENEVA Study Database
    Springer Science and Business Media LLC ; 2022
    In:  Obesity Surgery Vol. 32, No. 12 ( 2022-12), p. 3908-3921
    Details
    In: Obesity Surgery, Springer Science and Business Media LLC, Vol. 32, No. 12 ( 2022-12), p. 3908-3921
    Abstract: The coronavirus disease 2019 (COVID-19) pandemic led to a worldwide suspension of bariatric and metabolic surgery (BMS) services. The current study analyses data on patterns of service delivery, recovery of practices, and protective measures taken during the COVID-19 pandemic by bariatric teams. Materials and Methods The current study is a subset analysis of the GENEVA study which was an international cohort study between 01/05/2020 and 31/10/2020. Data were specifically analysed regarding the timing of BMS suspension, patterns of service recovery, and precautionary measures deployed. Results A total of 527 surgeons from 439 hospitals in 64 countries submitted data regarding their practices and handling of the pandemic. Smaller hospitals (with less than 200 beds) were able to restart BMS programmes more rapidly (time to BMS restart 60.8 ± 38.9 days) than larger institutions (over 2000 beds) (81.3 ± 30.5 days) ( p  = 0.032). There was a significant difference in the time interval between cessation/reduction and restart of bariatric services between government-funded practices (97.1 ± 76.2 days), combination practices (84.4 ± 47.9 days), and private practices (58.5 ± 38.3 days) ( p   〈  0.001). Precautionary measures adopted included patient segregation, utilisation of personal protective equipment, and preoperative testing. Following service recovery, 40% of the surgeons operated with a reduced capacity. Twenty-two percent gave priority to long waiters, 15.4% gave priority to uncontrolled diabetics, and 7.6% prioritised patients requiring organ transplantation. Conclusion This study provides global, real-world data regarding the recovery of BMS services following the COVID-19 pandemic. Graphical abstract
    Type of Medium: Online Resource
    ISSN: 0960-8923 , 1708-0428
    URL: Article
    DOI: 10.1007/s11695-022-06267-7
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2087903-9
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  • 6
    Online Resource
    Online Resource
    Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021
    Elsevier BV ; 2024
    In:  The Lancet Neurology Vol. 23, No. 4 ( 2024-04), p. 344-381
    Details
    In: The Lancet Neurology, Elsevier BV, Vol. 23, No. 4 ( 2024-04), p. 344-381
    Type of Medium: Online Resource
    ISSN: 1474-4422
    URL: Article
    DOI: 10.1016/S1474-4422(24)00038-3
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2024
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