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Article ; Online: Engaging Early-Career Physicians in Medical Device Innovation and Entrepreneurship.

Janardhan, Vallabh / Janardhan, Vikram

2022 Volume 53, Issue 5, Page(s) e197–e199

MeSH term(s)	Entrepreneurship ; Humans ; Physicians
Language	English
Publishing date	2022-03-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	80381-9
ISSN	1524-4628 ; 0039-2499 ; 0749-7954
ISSN (online)	1524-4628
ISSN	0039-2499 ; 0749-7954
DOI	10.1161/STROKEAHA.121.036866
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Article ; Online: COVID-19 as a Blood Clotting Disorder Masquerading as a Respiratory Illness: A Cerebrovascular Perspective and Therapeutic Implications for Stroke Thrombectomy.

Janardhan, Vallabh / Janardhan, Vikram / Kalousek, Vladimir

Journal of neuroimaging : official journal of the American Society of Neuroimaging

2020 Volume 30, Issue 5, Page(s) 555–561

Abstract: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as the name suggests was initially thought to only cause a respiratory illness. However, several reports have been published of patients with ischemic strokes in the setting of coronavirus ... ...

Abstract	Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as the name suggests was initially thought to only cause a respiratory illness. However, several reports have been published of patients with ischemic strokes in the setting of coronavirus disease 2019 (COVID-19). The mechanisms of how SARS-CoV-2 results in blood clots and large vessel strokes need to be defined as it has therapeutic implications. SARS-CoV-2 enters the blood stream by breaching the blood-air barrier via the lung capillary adjacent to the alveolus, and then attaches to the angiotensin-converting enzyme II receptors on the endothelial cells. Once SARS-CoV-2 enters the blood stream, a cascade of events (Steps 1-8) unfolds including accumulation of angiotensin II, reactive oxygen species, endothelial dysfunction, oxidation of beta 2 glycoprotein 1, formation of antiphospholipid antibody complexes promoting platelet aggregation, coagulation cascade, and formation of cross-linked fibrin blood clots, leading to pulmonary emboli (PE) and large vessel strokes seen on angiographic imaging studies. There is emerging evidence for COVID-19 being a blood clotting disorder and SARS-CoV-2 using the respiratory route to enter the blood stream. As the blood-air barrier is breached, varying degrees of collateral damage occur. Although antiviral and immune therapies are studied, the role of blood thinners in the prevention, and management of blood clots in Covid-19 need evaluation. In addition to ventilators and blood thinners, continuous aspiration and clot retrieval devices (approved in Europe, cleared in the United States) or cyclical aspiration devices (approved in Europe) need to be considered for the emergent management of life-threatening clots including PE and large vessel strokes.
MeSH term(s)	Betacoronavirus ; Blood Coagulation ; COVID-19 ; Coronavirus Infections/complications ; Endothelial Cells ; Humans ; Pandemics ; Pneumonia, Viral/complications ; SARS-CoV-2 ; Stroke/etiology ; Stroke/surgery ; Thrombectomy
Keywords	covid19
Language	English
Publishing date	2020-08-18
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S. ; Review
ZDB-ID	1071724-9
ISSN	1552-6569 ; 1051-2284
ISSN (online)	1552-6569
ISSN	1051-2284
DOI	10.1111/jon.12770
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Article ; Online: COVID‐19 as a Blood Clotting Disorder Masquerading as a Respiratory Illness

Janardhan, Vallabh / Janardhan, Vikram / Kalousek, Vladimir

Journal of Neuroimaging

A Cerebrovascular Perspective and Therapeutic Implications for Stroke Thrombectomy

2020 Volume 30, Issue 5, Page(s) 555–561

Keywords	Radiology Nuclear Medicine and imaging ; Clinical Neurology ; covid19
Language	English
Publisher	Wiley
Publishing country	us
Document type	Article ; Online
ZDB-ID	1071724-9
ISSN	1552-6569 ; 1051-2284
ISSN (online)	1552-6569
ISSN	1051-2284
DOI	10.1111/jon.12770
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Cyclical aspiration using a novel mechanical thrombectomy device is associated with a high TICI 3 first pass effect in large-vessel strokes.

Kalousek, Vladimir / Yoo, Albert J / Sheth, Sunil A / Janardhan, Vikram / Mamic, Josip / Janardhan, Vallabh

Journal of neuroimaging : official journal of the American Society of Neuroimaging

2021 Volume 31, Issue 5, Page(s) 912–924

Abstract: Background and purpose: Complete reperfusion (TICI 3) after the first thrombectomy attempt or first pass effect (FPE) is associated with best clinical outcomes in large-vessel occlusion (LVO) acute ischemic stroke. While endovascular therapy techniques ... ...

Abstract	Background and purpose: Complete reperfusion (TICI 3) after the first thrombectomy attempt or first pass effect (FPE) is associated with best clinical outcomes in large-vessel occlusion (LVO) acute ischemic stroke. While endovascular therapy techniques have improved substantially, FPE remains low (24-30%), and new methods to improve reperfusion efficiency are needed. Methods: In a prospective observational cohort study, 40 consecutive patients underwent cyclical aspiration thrombectomy using CLEAR Results: Among 38 patients who met criteria for LVO, median age was 75 (range 31-96). FPE was high (TICI 3: 26/38 [68%], TICI 2c/3: 29/38 [76%]). Among anterior circulation strokes, core lab-adjudicated FPE remained high (TICI 3: 17/29 [59%], TICI 2c/3: 20/29 [69%]), with excellent final successful revascularization results (Final TICI 3: 24/29 [83%], Final TICI 2c/3: 27/29 [93%]). FPE in the CLEAR-1 cohort was significantly higher compared to FPE using existing devices (meta-analysis) from historical controls (TICI 2c/3: 76% vs. 28%, p = 0.0001). High rates of early neurological improvement were observed (delta NIHSS≥4: 35/38 [92.1%]; delta NIHSS≥10: 27/38 [71%]). Similarly, high rates of good functional outcomes (mRS 0-2: 32/38 [84%]) and low mortality (2/38 [5%]) were observed. Conclusion: Cyclical aspiration using the CLEAR
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Brain Ischemia/diagnostic imaging ; Brain Ischemia/surgery ; Humans ; Middle Aged ; Prospective Studies ; Retrospective Studies ; Stroke/diagnostic imaging ; Stroke/surgery ; Thrombectomy ; Treatment Outcome
Language	English
Publishing date	2021-06-08
Publishing country	United States
Document type	Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	1071724-9
ISSN	1552-6569 ; 1051-2284
ISSN (online)	1552-6569
ISSN	1051-2284
DOI	10.1111/jon.12889
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Article: COVID-19 as a Blood Clotting Disorder Masquerading as a Respiratory Illness: A Cerebrovascular Perspective and Therapeutic Implications for Stroke Thrombectomy

Janardhan, Vallabh / Janardhan, Vikram / Kalousek, Vladimir

J Neuroimaging

Abstract	Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as the name suggests was initially thought to only cause a respiratory illness. However, several reports have been published of patients with ischemic strokes in the setting of coronavirus disease 2019 (COVID-19). The mechanisms of how SARS-CoV-2 results in blood clots and large vessel strokes need to be defined as it has therapeutic implications. SARS-CoV-2 enters the blood stream by breaching the blood-air barrier via the lung capillary adjacent to the alveolus, and then attaches to the angiotensin-converting enzyme II receptors on the endothelial cells. Once SARS-CoV-2 enters the blood stream, a cascade of events (Steps 1-8) unfolds including accumulation of angiotensin II, reactive oxygen species, endothelial dysfunction, oxidation of beta 2 glycoprotein 1, formation of antiphospholipid antibody complexes promoting platelet aggregation, coagulation cascade, and formation of cross-linked fibrin blood clots, leading to pulmonary emboli (PE) and large vessel strokes seen on angiographic imaging studies. There is emerging evidence for COVID-19 being a blood clotting disorder and SARS-CoV-2 using the respiratory route to enter the blood stream. As the blood-air barrier is breached, varying degrees of collateral damage occur. Although antiviral and immune therapies are studied, the role of blood thinners in the prevention, and management of blood clots in Covid-19 need evaluation. In addition to ventilators and blood thinners, continuous aspiration and clot retrieval devices (approved in Europe, cleared in the United States) or cyclical aspiration devices (approved in Europe) need to be considered for the emergent management of life-threatening clots including PE and large vessel strokes.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #703640
Database	COVID19

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Article: Understanding the Radial Force of Stroke Thrombectomy Devices to Minimize Vessel Wall Injury: Mechanical Bench Testing of the Radial Force Generated by a Novel Braided Thrombectomy Assist Device Compared to Laser-Cut Stent Retrievers in Simulated MCA Vessel Diameters.

Katz, Jeffrey M / Hakoun, Abdullah M / Dehdashti, Amir R / Chebl, Alex B / Janardhan, Vikram / Janardhan, Vallabh

Interventional neurology

2019 Volume 8, Issue 2-6, Page(s) 206–214

Abstract: Background: Recent reports have raised various concerns about the risk of vessel wall injury while withdrawing current laser-cut stent retrievers during active strut apposition to the vessel walls. The development of braided thrombectomy assist devices ... ...

Abstract	Background: Recent reports have raised various concerns about the risk of vessel wall injury while withdrawing current laser-cut stent retrievers during active strut apposition to the vessel walls. The development of braided thrombectomy assist devices in conjunction with aspiration systems may be gentler on the fragile brain vessels and more optimized with regard to the radial force (RF) for vessel diameters of proximal (M1) and distal (M2) large vessel occlusions (LVOs). Methods: Mechanical bench testing of the RF was performed using a radial compression station mounted on a tensile testing machine. The total RF in newtons (N) generated in vessels with diameters ranging from 2.25 to 3 mm as seen in proximal LVOs (∼M1), and in vessel diameters ranging from 1.5 to 2.24 mm as seen in distal LVOs (∼M2), was measured. The outer diameter of each stent was recorded, and an RF ≤1 N was grouped as "low," while an RF >1 N was grouped as "high" for this analysis. Results: The total RFs of all laser-cut stent retrievers were all higher in the simulated M2 vessels (>1 N) than in the M1 vessels (<1 N), whereas the total RFs of the braided thrombectomy assist devices were uniformly low in both the simulated M1 and the simulated M2 vessels. Conclusions: Novel braided thrombectomy assist devices in conjunction with aspiration systems have lower RFs than existing laser-cut stent retrievers in M1 and M2 vessel diameters. Further in vivo studies are needed to delineate the impact of lowering the RF on vessel wall integrity.
Language	English
Publishing date	2019-08-05
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662855-7
ISSN	1664-5545 ; 1664-9737
ISSN (online)	1664-5545
ISSN	1664-9737
DOI	10.1159/000501080
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Article: Society of Vascular and Interventional Neurology (SVIN) Stroke Interventional Laboratory Consensus (SILC) Criteria: A 7M Management Approach to Developing a Stroke Interventional Laboratory in the Era of Stroke Thrombectomy for Large Vessel Occlusions.

Shams, Tanzila / Zaidat, Osama / Yavagal, Dileep / Xavier, Andrew / Jovin, Tudor / Janardhan, Vallabh

Interventional neurology

2016 Volume 5, Issue 1-2, Page(s) 1–28

Abstract: Brain attack care is rapidly evolving with cutting-edge stroke interventions similar to the growth of heart attack care with cardiac interventions in the last two decades. As the field of stroke intervention is growing exponentially globally, there is ... ...

Abstract	Brain attack care is rapidly evolving with cutting-edge stroke interventions similar to the growth of heart attack care with cardiac interventions in the last two decades. As the field of stroke intervention is growing exponentially globally, there is clearly an unmet need to standardize stroke interventional laboratories for safe, effective, and timely stroke care. Towards this goal, the Society of Vascular and Interventional Neurology (SVIN) Writing Committee has developed the Stroke Interventional Laboratory Consensus (SILC) criteria using a 7M management approach for the development and standardization of each stroke interventional laboratory within stroke centers. The SILC criteria include: (1) manpower: personnel including roles of medical and administrative directors, attending physicians, fellows, physician extenders, and all the key stakeholders in the stroke chain of survival; (2) machines: resources needed in terms of physical facilities, and angiography equipment; (3) materials: medical device inventory, medications, and angiography supplies; (4) methods: standardized protocols for stroke workflow optimization; (5) metrics (volume): existing credentialing criteria for facilities and stroke interventionalists; (6) metrics (quality): benchmarks for quality assurance; (7) metrics (safety): radiation and procedural safety practices.
Language	English
Publishing date	2016-02-26
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662855-7
ISSN	1664-5545 ; 1664-9737
ISSN (online)	1664-5545
ISSN	1664-9737
DOI	10.1159/000443617
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Article: TARGET® Intracranial Aneurysm Coiling Prospective Multicenter Registry: Final Analysis of Peri-Procedural and Long-Term Safety and Efficacy Results.

Zaidat, Osama O / Castonguay, Alicia C / Rai, Ansaar T / Badruddin, Aamir / Mack, William J / Alshekhlee, Amer K / Shah, Qaisar A / Hussain, Syed I / Kabbani, Mouhammed R / Bulsara, Ketan R / Taqi, Asif M / Janardhan, Vallabh / Patterson, Mary S / Nordhaus, Brittany L / Elijovich, Lucas / Puri, Ajit S

Frontiers in neurology

2019 Volume 10, Page(s) 737

Abstract: Background and Purpose: ...

Abstract	Background and Purpose:
Language	English
Publishing date	2019-07-09
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2564214-5
ISSN	1664-2295
ISSN	1664-2295
DOI	10.3389/fneur.2019.00737
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Article ; Online: Blood-brain barrier, reperfusion injury, and hemorrhagic transformation in acute ischemic stroke.

Khatri, Rakesh / McKinney, Alexander M / Swenson, Barbara / Janardhan, Vallabh

Neurology

2012 Volume 79, Issue 13 Suppl 1, Page(s) S52–7

MeSH term(s)	Animals ; Blood-Brain Barrier/metabolism ; Blood-Brain Barrier/pathology ; Blood-Brain Barrier/physiopathology ; Brain Ischemia/metabolism ; Brain Ischemia/pathology ; Brain Ischemia/physiopathology ; Cerebral Hemorrhage/metabolism ; Cerebral Hemorrhage/pathology ; Cerebral Hemorrhage/physiopathology ; Humans ; Reperfusion Injury/metabolism ; Reperfusion Injury/pathology ; Reperfusion Injury/physiopathology ; Stroke/metabolism ; Stroke/pathology ; Stroke/physiopathology
Language	English
Publishing date	2012-09-25
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	207147-2
ISSN	1526-632X ; 0028-3878
ISSN (online)	1526-632X
ISSN	0028-3878
DOI	10.1212/WNL.0b013e3182697e70
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Article: Advances in interventional neuroimaging.

Janardhan, Vallabh / Qureshi, Adnan I

Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics

2005 Volume 4, Issue 3, Page(s) 414–419

Abstract: Advances in neuroimaging have aided in the development of useful diagnostic modalities for neurological disease and have helped improve existing therapies and pioneer newer therapies in the field of interventional neurology, a new subspecialty of ... ...

Abstract	Advances in neuroimaging have aided in the development of useful diagnostic modalities for neurological disease and have helped improve existing therapies and pioneer newer therapies in the field of interventional neurology, a new subspecialty of neurology. In this chapter, the authors discuss the advances in various neuroimaging modalities, such as digital subtraction angiography, transcranial and intravascular ultrasonography, interventional dynamic computed tomography and 64-slice computed tomographic scanners, magnetic resonance image-guided interventions and intravascular magnetic resonance imaging, and molecular and cellular neuroimaging tools using microbubbles. The authors also summarize the clinical usefulness of these advances and their role in improving the diagnostic and therapeutic potential of neurointerventional procedures.
MeSH term(s)	Central Nervous System/anatomy & histology ; Humans ; Imaging, Three-Dimensional/instrumentation ; Imaging, Three-Dimensional/methods ; Imaging, Three-Dimensional/trends
Language	English
Publishing date	2005-09-21
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2316693-9
ISSN	1878-7479 ; 1933-7213
ISSN (online)	1878-7479
ISSN	1933-7213
DOI	10.1016/j.nurt.2007.05.002
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