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Article ; Online: By and Large, Thrombectomy in Large Core Is a Palpable Reality.

Haussen, Diogo C / Fiehler, Jens

2022 Volume 53, Issue 8, Page(s) 2709–2712

Abstract: Our Japanese colleagues deserve much praise for finishing the first randomized clinical trial of thrombectomy in Alberta Stroke Program Early CT Score 3 to 5 patients showing an impressive therapy effect of thrombectomy. The predominant use of magnetic ... ...

Abstract	Our Japanese colleagues deserve much praise for finishing the first randomized clinical trial of thrombectomy in Alberta Stroke Program Early CT Score 3 to 5 patients showing an impressive therapy effect of thrombectomy. The predominant use of magnetic resonance imaging for patient selection, the low rate of alteplase therapy and its low dose limit direct comparisons with patients treated outside of Japan. Another limitation is the lack of benefit when using the traditional metric-modified Rankin Scale score 0-2. We consider the results of RESCUE-Japan LIMIT encouraging and a clear motivation to continue and complete other studies.
MeSH term(s)	Brain Ischemia/drug therapy ; Endovascular Procedures ; Humans ; Stroke/diagnostic imaging ; Stroke/surgery ; Thrombectomy/methods ; Tissue Plasminogen Activator/therapeutic use ; Treatment Outcome
Chemical Substances	Tissue Plasminogen Activator (EC 3.4.21.68)
Language	English
Publishing date	2022-07-06
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Comment
ZDB-ID	80381-9
ISSN	1524-4628 ; 0039-2499 ; 0749-7954
ISSN (online)	1524-4628
ISSN	0039-2499 ; 0749-7954
DOI	10.1161/STROKEAHA.122.039069
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Zs.A 448: Show issues

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Article ; Online: When More Is Better….

Coutts, Shelagh B / Haussen, Diogo C

Stroke

2021 Volume 52, Issue 9, Page(s) 2743–2745

MeSH term(s)	Brain Ischemia ; Humans ; Thrombectomy
Language	English
Publishing date	2021-07-08
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	80381-9
ISSN	1524-4628 ; 0039-2499 ; 0749-7954
ISSN (online)	1524-4628
ISSN	0039-2499 ; 0749-7954
DOI	10.1161/STROKEAHA.121.035303
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Zs.A 448: Show issues

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Article ; Online: Response by Haussen and Saleem to Letters Regarding Article, "Acute Neurological Deterioration in Large Vessel Occlusions and Mild Symptoms Managed Medically".

Haussen, Diogo C / Saleem, Yasir

Stroke

2020 Volume 51, Issue 10, Page(s) e289–e290

MeSH term(s)	Brain Ischemia/drug therapy ; Humans ; Thrombolytic Therapy
Language	English
Publishing date	2020-09-28
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	80381-9
ISSN	1524-4628 ; 0039-2499 ; 0749-7954
ISSN (online)	1524-4628
ISSN	0039-2499 ; 0749-7954
DOI	10.1161/STROKEAHA.120.030854
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Zs.A 448: Show issues

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Article ; Online: Carotid Web and Ischemic Stroke: A Primer for Nursing.

Sutherly, Loretta J / Wasserman, Jessica / Haussen, Diogo C

The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses

2021 Volume 53, Issue 3, Page(s) 140–142

Abstract: Abstract: BACKGROUND: Carotid artery web may cause ischemic stroke and affects a vulnerable population of mostly younger patients. Multiple treatment options and lack of diagnostic consensus can cause confusion and reduce the likelihood to follow the ... ...

Abstract	Abstract: BACKGROUND: Carotid artery web may cause ischemic stroke and affects a vulnerable population of mostly younger patients. Multiple treatment options and lack of diagnostic consensus can cause confusion and reduce the likelihood to follow the recommended follow-up care. METHODS: We reviewed relevant literature using the following keywords: carotid web, CW, risk factors, stroke, treatments, education, incidence, prevalence, diagnostics, and nursing care. RESULTS: CW is commonly missed or misdiagnosed, which has led to scarce prevalence data. It has been reported to potentially represent approximately 0.5% of all ischemic strokes; however, after appropriate workup of patients with no clear stroke etiology, as many as 9.4% to 37% were found to have CW. This fibrotic shelflike lesion in the internal carotid bifurcation leads to flow disruption and possible thrombus formation. Treatment options include dual antiplatelets and anticoagulation or more invasive options such as revascularization with surgical excision or stenting, but research remains limited on which could be most beneficial. CONCLUSION: With multiple options and the uncertainty of which are best, patients can be lost to follow-up because of confusion and stress. Involving neuroscience nurses in the education process of these patients may help facilitate understanding of this disease phenomenon and increase patient understanding and compliance.
MeSH term(s)	Brain Ischemia ; Carotid Arteries ; Humans ; Ischemic Stroke ; Stents ; Stroke/epidemiology
Language	English
Publishing date	2021-03-24
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	632790-4
ISSN	1945-2810 ; 0888-0395
ISSN (online)	1945-2810
ISSN	0888-0395
DOI	10.1097/JNN.0000000000000589
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Zs.B 1501: Show issues

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Article ; Online: Subjects with carotid webs demonstrate pro-thrombotic hemodynamics compared to subjects with carotid atherosclerosis.

El Sayed, Retta / Lucas, Carissa J / Cebull, Hannah L / Nahab, Fadi B / Haussen, Diogo C / Allen, Jason W / Oshinski, John N

Scientific reports

2024 Volume 14, Issue 1, Page(s) 10092

Abstract: Carotid artery webs (CaW) are non-atherosclerotic projections into the vascular lumen and have been linked to up to one-third of cryptogenic strokes in younger patients. Determining how CaW affects local hemodynamics is essential for understanding clot ... ...

Abstract	Carotid artery webs (CaW) are non-atherosclerotic projections into the vascular lumen and have been linked to up to one-third of cryptogenic strokes in younger patients. Determining how CaW affects local hemodynamics is essential for understanding clot formation and stroke risk. Computational fluid dynamics simulations were used to investigate patient-specific hemodynamics in carotid artery bifurcations with CaW, bifurcations with atherosclerotic lesions having a similar degree of lumen narrowing, and with healthy carotid bifurcations. Simulations were conducted using segmented computed tomography angiography geometries with inlet boundary conditions extracted from 2D phase contrast MRI scans. The study included carotid bifurcations with CaW (n = 13), mild atherosclerosis (n = 7), and healthy bifurcation geometries (n = 6). Hemodynamic parameters associated with vascular dysfunction and clot formation, including shear rate, oscillatory shear index (OSI), low velocity, and flow stasis were calculated and compared between the subject groups. Patients with CaW had significantly larger regions containing low shear rate, high OSI, low velocity, and flow stasis in comparison to subjects with mild atherosclerosis or normal bifurcations. These abnormal hemodynamic metrics in patients with CaW are associated with clot formation and vascular dysfunction and suggest that hemodynamic assessment may be a tool to assess stroke risk in these patients.
MeSH term(s)	Humans ; Hemodynamics ; Male ; Carotid Artery Diseases/physiopathology ; Carotid Artery Diseases/diagnostic imaging ; Female ; Middle Aged ; Aged ; Carotid Arteries/diagnostic imaging ; Carotid Arteries/physiopathology ; Computed Tomography Angiography ; Thrombosis/physiopathology ; Thrombosis/diagnostic imaging ; Magnetic Resonance Imaging
Language	English
Publishing date	2024-05-02
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-024-60666-7
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Article ; Online: Anticoagulants versus Antiplatelet Treatment in the Medical Management of Carotid Floating Thrombus.

Aboul-Nour, Hassan / Alshaer, Qasem / Khalid, Fatima Chughtai / Osehobo, Ehizele / Tarek, Mohamed A / Mohammaden, Mahmoud H / Haussen, Diogo C / Dolia, Jaydevsinh N

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

2024 Volume 33, Issue 7, Page(s) 107760

Abstract: Background: Carotid free-floating thrombus (CFT) is a rare cause of stroke describing an intraluminal thrombus that is loosely associated with the arterial wall and manifesting as a filling defect fully surrounded by flow on vascular imaging. ... ...

Abstract	Background: Carotid free-floating thrombus (CFT) is a rare cause of stroke describing an intraluminal thrombus that is loosely associated with the arterial wall and manifesting as a filling defect fully surrounded by flow on vascular imaging. Unfortunately, there is no clear consensus among experts on the ideal treatment for this pathology. Methods: Retrospective analysis of acute ischemic stroke (AIS) and transient ischemic attack (TIA) patients diagnosed with CFT on computed tomography angiogram (CTA) between January 2015-March 2023. We aimed to compare two treatment regimens: anticoagulation (ACT) and antiplatelet (APT) in the treatment of CFT. APT regimens included the use of dual or single antiplatelets (DAPT or SAPT; aspirin, clopidogrel and ticagrelor) and ACT regimens included the use of direct oral anticoagulants, warfarin, heparin or low molecular weight heparin +/- ASA. Patients that underwent mechanical thrombectomy were excluded. Results: During study time there were 8252 acute ischemic stroke hospitalizations, of which 135 (1.63 %) patients were diagnosed with CFT. Sixty-six patients were included in our analysis. Patients assigned to APT were older (60.41years ± 12.82;p < 0.01). Other demographic variables were similar between ACT and APT groups. Complete CFT resolution on repeat vascular imaging was numerically higher at 30 days (58.8 vs 31.6 %, respectively; p = 0.1) and at latest follow-up (70.8 vs 50 %; p = 0.1) on ACT vs APT, respectively without reaching statistical significance. Similarly, there was numerically higher rates of any ICH with ACT compared to APT but it did not achieve statistical significance (27.6 % vs 13.5 %; p = 0.5). There were similar rates of PH1/2 hemorrhagic transformation, independence at discharge and similar hospital length of stay between ACT and APT groups. Patients assigned to APT were more likely to be discharged on their assigned treatment compared to those assigned to ACT (86.5 vs 55.2 %; p < 0.001). The rate of 30-day recurrent stroke was comparable among ACT and APT at 30 days (3.4 vs 0 %; p = 0.1, respectively). Subgroup analysis comparing exclusive ACT vs Dual APT lead to similar results. Conclusion: Our study showed comparable efficacy and safety outcomes in CFT patients who were exclusively managed medically with ACT vs APT. Larger prospective studies are needed.
Language	English
Publishing date	2024-05-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	1131675-5
ISSN	1532-8511 ; 1052-3057
ISSN (online)	1532-8511
ISSN	1052-3057
DOI	10.1016/j.jstrokecerebrovasdis.2024.107760
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Zs.A 3519: Show issues

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Article ; Online: Importance of the Intention-to-Treat Principle.

Nagel, Simon / Haussen, Diogo C / Nogueira, Raul G

JAMA neurology

2020 Volume 77, Issue 7, Page(s) 905–906

MeSH term(s)	Humans ; Intention ; Intention to Treat Analysis ; Stroke ; Thrombectomy
Language	English
Publishing date	2020-06-21
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	2702023-X
ISSN	2168-6157 ; 2168-6149
ISSN (online)	2168-6157
ISSN	2168-6149
DOI	10.1001/jamaneurol.2020.0848
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Article ; Online: Carotid Artery Stenting: Applications and Technical Considerations.

Al-Bayati, Alhamza R / Nogueira, Raul G / Haussen, Diogo C

Neurology

2021 Volume 97, Issue 20 Suppl 2, Page(s) S137–S144

Abstract: Purpose of the review: To examine current understanding of diverse etiologies of extracranial carotid disease, including clinical and imaging manifestations as well as treatment approaches.: Recent findings: Increasing availability of advanced ... ...

Abstract	Purpose of the review: To examine current understanding of diverse etiologies of extracranial carotid disease, including clinical and imaging manifestations as well as treatment approaches. Recent findings: Increasing availability of advanced cerebrovascular imaging modalities continues to elucidate atherosclerotic and nonatherosclerotic carotid steno-occlusive disease as a common culprit of cerebral ischemia. Individualized treatment strategies targeting each etiologic subset would optimize preventive measures and minimize recurrence of cerebral ischemia. Summary: Ischemic stroke is a prominent cause of mortality and long-term disability worldwide. The magnified effect of carotid disease warrants constant and close inspection.
MeSH term(s)	Brain Ischemia/prevention & control ; Carotid Artery Diseases/surgery ; Humans ; Stents
Language	English
Publishing date	2021-11-14
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.0000000000012802
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Ui II Zs.153: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
Zs.MG 18: Show issues
Zs.MO 374: Show issues

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Article ; Online: Assessment of Complex Flow Patterns in Patients With Carotid Webs, Patients With Carotid Atherosclerosis, and Healthy Subjects Using 4D Flow MRI.

El Sayed, Retta / Park, Charlie C / Shah, Zahraw / Nahab, Fadi B / Haussen, Diogo C / Allen, Jason W / Oshinski, John N

Journal of magnetic resonance imaging : JMRI

2023 Volume 59, Issue 6, Page(s) 2001–2010

Abstract: Background: Carotid webs (CaWs) are fibromuscular projections in the internal carotid artery (ICA) that cause mild luminal narrowing (<50%), but may be causative in up to one-third of seemingly cryptogenic strokes. Understanding hemodynamic alterations ... ...

Abstract	Background: Carotid webs (CaWs) are fibromuscular projections in the internal carotid artery (ICA) that cause mild luminal narrowing (<50%), but may be causative in up to one-third of seemingly cryptogenic strokes. Understanding hemodynamic alterations caused by CaWs is imperative to assessing stroke risk. Time-Average Wall Shear Stress (TAWSS) and Oscillatory Shear Index (OSI) are hemodynamic parameters linked to vascular dysfunction and thrombosis. Purpose: To test the hypothesis: "CaWs are associated with lower TAWSS and higher OSI than mild atherosclerosis or healthy carotid bifurcation." Study type: Prospective study. Population: A total of 35 subjects (N = 14 bifurcations with CaW, 11F, age: 49 ± 10, 10 mild atherosclerosis 6F, age: 72 ± 9, 11 healthy 9F, age: 42 ± 13). Field strength/sequence: 4D flow/STAR-MATCH/3D TOF/3T MRI, CTA. Assessment: 4D Flow velocity data were analyzed in two ways: 1) 3D ROI in the ICA bulbar segment (complex flow patterns are expected) was used to quantify the regions with low TAWSS and high OSI. 2) 2D planes were placed perpendicular to the centerline of the carotid bifurcation for detailed analysis of TAWSS and OSI. Statistical tests: Independent-samples Kruskal-Wallis-H test with 0.05 used for statistical significance. Results: The percent surface area where low TAWSS was present in the ICA bulb was 12.3 ± 8.0% (95% CI: 7.6-16.9) in CaW subjects, 1.6 ± 1.9% (95% CI: 0.2-2.9) in atherosclerosis, and 8.5 ± 7.7% (95% CI: 3.6-13.4) in healthy subjects, all differences were statistically significant (ƞ Conclusion: Lower TAWSS and higher OSI are present in the ICA bulb in patients with CaW when compared to patients with atherosclerotic or healthy subjects. Evidence level: 2 TECHNICAL EFFICACY: Stage 2.
MeSH term(s)	Humans ; Female ; Male ; Middle Aged ; Aged ; Prospective Studies ; Carotid Artery Diseases/diagnostic imaging ; Carotid Artery Diseases/physiopathology ; Blood Flow Velocity ; Adult ; Carotid Artery, Internal/diagnostic imaging ; Carotid Artery, Internal/physiopathology ; Magnetic Resonance Imaging/methods ; Hemodynamics ; Imaging, Three-Dimensional/methods ; Magnetic Resonance Angiography/methods
Language	English
Publishing date	2023-09-14
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	1146614-5
ISSN	1522-2586 ; 1053-1807
ISSN (online)	1522-2586
ISSN	1053-1807
DOI	10.1002/jmri.29013
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Zs.A 3648: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 236: Show issues

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Article ; Online: Optical Coherence Tomography in the Evaluation of Suspected Carotid Webs.

Al-Bayati, Alhamza R / Nogueira, Raul G / Sachdeva, Rajesh / Mohammaden, Mahmoud H / Bhatt, Nirav R / Liberato, Bernardo / Frankel, Michael R / Haussen, Diogo C

Journal of neurointerventional surgery

2023

Abstract: Background: Carotid web (CaW) is a subtype of fibromuscular dysplasia that predominantly involves the intimal layer of the arterial wall and is commonly overlooked as a separate causative entity for recurrent strokes. CaW is defined as a shelf-like ... ...

Abstract	Background: Carotid web (CaW) is a subtype of fibromuscular dysplasia that predominantly involves the intimal layer of the arterial wall and is commonly overlooked as a separate causative entity for recurrent strokes. CaW is defined as a shelf-like lesion at the carotid bulb, although different morphological features have been reported. Optical coherence tomography (OCT) has been described in the literature as a useful microscopic and cross-sectional tomographic imaging tool. This study aimed to evaluate the potential utility of OCT in characterizing the wall structure features of patients with suspected CaW. Methods: Retrospective analysis of patients with suspected CaW who underwent digital subtraction angiography (DSA) coupled with OCT of the carotid bulb from 2018 to 2021 in a single comprehensive stroke center. Results: Sixteen patients were included. The median age was 56 years (IQR 46-61) and 50% were women. OCT corroborated the diagnosis of CaW in 12/16 (75%) cases and ruled it out in 4/16 (25%) patients in whom atherosclerotic disease was demonstrated. Five of the 12 lesions demonstrated a thick fibrotic ridge consistent with CaW but also showed atherosclerotic changes in the vicinity of the carotid bulb (labeled as "CaW+"). In 4/16 (25%) patients, microthrombi adhered to the vessel wall were noted on OCT (inside the CaW pocket or just distal to the web), none of which were observed on CT angiography or DSA. Conclusions: OCT may have value as a complementary imaging tool in the investigation of patients with suspected CaW and atypical morphological features. Further studies are warranted.
Language	English
Publishing date	2023-11-24
Publishing country	England
Document type	Journal Article
ZDB-ID	2514982-9
ISSN	1759-8486 ; 1759-8478
ISSN (online)	1759-8486
ISSN	1759-8478
DOI	10.1136/jnis-2023-020813
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