Author
Osama O. Zaidat
Other affiliations: Mercy Health, Ghent University, Brown University ...read more
Bio: Osama O. Zaidat is an academic researcher from Mercy Medical Center (Baltimore, Maryland). The author has contributed to research in topics: Stroke & Modified Rankin Scale. The author has an hindex of 13, co-authored 53 publications receiving 1020 citations. Previous affiliations of Osama O. Zaidat include Mercy Health & Ghent University.
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TL;DR: The achievement of complete revascularization from a single Solitaire thrombectomy device pass (FPE) is associated with significantly higher rates of good clinical outcome and the FPE is more frequently associated with the use of balloon guide catheters and less likely to be achieved with internal carotid artery terminus occlusion.
Abstract: Background and Purpose—In acute ischemic stroke, fast and complete recanalization of the occluded vessel is associated with improved outcomes. We describe a novel measure for newer generation devic...
407 citations
Mayo Clinic1, New York University2, University at Buffalo3, Thomas Jefferson University4, Toronto Western Hospital5, Mercy Medical Center (Baltimore, Maryland)6, Johns Hopkins University7, University of California, Los Angeles8, University of South Florida9, Geisinger Medical Center10, Baptist Health11, University of Utah12, Cleveland Clinic13, University of Kentucky14, Rush University Medical Center15, Oregon Health & Science University16, Baylor College of Medicine17, Stony Brook University18, University of Wisconsin-Madison19, Houston Methodist Hospital20, Tufts University21, Emory University22, University of Massachusetts Medical School23
TL;DR: Treatment of wide necked small/medium aneurysms with the PED results in high rates of complete occlusion without significant parent vessel stenosis and low rates of permanent neurologic complications.
Abstract: Background Preliminary clinical studies on the safety and efficacy of the pipeline embolization device (PED) for the treatment of small/medium aneurysms have demonstrated high occlusion rates with low complications. Objective To evaluate the safety and effectiveness of the PED for treatment of wide necked small and medium intracranial aneurysms. Methods PREMIER is a prospective, multicenter, single arm trial. Patients were treated with the PED for unruptured wide necked aneurysms, measuring ≤12 mm along the internal carotid artery or vertebral artery, between July 2014 and November 2015. At 1 year post-procedure, the primary effectiveness endpoint was complete occlusion (Raymond grade 1) without major parent vessel stenosis (≤50%) or retreatment, and the primary safety endpoint was major stroke in the territory supplied by the treated artery or neurologic death. Results A total of 141 patients were treated with PEDs (mean age 54.6±11.3 years, 87.9% (124/141) women). Mean aneurysm size was 5.0±1.92 mm, and 84.4% (119/141) measured Conclusions Treatment of wide necked small/medium aneurysms with the PED results in high rates of complete occlusion without significant parent vessel stenosis and low rates of permanent neurologic complications. Trial registration NCT02186561.
154 citations
Mayo Clinic1, Houston Methodist Hospital2, University at Buffalo3, St. Joseph's Hospital and Medical Center4, Boston Children's Hospital5, Royal University Hospital6, University of Toronto7, University of California, Los Angeles8, Ohio State University9, Rush University Medical Center10, University of Alabama at Birmingham11, Medical University of South Carolina12, Medical College of Wisconsin13, Ghent University14, Washington University in St. Louis15, Thomas Jefferson University16, Stony Brook University17
TL;DR: A prospective postmarket study confirms that PED treatment of aneurysms in a heterogeneous patient population is safe with low rates of neurological morbidity and mortality.
Abstract: Background and Objective: Few prospective studies exist evaluating the safety and efficacy of the Pipeline Embolization Device (PED) in the treatment of intracran
153 citations
Mercy Medical Center (Baltimore, Maryland)1, Vanderbilt University2, University of California, Los Angeles3, Harvard University4, Houston Methodist Hospital5, University of Miami6, Boston Children's Hospital7, University of Pittsburgh8, Oregon Health & Science University9, Emory University10, Baptist Health11, Providence St. Vincent Medical Center12, Baptist Hospital of Miami13, Jackson Memorial Hospital14, University of Tennessee15, Advocate Lutheran General Hospital16, Cleveland Clinic17, Baylor University Medical Center18, Riverside Methodist Hospital19, Maine Medical Center20, Geisinger Medical Center21, Baptist Memorial Hospital-Memphis22, Washington University in St. Louis23, Mercy San Juan Medical Center24, University of Arizona25, University of Kentucky26, West Virginia University27, Albany Medical College28, University of Maryland, Baltimore29, Memorial Medical Center30, Virginia Mason Medical Center31, Mayo Clinic32, Erlanger Health System33, ProMedica34, California Pacific Medical Center35, University of California, Irvine36, St. John Providence Health System37, Carolinas Medical Center38
TL;DR: This largest-to-date Solitaire registry documents that the results of the randomized trials can be reproduced in the community and the decrease of clinical benefit over time warrants optimization of the system of care.
Abstract: Background and Purpose— Mechanical thrombectomy with stent retrievers has become standard of care for treatment of acute ischemic stroke patients because of large vessel occlusion. The STRATIS registry (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke) aimed to assess whether similar process timelines, technical, and functional outcomes could be achieved in a large real world cohort as in the randomized trials. Methods— STRATIS was designed to prospectively enroll patients treated in the United States with a Solitaire Revascularization Device and Mindframe Capture Low Profile Revascularization Device within 8 hours from symptom onset. The STRATIS cohort was compared with the interventional cohort of a previously published SEER patient-level meta-analysis. Results— A total of 984 patients treated at 55 sites were analyzed. The mean National Institutes of Health Stroke Scale score was 17.3. Intravenous tissue-type plasminogen activator was administered in 64.0%. The median time from onset to arrival in the enrolling hospital, door to puncture, and puncture to reperfusion were 138, 72, and 36 minutes, respectively. The Core lab–adjudicated modified Thrombolysis in Cerebral Infarction ≥2b was achieved in 87.9% of patients. At 90 days, 56.5% achieved a modified Rankin Scale score of 0 to 2, all-cause mortality was 14.4%, and 1.4% suffered a symptomatic intracranial hemorrhage. The median time from emergency medical services scene arrival to puncture was 152 minutes, and each hour delay in this interval was associated with a 5.5% absolute decline in the likelihood of achieving modified Rankin Scale score 0 to 2. Conclusions— This largest-to-date Solitaire registry documents that the results of the randomized trials can be reproduced in the community. The decrease of clinical benefit over time warrants optimization of the system of care. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT02239640.
144 citations
Rowan University1, Cooper University Hospital2, Bellvitge University Hospital3, Spanish National Research Council4, University of Valladolid5, Robert Wood Johnson University Hospital6, Rutgers University7, Autonomous University of Barcelona8, Emory University9, Grady Memorial Hospital10, University of Barcelona11, Alexandria University12, Boston University13, Carol Davila University of Medicine and Pharmacy14, University of Texas Health Science Center at Houston15, Ronald Reagan UCLA Medical Center16, University of Iowa Hospitals and Clinics17, University of Texas at Austin18
TL;DR: COVID-19 is associated with a small but significant risk of clinically relevant cerebrovascular events, particularly ischemic stroke, and aggressive monitoring and early intervention should be pursued to mitigate poor outcomes.
Abstract: BackgroundSevere acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has been associated with a significant risk of thrombotic events in critically ill patients.AimTo summarize the findings of a ...
108 citations
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Journal Article•
TL;DR: For a selected cohort of men with symptoms of cerebral or retinal ischemia in the distribution of a high-grade internal carotid artery stenosis, carOTid endarterectomy can effectively reduce the risk of subsequent ipsilateral cerebral ischemies.
Abstract: Objective. —To determine whether carotid endarterectomy provides protection against subsequent cerebral ischemia in men with ischemic symptoms in the distribution of significant (>50%) ipsilateral internal carotid artery stenosis. Design. —Prospective, randomized, multicenter trial. Setting. —Sixteen university-affiliated Veterans Affairs medical centers. Patients. —Men who presented within 120 days of onset of symptoms that were consistent with transient ischemic attacks, transient monocular blindness, or recent small completed strokes between July 1988 and February 1991. Among 5000 patients screened, 189 individuals were randomized with angiographic internal carotid artery stenosis greater than 50% ipsilateral to the presenting symptoms. Forty-eight eligible patients who refused entry were followed up outside of the trial. Outcome Measures. —Cerebral infarction or crescendo transient ischemic attacks in the vascular distribution of the original symptoms or death within 30 days of randomization. Intervention. —Carotid endarterectomy plus the best medical care (n = 91) vs the best medical care alone (n=98). Results. —At a mean follow-up of 11.9 months, there was a significant reduction in stroke or crescendo transient ischemic attacks in patients who received carotid endarterectomy (7.7%) compared with nonsurgical patients (19.4%), or an absolute risk reduction of 11.7% (P=.011). The benefit of surgery was more profound in patients with internal carotid artery stenosis greater than 70% (absolute risk reduction, 17.7%;P=.004). The benefit of surgery was apparent within 2 months after randomization, and only one stroke was noted in the surgical group beyond the 30-day perioperative period. Conclusions. —For a selected cohort of men with symptoms of cerebral or retinal ischemia in the distribution of a high-grade internal carotid artery stenosis, carotid endarterectomy can effectively reduce the risk of subsequent ipsilateral cerebral ischemia. The risk of cerebral ischemia in this subgroup of patients is considerably higher than previously estimated. (JAMA. 1991;266:3289-3294)
811 citations
26 Feb 2019
TL;DR: High quality evidence to recommend MT plus best medical management (BMM, including intravenous thrombolysis whenever indicated) to improve functional outcome in patients with LVO-related acute ischaemic stroke within 6 hours after symptom onset is found.
Abstract: BackgroundMechanical thrombectomy (MT) has become the cornerstone of acute ischaemic stroke management in patients with large vessel occlusion (LVO). The aim of this guideline document is to assist...
304 citations
TL;DR: High quality evidence is found to recommend Mechanical thrombectomy plus best medical management (BMM) to improve functional outcome in patients with LVO related acute ischemic stroke within 6 hours after symptom onset.
Abstract: Background Mechanical thrombectomy (MT) has become the cornerstone of acute ischemic stroke management in patients with large vessel occlusion (LVO). Objective To assist physicians in their clinical decisions with regard toMT. Methods These guidelines were developed based on the standard operating procedure of the European Stroke Organisation and followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. An interdisciplinary working group identified 15 relevant questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence, and wrote evidence-based recommendations. Expert opinion was provided if not enough evidence was available to provide recommendations based on the GRADE approach. Results We found high-quality evidence to recommend MT plus best medical management (BMM, including intravenous thrombolysis whenever indicated) to improve functional outcome in patients with LVO-related acute ischemic stroke within 6 hours after symptom onset. We found moderate quality of evidence to recommend MT plus BMM in the 6–24h time window in patients meeting the eligibility criteria of published randomized trials. These guidelinesdetails aspects of prehospital management, patient selection based on clinical and imaging characteristics, and treatment modalities. Conclusions MT is the standard of care in patients with LVO-related acute stroke. Appropriate patient selection and timely reperfusion are crucial. Further randomized trials are needed to inform clinical decision-making with regard tothe mothership and drip-and-ship approaches, anesthaesia modalities during MT, and to determine whether MT is beneficial in patients with low stroke severity or large infarct volume.
304 citations
TL;DR: Endovascular treatment with mechanical thrombectomy (MT) is beneficial for patients with acute stroke suffering a large-vessel occlusion, although treatment efficacy is highly time-depen...
Abstract: Background:Endovascular treatment with mechanical thrombectomy (MT) is beneficial for patients with acute stroke suffering a large-vessel occlusion, although treatment efficacy is highly time-depen
297 citations
TL;DR: Chest CT is valuable to detect both alternative diagnoses and complications of COVID-19 (acute respiratory distress syndrome, pulmonary embolism, and heart failure), while its role for prognostication requires further investigation.
Abstract: Chest CT has a potential role in the diagnosis, detection of complications, and prognostication of coronavirus disease 2019 (COVID-19). Implementation of appropriate precautionary safety measures, chest CT protocol optimization, and a standardized reporting system based on the pulmonary findings in this disease will enhance the clinical utility of chest CT. However, chest CT examinations may lead to both false-negative and false-positive results. Furthermore, the added value of chest CT in diagnostic decision making is dependent on several dynamic variables, most notably available resources (real-time reverse transcription-polymerase chain reaction [RT-PCR] tests, personal protective equipment, CT scanners, hospital and radiology personnel availability, and isolation room capacity) and the prevalence of both COVID-19 and other diseases with overlapping manifestations at chest CT. Chest CT is valuable to detect both alternative diagnoses and complications of COVID-19 (acute respiratory distress syndrome, pulmonary embolism, and heart failure), while its role for prognostication requires further investigation. The authors describe imaging and managing care of patients with COVID-19, with topics including (a) chest CT protocol, (b) chest CT findings of COVID-19 and its complications, (c) the diagnostic accuracy of chest CT and its role in diagnostic decision making and prognostication, and (d) reporting and communicating chest CT findings. The authors also review other specific topics, including the pathophysiology and clinical manifestations of COVID-19, the World Health Organization case definition, the value of performing RT-PCR tests, and the radiology department and personnel impact related to performing chest CT in COVID-19. ©RSNA, 2020.
277 citations