Research

Trials

Ongoing Research Trials

Stroke has a tremendous global and national disease burden. It is estimated that there are approximately 795,000 incident strokes each year in the US. The overall prevalence of clinical stroke in US adult population is about 2.6%, however these estimates range between 6 - 28% if sub-clinical disease is included.

The objective of this proposed study is to assess regional patterns of care for adult patients with primary Intra-cerebral Hemorrhage (ICH}. We define primary ICH as intra-parenchymal hemorrhage not secondary to trauma or any underlying structural pathology, such as aneurysm or tumor, etc. We aim to study the factors underlying the decision to transfer these patients across various levels of care, resource utilization during and following hospital admission, and patients' outcomes, including quality oflife.

This is a prospective, observational study of adult patients with primary ICH presenting and managed at various hospitals across El Paso, Texas. Patients will be consented during their stay, and data on their initial and continued management will be captured in a web-based, study­specific database. The enrolled patients will be followed up in hospital / at time of consent and then by phone at 30 and 90 days post-discharge. Follow up information will include clinical, resource utilization and functional outcome. Concomitantly, resource utilization/ cost data will be collected from participating institutions.

This protocol does not entail any medical/ surgical, psychological, educational, or cognitive interventions, and all patients will continue to receive standard of care therapy as dictated by their clinical condition and in line with physicians'/ institutional protocols.

The primary aims of the study is to examine the association between level of care (i.e. care at Comprehensive Stroke Certified [CSC] centers, vs. non-CSC hospitals like Primary Stroke Certified [PSC] centers, and other hospitals) and outcomes in patients with spontaneous ICH 

i. To evaluate the association between level of care (CSC vs. Non-CSC hospitals) and day-90 functional outcome as measured by the modified Rankin Scale (mRS) among ICH patients.

ii. To determine the association between levels of care and all-cause mortality for ICH patients during the follow up period of 90 days.

iii. To compare all cause 30-day readmission rates for ICH patients managed at different levels of care (CSC vs. Non-CSC hospitals).

iv. And finally, to estimate the health economic impact of management of patients with spontaneous ICH at various levels of care (CSC vs. Non-CSC). This will be achieved by performing a cost effectiveness analysis that quantified incremental gain in quality of life for additional costs incurred by management of risk adjusted spontaneous ICH patients at a CSC vs. non­CSC hospitals.

The study is funded by the Lone Start Stoke Research Consortium of Texas.

The primary investigator (Pl) is Salvador Cruz-Flores, M.D., MPH, and co-investigator Jose Gustavo Rodriguez, M.D.

For more information regarding the clinical trial, please contact the Clinical Research Coordinator, Israel Alba, CCRP, at lsrael.alba@ttuhsc.edu.

 

About 20% of ischemic strokes are not lacunar (i.e. not due to cerebral small artery disease) or associated with a major source of embolism in the heart or the arteries to the brain, such as atrial fibrillation or severe atherosclerotic stenosis of the cerebral arteries. These ischemic strokes were formerly called cryptogenic, but as recent monitoring and imaging studies have identified a number of potential sources of embolism in these patients, it has been suggested that many can be more accurately characterized as Embolic Stroke of Undetermined Source (ESUS).

The sources of embolism underlying ESUS include the heart (either within the heart or via paradoxical embolism from a venous source), aortic arch, or the large cervical and cerebral arteries. As many potential embolic sources are common or co-exist in patients, it is often difficult to confidently establish a definite causal relationship between and embolic source and the embolic stroke. This new clinical construct Embolic Stroke of Undetermined Source (ESUS) is the basis for two ongoing large international randomized trials; NAVIGATE-ESUS and RESPECT ESUS. Both trials are comparing the safety and efficacy of direct oral anticoagulant therapy with antiplatelet therapy in patients with ESUS. In total the two trials will have a sample size of around 13,000 by the end of recruitment; however, there will be a limited number of ESUS patients under the age of SO years enrolled due to the respective study designs. Therefore although these trials are likely to provide us with valuable information about older ESUS population there will be a gap in the knowledge of the young ESUS patients (patients under the age of SO years with Embolic Stroke of Undetermined Source). Data from the recently published ESUS Global Registry have shown a substantial percentage (about 20%) of ESUS patients to be under the age 50 with high fractions in Latin American and East Asian countries.

Aims of the Study: 

1. To describe clinical, laboratory, and imaging characteristics of patients with ESUS SO years and under, including antithrombotic therapy used for secondary prevention, overall and per different global regions.

2. To determine the rates of recurrent ischemic stroke and/or death in a well-defined cohort of young ESUS patients, overall and per different global regions.

3. To explore clinical, laboratory and imaging predictors of recurrent ischemic stroke and/or death in a cohort of young ESUS patients.

4. To determine rates of new onset atrial fibrillation in a well-defined cohort of young ESUS patients, overall and per different global region.

The study is actively recruiting patients into the registry from University Medical Center of El Paso and follow ups are perform at TTUHSC El Paso Department of Neurology Clinic.

The Study is funded by Bayer Pharmaceuticals and Primary Investigator is Alberto Maud, M.D., and co-investigators are Salvador Cruz-Flores, M.D., Rakesh Khatri, M.D., Paisith Piriyawat, M.D., and Gustavo J. Rodriguez, M.D.

For more information regarding this clinical trial please contact the Clinical Research Coordinator, Israel Alba, CCRP at lsrael.alba@ttuhsc.edu.

Histopathological correlation of th'e retrieved clot in cerebral mechanical thrombectomy is an area of active clinical research. Thrombus histological composition might have a role in future device design and selection as well as it might explain the rate of successful or failure recanalization. Hispanic are underrepresented in samples of the studies published in this subject. We postulate that there could be a difference in histological composition of thrombus among Hispanic and non-Hispanic patient population.

Globally the incidence of ischemic stroke accounts for 68% and in US, 87% of all strokes are ischemic. Data about ischemic stroke incidence in Hispanics is limited. It was noticed that stroke occurs at an early age in Hispanic population and have more length of stay in hospital compared to whites. Past studies stated that there is an increase in stroke death rate in Hispanics compared to previous years. This could be due to risk factors, etiology, gross/ microscopic thrombi appearance, response to treatment, care.

Although previous studies have shown the correlation between histological composition, etiology, imaging and angiographic outcomes in AIS patients, there is limited data available about clot composition in different ethnicities. The current study will retrospective assess the histopathological clot composition in Hounsfield unit (HU) on non-enhanced CT of the head at the tfme of the acute stroke presentation in patient that were treated with mechanical embolectomy for emergent large vessel occlusion at UMC of El Paso and compare for any differences in the clot composition across ethnicities. In order to identify the patients who underwent mechanical thrombectomies we will use a retrospective data. This is a retrospective observational study from stroke registries.

The primary aims of the includes the identification of acute ischemic stroke patients who underwent mechanical thrombectomies in our institution. The retrieved thrombus are studied in terms of histological composition, and correlated with subtype of ischemic stroke etiology, effectiveness of the mechanical thrombectomy and compare data across ethnicity.

The study is actively reviewing medical records to find possible candidates for the registry.

The study is funded and supported by the TTUHSC Department of Neurology.

The primary investigator is Alberto Maud, M.D., and Co-Investigators are Pranitha Arrabyru, M.D., Rakesh Khatri, M.D., Gustavo J. Rodriguez, M.D., and Salvador Cruz-Flores, M.D.

For more information regarding the Clinical Registry, please contact the Clinical Research Coordinator, Israel Alba, CCRP at lsrael.alba@ttuhsc.edu.

Fibromuscular dysplasia (FMD) is a non-atherosclerotic, non-inflammatory vascular disease that most commonly affects the renal and internal carotid arteries but has been described in almost every arterial bed in the body. It may be entirely asymptomatic and discovered incidentally or it may present with one or more of the following; 

• Hypertension

• Transient ischemic attack

• Stroke

• Renal failure

• Homer's syndrome

• Subarachnoid hemorrhage

• Arterial dissection

• Dizziness

• Headache

• Claudication

• Mesenteric ischemia

The prevalence and natural history of FMD in the United States is not known. Since FMD may involve many different organ systems, a number of different specialists may see patients with FMD. Since fibromuscular dysplasia is not commonly recognized, and is less common than other diseases seen by internists, nephrologists, neurologists, pediatricians and vascular specialists, no large, randomized prospective trials exist to help guide therapy. Therefore, recommendations are based only on a few small case series, multiple case reports, and the recommendations of experts who commonly encounter this condition.

TTUHSC El Paso is currently participating as one of the 8 centers in the United States and we are currently seeking patients with FMD to participate in the Registry.

The goals of the FMD are to create a data form with variables that will collect information, understand the natural history of FMD, as well to answer the following questions;

a. How do patients with FMD present?

b. Are there any environmental, hormonal or genetic factors that can be identified in patients with FMD?

c. Can we develop a standardized definition of what constitutes FMD?

d. Does FMD cluster with other diseases such as Ehlers-Danlos Syndrome or Neurofibromatosis?

e. What is the natural history of FMD?

f. What imaging modalities are used to make the diagnosis of FMD and are the noninvasive methods as good as catheter-based angiography?

g. What are the most common treatment modalities utilized in patients with FMD?

h. Are there any markers of a more favorable prognosis or a more serious prognosis?

i. What is the best way to determine if a percutaneous intervention was successful?

i. Does the disease come back in a vessel treated?

ii. Does disease form in new vessels over time?

j. Is spontaneous dissection of an artery more common in patients with FMD? If so, what type of FMD?

Subjects with fibro-muscular dysplasia will be identified either by provider contact or through a search of diagnosis codes from medical records. All identified patients carrying a diagnosis of FMD will be approached for enrollment. Subjects who return signed written consent will have their data abstracted from medical records and added to the database. Baseline data to be collected includes past medical history, results of diagnostic testing, invasive procedures performed, symptoms at time of diagnosis and medications used. Follow-up data will be collected from subsequent provider visits, by mailed questionnaires or telephone.

The Primary investigator (Pl) is Alberto Maud, M.D., and co-investigator Jose Gustavo Rodriguez, M.D., Salvador Cruz­Flores, M.D., MPH, Rakesh Khatri, M.D., Paisith Piriyawat, M.D., Israel Alba, M.D., MBA.

For more information regarding this clinical trial, please contact the Clinical Research Coordinator, Israel Alba, CCRP, at lsrael.alba@ttuhsc.edu.

Nearly 800,000 people in the United States have a stroke every year. Stroke is currently the 5th leading cause of death annually. Stroke is also the leading cause of long-term disability and the leading preventable cause of disability. An estimated 15% of all strokes are a result of untreated atrial fibrillation (AF), and those patients suffering from stroke and AF typically have larger infarct areas and poorer outcomes. Atrial fibrillation is the most common type of arrhythmia, affecting an estimated 2.7 million Americans, and the occurrence of Atrial Fibrillation increases the risk of stroke nearly five times over the risk in the general population. Preventing recurrent stroke in patients with atrial fibrillation is of the utmost importance. Long term anticoagulation is standard for secondary stroke prevention in patients with AF. Current AHA guidelines state that it is reasonable to initiate anticoagulation within 14 days, but do not currently offer recommendations on the optimal time of initiation.

The primary aims of the study is to determine the optimal time to initiate anticoagulation with a Non-Vitamin K Oral Anticoagulant (NOAC) after ischemic stroke in patients with non-valvular atrial fibrillation.

The study is actively recruiting patients at Tennet Hospitals of El Paso and at the University Medical Center of El Paso (UMC-EI Paso).

The study is funded through The University of Texas at Austin of the Lone Star Stroke Research Consortium of Texas.

The Primary invest igator (Pl) is Salvador Cruz-Flores, M.D., MPH, and co-investigator Jose Gustavo Rodriguez, M.D.

For more information regarding this clinical trial, please contact the Clinical Research Coordinator, Israel Alba, MBA, CCRP, at lsrael.alba@ttuhsc.edu

Inherited Peripheral Neuropathy (IPN) results in damage of the peripheral nerves and causes significant morbidity including pain, numbness, tingling, weakness, and walking difficulty.

IPN can be evaluated by nerve conduction study and electromyography. These electrodiagnostic tests have demonstrated several pathological processes including demyelination, axonal defects, and the presence of denervation. But while these diagnostic approaches have advanced our description of IPN, they have done little to allow understanding the underlying mechanism of the peripheral neuropathy. Inherited Peripheral neuropathy is an incurable disorder. Regardless of the underlying causative gene, the treatment is symptomatic. The study will isolated patient's DNA from buccal swab or saliva sample and be delivered to the University of Texas at El Paso for its analysis.

The primary objective of this study is to identify novel genes associated with inherited peripheral neuropathy.

The study is actively identifying potential patients consistent with genetic IPN at the Outpatient Clinic of the Department of Neurology, TTUHSC- El Paso.

The Primary Investigat or (Pl) is Darine Kassar, M.D.

For more information regarding this clinical trial, please contact the Clinical Research Coordinator, Israel Alba, MBA, CCRP, at lsrael.alba@ttuhsc.edu

It is a standardpractice in inpatient and intensive care settings to monitor blood pressure by Non-Invasive technique. Blood pressure measurements frequently guide management in these settings. Discrepancies between direct intra-arterial blood pressure (IABP) and indirect noninvasive blood pressure (NIBP) measurements can adversely affect therapeuticdecisions and may have a negative impact on outcomes. To date, there are no studies evaluating the accuracy or precision of these devices in acute ischemic stroke patients undergoing endovascular procedures. In addition, there are no large clinical studies evaluating NIBP monitoring in a complex medical intensive care population with varying hemodynamics. Our hypothesis is that NIBP in the medical intensive care patients is highly variable and not a reliable means of arterial blood pressure monitoring. There is limited data in critically ill patients

The primary objective of this study is to compare direct Intra-Arterial Blood Pressure (IABP) with Non-Invasive Blood Pressure (NIBP) readings among acute ischemic stroke patients undergoing endovascular procedures.

The study is actively searching for patients at the University Medical Center of El Paso. The study is funded by the Department of Neurology TTUHSC El Paso.

The Primary investigato r (Pl) is Jose Gustavo Rodriguez, M.D. and co-investigators are Salvador Cruz-Flores, M.D., MPH and Alberto Maud, M.D.,

For more information regarding this clinical trial, please contact the Clinical Research Coordinator, Israel Alba, MBA, CCRP, at lsrael.alba@ttuhsc.edu

Strokes & Transient lschemic Attack (TIA), or a cerebrovascularaccidents (CVA), are neurologic insults that occurs when either the blood supply to part of the brain is reduced or is lacking or when blood vessels bursts in the brain. In the United States, it is the leading cause of chronic debilitating morbidity and the fifth most common cause of mortality. Thus, continuing to expand our knowledge in understanding the epidemiology, its pathophysiology and contributing factors of this disease is a paramount endeavor researchers continue to explore. The effects of changes in incidence and improved survival on the downward trend in stroke & TIA mortality have not been quantified adequately, chiefly because of the difficulties involved in the accurate measurement of stroke & TIA incidence. Our hypothesis is that the incidence of patients with stroke & TIA is comparatively higher than the general population or other cities in the United States. We also hypothesize that one of the reasons may be the higher prevalence of vascular risk factors.

The primary objective of this study is to identify the patients with known stroke & TIA admitted to hospitals where Texas Tech physicians provide care. The risk factors, treatment and outcome for these patients will be collected retrospectively and analyzed mainly for improvement of current practices.

The study is actively searching for patients at the University Medical Center of El Paso. The study is funded by the Department of Neurology TTUHSC El Paso.

The Primary investigat or (Pl) is Salvador Cruz-Flores, M.D., MPH and co-investigators Jose Gustavo Rodriguez, M.D., Alberto Maud, M.D., Paisith Piriyawat, M.D., Hunter Collins, M.D., lhtesham A Qureshi, M.D., Israel Alba, M.D., Isabel Zuniga, MSN, APRN, AGACNP-BC and Demi Castrellon, MSN, APRN, ACNP-BC.

For more information regarding this clinical trial, please contact the Clinical Research Coordinator, Israel Alba, MBA, CCRP, at lsrael.alba@ttuhsc.edu

Risk of Hemorrhage in patients with Acute lschemic Stroke (AIS) and Cerebral Cavernous Malformation (CCM) following Intravenous Thrombolysis.

lntracranial neoplasms, arteriovenous malformations, aneurysms or previous history of intracranial hemorrhage are contraindications for intravenous thrombolysis in patients presenting with acute ischemic stroke. However, cerebral cavernous malformations (CCM) is a rare condition composed of clusters of endothelial-lined sinusoidal channels filled with blood, at different stages of evolution. They are frequently diagnosed on imaging with a prevalence ranging between 0.1 to 0.8% in general population. Although the most studied factor of CCM's is their natural history, there is very scarce information available to assess the possibility of hemorrhagic complications in patients with acute ischemic stroke (AIS) with concomitant CCM. Concern of potential hemorrhage has often dissuaded clinicians from administering IV tPA in stroke patients with associated CCM, despite the fact that there are no systemic studies available to substantiate the hypothesis. We believe it might not necessarily increase the risk of hemorrhage after administration of IV tPA in subjects with AIS and concomitant CCM.

The primary objective of the study is to identify the patients with acute ischemic stroke and concomitant AIS admitted at the Tenet Hospitals of El Paso and at the University Medical Center of El Paso, and to look for the incidence of associated hemorrhage after administration of IV tPA. The outcomes of these patients will be collected retrospectively and analyzed mainly for improvement of clinical practices.

The study is funded by the Department of Neurology TTUHSC El Paso.

The Primary investigator (Pl) is Alberto Maud, M.D., and co-investigators are Salvador Cruz­ Flores, M.D., MPH, Jose Gustavo Rodriguez, M.D., Paisith Piriyawat, M.D., lhtesham A Qureshi, M.D., Mohtashim Arbaab Qureshi, M.D., Mohammed Rauf Afzal, M.D., Darine Kassar, M.D., Anantha Vellipuram, M.D., Rakesh Khatri, M.D.,

For more information regarding this clinical trial, please contact the Clinical Research Coordinator, Israel Alba, MBA, CCRP, at lsrael.alba@ttuhsc.edu

Treatment with IV t-PA has been established as an effective treatment for acute ischemic stroke patients treated within the first few hours of symptom onset. Although the treatment window for effectiveness was recently extended from 3 to 4.5 hours, it has been clearly demonstrated that earlier treatment is statistically associated with a higher likelihood of a better outcome. In addition, intra-arterial therapy now has been demonstrated in multiple trials to improve outcomes in acute stroke patients when treated within 6 hours. This had led the AHA/ASA to release guidelines recommending endovascular procedures for selected patients and that systems of care need to be organized to facilitate the delivery of this treatment.

Unfortunately, not all patients eligible for endovascular therapy present to facilities capable of delivering endovascular treatment, and need to be transferred to larger hospitals, most often comprehensive stroke centers for the procedure to be performed. The transfer process is complex and often involves multiple teams of physicians and administrative personnel to coordinate that transfer of the patient. The complexity can often lead to delays in arrival of the patient to the hub and possibly lead to less than ideal outcomes or at times often exclude the patient from the procedure due to the limited time window. Currently, there are no standard time metrics recommended for the IAT transfer process. We therefore aim to describe the current landscape of IAT transfer times at Texas CSCs/lAT-capable stroke centers to identify barriers/delays in the transfer process.

We plan to prospectively collect data from participating Texas CSC/IAT- Capable stroke centers regarding patients that were transferred for potential endovascular therapy for acute ischemic stroke.

The aims of the study are to report the time metrics for spoke drip and ship patients transferred to a Texas CSC/IAT-capable stroke center for evaluation of intra-arterial therapy, to identify potential barriers/delays in the transfer process that can lead to delays for drip and ship patients destined for intra-arterial therapy at a Texas CSC/IAT-Capable stroke center and to develop best practice time parameters for patients transferred to Texas CSC/IAT-Capable stroke center for intra-arterial therapy.

The study is funded through The University of Texas at San Antonio of the Lone Star Stroke Research Consortium of Texas.

The Primary investigator (Pl) is Salvador Cruz-Flores, M.D., MPH, and co-investigators are Jose Gustavo Rodriguez, M.D., Maud Alberto, M.D, and Rakesh Khatri, M.D.

For more information regarding this clinical trial, please contact the Clinical Research Coordinator, Israel Alba, MBA, CCRP, at lsrael.alba@ttuhsc.edu

Closed Research Trials

NAVIGATE ESUS is a descriptor for the world wide clinical trial Multicenter, a randomized, double-blind, double-dummy, active competitor, event-driven, superiority phase Ill study of secondary prevention of stroke and prevention of systemic embolism in patients with a recent embolic stroke of undetermined source (ESUS). The clinical trial, funded by Bayer Pharmaceuticals, has ended recruitment on September 20, 2017. The study enrolled a total of i7214 in all their global sites. In the US, the study enrolled 187 patients and TTUHSC El Paso's Department of Neurology was able to recruit a total of 6 patients.

The pharmaceutical trial was established in response to the clinical need to find more effective anti-thrombotic medications. Patients enrolled into this study were randomized into either a blind ASA group or a blind Rivaroxaban group. The purpose is to develop an oral anticoagulant with a low-risk profile for ESUS patients. The study continues as follow-up for all subjects enrolled. Un­ blinding of the groups and research outcomes are expected by the Sponsor on the 3rd or 4th quarter of 2018.

The primary investigator (Pl) is Alberto Maud, M.D., and co-investigators include Salvador Cruz­ Flores, M.D., Gustavo J. Rodriguez, M.D., and Paisith Piriyawat, M.D.

For more information regarding this clinical trial, please contact Clinical Research Coordinator, Israel Alba, MBA, CCRP, at lsrael.alba@ttuhsc.edu.

RESPECT ESUS is a descriptor for the world wide clinical trial Multicenter, Randomized, double-blind, Evaluation in secondary Stroke Prevention comparing the efficacy and safety of the oral Thrombin inhibitor dabigatran Etexilate (110 mg or 150 mg, oral b.i.d.) versus acetylsalicylic acid (100 mg oral q.d.) in patients with Embolic Stroke of Undetermined Source (RESPECT ESUS).

Approximately 20-25% of ischemic strokes are not lacunar (i.e. due to small artery disease), are not associated with occlusive atherosclerotic stenosis, and do not have a major cardio embolic source, such as in atrial fibrillation. Recent monitoring and imaging studies have characterized a number of potential sources of embolism in these patients, supporting that most strokes formerly called "cryptogenic" can be more usefully characterized as an Embolic Stroke of Undetermined Source (ESUS). Improvements in imaging technologies and a better understanding of the underlying pathophysiology of ESUS have resulted in a pragmatic clinical definition and an international "ESUS Working Group" has been established with this group defining ESUS as a new stroke entity. The embolic mechanism implies a common potential treatment strategy, anticoagulation, making precise characterization of the embolic source of uncertain clinical value. The purpose of this clinical trial is to test the effectiveness and safety parameters of dabigatran etexilate plus placebo versus aspirin and placebo in an ESUS randomized, double-blind clinical trial. Dabigatran etexilate is already FDA approved as a

blood-thinning medicine used to reduce the risk of stroke and blood clots in patients with atrial fibrillation not caused by a heart valve problem, as well as for the treatment of blood clots in patients with deep vein thrombosis or pulmonary embolism.

The clinical trial is funded by the pharmaceutical Boehringer lngelheim and is actively enrolling patients. The study is scheduled to finish global recruitment on December 31, 2017.

The primary investigator (Pl) is Paisith Piriyawat, M.D., and co-investigators include Alberto Maud, M.D., and Gustavo Jose Rodriguez, M.D.

For more information regarding this clinical trial, please contact Clinical Research Coordinator, Israel Alba, MBA, CCRP, at lsrael.alba@ttuhsc.edu.

PRISMS, or A Phase IIIb, Double-Blind, Multicenter Study to Evaluate the Efficacy and Safety of Alteplase in Patients with Mild Stroke: Rapidly Improving Symptoms and Minor Neurologic Deficits is a study sponsored by Genentech, Inc., which is being conducted in the TTUHSC El Paso Department of Neurology.

Alteplase has been previously approved by the FDA for use in patients who have had moderate or severe strokes. This study will test the investigational use of the drug alteplase to determine if the use of the drug leads to an overall better outcome in individuals who have had mild strokes.

This study is expected to be ongoing for the next four years.

The PI for this study is Salvador Cruz-Flores, M.D., and co-investigators are Alberto Maud, M.D., Gustavo J. Rodriguez, M.D., and Paisith Piriyawat, M.D.

For more information about this clinical trial please call study coordinator Israel Alba at 915-215-4616.

SOCRATES is the descriptor for the study Acute Stroke or Transient Ischaemic Attack Treated with Aspirin or Ticagrelor Compared to Aspirin and Patient Outcomes: A Randomised, Double-Blind, Multinational Study to Prevent Major Vascular Events with Ticagrelor Compared to Aspirin (ASA) in Patients with Acute Ischaemic Stroke or TIA which is being conducted in the TTUHSC El Paso Department of Neurology.

The study is being funded by AstraZeneca Pharmaceuticals and enrollment is planned for the next three years.

The objective of this pharmaceutical trial is to compare the efficacy of the study compound ticagrelor to aspirin in the treatment of an acute ischaemic or a transient ischaemic attack. Ticagrelor, or Brilinta, is a blood-thinning drug approved by the FDA used to reduce cardiovascular death and heart in patients with acute coronary syndromes.

The PI is Salvador Cruz-Flores, M.D., and co-investigators include Paisith Piriyawat, M.D., Alberto Maud, M.D., and Gustavo J. Rodriguez, M.D.

For more information about this clinical trial please call the study coordinator Israel Alba at 915-215-4616.

ATACH-II is the acronym for the Antihypertensive Treatment of Acute Cerebral Hemorrhage: A Phase III Randomized Multicenter Clinical Trial of Blood Pressure Reduction for Hypertension in Acute Intracerebral Hemorrhage currently being conducted in the TTUHSC El Paso Department of Neurology. ATACH-II is funded by NINDS and NIH, with a planned enrollment period of four years and a planned duration of the study over a period of five years.

The primary objective of this study is to determine the therapeutic benefit of intensive systolic blood pressure (SPB < 140 mmHg) compared with standard systolic blood pressure (SBP < 180 mmHg) in reducing the number of patients with death and disability at day ninety among subjects with intracerebral hemorrhage treated within 4.50 hours of symptom onset.

The study hypothesis proposes that intensive systolic blood pressure reduction using intravenous nicardipine with treatment initiated within the 4.50 hours of ICH onset, and continued for the next 24 hours, will reduce the outcome of death or disability among these patients.

The PI of this trial is Gustavo J. Rodriguez, M.D., and co-investigators include Alberto Maud, M.D., Salvador Cruz-Flores, M.D., and Paisith Piriyawat, M.D.

For additional information regarding this project please contact the study coordinator with the department of neurology, Israel Alba at 915-215-4616.

Humanitarian Use Devices

Patients with angiographically documented wide-neck, intracranial, saccular or fusiform aneurysms who are deemed by the attending neurointerventionalist to be acceptable candidates for endovascular embolization. There are no age or gender restrictions.  A brain aneurysm is a weakening in the wall of an artery in the brain, causing the affected area to stretch out like a balloon. Intracranial aneurysms are classified as saccular and nonsaccular, according to their shape and etiology.

A wide-neck aneurysm is one that has a wide opening where the aneurysm arises from the artery. Wide-neck aneurysms have a neck width greater than or equal to 4mm or a dome-to-neck ratio of less than 2mm. These types of aneurysms occur in about 25% of persons with brain aneurysms. Wide-neck aneurysms are difficult to treat both surgically and endovascular.

The Codman Enterprise 2  is authorized by Federal Law for use with embolic coils for the treatment of wide-neck, intracranial, saccular or fusiform aneurysms arising from a parent vessel with a diameter of ≥2.5 mm and ≤4 mm. Wide-neck is defined as having a neck width >4 mm or a dome-to-neck ratio.

Device Description

The Codman Enterprise 2 is comprised of a self-expanding stent (VRD) and a delivery system. The delivery system is comprised of a delivery wire and an introducer. The stent is pre-loaded on the delivery wire inside the introducer. The implantable stent is made of Nitinol and has a closed cell design. The stent has 4 markers on each end, and is coated with a polymer. The delivery wire is composed of a Nitinol core-wire with radiopaque markers. The introducer consists of a polymer tube with a tapered distal end. It is designed to protect the stent from damage and creates an uninterrupted passage for the stent to be transferred from the introducer into the infusion catheter. The Codman Enterprise 2 is designed for use under fluoroscopy with the Prowler Select Plus Infusion Catheter (a 0.021” inner diameter, 5 cm distal length infusion catheter manufactured by Codman Neuro).

Indications for Use

The Codman Enterprise 2 Vascular Reconstruction Device is intended for use with embolic coils for the treatment of wide-neck, intracranial, saccular or fusiform aneurysms arising from a parent vessel with a diameter of ≥2.5 mm and ≤4 mm. Wide-neck is defined as having a neck width ≥4 mm or a dome-to-neck ratio <2.

For more information regarding the Humanitarian Device please contact the neurointerventionalists Israel Alba, MBA at 915-215-4616 to schedule a conference call with one of our Interventionist Neurologist or to schedule a Clinic Visit please contact our Clinic office Manager, Estela Gonzalez, MHA  at 915-215-5914.

Wide neck aneurysms are difficult to treat both surgically and endovascular with clipping and this technique may be difficult or impossible if there is no true neck present. Coiling involves endovascular placement of embolic coils into the aneurysm sac, but aneurysm with wide necks cannot often structurally retain embolization coils and complications such as protrusion of the coil into the parent artery may occur.

Device Description

The LVIS Device is intended for use with bare platinum embolic coils for the treatment of un-ruptured, wide neck (neck > 4 mm or dome to neck ratio < 2), intracranial, secular aneurysms arising from a parent vessel with a diameter >2.5 mm and < 4.5 mm. 

The LVIS device consist of a self-expanding nickel-titanium, single wire braid, compliant closed cell implant that can be deployed and retrieved by a single operator.

Indication for use

Endovascular therapy of wide neck aneurysms is sometimes limited to parent artery occlusion, if there adequate collateral flow or by a balloon-assisted technique. Availability of neurovascular stents through the Humanitarian Device Exemption regulatory provision has provided for an additional approach to aneurysm occlusion using endovascular techniques. Recently, a device, intracranial aneurism flow diverter, has been made available, but the device is limited to large or giant wide necked aneurysms in the internal carotid artery from the petrous to the superior hypophyseal segments. If left untreated, aneurysms can rupture, causing death or significant morbidity.  

For more information regarding the Humanitarian Device please contact the research coordinator Israel Alba, MBA at 915-215-4616 to schedule a conference call with one of our neurointerventionalists or to schedule a Clinic Visit please contact our Clinic office Manager, Estela Gonzalez, MHA  at 915-215-5914.

Wide neck aneurysms are difficult to treat both surgically and endovascular with clipping and this technique may be difficult or impossible if there is no true neck present. Coiling involves endovascular placement of embolic coils into the aneurysm sac, but aneurysm with wide necks cannot often structurally retain embolization coils and complications such as protrusion of the coil into the parent artery may occur.

Device Description

The LVIS Device is intended for use with bare platinum embolic coils for the treatment of un-ruptured, wide neck (neck > 4 mm or dome to neck ratio < 2), intracranial, secular aneurysms arising from a parent vessel with a diameter >2.5 mm and < 4.5 mm. 

The LVIS device consist of a self-expanding nickel-titanium, single wire braid, compliant closed cell implant that can be deployed and retrieved by a single operator.

Indication for use

Endovascular therapy of wide neck aneurysms is sometimes limited to parent artery occlusion, if there adequate collateral flow or by a balloon-assisted technique. Availability of neurovascular stents through the Humanitarian Device Exemption regulatory provision has provided for an additional approach to aneurysm occlusion using endovascular techniques. Recently, a device, intracranial aneurism flow diverter, has been made available, but the device is limited to large or giant wide necked aneurysms in the internal carotid artery from the petrous to the superior hypophyseal segments. If left untreated, aneurysms can rupture, causing death or significant morbidity.  

For more information regarding the Humanitarian Device please contact the research coordinator Israel Alba, MBA at 915-215-4616 to schedule a conference call with one of our neurointerventionalists or to schedule a Clinic Visit please contact our Clinic office Manager, Estela Gonzalez, MHA  at 915-215-5914.

The Neuroform Atlas (Stryker Neurovascular, Fremont, USA) stent is a successor to the Neuroform stent as the first approved stent for aneurysm treatment. It is intended for the treatment of aneurysms on small parent vessels ranging from 2 to 4.5mm. It gained its CE mark in May 2015. Similar to other microstents (Leo Baby, LVIS Jr, and Acclino flex), it can be delivered through standard coiling catheters down to an inner diameter of 0.0165 inches.

Device description

The Neuroform Microdelivery Stent System includes:

A self-expanding, nitinol stent with four radiopaque markerbands on each end (distal and proximal). The stent is available in 2 interconnect (original configuration) and 3 interconnect configurations. The 3 interconnects create an additional link between the stent cells, provide better support of the coil mass within the aneurysm, and minimize stent deflection.

  • A flexible over-the-wire 3F Microdelivery Catheter with a distal tip markerband. The stent and peelable sheath is preloaded into the distal end of the 3F Microdelivery Catheter.
  • A 2F Stabilizer Catheter with a distal tip markerband. The 2F Stabilizer Catheter maintains the stent position during deployment.
  • A Peelable Sheath to aid in the insertion of the guidewire into the 3F Microdelivery Catheter. The peelable sheath is preloaded into the tip of the 3F Microdelivery Catheter.
  • Rotating Hemostasis Valves (RHVs), one provided with the 3F Microdelivery Catheter and one provided with the 2F Stabilizer Catheter. This system is available in two specific packaging configurations:
  • Neuroform 2 Microdelivery Stent System is available with the 2 interconnect stent only.
  • Neuroform 3 Microdelivery Stent System is available with the 3 interconnect stent only and is packaged with the components preassembled. Although there are two specific packaging configurations, all references in this DFU apply to both configurations unless stated otherwise.

Indication for use

The Neuroform Microdelivery Stent System is for use with embolic coils for the treatment of wide neck, intracranial, saccular aneurysms arising from a parent vessel with a diameter of ≥2 mm and ≤4.5 mm that are not amenable to treatment with surgical clipping. Wide neck aneurysms are defined as having a neck ≥4 mm or a dome-to-neck ratio of <2.

For more information regarding the Humanitarian Device please contact the research coordinator Israel Alba, MBA at 915-215-4616 to schedule a conference call with one of our neuroinveterventionalists or to schedule a Clinic Visit please contact our Clinic office Manager, Estela Gonzalez, MHA  at 915-215-5914.

The Wingspan Stent System with Gateway PTA Balloon Catheter is a self-expanding, neurovascular, nitinol Stent and Delivery System and Balloon Catheter that consists of the following components:

  • Wingspan Stent
  • Wingspan Delivery System
  • Gateway PTA Balloon Catheter

A detailed description of each of the three components of the Wingspan Stent System with Gateway PTA Balloon Catheter follows:

Wingspan Stent - The Stent has a tubular mesh (zigzag struts) design. Along the length of the Stent, several individual sections self-expand as the Stent deploys. Sections are joined by 2 interconnecting struts. It is made from nitinol. There are 8 radiopaque markerbands, 4 per end, which are secured to tabs on the Stent. The Stent is available in five diameters (2.5mm to 4.5mm) and three lengths (9mm, 15mm, and 20mm).

Wingspan Delivery System - The Delivery System is used to deliver the Stent to the treatment site within the patient's artery. The Delivery System is a single lumen, overthe-wire, coaxial microcatheter. The material composition of the catheter shaft changes over the length of it to create three distinct stiffness regions: proximal, middle, and distal. The proximal end has a strain relief and standard, female Luer fitting. The Delivery System is hydrophilically pass coated.1 The Delivery System is provided sterile with the Stent preloaded. The shaft has an overall nominal working length of 135cm.

For more information regarding the Humanitarian Device please contact the research coordinator Israel Alba, MBA at 915-215-4616 to schedule a conference call with one of our neurointerventionalists or to schedule a Clinic Visit please contact our Clinic office Manager, Estela Gonzalez, MHA  at 915-215-5914.

Publications

SCHOLARLY WORK - LAST 2 YEARS

General number: 915-215-5900

2018:

Clopidogrel and Aspirin in Acute Ischemic Stroke and High-Risk TIA.
Johnston SC, Easton JD, Farrant M, Barsan W, Conwit RA, Elm JJ, Kim AS, Lindblad AS, Palesch YY; Clinical Research Collaboration, Neurological Emergencies Treatment Trials Network, and the POINT Investigators.
N Engl J Med. 2018 Jul 19;379(3):215-225. doi: 10.1056/NEJMoa1800410. Epub 2018 May 16.
PMID: 29766750

Current Endovascular Approach to the Management of Acute Ischemic Stroke.
Khatri R, Vellipuram AR, Maud A, Cruz-Flores S, Rodriguez GJ.
Curr Cardiol Rep. 2018 May 7;20(6):46. doi: 10.1007/s11886-018-0989-4. Review.
PMID: 29736735

Cardiovascular Disease and Breast Cancer: Where These Entities Intersect: A Scientific Statement From the American Heart Association.
Mehta LS, Watson KE, Barac A, Beckie TM, Bittner V, Cruz-Flores S, Dent S, Kondapalli L, Ky B, Okwuosa T, Piña IL, Volgman AS; American Heart Association Cardiovascular Disease in Women and Special Populations Committee of the Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; and Council on Quality of Care and Outcomes Research.
Circulation. 2018 Feb 20;137(8):e30-e66. doi: 10.1161/CIR.0000000000000556. Epub 2018 Feb 1. Review.
PMID: 29437116

Challenges and Opportunities to Scale Up Cardiovascular Disease Secondary Prevention in Latin America and the Caribbean.
Avezum Á, Perel P, Oliveira GBF, Lopez-Jaramillo P, Restrepo G, Loustalot F, Srur A, de La Noval R, Connell KI, Cruz-Flores S, de Moura L, Castellac G, Mattos AC, Ordunez P.
Glob Heart. 2018 Jun;13(2):83-91. doi: 10.1016/j.gheart.2017.05.002. Epub 2017 Oct 9. No abstract available.
PMID: 29032937

Albumin-Induced Neuroprotection in Focal Cerebral Ischemia in the ALIAS Trial: Does Severity, Mechanism, and Time of Infusion Matter?
Khatri R, Afzal MR, Rodriguez GJ, Maud A, Miran MS, Qureshi MA, Cruz-Flores S, Qureshi AI.
Neurocrit Care. 2018 Feb;28(1):60-64. doi: 10.1007/s12028-017-0400-0.
PMID: 28439774

2017:

Persistent focal enhancement of the cisternal segment of oculomotor nerve in ophthalmoplegic migraine.
Qureshi IA, Rodriguez GJ, Cruz-Flores S, Maud A.
Neurol Clin Pract. 2017 Oct;7(5):381-383. doi: 10.1212/CPJ.0000000000000303. No abstract available.
PMID: 29620088

Cervical Arterial Fibromuscular Dysplasia in a Biethnic Population: A Retrospective Study in the U.S.-Mexican Border.
Qureshi IA, Rodriguez GJ, Chacon-Quesada T, Jose GH, Cruz-Flores S, Maud A.
Int J Angiol. 2017 Dec;26(4):253-258. doi: 10.1055/s-0036-1593773. Epub 2016 Oct 31.
PMID: 29142493

CSF inflammatory response after intraventricular hemorrhage.
Fam MD, Zeineddine HA, Eliyas JK, Stadnik A, Jesselson M, McBee N, Lane K, Cao Y, Wu M, Zhang L, Thompson RE, John S, Ziai W, Hanley DF, Awad IA; CLEAR III Trial Investigators.
Neurology. 2017 Oct 10;89(15):1553-1560. doi: 10.1212/WNL.0000000000004493. Epub 2017 Sep 8.
PMID: 28887375

A 31-year-old with idiopathic reversible cerebral vasoconstriction syndrome.
Qureshi IA, Qureshi MA, Kanu O, Cruz-Flores S.
Clin Case Rep. 2017 Jul 20;5(9):1544-1545. doi: 10.1002/ccr3.1090. eCollection 2017 Sep.
PMID: 28878923

Risk for Major Bleeding in Patients Receiving Ticagrelor Compared With Aspirin After Transient Ischemic Attack or Acute Ischemic Stroke in the SOCRATES Study (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes).
Easton JD, Aunes M, Albers GW, Amarenco P, Bokelund-Singh S, Denison H, Evans SR, Held P, Jahreskog M, Jonasson J, Minematsu K, Molina CA, Wang Y, Wong KSL, Johnston SC; SOCRATES Steering Committee and Investigators.
Circulation. 2017 Sep 5;136(10):907-916. doi: 10.1161/CIRCULATIONAHA.117.028566. Epub 2017 Jun 27.
PMID: 28655834

Efficacy and Safety of Degludec versus Glargine in Type 2 Diabetes.
Marso SP, McGuire DK, Zinman B, Poulter NR, Emerson SS, Pieber TR, Pratley RE, Haahr PM, Lange M, Brown-Frandsen K, Moses A, Skibsted S, Kvist K, Buse JB; DEVOTE Study Group.
N Engl J Med. 2017 Aug 24;377(8):723-732. doi: 10.1056/NEJMoa1615692. Epub 2017 Jun 12.
PMID:  28605603

Black Tar Heroin Skin Popping as a Cause of Wound Botulism.
Qureshi IA, Qureshi MA, Rauf Afzal M, Maud A, Rodriguez GJ, Cruz-Flores S, Kassar D.
Neurocrit Care. 2017 Dec;27(3):415-419. doi: 10.1007/s12028-017-0415-6.
PMID: 28569348

Are We Overlooking Stroke Chameleons? A Retrospective Study on the Delayed Recognition of Stroke Patients.
Chompoopong P, Rostambeigi N, Kassar D, Maud A, Qureshi IA, Cruz-Flores S, Rodriguez GJ.
Cerebrovasc Dis. 2017;44(1-2):83-87. doi: 10.1159/000471929. Epub 2017 May 17.
PMID: 28511184

Acute Stroke and Transient Ischemic Attack in the Outpatient Clinic.
Cruz-Flores S.
Med Clin North Am. 2017 May;101(3):479-494. doi: 10.1016/j.mcna.2017.01.001. Epub 2017 Mar 6. Review.
PMID: 28372708

Mycotic Intracranial Aneurysm Secondary to Left Ventricular Assist Device Infection.
Remirez JM, Sabet Y, Baca M, Maud A, Cruz-Flores S, Rodriguez GJ, Mukherjee D, Abbas A.
J Vasc Interv Neurol. 2017 Jan;9(3):23-25.
PMID: 28243347

Spanish Version of the National Institutes of Health Stroke Scale: Awareness and Use in United States. A Survey Study.
Villalobos E, Barnes SR, Qureshi IA, Cruz-Flores S, Maud A, Rodriguez GJ.
J Vasc Interv Neurol. 2017 Jan;9(3):1-6.
PMID: 28243343

2016:

Results of the ICTuS 2 Trial (Intravascular Cooling in the Treatment of Stroke 2).
Lyden P, Hemmen T, Grotta J, Rapp K, Ernstrom K, Rzesiewicz T, Parker S, Concha M, Hussain S, Agarwal S, Meyer B, Jurf J, Altafullah I, Raman R; Collaborators.
Stroke. 2016 Dec;47(12):2888-2895. Epub 2016 Nov 10.
PMID: 27834742

Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes.
Marso SP, Bain SC, Consoli A, Eliaschewitz FG, Jódar E, Leiter LA, Lingvay I, Rosenstock J, Seufert J, Warren ML, Woo V, Hansen O, Holst AG, Pettersson J, Vilsbøll T; SUSTAIN-6 Investigators.
N Engl J Med. 2016 Nov 10;375(19):1834-1844. Epub 2016 Sep 15.
PMID: 27633186

Topsy-turvy by the Belly Dancer.
Maud A, Qureshi IA, Cruz-Flores S, Rodriguez GJ.
Clin Case Rep. 2016 Jul 15;4(8):844-5. doi: 10.1002/ccr3.622. eCollection 2016 Aug.
PMID: 27525100

Seronegative Neuromyelitis Optica: A Case Report of a Hispanic Male.
Badri N, Teleb M, Syed S, Wardi M, Porres-Aguilar M, Cruz-Flores S.
Case Rep Neurol. 2016 May 24;8(2):102-7. doi: 10.1159/000446105. eCollection 2016 May-Aug.
PMID: 27403130

Comment: The elusive search for markers of hematoma expansion.
Rodriguez GJ, Maud A, Piriyawat P, Cruz-Flores S.
Neurology. 2016 Jul 26;87(4):363. doi: 10.1212/WNL.0000000000002902. Epub 2016 Jun 24. No abstract available.
PMID: 27343069

Ticagrelor versus Aspirin in Acute Stroke or Transient Ischemic Attack.
Johnston SC, Amarenco P, Albers GW, Denison H, Easton JD, Evans SR, Held P, Jonasson J, Minematsu K, Molina CA, Wang Y, Wong KS; SOCRATES Steering Committee and Investigators.
N Engl J Med. 2016 Jul 7;375(1):35-43. doi: 10.1056/NEJMoa1603060. Epub 2016 May 10.
PMID: 27160892

Ischemic Stroke with Troponin Elevation: Patient Characteristics, Resource Utilization, and In-Hospital Outcomes.
Peddada K, Cruz-Flores S, Goldstein LB, Feen E, Kennedy KF, Heuring T, Stolker JM.
Cerebrovasc Dis. 2016;42(3-4):213-23. doi: 10.1159/000445526. Epub 2016 May 3.
PMID: 27160243

Letter to the Editor: Physician specialty and endovascular treatment of intracerebral aneurysms.
Maud A, Rodriguez GJ, Piriyawat P, Cruz-Flores S.
J Neurosurg. 2016 Jun;124(6):1876-8. doi: 10.3171/2015.9.JNS152035. Epub 2016 Apr 8. No abstract available.
PMID: 27058196

Main Trunk and Division Middle Cerebral Artery Occlusions: Differences in Recanalization Times, Number of Stent Retriever Passes and Clinical Outcomes: A Single-Center Experience.
Qureshi IA, Maud A, Cruz-Flores S, Rodriguez GJ.
Interv Neurol. 2016 Mar;4(3-4):83-9. doi: 10.1159/000442578. Epub 2015 Dec 19.
PMID: 27051403

Pathological laughter and crying: A case series and proposal for a new classification.
Gondim Fde A, Thomas FP, Cruz-Flores S, Nasrallah HA, Selhorst JB.
Ann Clin Psychiatry. 2016 Feb;28(1):11-21.
PMID: 26855981

2018:

Rivaroxaban for Stroke Prevention after Embolic Stroke of Undetermined Source.
Hart RG, Sharma M, Mundl H, Kasner SE, Bangdiwala SI, Berkowitz SD, Swaminathan B, Lavados P, Wang Y, Wang Y, Davalos A, Shamalov N, Mikulik R, Cunha L, Lindgren A, Arauz A, Lang W, Czlonkowska A, Eckstein J, Gagliardi RJ, Amarenco P, Ameriso SF, Tatlisumak T, Veltkamp R, Hankey GJ, Toni D, Bereczki D, Uchiyama S, Ntaios G, Yoon BW, Brouns R, Endres M, Muir KW, Bornstein N, Ozturk S, O'Donnell MJ, De Vries Basson MM, Pare G, Pater C, Kirsch B, Sheridan P, Peters G, Weitz JI, Peacock WF, Shoamanesh A, Benavente OR, Joyner C, Themeles E, Connolly SJ; NAVIGATE ESUS Investigators.
N Engl J Med. 2018 Jun 7;378(23):2191-2201. doi: 10.1056/NEJMoa1802686. Epub 2018 May 16.
PMID: 29766772

LVIS Jr Device for Y-Stent-Assisted Coil Embolization of Wide-Neck Intracranial Aneurysms: A Multicenter Experience.
Samaniego EA, Mendez AA, Nguyen TN, Kalousek V, Guerrero WR, Dandapat S, Dabus G, Linfante I, Hassan AE, Drofa A, Kouznetsov E, Leedahl D, Hasan D, Maud A, Ortega-Gutierrez S.
Interv Neurol. 2018 Apr;7(5):271-283. doi: 10.1159/000487545. Epub 2018 Apr 3.
PMID: 29765397

Current Endovascular Approach to the Management of Acute Ischemic Stroke.
Khatri R, Vellipuram AR, Maud A, Cruz-Flores S, Rodriguez GJ.
Curr Cardiol Rep. 2018 May 7;20(6):46. doi: 10.1007/s11886-018-0989-4. Review.
PMID: 29736735

Albumin-Induced Neuroprotection in Focal Cerebral Ischemia in the ALIAS Trial: Does Severity, Mechanism, and Time of Infusion Matter?
Khatri R, Afzal MR, Rodriguez GJ, Maud A, Miran MS, Qureshi MA, Cruz-Flores S, Qureshi AI.
Neurocrit Care. 2018 Feb;28(1):60-64. doi: 10.1007/s12028-017-0400-0.
PMID: 28439774

2017:

Persistent focal enhancement of the cisternal segment of oculomotor nerve in ophthalmoplegic migraine.
Qureshi IA, Rodriguez GJ, Cruz-Flores S, Maud A.
Neurol Clin Pract. 2017 Oct;7(5):381-383. doi: 10.1212/CPJ.0000000000000303. No abstract available.
PMID: 29620088

Delayed Coil Migration: Uncommon Cause of Ischemic Stroke and Retrieval Technique.
Afzal MR, Qureshi MA, Miran MS, Rodriguez GJ, Maud A, Khatri R.
J Vasc Interv Neurol. 2017 Dec;9(6):36-37. No abstract available.
PMID: 29445437

Aggressive blood pressure treatment of hypertensive intracerebral hemorrhage may lead to global cerebral hypoperfusion: Case report and imaging perspective.
Gavito-Higuera J, Khatri R, Qureshi IA, Maud A, Rodriguez GJ.
World J Radiol. 2017 Dec 28;9(12):448-453. doi: 10.4329/wjr.v9.i12.448.
PMID: 29354210

Possible Reversible Cerebral Vasoconstriction Syndrome Associated with Eucalyptus: Case Report.
Lapid D, Qureshi MA, Quresh IA, Afzal MR, Maud A, Rodriguez GJ, Khatri R.
J Vasc Interv Neurol. 2017 Oct;9(5):17-20.
PMID: 29163745

Cervical Arterial Fibromuscular Dysplasia in a Biethnic Population: A Retrospective Study in the U.S.-Mexican Border.
Qureshi IA, Rodriguez GJ, Chacon-Quesada T, Jose GH, Cruz-Flores S, Maud A.
Int J Angiol. 2017 Dec;26(4):253-258. doi: 10.1055/s-0036-1593773. Epub 2016 Oct 31.
PMID: 29142493

A 72-year-old with eyelid opening apraxia in Steele-Richardson-Olszewski syndrome.
Qureshi IA, Qureshi MA, Maud A.
Clin Case Rep. 2017 Apr 26;5(6):1054-1055. doi: 10.1002/ccr3.958. eCollection 2017 Jun.
PMID: 28588873

Black Tar Heroin Skin Popping as a Cause of Wound Botulism.
Qureshi IA, Qureshi MA, Rauf Afzal M, Maud A, Rodriguez GJ, Cruz-Flores S, Kassar D.
Neurocrit Care. 2017 Dec;27(3):415-419. doi: 10.1007/s12028-017-0415-6.
PMID: 28569348

Are We Overlooking Stroke Chameleons? A Retrospective Study on the Delayed Recognition of Stroke Patients.
Chompoopong P, Rostambeigi N, Kassar D, Maud A, Qureshi IA, Cruz-Flores S, Rodriguez GJ.
Cerebrovasc Dis. 2017;44(1-2):83-87. doi: 10.1159/000471929. Epub 2017 May 17.
PMID: 28511184

Mycotic Intracranial Aneurysm Secondary to Left Ventricular Assist Device Infection.
Remirez JM, Sabet Y, Baca M, Maud A, Cruz-Flores S, Rodriguez GJ, Mukherjee D, Abbas A.
J Vasc Interv Neurol. 2017 Jan;9(3):23-25.
PMID: 2824334

Spanish Version of the National Institutes of Health Stroke Scale: Awareness and Use in United States. A Survey Study.
Villalobos E, Barnes SR, Qureshi IA, Cruz-Flores S, Maud A, Rodriguez GJ.
J Vasc Interv Neurol. 2017 Jan;9(3):1-6.
PMID: 28243343

Formal research exposure during neurology residency training matters.
Maud A, Rodríguez GJ.
Neurology. 2017 Apr 4;88(14):1302. doi: 10.1212/WNL.0000000000003777. Epub 2017 Feb 22. No abstract available.
PMID: 28228563

2016:

Safety of Dual Antiplatelet Therapy After Carotid Endarterectomy for Prevention of Restenosis: A Single Center Experience.
Barboza MA, Chang J, Hernández A, Martínez E, Fernández H, Quirós G, Salazar J, Ramos-Esquivel A, Maud A.
J Vasc Interv Neurol. 2016 Oct;9(2):5-9.
PMID: 27829964

Topsy-turvy by the Belly Dancer.
Maud A, Qureshi IA, Cruz-Flores S, Rodriguez GJ.
Clin Case Rep. 2016 Jul 15;4(8):844-5. doi: 10.1002/ccr3.622. eCollection 2016 Aug.
PMID: 27525100

Comment: The elusive search for markers of hematoma expansion.
Rodriguez GJ, Maud A, Piriyawat P, Cruz-Flores S.
Neurology. 2016 Jul 26;87(4):363. doi: 10.1212/WNL.0000000000002902. Epub 2016 Jun 24. No abstract available.
PMID: 27343069

Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage.
Qureshi AI, Palesch YY, Barsan WG, Hanley DF, Hsu CY, Martin RL, Moy CS, Silbergleit R, Steiner T, Suarez JI, Toyoda K, Wang Y, Yamamoto H, Yoon BW; ATACH-2 Trial Investigators and the Neurological Emergency Treatment Trials Network.
N Engl J Med. 2016 Sep 15;375(11):1033-43. doi: 10.1056/NEJMoa1603460. Epub 2016 Jun 8.
PMID: 27276234

Letter to the Editor: Physician specialty and endovascular treatment of intracerebral aneurysms.
Maud A, Rodriguez GJ, Piriyawat P, Cruz-Flores S.
J Neurosurg. 2016 Jun;124(6):1876-8. doi: 10.3171/2015.9.JNS152035. Epub 2016 Apr 8. No abstract available.
PMID: 27058196

Main Trunk and Division Middle Cerebral Artery Occlusions: Differences in Recanalization Times, Number of Stent Retriever Passes and Clinical Outcomes: A Single-Center Experience.
Qureshi IA, Maud A, Cruz-Flores S, Rodriguez GJ.
Interv Neurol. 2016 Mar;4(3-4):83-9. doi: 10.1159/000442578. Epub 2015 Dec 19.
PMID: 27051403

Combined surgical and endovascular treatment of complex high-flow conus medullaris arteriovenous fistula associated with Parkes Weber syndrome: case report.
Bagherpour AN, Rodriguez GJ, Moorthy C, Trier TT, Maud A.
J Neurosurg Spine. 2016 Aug;25(2):234-8. doi: 10.3171/2016.1.SPINE151156. Epub 2016 Mar 25.
PMID: 27015132

2018:

Current Endovascular Approach to the Management of Acute Ischemic Stroke.
Khatri R, Vellipuram AR, Maud A, Cruz-Flores S, Rodriguez GJ.
Curr Cardiol Rep. 2018 May 7;20(6):46. doi: 10.1007/s11886-018-0989-4. Review.
PMID: 29736735

Prolonged Microcatheter-Based Local Thrombolytic Infusion as a Salvage Treatment After Failed Endovascular Treatment for Cerebral Venous Thrombosis: A Multicenter Experience.
Qureshi AI, Grigoryan M, Saleem MA, Aytac E, Wallery SS, Rodriguez GJ, Suri MFK.
Neurocrit Care. 2018 Aug;29(1):54-61. doi: 10.1007/s12028-018-0502-3.
PMID: 29484582

Albumin-Induced Neuroprotection in Focal Cerebral Ischemia in the ALIAS Trial: Does Severity, Mechanism, and Time of Infusion Matter?
Khatri R, Afzal MR, Rodriguez GJ, Maud A, Miran MS, Qureshi MA, Cruz-Flores S, Qureshi AI.
Neurocrit Care. 2018 Feb;28(1):60-64. doi: 10.1007/s12028-017-0400-0.
PMID: 28439774

2017:

Persistent focal enhancement of the cisternal segment of oculomotor nerve in ophthalmoplegic migraine.
Qureshi IA, Rodriguez GJ, Cruz-Flores S, Maud A.
Neurol Clin Pract. 2017 Oct;7(5):381-383. doi: 10.1212/CPJ.0000000000000303. No abstract available.
PMID: 29620088

Delayed Coil Migration: Uncommon Cause of Ischemic Stroke and Retrieval Technique.
Afzal MR, Qureshi MA, Miran MS, Rodriguez GJ, Maud A, Khatri R.
J Vasc Interv Neurol. 2017 Dec;9(6):36-37. No abstract available.
PMID: 29445437

Aggressive blood pressure treatment of hypertensive intracerebral hemorrhage may lead to global cerebral hypoperfusion: Case report and imaging perspective.
Gavito-Higuera J, Khatri R, Qureshi IA, Maud A, Rodriguez GJ.
World J Radiol. 2017 Dec 28;9(12):448-453. doi: 10.4329/wjr.v9.i12.448.
PMID: 29354210

Possible Reversible Cerebral Vasoconstriction Syndrome Associated with Eucalyptus: Case Report.
Lapid D, Qureshi MA, Quresh IA, Afzal MR, Maud A, Rodriguez GJ, Khatri R.
J Vasc Interv Neurol. 2017 Oct;9(5):17-20.
PMID: 29163745

Cervical Arterial Fibromuscular Dysplasia in a Biethnic Population: A Retrospective Study in the U.S.-Mexican Border.
Qureshi IA, Rodriguez GJ, Chacon-Quesada T, Jose GH, Cruz-Flores S, Maud A.
Int J Angiol. 2017 Dec;26(4):253-258. doi: 10.1055/s-0036-1593773. Epub 2016 Oct 31.
PMID: 29142493

Open-Label Phase I Clinical Study to Assess the Safety and Efficacy of Cilostazol in Patients Undergoing Internal Carotid Artery Stent Placement.
Hassan AE, Zacharatos H, Grigoryan M, Tekle WG, Khan A, Siddiq F, Rodriguez GJ, Tummala R, Jagadeesan B, Suri MFK, Qureshi AI.
Interv Neurol. 2017 Mar;6(1-2):42-48. doi: 10.1159/000452308. Epub 2016 Dec 8.
PMID: 28611833

Black Tar Heroin Skin Popping as a Cause of Wound Botulism.
Qureshi IA, Qureshi MA, Rauf Afzal M, Maud A, Rodriguez GJ, Cruz-Flores S, Kassar D.
Neurocrit Care. 2017 Dec;27(3):415-419. doi: 10.1007/s12028-017-0415-6.
PMID: 28569348

Are We Overlooking Stroke Chameleons? A Retrospective Study on the Delayed Recognition of Stroke Patients.
Chompoopong P, Rostambeigi N, Kassar D, Maud A, Qureshi IA, Cruz-Flores S, Rodriguez GJ.
Cerebrovasc Dis. 2017;44(1-2):83-87. doi: 10.1159/000471929. Epub 2017 May 17.
PMID: 28511184

Mycotic Intracranial Aneurysm Secondary to Left Ventricular Assist Device Infection.
Remirez JM, Sabet Y, Baca M, Maud A, Cruz-Flores S, Rodriguez GJ, Mukherjee D, Abbas A.
J Vasc Interv Neurol. 2017 Jan;9(3):23-25.
PMID: 28243347

Spanish Version of the National Institutes of Health Stroke Scale: Awareness and Use in United States. A Survey Study.
Villalobos E, Barnes SR, Qureshi IA, Cruz-Flores S, Maud A, Rodriguez GJ.
J Vasc Interv Neurol. 2017 Jan;9(3):1-6.
PMID: 28243343

Formal research exposure during neurology residency training matters.
Maud A, Rodríguez GJ.
Neurology. 2017 Apr 4;88(14):1302. doi: 10.1212/WNL.0000000000003777. Epub 2017 Feb 22. No abstract available.
PMID: 28228563

2016:

Topsy-turvy by the Belly Dancer.
Maud A, Qureshi IA, Cruz-Flores S, Rodriguez GJ.
Clin Case Rep. 2016 Jul 15;4(8):844-5. doi: 10.1002/ccr3.622. eCollection 2016 Aug.
PMID: 27525100

Comment: The elusive search for markers of hematoma expansion.
Rodriguez GJ, Maud A, Piriyawat P, Cruz-Flores S.
Neurology. 2016 Jul 26;87(4):363. doi: 10.1212/WNL.0000000000002902. Epub 2016 Jun 24. No abstract available.
PMID: 27343069

Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage.
Qureshi AI, Palesch YY, Barsan WG, Hanley DF, Hsu CY, Martin RL, Moy CS, Silbergleit R, Steiner T, Suarez JI, Toyoda K, Wang Y, Yamamoto H, Yoon BW; ATACH-2 Trial Investigators and the Neurological Emergency Treatment Trials Network.
N Engl J Med. 2016 Sep 15;375(11):1033-43. doi: 10.1056/NEJMoa1603460. Epub 2016 Jun 8.
PMID: 27276234

Letter to the Editor: Physician specialty and endovascular treatment of intracerebral aneurysms.
Maud A, Rodriguez GJ, Piriyawat P, Cruz-Flores S.
J Neurosurg. 2016 Jun;124(6):1876-8. doi: 10.3171/2015.9.JNS152035. Epub 2016 Apr 8. No abstract available.
PMID: 27058196

Main Trunk and Division Middle Cerebral Artery Occlusions: Differences in Recanalization Times, Number of Stent Retriever Passes and Clinical Outcomes: A Single-Center Experience.
Qureshi IA, Maud A, Cruz-Flores S, Rodriguez GJ.
Interv Neurol. 2016 Mar;4(3-4):83-9. doi: 10.1159/000442578. Epub 2015 Dec 19.
PMID: 27051403

Combined surgical and endovascular treatment of complex high-flow conus medullaris arteriovenous fistula associated with Parkes Weber syndrome: case report.
Bagherpour AN, Rodriguez GJ, Moorthy C, Trier TT, Maud A.
J Neurosurg Spine. 2016 Aug;25(2):234-8. doi: 10.3171/2016.1.SPINE151156. Epub 2016 Mar 25.
PMID: 27015132

2016:

Comment: The elusive search for markers of hematoma expansion.
Rodriguez GJ, Maud A, Piriyawat P, Cruz-Flores S.
Neurology. 2016 Jul 26;87(4):363. doi: 10.1212/WNL.0000000000002902. Epub 2016 Jun 24. No abstract available.
PMID: 27343069

Letter to the Editor: Physician specialty and endovascular treatment of intracerebral aneurysms.
Maud A, Rodriguez GJ, Piriyawat P, Cruz-Flores S.
J Neurosurg. 2016 Jun;124(6):1876-8. doi: 10.3171/2015.9.JNS152035. Epub 2016 Apr 8. No abstract available.
PMID: 27058196

2018:

Is black tar heroin use associated with wound botulism? A report of two Hispanic patients.
Qureshi IA, Qureshi MA, Vellipuram AR, Kassar D.
Clin Case Rep. 2018 May 29;6(7):1391-1392. doi: 10.1002/ccr3.1622. eCollection 2018 Jul.
PMID: 29988706

2017:

Black Tar Heroin Skin Popping as a Cause of Wound Botulism.
Qureshi IA, Qureshi MA, Rauf Afzal M, Maud A, Rodriguez GJ, Cruz-Flores S, Kassar D.
Neurocrit Care. 2017 Dec;27(3):415-419. doi: 10.1007/s12028-017-0415-6.
PMID: 28569348

Are We Overlooking Stroke Chameleons? A Retrospective Study on the Delayed Recognition of Stroke Patients.
Chompoopong P, Rostambeigi N, Kassar D, Maud A, Qureshi IA, Cruz-Flores S, Rodriguez GJ.
Cerebrovasc Dis. 2017;44(1-2):83-87. doi: 10.1159/000471929. Epub 2017 May 17.
PMID: 28511184

2016:

Case Report: 84 year-old woman with alien hand syndrome.
Qureshi IA, Korya D, Kassar D, Moussavi M.
F1000Res. 2016 Jul 1;5:1564. eCollection 2016.
PMID: 27990258 

2018:

Is black tar heroin use associated with wound botulism? A report of two Hispanic patients.
Qureshi IA, Qureshi MA, Vellipuram AR, Kassar D.
Clin Case Rep. 2018 May 29;6(7):1391-1392. doi: 10.1002/ccr3.1622. eCollection 2018 Jul.
PMID: 29988706

Somatosensory Evoked Potentials as a Tool to Evaluate Brainstem Herniation in the Neuroscience Intensive Care Unit.
Katyal N, Newey CR, George P, Nattanamai P, Beary JM, Ardelt A, Vellipuram A.
Cureus. 2018 Apr 6;10(4):e2443. doi: 10.7759/cureus.2443.
PMID: 29881656

Current Endovascular Approach to the Management of Acute Ischemic Stroke.
Khatri R, Vellipuram AR, Maud A, Cruz-Flores S, Rodriguez GJ.
Curr Cardiol Rep. 2018 May 7;20(6):46. doi: 10.1007/s11886-018-0989-4. Review.
PMID: 29736735

2017:

Colon Carcinoma Presenting as Streptococcus anginosus Bacteremia and Liver Abscess.
Rawla P, Vellipuram AR, Bandaru SS, Pradeep Raj J.
Gastroenterology Res. 2017 Dec;10(6):376-379. doi: 10.14740/gr884w. Epub 2018 Jan 3.
PMID: 29317948

Splenic Infarct and Pulmonary Embolism as a Rare Manifestation of Cytomegalovirus Infection.
Rawla P, Vellipuram AR, Bandaru SS, Raj JP.
Case Rep Hematol. 2017;2017:1850821. doi: 10.1155/2017/1850821. Epub 2017 Oct 11.
PMID: 29158925

Euglycemic diabetic ketoacidosis: a diagnostic and therapeutic dilemma.
Rawla P, Vellipuram AR, Bandaru SS, Pradeep Raj J.
Endocrinol Diabetes Metab Case Rep. 2017 Sep 4;2017. pii: 17-0081. doi: 10.1530/EDM-17-0081. eCollection 2017.
PMID: 28924481

Review of Infectious Etiology of Acute Pancreatitis.
Rawla P, Bandaru SS, Vellipuram AR.
Gastroenterology Res. 2017 Jun;10(3):153-158. doi: 10.14740/gr858w. Epub 2017 Jun 30. Review.
PMID: 28725301

2016:

Medical Decision Making: Hyposphagma Prior to Intravenous Tissue Plasminogen Activator in Acute Ischemic Stroke.
Newey CR, Cueva W, Vellipuram A, Hornik A.
J Stroke Cerebrovasc Dis. 2016 Oct;25(10):e181-2. doi: 10.1016/j.jstrokecerebrovasdis.2016.07.018. Epub 2016 Aug 1.
PMID: 27492945

2018:

Current Endovascular Approach to the Management of Acute Ischemic Stroke.
Khatri R, Vellipuram AR, Maud A, Cruz-Flores S, Rodriguez GJ.
Curr Cardiol Rep. 2018 May 7;20(6):46. doi: 10.1007/s11886-018-0989-4. Review.
PMID: 29736735

Albumin-Induced Neuroprotection in Focal Cerebral Ischemia in the ALIAS Trial: Does Severity, Mechanism, and Time of Infusion Matter?
Khatri R, Afzal MR, Rodriguez GJ, Maud A, Miran MS, Qureshi MA, Cruz-Flores S, Qureshi AI.
Neurocrit Care. 2018 Feb;28(1):60-64. doi: 10.1007/s12028-017-0400-0.
PMID: 28439774

2017:

Delayed Coil Migration: Uncommon Cause of Ischemic Stroke and Retrieval Technique.
Afzal MR, Qureshi MA, Miran MS, Rodriguez GJ, Maud A, Khatri R.
J Vasc Interv Neurol. 2017 Dec;9(6):36-37. No abstract available.
PMID: 29445437

Aggressive blood pressure treatment of hypertensive intracerebral hemorrhage may lead to global cerebral hypoperfusion: Case report and imaging perspective.
Gavito-Higuera J, Khatri R, Qureshi IA, Maud A, Rodriguez GJ.
World J Radiol. 2017 Dec 28;9(12):448-453. doi: 10.4329/wjr.v9.i12.448.
PMID: 29354210

Possible Reversible Cerebral Vasoconstriction Syndrome Associated with Eucalyptus: Case Report.
Lapid D, Qureshi MA, Quresh IA, Afzal MR, Maud A, Rodriguez GJ, Khatri R.
J Vasc Interv Neurol. 2017 Oct;9(5):17-20.
PMID: 29163745