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Dr. Sarraj graduated from Damascus University Medical School, ranked number 3 in his class. With the advent of mechanical thrombectomy becoming an approved treatment for acute stroke, his work is focused on optimizing stroke outcomes by developing methods to select patients who will maximally benefit from acute stroke therapies. With industry grants from Stryker, he is conducting the first investigator-initiated prospective studies to determine what variables derived from simple versus advanced imaging will optimally select patients for endovascular therapy for large artery occlusions both in early and late time windows. Dr. Sarraj was awarded the American Heart Association Mordecai Globus Award in 2012 for devising a scoring system to assess patient outcomes after endovascular treatment – the HIAT-2 score, which is used in clinical practice. Dr. Sarraj is also the stroke fellowship director at UTHealth, the largest training program in the United States, he is the director for general neurology services at UTHealth, and he is the recipient of numerous teaching awards at UTHealth
DEFUSE 3 (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3) infarct volumes at 24 hours did not significantly differ in the endovascular thrombectomy (EVT) versus medical management (MM) only groups. We hypothesized that this was due to underestimation of the final infarct volume among patients with persistent penumbral tissue 24 hours after randomization that subsequently progressed to infarction. We sought to assess the clinical outcomes in patients with persistent penumbral profile >24 hours from last known well and identify them based on the Persistent Penumbra Index (PPI, time-to-maximum of the residue function >6 s perfusion lesion divided by diffusion-weighted magnetic resonance imaging lesion volume on 24-hour postrandomization imaging).
Time elapsed from last-known well (LKW) and baseline imaging results are influential on endovascular thrombectomy (EVT) outcomes.
The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China and rapidly spread worldwide, with a vast majority of confirmed cases presenting with respiratory symptoms. Potential neurological manifestations and their pathophysiological mechanisms have not been thoroughly established. In this narrative review, we sought to present the neurological manifestations associated with coronavirus disease 2019 (COVID-19). Case reports, case series, editorials, reviews, case-control and cohort studies were evaluated, and relevant information was abstracted. Various reports of neurological manifestations of previous coronavirus epidemics provide a roadmap regarding potential neurological complications of COVID-19, due to many shared characteristics between these viruses and SARS-CoV-2. Studies from the current pandemic are accumulating and report COVID-19 patients presenting with dizziness, headache, myalgias, hypogeusia and hyposmia, but also with more serious manifestations including polyneuropathy, myositis, cerebrovascular diseases, encephalitis and encephalopathy. However, discrimination between causal relationship and incidental comorbidity is often difficult. Severe COVID-19 shares common risk factors with cerebrovascular diseases, and it is currently unclear whether the infection per se represents an independent stroke risk factor. Regardless of any direct or indirect neurological manifestations, the COVID-19 pandemic has a huge impact on the management of neurological patients, whether infected or not. In particular, the majority of stroke services worldwide have been negatively influenced in terms of care delivery and fear to access healthcare services. The effect on healthcare quality in the field of other neurological diseases is additionally evaluated.
Dr. Amrou Sarraj won the Emergency Medicine Award at the AHA International Stroke Conference for his work mapping access of US residents to hospitals that can perform thrombectomy for acute stroke.
“Current direct EVT [endovascular thrombectomy] access in the United States is suboptimal under predominate EMS routing protocols,” according to Dr. Sarraj. “Only in eight states did the coverage exceed 25% of the population, and nine states had coverage for less than 10% of the population. These results reflect limited access to an effective treatment that improves clinical outcomes in patients with large strokes and prevent potentially devastating disability.”
Dr. Sarraj shows in his paper using mapping methodology that bypassing non-EVT centers, when the added bypass time is less than 15 minutes, results in an anticipated overall U.S. gain in access of about 17%, or 52 million people. The second approach, converting the top 10% of stroke centers that currently do not provide EVT to centers that do offer EVT, would lead to expanded access for about 23 million additional Americans.
Starting August 2019, a worldwide clinical trial to evaluate endovascular thrombectomy efficacy and safety in acute stroke patients with large ischemic core infarcts will get underway under the leadership of Amrou Sarraj, MD, associate professor of neurology.
Damascus University College of Medicine, Damascus, Syria
University of Illinois-Advocate Christ Medical Center, Oak Lawn, IL
Neurology, The University of Texas Health Science Center at Houston, Houston, TX
Vascular Neurology, The University of Texas Health Science Center at Houston, Houston, TX
Neurophysiology, The University of Texas Health Science Center at Houston, Houston, TX