Fazzari, Melissa J.
Mayo Clinic
Albert Einstein College of Medicine
Citations 2
Petechial hemorrhage in mechanical thrombectomy for distal and medium-vessel occlusions: technical considerations and outcomes
Baker, Amanda , Adeeb, Nimer , Henninger, Nils , Sundararajan, Sri Hari , Khalife, Jane, Tan, Benjamin Yong‐Qiang , Regenhardt, Robert W. , Heit, Jeremy J. , Cancelliere, Nicole M., Fiehler, Jens, Puri, Ajit S., Dyzmann, Christian , Colasurdo, Marco, Filipe, João Pedro , Harker, Pablo, Abdalkader, Mohamad , Marotta, Thomas R. , Spears, Julian , Jabbour, Pascal , Biswas, Arundhati , Clarençon, Frédéric , Varela, Ricardo , Gonzalez, Nestor R. , Möhlenbruch, Markus , Costalat, Vincent , Gory, Benjamin , Yedavalli, Vivek , Stracke, Christian Paul , Shaikh, Hamza, Liebeskind, David S., Alexandre, Andrea , Faizy, Tobias D., Tancredi, Illario , Kalsoum, Erwah , Lubicz, Boris , Patel, Aman B. , Guenego, Adrien , Altschul, David , _, _, Amllay, Abdelaziz, Gopinathan, Anil, Dusart, Anne , Capirossi, Carolina , Mounayer, Charbel, Hsieh, Cheng-Yang, Stapleton, Christopher J. , Bellante, Flavio, Shaikh, Hamza , Cuellar-Saenz, Hugo H., Rabinov, James D. , Berge, Jérôme , Martinez-Gutierrez, Juan Carlos, Premat, Kévin , Chervak, Lina , Elhorany, Mahmoud, Quintero‐Consuegra, Miguel , Kan, Peter , Khandelwal, Priyank , Kadirvel, Ramanathan , Dofuku, Shogo , Nedelcu, Simona, Tjoumakaris, Stavropoula I, Barreau, Xavier, Liebeskind, David S. , Liebeskind, David S. , Heit, Jeremy J , Altschul, David J , Gonzalez, Nestor R , Regenhardt, Robert W , Yedavalli, Vivek S , Henninger, Nils , Tan, Benjamin Yq , Alexandre, Andrea M , Varela, Ricardo , Essibayi, Muhammed Amir , Salim, Hamza , Fazzari, Melissa J. , Khatri, Deepak , Baker, Amanda, Musmar, Basel , Kühn, Anna Luisa , Khalife, Jane , Ghozy, Sherief , Scarcia, Luca , Yeo, Leonard Ll , Cancelliere, Nicole M , Rouchaud, Aymeric , Sheth, Sunil A , Puri, Ajit S , Colasurdo, Marco , Renieri, Leonardo , Harker, Pablo , Aziz, Yasmin , Radu, Răzvan Alexandru , Klein, Piers , Ota, Takahiro , Mowla, Ashkan , Naamani, Kareem El , Jabbour, Pascal , Siegler, James E. , Nguyen, Thanh N. , Gory, Benjamin , Hecker, Constantin , Marnat, Gaultier , Griessenauer, Christoph J. , Pedicelli, Alessandro , Faizy, Tobias D. , Mendes Pereira, Vitor , Dmytriw, Adam A. , _, _, Amllay, Abdelaziz , Vagal, Achala , Schiphorst, Adrien ter , Thomas, Ajith J , Mounayer, Charbel , Weyland, Charlotte S. , Hsieh, Cheng‐Yang , Forestier, Géraud , Cuellar, Hugo , Valente, Iacopo , Sibon, Igor , Jesser, Jessica , Martinez-Gutierrez, Juan Carlos , Meyer, Lukas , Elhorany, Mahmoud , Aziz‐Sultan, Mohammad Ali , Killer-Oberpfalzer, Monika , Khandelwal, Priyank , Fahed, Robert , Salazar‐Marioni, Sergio , Nedelcu, Simona , Tjoumakaris, Stavropoula , Saleme, Suzana , Barreau, Xavier
Journal of Neurosurgery | July 4, 2025 | Volume: 143 | Issue: 6 | Pages: 1501-1513
OBJECTIVE Mechanical thrombectomy (MT) is well established for large-vessel occlusion (LVO) strokes, but its safety in distal and medium-vessel occlusions (DMVOs) requires further investigation. This study analyzed the relationship between procedural approaches, petechial hemorrhage (PetH), and clinical outcomes in DMVO thrombectomy, with particular attention to technical considerations and the complex interplay between tissue injury and hemorrhagic complications. METHODS A retrospective cohort study was conducted on DMVO stroke patients treated with MT at 37 stroke centers worldwide from 2016 to 2024. Patients were categorized based on follow-up imaging into those with or without PetH. Four logistic regression models analyzed the association of PetH with favorable functional outcomes (modified Rankin Scale score ≤ 2) at 90 days, early neurological improvement (≥ 4-point National Institutes of Health Stroke Scale score decrease at 24 hours), all-cause mortality, and independent determinants of PetH. Adjusted odds ratios (aORs), 95% confidence intervals, and p values were reported. RESULTS Of 1428 patients, 439 (30.7%) developed PetH. Factors independently associated with PetH were multiple thrombectomy passes (aOR 1.58, 95% CI 1.21–2.06; p = 0.001), IV thrombolysis (aOR 1.31, 95% CI 1.01–1.69; p = 0.04), and the combined use of a stent retriever with aspiration as the first-line method compared with aspiration alone (aOR 1.66, 95% CI 1.15–2.38; p = 0.007). Conversely, general anesthesia (aOR 0.55, 95% CI 0.40–0.77; p < 0.001), higher Alberta Stroke Program Early CT Scores (aOR 0.76, 95% CI 0.69–0.83; p < 0.001), and successful recanalization (aOR 0.56, 95% CI 0.39–0.80; p = 0.002) were significantly associated with a lower odds of PetH. PetH was associated with a decreased odds of favorable functional outcomes (aOR 0.51, 95% CI 0.36–0.73; p < 0.001), reduced early neurological improvement (aOR 0.59, 95% CI 0.44–0.79; p < 0.001), and increased all-cause mortality (aOR 1.84, 95% CI 1.23–2.76; p < 0.001). CONCLUSIONS PetH is a frequent sequela following MT in DMVO strokes and is associated with poorer outcomes, likely reflecting underlying ischemic injury rather than direct causation. Procedural factors influence PetH risk, suggesting medical treatment as first-line therapy for DMVOs, with MT reserved for refractory cases using less aggressive approaches.
Variation in Fluid and Vasopressor Use in Shock With and Without Physiologic Assessment: A Multicenter Observational Study
Chen, Jen‐Ting , Roberts, Russel J. , Qadir, Nida , Cairns, Charles B. , Mathews, Kusum S. , Park, Pauline, Khan, Akram , Gilmore, James F. , Brown, Anne Rain , Tsuei, Betty J., Handzel, Michele, Chang, Alfredo Lee, Herbert, James T. , Martinez, Anthony , Tonna, Joseph E. , Nazer, Lama , Heavner, Mojdeh S. , Pender, Erin, Chambers, Lauren, Kenes, Michael T. , Kaufman, David A. , Downey, April, Chaykosky, Darlene, Wolff, Armand, Smith, Michael , Nault, Katie, Sevransky, Jonathan, Gong, Michelle N. , Network, on behalf of the VOLUME-CHASERS Study Group and Society of Critical Care Medicine Discovery, Tonna, Joseph E. , Heavner, Mojdeh S , Khan, Akram , Fazzari, Melissa J. , Kashani, Kianoush , Park, Pauline K. , Duggal, Abhijit , Lanspa, Michael J. , Ammar, Mahmoud A , Hammond, Drayton A , Brown, Brent , Network, on behalf of the VOLUME-CHASERS Study Group and Society of Critical Care Medicine Discovery
Critical Care Medicine | June 30, 2020 | Volume: 48 | Issue: 10 | Pages: 1436-1444
Objectives: To characterize the association between the use of physiologic assessment (central venous pressure, pulmonary artery occlusion pressure, stroke volume variation, pulse pressure variation, passive leg raise test, and critical care ultrasound) with fluid and vasopressor administration 24 hours after shock onset and with in-hospital mortality. Design: Multicenter prospective cohort study between September 2017 and February 2018. Settings: Thirty-four hospitals in the United States and Jordan. Patients: Consecutive adult patients requiring admission to the ICU with systolic blood pressure less than or equal to 90 mm Hg, mean arterial blood pressure less than or equal to 65 mm Hg, or need for vasopressor. Interventions: None. Measurement and Main Results: Of 1,639 patients enrolled, 39% had physiologic assessments. Use of physiologic assessment was not associated with cumulative fluid administered within 24 hours of shock onset, after accounting for baseline characteristics, etiology and location of shock, ICU types, Acute Physiology and Chronic Health Evaluation III, and hospital (beta coefficient, 0.04; 95% CI, −0.07 to 0.15). In multivariate analysis, the use of physiologic assessment was associated with a higher likelihood of vasopressor use (adjusted odds ratio, 1.98; 95% CI, 1.45−2.71) and higher 24-hour cumulative vasopressor dosing as norepinephrine equivalent (beta coefficient, 0.37; 95% CI, 0.19−0.55). The use of vasopressor was associated with increased odds of in-hospital mortality (adjusted odds ratio, 1.88; 95% CI, 1.27−2.78). In-hospital mortality was not associated with the use of physiologic assessment (adjusted odds ratio, 0.86; 95% CI, 0.63−1.18). Conclusions: The use of physiologic assessment in the 24 hours after shock onset is associated with increased use of vasopressor but not with fluid administration.