Anas Hourani - Academia.edu (original) (raw)

Papers by Anas Hourani

Medical Research Archives

Background: Despite the advancement in acute ischemic stroke with large vessel occlusion (LVO), g... more Background: Despite the advancement in acute ischemic stroke with large vessel occlusion (LVO), golden time is lost in assessment lengthy neurological examination and redundantly in the Emergency department, often after emergency medical service prehospital stroke scale evaluation indicating possible LVO. A simple acute ischemic stroke scale (AISS) of the cortical representations of the anterior circulation can rapidly predict LVO, saving precious time to initiate early intravenous tissue plasminogen activator and endovascular mechanical thrombectomy. We proposed an ASIS in the emergency department called Gaze Weakness Neglect Speech (GWNS) to evaluate its feasibility and predictability for the detection of LVO in anterior circulation in the emergency department. Additionally, to evaluate if time can be gained that has been lost in obtaining National Institute of Health stroke Scale (NIHSS) and computed tomographic angiography (CTA), avoiding unnecessary radiation. Methods: This is ...

Stroke, 2015

Background: Acute ischemic stroke (AIS) due to large artery occlusion (LAO) with high NIHSS (>... more Background: Acute ischemic stroke (AIS) due to large artery occlusion (LAO) with high NIHSS (>10), especially in internal carotid artery terminus (ICA-T) are resistant to IV thrombolysis and endovascular thrombectomy is associated with better recanalization rates. IV thrombolysis in large clot burden (>8mm) (LCB) in the middle cerebral artery (MCA) is associated with poor recanalization and may impact outcome. However, thrombectomy in AIS with LAO within 3 hours is performed as secondary therapy after IV thrombolysis. Objectives: To evaluate the feasibility, safety and recanalization rate of primary thrombectomy within 3 hours in AIS with NIHSS >10 from occlusion of MCA with LCB. Additionally, we like to report the functional outcome. Methods: Based on institutionally approved protocol patients with LAO (ICA-T, MCA, vertebral-basilar artery) with LCB within 3 hours were offered primary thrombectomy as an alternative to IV rtPA. They were entered into a stroke database. Pati...

Electronic Poster Abstracts, 2018

Endovascular repair of the basilar artery bifurcation aneurysms (BABA) remains the preferred appr... more Endovascular repair of the basilar artery bifurcation aneurysms (BABA) remains the preferred approach, as clipping is associated with a higher chance of mortality and morbidity. Additionally, surgical clipping is not offered to those with poor grades. Objectives To determine the perioperative risk and outcomes of patients with ruptured BABA (RBABA) who underwent endovascular repair including those with poor grades. Methods Consecutive patients who underwent endovascular therapy of RBARA from January 2011 to December 2017 were retrospectively analyzed. Antiplatelet loading regimen: stent assisted coiling; Plavix 75 mg × 4 and chewable baby aspirin 81 mg x4. Coiling; chewable aspirin 81 mg × 4, both cases given at least 4 hours prior. Overpacking and primary coiling cases received additional 300 mg rectal aspiring immediate after the procedure. Heparin was administered for all stent-assisted and primary coiling cases prior to deployment of stent or coil with target 1.5 −2 × 2 baseline ACT. Ruptured primary coiling; heparin was administered after the deployment of first coil. Patients long-term outcome was measure using modified Rankin Scale (mRS). Results 26 patients with median age 55 (31–71), 21 women, median aneurysm size 11 mm (4–30) and 14 wide-neck underwent repair; primary coiling 17, stent-assisted coiling 9 and 15 required extra ventricular drainage (EVD). For the stent-assisted cases; planned EVD was placed at least 6 hours prior to the procedure for adequate hemostasis, were loaded with aspiring and Plavix at least 2 hours prior for those who can swallow and at least one hour before for those who received crushed loads via nasogastric tube. Presenting H and H grades; I in 7, II in 8, III in 4 and IV in 7. Off 7 patients with H and H IV, 5 demonstrated gradual improvement of their H and H grades after EVD placement. Perioperative stroke developed in one (3.8%) who achieved mRS 3 and EDV related subdural hemorrhage in one (initial grade was IV, not a stent-assisted case, no improvement and died). Immediate complete and near complete aneurysm obliteration in 81% (21; complete 10, near complete 11) and subtotal in 19% (5). 90 days good outcome was observed in 77% (mRS 0 in 16, mRS 1 in 2, mRS 2 in 2) and poor outcome in 19% (mRS 3 in 3, mRS 4 in 2, mRS 6 in 1). Among 7 patients (27%) with H and H IV; 57% (4) had good outcome (mRS 0 in 2, mRS 1 in 2), and 43% (3) had poor outcome (mRS 4 in 2 and mRS 6 in 1). Aneurysm racialized in 9 cases (5 large, 3 giant) including subtotal obliterated cases and those were retreated (5 stent-coil, 4 coiling). Conclusions Endovascular approach to repair RBABA is associated with low perioperative events and offers good functional outcomes including those who present with poor grades or require acute stent-assisted repair. Presenting poor grades may be related to the location of initial ictus in conjunction with hydrocephalus which may improve after EVD placements. Therefore, endovascular therapy should be offered for all RBABA patients including those present with poor grades. Further studies are required. Disclosures Y. Lodi: None. V. Reddy: None. S. Javed: None. S. Multani: None. W. Elnour: None. T. Wang: None. A. Hourani: None.

Electronic Poster Abstracts, 2018

Background Neuroendovascular approach of aneurysm treatment continues to gain popularity and has ... more Background Neuroendovascular approach of aneurysm treatment continues to gain popularity and has been preferred by patients’ due to short hospital stays with early return to the daily activities of living. However, middle cerebral artery aneurysms (MCA) are still favored for open craniotomy. Data on early discharge and complete return to full functionality after MCA aneurysm repair are lacking. Additionally, endovascular outcome of patients with a complex anatomy and/or wide neck are not well described. Objectives To evaluate the technical and long-term durable outcomes of patients with MCA aneurysm who were repaired in endovascular approach. Additionally, to determine the average hospital stay and early return to previous daily activities of living. Methods Consecutive patients who underwent endovascular repair of the MCA aneurysm from January 2011 to December 2017 were enrolled and data was retrospectively analyzed. Antiplatelet loading regimen: stent assisted coiling; Plavix 75 mg × 4 and rapid release chewable baby aspirin 81 mg × 4. Coiling; chewable aspirin 81 mg × 4, both cases given at least 4 hours prior. Overpacking and primary coiling cases received additional 300 mg rectal aspiring immediate after the procedure. Heparin was administered for all stent-assisted and primary coiling cases prior to deployment of stent or coil with target 1.5 −2 × 2 baseline activated coagulation time. Ruptured primary coiling; heparin was administered after the deployment of first coil. Patients long-term outcome was measure using modified Rankin Scale (mRS). Results 24 patients with median age of 61.5 years (38 to 78) with 26 MCA aneurysms underwent endovascular repair; Right MCA 19, wide neck and complex anatomy 19, ruptured 2, symptomatic 12, recurrent 3 and asymptomatic 9. Primary coiling was performed in 10 aneurysms; 6 small neck, 2 ruptured with 1 wide neck, and 2 unsuccessful attempted stent-assisted aneurysms. Stent-assisted coiling was intended in 18 but performed in 16 cases; unable to access M2 in one and faulty stent deployment in one. Intra-operative asymptomatic left M2 occlusion developed in one which was corrected using intra-arterial integrilin and achieved baseline mRS1. Clinical events in 2; subarachnoid hemorrhage in one after unsuccessful attempted M2 catheterization for stenting. Patient discharged home in 48 hours and achieved mRS 0. Post procedure temporal lobe stroke in other in primary coiling group, who had significant vascular risk factors and didn’t receive antiplatelet before or after the procedure. Immediate complete and near complete obliteration of aneurysm achieved in 23 aneurysms (88.5%) and 3 had subtotal obliteration (11.5%). Median 18 months aneurysm obliteration: complete and near-complete in 20 (77%), recurrence in 3 (11.5%) and subtotal in 3 (11.5%). Recurrent and subtotal cases were repaired with persistent obliteration. Median hospital stay was 1.4 days (1–7 days) excluding 2 ruptured cases. 90 days mRS 0 in 16 and mRS 1in 5 (87.5%) and mRS 2 in 2 patients (both has baseline mRS 2). Conclusions Our series demonstrates that MCA aneurysms could be safely repaired by endovascular approach including those with wide neck and complex morphology. Additionally, early return home and achieving full functionalities are possible. Further studies are needed. Disclosures Y. Lodi: None. A. Hourani: None. V. Reddy: None. S. Javed: None. S. Multani: None. T. Wang: None.

Journal of NeuroInterventional Surgery, 2015

Background In acute ischemic stroke (AIS), 1.9 million cells die each minute. Therefore, an early... more Background In acute ischemic stroke (AIS), 1.9 million cells die each minute. Therefore, an early effective recanalization is necessary to salvage the penumbra and to achieve a good outcome. AIS due to a large artery occlusion (LAO) with high NIHSS (>10), especially in internal carotid artery terminus (ICA-T) are resistant to IV thrombolysis and endovascular thrombectomy is associated with better recanalization rates. Recent randomized controlled trial demonstrated better recanalization rate and outcome in endovascular therapy compared to IV thrombolysis in AIS with LAO. Despite the benefit with endovascular therapy, 68% of patients were either disable or dead. Thrombectomy in AIS with LAO within 3 h (IV t-PA window) is performed as secondary therapy after IV thrombolysis, which is associated with delay in enrollment and recanalization. The delay in recanalization may be responsible for the disproportion between acceptable recanalization and good functional outcomes. The delay in recanalization may be responsible for not achieving a good functional of those who had acceptable recanalization. Objectives To evaluate the feasibility, safety and recanalization rate of primary acute thrombectomy within 3 h in AIS with NIHSS ‡10 from LAO. Additionally, we like to identify the functional outcome. Methods Based on institutionally approved protocol patients with LAO (ICA-T, MCA, vertebral-basilar artery) with LCB within 3 h were offered primary thrombectomy as an alternative to IV rtPA. They were entered into a stroke database. Patients who underwent PAST3 from LAO from 2012 to 2014 were retrospectively analyzed using SAS software. Outcomes were measured using modified Rankin Scale (mRS). Results 18 patients with LAO; mean age 628.3 ± 15.32 years and mean NIHSS 16 ± 4; chose primary thrombectomy after informed consent. Thrombectomy was performed using stentretriever device in addition to intra-arterial rtPA (2-10 mg). Mean number of passes was 1.6 ±. 0.9. Near complete (TICI2b) recanalization was observed in 5.56%% and complete (TICI3) in 94.44% of patients. Mean time to recanalization from symptoms onset was 188.5 ± 82.7 min. Immediate post-thrombectomy, 24 h and 30 day NIHSS score was 4.44 ± 3.75, 1.9 ± 3.2 and 0.28 ± 96 respectively. There was no procedure related complication. Asymptomatic perfusion related hemorrhage developed in 6 patients. 30 days mRS distributions was as followings: mRS0 38.89%, mRS1 44.44 % and mRS2 16.67%. 90 days outcomes were observed in followings: mRS0 50%, mRS1 44.44%, mRS2 5.56%). Conclusion: Our pilot study demonstrates that primary thrombectomy using SRT in AIS due to a LAO is not

Association rule based classification is one of the popular data mining techniques applied in med... more Association rule based classification is one of the popular data mining techniques applied in medical domain. The major advantage is its interpretable results that medical doctors can easily adopt for diagnostic decision-making. The classification framework consists of data discretization, association rule generation, and classification. The discretization step is required to convert numerical features such as blood pressure into a categorical format, to make it suitable for association rules mining. Existing discretization methods such as Omega algorithm construct several non-adjacent intervals to represent new categorical variables. However, such algorithms are not generalizable because of failure to recognize new observations that lie between constructed intervals; this will impact the accuracy of association rules based classification. To overcome this problem, an associative classification framework based on an improved discretization algorithm is proposed. In the discretizatio...

ABSTRACT Human resources are essential in manufacturing and service industries, and one of the ma... more ABSTRACT Human resources are essential in manufacturing and service industries, and one of the main issues regarding human resources is how to predict the risk of human errors in different circumstances. Human errors play a significant role in the overall performance of manufacturing and service industries. For example, according to the Institute of Medicine (IOM) report, called “To Err Is Human”, 44,000 to 98,000 patients die each year as a result of human caused medical errors in healthcare service industry.In this paper, a new fuzzy inference system approach is proposed to predict the risk of human errors. A hierarchical fuzzy inference system consisting of different sub FISs is applied, where each FIS represents different levels of the system. The independent variables including personal and environmental factors are fed to sub FISs to determine the intermediate variables that affect the level of human errors. The output of these FISs are fed into a mathematical model to determine the level of human errors in different circumstances. An example is provided to demonstrate how the results of the model can be interpreted and used for identifying appropriate strategies to decrease the risk of human errors.

Stroke, 2016

Background: Based on recent trials, AIS due to large artery occlusion (LAO) is resistant to IV th... more Background: Based on recent trials, AIS due to large artery occlusion (LAO) is resistant to IV thrombolysis and adjunctive stent retriever thrombectomy (SRT) is associated with better recanalization rates and outcomes.Despite the benefit with endovascular therapy 39% to 68% of patients were either disabled or dead.Thrombectomy in AIS with LAO within 3 hours (IV t-PA window) is performed as secondary therapy after IV thrombolysis, which may be associated with delay in enrollment and recanalization. Objective: Primary objective is to evaluate the safety, feasibility and recanalization rate of primary SRT (without IV tPA) within 3 hours in AIS with NIHSS >10 from LAO.Secondary objective is to determine the functional outcome in 30-days and 90-days. Methods: Based on institutionally approved protocol patients with LAO with LCB within 3 hours were offered primary SRT alone as an alternative to IV rtPA, after informed consent.Consecutive patients who underwent primary SRT for LAO withi...

Journal of NeuroInterventional Surgery, 2016

In recent trials, acute ischemic stroke (AIS) from large artery occlusion (LAO) was resistant to ... more In recent trials, acute ischemic stroke (AIS) from large artery occlusion (LAO) was resistant to intravenous thrombolysis and adjunctive stent retriever thrombectomy (SRT) was associated with better perfusion and outcomes. Despite benefit, 39-68% of patients had poor outcomes. Thrombectomy in AIS with LAO within 3 h is performed secondary to intravenous thrombolysis, which may be associated with delay. The purpose of our study is to evaluate the safety, feasibility, recanalization rate, and outcome of primary SRT within 3 h without intravenous thrombolysis in AIS from LAO. Based on an institutionally approved protocol, stroke patients with LAO within 3 h were offered primary SRT as an alternative to intravenous recombinant tissue plasminogen activator. Consecutive patients who underwent primary SRT for LAO within 3 h from 2012 to 2014 were enrolled. Outcomes were measured using the modified Rankin Scale (mRS). 18 patients with LAO of mean age 62.83±15.32 years and median NIH Stroke Scale (NIHSS) score 16 (10-23) chose primary SRT after giving informed consent. Near complete (TICI 2b in 1 patient) or complete (TICI 3 in 17 patients) recanalization was observed in all patients. Time to recanalization from symptom onset and groin puncture was 188.5±82.7 and 64.61±40.14 min, respectively. NIHSS scores immediately after thrombectomy, at 24 h and 30 days were 4 (0-12), 1 (0-12), and 0 (0-4), respectively. Asymptomatic perfusion-related hemorrhage developed in four patients (22%). 90-day outcomes were mRS 0 in 50%, mRS 1 in 44.4%, and mRS 2 in 5.6%. Our study demonstrates that primary SRT in AIS from LAO is safe and feasible and is associated with complete recanalization and good outcome. Further study is required.

ABSTRACT Background Due to the presence of a high morbidity and mortality associated with surgica... more ABSTRACT Background Due to the presence of a high morbidity and mortality associated with surgical clipping, most of patients with basilar artery bifurcation (BA) aneurysm are offered endovascular therapy. Objective of our study is to report our technical and clinical outcomes of BA ruptured patients who underwent endovascular therapy. Methods Consecutive patients with the diagnosis of ruptured BA aneurysms who underwent endovascular repair of aneurysm from 2007 to 2011 were enrolled. Patient's demographics including presenting Hunt & Hess (H&H) grade, Fisher scale, and aneurysm's morphology, use of stent, intra-operative complications and radiographic outcome were measured. Additionally, a 90 days clinical outcome was measured using Glasgow Outcome Scale (GOS). Results 20 patients with a mean age of 51±13 year underwent successful repair of the ruptured BA bifurcation aneurysms. Most of the patient were women (80%) and 75% of patients were active smoker. H&H I was present in 6 (30%), H&H II in 4 (20%), H&H III in 3 (15%), H&H IV in 6 (30%) and H&H V in 1 (5%) of patients. 10 patients with wide-necked aneurysms required stent-assisted coiling in the acute phase and were given oral loading doses of clopidogrel (300 mg) and aspirin (325 mg) at least 2 h prior to the stent deployment. There was no incidence of intra-operative or postoperative intracranial or systemic hemorrhages or thromboembolic event. Immediate complete (7) and near complete (9) obliteration was observed in 80% and subtotal in 4 (20%) of patients. 30 days good outcome (GOS 5 in 12, GOS 4 in four) was observed in 80% of patients including four of seven patients presented with poor grades (H&H IV & H&H V). Poor outcome (GOS 3) was observed in 4 (20%) of patients. When these patient were examined in 90 days; good outcome (GOS 5 in 14, GOS 4 in four) was observed in 90% including six of the seven patients who had presenting poor grades. Conclusions Endovascular techniques offer successful repair of ruptured BA aneurysms including those with wide neck and required stent-assisted coiling. Good outcome was observed in most of our patients including those with poor clinical grade. Poor H&H grade was not associated with poor long-time outcome in our series. Further study is required to evaluate the role of Hunt & Hess grade in BA aneurysm in a broader scale.

Introduction Thrombectomy is considered an option for all stroke patients who are either not or f... more Introduction Thrombectomy is considered an option for all stroke patients who are either not or failed candidate for intravenous thrombolytic. Objectives: To identify the rate of recanalization and outcome in acute ischemic stroke patients with MCA occlusion who underwent thrombectomy using Solitaire retrieval device. Methods Retrospective review of all consecutive MCA thrombectomy cases from June 2013 to March 28, 2014. Outcomes were measured using NIHSS and mRS. Results 18 patients including 2 failed IV tPA patients with MCA occlusion underwent thrombectomy. The mean age was 70±14 years old, mean NIHSS 17.1±1.4, 67% female and 33% were 80 years or older. Conscious sedation was given to all but two who were intubated due to the initial impact of stroke. Mean time to MCA microcatheter placement was 30±3 minutes. Compete recanalization (TICI3) was observed in 89% and partial (TICI2a) 11% with mean time of recanalization from groin puncture of 65±6 minutes. Immediate post procedure 10...

Background Due to the presence of a high morbidity and mortality associated with surgical clippin... more Background Due to the presence of a high morbidity and mortality associated with surgical clipping, most of patients with basilar artery bifurcation (BA) aneurysm are offered endovascular therapy. Objective of our study is to report our technical and clinical outcomes of BA ruptured patients who underwent endovascular therapy. Methods Consecutive patients with the diagnosis of ruptured BA aneurysms who underwent endovascular repair of aneurysm from 2007 to 2011 were enrolled. Patient's demographics including presenting Hunt & Hess (H&H) grade, Fisher scale, and aneurysm's morphology, use of stent, intra-operative complications and radiographic outcome were measured. Additionally, a 90 days clinical outcome was measured using Glasgow Outcome Scale (GOS). Results 20 patients with a mean age of 51±13 year underwent successful repair of the ruptured BA bifurcation aneurysms. Most of the patient were women (80%) and 75% of patients were active smoker. H&H I was present in 6 (30%)...

Introduction Antiplatelet regimen in stent-assisted treatment of intracranial aneurysm is not uni... more Introduction Antiplatelet regimen in stent-assisted treatment of intracranial aneurysm is not universal and varies from center to center. Objectives: To determine the safety, feasibility and clinical outcome of patients who underwent Enterprise stent-assisted repair of intracranial aneurysm using acute loading doses of aspirin and clopidogrel. Methods Consecutive patients underwent enterprise stent-assisted repair of aneurysm using loading doses of aspirin 324 mg and clopidogrel 300 mg were enrolled.The outcome was measured using national institute of health stroke scale (NIHSS) and modified Rankin Scale (mRS) Results 47 patients with mean age of 53 ± 13 underwent 56 stent-assisted procedures to treat 53 (2 ruptured cases) aneurysms. Stent deployed in (98%) but one who underwent aneurysm coiling. There was no intra-operative hemorrhagic event. Small left subtrachnoid hemorrhage was observed in one with right middle cerebral artery aneurysm (MCA). Intra-operative asymptomatic MCA bra...

Human resources are essential in manufacturing and service industries, and one of the main issues... more Human resources are essential in manufacturing and service industries, and one of the main issues regarding human resources is how to predict the risk of human errors in different circumstances. Human errors play a significant role in the overall performance of manufacturing and service industries. For example, according to the Institute of Medicine (IOM) report, called “To Err Is Human”, 44,000 to 98,000 patients die each year as a result of human caused medical errors in healthcare service industry.In this paper, a new fuzzy inference system approach is proposed to predict the risk of human errors. A hierarchical fuzzy inference system consisting of different sub FISs is applied, where each FIS represents different levels of the system. The independent variables including personal and environmental factors are fed to sub FISs to determine the intermediate variables that affect the level of human errors. The output of these FISs are fed into a mathematical model to determine the level of human errors in different circumstances. An example is provided to demonstrate how the results of the model can be interpreted and used for identifying appropriate strategies to decrease the risk of human errors.

American Journal of Pharmacology and Toxicology, 2008

Other uses, including reproduction and distribution, or selling or licensing copies, or posting t... more Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited.

American Journal of Pharmacology and Toxicology, 2008

Medical Research Archives

Stroke, 2015

Electronic Poster Abstracts, 2018

Journal of NeuroInterventional Surgery, 2015

Stroke, 2016

Journal of NeuroInterventional Surgery, 2016

American Journal of Pharmacology and Toxicology, 2008