Christina Mijalski Sells

All Publications

• Carotid-Cavernous Fistula Treatment in Vascular Ehlers-Danlos Syndrome: A Case Report and Review of Management. Stroke Wong, G. J., Pendharkar, A. V., Lyman, K. A., Thatikunta, P., Kraler, L. D., Mijalski, C., Liang, D. H., Dodd, R. L. 2023

  View details for DOI 10.1161/STROKEAHA.123.042623

  View details for PubMedID 37226776

• Visual review of acute stroke neuroimaging prior to transfer acceptance increases likelihood of endovascular therapy. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association McCullough-Hicks, M., Thatikunta, P., Mlynash, M., Albers, G. W., Mijalski-Sells, C. 2023; 32 (7): 107157

  Abstract

  OBJECTIVES: Demand for thrombectomy, and interhospital transfer to comprehensive stroke centers (CSCs), for acute stroke is increasing. There is an urgent need to identify patients most likely to benefit from transfer. We evaluated whether CSC providers' review of neuroimaging prior to transfer acceptance improved patient selection for thrombectomy and correlated with higher rates of treatment.MATERIALS AND METHODS: A retrospective database of all patients transferred to Stanford's CSC for thrombectomy between 2015-2019 was used. Pre-acceptance images, when available for visual review, were reviewed by the CSC stroke team via virtual PACS, RAPID software, or LifeImage platforms.RESULTS: 525 patients met inclusion criteria. 147 (28%) had neuroimaging available for review prior to transfer. Of those who did not recanalize en route, 267 (50.8%) underwent thrombectomy. Patients with imaging available for review prior to acceptance were significantly more likely to receive thrombectomy (68% vs 54%, RR 1.26; p=0.006, 95% CI 1.09-1.48). Patient images that were reviewed via RAPID were CT-based perfusion studies; these were more likely to receive thrombectomy (70% vs 54%, RR 1.30; p=0.01, 1.09-1.56). Patients who received EVT were more likely to have had pre-transfer vessel imaging, regardless of availability for visual review (76% vs 59%, RR 1.44; p<0.001, 1.18-1.76).CONCLUSIONS: Patients with concern for acute stroke transferred for consideration of thrombectomy who had neuroimaging visually reviewed prior to transfer acceptance and did not recanalize by time of arrival were significantly more likely to undergo thrombectomy. Additional prospective studies are needed to confirm our findings.

  View details for DOI 10.1016/j.jstrokecerebrovasdis.2023.107157

  View details for PubMedID 37126905

• Varicella Zoster Vasculopathy Exacerbated by Tofacitinib in a Patient With Ulcerative Colitis. Stroke Lyman, K. A., Sreekrishnan, A., Thatikunta, P., McConnell, R., Lansberg, M. G., Mijalski Sells, C. M. 2023

  View details for DOI 10.1161/STROKEAHA.122.042228

  View details for PubMedID 37021571

• Visual Review Of Neuroimaging Prior To Transfer Acceptance Is Significantly Associated With Higher Rates Of Endovascular Therapy Thatikunta, P., McCullough-Hicks, M. E., Mlynash, M., Albers, G. W., Mijalski Sells, C. M. LIPPINCOTT WILLIAMS & WILKINS. 2022

  View details for DOI 10.1161/str.53.suppl_1.TP49

  View details for Web of Science ID 000788100600335

• Perioperative Neurological Evaluation and Management to Lower the Risk of Acute Stroke in Patients Undergoing Noncardiac, Nonneurological Surgery: A Scientific Statement From the American Heart Association/American Stroke Association CIRCULATION Benesch, C., Glance, L. G., Derdeyn, C. P., Fleisher, L. A., Holloway, R. G., Messe, S. R., Mijalski, C., Nelson, M., Power, M., Welch, B. G., Amer Heart Assoc Stroke Council, Council Arteriosclerosis Thrombosi, Council Cardiovasc Stroke Nursing, Council Clinical Cardiology, Council Epidemiology Prevention 2021; 143 (19): E923-E946

  Abstract

  Perioperative stroke is a potentially devastating complication in patients undergoing noncardiac, nonneurological surgery. This scientific statement summarizes established risk factors for perioperative stroke, preoperative and intraoperative strategies to mitigate the risk of stroke, suggestions for postoperative assessments, and treatment approaches for minimizing permanent neurological dysfunction in patients who experience a perioperative stroke. The first section focuses on preoperative optimization, including the role of preoperative carotid revascularization in patients with high-grade carotid stenosis and delaying surgery in patients with recent strokes. The second section reviews intraoperative strategies to reduce the risk of stroke, focusing on blood pressure control, perioperative goal-directed therapy, blood transfusion, and anesthetic technique. Finally, this statement presents strategies for the evaluation and treatment of patients with suspected postoperative strokes and, in particular, highlights the value of rapid recognition of strokes and the early use of intravenous thrombolysis and mechanical embolectomy in appropriate patients.

  View details for DOI 10.1161/CIR.0000000000000968

  View details for Web of Science ID 000649074100004

  View details for PubMedID 33827230

• Review of Neuroimaging Prior to Transfer Acceptance and Rate of Endovascular Treatment McCullough-Hicks, M. E., Bernier, E., Mlynash, M., Albers, G., Sells, C. LIPPINCOTT WILLIAMS & WILKINS. 2020

  View details for Web of Science ID 000590040202019

• Tilt-Corrected Region Boundaries May Enhance the Alberta Stroke Program Early Computed Tomography Score for Less Experienced Raters. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association Culbertson, C. J., Christensen, S. n., Mlynash, M. n., Heit, J. J., Federau, C. n., Sells, C. M., Legault, C. n., McCaslin, A. F., Werbaneth, K. n., Albers, G. W., Lansberg, M. G. 2020: 104820

  Abstract

  The Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is widely used to quantify early ischemic changes in the anterior circulation but has limited inter-rater reliability.We investigated whether application of 3-dimensional boundaries outlining the ASPECTS regions improves inter-rater reliability and accuracy.We included all patients from our DEFUSE 2 database who had a pretreatment noncontrast computed tomography scan (NCCT) of acceptable quality. Six raters (2 neuroradiologists, 2 vascular neurologists, and 2 neurology residents) scored ASPECTS of each NCCT without ("CT-native") and with the superimposed boundary template ("CT-template"). Gold-standard ASPECTS were generated by the 2 neuroradiologists through joint adjudication. Inter-rater reliability and accuracy were assessed using the intraclass correlation coefficient (ICC) for full-scale agreements and Gwet's AC1 for dichotomized (ASPECTS 0-6 vs 7-10) agreements.Eighty-two patients were included. Inter-rater reliability improved with higher training level for both CT-native (ICC = .15, .31, .54 for residents, neurologists, and radiologists, respectively) and CT-template (ICC = .18, .33, .56). Use of the boundary template improved correlation with the gold-standard for one resident on full-scale agreement (ICC increased from .01 to .31, P = .01) and another resident on dichotomized agreement (AC1 increased from .36 to .64, P = .01), but resulted in no difference for other raters. The template did not improve ICC between raters of the same training level.Inter-rater reliability of ASPECTS improves with physician training level. Standardized display of ASPECTS region boundaries on NCCT does not improve inter-rater reliability but may improve accuracy for some less experienced raters.

  View details for DOI 10.1016/j.jstrokecerebrovasdis.2020.104820

  View details for PubMedID 32307316

• Stroke in Pregnancy SEMINARS IN NEUROLOGY Sells, C., Feske, S. K. 2017; 37 (6): 669-678

  Abstract

  Pregnancy and the postpartum period confer an increased risk of stroke. The risk appears to be increased for all strokes during the puerperium and for hemorrhagic strokes during pregnancy. During pregnancy, physiologic systems are under increased stress to accommodate the growing fetus, which results in substantial hemodynamic, cardiovascular, hematologic, immunologic, and structural connective tissue changes that account for much of this increased risk. In addition, preeclampsia-eclampsia has major effects on the vascular system, and this disorder, unique to pregnancy, is another major contributor to this risk. The common independent vascular risk factors for stroke, such as hypertension, diabetes, hyperlipidemia, and smoking, may also be present to contribute to the risks conferred by pregnancy. Though uncommon, stroke during pregnancy and in the postpartum period causes substantial morbidity and mortality in affected women, and it poses a significant risk to the fetus. This review will discuss the epidemiology of pregnancy-associated stroke, specific risk factors and mechanisms, clinical presentation and management, and future directions.

  View details for DOI 10.1055/s-0037-1608940

  View details for Web of Science ID 000418733000010

  View details for PubMedID 29270940