Bio


Neurology resident with interest in vascular and interventional neurology.

Undergraduate: University of California, Los Angeles (2014)
Medical School: Washington University School of Medicine (2020)
Internship: Barnes-Jewish Hospital/Washington University Medical Center (2021)

All Publications


  • Clinical Reasoning: A 7-Year-Old Boy With Acute-Onset Altered Mental Status NEUROLOGY Wong, G. J., Gaudioso, C. M., Castro, E., Sharifai, N., Dahiya, S., Dehner, L. P., Griffith, J. L. 2021; 96 (22): E2774-E2778

    View details for DOI 10.1212/WNL.0000000000012034

    View details for Web of Science ID 000702406800018

    View details for PubMedID 33849990

  • Frequency, Determinants, and Outcomes of Emboli to Distal and New Territories Related to Mechanical Thrombectomy for Acute Ischemic Stroke. Stroke Wong, G. J., Yoo, B., Liebeskind, D., Baharvahdat, H., Gornbein, J., Jahan, R., Szeder, V., Duckwiler, G., Tateshima, S., Colby, G., Nour, M., Sharma, L., Rao, N., Hinman, J., Starkman, S., Saver, J. L., UCLA Thrombectomy Investigators, Alfonso, R., Arch, A., Avila, G., Hosseini, M. B., Chatfield, F., Chhabra, A. S., Dobkin, B., Frischmann, L. K., Grunberg, I., Guzy, J., Huang, J. F., Kim, D., Malhotra, K., McManus, M., Restrepo, L., Singh, P., Tang, X. X., Tarpley, J. W., Tipirneni, A. 2021: STROKEAHA120033377

    Abstract

    BACKGROUND AND PURPOSE: Clot fragmentation and distal embolization during endovascular thrombectomy for acute ischemic stroke may produce emboli downstream of the target occlusion or in previously uninvolved territories. Susceptibility-weighted magnetic resonance imaging can identify both emboli to distal territories (EDT) and new territories (ENT) as new susceptibility vessel signs (SVS). Diffusion-weighted imaging (DWI) can identify infarcts in new territories (INT).METHODS: We studied consecutive acute ischemic stroke patients undergoing magnetic resonance imaging before and after thrombectomy. Frequency, predictors, and outcomes of EDT and ENT detected on gradient-recalled echo imaging (EDT-SVS and ENT-SVS) and INT detected on DWI (INT-DWI) were analyzed.RESULTS: Among 50 thrombectomy-treated acute ischemic stroke patients meeting study criteria, mean age was 70 (±16) years, 44% were women, and presenting National Institutes of Health Stroke Scale score 15 (interquartile range, 8-19). Overall, 21 of 50 (42%) patients showed periprocedural embolic events, including 10 of 50 (20%) with new EDT-SVS, 10 of 50 (20%) with INT-DWI, and 1 of 50 (2%) with both. No patient showed ENT-SVS. On multivariate analysis, model-selected predictors of EDT-SVS were lower initial diastolic blood pressure (odds ratio, 1.09 [95% CI, 1.02-1.16]), alteplase pretreatment (odds ratio, 5.54 [95% CI, 0.94-32.49]), and atrial fibrillation (odds ratio, 7.38 [95% CI, 1.02-53.32]). Classification tree analysis identified pretreatment target occlusion SVS as an additional predictor. On univariate analysis, INT-DWI was less common with internal carotid artery (5%), intermediate with middle cerebral artery (25%), and highest with vertebrobasilar (57%) target occlusions (P=0.02). EDT-SVS was not associated with imaging/functional outcomes, but INT-DWI was associated with reduced radiological hemorrhagic transformation (0% versus 54%; P<0.01).CONCLUSIONS: Among acute ischemic stroke patients treated with thrombectomy, imaging evidence of distal emboli, including EDT-SVS beyond the target occlusion and INT-DWI in novel territories, occur in about 2 in every 5 cases. Predictors of EDT-SVS are pretreatment intravenous fibrinolysis, potentially disrupting thrombus structural integrity; atrial fibrillation, possibly reflecting larger target thrombus burden; lower diastolic blood pressure, suggestive of impaired embolic washout; and pretreatment target occlusion SVS sign, indicating erythrocyte-rich, friable target thrombus.

    View details for DOI 10.1161/STROKEAHA.120.033377

    View details for PubMedID 34011171

  • A Prehospital Acute Stroke Trial has Only Modest Impact on Enrollment in Concurrent, Post-arrival-Recruiting Stroke Trials JOURNAL OF STROKE & CEREBROVASCULAR DISEASES Johnson-Black, P., Wong, G., Starkman, S., Sanossian, N., Sharma, L., Kim-Tenser, M., Liebeskind, D., Restrepo-Jimenez, L., Valdes-Sueiras, M., Stratton, S., Eckstein, M., Pratt, F., Conwit, R., Hamilton, S., Guzy, J., Grunberg, I., Shkirkova, K., Hemphill, C., Saver, J., FAST-MAG Investigators Coordinato 2020; 29 (11): 105200

    Abstract

    Because "time is brain," acute stroke trials are migrating to the prehospital setting. The impact upon enrollment in post-arrival trials of earlier recruitment in a prehospital trial requires delineation.We analyzed all patients recruited into acute and prevention stroke trials during an 8-year period when an academic medical center (AMC) was participating in a prehospital treatment trial - the NIH Field Administration of Stroke Treatment - Magnesium (FAST-MAG) study.During the study period, in addition to FAST-MAG, the AMC participated in 33 post-arrival stroke trials: 27 for acute cerebral ischemia, one for intracerebral hemorrhage, and 5 secondary prevention trials. Throughout the study period, the AMC was recruiting for at least 3 concurrent post-arrival acute trials. Among 199 patients enrolled in acute stroke trials, 98 (49%) were in FAST-MAG and 101 (51%) in concurrent, post-arrival acute trials. Among FAST-MAG patients, 67% were not eligible for any concurrent acute, post-arrival trial. Of 134 patients eligible for post-arrival acute trials, 101 (76%) were enrolled in post-arrival trials and 32 (24%) in FAST-MAG. Leading reasons FAST-MAG patients were ineligible for post-arrival acute trials were: NIHSS too low (23.4%), intracranial hemorrhage (17.9%), IV tPA used in standard management (9.0%), NIHSS too high (7.1%), and age too high (5.2%).A prehospital hyperacute stroke trial with wide entry criteria reduced only modestly, by one-fourth, enrollment into concurrently active, post-arrival stroke trials. Simultaneous performance of prehospital and post-arrival acute and secondary prevention stroke trials in research networks is feasible.

    View details for DOI 10.1016/j.jstrokecerebrovasdis.2020.105200

    View details for Web of Science ID 000579523100018

    View details for PubMedID 33066919

    View details for PubMedCentralID PMC7573197

  • Frequency, Predictors, and Outcomes of Prehospital and Early Postarrival Neurological Deterioration in Acute Stroke Exploratory Analysis of the FAST-MAG Randomized Clinical Trial JAMA NEUROLOGY Shkirkova, K., Saver, J. L., Starkman, S., Wong, G., Weng, J., Hamilton, S., Liebeskind, D. S., Eckstein, M., Stratton, S., Pratt, F., Conwit, R., Sanossian, N., FAST-MAG Trial Coordinators Invest 2018; 75 (11): 1364–74

    Abstract

    Studies of neurological deterioration in stroke have focused on the subacute period, but stroke treatment is increasingly migrating to the prehospital setting, where the neurological course has not been well delineated.To describe the frequency, predictors, and outcomes of neurological deterioration among patients in the ultra-early period following ischemic stroke or intracranial hemorrhage.Exploratory analysis of the prehospital, randomized Field Administration of Stroke Therapy-Magnesium (FAST-MAG) Trial conducted from 2005 to 2013 within 315 ambulances and 60 stroke patient receiving hospitals in Southern California. Participants were consecutively enrolled patients with suspected acute stroke who were transported by ambulance within 2 hours of stroke onset.The main outcome was neurological deterioration, defined as a worsening of 2 or more points on the Glasgow Coma Scale (GCS), a level of consciousness scale ranging from 3 to 15, with higher scores indicating more alertness. Imaging outcomes were ischemic or hemorrhagic injury extent identified during the first brain imaging scan. Outcomes at 3 months included global disability level (assessed using the modified Rankin Scale [mRS]; range, 0-6, with higher numbers indicating greater disability) and mortality.Among the 1690 patients (99.4%), the mean (SD) age was 69.4 (13.5) years, and 43% were female. Final diagnoses were acute cerebral ischemia in 1237 patients (73.2%), intracranial hemorrhage in 386 patients (22.8%), and neurovascular mimic in 67 patients (4.0%). The median (interquartile range [IQR]) minutes between the last well-known time and GCS assessments were 23 (14-42) minutes for prehospital, 58 (46-79) minutes for ED arrival, and 149 (120-180) minutes for early ED course assessments. From prehospital to early postarrival, ultra-early neurological deterioration (U-END) occurred in 200 of 1690 patients (11.8%), more often among patients with intracranial hemorrhage than among those with acute cerebral ischemia (119 of 386 [30.8%] vs 75 of 1237 [6.1%], P < .001). Patterns of U-END were prehospital U-END without early recovery in 30 of 965 patients (3.1%), stable prehospital course but early ED deterioration in 49 of 965 patients (5.1%), and continuous deterioration in both prehospital and early ED phases in 27 of 965 patients (2.8%). Ultra-early neurological deterioration was associated with worse 3-month outcomes, including increased global disability (mRS score, 4.6 vs 2.4; P < .001), reduced functional independence (mRS score 0-2, 32 of 200 [16.0%] vs 844 of 1490 [56.6%]; P < .001), and increased mortality (87 of 200 [43.5%] vs 176 of 1490 [11.8%]; P < .001).Ultra-early neurological deterioration occurs in 1 in 8 ambulance-transported patients with acute cerebrovascular disease, including 1 in 3 patients with intracranial hemorrhage and 1 in 16 patients with acute cerebral ischemia, and is associated with markedly reduced functional independence and increased mortality. Averting U-END may be a target for future prehospital therapeutics.ClinicalTrials.gov Identifier: NCT00059332.

    View details for DOI 10.1001/jamaneurol.2018.1893

    View details for Web of Science ID 000449955900009

    View details for PubMedID 30039165

    View details for PubMedCentralID PMC6248118