Mai N. Nguyen-Huynh, MD, MAS

To Walk-In or Not to Walk-In: Understanding Mode of Arrival Choices to the Emergency Department Among Acute Stroke Patients and Their Effects on Stroke Care Processes and Outcomes in Kaiser Permanente Northern and Southern California

Understanding Mode of Arrival Choices to the Emergency Department Among Acute Stroke Patients and Their Effects on Stroke Care Processes and Outcomes
Faster treatment time of stroke is associated with lower mortality and improved 90-day function. However, we have observed slower door-to-needle time for walk-in patients compared to those arriving via ambulance. To enhance patient care, we aim to investigate walk-in stroke patients, their decision factors for not using EMS, and potential delays in their treatment.
Funder: Garfield Memorial Fund

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Investigator: Nguyen-Huynh, Mai

Funder: Garfield Memorial Fund

NIH StrokeNet- NorCal Regional Coordinating Center RCC13

NIH StrokeNet- NorCal Regional Coordinating Center RCC13
The Regional Coordinating Stroke Center (CSC) is designed to maximize efficiencies to develop, promote and conduct high-quality, multi-site clinical trials focused on key interventions in stroke prevention, treatment, and recovery with the objective to have a balanced portfolio between all three approaches. NorCal-CSC will become a resource to any network principal investigator to plan, initiate and complete a clinical trial in the neurosciences. This will be a joint effort between UCSF and selected medical center(s) within Kaiser Permanente. NorCal-CSC will also provide training opportunities to medical students, residents, fellows and faculty within the network to plan and conduct clinical trials.
Funder: National Institute of Neurological Disorders and Stroke

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Investigator: Nguyen-Huynh, Mai

Funder: National Institute of Neurological Disorders and Stroke

Assessing adverse events and clinical outcomes in patients with multiple sclerosis on Rituximab versus biosimilar

In a real-world practice setting of Kaiser Permanente Northern California (KPNC), what are the effects of switching from Rituxan to Truxima as primary therapy for patients with multiple sclerosis (MS). Aims are to determine and compare the rates of adverse events for MS patients in KPNC on Rituxan versus Truxima during the study period and to assess and compare the rates of MS flares for MS patients in KPNC on Rituxan versus Truxima during the study period.

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Investigator: Nguyen-Huynh, Mai

Funder: TPMG Physician Researcher Program

Long-Term Observational Extension of Participants in the CREST-2 Randomized Clinical Trial (C2LOE)

CREST-2 is a multicenter randomized trial of intensive medical management with or without revascularization in patients with asymptomatic high-grade carotid stenosis.This study is a long-term observational extension of participants in the CREST-2 randomized clinical trial (C2LOE) to describe the comparative treatment efficacy over a longer period of expected benefit from revascularization than can be accomplished in the parent trial alone. The study will end
follow-up and report treatment differences when the last patient has been followed for 2 years.

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Investigator: Nguyen-Huynh, Mai

Funder: National Institute of Neurological Disorders and Stroke

Acute Emergency Care and Outcomes for Stroke, Myocardial Infarction, and Surgery During the COVID-19 Pandemic in Kaiser Permanente Northern California: Implications for Care Delivery During COVID-19 Recovery Phase and Future Surges

The decreased trend in patients seeking care for acute stroke, acute MI, and acute surgical presentations during the COVID-19 pandemic is concerning for potential long-term morbidity, mortality, rehabilitation costs, and preventable downstream health care utilization. We aim to assess the effects of the shelter-in-place order on acute stroke, AMI, and surgical care and outcomes and downstream consequences on the health care system.

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Investigator: Nguyen-Huynh, Mai

Funder: Garfield Memorial Fund

Extended Window for Thrombectomy – Have we extended our resources appropriately and effectively

Study will evaluate the performance of the RAPID software interpretation of CT perfusion (CTP) studies and determination of qualifications for endovascular therapy (EST). It will include a retrospective case review of prospectively collected data on consecutive stroke patients seen during the extended window for EST and screened with CTP in 2019 and 2020. It will also determine the rate of EST among those screened for the extended window and the rate of favorable 90-day functional outcome (defined as mRS 0-2) among those treated with EST. It will include a retrospective cohort study of prospectively collected data on consecutive Kaiser Permanente patients screened during the EW by telestroke neurologists in the Stroke EXPRESS program and who underwent EST.

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Investigator: Nguyen-Huynh, Mai

Nor-Cal-CSC for Northern California Regional Coordinating Center

The Northern California Regional Coordinating Stroke Center (NorCal-CSC) is a joint effort between U.C. San Francisco and selected medical center(s) within Kaiser Permanente as part of the National Institute of Neurological Disorders and Stroke (NINDS) Stroke Trials Network. This project has two aims. First, NorCal-CSC will become a resource to any network principal investigator to plan, initiate, and complete a clinical trial in the neurosciences. Second, NorCal-CSC will provide training opportunities to medical students, residents, fellows, and faculty within the network to plan and conduct clinical trials.

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Investigator: Nguyen-Huynh, Mai

Funder: National Institute of Neurological Disorders and Stroke

How Fast is Fast Enough? Assessing Door-to-Needle Times and Outcomes of Stroke Patients Receiving Acute Thrombolysis Therapy Under the Kaiser Permanente Northern California Stroke EXPRESS Program

With stroke treatment, there is a general belief that “time is brain.” However, there has been no published data examining specifically the association between door-to-needle times for acute treatment with intravenous alteplase in stroke patients and 90-day outcomes. In 2016, the Kaiser Permanente Northern California Stroke EXPRESS program rolled out at all 21 primary stroke centers with significant improvement in door-to-needle times. This study has two major aims: 1) to determine if there is an association between door-to-needle times and mortality at discharge and at 90-day post-treatment in patients who receive acute thrombolysis treatment with intravenous alteplase at Kaiser Permanente Northern California, and 2) to determine if there is an association between door-to-needle times and 90-day favorable functional outcome (defined as mRS 0-2) in patients who receive acute thrombolysis treatment with intravenous alteplase at Kaiser Permanente Northern California.

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Investigator: Nguyen-Huynh, Mai

Funder: The Permanente Medical Group

Predicting Readmission After Stroke Study (PRESS)

Hospital readmissions are a tremendous burden on patients, their families, and the health care system. In 2008, the Centers for Medicare and Medicaid Services began publicly reporting hospital-level, risk-standardized, 30-day readmission and mortality rates for acute myocardial infarction and heart failure. Stroke survivors also have high risk of new illness, worsened known diseases, functional decline, and a high death rate. Readmission rates of 20 to 27 percent within one year have been reported. A systematic review of predictors of hospital readmission after stroke yielded no risk-standardized models for comparing hospital readmission performance or predicting readmission risk after stroke. This project aims to create a risk-adjusted predictive model for re-hospitalization after ischemic stroke using retrospectively and prospectively collected patient-level and hospital-level data, and to validate the model retrospectively and prospectively.

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Investigator: Nguyen-Huynh, Mai

Funder: National Institute of Neurological Disorders and Stroke

A Randomized, Double-Blind, Multinational Study to Prevent Major Vascular Events with Ticagrelor Compared to Aspirin in Patients with Acute Ischemic Stroke

The primary objective of the trial is to compare the effect of 90-day treatment with ticagrelor (180 mg [two 90 mg tablets] loading dose on Day 1 followed by 90 mg twice daily maintenance dose for the remainder of the study) vs acetylsalicylic acid (ASA)-aspirin (300 mg [three 100 mg tablets] loading dose on Day 1 followed by 100 mg once daily maintenance dose for the remainder of the study) for the prevention of major vascular events (composite of stroke, myocardial infarction, and death) in patients with acute ischemic stroke or transient ischemic attack.

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Investigator: Nguyen-Huynh, Mai

Funder: AstraZeneca PLC

Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial (CREST-2)

Carotid revascularization for primary prevention of stroke (CREST-2) is two independent multi-center, randomized controlled trials of carotid revascularization and intensive medical management versus medical management alone in patients with asymptomatic high-grade carotid stenosis. One trial will randomize patients in a 1-to-1 ratio to endarterectomy versus no endarterectomy, and another will randomize patients in a 1-to-1 ratio to carotid stenting with embolic protection versus no stenting. Medical management will be uniform for all randomized treatment groups and will be centrally directed. The purpose of this trial is to determine the best way to prevent strokes in people who have a high amount of blockage of their carotid artery but no stroke symptoms related to that blockage.

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Investigator: Nguyen-Huynh, Mai; Avins, Andrew; Chang, Robert

Funder: National Institute of Neurological Disorders and Stroke

NINDS Stroke Trials Network Northern California Regional Coordinating Stroke Center

The primary goal of the NINDS Stroke Trials Network is to maximize efficiencies to develop, promote and conduct high-quality, multi-site clinical trials focused on key interventions in stroke prevention, treatment, and recovery with the objective to have a balanced portfolio between all three approaches. The aims of the Northern California Regional Coordinating Stroke Center are to: 1) Become a resource to any network PI to plan, initiate and complete a clinical trial in the neurosciences. This will be a joint effort between UCSF and selected medical centers within Kaiser Permanente; and 2) Provide training opportunities to medical students, residents, fellows and faculty within the network to plan and conduct clinical trials.

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Investigator: Nguyen-Huynh, Mai

Funder: National Institute of Neurological Disorders and Stroke

Diet quality and cardiovascular disease risk among breast cancer survivors in the Pathways Study

Authors: Ergas, Isaac J;Kushi, Lawrence H;Iribarren, Carlos;Nguyen-Huynh, Mai;Rana, Jamal S;Quesenberry, Charles P;Kwan, Marilyn L;Kwan, Marilyn L;et al.

JNCI Cancer Spectr. 2024 Feb 29;8(2).

PubMed abstract

Adherence to cardiovascular medications and risk of cardiovascular disease in breast cancer patients: A causal inference approach in the Pathways Heart Study

Authors: Kwan, Marilyn L;Iribarren, Carlos;Rana, Jamal S;Nguyen-Huynh, Mai;Kushi, Lawrence H;Neugebauer, Romain;Neugebauer, Romain;et al.

PLoS One. 2024;19(9):e0310531. Epub 2024-09-19.

PubMed abstract

Comparative safety of tenecteplase vs alteplase for acute ischemic stroke

Authors: Flint, Alexander C;Eaton, Abigail;Melles, Ronald B;Hartman, Jonathan;Cullen, Sean P;Chan, Sheila L;Rao, Vivek A;Nguyen-Huynh, Mai N;Kapadia, Brij;Patel, Nihar U;Klingman, Jeffrey G

J Stroke Cerebrovasc Dis. 2024 Jan;33(1):107468. Epub 2023-11-30.

PubMed abstract

Stroke Characteristics and Outcomes in Urban Tanzania: Data from the Prospective Lake Zone Stroke Registry

Authors: Matuja, Sarah Shali;Nguyen, Huynh Mai;Peck, Robert;et al.

Int J Stroke. 2023 Nov 30:17474930231219584.

PubMed abstract

Early Pregnancy Systolic Blood Pressure Patterns Predict Early- and Later-Onset Preeclampsia and Gestational Hypertension Among Ostensibly Low-to-Moderate Risk Groups

Authors: Gunderson, Erica P;Greenberg, Mara;Sun, Baiyang;Goler, Nancy;Go, Alan S;Roberts, James M;Nguyen-Huynh, Mai N;Tao, Wei;Alexeeff, Stacey E

J Am Heart Assoc. 2023 Aug;12(15):e029617. Epub 2023-07-12.

PubMed abstract

Development of cardiometabolic risk factors following endocrine therapy in women with breast cancer

Authors: Rillamas-Sun, Eileen;Kwan, Marilyn L;Cheng, Richard;Neugebauer, Romain;Rana, Jamal S;Hershman, Dawn L;Greenlee, Heather;et al.

Breast Cancer Res Treat. 2023 Aug;201(1):117-126. Epub 2023-06-16.

PubMed abstract

A comparative effectiveness study of carotid intervention for long-term stroke prevention in patients with severe asymptomatic stenosis from a large integrated health system

Authors: Chang, Robert W;Pimentel, Noel;Tucker, Lue-Yen;Rothenberg, Kara A;Avins, Andrew L;Flint, Alexander C;Faruqi, Rishad M;Nguyen-Huynh, Mai N;Neugebauer, Romain

J Vasc Surg. 2023 Jul 04.

PubMed abstract

Development of cardiometabolic risk factors following endocrine therapy in women with breast cancer

Authors: Rillamas-Sun, Eileen; Kwan, Marilyn L; Iribarren, Carlos; Neugebauer, Romain; Rana, Jamal S; Nguyen-Huynh, Mai; Kushi, Lawrence H; Greenlee, Heather; et al.

Res Sq. 2023 Mar 22.

PubMed abstract

Outcome prediction in large vessel occlusion ischemic stroke with or without endovascular stroke treatment: THRIVE-EVT

Authors: Flint, Alexander C; Nguyen-Huynh, Mai N; On Behalf Of The Vista-Endovascular Collaboration,; et al.

Int J Stroke. 2023 Mar;18(3):331-337. Epub 2022-04-29.

PubMed abstract

Reply to M.S. Ewer et al

Authors: Greenlee, Heather; Rillamas-Sun, Eileen; Cheng, Richard; Iribarren, Carlos; Rana, Jamal S; Nguyen-Huynh, Mai; Kushi, Lawrence H; Kwan, Marilyn L

J Clin Oncol. 2022 Dec 10;40(35):4159-4160. Epub 2022-07-25.

PubMed abstract

Ischemic Stroke in Patients With Asymptomatic Severe Carotid Stenosis Without Surgical Intervention-Reply

Authors: Chang, Robert W; Nguyen-Huynh, Mai N; Avins, Andrew L

JAMA. 2022 09 27;328(12):1257.

PubMed abstract

Natural History of Asymptomatic Moderate Carotid Artery Stenosis in a Large Community-Based Cohort

Authors: Gologorsky, Rebecca C; Lancaster, Elizabeth; Tucker, Lue-Yen; Nguyen-Huynh, Mai N; Rothenberg, Kara A; Avins, Andrew L; Kuang, Hui C; Chang, Robert W

Stroke. 2022 Sep;53(9):2838-2846. Epub 2022-06-08.

PubMed abstract

Incidence of Ischemic Stroke in Patients With Asymptomatic Severe Carotid Stenosis Without Surgical Intervention

Authors: Chang, Robert W; Tucker, Lue-Yen; Rothenberg, Kara A; Lancaster, Elizabeth; Faruqi, Rishad M; Kuang, Hui C; Flint, Alexander C; Avins, Andrew L; Nguyen-Huynh, Mai N

JAMA. 2022 05 24;327(20):1974-1982.

PubMed abstract

Risk of Cardiovascular Disease in Women With and Without Breast Cancer: The Pathways Heart Study

Authors: Greenlee, Heather; Rana, Jamal S; Cheng, Richard; Rillamas-Sun, Eileen; Neugebauer, Romain; Kwan, Marilyn L; Kwan, Marilyn L; et al.

J Clin Oncol. 2022 05 20;40(15):1647-1658. Epub 2022-04-06.

PubMed abstract

Risk of Cardiometabolic Risk Factors in Women With and Without a History of Breast Cancer: The Pathways Heart Study

Authors: Kwan, Marilyn L; Iribarren, Carlos; Neugebauer, Romain; Rana, Jamal S; Nguyen-Huynh, Mai; Kushi, Lawrence H; Greenlee, Heather; et al.

J Clin Oncol. 2022 05 20;40(15):1635-1646. Epub 2022-01-13.

PubMed abstract

Effect of Lifestyle Coaching or Enhanced Pharmacotherapy on Blood Pressure Control Among Black Adults With Persistent Uncontrolled Hypertension: A Cluster Randomized Clinical Trial

Authors: Nguyen-Huynh, Mai N; Young, Joseph D; Ovbiagele, Bruce; Alexander, Janet G; Alexeeff, Stacey; Lee, Catherine; Blick, Noelle; Caan, Bette J; Go, Alan S; Sidney, Stephen

JAMA Netw Open. 2022 May 02;5(5):e2212397. Epub 2022-05-02.

PubMed abstract

Early Pregnancy Blood Pressure Patterns Identify Risk of Hypertensive Disorders of Pregnancy Among Racial and Ethnic Groups

Authors: Gunderson, Erica P; Greenberg, Mara; Nguyen-Huynh, Mai N; Tierney, Cassidy; Roberts, James M; Go, Alan S; Tao, Wei; Alexeeff, Stacey E

Hypertension. 2022 03;79(3):599-613. Epub 2021-12-29.

PubMed abstract

Establishing a Carotid Artery Stenosis Disease Cohort for Comparative Effectiveness Research Using Natural Language Processing

Authors: Chang, Robert W; Tucker, Lue-Yen; Rothenberg, Kara A; Lancaster, Elizabeth M; Avins, Andrew L; Kuang, Hui C; Faruqi, Rishad M; Nguyen-Huynh, Mai N

J Vasc Surg. 2021 12;74(6):1937-1947.e3. Epub 2021-06-25.

PubMed abstract

Changes in Patterns of Hospital Visits for Acute Myocardial Infarction or Ischemic Stroke During COVID-19 Surges

Authors: Solomon, Matthew D; Nguyen-Huynh, Mai; Leong, Thomas K; Alexander, Janet; Rana, Jamal S; Klingman, Jeffrey; Go, Alan S

JAMA. 2021 07 06;326(1):82-84.

PubMed abstract

Potential accuracy of prehospital NIHSS-based triage for selection of candidates for acute endovascular stroke therapy

Authors: Klingman, Jeffrey G; Alexander, Janet G; Vinson, David R; Klingman, Lauren E; Nguyen-Huynh, Mai N

J Am Coll Emerg Physicians Open. 2021 Jun;2(3):e12441. Epub 2021-05-01.

PubMed abstract

Blood Pressure Levels in Young Adulthood and Midlife Stroke Incidence in a Diverse Cohort

Authors: Gerber, Yariv; Rana, Jamal S; Nguyen-Huynh, Mai N; Sidney, Stephen; et al.

Hypertension. 2021 05 05;77(5):1683-1693. Epub 2021-03-29.

PubMed abstract

Long-term Stroke Risk with Carotid Endarterectomy in Patients with Severe Carotid Stenosis

Authors: Rothenberg KA; Tucker LY; Gologorsky RC; Avins AL; Kuang HC; Faruqi RM; Flint AC; Nguyen-Huynh MN; Chang RW

J Vasc Surg. 2021 03;73(3):983-991. Epub 2020-07-21.

PubMed abstract

Response by Flint et al to Letter Regarding Article, “Risk of Distal Embolization From tPA (Tissue-Type Plasminogen Activator) Administration Prior to Endovascular Stroke Treatment”

Authors: Flint AC; Avins AL; Nguyen-Huynh MN

Stroke. 2021 Jan;52(1):e39-e40. Epub 2020-12-28.

PubMed abstract

Validation Study of Kaiser Permanente Bedside Dysphagia Screening Tool in Acute Stroke Patients

Authors: Finnegan, Barbara Schumacher; Meighan, Melissa M; Warren, Noelani C; Hatfield, Meghan K; Alexeeff, Stacey; Lipiz, Jorge; Nguyen-Huynh, Mai

Perm J. 2020 12;24:1.

PubMed abstract

Interventions Targeting Racial/Ethnic Disparities in Stroke Prevention and Treatment

Authors: Levine, Deborah A; Duncan, Pamela W; Nguyen-Huynh, Mai N; Ogedegbe, Olugbenga G

Stroke. 2020 11;51(11):3425-3432. Epub 2020-10-26.

PubMed abstract

Acute Stroke Presentation, Care, and Outcomes in Community Hospitals in Northern California During the COVID-19 Pandemic

Authors: Nguyen-Huynh, Mai N; Tang, Xian Nan; Vinson, David R; Flint, Alexander C; Alexander, Janet G; Meighan, Melissa; Burnett, Molly; Sidney, Stephen; Klingman, Jeffrey G

Stroke. 2020 10;51(10):2918-2924. Epub 2020-08-07.

PubMed abstract

Risk of Distal Embolization From tPA (Tissue-Type Plasminogen Activator) Administration Prior to Endovascular Stroke Treatment

Authors: Flint, Alexander C; Avins, Andrew L; Nguyen-Huynh, Mai N; et al.

Stroke. 2020 09;51(9):2697-2704. Epub 2020-08-06.

PubMed abstract

Development of an algorithm to detect methotrexate wrong frequency error using computerized health care data

Authors: Herrinton LJ; Woodworth TS; Eworuke E; Amsden LB; Liu L; Wyeth J; Petrone A; Menzin TJ; Williams J; Goldfien R; Nguyen M

Pharmacoepidemiol Drug Saf. 2019 10;28(10):1361-1368. Epub 2019-08-13.

PubMed abstract

Shake Rattle & Roll – Design and rationale for a pragmatic trial to improve blood pressure control among blacks with persistent hypertension

Authors: Nguyen-Huynh MN; Young JD; Alexeeff S; Hatfield MK; Sidney S

Contemp Clin Trials. 2019 01;76:85-92. Epub 2018-11-28.

PubMed abstract

Comparative Trends in Heart Disease, Stroke, and All-Cause Mortality in the United States and a Large Integrated Healthcare Delivery System

Authors: Sidney S; Sorel ME; Quesenberry CP; Jaffe MG; Solomon MD; Nguyen-Huynh MN; Go AS; Rana JS

Am J Med. 2018 07;131(7):829-836.e1. Epub 2018-04-02.

PubMed abstract

Novel Telestroke Program Improves Thrombolysis for Acute Stroke Across 21 Hospitals of an Integrated Healthcare System

Authors: Nguyen-Huynh MN; Klingman JG; Avins AL; Rao VA; Eaton A; Bhopale S; Kim AC; Morehouse JW; Flint AC; KPNC Stroke FORCE Team

Stroke. 2018 Jan;49(1):133-139. Epub 2017-12-15.

PubMed abstract

Race-ethnicity on blood pressure control after ischemic stroke: a prospective cohort study

Authors: Nguyen-Huynh MN; Hills NK; Sidney S; Klingman JG; Johnston SC

J Am Soc Hypertens. 2017 Jan;11(1):38-44. Epub 2016-11-17.

PubMed abstract

Recent Trends in Cardiovascular Mortality in the United States and Public Health Goals

Authors: Sidney S; Quesenberry CP; Jaffe MG; Sorel M; Nguyen-Huynh MN; Kushi LH; Go AS; Rana JS

JAMA Cardiol. 2016 08 01;1(5):594-9.

PubMed abstract

Clopidogrel with aspirin in acute minor stroke or transient ischemic attack

Authors: Wang Y; Zhao X; CHANCE Investigators; et al.

N Engl J Med. 2013 Jul 4;369(1):11-9. Epub 2013-06-26.

PubMed abstract

Inpatient statin use predicts improved ischemic stroke discharge disposition

Authors: Flint AC; Nguyen-Huynh M; Johnston SC; et al.

Neurology. 2012 May 22;78(21):1678-83.

PubMed abstract

Validation of the Stroke Prognostic Instrument-II in a Large, Modern, Community-Based Cohort of Ischemic Stroke Survivors

Authors: Navi BB; Kamel H; Sidney S; Klingman JG; Nguyen-Huynh MN; Johnston SC

Stroke. 2011 Dec;42(12):3392-6. Epub 2011 Sep 29.

PubMed abstract

How accurate is CT angiography in evaluating intracranial atherosclerotic disease?

Authors: Nguyen-Huynh MN1; Wintermark M; English J; Lam J; Vittinghoff E; Smith WS; Johnston SC;

​Stroke. 2008 Apr;39(4):1184-8. doi: 10.1161/STROKEAHA.107.502906. Epub 2008 Feb 21.

PubMed abstract

Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack

Authors: Johnston SC; Rothwell PM; Nguyen-Huynh MN; Giles MF; Elkins JS; Bernstein AL; Sidney S

Lancet. 2007 Jan 27;369(9558):283-92.

PubMed abstract

National Stroke Association guidelines for the management of transient ischemic attacks

Authors: Johnston SC1; Nguyen-Huynh MN; Schwarz ME; Fuller K; Williams CE; Josephson SA; Hankey GJ; Hart RG; Levine SR; Biller J; Brown RD Jr; Sacco RL; Kappelle LJ; Koudstaal PJ; Bogousslavsky J; Caplan LR; van Gijn J; Algra A; Rothwell PM; Adams HP; Albers GW;

Ann Neurol. 2006 Sep;60(3):301-13.

PubMed abstract