Thomas Ford, MD

Father, husband, music fanatic, vascular neurologist at @umassneurology, and assistant professor at @UmassChan. Former fellow/resident at @bmcneurology.

[Thomas Ford, MD @DrThomasFord]

With that said, I’m proud to be joining @umassneurology as a vascular neurologist and an assistant professor at @UMassChan! Another example of life going full-circle as I hope to share the joy of treating neurological diseases with students at the place where my journey started.

[Thanh Nguyen 🇺🇦 @NguyenThanhMD]

@bmcneurology reunion! @AbdalkaderMD @PiersKlein @AnuragSahoo91 @DrThomasFord Madhav @ShuLiqi @adnan_mujanovic Willow

[Thomas Ford, MD @DrThomasFord]

@almuftifawaz Thank you for the great Grand Rounds talk today and taking the time to answer my question! I appreciate your advocacy for pregnant and developmentally disabled patients (and always love finding fellow skeptics when it comes to using perfusion to exclude from EVT).

[Thomas Ford, MD @DrThomasFord]

@LesterLeung One thing I’ve been wondering, Lester, is whether a PFO small enough to not be found on TEE will have the same secondary prevention benefit in closure as one found on less sensitive testing. Good to know if it’s there, but less clear whether closure is as effective here.

[Thomas Ford, MD @DrThomasFord]

@MatthewHoMD is the driver of the elevated BP, and dropping it acutely risks worsening perfusion to ischemic tissue. CATIS in 2014 did not see an outcome benefit from acute lowering in the first 24 hours: https://t.co/yHS6xzQ6Af (2/2)

[Thomas Ford, MD @DrThomasFord]

@MatthewHoMD I think I've found the paper your figure is from: https://t.co/HwFKfBNzYi

I think this paper misses the mark completely as far as the cause-and-effect relationship of severely elevated BP and acute ischemic stroke, where autoregulation in the setting of thrombosis (1/2)

[Thomas Ford, MD @DrThomasFord]

@MicieliA_MD WAKE-UP and EXTEND had me very excited about wake-up thrombolysis years ago, but TIMELESS and CHABLIS-T II have me concerned about the lack of consistent benefit in trials with tenecteplase. Hard to recommend DAPT without knowing the NIH Stroke Scale. 🤷‍♂️

[Thomas Ford, MD @DrThomasFord]

@MicieliA_MD @maramd @NEJM It’s hard to imagine IR turning down an ICA or M1 occlusion with such favorable perfusion imaging (unless there’s some sort of technical reason they legitimately can’t get to the occlusion) 🤷‍♂️

[Thomas Ford, MD @DrThomasFord]

@MicieliA_MD Also a reminder that just because large-scale clinical trials ignore pregnant women doesn’t mean that we should! Great case and great outcome.

[Thomas Ford, MD @DrThomasFord]

@NguyenThanhMD Thanks for the reply, Thanh! That makes sense. This certainly isn’t the biggest gap I’ve seen (I remember some studies that had 70%+ men at ISC), although it hurts the generalizability a bit.

[Thomas Ford, MD @DrThomasFord]

Few thoughts on this paper:

1. Seeing large stroke trials that are still unable to find a better balance of men and women (65%/35% here) in 2024 is discouraging. We need to do better for the women we care for in assuring equal representation in therapeutic trials.

[JAMA Neurology @JAMANeuro]

Study findings suggest that dual antiplatelet therapy, compared with aspirin alone, may be a superior treatment option for patients with acute mild to moderate ischemic stroke. https://t.co/JHwobvYXeW

[Thomas Ford, MD @DrThomasFord]

In all, does this study move the needle for me in terms of my practice? Not sure.

The numerical trend toward better functional outcomes (mRS 0-1 and mRS distribution at 90 days) is promising, but I'd like to see these results replicated in a more heterogeneous cohort first.

[Thomas Ford, MD @DrThomasFord]

4. The safety profile of DAPT in this study was excellent, which is great news for our comfort in using DAPT for a higher NIHSS range than seen in POINT/CHANCE. With THALES including NIHSS 0-5 and most of this study's patients being 0-6, it seems we can be a bit more inclusive.

[NeuroNews @NN_publishing]

The #ISC24 meeting hosted discussions on the state of play in #Carotid stenosis treatment—including advances that may erode the dominance of established revascularisation procedures in the USA
@LBGoldsteinMD @ChaturvediNeuro @CaitlinWHicks @DrThomasFord
https://t.co/b0n74NGNZ0

[Thomas Ford, MD @DrThomasFord]

@MicieliA_MD I even slap the applicable diagram and a reference at the end of my note so the proceduralist has a clear sense of what I want (and probably eases some medicolegal anxiety by having someone else decide).

[Thomas Ford, MD @DrThomasFord]

@MicieliA_MD I really like this regimen from the PAUSE trial that basically says patients undergoing low-risk procedures can hold the day before / day of, then restart the next day. High-risk procedures add one additional day per-procedure and one day post-procedure. https://t.co/Fb4qx1F6Sp

[Thomas Ford, MD @DrThomasFord]

With this trial, along with TIMELESS’s finding of no difference in functional outcomes with use of DWI/FLAIR mismatch, does this effectively kill the idea of wake-up thrombolysis with TNK? #ISC24 @StrokeAHA_ASA

[Thomas Ford, MD @DrThomasFord]

CHABLIS-T II, a randomized, controlled trial of Tenecteplase beyond 4.5 hours of last known well for patients with favorable perfusion imaging and identified large vessel occlusion, showed benefit in radiographic reperfusion outcomes without improved functional outcomes.