About

Hermelinda G. Abcede is an Associate Clinical Professor of Neurology at the University of California, Irvine School of Medicine. She holds a B.S. in Neuroscience from the University of California, Los Angeles, obtained in 2001, and an M.D. from the Medical College of Wisconsin, earned in 2006. Her research interests include acute stroke management and stroke in women. Dr. Abcede has been recognized for her teaching excellence with awards such as the UC Irvine School of Medicine Excellence in Teaching Award in 2012 and the UC Irvine Department of Neurology Faculty Teaching Award in 2012 and 2015. She has also been acknowledged as a Super Doctors Southern California Rising Star in 2013, 2014, and 2015. Her professional experience includes serving as a Neurohospitalist at SAGE NeuroHospitalist Management Group from 2015 to 2016. She is involved in graduate programs related to neurology, specifically vascular neurology.

Research topics

• Cardiology
• Medicine
• Internal medicine
• Engineering
• Psychiatry
• Pathology
• Surgery
• Emergency medicine
• Anesthesia

Selected publications

• Rescue therapy after thrombectomy for large vessel occlusion due to underlying atherosclerosis: review of literature

  Frontiers in Neurology · 2023-06-16 · 4 citations

  reviewOpen access

  In this review article, we summarized the current advances in rescue management for reperfusion therapy of acute ischemic stroke from large vessel occlusion due to underlying intracranial atherosclerotic stenosis (ICAS). It is estimated that 24–47% of patients with acute vertebrobasilar artery occlusion have underlying ICAS and superimposed in situ thrombosis. These patients have been found to have longer procedure times, lower recanalization rates, higher rates of reocclusion and lower rates of favorable outcomes than patients with embolic occlusion. Here, we discuss the most recent literature regarding the use of glycoprotein IIb/IIIa inhibitors, angioplasty alone, or angioplasty with stenting for rescue therapy in the setting of failed recanalization or instant/imminent reocclusion during thrombectomy. We also present a case of rescue therapy post intravenous tPA and thrombectomy with intra-arterial tirofiban and balloon angioplasty followed by oral dual antiplatelet therapy in a patient with dominant vertebral artery occlusion due to ICAS. Based on the available literature data, we conclude that glycoprotein IIb/IIIa is a reasonably safe and effective rescue therapy for patients who have had a failed thrombectomy or have residual severe intracranial stenosis. Balloon angioplasty and/or stenting may be helpful as a rescue treatment for patients who have had a failed thrombectomy or are at risk of reocclusion. The effectiveness of immediate stenting for residual stenosis after successful thrombectomy is still uncertain. Rescue therapy does not appear to increase the risk of sICH. Randomized controlled trials are warranted to prove the efficacy of rescue therapy.

  PublisherOA PDFDOI

• Correction to: Comparative Studies of Cerebral Reperfusion Injury in the Posterior and Anterior Circulations After Mechanical Thrombectomy

  Translational Stroke Research · 2022-02-17 · 2 citations

  erratumOpen access
  PublisherOA PDFDOI

• Possible synergism of tissue plasminogen activator and neurocysticercosis leading to intracranial hemorrhage

  Brain Hemorrhages · 2022-04-08

  articleOpen access

  Neurocysticercosis (NCC) remains the most common helminth infection of the human central nervous system worldwide. Patients with NCC are especially predisposed to cerebrovascular events such as acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage due to an immune-mediated process in which infiltration of inflammatory cells into blood vessel walls leads to endothelial hyperplasia and endarteritis, known as cysticercotic angiitis. Additionally, the oncosphere of the parasite causing NCC produces T. solium enolase, an enzyme which binds and activates human plasminogen receptor proteins to plasmin, leading to a hypercoagulable state. Currently, NCC is not a contraindication to administration of tissue plasminogen activator (tPA) for a suspected AIS. However, to our knowledge, it has not been assessed whether the presence of NCC increases the likelihood of hemorrhagic conversion of an AIS after tPA administration. We present the case of an 83-year-old lady with NCC who developed multifocal right-sided ICH involving the temporal, parietal, and frontal lobes six and a half hours after tPA administration for a suspected AIS. Given this event and the cellular mechanisms provided, we recommend a safety surveillance study to further determine the potential risks of hemorrhagic conversion in this population.

  PublisherDOI

• Comparative Studies of Cerebral Reperfusion Injury in the Posterior and Anterior Circulations After Mechanical Thrombectomy

  Translational Stroke Research · 2022 · 17 citations

  • Medicine
  • Anesthesia
  • Internal medicine

  Cerebral reperfusion injury is the major complication of mechanical thrombectomy (MT) for acute ischemic stroke (AIS). Contrast extravasation (CE) and intracranial hemorrhage (ICH) are the key radiographical features of cerebral reperfusion injury. The aim of this study was to investigate CE and ICH after MT in the anterior and posterior circulation, and their effect on functional outcome. This is a retrospective study of all consecutive patients who were treated with MT for AIS at University of California Irvine Medical Center between January 1, 2014, and December 31, 2017. Patient characteristics, clinical features, procedural variables, contrast extravasation, ICH, and outcomes after MT were analyzed. A total of 131 patients with anterior circulation (AC) stroke and 25 patients with posterior circulation (PC) stroke underwent MT during the study period. There was no statistically significant difference in admission NIHSS score, blood pressure, rate of receiving intravenous tPA, procedural variables, contrast extravasation, and symptomatic ICH between the 2 groups. Patients with PC stroke had a similar rate of favorable outcome (mRS 0-2) but significantly higher mortality (40.0% vs. 10.7%, p < 0.01) than patients with AC stroke. Multivariate regression analysis identified initial NIHSS score (OR 1.1, CI 1.0-1.2, p = 0.01), number of passes with stent retriever (OR 2.1, CI 1.3-3.6, p < 0.01), and PC stroke (OR 9.3, CI 2.5-35.1, p < 0.01) as independent risk factors for death. There was no significant difference in functional outcomes between patients with and without evidence of cerebral reperfusion injury after MT. We demonstrated that AC and PC stroke had similar rates of cerebral reperfusion injury and favorable outcome after MT. Cerebral reperfusion injury is not a significant independent risk factor for poor functional outcome.

  PublisherOA PDFDOI

• Methamphetamine use is associated with severe cerebral small vessel disease in patients with acute ischemic stroke (1853)

  Neurology · 2021

  • Medicine
  • Cardiology
  • Internal medicine

  Our study aimed to investigate the role of methamphetamine use in the development of CSVD.

  PublisherDOI

• Case of Scattered Ischemic Stroke Secondary to Large Internal Carotid Thrombus in Setting of COVID infection (5129)

  Neurology · 2021-04-13

  articleSenior author

  NA

  PublisherDOI

• Vanishing Beauty: A Case of a 59-Year-Old Woman with Iatrogenic Central Retinal Artery Occlusion After Cosmetic Facial Augmentation with Filler Injections (2694)

  Neurology · 2020-04-14

  articleSenior author

  To bring awareness to the newly emerging etiology of iatrogenic central retinal artery occlusion (CRAO) as a consequence of cosmetic dermal filler injections.

  PublisherDOI

• Ongoing Quality Improvement for Acute Ischemic Stroke at Comprehensive Stroke Center (4045)

  Neurology · 2020-04-14

  article

  To examine the progressive quality benchmarks for acute ischemic stroke (AIS) at an academic comprehensive stroke center (CSC).

  PublisherDOI

• Optimized Hemodynamic Assessment to Predict Stroke Risk in Vertebrobasilar Disease: Analysis From the VERiTAS Study

  Journal of the American Heart Association · 2020 · 16 citations

  • Medicine
  • Internal medicine
  • Cardiology

  Background Atherosclerotic vertebrobasilar disease is a significant etiology of posterior circulation stroke. The prospective observational VERiTAS (Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke) study demonstrated that distal hemodynamic status is a robust predictor of subsequent vertebrobasilar stroke risk. We sought to compare predictive models using thresholds for posterior circulation vessel flows standardized to age and vascular anatomy to optimize risk prediction. Methods and Results VERiTAS enrolled patients with recent vertebrobasilar transient ischemic attack or stroke and ≥50% atherosclerotic stenosis/occlusion in vertebral and/or basilar arteries. Quantitative magnetic resonance angiography measured large-vessel vertebrobasilar territory flow, and patients were designated as low or normal flow based on a prespecified empiric algorithm considering distal territory regional flow and collateral capacity. For the present study, post hoc analysis was performed to generate additional predictive models using age-specific normalized flow measurements. Sensitivity, specificity, and time-to-event analyses were compared between the algorithms. The original prespecified algorithm had 50% sensitivity and 79% specificity for future stroke risk prediction; using a predictive model based on age-normalized flows in the basilar and posterior cerebral arteries, standardized to vascular anatomy, optimized flow status thresholds were identified. The optimized algorithm maintained sensitivity and increased specificity to 84%, while demonstrating a larger and more significant hazard ratio for stroke on time-to-event analysis. Conclusions These results indicate that flow remains a strong predictor of stroke across different predictive models, and suggest that prediction of future stroke risk can be optimized by use of vascular anatomy and age-specific normalized flows.

  PublisherOA PDFDOI

• Abstract TP253: Ongoing Quality Improvement for Acute Ischemic Stroke at Comprehensive Stroke Center

  Stroke · 2020-02-01

  article

  Background: Ongoing quality improvement is essential for better outcomes and healthcare cost control. The aim of this study is to examine the progressive quality benchmarks for acute ischemic stroke (AIS) at an academic comprehensive stroke center (CSC). Methods: We retrospectively analyzed consecutive patients with AIS at University of California Irvine Medical Center from Jan 1 st , 2013 to Dec 31 th , 2018.Demographics and clinical data were collected from the Get-With-The-Guideline (GWTG) -Stroke registry and electronic medical records. Patients were stratified into 3 time periods according to their admission dates: 2013 to 2014; 2015 to 2016; and 2017 to 2018. Quality benchmarks for AIS, including door-to-needle (DTN) times, rates of receiving IV tPA and/or endovascular thrombectomy (EVT), rate of symptomatic intracerebral hemorrhage (sICH), and outcomes at hospital discharge were analyzed to identify trends of quality improvement in the last 6 years. Results: A total of 1369 patients were included in the study; 398 (29%) patients received acute reperfusion therapy, with 231 (17%) receiving IV tPA, 97 (7%) receiving both IV tPA and EVT, 70 (5%) receiving EVT only. There was no significant difference in baseline characteristics of the patients during the 3 time periods. IV tPA rates were 20% in 2013-2014, 30% in 2015-2016, and 22% in 2017-2018 ( p =0.0005). The EVT rates in 2017-2018 (15% vs. 9%; OR: 1.77; 95% CI: 1.16 - 2.68; p = 0.008) and 2015-2016 (14% vs. 9%; OR: 1.70; 95% CI: 1.11 - 2.59; p = 0.01) were significantly higher than in 2013-2014. There were significant ongoing improvements in median DTN times, with 57 minutes in 2013-2014, 45 minutes in 2015-2016, and 39 minutes in 2017-2018. Among patients receiving IV tPA, significantly more patients had favorable outcomes (mRS score 0-3) at hospital discharge in 2015-2016 (67% vs. 42%; OR: 2.80; 95% CI: 1.46 - 5.40; p =0.002) than in 2013-2014. Conclusions: We demonstrate ongoing improvement in rates of IV tPA and EVT as well as DTN times for IV tPA in patients with AIS.

  PublisherDOI

Frequent coauthors

• David S. Liebeskind

  17 shared

• Wengui Yu

  University of California, Irvine

  16 shared

• Scott E. Kasner

  Hospital of the University of Pennsylvania

  16 shared

• Keith R. Thulborn

  University of Illinois Chicago

  14 shared

• DeJuran Richardson

  14 shared

• Xinjian Du

  13 shared

• Philip B. Gorelick

  13 shared

• Dilip K. Pandey

  Okinawa Institute of Science and Technology Graduate University

  13 shared

Awards & honors

• UC Irvine School of Medicine Excellence in Teaching Award 20…
• UC Irvine Department of Neurology Faculty Teaching Award 201…
• Super Doctors Southern California Rising Stars 2013, 2014, 2…