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Gao Y, Liu B, Yang H, Wang G, Huang J, Li C, Zhao P, Yang L, Yang Z. Comparison of Transradial Access and Transfemoral Access for Diagnostic Cerebral Angiography in the Elderly Population. World Neurosurg 2024; 181:e411-e421. [PMID: 37858864 DOI: 10.1016/j.wneu.2023.10.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE Evaluate the efficacy, safety, and patient satisfaction of transradial access (TRA) compared with conventional transfemoral access (TFA) for diagnostic cerebral angiography in elderly patients (≥65 years of age). METHODS We performed a retrospective review of patients receiving cerebral angiography via TRA or TFA between October 2020 and December 2021 at 3 institutions. Basic patient characteristics, angiographic data, postoperative complications, and patient satisfaction were collected for analysis. RESULTS Of the 357 enrolled elderly patients, 175 were performed through TRA and 182 were performed through TFA. There was no significant difference in mean fluoroscopy time (8.6 ± 3.8 minutes vs. 9.1 ± 3.1 minutes; P = 0.103) and radiation exposure (47.7 ± 10.8 Gy-cm2 vs. 49.8 ± 11.3 Gy-cm2; P = 0.068) between the TRA and TFA groups. However, the TRA group had a shorter procedural time (54.7 ± 6.2 minutes vs. 61.1 ± 5.6 minutes; P < 0.001) and less contrast agent (83.2 ± 28.1 mL vs. 100.1 ± 26.2 mL; P < 0.001) than the TFA group. In terms of safety, the incidence of minor vascular access complications in the TRA group was lower than that in the TFA group (1.7% vs. 8.8%; P = 0.003). The incidence of serious complications and neurologic complications in the TRA group was also lower, although the difference was not statistically significant. Overall patient satisfaction was higher in the TRA group than that in the TFA group. CONCLUSIONS TRA was an efficient and safe alternative to conventional TFA in elderly patients who underwent diagnostic cerebral angiography and who underwent TRA were more satisfied. Findings supported the radial-first strategy for cerebral angiography in elderly populations.
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Affiliation(s)
- Yang Gao
- Department of Neurosurgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Bin Liu
- Department of Neurology, Minhang Central Hospital, Shanghai, China; Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hantao Yang
- Department of Neurosurgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Guiping Wang
- Department of Neurology, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Jinlong Huang
- Department of Neurosurgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Chen Li
- Department of Neurosurgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Puyuan Zhao
- Department of Neurosurgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Liangliang Yang
- Department of Neurosurgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Zhigang Yang
- Department of Neurosurgery, Zhongshan Hospital Fudan University, Shanghai, China; Department of Neurosurgery, National Clinical Research Center for Interventional Medicine of China, Shanghai, China.
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2
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Bram R, Atwal G. Transradial flow diversion with an aberrant right subclavian artery. J Neurointerv Surg 2023; 15:1164. [PMID: 36958827 DOI: 10.1136/jnis-2023-020182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/16/2023] [Indexed: 03/25/2023]
Abstract
Transradial access for diagnostic and therapeutic neurointerventional procedures has gained popularity due to a decreased incidence of access site complications and improved patient comfort compared with transfemoral access.1-4 An aberrant right subclavian artery is an aortic arch variant characterized by a right subclavian artery that arises directly from the arch as the most distal great vessel. Transradial access with an aberrant right subclavian artery is anatomically challenging due to the predilection of the catheter system to collapse into the descending aorta. In this (video 1), we describe a step-by-step technique for transradial access in a patient with an aberrant right subclavian artery undergoing endovascular flow diversion for a left superior hypophyseal artery aneurysm. Particular emphasis is placed on the technique for accessing the proximal arch and aortic valve as well as distal catheter navigation while avoiding prolapse into the descending aorta. neurintsurg;15/11/1164/V1F1V1Video 1 .
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Affiliation(s)
- Richard Bram
- Neurosurgery, University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Gursant Atwal
- Neurosurgery, University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
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Findlay MC, Baker CM, Childs S, Gautam D, Salah WK, Bounajem M, Joyce E, Budohoski KP, Kilburg C, Alexander MD, Taussky P, Grandhi R. Analysis of treatment cost differences in patients undergoing femoral versus radial access in outpatient diagnostic cerebral arteriograms. Interv Neuroradiol 2023:15910199231207408. [PMID: 37817545 DOI: 10.1177/15910199231207408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Outpatient diagnostic cerebral arteriograms are the most common procedure in neuroendovascular surgery, and the use of transradial access for these studies is growing. Although transradial access has been associated with lower hospital costs for elective diagnostic and interventional neuroendovascular procedures, no study has compared transfemoral access and transradial access costs for a homogenous population of patients undergoing outpatient diagnostic cerebral arteriogram. METHODS In this single-center retrospective study, the Value Driven Outcomes database was used to evaluate treatment costs for patients who underwent outpatient diagnostic cerebral arteriogram from January 2019 to December 2022. Propensity-score matching was performed to reduce confounders. Costs from each encounter were subcategorized into imaging, supplies, pharmacy, procedures, labs, and facility costs. RESULTS After matching, 337 patients each for transradial access and transfemoral access were available for analysis. A total of 118,992 cost data points were associated with all encounters. Overall, per-visit costs were 15.2% cheaper for patients who underwent transradial access versus transfemoral access (p < 0.001). Most of the cost difference was due to supplies (35.2% cost difference, p < 0.001) and procedure costs (9.3% cost difference, p < 0.001). No statistical differences were observed between the two approaches in imaging, pharmacy, labs, and facility costs (all p > 0.05). CONCLUSIONS Costs for outpatient diagnostic cerebral arteriogram were lower in patients who underwent transradial access versus transfemoral access because of supply and procedure costs. Understanding reasons for cost differences in common procedures is important for creating strategies to reduce overall healthcare costs. Additionally, addressing the cost differences of newer techniques may increase the likelihood that they are more readily implemented by hospitals and providers.
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Affiliation(s)
| | - Cordell M Baker
- Department of Neurosurgery, Clinical Neuroscience Center, University of Utah, Salt Lake City, UT, USA
| | - Sarah Childs
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Diwas Gautam
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Walid K Salah
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Michael Bounajem
- Department of Neurosurgery, Clinical Neuroscience Center, University of Utah, Salt Lake City, UT, USA
| | - Evan Joyce
- Department of Neurosurgery, Clinical Neuroscience Center, University of Utah, Salt Lake City, UT, USA
| | - Karol P Budohoski
- Department of Neurosurgery, Clinical Neuroscience Center, University of Utah, Salt Lake City, UT, USA
| | - Craig Kilburg
- Department of Neurosurgery, Clinical Neuroscience Center, University of Utah, Salt Lake City, UT, USA
| | - Matthew D Alexander
- Department of Neurosurgery, Clinical Neuroscience Center, University of Utah, Salt Lake City, UT, USA
- Department of Radiology and Imaging Sciences, Salt Lake City, UT, USA
| | - Phillip Taussky
- Department of Neurosurgery, Clinical Neuroscience Center, University of Utah, Salt Lake City, UT, USA
| | - Ramesh Grandhi
- Department of Neurosurgery, Clinical Neuroscience Center, University of Utah, Salt Lake City, UT, USA
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Catapano JS, Winkler EA, Srinivasan VM, Dishion EL, Rutledge C, Baranoski JF, Cole TS, Rudy RF, Rumalla K, Zomaya MP, Jadhav AP, Ducruet AF, Albuquerque FC. Retained radial catheters associated with variant radial anatomy in neurointerventional procedures. J Neurointerv Surg 2023; 15:858-863. [PMID: 36190952 DOI: 10.1136/jnis-2022-019004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/15/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Transradial artery access (TRA) for neurointerventional procedures is gaining widespread acceptance. However, complications that were previously rare may arise as TRA procedures increase. Here we report a series of retained catheter cases with a literature review. METHODS All patients who underwent a neurointerventional procedure during a 23-month period at a single institution were retrospectively reviewed for a retained catheter in TRA cases. In cases of retained catheters, imaging was reviewed for anatomical variances in the radial artery, and clinical and demographic case details were analyzed. RESULTS A total of 1386 nondiagnostic neurointerventional procedures were performed during the study period, 631 (46%) initially via TRA. The 631 TRA cases were performed for aneurysm embolization (n=221, 35%), mechanical thrombectomy (n=116, 18%), carotid stent/angioplasty (n=40, 6%), arteriovenous malformation embolization (n=38, 6%), and other reasons (n=216, 34%). Thirty-nine (6%) TRA procedures crossed over to femoral access, most commonly because the artery of interest could not be catheterized (26/39, 67%). A retained catheter was identified in five cases (1%), and one (0.2%) patient had an entrapped catheter that was recovered. All six patients with a retained or entrapped catheter had aberrant radial anatomy. CONCLUSION Retained catheters for neurointerventional procedures performed via TRA are rare. However, this complication may be associated with variant radial anatomy. With the increased use of TRA for neurointerventional procedures, awareness of anatomical abnormalities that may lead to a retained catheter is necessary. We propose a simple protocol to avoid catheter entrapment, including in emergent situations such as TRA for stroke thrombectomy.
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Affiliation(s)
- Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Ethan A Winkler
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Evan L Dishion
- Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Caleb Rutledge
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Jacob F Baranoski
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Tyler S Cole
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Robert F Rudy
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Kavelin Rumalla
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Martin P Zomaya
- The University of Arizona College of Medicine Phoenix, Phoenix, Arizona, USA
| | - Ashutosh P Jadhav
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
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5
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Fuga M, Tanaka T, Tachi R, Tomoto K, Okawa S, Teshigawara A, Ishibashi T, Hasegawa Y, Murayama Y. Therapeutic efficacy and complications of radial versus femoral access in endovascular treatment of unruptured intracranial aneurysms. Neuroradiol J 2023; 36:442-452. [PMID: 36564905 PMCID: PMC10588597 DOI: 10.1177/19714009221147230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The transradial approach (TRA) in neuroendovascular treatment is known to have a lower risk of complications than the transfemoral approach (TFA). However, little research has focused on assessments of efficacy and risk of complications in the treatment of intracranial aneurysms. This study aimed to compare the efficacy and complications of TRA and TFA in coil embolization of unruptured intracranial aneurysms (UIAs) at our institution. METHODS Consecutive patients who underwent endovascular surgery via TRA or TFA at a single institution from 1 April 2019, to 28 February 2022, were retrospectively analyzed. Patients were classified into TRA and TFA groups and assessed using propensity-adjusted analysis for outcomes including fluoroscopy time, volume embolization ratio (VER), and complications. RESULTS A total of 163 consecutive UIAs were treated with coil embolization during the 35-months study period. The incidence of minor access site complications (ASCs) was significantly higher with TFA (20%, 25/126) than with TRA (2.7%, 1/37; p = 0.01). Propensity-adjusted analysis (matched for age, sex, aneurysm volume, embolization technique, and sheath size) revealed that TRA was associated with a lower risk of minor ASCs (odds ratio, 0.085; 95% confidence interval 0.0094-0.78; p = 0.029). However, TRA did not differ significantly from TFA with respect to fluoroscopy time, VER, major ASCs, and non-ASCs. CONCLUSIONS Coil embolization for UIAs via TRA can reduce risk of minor ASCs without increasing the risk of non-ASCs compared with conventional TFA, and can achieve comparable results in term of efficacy and fluoroscopy time.
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Affiliation(s)
- Michiyasu Fuga
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Toshihide Tanaka
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Rintaro Tachi
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Kyoichi Tomoto
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Shun Okawa
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Akihiko Teshigawara
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Toshihiro Ishibashi
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Yuzuru Hasegawa
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
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6
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Coulibaly NJO, Ernst GL, Shallwani H, Hawkins B, Baber U, Shakir HJ. Novel usage of everolimus-eluting coronary stent for intracranial atherosclerotic disease: a technical report and case series. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2023; 5:e000171. [PMID: 37564132 PMCID: PMC10410926 DOI: 10.1136/bmjsit-2022-000171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 04/25/2023] [Indexed: 08/12/2023] Open
Abstract
Objectives This report describes the use of an Everolimus-eluting stent (Xience Skypoint stent) for the treatment of medically-refractory ICAD. Design Retrospective, case-series. Setting In-hospital patients. Participants All patients in this report had a history of stroke secondary to ICAD. All patients failed aggressive medical treatments and had recurrence of symptoms despite anticoagulation or dual-antiplatelet therapy plus a statin. Diagnostic angiogram in each case showed severe vessel stenosis, therefore patients were recommended for intracranial artery stenting. Main outcome measures Technical feasibility of deploying Xience Skypoint stent for treatmet of ICAD. Results The Xience Skypoint stent was safely and effectively deployed in the vertebral artery (x1) and the internal carotid artery (x2) using trans-ulnar (x1), trans-radial (x1), and trans-femoral (x1) approaches without the use of an intermediate catheter. Conclusion Second-generation EES such as Xience Skypoint may be utilized for treatment of medically-refractory ICAD. This technical report serves as a proof of concept for further studies analysing long-term safety and efficacy of such stents for treatment of ICAD.
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Affiliation(s)
| | - Griffin L Ernst
- Department of Neurosurgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Hussain Shallwani
- Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Beau Hawkins
- Department of Cardiology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Usman Baber
- Department of Cardiology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Hakeem J Shakir
- Department of Neurosurgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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7
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Safety of Sheathless Transradial Balloon Guide Catheter Placement for Acute Stroke Thrombectomy. World Neurosurg 2022; 165:e235-e241. [PMID: 35691519 DOI: 10.1016/j.wneu.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/02/2022] [Accepted: 06/02/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Transradial access has been described for mechanical thrombectomy in acute stroke, and proximal balloon occlusion has been shown to improve recanalization and outcomes. However, sheathed access requires a larger total catheter diameter at the access site. We aimed to characterize the safety of sheathless transradial balloon guide catheter use in acute stroke intervention. METHODS Consecutive patients who underwent sheathless right-sided transradial access for thrombectomy with a balloon guide catheter were identified in a prospectively collected dataset from 2019 to 2021. Demographics, procedure details, and short-term outcomes were collected and reported with descriptive statistics. RESULTS A total of 48 patients (20 women) with a mean age of 72.3 years were identified. Of patients, 56.3% had occlusions in the left-sided circulation; 35 (72.9%) had M1 occlusions, 7 (14.6%) had M2 occlusions, and 6 (12.5%) had internal carotid artery occlusions. Tissue plasminogen activator was administered to 16 (33.3%) patients. Five (10.4%) patients underwent intraprocedural carotid stenting. The cohort had successful reperfusion after a median of 1 (interquartile range: 1, 2) pass. Median time from access to recanalization was 31 (interquartile range: 25, 53) minutes. A postprocedural Thrombolysis In Cerebral Infarction score of ≥2b was achieved in 46 (95.8%) patients. Five patients had wrist access site hematomas. All hematomas resolved with warm compresses, and no further intervention was required. CONCLUSIONS Sheathless radial access using a balloon guide catheter may be safely performed for acute ischemic stroke with excellent radiographic outcomes. Further investigation is warranted to evaluate the comparative effectiveness of sheathless compared with sheathed transradial balloon guide access.
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Catapano JS, Scherschinski L, Rumalla K, Srinivasan VM, Cole TS, Baranoski JF, Lawton MT, Jadhav AP, Ducruet AF, Albuquerque FC. Emergency Department Visits for Chronic Subdural Hematomas within 30 Days after Surgical Evacuation with and without Middle Meningeal Artery Embolization. AJNR Am J Neuroradiol 2022; 43:1148-1151. [PMID: 35863784 PMCID: PMC9575430 DOI: 10.3174/ajnr.a7572] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/16/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Middle meningeal artery embolization after surgical evacuation of a chronic subdural hematomas is associated with fewer treatment failures than surgical evacuation. We compared emergency department visits within 30 days for patients with chronic subdural hematomas with and without adjunctive middle meningeal artery embolization. MATERIALS AND METHODS All cases of chronic subdural hematoma treated from January 1, 2018, through December 31, 2020, were retrospectively reviewed. Treatment was classified as surgery only or surgery combined with middle meningeal artery embolization. The primary outcome was 30-day emergency department presentation and readmission. RESULTS Of 137 patients who met the study criteria, 28 (20%) underwent surgery combined with middle meningeal artery embolization. Of these 28 patients, 15 (54%) underwent planned middle meningeal artery embolization and 13 (46%) underwent embolization after surgical failure. The mean chronic subdural hematoma size at presentation in the group with surgery only (n = 109, 20.5 [SD, 6.9] mm) was comparable with that in the combined group (n = 28, 18.7 [SD, 4.5] mm; P = .16). A significantly higher percentage of the surgery-only group presented to the emergency department within 30 days compared with the combined group (32 of 109 [29%] versus 2 of 28 [7%] patients; P = .02). No significant difference was found with respect to readmission (16 [15%] versus 1 [4%] patient; P = .11). Nine patients (8%) in the surgery-only group were readmitted for significant reaccumulation or residual subdural hematoma compared with only 1 patient (4%) in the combined group (P = .40). CONCLUSIONS Surgical evacuation combined with middle meningeal artery embolization in patients with chronic subdural hematoma is associated with fewer 30-day emergency department visits compared with surgery alone.
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Affiliation(s)
- J S Catapano
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - L Scherschinski
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - K Rumalla
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - V M Srinivasan
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - T S Cole
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - J F Baranoski
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - M T Lawton
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - A P Jadhav
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - A F Ducruet
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - F C Albuquerque
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Scherschinski L, Catapano JS, Karahalios K, Koester SW, Benner D, Winkler EA, Graffeo CS, Srinivasan VM, Jha RM, Jadhav AP, Ducruet AF, Albuquerque FC, Lawton MT. Electroencephalography for detection of vasospasm and delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a retrospective analysis and systematic review. Neurosurg Focus 2022; 52:E3. [DOI: 10.3171/2021.12.focus21656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/22/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Good functional outcomes after aneurysmal subarachnoid hemorrhage (aSAH) are often dependent on early detection and treatment of cerebral vasospasm (CVS) and delayed cerebral ischemia (DCI). There is growing evidence that continuous monitoring with cranial electroencephalography (cEEG) can predict CVS and DCI. Therefore, the authors sought to assess the value of continuous cEEG monitoring for the detection of CVS and DCI in aSAH.
METHODS
The cerebrovascular database of a quaternary center was reviewed for patients with aSAH and cEEG monitoring between January 1, 2017, and July 31, 2019. Demographic data, cardiovascular risk factors, Glasgow Coma Scale score at admission, aneurysm characteristics, and outcomes were abstracted from the medical record. Patient data were retrospectively analyzed for DCI and angiographically assessed CVS. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and odds ratio for cEEG, transcranial Doppler ultrasonography (TCDS), CTA, and DSA in detecting DCI and angiographic CVS were calculated. A systematic literature review was conducted in accordance with PRISMA guidelines querying the PubMed, Cochrane Controlled Trials Register, Web of Science, and Embase databases.
RESULTS
A total of 77 patients (mean age 60 years [SD 15 years]; female sex, n = 54) were included in the study. Continuous cEEG monitoring detected DCI and angiographically assessed CVS with specificities of 82.9% (95% CI 66.4%–93.4%) and 94.4% (95% CI 72.7%–99.9%), respectively. The sensitivities were 11.1% (95% CI 3.1%–26.1%) for DCI (n = 71) and 18.8% (95% CI 7.2%–36.4%) for angiographically assessed CVS (n = 50). Furthermore, TCDS detected angiographically determined CVS with a sensitivity of 87.5% (95% CI 71.0%–96.5%) and specificity of 25.0% (95% CI 7.3%–52.4%). In patients with DCI, TCDS detected vasospasm with a sensitivity of 85.7% (95% CI 69.7%–95.2%) and a specificity of 18.8% (95% CI 7.2%–36.4%). DSA detected vasospasm with a sensitivity of 73.9% (95% CI 51.6%–89.8%) and a specificity of 47.8% (95% CI 26.8%–69.4%).
CONCLUSIONS
The study results suggest that continuous cEEG monitoring is highly specific in detecting DCI as well as angiographically assessed CVS. More prospective studies with predetermined thresholds and endpoints are needed to assess the predictive role of cEEG in aSAH.
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Affiliation(s)
- Lea Scherschinski
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
| | - Joshua S. Catapano
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
| | - Katherine Karahalios
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
| | - Stefan W. Koester
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
| | - Dimitri Benner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
| | - Ethan A. Winkler
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
| | - Christopher S. Graffeo
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
| | - Visish M. Srinivasan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
| | - Ruchira M. Jha
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
| | - Ashutosh P. Jadhav
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
| | - Andrew F. Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
| | - Felipe C. Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
| | - Michael T. Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
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Gilchrist IC, Muallem SN, Norton JM. Radial has come a long way; there is still a distance to go. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 36:121-122. [PMID: 34972668 DOI: 10.1016/j.carrev.2021.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 12/15/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Ian C Gilchrist
- Penn State University, College of Medicine, Heart & Vascular Institute, MS Hershey Medical Center, Hershey, PA, USA.
| | - Samer N Muallem
- Penn State University, College of Medicine, Heart & Vascular Institute, MS Hershey Medical Center, Hershey, PA, USA.
| | - Jonathan M Norton
- Penn State University, College of Medicine, Heart & Vascular Institute, MS Hershey Medical Center, Hershey, PA, USA.
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Catapano JS, Ducruet AF, Srinivasan VM, Rumalla K, Nguyen CL, Rutledge C, Cole TS, Baranoski JF, Lawton MT, Jadhav AP, Albuquerque FC. Radiographic clearance of chronic subdural hematomas after middle meningeal artery embolization. J Neurointerv Surg 2021; 14:1279-1283. [PMID: 34872986 DOI: 10.1136/neurintsurg-2021-018073] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/16/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Few reports discuss variables associated with improved outcomes after middle meningeal artery (MMA) embolization for chronic subdural hematomas (cSDHs). We analyzed radiographic evidence of cSDH clearance after MMA embolization to elucidate optimal techniques, hematoma clearance rates, and suitable length of follow-up. METHODS Patients who underwent MMA embolization for cSDH from January 1, 2018 through December 31, 2020 were analyzed. Patient characteristics, demographics, and technical procedural details were examined. Outcomes for cSDHs analyzed included complete or near-complete resolution at 30, 90, and 180 days following embolization. A multivariable logistic regression analysis identified variables predictive of rapid clearance and resolution of hematomas at 90 days. RESULTS The study cohort comprised 66 patients with 84 treated cSDHs. The mean (SD) cSDH size differed significantly at 30-day (8.8 (4.3) mm), 90-day (3.4 (3.0) mm), and 180-day (1.0 (1.7) mm) follow-up (p<0.001). More cSDHs had complete or near-complete resolution at 180 days (92%, 67/73) than at 90 (63%, 45/72) and 30 days (18%, 15/84) post-embolization (p<0.001). Only distal embolysate penetration was independently associated with rapid clearance (OR 3.9, 95% CI 1.4 to 11.1; p=0.01) and resolution of cSDHs at 90 days (OR 5.0, 95% CI 1.7 to 14.6; p=0.003). CONCLUSION Although 63% of cSDHs with MMA embolization had complete or near-complete resolution by 90 days post-procedure, 92% reached this stage by 180 days. Therefore, 90-day follow-up may be insufficient to determine the effectiveness of MMA embolization for cSDHs, particularly compared with surgical evacuation alone. Also, distal MMA penetration may be associated with more rapid hematoma clearance.
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Affiliation(s)
- Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Kavelin Rumalla
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Candice L Nguyen
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Caleb Rutledge
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Tyler S Cole
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Jacob F Baranoski
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Ashutosh P Jadhav
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
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Narsinh KH, Mirza MH, Caton MT, Baker A, Winkler E, Higashida RT, Halbach VV, Amans MR, Cooke DL, Hetts SW, Abla AA, Dowd CF. Radial artery access for neuroendovascular procedures: safety review and complications. J Neurointerv Surg 2021; 13:1132-1138. [PMID: 34551991 DOI: 10.1136/neurintsurg-2021-017325] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/16/2021] [Indexed: 01/01/2023]
Abstract
Although enthusiasm for transradial access for neurointerventional procedures has grown, a unique set of considerations bear emphasis to preserve safety and minimize complications. In the first part of this review series, we reviewed anatomical considerations for safe and easy neuroendovascular procedures from a transradial approach. In this second part of the review series, we aim to (1) summarize evidence for safety of the transradial approach, and (2) explain complications and their management.
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Affiliation(s)
- Kazim H Narsinh
- Radiology & Biomedical Imaging, University California San Francisco, San Francisco, California, USA
| | - Mohammed H Mirza
- Radiology, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA
| | - M Travis Caton
- Radiology & Biomedical Imaging, University California San Francisco, San Francisco, California, USA
| | - Amanda Baker
- Radiology & Biomedical Imaging, University California San Francisco, San Francisco, California, USA
| | - Ethan Winkler
- Neurological Surgery, University California San Francisco, San Francisco, California, USA
| | - Randall T Higashida
- Radiology & Biomedical Imaging, University California San Francisco, San Francisco, California, USA
| | - Van V Halbach
- Radiology & Biomedical Imaging, University California San Francisco, San Francisco, California, USA
| | - Matthew R Amans
- Radiology & Biomedical Imaging, University California San Francisco, San Francisco, California, USA
| | - Daniel L Cooke
- Radiology & Biomedical Imaging, University California San Francisco, San Francisco, California, USA
| | - Steven W Hetts
- Radiology & Biomedical Imaging, University California San Francisco, San Francisco, California, USA
| | - Adib A Abla
- Neurological Surgery, University California San Francisco, San Francisco, California, USA
| | - Christopher F Dowd
- Radiology & Biomedical Imaging, University California San Francisco, San Francisco, California, USA
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13
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Schartz D, Akkipeddi SMK, Ellens N, Rahmani R, Kohli GS, Bruckel J, Caplan JM, Mattingly TK, Bhalla T, Bender MT. Complications of transradial versus transfemoral access for neuroendovascular procedures: a meta-analysis. J Neurointerv Surg 2021; 14:820-825. [PMID: 34479985 DOI: 10.1136/neurintsurg-2021-018032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/23/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Transradial access (TRA) has gained increased usage among neurointerventionalists. However, the overall safety profile of access site complications (ASCs) and non-access site complications (NASCs) of TRA versus transfemoral access (TFA) for neuroendovascular procedures remains unclear. METHODS A systematic literature review and meta-analysis using a random effects model was conducted to investigate the pooled odds ratios (OR) of ASCs and NASCs. Randomized, case-control, and cohort studies comparing access-related complications were analyzed. An assessment of study heterogeneity and publication bias was also completed. RESULTS Seventeen comparative studies met the inclusion criteria for final analysis. Overall, there was a composite ASC rate of 1.8% (49/2767) versus 3.2% (168/5222) for TRA and TFA, respectively (P<0.001). TRA was associated with a lower odds of ASC compared with TFA (OR 0.42; 95% CI 0.25 to 0.68, P<0.001, I2=31%). There was significantly lower odds of complications within the intervention and diagnostic subgroups. For NASC, TRA had a lower composite incidence of complications than TFA at 1.2% (31/2586) versus 4.2% (207/4909), P<0.001). However, on meta-analysis, we found no significant difference overall between TRA and TFA for NASCs (OR 0.79; 95% CI 0.51 to 1.22, P=0.28, I2=0%), which was also the case on subgroup analysis. CONCLUSION On meta-analysis, the current literature indicates that TRA is associated with a lower incidence of ASCs compared with TFA, but is not associated with a lower rate of NASCs.
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Affiliation(s)
- Derrek Schartz
- Imaging Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | | | - Nathaniel Ellens
- Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Redi Rahmani
- Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| | | | - Jeffrey Bruckel
- Cardiology, University of Rochester Medical Center, Rochester, New York, USA
| | - Justin M Caplan
- Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Thomas K Mattingly
- Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Tarun Bhalla
- Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Matthew T Bender
- Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
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14
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Catapano JS, Karahalios K, Srinivasan VM, Baranoski JF, Rutledge C, Cole TS, Ducruet AF, Albuquerque FC, Jadhav AP. Chronic headaches and middle meningeal artery embolization. J Neurointerv Surg 2021; 14:301-303. [PMID: 33888570 DOI: 10.1136/neurintsurg-2021-017602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND The middle meningeal artery (MMA) has been implicated in chronic headaches, but no studies have examined the relationship between MMA embolization and headaches. METHODS Patients treated with MMA embolization for a chronic subdural hematoma (cSDH) between January 1, 2018, and December 31, 2020, were retrospectively assessed. Patients with a Glasgow Coma Scale (GCS) score of 15 at discharge received a follow-up telephone call to assess their history of chronic headache, defined as a headache ≥2 years before the cSDH and symptoms ≥2 days/month. A Headache Impact Test (HIT-6) was performed during the follow-up telephone call. The primary outcome was resolution or improvement of headaches after embolization. RESULTS Of 76 patients undergoing MMA embolization for a cSDH during the study period, 56 (74%) had a discharge GCS score of 15. Of these 56 patients, 46 (82%) responded to a follow-up telephone call and were analyzed (mean [SD] age 68 [11] years; 36 [78%] men and 10 [22%] women). Nine (20%) reported chronic headaches before embolization. With a mean (SD) follow-up of 489 (173) days, eight of the nine patients reported improvement of chronic headaches, with seven having complete resolution. For these nine patients, the mean (SD) HIT-6 score was significantly higher before embolization than after embolization (64 [7.1] vs 40 [9.1], p<0.001). CONCLUSION In patients with chronic headaches who underwent MMA embolization for a cSDH, the majority reported improvement of headaches after the procedure. Future prospective studies are warranted to assess the usefulness of MMA embolization to treat chronic headaches.
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Affiliation(s)
- Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Katherine Karahalios
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Jacob F Baranoski
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Caleb Rutledge
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Tyler S Cole
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Ashutosh P Jadhav
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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