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Ansari HUH, Qazi SU, Sajid F, Altaf Z, Ghazanfar S, Naveed N, Ashfaq AS, Siddiqui AH, Iqbal H, Qazi S. Efficacy and Safety of Glucagon-Like Peptide-1 Receptor Agonists on Body Weight and Cardiometabolic Parameters in Individuals With Obesity and Without Diabetes: A Systematic Review and Meta-Analysis. Endocr Pract 2024; 30:160-171. [PMID: 38029929 DOI: 10.1016/j.eprac.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/02/2023] [Accepted: 11/19/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), initially for type 2 diabetes mellitus, show promise in promoting weight loss and improving heart health in obese individuals without diabetes. Our goal was to examine existing research for conclusive evidence on various types of GLP-1 RAs for weight loss and cardiometabolic benefits in obesity without diabetes. METHODS We conducted an electronic search on PubMed, Scopus, and Cochrane Central using keywords, such as "GLP-1 RA," "obesity," and "weight loss." We considered all available global GLP-1 RAs for inclusion. Our analysis focused on weight loss, blood pressure (BP) changes (systolic and diastolic BPs), and lipid profile effects (high-density lipoprotein, low-density lipoprotein, total cholesterol, and triacylglycerol). We used a random-effects meta-analysis with the standardized mean difference (SMD), mean difference (MD), odds ratio, and relative risk to present the results. RESULTS Our search yielded a total of 7535 articles. We included 15 trials in our study. GLP-1 RAs led to significant weight loss (MD, -8.77 kg; P <.01) in obese individuals. GLP-1 RAs also improved the systolic BP (MD, -4.13 mm Hg; P <.01), diastolic BP (MD, -1.39 mm Hg; P <.01), and lipid profiles, including improved levels of triacylglycerol (SMD, -0.99 mg/dL; P <.01), total cholesterol (SMD, -0.73 mg/dL; P <.01), very low-density lipoprotein (SMD, -1.11 mg/dL; P <.01), and low-density lipoprotein (SMD, -0.27 mg/dL; P <.01), and significantly increased high-density lipoprotein levels (SMD, 0.11 mg/dL; P <.01). However, GLP-1 RAs were associated with an increased risk of gastrointestinal adverse events. CONCLUSION GLP-1 RAs were found to be beneficial for not only weight loss but also reduction in risk factors for cardiovascular disease such as BP and lipid profile. Consistent beneficial results were observed across the various subtypes of GLP-1 RAs.
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Affiliation(s)
| | - Shurjeel Uddin Qazi
- Department of Internal Medicine, Dow University of Health Sciences, Pakistan
| | - Faiza Sajid
- Department of Medicine, Liaquat National Hospital and Medical College, Pakistan
| | - Zahabia Altaf
- Department of Internal Medicine, Dow University of Health Sciences, Pakistan
| | - Shamas Ghazanfar
- Department of Internal Medicine, Dow University of Health Sciences, Pakistan
| | - Naveen Naveed
- Department of Medicine, Jinnah Sindh Medical University, Pakistan
| | - Amna Shakil Ashfaq
- Department of Internal Medicine, Dow University of Health Sciences, Pakistan
| | | | - Hamza Iqbal
- Department of Internal Medicine, Dow University of Health Sciences, Pakistan
| | - Sana Qazi
- Department of Internal Medicine, Dow University of Health Sciences, Pakistan
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Yasmin F, Aamir M, Najeeb H, Atif AR, Siddiqui AH, Ahsan MN, Moeed A, Ali SH, Tahir HM, Asghar MS. Efficacy and safety of finerenone in chronic kidney disease and type 2 diabetes patients: a systematic review and meta-analysis. Ann Med Surg (Lond) 2023; 85:4973-4980. [PMID: 37811017 PMCID: PMC10553111 DOI: 10.1097/ms9.0000000000001180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 08/05/2023] [Indexed: 10/10/2023] Open
Abstract
Background and objectives The incidence of morbidity and mortality in patients with type 2 diabetes mellitus is substantially correlated with cardiovascular disease and chronic kidney disease. The current guidelines recommend the use of renin-angiotensin system blockers, but recent studies probed into the effects of finerenone to mitigate the risk of cardiorenal events. This meta-analysis was performed to demonstrate the effects of finerenone on cardiorenal events, comprising cardiovascular mortality, heart failure, change in estimated glomerular filtration rate, and serum potassium levels. Methods After screening with our eligibility criteria, 350 articles were identified with an initial literature search on multiple databases, including PubMed, Science Direct, and Cochrane Central. Seven randomized controlled trials with a total of 15 462 patients (n=8487 in the finerenone group; n=6975 in the control group) were included. Results Patients receiving finerenone were at a reduced risk for cardiovascular mortality [HR: 0.84 (0.74, 0.95)], heart failure [OR: 0.79 (0.68, 0.92)], decrease in estimated glomerular filtration rate by 40% [OR: 0.82 (0.74, 0.91)] and by 57% [OR: 0.70 (0.59, 0.82)]; and a higher incidence of moderate hyperkalemia [OR: 2.25 (1.78, 2.84)]. Conclusion Finerenone, owing to its better mineralocorticoid affinity, and a much lower risk of adverse effects, promises to be a much better alternative than other renin-angiotensin system blockers available for the treatment of chronic kidney disease patients with type 2 diabetes. Further trials should be conducted to provide more definitive evidence to assess the safety and efficacy of finerenone compared to spironolactone and eplerenone.
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Affiliation(s)
- Farah Yasmin
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences
| | - Muhammad Aamir
- Department of Cardiovascular Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania
| | - Hala Najeeb
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences
| | - Abdul Raafe Atif
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences
| | - Abdul Hannan Siddiqui
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences
| | - Muhammad Nadeem Ahsan
- Department of Nephrology and Dialysis Unit, Dow University of Health Sciences-Ojha Campus, Karachi, Pakistan
| | - Abdul Moeed
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences
| | - Syed Hasan Ali
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences
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Mir BA, Ahmad A, Farooq N, Priya MV, Siddiqui AH, Asif M, Manzoor R, Ishqi HM, Alomar SY, Rahaman PF. Increased expression of HPV-E7 oncoprotein correlates with a reduced level of pRb proteins via high viral load in cervical cancer. Sci Rep 2023; 13:15075. [PMID: 37699974 PMCID: PMC10497568 DOI: 10.1038/s41598-023-42022-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/04/2023] [Indexed: 09/14/2023] Open
Abstract
Human Papillomavirus (HPV) is the most common cause of sexually transmitted diseases and causes a wide range of pathologies including cervical carcinoma. Integration of the HR-HPV DNA into the host genome plays a crucial role in cervical carcinoma. An alteration of the pRb pathways by the E7 proteins is one of the mechanisms that's account for the transforming capacity of high-risk papillomavirus. For the proper understanding of the underline mechanism of the progression of the disease, the present study investigate the correlation of concentration of host pRb protein, viral E7 oncoprotein and viral load in early and advanced stages of cervical carcinoma. It was found that the viral load in early stages (stage I and II) was less (log10 transformed mean value 2.6 and 3.0) compared to advanced stages (stage III and IV) (Log10 transformed value 5.0 and 5.8) having high expression of HPV E7 onco-protein and reduced level of pRb protein, signifying the role of viral load and expression level of E7 oncoprotein in the progression of cervical cancer.
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Affiliation(s)
- Bilal Ahmad Mir
- Zoology Section, School of Sciences, Maulana Azad National Urdu University, Hyderabad, India
| | - Arif Ahmad
- Zoology Section, School of Sciences, Maulana Azad National Urdu University, Hyderabad, India
| | - Nighat Farooq
- Zoology Section, School of Sciences, Maulana Azad National Urdu University, Hyderabad, India
| | - M Vishnu Priya
- Department of Radiation Oncology, MNJ Cancer Hospital, Hyderabad, India
| | - A H Siddiqui
- School of Medical Sciences, University of Hyderabad, Hyderabad, India
| | - M Asif
- Zoology Section, School of Sciences, Maulana Azad National Urdu University, Hyderabad, India
| | - Rouquia Manzoor
- Sher-i-Kashmir Institute of Medical Sciences, Soura Srinagar, J&K, India
| | - Hassan Mubarak Ishqi
- Department of Surgery and Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Suliman Y Alomar
- Department of Zoology, King Saud University, 11451, Riyadh, Kingdom of Saudi Arabia.
| | - P F Rahaman
- Zoology Section, School of Sciences, Maulana Azad National Urdu University, Hyderabad, India.
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Siddiqui AH, Alsabe MR, Tehseen Z, Hatamleh MI, Taslim S, Abdelrahman A, Saleem F. Dubin-Johnson Syndrome: A Case Report. Cureus 2023; 15:e36115. [PMID: 37065356 PMCID: PMC10099096 DOI: 10.7759/cureus.36115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 03/18/2023] Open
Abstract
Dubin-Johnson syndrome (DJS) is a rare autosomal recessive genetic disease caused by mutations in the bilirubin transporter MRP2. It is characterized by recurrent episodes of jaundice and conjugated hyperbilirubinemia. Numerous instances of hyperbilirubinemia disorders resembling Dubin-Johnson syndrome have been documented, but they differ in the clinical presentation, amount of conjugated bilirubin present, and their reaction to therapy. Most people with this syndrome do not have any symptoms, so their cases are often misdiagnosed and not properly taken care of. Here, we present a case of a teenage male patient who complained of recurring jaundice and abdominal pain. Further examination and testing revealed that the patient had been jaundiced since birth and had a family history of the condition. Conservative management was implemented, and follow-up demonstrated a positive prognosis. This case is a rare example of Dubin-Johnson syndrome, although patients with the condition generally have a normal life expectancy and only require conservative management.
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Adeeb N, Dibas M, Griessenauer CJ, Cuellar HH, Salem MM, Xiang S, Enriquez-Marulanda A, Hong T, Zhang H, Taussky P, Grandhi R, Waqas M, Aldine AS, Tutino VM, Aslan A, Siddiqui AH, Levy EI, Ogilvy CS, Thomas AJ, Ulfert C, Möhlenbruch MA, Renieri L, Bengzon Diestro JD, Lanzino G, Brinjikji W, Spears J, Vranic JE, Regenhardt RW, Rabinov JD, Harker P, Müller-Thies-Broussalis E, Killer-Oberpfalzer M, Islak C, Kocer N, Sonnberger M, Engelhorn T, Kapadia A, Yang VXD, Salehani A, Harrigan MR, Krings T, Matouk CC, Mirshahi S, Chen KS, Aziz-Sultan MA, Ghorbani M, Schirmer CM, Goren O, Dalal SS, Finkenzeller T, Holtmannspötter M, Buhk JH, Foreman PM, Cress MC, Hirschl RA, Reith W, Simgen A, Janssen H, Marotta TR, Stapleton CJ, Patel AB, Dmytriw AA. Learning Curve for Flow Diversion of Posterior Circulation Aneurysms: A Long-Term International Multicenter Cohort Study. AJNR Am J Neuroradiol 2022; 43:1615-1620. [PMID: 36229166 PMCID: PMC9731249 DOI: 10.3174/ajnr.a7679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 06/28/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Flow diversion has gradually become a standard treatment for intracranial aneurysms of the anterior circulation. Recently, the off-label use of the flow diverters to treat posterior circulation aneurysms has also increased despite initial concerns of rupture and the suboptimal results. This study aimed to explore the change in complication rates and treatment outcomes across time for posterior circulation aneurysms treated using flow diversion and to further evaluate the mechanisms and variables that could potentially explain the change and outcomes. MATERIALS AND METHODS A retrospective review using a standardized data set at multiple international academic institutions was performed to identify patients with ruptured and unruptured posterior circulation aneurysms treated with flow diversion during a decade spanning January 2011 to January 2020. This period was then categorized into 4 intervals. RESULTS A total of 378 procedures were performed during the study period. Across time, there was an increasing tendency to treat more vertebral artery and fewer large vertebrobasilar aneurysms (P = .05). Moreover, interventionalists have been increasingly using fewer overlapping flow diverters per aneurysm (P = .07). There was a trend toward a decrease in the rate of thromboembolic complications from 15.8% in 2011-13 to 8.9% in 2018-19 (P = .34). CONCLUSIONS This multicenter experience revealed a trend toward treating fewer basilar aneurysms, smaller aneurysms, and increased usage of a single flow diverter, leading to a decrease in the rate of thromboembolic and hemorrhagic complications.
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Affiliation(s)
- N Adeeb
- From the Departments of Neurosurgery and Interventional Neuroradiology (N.A., M.D., H.H.C., A.S.A., A.A.), Louisiana State University Hospital, Shreveport, Louisiana
| | - M Dibas
- From the Departments of Neurosurgery and Interventional Neuroradiology (N.A., M.D., H.H.C., A.S.A., A.A.), Louisiana State University Hospital, Shreveport, Louisiana
| | - C J Griessenauer
- Departments of Neurosurgery and Radiology (C.J.G., C.M.S., O.G., S.S.D.), Geisinger, Danville, Pennsylvania
- Department of Neurology/Institut of Neurointervention (C.J.G., E.M.-T.-B., M.K.-O.), University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - H H Cuellar
- From the Departments of Neurosurgery and Interventional Neuroradiology (N.A., M.D., H.H.C., A.S.A., A.A.), Louisiana State University Hospital, Shreveport, Louisiana
| | - M M Salem
- Neurosurgical Service (M.M.S., A.E.-M., P.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - S Xiang
- Department of Neurosurgery (S.X., H.Z., T.H.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - A Enriquez-Marulanda
- Neurosurgical Service (M.M.S., A.E.-M., P.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - T Hong
- Department of Neurosurgery (S.X., H.Z., T.H.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - H Zhang
- Department of Neurosurgery (S.X., H.Z., T.H.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - P Taussky
- Neurosurgical Service (M.M.S., A.E.-M., P.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Neurosurgery (P.T., R.G.), University of Utah, Salt Lake City, Utah
| | - R Grandhi
- Department of Neurosurgery (P.T., R.G.), University of Utah, Salt Lake City, Utah
| | - M Waqas
- Department of Neurosurgery (M.W., V.M.T., A.H.S., E.I.L.), State University of New York at Buffalo, Buffalo, New York
| | - A S Aldine
- From the Departments of Neurosurgery and Interventional Neuroradiology (N.A., M.D., H.H.C., A.S.A., A.A.), Louisiana State University Hospital, Shreveport, Louisiana
| | - V M Tutino
- Department of Neurosurgery (M.W., V.M.T., A.H.S., E.I.L.), State University of New York at Buffalo, Buffalo, New York
| | - A Aslan
- From the Departments of Neurosurgery and Interventional Neuroradiology (N.A., M.D., H.H.C., A.S.A., A.A.), Louisiana State University Hospital, Shreveport, Louisiana
| | - A H Siddiqui
- Department of Neurosurgery (M.W., V.M.T., A.H.S., E.I.L.), State University of New York at Buffalo, Buffalo, New York
| | - E I Levy
- Department of Neurosurgery (M.W., V.M.T., A.H.S., E.I.L.), State University of New York at Buffalo, Buffalo, New York
| | - C S Ogilvy
- Neurosurgical Service (M.M.S., A.E.-M., P.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - A J Thomas
- Department of Neurological Surgery (A.J.T.), Cooper University Health Care, Cooper Medical School of Rowan University, Camden, New Jersey
| | - C Ulfert
- Department of Neuroradiology (C.U., M.A.M.), Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - M A Möhlenbruch
- Department of Neuroradiology (C.U., M.A.M.), Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - L Renieri
- Department of Interventional Neuroradiology (L.R.), University of Florence, Florence, Italy
| | - J D Bengzon Diestro
- Division of Diagnostic and Therapeutic Neuroradiology (J.D.B.D., J.S., T.R.M.), St. Michael's Hospital, Toronto, Ontario, Canada
| | - G Lanzino
- Department of Neurological Surgery (G.L., W.B.), Mayo Clinic, Rochester, Minnesota
| | - W Brinjikji
- Department of Neurological Surgery (G.L., W.B.), Mayo Clinic, Rochester, Minnesota
| | - J Spears
- Division of Diagnostic and Therapeutic Neuroradiology (J.D.B.D., J.S., T.R.M.), St. Michael's Hospital, Toronto, Ontario, Canada
| | - J E Vranic
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - R W Regenhardt
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - J D Rabinov
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - P Harker
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - E Müller-Thies-Broussalis
- Department of Neurology/Institut of Neurointervention (C.J.G., E.M.-T.-B., M.K.-O.), University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - M Killer-Oberpfalzer
- Department of Neurology/Institut of Neurointervention (C.J.G., E.M.-T.-B., M.K.-O.), University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - C Islak
- Department of Neuroradiology (C.I., N.K.), Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | - N Kocer
- Department of Neuroradiology (C.I., N.K.), Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | - M Sonnberger
- Department of Neuroradiology (M.S.), Kepler Universitätsklinikum Linz, Linz, Austria
| | - T Engelhorn
- Department of Neuroradiology (T.E.), University Hospital Erlangen, Erlangen, Germany
| | - A Kapadia
- Departments of Medical Imaging and Neurosurgery (A.K.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - V X D Yang
- Neurointerventional Program (V.X.D.Y., A.A.D.), Departments of Medical Imaging & Clinical Neurological Sciences, London Health Sciences Centre, Western University, Ontario, Canada
| | - A Salehani
- Department of Neurosurgery (A. Salehani, M.R.H.), University of Alabama at Birmingham, Birmingham, Alabama
| | - M R Harrigan
- Department of Neurosurgery (A. Salehani, M.R.H.), University of Alabama at Birmingham, Birmingham, Alabama
| | - T Krings
- Division of Interventional Neuroradiology (T.K.), Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - C C Matouk
- Department of Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, Connecticut
| | - S Mirshahi
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - K S Chen
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - M A Aziz-Sultan
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - M Ghorbani
- Division of Vascular and Endovascular Neurosurgery (M.G.), Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - C M Schirmer
- Departments of Neurosurgery and Radiology (C.J.G., C.M.S., O.G., S.S.D.), Geisinger, Danville, Pennsylvania
| | - O Goren
- Departments of Neurosurgery and Radiology (C.J.G., C.M.S., O.G., S.S.D.), Geisinger, Danville, Pennsylvania
| | - S S Dalal
- Departments of Neurosurgery and Radiology (C.J.G., C.M.S., O.G., S.S.D.), Geisinger, Danville, Pennsylvania
| | - T Finkenzeller
- Institute of Radiology and Neuroradiology (T.F., M.H.), Klinikum Nuernberg Sued, Paracelsus Medical University Nuernberg, Nuernberg, Germany
| | - M Holtmannspötter
- Institute of Radiology and Neuroradiology (T.F., M.H.), Klinikum Nuernberg Sued, Paracelsus Medical University Nuernberg, Nuernberg, Germany
- Department of Neuroradiology (M.H.), Klinikum Weiden, Weiden, Germany
| | - J-H Buhk
- Department of Neuroradiology (J.-H.B.), University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - P M Foreman
- Neuroscience and Rehabilitation Institute (P.M.F., M.C.C., R.A.H.), Orlando Health, Orlando, Florida
| | - M C Cress
- Neuroscience and Rehabilitation Institute (P.M.F., M.C.C., R.A.H.), Orlando Health, Orlando, Florida
| | - R A Hirschl
- Neuroscience and Rehabilitation Institute (P.M.F., M.C.C., R.A.H.), Orlando Health, Orlando, Florida
| | - W Reith
- Clinic for Diagnostic and Interventional Neuroradiology (W.R., A. Simgen), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - A Simgen
- Clinic for Diagnostic and Interventional Neuroradiology (W.R., A. Simgen), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - H Janssen
- Institute for Neuroradiology (H.J.), Klinikum Ingolstadt, Ingolstadt, Germany
| | - T R Marotta
- Division of Diagnostic and Therapeutic Neuroradiology (J.D.B.D., J.S., T.R.M.), St. Michael's Hospital, Toronto, Ontario, Canada
| | - C J Stapleton
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - A B Patel
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - A A Dmytriw
- Neurointerventional Program (V.X.D.Y., A.A.D.), Departments of Medical Imaging & Clinical Neurological Sciences, London Health Sciences Centre, Western University, Ontario, Canada
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Rehan ST, Siddiqui AH, Khan Z, Imran L, Syed AA, Tahir MJ, Jassani Z, Singh M, Asghar MS, Ahmed A. Samidorphan/olanzapine combination therapy for schizophrenia: Efficacy, tolerance and adverse outcomes of regimen, evidence-based review of clinical trials. Ann Med Surg (Lond) 2022; 79:104115. [PMID: 35860157 PMCID: PMC9289510 DOI: 10.1016/j.amsu.2022.104115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/27/2022] [Accepted: 06/27/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Objectives Methods Results Conclusion FDA approved a combination dose of olanzapine and samidorphan (OLZ/SAM) for treatment of schizophrenia and bipolar I disorder. Overall, OLZ/SAM showed a significant reduction in symptoms for long-term treatment. Major adverse events included nervous system disorders, blood, metabolic or nutritional changes.
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7
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Patel TR, Fricano S, Waqas M, Tso M, Dmytriw AA, Mokin M, Kolega J, Tomaszewski J, Levy EI, Davies JM, Snyder KV, Siddiqui AH, Tutino VM. Increased Perviousness on CT for Acute Ischemic Stroke is Associated with Fibrin/Platelet-Rich Clots. AJNR Am J Neuroradiol 2021; 42:57-64. [PMID: 33243895 PMCID: PMC7814781 DOI: 10.3174/ajnr.a6866] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/21/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Clot perviousness in acute ischemic stroke is a potential CT imaging biomarker for mechanical thrombectomy efficacy. We investigated the association among perviousness, clot cellular composition, and first-pass effect. MATERIALS AND METHODS In 40 mechanical thrombectomy-treated cases of acute ischemic stroke, we calculated perviousness as the difference in clot density on CT angiography and noncontrast CT. We assessed the proportion of fibrin/platelet aggregates, red blood cells, and white blood cells on clot histopathology. We tested for linear correlation between histologic components and perviousness, differences in components between "high" and "low" pervious clots defined by median perviousness, and differences in perviousness/composition between cases that did and did not achieve a first-pass effect. RESULTS Perviousness significantly positively and negatively correlated with the percentage of fibrin/platelet aggregates (P = .001) and the percentage of red blood cells (P = .001), respectively. Higher pervious clots had significantly greater fibrin/platelet aggregate content (P = .042). Cases that achieved a first-pass effect (n = 14) had lower perviousness, though not significantly (P = .055). The percentage of red blood cells was significantly higher (P = .028) and the percentage of fibrin/platelet aggregates was significantly lower (P = .016) in cases with a first-pass effect. There was no association between clot density on NCCT and clot composition or first-pass effect. Receiver operating characteristic analysis indicated that clot composition was the best predictor of first-pass effect (area under receiver operating characteristic curve: percentage of fibrin/platelet aggregates = 0.731, percentage of red blood cells = 0.706, perviousness = 0.668). CONCLUSIONS Clot perviousness on CT is associated with a higher percentage of fibrin/platelet aggregate content. Histologic data and, to a lesser degree, perviousness may have value in predicting first-pass outcome. Imaging metrics that more strongly reflect clot biology than perviousness may be needed to predict a first-pass effect with high accuracy.
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Affiliation(s)
- T R Patel
- From the Canon Stroke and Vascular Research Center (T.R.P., S.F., M.W., M.T., J.K., J.T., E.I.L., J.M.D., K.V.S., A.H.S., V.M.T.)
- Department of Mechanical and Aerospace Engineering (T.R.P., V.M.T.)
| | - S Fricano
- From the Canon Stroke and Vascular Research Center (T.R.P., S.F., M.W., M.T., J.K., J.T., E.I.L., J.M.D., K.V.S., A.H.S., V.M.T.)
- Pathology and Anatomical Sciences (S.F., J.K., J.T., V.M.T.)
| | - M Waqas
- From the Canon Stroke and Vascular Research Center (T.R.P., S.F., M.W., M.T., J.K., J.T., E.I.L., J.M.D., K.V.S., A.H.S., V.M.T.)
- Neurosurgery (M.W., M.T., E.I.L., J.M.D., K.V.S., A.H.S., V.M.T.)
| | - M Tso
- From the Canon Stroke and Vascular Research Center (T.R.P., S.F., M.W., M.T., J.K., J.T., E.I.L., J.M.D., K.V.S., A.H.S., V.M.T.)
- Neurosurgery (M.W., M.T., E.I.L., J.M.D., K.V.S., A.H.S., V.M.T.)
| | - A A Dmytriw
- Department of Medical Imaging (A.A.D.), University of Toronto, Toronto, Ontario, Canada
| | - M Mokin
- Department of Neurosurgery (M.M.), University of South Florida, Tampa, Florida
| | - J Kolega
- From the Canon Stroke and Vascular Research Center (T.R.P., S.F., M.W., M.T., J.K., J.T., E.I.L., J.M.D., K.V.S., A.H.S., V.M.T.)
- Pathology and Anatomical Sciences (S.F., J.K., J.T., V.M.T.)
| | - J Tomaszewski
- From the Canon Stroke and Vascular Research Center (T.R.P., S.F., M.W., M.T., J.K., J.T., E.I.L., J.M.D., K.V.S., A.H.S., V.M.T.)
- Pathology and Anatomical Sciences (S.F., J.K., J.T., V.M.T.)
| | - E I Levy
- From the Canon Stroke and Vascular Research Center (T.R.P., S.F., M.W., M.T., J.K., J.T., E.I.L., J.M.D., K.V.S., A.H.S., V.M.T.)
- Neurosurgery (M.W., M.T., E.I.L., J.M.D., K.V.S., A.H.S., V.M.T.)
| | - J M Davies
- From the Canon Stroke and Vascular Research Center (T.R.P., S.F., M.W., M.T., J.K., J.T., E.I.L., J.M.D., K.V.S., A.H.S., V.M.T.)
- Neurosurgery (M.W., M.T., E.I.L., J.M.D., K.V.S., A.H.S., V.M.T.)
- Biomedical Informatics (J.M.D.), University at Buffalo, Buffalo, New York
| | - K V Snyder
- From the Canon Stroke and Vascular Research Center (T.R.P., S.F., M.W., M.T., J.K., J.T., E.I.L., J.M.D., K.V.S., A.H.S., V.M.T.)
- Neurosurgery (M.W., M.T., E.I.L., J.M.D., K.V.S., A.H.S., V.M.T.)
| | - A H Siddiqui
- From the Canon Stroke and Vascular Research Center (T.R.P., S.F., M.W., M.T., J.K., J.T., E.I.L., J.M.D., K.V.S., A.H.S., V.M.T.)
- Neurosurgery (M.W., M.T., E.I.L., J.M.D., K.V.S., A.H.S., V.M.T.)
| | - V M Tutino
- From the Canon Stroke and Vascular Research Center (T.R.P., S.F., M.W., M.T., J.K., J.T., E.I.L., J.M.D., K.V.S., A.H.S., V.M.T.)
- Department of Mechanical and Aerospace Engineering (T.R.P., V.M.T.)
- Pathology and Anatomical Sciences (S.F., J.K., J.T., V.M.T.)
- Neurosurgery (M.W., M.T., E.I.L., J.M.D., K.V.S., A.H.S., V.M.T.)
- Biomedical Engineering (V.M.T.)
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8
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Rava RA, Snyder KV, Mokin M, Waqas M, Allman AB, Senko JL, Podgorsak AR, Shiraz Bhurwani MM, Hoi Y, Siddiqui AH, Davies JM, Levy EI, Ionita CN. Assessment of a Bayesian Vitrea CT Perfusion Analysis to Predict Final Infarct and Penumbra Volumes in Patients with Acute Ischemic Stroke: A Comparison with RAPID. AJNR Am J Neuroradiol 2020; 41:206-212. [PMID: 31948951 DOI: 10.3174/ajnr.a6395] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/04/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Brain CTP is used to estimate infarct and penumbra volumes to determine endovascular treatment eligibility for patients with acute ischemic stroke. We aimed to assess the accuracy of a Bayesian CTP algorithm in determining penumbra and final infarct volumes. MATERIALS AND METHODS Data were retrospectively collected for 105 patients with acute ischemic stroke (55 patients with successful recanalization [TICI 2b/2c/3] and large-vessel occlusions and 50 patients without interventions). Final infarct volumes were calculated using DWI and FLAIR 24 hours following CTP imaging. RAPID and the Vitrea Bayesian CTP algorithm (with 3 different settings) predicted infarct and penumbra volumes for comparison with final infarct volumes to assess software performance. Vitrea settings used different combinations of perfusion maps (MTT, TTP, CBV, CBF, delay time) for infarct and penumbra quantification. Patients with and without interventions were included for assessment of predicted infarct and penumbra volumes, respectively. RESULTS RAPID and Vitrea default setting had the most accurate final infarct volume prediction in patients with interventions ([Spearman correlation coefficient, mean infarct difference] default versus FLAIR: [0.77, 4.1 mL], default versus DWI: [0.72, 4.7 mL], RAPID versus FLAIR: [0.75, 7.5 mL], RAPID versus DWI: [0.75, 6.9 mL]). Default Vitrea and RAPID were the most and least accurate in determining final infarct volume for patients without an intervention, respectively (default versus FLAIR: [0.76, -0.4 mL], default versus DWI: [0.71, -2.6 mL], RAPID versus FLAIR: [0.68, -49.3 mL], RAPID versus DWI: [0.65, -51.5 mL]). CONCLUSIONS Compared with RAPID, the Vitrea default setting was noninferior for patients with interventions and superior in penumbra estimation for patients without interventions as indicated by mean infarct differences and correlations with final infarct volumes.
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Affiliation(s)
- R A Rava
- From the Departments of Biomedical Engineering (R.A.R., A.B.A., J.L.S., A.R.P., M.M.S.B., C.N.I.) .,Canon Stroke and Vascular Research Center (R.A.R., K.V.S., M.W., A.B.A., J.L.S., A.R.P., M.M.S.B., A.H.S., J.M.D., E.I.L., C.N.I.), Buffalo, New York
| | - K V Snyder
- Neurosurgery (K.V.S., M.W., A.R.P., A.H.S., J.M.D., E.I.L., C.N.I.).,Canon Stroke and Vascular Research Center (R.A.R., K.V.S., M.W., A.B.A., J.L.S., A.R.P., M.M.S.B., A.H.S., J.M.D., E.I.L., C.N.I.), Buffalo, New York
| | - M Mokin
- Department of Neurosurgery (M.M.), University of South Florida, Tampa, Florida
| | - M Waqas
- Neurosurgery (K.V.S., M.W., A.R.P., A.H.S., J.M.D., E.I.L., C.N.I.).,Canon Stroke and Vascular Research Center (R.A.R., K.V.S., M.W., A.B.A., J.L.S., A.R.P., M.M.S.B., A.H.S., J.M.D., E.I.L., C.N.I.), Buffalo, New York
| | - A B Allman
- From the Departments of Biomedical Engineering (R.A.R., A.B.A., J.L.S., A.R.P., M.M.S.B., C.N.I.).,Canon Stroke and Vascular Research Center (R.A.R., K.V.S., M.W., A.B.A., J.L.S., A.R.P., M.M.S.B., A.H.S., J.M.D., E.I.L., C.N.I.), Buffalo, New York
| | - J L Senko
- From the Departments of Biomedical Engineering (R.A.R., A.B.A., J.L.S., A.R.P., M.M.S.B., C.N.I.).,Canon Stroke and Vascular Research Center (R.A.R., K.V.S., M.W., A.B.A., J.L.S., A.R.P., M.M.S.B., A.H.S., J.M.D., E.I.L., C.N.I.), Buffalo, New York
| | - A R Podgorsak
- From the Departments of Biomedical Engineering (R.A.R., A.B.A., J.L.S., A.R.P., M.M.S.B., C.N.I.).,Neurosurgery (K.V.S., M.W., A.R.P., A.H.S., J.M.D., E.I.L., C.N.I.).,Medical Physics (A.R.P.).,Canon Stroke and Vascular Research Center (R.A.R., K.V.S., M.W., A.B.A., J.L.S., A.R.P., M.M.S.B., A.H.S., J.M.D., E.I.L., C.N.I.), Buffalo, New York
| | - M M Shiraz Bhurwani
- From the Departments of Biomedical Engineering (R.A.R., A.B.A., J.L.S., A.R.P., M.M.S.B., C.N.I.).,Canon Stroke and Vascular Research Center (R.A.R., K.V.S., M.W., A.B.A., J.L.S., A.R.P., M.M.S.B., A.H.S., J.M.D., E.I.L., C.N.I.), Buffalo, New York
| | - Y Hoi
- Canon Medical Systems USA (Y.H.), Tustin, California
| | - A H Siddiqui
- Neurosurgery (K.V.S., M.W., A.R.P., A.H.S., J.M.D., E.I.L., C.N.I.).,Canon Stroke and Vascular Research Center (R.A.R., K.V.S., M.W., A.B.A., J.L.S., A.R.P., M.M.S.B., A.H.S., J.M.D., E.I.L., C.N.I.), Buffalo, New York
| | - J M Davies
- Neurosurgery (K.V.S., M.W., A.R.P., A.H.S., J.M.D., E.I.L., C.N.I.).,Canon Stroke and Vascular Research Center (R.A.R., K.V.S., M.W., A.B.A., J.L.S., A.R.P., M.M.S.B., A.H.S., J.M.D., E.I.L., C.N.I.), Buffalo, New York
| | - E I Levy
- Neurosurgery (K.V.S., M.W., A.R.P., A.H.S., J.M.D., E.I.L., C.N.I.).,Canon Stroke and Vascular Research Center (R.A.R., K.V.S., M.W., A.B.A., J.L.S., A.R.P., M.M.S.B., A.H.S., J.M.D., E.I.L., C.N.I.), Buffalo, New York
| | - C N Ionita
- From the Departments of Biomedical Engineering (R.A.R., A.B.A., J.L.S., A.R.P., M.M.S.B., C.N.I.).,Neurosurgery (K.V.S., M.W., A.R.P., A.H.S., J.M.D., E.I.L., C.N.I.).,Canon Stroke and Vascular Research Center (R.A.R., K.V.S., M.W., A.B.A., J.L.S., A.R.P., M.M.S.B., A.H.S., J.M.D., E.I.L., C.N.I.), Buffalo, New York
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9
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Rajabzadeh-Oghaz H, Wang J, Varble N, Sugiyama SI, Shimizu A, Jing L, Liu J, Yang X, Siddiqui AH, Davies JM, Meng H. Novel Models for Identification of the Ruptured Aneurysm in Patients with Subarachnoid Hemorrhage with Multiple Aneurysms. AJNR Am J Neuroradiol 2019; 40:1939-1946. [PMID: 31649161 DOI: 10.3174/ajnr.a6259] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 08/23/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE In patients with SAH with multiple intracranial aneurysms, often the hemorrhage pattern does not indicate the rupture source. Angiographic findings (intracranial aneurysm size and shape) could help but may not be reliable. Our purpose was to test whether existing parameters could identify the ruptured intracranial aneurysm in patients with multiple intracranial aneurysms and whether composite predictive models could improve the identification. MATERIALS AND METHODS We retrospectively collected angiographic and medical records of 93 patients with SAH with at least 2 intracranial aneurysms (total of 206 saccular intracranial aneurysms, 93 ruptured), in which the ruptured intracranial aneurysm was confirmed through surgery or definitive hemorrhage patterns. We calculated 13 morphologic and 10 hemodynamic parameters along with location and type (sidewall/bifurcation) and tested their ability to identify rupture in the 93 patients. To build predictive models, we randomly assigned 70 patients to training and 23 to holdout testing cohorts. Using a linear regression model with a customized cost function and 10-fold cross-validation, we trained 2 rupture identification models: RIMC using all parameters and RIMM excluding hemodynamics. RESULTS The 25 study parameters had vastly different positive predictive values (31%-87%) for identifying rupture, the highest being size ratio at 87%. RIMC incorporated size ratio, undulation index, relative residence time, and type; RIMM had only size ratio, undulation index, and type. During cross-validation, positive predictive values for size ratio, RIMM, and RIMC were 86% ± 4%, 90% ± 4%, and 93% ± 4%, respectively. In testing, size ratio and RIMM had positive predictive values of 85%, while RIMC had 92%. CONCLUSIONS Size ratio was the best individual factor for identifying the ruptured aneurysm; however, RIMC, followed by RIMM, outperformed existing parameters.
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Affiliation(s)
- H Rajabzadeh-Oghaz
- From the Canon Stroke and Vascular Research Center (H.R.-O., N.V., A.H.S., J.M.D., H.M.).,Departments of Mechanical and Aerospace Engineering (H.R.-O., N.V., H.M.)
| | - J Wang
- Biostatistics (J.W.), University at Buffalo, Buffalo, New York
| | - N Varble
- From the Canon Stroke and Vascular Research Center (H.R.-O., N.V., A.H.S., J.M.D., H.M.).,Departments of Mechanical and Aerospace Engineering (H.R.-O., N.V., H.M.)
| | - S-I Sugiyama
- Department of Neuroanesthesia (S.-I.S.), Kohnan Hospital, Sendai, Japan.,Department of Neurosurgery (S.-I.S., A.S.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - A Shimizu
- Department of Neurosurgery (S.-I.S., A.S.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - L Jing
- Department of Interventional Neuroradiology (L.J., J.L., X.Y., H.M.), Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - J Liu
- Department of Interventional Neuroradiology (L.J., J.L., X.Y., H.M.), Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - X Yang
- Department of Interventional Neuroradiology (L.J., J.L., X.Y., H.M.), Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - A H Siddiqui
- From the Canon Stroke and Vascular Research Center (H.R.-O., N.V., A.H.S., J.M.D., H.M.).,Departments of Neurosurgery (A.H.S., J.M.D.).,Radiology (A.H.S.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.,Jacobs Institute (A.H.S., J.M.D), Buffalo, New York
| | - J M Davies
- From the Canon Stroke and Vascular Research Center (H.R.-O., N.V., A.H.S., J.M.D., H.M.).,Departments of Neurosurgery (A.H.S., J.M.D.).,Bioinformatics (J.M.D.).,Jacobs Institute (A.H.S., J.M.D), Buffalo, New York
| | - H Meng
- From the Canon Stroke and Vascular Research Center (H.R.-O., N.V., A.H.S., J.M.D., H.M.) .,Departments of Mechanical and Aerospace Engineering (H.R.-O., N.V., H.M.).,Department of Interventional Neuroradiology (L.J., J.L., X.Y., H.M.), Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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10
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Krebs JM, Shankar A, Setlur Nagesh SV, Davies JM, Snyder KV, Levy EI, Hopkins LN, Mokin M, Bednarek DR, Siddiqui AH, Rudin S. Flow-Pattern Details in an Aneurysm Model Using High-Speed 1000-Frames-per-Second Angiography. AJNR Am J Neuroradiol 2019; 40:1197-1200. [PMID: 31171521 DOI: 10.3174/ajnr.a6090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/25/2019] [Indexed: 11/07/2022]
Abstract
Traditional digital subtraction angiography provides rather limited evaluation of contrast flow dynamics when studying and treating intracranial brain aneurysms. A 1000-frames-per-second photon-counting x-ray detector was used to image detailed iodine-contrast flow patterns in an internal carotid artery aneurysm of a 3D-printed vascular phantom. High-speed imaging revealed differences in vortex and inflow patterns with and without a Pipeline Embolization Device flow diverter in more detail and clarity than could be seen in standard pulsed angiography. Improved temporal imaging has the potential to impact the outcomes of endovascular interventions by allowing clinicians to better understand and act on flow dynamics in real-time.
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Affiliation(s)
- J M Krebs
- From the Canon (formerly Toshiba) Stroke and Vascular Research Center (J.M.K., A.K., S.V.S.N., K.V.S., E.I.L., L.N.H., D.R.B., A.H.S., S.R.)
| | - A Shankar
- From the Canon (formerly Toshiba) Stroke and Vascular Research Center (J.M.K., A.K., S.V.S.N., K.V.S., E.I.L., L.N.H., D.R.B., A.H.S., S.R.)
| | - S V Setlur Nagesh
- From the Canon (formerly Toshiba) Stroke and Vascular Research Center (J.M.K., A.K., S.V.S.N., K.V.S., E.I.L., L.N.H., D.R.B., A.H.S., S.R.).,Departments of Neurosurgery (S.V.S.N., J.M.D., K.V.S., E.I.L., L.N.H., D.R.B., A.H.S., S.R.)
| | - J M Davies
- Department of Neurosurgery (J.M.D., K.V.S., E.I.L., L.N.H., A.H.S., S.R.), Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Departments of Neurosurgery (S.V.S.N., J.M.D., K.V.S., E.I.L., L.N.H., D.R.B., A.H.S., S.R.).,Bioinformatics (J.M.D.).,Jacobs Institute (J.M.D., K.V.S., E.I.L., L.N.H., A.H.S.), Buffalo, New York
| | - K V Snyder
- From the Canon (formerly Toshiba) Stroke and Vascular Research Center (J.M.K., A.K., S.V.S.N., K.V.S., E.I.L., L.N.H., D.R.B., A.H.S., S.R.).,Department of Neurosurgery (J.M.D., K.V.S., E.I.L., L.N.H., A.H.S., S.R.), Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Departments of Neurosurgery (S.V.S.N., J.M.D., K.V.S., E.I.L., L.N.H., D.R.B., A.H.S., S.R.).,Neurology (K.V.S.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York.,Jacobs Institute (J.M.D., K.V.S., E.I.L., L.N.H., A.H.S.), Buffalo, New York
| | - E I Levy
- From the Canon (formerly Toshiba) Stroke and Vascular Research Center (J.M.K., A.K., S.V.S.N., K.V.S., E.I.L., L.N.H., D.R.B., A.H.S., S.R.).,Department of Neurosurgery (J.M.D., K.V.S., E.I.L., L.N.H., A.H.S., S.R.), Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Departments of Neurosurgery (S.V.S.N., J.M.D., K.V.S., E.I.L., L.N.H., D.R.B., A.H.S., S.R.).,Radiology (E.I.L., L.N.H., D.R.B., A.H.S., S.R.).,Jacobs Institute (J.M.D., K.V.S., E.I.L., L.N.H., A.H.S.), Buffalo, New York
| | - L N Hopkins
- From the Canon (formerly Toshiba) Stroke and Vascular Research Center (J.M.K., A.K., S.V.S.N., K.V.S., E.I.L., L.N.H., D.R.B., A.H.S., S.R.).,Department of Neurosurgery (J.M.D., K.V.S., E.I.L., L.N.H., A.H.S., S.R.), Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Departments of Neurosurgery (S.V.S.N., J.M.D., K.V.S., E.I.L., L.N.H., D.R.B., A.H.S., S.R.).,Radiology (E.I.L., L.N.H., D.R.B., A.H.S., S.R.).,Jacobs Institute (J.M.D., K.V.S., E.I.L., L.N.H., A.H.S.), Buffalo, New York
| | - M Mokin
- Department of Neurosurgery and Brain Repair (M.M.), University of South Florida, Tampa, Florida
| | - D R Bednarek
- From the Canon (formerly Toshiba) Stroke and Vascular Research Center (J.M.K., A.K., S.V.S.N., K.V.S., E.I.L., L.N.H., D.R.B., A.H.S., S.R.).,Departments of Neurosurgery (S.V.S.N., J.M.D., K.V.S., E.I.L., L.N.H., D.R.B., A.H.S., S.R.).,Radiology (E.I.L., L.N.H., D.R.B., A.H.S., S.R.)
| | - A H Siddiqui
- From the Canon (formerly Toshiba) Stroke and Vascular Research Center (J.M.K., A.K., S.V.S.N., K.V.S., E.I.L., L.N.H., D.R.B., A.H.S., S.R.).,Department of Neurosurgery (J.M.D., K.V.S., E.I.L., L.N.H., A.H.S., S.R.), Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Departments of Neurosurgery (S.V.S.N., J.M.D., K.V.S., E.I.L., L.N.H., D.R.B., A.H.S., S.R.).,Radiology (E.I.L., L.N.H., D.R.B., A.H.S., S.R.).,Jacobs Institute (J.M.D., K.V.S., E.I.L., L.N.H., A.H.S.), Buffalo, New York
| | - S Rudin
- From the Canon (formerly Toshiba) Stroke and Vascular Research Center (J.M.K., A.K., S.V.S.N., K.V.S., E.I.L., L.N.H., D.R.B., A.H.S., S.R.) .,Departments of Biomedical Engineering (S.R.).,Mechanical and Aerospace Engineering (S.R.).,Electrical Engineering (S.R.), University at Buffalo, State University of New York, Buffalo, New York.,Department of Neurosurgery (J.M.D., K.V.S., E.I.L., L.N.H., A.H.S., S.R.), Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Departments of Neurosurgery (S.V.S.N., J.M.D., K.V.S., E.I.L., L.N.H., D.R.B., A.H.S., S.R.).,Radiology (E.I.L., L.N.H., D.R.B., A.H.S., S.R.)
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11
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Setlur Nagesh SV, Fennel V, Krebs J, Ionita C, Davies J, Bednarek DR, Mokin M, Siddiqui AH, Rudin S. High-Definition Zoom Mode, a High-Resolution X-Ray Microscope for Neurointerventional Treatment Procedures: A Blinded-Rater Clinical-Utility Study. AJNR Am J Neuroradiol 2019; 40:302-308. [PMID: 30591511 DOI: 10.3174/ajnr.a5922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/12/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Quality of visualization of treatment devices during critical stages of endovascular interventions, can directly impact their safety and efficacy. Our aim was to compare the visualization of neurointerventional procedures and treatment devices using a 194-μm pixel flat panel detector mode and a 76-μm pixel complementary metal oxide semiconductor detector mode (high definition) of a new-generation x-ray detector system using a blinded-rater study. MATERIALS AND METHODS Deployment of flow-diversion devices for the treatment of internal carotid artery aneurysms was performed under flat panel detector and high-definition-mode image guidance in a neurointerventional phantom simulating patient cranium and tissue attenuation, embedded with 3D-printed intracranial vascular models, each with an aneurysm in the ICA segment. Image-sequence pairs of device deployments for each detector mode, under similar exposure and FOV conditions, were evaluated by 2 blinded experienced neurointerventionalists who independently selected their preferred image on the basis of visualization of anatomic features, image noise, and treatment device. They rated their selection as either similar, better, much better, or substantially better than the other choice. Inter- and intrarater agreement was calculated and categorized as poor, moderate, and good. RESULTS Both raters demonstrating good inter- and intrarater agreement selected high-definition-mode images with a frequency of at least 95% each and, on average, rated the high-definition images as much better than flat panel detector images with a frequency of 73% from a total of 60 image pairs. CONCLUSIONS Due to their higher resolution, high-definition-mode images are sharper and visually preferred compared with the flat panel detector images. The improved imaging provided by the high-definition mode can potentially provide an advantage during neurointerventional procedures.
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Affiliation(s)
- S V Setlur Nagesh
- From the Canon (formerly Toshiba) Stroke and Vascular Research Center (S.V.S.N., J.K., C.I., D.R.B., A.H.S., S.R.)
- Departments of Neurosurgery (S.V.S.N., V.F., C.I., J.D., D.R.B., A.H.S.)
| | - V Fennel
- Department of Neurosurgery (V.F., J.D.), Gates Vascular Institute at Kaleida Health, Buffalo, New York
- Departments of Neurosurgery (S.V.S.N., V.F., C.I., J.D., D.R.B., A.H.S.)
| | - J Krebs
- From the Canon (formerly Toshiba) Stroke and Vascular Research Center (S.V.S.N., J.K., C.I., D.R.B., A.H.S., S.R.)
| | - C Ionita
- From the Canon (formerly Toshiba) Stroke and Vascular Research Center (S.V.S.N., J.K., C.I., D.R.B., A.H.S., S.R.)
- Departments of Biomedical Engineering (C.I., S.R.)
- Departments of Neurosurgery (S.V.S.N., V.F., C.I., J.D., D.R.B., A.H.S.)
| | - J Davies
- Department of Neurosurgery (V.F., J.D.), Gates Vascular Institute at Kaleida Health, Buffalo, New York
- Departments of Neurosurgery (S.V.S.N., V.F., C.I., J.D., D.R.B., A.H.S.)
- Bioinformatics (J.D.)
- Jacobs Institute (J.D., A.H.S.), Buffalo, New York
| | - D R Bednarek
- From the Canon (formerly Toshiba) Stroke and Vascular Research Center (S.V.S.N., J.K., C.I., D.R.B., A.H.S., S.R.)
- Departments of Neurosurgery (S.V.S.N., V.F., C.I., J.D., D.R.B., A.H.S.)
- Radiology (D.R.B., A.H.S., S.R.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - M Mokin
- Department of Neurosurgery and Brain Repair (M.M.), University of South Florida, Tampa, Florida
| | - A H Siddiqui
- From the Canon (formerly Toshiba) Stroke and Vascular Research Center (S.V.S.N., J.K., C.I., D.R.B., A.H.S., S.R.)
- Departments of Neurosurgery (S.V.S.N., V.F., C.I., J.D., D.R.B., A.H.S.)
- Radiology (D.R.B., A.H.S., S.R.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
- Jacobs Institute (J.D., A.H.S.), Buffalo, New York
| | - S Rudin
- From the Canon (formerly Toshiba) Stroke and Vascular Research Center (S.V.S.N., J.K., C.I., D.R.B., A.H.S., S.R.)
- Departments of Biomedical Engineering (C.I., S.R.)
- Mechanical and Aerospace Engineering (S.R.)
- Electrical Engineering (S.R.), University at Buffalo, State University of New York; Buffalo, New York
- Radiology (D.R.B., A.H.S., S.R.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
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12
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Paliwal N, Tutino VM, Shallwani H, Beecher JS, Damiano RJ, Shakir HJ, Atwal GS, Fennell VS, Natarajan SK, Levy EI, Siddiqui AH, Davies JM, Meng H. Ostium Ratio and Neck Ratio Could Predict the Outcome of Sidewall Intracranial Aneurysms Treated with Flow Diverters. AJNR Am J Neuroradiol 2019; 40:288-294. [PMID: 30679216 DOI: 10.3174/ajnr.a5953] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 11/07/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Incompletely occluded flow diverter treated aneurysms remain at risk of rupture and thromboembolic complications. Our aim was to identify the potential for incomplete occlusion of intracranial aneurysms treated by flow diverters. We investigated whether aneurysm ostium size in relation to parent artery size affects angiographic outcomes of flow diverter-treated sidewall aneurysms. MATERIALS AND METHODS Flow diverter-treated sidewall aneurysms were divided into "occluded" and "residual" (incomplete occlusion) groups based on 6-month angiographic follow-up. We calculated the ostium ratio, a new parameter defined as the aneurysm ostium surface area versus the circumferential surface area of the parent artery. We also calculated the neck ratio, defined as clinical aneurysm neck diameter versus parent artery diameter from pretreatment 2D DSA, as a 2D surrogate. We compared the performance of these ratios with existing aneurysm morphometrics (size, neck diameter, volume, aspect ratio, size ratio, undulation index, nonsphericity index, ellipticity index, bottleneck factor, aneurysm angle, and parent vessel angle) and flow diverter-related parameters (metal coverage rate and pore density). Statistical tests and receiver operating characteristic analyses were performed to identify significantly different parameters between the 2 groups and test their predictive performances. RESULTS We included 63 flow diverter-treated aneurysms, 46 occluded and 17 residual. The ostium ratio and neck ratio were significantly higher in the residual group than in the occluded group (P < .001 and P = .02, respectively), whereas all other parameters showed no statistical difference. As discriminating parameters for occlusion, ostium ratio and neck ratio achieved areas under the curve of 0.912 (95% CI, 0.838-0.985) and 0.707 (95% CI, 0.558-0.856), respectively. CONCLUSIONS High ostium ratios and neck ratios could predict incomplete occlusion of flow diverter-treated sidewall aneurysms. Neck ratio can be easily calculated by interventionists to predict flow-diverter treatment outcomes.
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Affiliation(s)
- N Paliwal
- From the Department of Mechanical and Aerospace Engineering (N.P., R.J.D., H.M.).,Canon Stroke and Vascular Research Center (N.P., V.M.T., R.J.D., E.I.L., A.H.S., J.M.D., H.M.)
| | - V M Tutino
- Canon Stroke and Vascular Research Center (N.P., V.M.T., R.J.D., E.I.L., A.H.S., J.M.D., H.M.).,Department of Biomedical Engineering (V.M.T., H.M.), University at Buffalo, Buffalo, New York.,Departments of Neurosurgery (V.M.T., H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., E.I.L., A.H.S., J.M.D., H.M.)
| | - H Shallwani
- Departments of Neurosurgery (V.M.T., H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., E.I.L., A.H.S., J.M.D., H.M.).,Department of Neurosurgery (H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., A.H.S., J.M.D.), Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - J S Beecher
- Departments of Neurosurgery (V.M.T., H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., E.I.L., A.H.S., J.M.D., H.M.).,Department of Neurosurgery (H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., A.H.S., J.M.D.), Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - R J Damiano
- From the Department of Mechanical and Aerospace Engineering (N.P., R.J.D., H.M.).,Canon Stroke and Vascular Research Center (N.P., V.M.T., R.J.D., E.I.L., A.H.S., J.M.D., H.M.)
| | - H J Shakir
- Departments of Neurosurgery (V.M.T., H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., E.I.L., A.H.S., J.M.D., H.M.).,Department of Neurosurgery (H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., A.H.S., J.M.D.), Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - G S Atwal
- Departments of Neurosurgery (V.M.T., H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., E.I.L., A.H.S., J.M.D., H.M.).,Department of Neurosurgery (H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., A.H.S., J.M.D.), Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - V S Fennell
- Departments of Neurosurgery (V.M.T., H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., E.I.L., A.H.S., J.M.D., H.M.).,Department of Neurosurgery (H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., A.H.S., J.M.D.), Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - S K Natarajan
- Departments of Neurosurgery (V.M.T., H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., E.I.L., A.H.S., J.M.D., H.M.).,Department of Neurosurgery (H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., A.H.S., J.M.D.), Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - E I Levy
- Canon Stroke and Vascular Research Center (N.P., V.M.T., R.J.D., E.I.L., A.H.S., J.M.D., H.M.).,Departments of Neurosurgery (V.M.T., H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., E.I.L., A.H.S., J.M.D., H.M.).,Radiology (E.I.L., A.H.S.)
| | - A H Siddiqui
- Canon Stroke and Vascular Research Center (N.P., V.M.T., R.J.D., E.I.L., A.H.S., J.M.D., H.M.).,Departments of Neurosurgery (V.M.T., H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., E.I.L., A.H.S., J.M.D., H.M.).,Radiology (E.I.L., A.H.S.).,Department of Neurosurgery (H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., A.H.S., J.M.D.), Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Jacobs Institute (A.H.S., J.M.D.), Buffalo, New York
| | - J M Davies
- Canon Stroke and Vascular Research Center (N.P., V.M.T., R.J.D., E.I.L., A.H.S., J.M.D., H.M.).,Departments of Neurosurgery (V.M.T., H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., E.I.L., A.H.S., J.M.D., H.M.).,Biomedical Informatics (J.M.D.), Jacobs School of Medicine, University at Buffalo, Buffalo, New York.,Department of Neurosurgery (H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., A.H.S., J.M.D.), Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Jacobs Institute (A.H.S., J.M.D.), Buffalo, New York
| | - H Meng
- From the Department of Mechanical and Aerospace Engineering (N.P., R.J.D., H.M.) .,Canon Stroke and Vascular Research Center (N.P., V.M.T., R.J.D., E.I.L., A.H.S., J.M.D., H.M.).,Department of Biomedical Engineering (V.M.T., H.M.), University at Buffalo, Buffalo, New York.,Departments of Neurosurgery (V.M.T., H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., E.I.L., A.H.S., J.M.D., H.M.)
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13
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Adeeb N, Griessenauer CJ, Dmytriw AA, Shallwani H, Gupta R, Foreman PM, Shakir H, Moore J, Limbucci N, Mangiafico S, Kumar A, Michelozzi C, Zhang Y, Pereira VM, Matouk CC, Harrigan MR, Siddiqui AH, Levy EI, Renieri L, Marotta TR, Cognard C, Ogilvy CS, Thomas AJ. Risk of Branch Occlusion and Ischemic Complications with the Pipeline Embolization Device in the Treatment of Posterior Circulation Aneurysms. AJNR Am J Neuroradiol 2018; 39:1303-1309. [PMID: 29880475 DOI: 10.3174/ajnr.a5696] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 04/10/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Flow diversion with the Pipeline Embolization Device is increasingly used for endovascular treatment of intracranial aneurysms due to high reported obliteration rates and low associated morbidity. While obliteration of covered branches in the anterior circulation is generally asymptomatic, this has not been studied within the posterior circulation. The aim of this study was to evaluate the association between branch coverage and occlusion, as well as associated ischemic events in a cohort of patients with posterior circulation aneurysms treated with the Pipeline Embolization Device. MATERIALS AND METHODS A retrospective review of prospectively maintained databases at 8 academic institutions from 2009 to 2016 was performed to identify patients with posterior circulation aneurysms treated with the Pipeline Embolization Device. Branch coverage following placement was evaluated, including the posterior inferior cerebellar artery, anterior inferior cerebellar artery, superior cerebellar artery, and posterior cerebral artery. If the Pipeline Embolization Device crossed the ostia of the contralateral vertebral artery, its long-term patency was assessed as well. RESULTS A cohort of 129 consecutive patients underwent treatment of 131 posterior circulation aneurysms with the Pipeline Embolization Device. Adjunctive coiling was used in 40 (31.0%) procedures. One or more branches were covered in 103 (79.8%) procedures. At a median follow-up of 11 months, 11% were occluded, most frequently the vertebral artery (34.8%). Branch obliteration was most common among asymptomatic aneurysms (P < .001). Ischemic complications occurred in 29 (22.5%) procedures. On multivariable analysis, there was no significant difference in ischemic complications in cases in which a branch was covered (P = .24) or occluded (P = .16). CONCLUSIONS There was a low occlusion incidence in end arteries following branch coverage at last follow-up. The incidence was higher in the posterior cerebral artery and vertebral artery where collateral supply is high. Branch occlusion was not associated with a significant increase in ischemic complications.
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Affiliation(s)
- N Adeeb
- From the Beth Israel Deaconess Medical Center (N.A., C.J.G., A.A.D., R.G., J.M., C.S.O., A.J.T.), Harvard Medical School, Boston, Massachusetts
| | - C J Griessenauer
- From the Beth Israel Deaconess Medical Center (N.A., C.J.G., A.A.D., R.G., J.M., C.S.O., A.J.T.), Harvard Medical School, Boston, Massachusetts
- Department of Neurosurgery (C.J.G.), Geisinger Medical Center, Geisinger Commonwealth School of Medicine, Danville, Pennsylvania
| | - A A Dmytriw
- From the Beth Israel Deaconess Medical Center (N.A., C.J.G., A.A.D., R.G., J.M., C.S.O., A.J.T.), Harvard Medical School, Boston, Massachusetts
- Department of Medical Imaging (A.A.D., Y.Z., V.M.P.), Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Division of Diagnostic and Therapeutic Neuroradiology (A.A.D., A.K., T.R.M.), St. Michael's Hospital, Toronto, Ontario, Canada
| | - H Shallwani
- Department of Neurosurgery (H. Shallwani, H. Shakir, A.H.S., E.I.L.), State University of New York at Buffalo, Buffalo, New York
| | - R Gupta
- From the Beth Israel Deaconess Medical Center (N.A., C.J.G., A.A.D., R.G., J.M., C.S.O., A.J.T.), Harvard Medical School, Boston, Massachusetts
| | - P M Foreman
- Department of Neurosurgery (P.M.F., M.R.H.), University of Alabama at Birmingham, Birmingham, Alabama
| | - H Shakir
- Department of Neurosurgery (H. Shallwani, H. Shakir, A.H.S., E.I.L.), State University of New York at Buffalo, Buffalo, New York
| | - J Moore
- From the Beth Israel Deaconess Medical Center (N.A., C.J.G., A.A.D., R.G., J.M., C.S.O., A.J.T.), Harvard Medical School, Boston, Massachusetts
| | - N Limbucci
- Department of Interventional Neuroradiology (N.L., S.M., L.R.), University of Florence, Florence, Italy
| | - S Mangiafico
- Department of Interventional Neuroradiology (N.L., S.M., L.R.), University of Florence, Florence, Italy
| | - A Kumar
- Division of Diagnostic and Therapeutic Neuroradiology (A.A.D., A.K., T.R.M.), St. Michael's Hospital, Toronto, Ontario, Canada
| | - C Michelozzi
- Department of Diagnostic and Therapeutic Neuroradiology (C.M., C.C.), Toulouse University Hospital, Toulouse, France
| | - Y Zhang
- Department of Medical Imaging (A.A.D., Y.Z., V.M.P.), Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - V M Pereira
- Department of Medical Imaging (A.A.D., Y.Z., V.M.P.), Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - C C Matouk
- Department of Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, Connecticut
| | - M R Harrigan
- Department of Neurosurgery (P.M.F., M.R.H.), University of Alabama at Birmingham, Birmingham, Alabama
| | - A H Siddiqui
- Department of Neurosurgery (H. Shallwani, H. Shakir, A.H.S., E.I.L.), State University of New York at Buffalo, Buffalo, New York
| | - E I Levy
- Department of Neurosurgery (H. Shallwani, H. Shakir, A.H.S., E.I.L.), State University of New York at Buffalo, Buffalo, New York
| | - L Renieri
- Department of Interventional Neuroradiology (N.L., S.M., L.R.), University of Florence, Florence, Italy
| | - T R Marotta
- Division of Diagnostic and Therapeutic Neuroradiology (A.A.D., A.K., T.R.M.), St. Michael's Hospital, Toronto, Ontario, Canada
| | - C Cognard
- Department of Diagnostic and Therapeutic Neuroradiology (C.M., C.C.), Toulouse University Hospital, Toulouse, France
| | - C S Ogilvy
- From the Beth Israel Deaconess Medical Center (N.A., C.J.G., A.A.D., R.G., J.M., C.S.O., A.J.T.), Harvard Medical School, Boston, Massachusetts
| | - A J Thomas
- From the Beth Israel Deaconess Medical Center (N.A., C.J.G., A.A.D., R.G., J.M., C.S.O., A.J.T.), Harvard Medical School, Boston, Massachusetts
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14
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Sonig A, Setlur Nagesh SV, Fennell VS, Gandhi S, Rangel-Castilla L, Ionita CN, Snyder KV, Hopkins LN, Bednarek DR, Rudin S, Siddiqui AH, Levy EI. A Patient Dose-Reduction Technique for Neuroendovascular Image-Guided Interventions: Image-Quality Comparison Study. AJNR Am J Neuroradiol 2018; 39:734-741. [PMID: 29449282 DOI: 10.3174/ajnr.a5552] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 12/06/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The ROI-dose-reduced intervention technique represents an extension of ROI fluoroscopy combining x-ray entrance skin dose reduction with spatially different recursive temporal filtering to reduce excessive image noise in the dose-reduced periphery in real-time. The aim of our study was to compare the image quality of simulated neurointerventions with regular and reduced radiation doses using a standard flat panel detector system. MATERIALS AND METHODS Ten 3D-printed intracranial aneurysm models were generated on the basis of a single patient vasculature derived from intracranial DSA and CTA. The incident dose to each model was reduced using a 0.7-mm-thick copper attenuator with a circular ROI hole (10-mm diameter) in the middle mounted inside the Infinix C-arm. Each model was treated twice with a primary coiling intervention using ROI-dose-reduced intervention and regular-dose intervention protocols. Eighty images acquired at various intervention stages were shown twice to 2 neurointerventionalists who independently scored imaging qualities (visibility of aneurysm-parent vessel morphology, associated vessels, and/or devices used). Dose-reduction measurements were performed using an ionization chamber. RESULTS A total integral dose reduction of 62% per frame was achieved. The mean scores for regular-dose intervention and ROI dose-reduced intervention images did not differ significantly, suggesting similar image quality. Overall intrarater agreement for all scored criteria was substantial (Kendall τ = 0.62887; P < .001). Overall interrater agreement for all criteria was fair (κ = 0.2816; 95% CI, 0.2060-0.3571). CONCLUSIONS Substantial dose reduction (62%) with a live peripheral image was achieved without compromising feature visibility during neuroendovascular interventions.
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Affiliation(s)
- A Sonig
- From the Departments of Neurosurgery (A.S., V.S.F., L.R.-C., C.N.I., K.V.S., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).,Department of Neurosurgery (A.S., V.S.F., S.G., L.R.-C., K.V.S., L.N.H., S.R., A.H.S., E.I.L.), Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - S V Setlur Nagesh
- Toshiba Stroke and Vascular Research Center (S.V.S.N., C.N.I., L.N.H., D.R.B., S.R., A.H.S., E.I.L.)
| | - V S Fennell
- From the Departments of Neurosurgery (A.S., V.S.F., L.R.-C., C.N.I., K.V.S., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).,Department of Neurosurgery (A.S., V.S.F., S.G., L.R.-C., K.V.S., L.N.H., S.R., A.H.S., E.I.L.), Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - S Gandhi
- Neurology (S.G., K.V.S.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York.,Department of Neurosurgery (A.S., V.S.F., S.G., L.R.-C., K.V.S., L.N.H., S.R., A.H.S., E.I.L.), Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Buffalo Neuroimaging Analysis Center (S.G.), Buffalo, New York
| | - L Rangel-Castilla
- From the Departments of Neurosurgery (A.S., V.S.F., L.R.-C., C.N.I., K.V.S., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).,Department of Neurosurgery (A.S., V.S.F., S.G., L.R.-C., K.V.S., L.N.H., S.R., A.H.S., E.I.L.), Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - C N Ionita
- From the Departments of Neurosurgery (A.S., V.S.F., L.R.-C., C.N.I., K.V.S., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).,Toshiba Stroke and Vascular Research Center (S.V.S.N., C.N.I., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).,Department of Biomedical Engineering (C.N.I., S.R.)
| | - K V Snyder
- From the Departments of Neurosurgery (A.S., V.S.F., L.R.-C., C.N.I., K.V.S., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).,Radiology (K.V.S., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).,Neurology (S.G., K.V.S.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York.,Department of Neurosurgery (A.S., V.S.F., S.G., L.R.-C., K.V.S., L.N.H., S.R., A.H.S., E.I.L.), Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - L N Hopkins
- From the Departments of Neurosurgery (A.S., V.S.F., L.R.-C., C.N.I., K.V.S., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).,Radiology (K.V.S., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).,Department of Neurosurgery (A.S., V.S.F., S.G., L.R.-C., K.V.S., L.N.H., S.R., A.H.S., E.I.L.), Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Toshiba Stroke and Vascular Research Center (S.V.S.N., C.N.I., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).,Jacobs Institute (L.N.H., A.H.S.), Buffalo, New York
| | - D R Bednarek
- From the Departments of Neurosurgery (A.S., V.S.F., L.R.-C., C.N.I., K.V.S., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).,Radiology (K.V.S., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).,Toshiba Stroke and Vascular Research Center (S.V.S.N., C.N.I., L.N.H., D.R.B., S.R., A.H.S., E.I.L.)
| | - S Rudin
- From the Departments of Neurosurgery (A.S., V.S.F., L.R.-C., C.N.I., K.V.S., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).,Radiology (K.V.S., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).,Department of Neurosurgery (A.S., V.S.F., S.G., L.R.-C., K.V.S., L.N.H., S.R., A.H.S., E.I.L.), Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Toshiba Stroke and Vascular Research Center (S.V.S.N., C.N.I., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).,Department of Biomedical Engineering (C.N.I., S.R.).,Department of Mechanical and Aerospace Engineering (S.R.).,Department of Electrical Engineering (S.R.), University at Buffalo, State University of New York, Buffalo, New York
| | - A H Siddiqui
- From the Departments of Neurosurgery (A.S., V.S.F., L.R.-C., C.N.I., K.V.S., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).,Radiology (K.V.S., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).,Department of Neurosurgery (A.S., V.S.F., S.G., L.R.-C., K.V.S., L.N.H., S.R., A.H.S., E.I.L.), Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Toshiba Stroke and Vascular Research Center (S.V.S.N., C.N.I., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).,Jacobs Institute (L.N.H., A.H.S.), Buffalo, New York
| | - E I Levy
- From the Departments of Neurosurgery (A.S., V.S.F., L.R.-C., C.N.I., K.V.S., L.N.H., D.R.B., S.R., A.H.S., E.I.L.) .,Radiology (K.V.S., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).,Department of Neurosurgery (A.S., V.S.F., S.G., L.R.-C., K.V.S., L.N.H., S.R., A.H.S., E.I.L.), Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Toshiba Stroke and Vascular Research Center (S.V.S.N., C.N.I., L.N.H., D.R.B., S.R., A.H.S., E.I.L.)
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Adeeb N, Moore JM, Wirtz M, Griessenauer CJ, Foreman PM, Shallwani H, Gupta R, Dmytriw AA, Motiei-Langroudi R, Alturki A, Harrigan MR, Siddiqui AH, Levy EI, Thomas AJ, Ogilvy CS. Predictors of Incomplete Occlusion following Pipeline Embolization of Intracranial Aneurysms: Is It Less Effective in Older Patients? AJNR Am J Neuroradiol 2017; 38:2295-2300. [PMID: 28912285 DOI: 10.3174/ajnr.a5375] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 07/08/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Flow diversion with the Pipeline Embolization Device (PED) for the treatment of intracranial aneurysms is associated with a high rate of aneurysm occlusion. However, clinical and radiographic predictors of incomplete aneurysm occlusion are poorly defined. In this study, predictors of incomplete occlusion at last angiographic follow-up after PED treatment were assessed. MATERIALS AND METHODS A retrospective analysis of consecutive aneurysms treated with the PED between 2009 and 2016, at 3 academic institutions in the United States, was performed. Cases with angiographic follow-up were selected to evaluate factors predictive of incomplete aneurysm occlusion at last follow-up. RESULTS We identified 465 aneurysms treated with the PED; 380 (81.7%) aneurysms (329 procedures; median age, 58 years; female/male ratio, 4.8:1) had angiographic follow-up, and were included. Complete occlusion (100%) was achieved in 78.2% of aneurysms. Near-complete (90%-99%) and partial (<90%) occlusion were collectively achieved in 21.8% of aneurysms and defined as incomplete occlusion. Of aneurysms followed for at least 12 months (211 of 380), complete occlusion was achieved in 83.9%. Older age (older than 70 years), nonsmoking status, aneurysm location within the posterior communicating artery or posterior circulation, greater aneurysm maximal diameter (≥21 mm), and shorter follow-up time (<12 months) were significantly associated with incomplete aneurysm occlusion at last angiographic follow-up on univariable analysis. However, on multivariable logistic regression, only age, smoking status, and duration of follow-up were independently associated with occlusion status. CONCLUSIONS Complete occlusion following PED treatment of intracranial aneurysms can be influenced by several factors related to the patient, aneurysm, and treatment. Of these factors, older age (older than 70 years) and nonsmoking status were independent predictors of incomplete occlusion. While the physiologic explanation for these findings remains unknown, identification of factors predictive of incomplete aneurysm occlusion following PED placement can assist in patient selection and counseling and might provide insight into the biologic factors affecting endothelialization.
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Affiliation(s)
- N Adeeb
- From the Neurosurgical Service (N.A., J.M.M., M.W., C.J.G., R.G., A.A.D., R.M.-L., A.A., A.J.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Neurosurgery (N.A.), Louisiana State University, Shreveport, Louisiana
| | - J M Moore
- From the Neurosurgical Service (N.A., J.M.M., M.W., C.J.G., R.G., A.A.D., R.M.-L., A.A., A.J.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - M Wirtz
- From the Neurosurgical Service (N.A., J.M.M., M.W., C.J.G., R.G., A.A.D., R.M.-L., A.A., A.J.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - C J Griessenauer
- From the Neurosurgical Service (N.A., J.M.M., M.W., C.J.G., R.G., A.A.D., R.M.-L., A.A., A.J.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - P M Foreman
- Department of Neurosurgery (P.M.F., M.R.H.), University of Alabama at Birmingham, Birmingham, Alabama
| | - H Shallwani
- Department of Neurosurgery (H.S., A.H.S., E.I.L.), State University of New York at Buffalo, Buffalo, New York
| | - R Gupta
- From the Neurosurgical Service (N.A., J.M.M., M.W., C.J.G., R.G., A.A.D., R.M.-L., A.A., A.J.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - A A Dmytriw
- From the Neurosurgical Service (N.A., J.M.M., M.W., C.J.G., R.G., A.A.D., R.M.-L., A.A., A.J.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - R Motiei-Langroudi
- From the Neurosurgical Service (N.A., J.M.M., M.W., C.J.G., R.G., A.A.D., R.M.-L., A.A., A.J.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - A Alturki
- From the Neurosurgical Service (N.A., J.M.M., M.W., C.J.G., R.G., A.A.D., R.M.-L., A.A., A.J.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - M R Harrigan
- Department of Neurosurgery (P.M.F., M.R.H.), University of Alabama at Birmingham, Birmingham, Alabama
| | - A H Siddiqui
- Department of Neurosurgery (H.S., A.H.S., E.I.L.), State University of New York at Buffalo, Buffalo, New York
| | - E I Levy
- Department of Neurosurgery (H.S., A.H.S., E.I.L.), State University of New York at Buffalo, Buffalo, New York
| | - A J Thomas
- From the Neurosurgical Service (N.A., J.M.M., M.W., C.J.G., R.G., A.A.D., R.M.-L., A.A., A.J.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - C S Ogilvy
- From the Neurosurgical Service (N.A., J.M.M., M.W., C.J.G., R.G., A.A.D., R.M.-L., A.A., A.J.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Siddiqui F, Abbassi S, Siddiqui AH, Narula N, Saqib A, Chalhoub M. Trends and Outcomes of Noninvasive and Invasive Ventilation in Acute Respiratory Failure Due to Pneumonia. Chest 2017. [DOI: 10.1016/j.chest.2017.08.246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Adeeb N, Moore JM, Griessenauer CJ, Foreman PM, Shallwani H, Dmytriw AA, Shakir H, Siddiqui AH, Levy EI, Davies JM, Harrigan MR, Thomas AJ, Ogilvy CS. Treatment of Tandem Internal Carotid Artery Aneurysms Using a Single Pipeline Embolization Device: Evaluation of Safety and Efficacy. AJNR Am J Neuroradiol 2017; 38:1605-1609. [PMID: 28522668 DOI: 10.3174/ajnr.a5221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 03/13/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Tandem aneurysms are defined as multiple aneurysms located in close proximity on the same parent vessel. Endovascular treatment of these aneurysms has rarely been reported. Our aim was to evaluate the safety and efficacy of a single Pipeline Embolization Device for the treatment of tandem aneurysms of the internal carotid artery. MATERIALS AND METHODS A retrospective analysis of consecutive aneurysms treated with the Pipeline Embolization Device between 2009 and 2016 at 3 institutions in the United States was performed. Cases included aneurysms of the ICA treated with a single Pipeline Embolization Device, and they were divided into tandem versus solitary. Angiographic and clinical outcomes were compared. RESULTS The solitary group (median age, 58 years) underwent 184 Pipeline Embolization Device procedures for 184 aneurysms. The tandem group (median age, 50.5 years) underwent 34 procedures for 78 aneurysms. Aneurysms were primarily located along the paraophthalmic segment of the ICA in both the single and tandem groups (72.3% versus 78.2%, respectively, P = .53). The median maximal diameters in the solitary and tandem groups were 6.2 and 6.7 mm, respectively. Complete occlusion on the last angiographic follow-up was achieved in 75.1% of aneurysms in the single compared with 88.6%% in the tandem group (P = .06). Symptomatic thromboembolic complications were encountered in 2.7% and 8.8% of procedures in the single and tandem groups, respectively (P = .08). CONCLUSIONS Tandem aneurysms of the ICA can be treated with a single Pipeline Embolization Device with high rates of complete occlusion. While there appeared to be a trend toward higher thromboembolic complication rates, this did not reach statistical significance.
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Affiliation(s)
- N Adeeb
- From the Neurosurgical Service (N.A., J.M.M., C.J.G., A.A.D., A.J.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - J M Moore
- From the Neurosurgical Service (N.A., J.M.M., C.J.G., A.A.D., A.J.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - C J Griessenauer
- From the Neurosurgical Service (N.A., J.M.M., C.J.G., A.A.D., A.J.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - P M Foreman
- Department of Neurosurgery (P.M.F., M.R.H.), University of Alabama at Birmingham, Birmingham, Alabama
| | - H Shallwani
- Department of Neurosurgery (H. Shallwani, H. Shakir, A.H.S., E.I.L., J.M.D.), State University of New York at Buffalo, Buffalo, New York
| | - A A Dmytriw
- From the Neurosurgical Service (N.A., J.M.M., C.J.G., A.A.D., A.J.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - H Shakir
- Department of Neurosurgery (H. Shallwani, H. Shakir, A.H.S., E.I.L., J.M.D.), State University of New York at Buffalo, Buffalo, New York
| | - A H Siddiqui
- Department of Neurosurgery (H. Shallwani, H. Shakir, A.H.S., E.I.L., J.M.D.), State University of New York at Buffalo, Buffalo, New York
| | - E I Levy
- Department of Neurosurgery (H. Shallwani, H. Shakir, A.H.S., E.I.L., J.M.D.), State University of New York at Buffalo, Buffalo, New York
| | - J M Davies
- Department of Neurosurgery (H. Shallwani, H. Shakir, A.H.S., E.I.L., J.M.D.), State University of New York at Buffalo, Buffalo, New York
| | - M R Harrigan
- Department of Neurosurgery (P.M.F., M.R.H.), University of Alabama at Birmingham, Birmingham, Alabama
| | - A J Thomas
- From the Neurosurgical Service (N.A., J.M.M., C.J.G., A.A.D., A.J.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - C S Ogilvy
- From the Neurosurgical Service (N.A., J.M.M., C.J.G., A.A.D., A.J.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Abstract
INTRODUCTION Patients with haemophilia are prone to medical emergencies. Emergency departments (ED) often do not have a haematologist on-call for consultation. AIM The aim of this study was to determine the utilization of ED by patients with haemophilia. METHODS Retrospective review of the 'National ED Database Sample' for years 2006-2013 was performed. Patient and hospital demographics were collected. Hospital charges were projected to national levels using discharge-weighted variables. RESULTS During the 8-year study period, haemophilia patients made 162 982 ED visits. This represents 0.016% of total ED visits nationwide. Children utilized ED the most. More than half of patients resided in metropolitan cities; 20% had over $63 000 annual household income. Government insurances were the largest primary payers; 30% had private insurance. In the year 2012, 4488 ED visits with 21 000 diagnoses codes were recorded. Mean age was 29 years. Cardiovascular were the most frequently reported complaints followed by injuries, haemorrhages and sepsis. Seventy percent patients were treated and released from the ED. Two patients died in ED, whereas 35 after admission to hospital. Cause of death included Sepsis (n = 26) and brain haemorrhage (n = 4). Among children, injuries were the most frequent complaints followed by joint/soft tissue disorders; fevers and central line complications. Average charge per visit at private vs. public hospital was $2988 and $2254 respectively (P = 0.03). National estimate of total charges was $60 million. CONCLUSION Patients with haemophilia have tendency to utilize ED. Hypertension was the single most common presenting complaint in adults. No deaths were reported in children from brain haemorrhage.
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Affiliation(s)
- A Zakieh
- Department of Pediatrics, University of South Alabama, Mobile, AL, USA
| | - A H Siddiqui
- Department of Pediatrics, University of South Alabama, Mobile, AL, USA
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Damiano RJ, Tutino VM, Paliwal N, Ma D, Davies JM, Siddiqui AH, Meng H. Compacting a Single Flow Diverter versus Overlapping Flow Diverters for Intracranial Aneurysms: A Computational Study. AJNR Am J Neuroradiol 2017; 38:603-610. [PMID: 28057633 DOI: 10.3174/ajnr.a5062] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 10/27/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Locally compacting the mesh of a flow diverter by a dynamic push-pull technique can accelerate intracranial aneurysm healing. We asked how this deployment strategy compares with overlapping 2 flow diverters for aneurysmal flow reduction. MATERIALS AND METHODS Using a high-fidelity virtual stent placement method, we simulated 3 flow-diverter strategies (single noncompacted, 2 overlapped, and single compacted) in 3 aneurysms (fusiform, large saccular, and medium saccular). Computational fluid dynamics analysis provided posttreatment hemodynamic parameters, including time-averaged inflow rate, aneurysm-averaged velocity, wall shear stress, total absolute circulation, and turnover time. We examined the relationship between the achieved degree of compaction and aneurysm orifice area. RESULTS Flow-diverter compaction resulted in a compaction coverage of 57%, 47%, and 22% over the orifice of the fusiform, large, and medium saccular aneurysm, respectively. Compaction coverage increased linearly with orifice area. In the fusiform aneurysm, the single compacted flow diverter accomplished more aneurysmal flow reduction than the other 2 strategies, as indicated by all 5 hemodynamic parameters. In the 2 saccular aneurysms, the overlapped flow diverters achieved the most flow reduction, followed by the single compacted and the noncompacted flow diverter. CONCLUSIONS Compacting a single flow diverter can outperform overlapping 2 flow diverters in aneurysmal flow reduction, provided that the compaction produces a mesh denser than 2 overlapped flow diverters and this denser mesh covers a sufficient portion of the aneurysm orifice area, for which we suggest a minimum of 50%. This strategy is most effective for aneurysms with large orifices, especially fusiform aneurysms.
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Affiliation(s)
- R J Damiano
- From the Department of Mechanical and Aerospace Engineering (R.J.D., N.P., D.M., H.M.).,Toshiba Stroke and Vascular Research Center (R.J.D., V.M.T., N.P., D.M., J.M.D., A.H.S., H.M.)
| | - V M Tutino
- Toshiba Stroke and Vascular Research Center (R.J.D., V.M.T., N.P., D.M., J.M.D., A.H.S., H.M.).,Department of Biomedical Engineering (V.M.T., H.M.)
| | - N Paliwal
- From the Department of Mechanical and Aerospace Engineering (R.J.D., N.P., D.M., H.M.).,Toshiba Stroke and Vascular Research Center (R.J.D., V.M.T., N.P., D.M., J.M.D., A.H.S., H.M.)
| | - D Ma
- From the Department of Mechanical and Aerospace Engineering (R.J.D., N.P., D.M., H.M.).,Toshiba Stroke and Vascular Research Center (R.J.D., V.M.T., N.P., D.M., J.M.D., A.H.S., H.M.)
| | - J M Davies
- Toshiba Stroke and Vascular Research Center (R.J.D., V.M.T., N.P., D.M., J.M.D., A.H.S., H.M.).,Department of Neurosurgery (J.M.D., A.H.S., H.M.), University at Buffalo, State University of New York, Buffalo, New York
| | - A H Siddiqui
- Toshiba Stroke and Vascular Research Center (R.J.D., V.M.T., N.P., D.M., J.M.D., A.H.S., H.M.).,Department of Neurosurgery (J.M.D., A.H.S., H.M.), University at Buffalo, State University of New York, Buffalo, New York
| | - H Meng
- From the Department of Mechanical and Aerospace Engineering (R.J.D., N.P., D.M., H.M.) .,Toshiba Stroke and Vascular Research Center (R.J.D., V.M.T., N.P., D.M., J.M.D., A.H.S., H.M.).,Department of Biomedical Engineering (V.M.T., H.M.).,Department of Neurosurgery (J.M.D., A.H.S., H.M.), University at Buffalo, State University of New York, Buffalo, New York
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Brinjikji W, Lanzino G, Cloft HJ, Siddiqui AH, Boccardi E, Cekirge S, Fiorella D, Hanel R, Jabbour P, Levy E, Lopes D, Lylyk P, Szikora I, Kallmes DF. Risk Factors for Ischemic Complications following Pipeline Embolization Device Treatment of Intracranial Aneurysms: Results from the IntrePED Study. AJNR Am J Neuroradiol 2016; 37:1673-8. [PMID: 27102308 DOI: 10.3174/ajnr.a4807] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 02/09/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Risk factors for acute ischemic stroke following flow-diverter treatment of intracranial aneurysms are poorly understood. Using the International Retrospective Study of Pipeline Embolization Device (IntrePED) registry, we studied demographic, aneurysm, and procedural characteristics associated with postoperative acute ischemic stroke following Pipeline Embolization Device (PED) treatment. MATERIALS AND METHODS We identified patients in the IntrePED registry with post-PED-treatment acute ischemic stroke. The rate of postoperative acute ischemic stroke was determined by demographics, comorbidities, aneurysm characteristics, and procedure characteristics (including anticoagulation use, platelet testing, number of devices used, sheaths, and so forth). Categoric variables were compared with χ(2) testing, and continuous variables were compared with the Student t test. Odds ratios and 95% confidence intervals were obtained by using univariate logistic regression. Multivariate logistic regression analysis was used to determine which factors were independently associated with postoperative stroke. RESULTS Of 793 patients with 906 aneurysms, 36 (4.5%) patients had acute ischemic stroke. Twenty-six (72.2%) strokes occurred within 30 days of treatment (median, 3.5 days; range, 0-397 days). Ten patients died, and the remaining 26 had major neurologic morbidity. Variables associated with higher odds of acute ischemic stroke on univariate analysis included male sex, hypertension, treatment of MCA aneurysms, treatment of fusiform aneurysms, treatment of giant aneurysms, and use of multiple PEDs. However, on multivariate analysis, the only one of these variables independently associated with stroke was treatment of fusiform aneurysms (OR, 2.74; 95% CI, 1.11-6.75; P = .03). Fusiform aneurysms that were associated with stroke were significantly larger than those not associated with stroke (mean, 24.5 ± 12.5 mm versus 13.6 ± 6.8 mm; P < .001). CONCLUSIONS Ischemic stroke following PED treatment is an uncommon-but-devastating complication. Fusiform aneurysms were the only variable independently associated with postoperative stroke.
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Affiliation(s)
- W Brinjikji
- From the Departments of Radiology (W.B., G.L., H.J.C., D.F.K.)
| | - G Lanzino
- From the Departments of Radiology (W.B., G.L., H.J.C., D.F.K.) Neurosurgery (G.L., H.J.C., D.F.K.), Mayo Clinic, Rochester, Minnesota
| | - H J Cloft
- From the Departments of Radiology (W.B., G.L., H.J.C., D.F.K.) Neurosurgery (G.L., H.J.C., D.F.K.), Mayo Clinic, Rochester, Minnesota
| | - A H Siddiqui
- Department of Neurosurgery (A.H.S., D.F., E.L.), State University of New York, Buffalo, New York
| | - E Boccardi
- Department of Neuroradiology (E.B.), Ospedale Niguarda-Ca' Granda, Milan, Italy
| | - S Cekirge
- Department of Radiology (S.C.), Hacettepe University Hospitals, Ankara, Turkey
| | - D Fiorella
- Department of Neurosurgery (A.H.S., D.F., E.L.), State University of New York, Buffalo, New York
| | - R Hanel
- Department of Neurosurgery (R.H.), Baptist Neurological Institute, Jacksonville, Florida
| | - P Jabbour
- Department Neurosurgery (P.J.), Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - E Levy
- Department of Neurosurgery (A.H.S., D.F., E.L.), State University of New York, Buffalo, New York
| | - D Lopes
- Department of Neurosurgery (D.L.), Rush University Medical Center, Chicago, Illinois
| | - P Lylyk
- Department of Interventional Neuroradiology (P.L.), Instituto Clínico ENERI, Buenos Aires, Argentina
| | - I Szikora
- Department of Neuroradiology (I.S.), National Institute of Neurosciences, Budapest, Hungary
| | - D F Kallmes
- From the Departments of Radiology (W.B., G.L., H.J.C., D.F.K.) Neurosurgery (G.L., H.J.C., D.F.K.), Mayo Clinic, Rochester, Minnesota
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Rangel-Castilla L, Snyder KV, Siddiqui AH, Levy EI, Hopkins LN. Endovascular intracranial treatment of acute ischemic strokes. J Cardiovasc Surg (Torino) 2015:R37Y9999N00A150096. [PMID: 26683822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Acute ischemic stroke (AIS) is the leading cause of long-term disability and the second cause of death worldwide. Intravenous (IV) tissue plasminogen activator (tPA) remains the only FDA-approved treatment for AIS. The use of IV tPA in AIS related to large-vessel occlusion (LVO) has shown low recanalization rates and poor clinical outcomes. Over the last decade, endovascular treatment has demonstrated safety and effectiveness in the management of LVO-associated AIS due to the evolution of endovascular techniques and technologies, beginning with intraarterial thrombolysis, aspiration, self- expanding intracranial stents, and now retrievable stents. With the recent publication of the results of 5 randomized controlled studies, mechanical thrombectomy in combination with IV tPA demonstrated significant radiographic and clinical benefit over traditional strategies with IV tPA alone. In light of these results, endovascular therapy has been placed at the forefront of stroke treatment, redefining the standard of care. This review presents the evolution of endovascular treatment of AIS resulting from LVO; provides an analysis of the initial and latest RCTs; and discusses the association between endovascular mechanical thrombectomy and clinical outcomes, functional outcomes, and rates of revascularization, intracranial hemorrhage, morbidity, and mortality. Finally, shortcomings of the recent technological advances, such as clot fragmentation, and potential solutions to overcome these drawbacks are presented.
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Affiliation(s)
- L Rangel-Castilla
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA -
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Brinjikji W, Lanzino G, Cloft HJ, Siddiqui AH, Kallmes DF. Risk Factors for Hemorrhagic Complications following Pipeline Embolization Device Treatment of Intracranial Aneurysms: Results from the International Retrospective Study of the Pipeline Embolization Device. AJNR Am J Neuroradiol 2015; 36:2308-13. [PMID: 26251427 DOI: 10.3174/ajnr.a4443] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 05/10/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Spontaneous intraparenchymal hemorrhage is a dreaded complication of unknown etiology following flow-diversion treatment. Using the International Retrospective Study of the Pipeline Embolization Device registry, we studied demographic, aneurysm, and procedural characteristics associated with intraparenchymal hemorrhage following Pipeline Embolization Device treatment. MATERIALS AND METHODS We identified patients in the International Retrospective Study of the Pipeline Embolization Device registry with intraparenchymal hemorrhage unrelated to index aneurysm rupture post-Pipeline Embolization Device treatment. The rate of intraparenchymal hemorrhage was determined by baseline demographics, comorbidities, aneurysm characteristics, and procedural characteristics (including anticoagulation use, platelet testing, number of devices used, sheaths, catheters, and guidewires). Categoric variables were compared with χ(2) testing, and continuous variables were compared with the Student t test. RESULTS Of 793 patients with 906 aneurysms, 20 (2.5%) had intraparenchymal hemorrhage. Fifteen intraparenchymal hemorrhages (75.0%) occurred within 30 days of treatment (median, 5 days; range, 0-150 days). Nine patients with intraparenchymal hemorrhage (45.0%) died, 10 (50.0%) had major neurologic morbidity, and 1 had minor neurologic morbidity (5.0%). Intraparenchymal hemorrhage was ipsilateral to the Pipeline Embolization Device in 16 patients (80%) and contralateral in 3 patients (15.0%). Variables associated with higher odds of intraparenchymal hemorrhage included treatment of ruptured aneurysms (OR, 4.44; 95% CI, 1.65-11.94; P = .005) and the use of ≥ 3 Pipeline Embolization Devices (OR, 4.10; 95% CI, 1.34-12.58; P = .04). The Shuttle sheath was not associated with intraparenchymal hemorrhage (OR, 0.97; 95% CI, 0.38-2.45; P = .95). CONCLUSIONS Spontaneous intraparenchymal hemorrhage following Pipeline Embolization Device treatment is a rare-but-devastating complication, with nearly all patients having morbidity or mortality. Variables associated with intraparenchymal hemorrhage included the use of multiple Pipeline Embolization Devices and treatment of ruptured aneurysms. The Shuttle, a device that was previously thought to be associated with intraparenchymal hemorrhage, was not associated with it.
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Affiliation(s)
- W Brinjikji
- From the Departments of Radiology (W.B., G.L., H.J.C., D.F.K.)
| | - G Lanzino
- From the Departments of Radiology (W.B., G.L., H.J.C., D.F.K.) Neurosurgery (G.L., H.J.C., D.F.K.), Mayo Clinic, Rochester, Minnesota
| | - H J Cloft
- From the Departments of Radiology (W.B., G.L., H.J.C., D.F.K.) Neurosurgery (G.L., H.J.C., D.F.K.), Mayo Clinic, Rochester, Minnesota
| | - A H Siddiqui
- Department of Neurosurgery (A.H.S.), State University of New York, Buffalo, New York
| | - D F Kallmes
- From the Departments of Radiology (W.B., G.L., H.J.C., D.F.K.) Neurosurgery (G.L., H.J.C., D.F.K.), Mayo Clinic, Rochester, Minnesota
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Coutinho JM, Liebeskind DS, Slater LA, Nogueira RG, Baxter BW, Levy EI, Siddiqui AH, Goyal M, Zaidat OO, Davalos A, Bonafé A, Jahan R, Gralla J, Saver JL, Pereira VM. Mechanical Thrombectomy for Isolated M2 Occlusions: A Post Hoc Analysis of the STAR, SWIFT, and SWIFT PRIME Studies. AJNR Am J Neuroradiol 2015; 37:667-72. [PMID: 26564442 DOI: 10.3174/ajnr.a4591] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 08/11/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Mechanical thrombectomy is beneficial for patients with acute ischemic stroke and a proximal anterior occlusion, but it is unclear if these results can be extrapolated to patients with an M2 occlusion. The purpose of this study was to examine the technical aspects, safety, and outcomes of mechanical thrombectomy with a stent retriever in patients with an isolated M2 occlusion who were included in 3 large multicenter prospective studies. MATERIALS AND METHODS We included patients from the Solitaire Flow Restoration Thrombectomy for Acute Revascularization (STAR), Solitaire With the Intention For Thrombectomy (SWIFT), and Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment (SWIFT PRIME) studies, 3 large multicenter prospective studies on thrombectomy for ischemic stroke. We compared outcomes and technical details of patients with an M2 with those with an M1 occlusion. All patients were treated with a stent retriever. Imaging data and outcomes were scored by an independent core laboratory. Successful reperfusion was defined as modified Thrombolysis in Cerebral Infarction score of 2b/3. RESULTS We included 50 patients with an M2 and 249 patients with an M1 occlusion. Patients with an M2 occlusion were older (mean age, 71 versus 67 years; P = .04) and had a lower NIHSS score (median, 13 versus 17; P < .001) compared with those with an M1 occlusion. Procedural time was nonsignificantly shorter in patients with an M2 occlusion (median, 29 versus 35 minutes; P = .41). The average number of passes with a stent retriever was also nonsignificantly lower in patients with an M2 occlusion (mean, 1.4 versus 1.7; P = .07). There were no significant differences in successful reperfusion (85% versus 82%, P = .82), symptomatic intracerebral hemorrhages (2% versus 2%, P = 1.0), device-related serious adverse events (6% versus 4%, P = .46), or modified Rankin Scale score 0-2 at follow-up (60% versus 56%, P = .64). CONCLUSIONS Endovascular reperfusion therapy appears to be feasible in selected patients with ischemic stroke and an M2 occlusion.
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Affiliation(s)
- J M Coutinho
- From the Divisions of Neuroradiology (J.M.C., L.-A.S., V.M.P.)
| | - D S Liebeskind
- Neurovascular Imaging Research Core and the University of California, Los Angeles Stroke Center (D.S.L.), Los Angeles, California
| | - L-A Slater
- From the Divisions of Neuroradiology (J.M.C., L.-A.S., V.M.P.)
| | - R G Nogueira
- Marcus Stroke and Neuroscience Center (R.G.N.), Department of Neurology, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia
| | - B W Baxter
- Department of Radiology (B.W.B.), Erlanger Hospital at University of Tennessee, Chattanooga, Tennessee
| | - E I Levy
- Department of Neurosurgery (E.I.L., A.H.S.)
| | - A H Siddiqui
- Department of Neurosurgery (E.I.L., A.H.S.) Toshiba Stroke and Vascular Research Center (A.H.S.), State University of New York at Buffalo, Buffalo, New York
| | - M Goyal
- Departments of Radiology and Clinical Neurosciences (M.G.), University of Calgary, Calgary, Alberta, Canada
| | - O O Zaidat
- Department of Neurology (O.O.Z.), Medical College of Wisconsin, Milwaukee, Wisconsin
| | - A Davalos
- Department of Neurosciences (A.D.), Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - A Bonafé
- Department of Neuroradiology (A.B.), Hôpital Gui-de-Chauliac, Montpellier, France
| | - R Jahan
- Division of Interventional Neuroradiology (R.J.)
| | - J Gralla
- Departments of Diagnostic and Interventional Neuroradiology (J.G.), Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - J L Saver
- Department of Neurology and Comprehensive Stroke Center (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - V M Pereira
- From the Divisions of Neuroradiology (J.M.C., L.-A.S., V.M.P.) Neurosurgery (V.M.P.), Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
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Brinjikji W, Lanzino G, Cloft HJ, Siddiqui AH, Hanel RA, Kallmes DF. Platelet Testing is Associated with Worse Clinical Outcomes for Patients Treated with the Pipeline Embolization Device. AJNR Am J Neuroradiol 2015; 36:2090-5. [PMID: 26251435 DOI: 10.3174/ajnr.a4411] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 03/24/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The necessity for platelet-inhibition testing before aneurysm treatment in patients premedicated with antiplatelet agents is controversial. Using the International Retrospective Study of Pipeline Embolization Device registry, we studied complication rates in groups of patients who underwent platelet testing and those who did not undergo platelet testing to determine if these test results were associated with improved outcomes. MATERIALS AND METHODS Patients in the International Retrospective Study of Pipeline Embolization Device registry with an unruptured aneurysm were categorized as those who underwent platelet testing before Pipeline embolization device treatment or those who did not. Complication rates were compared by using the Fisher exact or Pearson χ(2) test. Multivariate analysis was performed to determine if platelet function testing was independently associated with poor outcomes after adjusting for age, number of devices and aneurysms, aneurysm location and size, and practitioner and center volume. RESULTS Compared with the patients who received a Pipeline embolization device without platelet testing, those who underwent platelet testing and Pipeline embolization device placement experienced higher rates of intracranial hemorrhage (0 of 187 [0.0%] vs 12 of 511 [2.3%], respectively; P = .04), neurologic morbidity (4 of 187 [2.1%] vs 42 of 511 [8.2%], respectively; P < .01), and combined neurologic morbidity and mortality (6 of 187 [3.2%] vs 45 of 511 [8.8%], respectively; P = .01). More patients in the platelet testing and Pipeline embolization device group were treated with multiple devices (227 [38.0%] vs 56 [27.8] patients, respectively; P = .01). On multivariate analysis, the group of patients who underwent platelet testing and Pipeline embolization device placement had higher odds of neurologic morbidity (OR, 3.25 [95% CI, 1.10-9.61]; P = .03). CONCLUSIONS Platelet testing in patients who undergo Pipeline embolization device placement is associated with higher rates of morbidity. Additional prospective studies are needed to determine if and when platelet testing in these patients is appropriate.
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Affiliation(s)
- W Brinjikji
- From the Departments of Radiology (W.B., G.L., H.J.C., D.F.K.)
| | - G Lanzino
- From the Departments of Radiology (W.B., G.L., H.J.C., D.F.K.) Neurosurgery (G.L., H.J.C., D.F.K.), Mayo Clinic, Rochester, Minnesota
| | - H J Cloft
- From the Departments of Radiology (W.B., G.L., H.J.C., D.F.K.) Neurosurgery (G.L., H.J.C., D.F.K.), Mayo Clinic, Rochester, Minnesota
| | - A H Siddiqui
- Department of Neurosurgery (A.H.S.), State University of New York, Buffalo, New York
| | - R A Hanel
- Department of Neurosurgery (R.A.H.), Baptist Neurological Institute, Jacksonville, Florida
| | - D F Kallmes
- From the Departments of Radiology (W.B., G.L., H.J.C., D.F.K.) Neurosurgery (G.L., H.J.C., D.F.K.), Mayo Clinic, Rochester, Minnesota
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Mokin M, Setlur Nagesh SV, Ionita CN, Levy EI, Siddiqui AH. Comparison of modern stroke thrombectomy approaches using an in vitro cerebrovascular occlusion model. AJNR Am J Neuroradiol 2015; 36:547-51. [PMID: 25376809 DOI: 10.3174/ajnr.a4149] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE A new in vitro cerebrovascular occlusion model of the intracranial circulation was developed recently for testing thrombectomy devices. Using this model, we compared recanalization success associated with different modern endovascular thrombectomy approaches. MATERIALS AND METHODS Model experiments were performed in 4 thrombectomy test groups: 1) primary or direct Stentriever thrombectomy with a conventional guide catheter (control group), 2) primary Stentriever thrombectomy with a balloon-guide catheter, 3) combined Stentriever-continuous aspiration approach, and 4) direct aspiration alone. Successful recanalization was defined as a TICI score of 2b or 3. RESULTS Seventy-one thrombectomy experiments were conducted. Similar rates of TICI 2b-3 scores were achieved with balloon-guide and conventional guide catheters (P = .34). The combined Stentriever plus aspiration approach and the primary aspiration thrombectomy resulted in significantly higher rates of TICI 2b or 3 than the conventional guide-catheter approach in the control group (P = .008 and P = .0001, respectively). The primary Stentriever thrombectomy with the conventional guide catheter showed the highest rate of embolization to new territories (53%). CONCLUSIONS Data from our in vitro model experiments show that the Stentriever thrombectomy under continuous aspiration and primary aspiration thrombectomy approaches led to the highest degree of recanalization.
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Affiliation(s)
- M Mokin
- From the Departments of Neurosurgery (M.M., E.I.L., A.H.S.)
| | - S V Setlur Nagesh
- Biomedical Engineering (S.V.S.N., C.N.I.) Electrical Engineering (S.V.S.N.) Mechanical and Aerospace Engineering (S.V.S.N.)
| | - C N Ionita
- Biomedical Engineering (S.V.S.N., C.N.I.) Toshiba Stroke and Vascular Research Center (C.N.I., E.I.L., A.H.S.), University at Buffalo, State University of New York, Buffalo, New York
| | - E I Levy
- From the Departments of Neurosurgery (M.M., E.I.L., A.H.S.) Radiology (E.I.L., A.H.S.) Toshiba Stroke and Vascular Research Center (C.N.I., E.I.L., A.H.S.), University at Buffalo, State University of New York, Buffalo, New York
| | - A H Siddiqui
- From the Departments of Neurosurgery (M.M., E.I.L., A.H.S.) Radiology (E.I.L., A.H.S.) Toshiba Stroke and Vascular Research Center (C.N.I., E.I.L., A.H.S.), University at Buffalo, State University of New York, Buffalo, New York Jacobs Institute (A.H.S.), Buffalo, New York.
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Ma D, Xiang J, Choi H, Dumont TM, Natarajan SK, Siddiqui AH, Meng H. Enhanced aneurysmal flow diversion using a dynamic push-pull technique: an experimental and modeling study. AJNR Am J Neuroradiol 2014; 35:1779-85. [PMID: 24763414 DOI: 10.3174/ajnr.a3933] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Neurovascular flow diverters are flexible, braided stent-meshes for intracranial aneurysm treatment. We applied the dynamic push-pull technique to manipulate the flow-diverter mesh density at the aneurysm orifice to maximize flow diversion. This study investigated the hemodynamic impact of the dynamic push-pull technique on patient-specific aneurysms by using the developed high-fidelity virtual-stenting computational modeling technique combined with computational fluid dynamics. MATERIALS AND METHODS We deployed 2 Pipeline Embolization Devices into 2 identical sidewall anterior cerebral artery aneurysm phantoms by using the dynamic push-pull technique with different delivery-wire advancements. We then numerically simulated these deployment processes and validated the simulated mesh geometry. Computational fluid dynamics analysis was performed to evaluate detailed hemodynamic changes by deployed flow diverters in the sidewall aneurysm and a fusiform basilar trunk aneurysm (deployments implemented previously). Images of manipulated flow diverter mesh from sample clinical cases were also evaluated. RESULTS The flow diverters deployed in silico accurately replicated in vitro geometries. Increased delivery wire advancement (21 versus 11 mm) by using a dynamic push-pull technique produced a higher mesh compaction at the aneurysm orifice (50% metal coverage versus 36%), which led to more effective aneurysmal inflow reduction (62% versus 50% in the sidewall aneurysm; 57% versus 36% in the fusiform aneurysm). The dynamic push-pull technique also caused relatively lower metal coverage along the parent vessel due to elongation of the flow diverter. High and low mesh compactions were also achieved for 2 real patients by using the dynamic push-pull technique. CONCLUSIONS The described dynamic push-pull technique increases metal coverage of pure braided flow diverters over the aneurysm orifice, thereby enhancing the intended flow diversion, while reducing metal coverage along the parent vessel to prevent flow reduction in nearby perforators.
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Affiliation(s)
- D Ma
- From the Toshiba Stroke and Vascular Research Center (D.M., J.X., A.H.S., H.M.) Departments of Mechanical and Aerospace Engineering (D.M., J.X., H.M.)
| | - J Xiang
- From the Toshiba Stroke and Vascular Research Center (D.M., J.X., A.H.S., H.M.) Departments of Mechanical and Aerospace Engineering (D.M., J.X., H.M.) Neurosurgery (J.X., S.K.N., A.H.S., H.M.)
| | - H Choi
- Department of Neurosurgery (H.C.), Upstate Medical University, The State University of New York, Syracuse, New York
| | - T M Dumont
- Department of Surgery (T.M.D.), The University of Arizona; Tucson, Arizona
| | | | - A H Siddiqui
- From the Toshiba Stroke and Vascular Research Center (D.M., J.X., A.H.S., H.M.) Neurosurgery (J.X., S.K.N., A.H.S., H.M.) Radiology (A.H.S.), University at Buffalo, The State University of New York, Buffalo, New York
| | - H Meng
- From the Toshiba Stroke and Vascular Research Center (D.M., J.X., A.H.S., H.M.) Departments of Mechanical and Aerospace Engineering (D.M., J.X., H.M.) Neurosurgery (J.X., S.K.N., A.H.S., H.M.)
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Dolic K, Marr K, Valnarov V, Dwyer MG, Carl E, Karmon Y, Kennedy C, Brooks C, Kilanowski C, Hunt K, Siddiqui AH, Hojnacki D, Weinstock-Guttman B, Zivadinov R. Intra- and extraluminal structural and functional venous anomalies in multiple sclerosis, as evidenced by 2 noninvasive imaging techniques. AJNR Am J Neuroradiol 2011; 33:16-23. [PMID: 22194367 DOI: 10.3174/ajnr.a2877] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Chronic cerebrospinal venous insufficiency (CCSVI) is a vascular condition characterized by anomalies of the main extracranial cerebrospinal venous routes that interfere with normal venous outflow. Research into CCSVI will determine its sensitivity and specificity for a diagnosis of MS, its prevalence in MS patients, and its clinical, MRI, and genetic correlates. Our aim was to investigate the prevalence and number of intra- and extraluminal structural and functional extracranial venous abnormalities by using DS and MRV, in patients with MS and HCs. MATERIALS AND METHODS One hundred fifty patients with MS, 104 (69.3%) with RR and 46 (30.7%) with a progressive MS course, and 63 age- and sex-matched HCs were scanned with 3T MR imaging by using TOF and TRICKS sequences (only patients with MS). All subjects underwent DS examination for intra- and extraluminal structural and functional abnormalities of the IJVs. Absent/pinpoint IJV flow morphology on MRV was considered an abnormal finding. Prominence of collateral extracranial veins was assessed with MRV. RESULTS Patients with MS had a significantly higher number of functional (P < .0001), total (P = .001), and intraluminal (P = .005) structural IJV DS abnormalities than HCs. There was a trend for more patients with MS with extraluminal IJV DS abnormalities (P = .023). No significant differences were found on the MRV IJV flow morphology scale between patients with MS and HCs. Patients with progressive MS showed more extraluminal IJV DS abnormalities (P = .01) and more MRV flow abnormalities on TOF (P = .006) and TRICKS (P = .01) than patients with nonprogressive MS. There was a trend for a higher number of collateral veins in patients with MS than in HCs (P = .016). CONCLUSIONS DS is more sensitive than MRV in detecting intraluminal structural and functional venous abnormalities in patients with MS compared with HCs, whereas MRV is more sensitive in showing collaterals.
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Affiliation(s)
- K Dolic
- Buffalo Neuroimaging Analysis Center, State University of New York, Buffalo, USA
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Binning MJ, Yashar P, Orion D, Hauck EF, Levy EI, Hopkins LN, Siddiqui AH. Use of the Outreach Distal Access Catheter for microcatheter stabilization during intracranial arteriovenous malformation embolization. AJNR Am J Neuroradiol 2011; 33:E117-9. [PMID: 21757517 DOI: 10.3174/ajnr.a2547] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The Outreach DAC is an intermediate-sized catheter designed for use with the Merci clot retriever in acute stroke. We investigated its utility as an adjunctive device during AVM pedicle embolization. In the authors' opinion, the DAC provided additional guide-catheter and microcatheter support, improved selective angiographic visualization of AVM angioarchitecture, aided microcatheter removal from its embedded position in the AVM Onyx cast, and enhanced local microcatheter control and safety, compared with embolization with the guide and microcatheter alone.
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Affiliation(s)
- M J Binning
- Department of Neurosurgery and Toshiba Stroke Research Center, University at Buffalo, State University of New York, NY, USA
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Ionita CN, Natarajan SK, Wang W, Hopkins LN, Levy EI, Siddiqui AH, Bednarek DR, Rudin S. Evaluation of a second-generation self-expanding variable-porosity flow diverter in a rabbit elastase aneurysm model. AJNR Am J Neuroradiol 2011; 32:1399-407. [PMID: 21757527 DOI: 10.3174/ajnr.a2548] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The self-expanding V-POD is a second-generation flow-diverting device with a low-porosity PTFE patch on a self-expanding microstent. The authors evaluated this device for the treatment of elastase-induced aneurysms in rabbits. MATERIALS AND METHODS Three V-POD types (A, circumferential patch closed-cell stent [n = 9]; B, asymmetric patch closed-cell stent [n = 7]; and C, asymmetric patch open-cell stent [n = 4]) were evaluated by using angiography, conebeam micro-CT, histology, and SEM. Aneurysm flow modifications were expressed in terms of immediate poststent/prestent ratios of maximum CA volume entering the aneurysm dome tracked on procedural angiograms. Flow modifications were correlated with 4 weeks' follow-up angiographic, micro-CT, histologic, and SEM results. RESULTS Mechanical stent-deployment difficulties in 4 aneurysms (1 type A; 3 type B) led to suboptimal results and exclusion from analysis. Of the remaining 16 aneurysms, 4-week post-treatment angiograms showed no aneurysm filling in 10 (63%), 3 (∼19%) had no filling with a small remnant neck, and 3 (∼19%) had <0.25 filling. Successfully treated aneurysms (n = 16) demonstrated an immediate poststent/prestent CA maximum volume ratio of 0.13 ± 0.18% (0.0%-0.5%). Favorable contrast-flow modification on immediate angiography after deployment correlated significantly with aneurysm occlusion on follow-up angiography, micro-CT, and histology. The occlusion percentage derived from micro-CT was 96 ± 6.8%. Histology indicated advanced healing (grade ≥3) in the aneurysm dome in 13 of 16 cases. SEM revealed 15 of 16 stents in an advanced state of endothelialization. CONCLUSIONS This study showed the feasibility and effectiveness of V-POD for aneurysm healing in a rabbit elastase model.
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Affiliation(s)
- C N Ionita
- Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA
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Meng H, Natarajan SK, Gao L, Ionita C, Kolega J, Siddiqui AH, Mocco J. Aneurysmal changes at the basilar terminus in the rabbit elastase aneurysm model. AJNR Am J Neuroradiol 2010; 31:E35-6; author reply E37. [PMID: 20053800 DOI: 10.3174/ajnr.a2012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Jahromi BS, Tummala RP, Yamamoto J, Levy EI, Siddiqui AH, Hopkins LN. Early carotid stenting for symptomatic stenosis and intraluminal thrombus presenting with stroke. Neurology 2008; 71:1831-3. [PMID: 19029524 DOI: 10.1212/01.wnl.0000339379.15449.65] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- B S Jahromi
- Department of Neurosurgery, Millard Fillmore Gates Hospital, Kaleida Health, Buffalo, NY, USA.
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Chiam PTL, Samuelson RM, Mocco J, Hanel RA, Siddiqui AH, Hopkins LN, Levy EI. Navigability trumps all: stenting of acute middle cerebral artery occlusions with a new self-expandable stent. AJNR Am J Neuroradiol 2008; 29:1956-8. [PMID: 18768730 DOI: 10.3174/ajnr.a1221] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Acute stroke intervention is rapidly evolving. New technologies are improving device deliverability and rates of recanalization. We describe 2 cases of acute middle cerebral artery occlusions wherein Wingspan stents could not be delivered to the occlusive site because of excessive vascular tortuosity. Merci thrombectomy was also unsuccessful. Revascularization was only achieved with deployment of the highly navigable Enterprise stent, resulting in thrombolysis in myocardial infarction 2/3 flow. Thus, all devices should be considered in the armamentarium of stroke therapy.
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Affiliation(s)
- P T L Chiam
- Department of Neurosurgery and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
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Siddiqui AH, Mulligan ME, Mahenthiralingam E, Hebden J, Brewrink J, Qaiyumi S, Johnson JA, LiPuma JJ. An episodic outbreak of genetically related Burkholderia cepacia among non-cystic fibrosis patients at a university hospital. Infect Control Hosp Epidemiol 2001; 22:419-22. [PMID: 11583209 DOI: 10.1086/501927] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate an outbreak of Burkholderia cepacia. DESIGN Observational study and chart review. PATIENTS Adult non-cystic fibrosis (CF) patients. SETTING Intensive care units (ICUs) at a university-affiliated teaching hospital. METHODS As part of the epidemiological investigation, we conducted a chart review and collected environmental samples. A review of work schedules of healthcare workers also was performed. We used B. cepacia selective agar for preliminary screening for all isolates, which subsequently were confirmed as members of the B. cepacia complex by polyphasic analysis employing conventional biochemical reactions and genus- and species-specific polymerase chain reaction assays. Pulsed-field gel electrophoresis, randomly amplified polymorphic DNA typing, and automated ribotyping were used to genotype the isolates. As part of the intervention, contact isolation precautions were initiated for all patients identified as having had a culture positive for B. cepacia. RESULTS Between September 1997 and September 1999, B. cepacia was isolated from 31 adult patients without CF in ICUs at a university-affiliated teaching hospital. Based on geographic clustering and genotypic analysis, three distinct clusters were observed involving 20 patients. Isolates from 17 of these patients were available for testing and were found to be of the same strain (outbreak strain). Further taxonomic analysis indicated that the outbreak strain was B. cepacia complex genomovar III. Twelve (71%) of the 17 patients were judged to be infected, and 5 (29%) were colonized with this strain. Six of 200 environmental cultures from multiple sources in the hospital's ICUs yielded B. cepacia. Two of these isolates, both recovered from rooms of colonized patients, were the same genotype as the outbreak strain recovered from patients. CONCLUSION Despite an extensive investigation, the source of the B. cepacia clone involved in this outbreak remains unknown. The spatial and temporal pattern of cases suggests that cross-transmission of a genetically related strain contributed to clustering among patients. The initiation of contact isolation may have limited the extent of this transmission. Additional studies are needed to elucidate better the epidemiology of nosocomial B. cepacia infection among non-CF adult patients.
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Affiliation(s)
- A H Siddiqui
- Department of Medicine, University of Maryland School of Medicine, VA Maryland Health Care System, Baltimore, USA
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Affiliation(s)
- M L Romero
- Division of Infectious Disease, University of Maryland School of Medicine, Veterans AAfairs Maryland Health Care System, Baltimore, MD 21201, USA
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Rhode PR, Burkhardt M, Jiao J, Siddiqui AH, Huang GP, Wong HC. Single-chain MHC class II molecules induce T cell activation and apoptosis. J Immunol 1996; 157:4885-91. [PMID: 8943392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
MHC class II/peptide complexes displayed on the surface of APCs play a pivotal role in initiating specific T cell responses. Evidence is presented here that components of this heterotrimeric complex can be genetically linked into a single polypeptide chain. Soluble single-chain (sc) murine class II IA(d) molecules with and without covalently attached peptides were produced in a recombinant baculovirus-insect cell expression system. Correct conformation of these molecules was verified based on 1) reactivity to Abs directed against conformational epitopes in IA(d) and 2) peptide-specific recognition of the IA(d)/peptide complexes by T cells. Both sc class II molecules loaded the appropriate peptides and sc class II/peptide fusions were effective in stimulating T cell responses, including cytokine release and apoptosis. Mammalian cells were also found to be capable of expressing functional sc class II molecules on their cell surfaces. The findings reported here open up the possibility of producing large amounts of stable sc class II/peptide fusion molecules for structural characterization and immunotherapeutic applications.
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Affiliation(s)
- P R Rhode
- Sunol Molecular Corporation, Miami, FL 33172, USA
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Rhode PR, Burkhardt M, Jiao J, Siddiqui AH, Huang GP, Wong HC. Single-chain MHC class II molecules induce T cell activation and apoptosis. The Journal of Immunology 1996. [DOI: 10.4049/jimmunol.157.11.4885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Abstract
MHC class II/peptide complexes displayed on the surface of APCs play a pivotal role in initiating specific T cell responses. Evidence is presented here that components of this heterotrimeric complex can be genetically linked into a single polypeptide chain. Soluble single-chain (sc) murine class II IA(d) molecules with and without covalently attached peptides were produced in a recombinant baculovirus-insect cell expression system. Correct conformation of these molecules was verified based on 1) reactivity to Abs directed against conformational epitopes in IA(d) and 2) peptide-specific recognition of the IA(d)/peptide complexes by T cells. Both sc class II molecules loaded the appropriate peptides and sc class II/peptide fusions were effective in stimulating T cell responses, including cytokine release and apoptosis. Mammalian cells were also found to be capable of expressing functional sc class II molecules on their cell surfaces. The findings reported here open up the possibility of producing large amounts of stable sc class II/peptide fusion molecules for structural characterization and immunotherapeutic applications.
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Affiliation(s)
- P R Rhode
- Sunol Molecular Corporation, Miami, FL 33172, USA
| | - M Burkhardt
- Sunol Molecular Corporation, Miami, FL 33172, USA
| | - J Jiao
- Sunol Molecular Corporation, Miami, FL 33172, USA
| | - A H Siddiqui
- Sunol Molecular Corporation, Miami, FL 33172, USA
| | - G P Huang
- Sunol Molecular Corporation, Miami, FL 33172, USA
| | - H C Wong
- Sunol Molecular Corporation, Miami, FL 33172, USA
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Abstract
A successful approach in the synthesis of 3 beta-acetoxy-17a-selena-D-homo-1,3,5(10)-estratrien-17 -one (5), 3 beta-acetoxy-17a tellura-D-homo-1,3,5(10)-estratrien-17-one (6), and 3 beta-acetoxy-17a-thia-D-homo-1,3,5(10)-estratrien-17-one (7) was achieved from 3 beta-acetoxy-1,3,5(10)-estratrien-17-one (1). The Baeyer-Villiger reaction of 3 beta-acetoxy-1,3,5(10)-estratrien-17-one (1) with perbenzoic acid afforded 3 beta-acetoxy-17a-oxa-D-homo-1,3,5(10)-estratrien-17-one (2), which on reaction with hydrobromic acid gave 3 beta-acetoxy-seco-13-bromo-1,3,5(10)-estratrien-16-oic acid (3). Treatment of bromo acid (3) with thionyl chloride gave 3 beta-acetoxy-seco-13-bromo-1,3,5(10)-estratrien-17 acid chloride (4), whose reaction with Se and Te in the presence of sodium borohydride gave the desired products 5 and 6. Reaction of 3 beta-acetoxy-seco-13-bromo-1,3,5(10)-estratrien-17 acid chloride (4) with sodium sulfide gave the thia lactone derivative (7).
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Affiliation(s)
- A U Siddiqui
- Department of Chemistry, Nizam College, Osmania University, Hyderabad, India
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Fong CW, Siddiqui AH, Mark DF. Characterization of protein complexes formed on the repressor elements of the human tumor necrosis factor alpha gene. J Interferon Cytokine Res 1995; 15:887-95. [PMID: 8564711 DOI: 10.1089/jir.1995.15.887] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Human tumor necrosis factor alpha (TNF-alpha) is an important cytokine responsible for pleiotropic effects in vivo. The expression of TNF-alpha is under both positive and negative regulation. Previously we showed that a 108 bp region (-280 to -172) in the TNF-alpha promoter represses TNF-alpha transcription in U937 cells. We also demonstrated that a smaller region of the promoter spanning base pairs -254 and -230 is sufficient for repressor function. This 25 bp TNF-alpha repressor site (TRS) contains a 10 bp sequence homologous to the binding site of activator protein AP-2, yet it does not bind the AP-2 protein. In this study, we demonstrate that this 10 bp core sequence is an essential element for the repressor function of the TRS. Using gel retardation analysis with the 108 bp repressor element and the TRS as probes, multiple specific DNA binding complexes have been identified from U937 nuclear extracts. The complexes B, C, and D on the 108 bp probe and the three major complexes on the 25 bp TRS probe are also present in Jurkat and Mono Mac 6 cells, and their abundance in these cell lines seems to correlate with their postulated repressor function. We have demonstrated that the major TRS binding proteins, with estimated MWs of 30-60 kD, copurify on a heparin agarose column and on a DNA affinity column conjugated with the 10 bp core sequence.
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Affiliation(s)
- C W Fong
- Department of Microbial Chemotherapeutics and Molecular Genetics, Merck Research Laboratories, Rahway, NJ 07065, USA
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Fong CL, Siddiqui AH, Mark DF. Identification and characterization of a novel repressor site in the human tumor necrosis factor alpha gene. Nucleic Acids Res 1994; 22:1108-14. [PMID: 8152914 PMCID: PMC307937 DOI: 10.1093/nar/22.6.1108] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
In human monocytic cell lines, tumor necrosis factor alpha (TNF alpha) expression is induced by phorbol myristate acetate (PMA). We have identified positive and negative cis-acting elements in the TNF alpha promoter by deletion analysis. Here we present the initial characterization of the repressor element. The repressor element was shown to function in either orientation and at various distances upstream from the positive element of the TNF alpha promoter. The TNF alpha repressor site (TRS) has been localized to a 25 bp region between base pairs -254 and -230 in the promoter. This region contains a 10 bp sequence with homology to the binding site of the activator protein AP-2. Mutation of the 6 C's of this 10 bp AP-2-like site abolish TRS repressor function. However, this AP-2-like site is not a binding site for AP-2 protein based on gel retardation analysis. In addition, a well-characterized AP-2-binding site placed upstream of the positive element of the TNF alpha gene did not cause repression. Therefore, this repression is very likely mediated by a novel protein(s) which interacts with the AP-2 consensus site in the TRS.
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Affiliation(s)
- C L Fong
- Department of Microbial Chemotherapeutics and Molecular Genetics, Merck Research Laboratories, Rahway, NJ 07065
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40
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Abstract
In order to evaluate the efficacy of L-phenylalanine (L-Phe) in combination with UVA therapy for vitiligo an open trial (149 patients, 18 months) and a small double-blind trial (32 patients, 6 months) were conducted. Oral L-Phe loading resulted in peak plasma levels of L-Phe after 30-60 min and a slight increase in the plasma tyrosine level. Response to L-Phe plus UVA irradiation was positive, and various grades of repigmentation not exceeding 77% in the open and 60% in the blind trial were observed. An increased L-Phe dose resulted in increased L-Phe plasma levels but not in improved clinical results. The optimal L-Phe dose appears to be lower than 50 mg/kg/day. Although it is difficult to draw firm conclusions from the present investigation, we think that L-Phe may have a place in the treatment of vitiligo and its role merits further investigation.
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Affiliation(s)
- A H Siddiqui
- Department of Dermatology, Academisch Medisch Centrum, University of Amsterdam, The Netherlands
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Abstract
The PUT1 and PUT2 genes encoding the enzymes of the proline utilization pathway of Saccharomyces cerevisiae are induced by proline and activated by the product of the PUT3 gene. Two upstream activation sequences (UASs) in the PUT1 promoter were identified by homology to the PUT2 UAS. Deletion analysis of the two PUT1 UASs showed that they were functionally independent and additive in producing maximal levels of gene expression. The consensus PUT UAS is a 21-base-pair partially palindromic sequence required in vivo for induction of both genes. The results of a gel mobility shift assay demonstrated that the proline-specific UAS is the binding site of a protein factor. In vitro complex formation was observed in crude extracts of yeast strains carrying either a single genomic copy of the PUT3 gene or the cloned PUT3 gene on a 2 microns plasmid, and the binding was dosage dependent. DNA-binding activity was not observed in extracts of strains carrying either a put3 mutation that caused a noninducible (Put-) phenotype or a deletion of the gene. Wild-type levels of complex formation were observed in an extract of a strain carrying an allele of PUT3 that resulted in a constitutive (Put+) phenotype. Extracts from a strain carrying a PUT3-lacZ gene fusion formed two complexes of slower mobility than the wild-type complex. We conclude that the PUT3 product is either a DNA-binding protein or part of a DNA-binding complex that recognizes the UASs of both PUT1 and PUT2. Binding was observed in extracts of a strain grown in the presence or absence of proline, demonstrating the constitutive nature of the DNA-protein interaction.
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Affiliation(s)
- A H Siddiqui
- Department of Microbiology and Molecular Genetics, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark 07103
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Abstract
The irritation response to anthralin was studied using the chamber-testing technique in 17 patients with vitiligo. Anthralin concentrations of 0.1%, 0.5%, 1%, and 5% in lanette wax were applied to both vitiliginous and adjacent pigmented skin for 24 h. The extent of the erythematous reaction was evaluated on the 2nd day after application. The visual assessment of the paired anthralin patches indicated that the erythema was more intense in pigmented skin than in vitiliginous skin in 15 out of 17 patients. Chromometer readings, however, clearly indicated that the erythematous response was stronger in the vitiliginous skin than in the pigmented skin, confirming the known fact that the human eye is not accurate in the quantitative assessment of complex colors. Immunophenotypification of cellular infiltrates, using the combination of different monoclonal antibodies and the peroxidase technique, showed that inflammatory cell infiltrates caused by the anthralin exposure contained increased numbers of granulocytes and monocytes in vitiliginous skin when compared with normal skin. The percentage of T-cell subsets, Langerhans cells, and mast cells in the same infiltrates of both types of skin were similar. Our results are discussed in accordance with the view that anthralin-induced radical species of the pigmented skin can be neutralized by the scavenging properties of melanin.
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Affiliation(s)
- W Westerhof
- Department of Dermatology, University of Amsterdam, The Netherlands
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Smit NP, Westerhof W, Asghar SS, Pavel S, Siddiqui AH. Large-scale cultivation of human melanocytes using collagen-coated Sephadex beads (cytodex 3). J Invest Dermatol 1989; 92:18-21. [PMID: 2462596 DOI: 10.1111/1523-1747.ep13070406] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Pure melanocytes were obtained from the epidermis of human foreskin by a modification of a previously described method in which geneticin was added for selective killing of fibroblasts. Purity of the culture was confirmed by light and electron microscopy and by the use of a monoclonal antibody NKI-beteb, which is specific for a vesicular membrane antigen present on melanocytes. Melanocytes were tested for their affinity to several microcarriers. They attached to cytodex 1 and 3 and dorma cell, but they did not attach to glass and gelatin beads. The best results were obtained with cytodex 3. After an almost immediate and total attachment of melanocytes a fourfold to fivefold increase in cell number was achieved on this microcarrier within 3 weeks. With the results obtained, it seems that the collagen-coated cytodex 3 microcarrier surface supports the growth of melanocytes. Preliminary results obtained with a microcarrier cell culture fermenter clearly indicate that the large-scale cultivation of normal human melanocytes in such an automated system is possible.
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Affiliation(s)
- N P Smit
- Department of Dermatology, Academic Medical Center, University of Amsterdam, The Netherlands
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Abstract
Deletion analysis of the promoter of the PUT2 gene that functions in the proline utilization pathway of Saccharomyces cerevisiae identified a PUT2 upstream activation site (UAS). It is contained within a single 40-base-pair (bp) region located immediately upstream of the TATA box and is both necessary and sufficient for proline induction. When placed upstream of a CYC7-lacZ gene fusion, the 40-bp sequence conferred proline regulation on CYC7-lacZ. A 35-bp deletion within the PUT2 UAS in an otherwise intact PUT2 promoter resulted in noninducible expression of a PUT2-lacZ gene fusion. When a plasmid bearing this UAS-deleted promoter was placed in a strain carrying a constitutive mutation in the positive regulatory gene PUT3, expression of PUT2-lacZ was not constitutive but occurred at levels below those found under noninducing conditions. In heterologous as well as homologous gene fusions, the PUT2 UAS appeared to be responsible for uninduced as well as proline-induced levels of expression. Although located immediately adjacent to the PUT2 UAS, the TATA box did not appear to play a regulatory role, as indicated by the results of experiments in which it was replaced by the CYC7 TATA box. A 26-bp sequence containing this TATA box was critical to the expression of PUT2, since a deletion of this region completely abolished transcriptional activity of the gene under both inducing and noninducing conditions. Our results indicate that the PUT2 promoter has a comparatively simple structure, requiring UAS and TATA sequences as well as the PUT3 gene product (directly or indirectly) for its expression.
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Affiliation(s)
- A H Siddiqui
- Department of Microbiology and Molecular Genetics, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark 07103-2757
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Abstract
The psoralen derivative 8-methoxypsoralen (8-MOP) and to a lesser extent some other psoralens, including 5-methoxypsoralen (5-MOP) and 4,5',8-trimethylpsoralen (TMP) have acquired a place in the treatment of psoriasis and other dermatoses. They are only active when combined with long-wave ultraviolet light: PUVA therapy (Psoralen plus UVA). Successful PUVA therapy depends on sufficiently high psoralen concentrations coinciding with the time of irradiation. The use of oral or rectal pharmaceutical formulations with 8-MOP dissolved in liquid is preferable to conventional tablets or capsules. Since no formulation of 5-MOP with fast and predictable absorption is available 8-MOP should be preferred in PUVA therapy. The effectiveness of oral TMP is doubtful, because of low serum concentrations, probably due to malabsorption.
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Affiliation(s)
- L M Stolk
- Department of Pharmacy, Academic Medical Centre, Amsterdam, The Netherlands
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Stolk LM, de Ruiter R, Saadawi A, Siddiqui AH, Cormane RH. Determination of psoralen in serum by reversed-phase high-performance liquid chromatography. J Chromatogr 1987; 423:383-6. [PMID: 3443677 DOI: 10.1016/0378-4347(87)80369-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- L M Stolk
- Department of Pharmacy, University Medical Centre, Amsterdam, The Netherlands
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Stolk LM, Siddiqui AH, Cormane RH. 8-Methoxypsoralen levels in blood. J Invest Dermatol 1987; 89:305-6. [PMID: 3624903 DOI: 10.1111/1523-1747.ep12471651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Kuiters GR, Hup JM, Siddiqui AH, Cormane RH. Oral phenylalanine loading and sunlight as source of UVA irradiation in vitiligo on the Caribbean island of Curacao NA. J Trop Med Hyg 1986; 89:149-55. [PMID: 3773027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Recently, favourable results have been reported from oral L-phenylalanine (Phe) combined with UVA/sunlight irradiation (Phe-UVA) in the treatment of vitiligo. In the present pilot study vitiligo patients were treated on a thrice weekly scheme of 50 mg Phe.kg-1 body weight and exposed to sunlight as a source of UVA. An observed 81% response on the skin disorder correlates with earlier figures; 43% responded within 3 months. The self-controlled treatment includes the risk of over-irradiation, as possibly happened with one patient. The repigmentation was predominantly of follicular pattern. The assumption that Phe plays a central biochemical regulatory role in melanin, catecholamine and antibody synthesis forms an attractive challenge for the explanation of repigmentation and requires further investigation.
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Asghar SS, Siddiqui AH, van der Goot H, Timmerman H. Inhibition of complement by a series of substituted 2-aryl-1,3-indandiones: interaction with the fifth component of complement. Mol Immunol 1986; 23:459-65. [PMID: 3748011 DOI: 10.1016/0161-5890(86)90109-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A series of substituted 2-aryl-1,3-indandiones were investigated for their ability to inhibit the complement system. Some of them were found to be considerably strong inhibitors. The inhibitory activity was mainly dependent on substitutions at positions 3 and 5 of the phenyl ring. 3,5-dichloro-(8), 3,5-bis(trifluoromethyl)- (7), 3,5-diisopropyl- (3) and 3,5-di-t-butyl- (5) phenylindandiones were the strongest inhibitors of the series. The generation of EAC1-5 cells from EAC1-3 cells and C5 was most strongly inhibited by these compounds although some inhibition of the interaction of EAC1-5 with C6-C9 and EAC1-6 with C7-C9 was also observed. Slight inhibition at other steps of complement activation was also seen but this was not considered to be appreciable. Dialysis of normal serum or purified C5 pre-incubated with compounds 3, 5, 7 and 8 did not cause recovery of the hemolytic activity of normal serum or purified C5. Thus, the main site of inhibition in the complement cascade appeared to be at C5. The total alternative pathway was also inhibited to some extent by these compounds, probably due to their interaction with C5.
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