1
|
Samaniego EA, Dabus G, Meyers PM, Kan PT, Frösen J, Lanzino G, Welch BG, Volovici V, Gonzalez F, Fifi J, Charbel FT, Hoh BL, Khalessi A, Marks MP, Berenstein A, Pereira VM, Bain M, Colby GP, Narayanan S, Tateshima S, Siddiqui AH, Wakhloo AK, Arthur AS, Lawton MT. Most Promising Approaches to Improve Brain AVM Management: ARISE I Consensus Recommendations. Stroke 2024; 55:1449-1463. [PMID: 38648282 DOI: 10.1161/strokeaha.124.046725] [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: 10/21/2023] [Accepted: 03/01/2024] [Indexed: 04/25/2024]
Abstract
Brain arteriovenous malformations (bAVMs) are complex, and rare arteriovenous shunts that present with a wide range of signs and symptoms, with intracerebral hemorrhage being the most severe. Despite prior societal position statements, there is no consensus on the management of these lesions. ARISE (Aneurysm/bAVM/cSDH Roundtable Discussion With Industry and Stroke Experts) was convened to discuss evidence-based approaches and enhance our understanding of these complex lesions. ARISE identified the need to develop scales to predict the risk of rupture of bAVMs, and the use of common data elements to perform prospective registries and clinical studies. Additionally, the group underscored the need for comprehensive patient management with specialized centers with expertise in cranial and spinal microsurgery, neurological endovascular surgery, and stereotactic radiosurgery. The collection of prospective multicenter data and gross specimens was deemed essential for improving bAVM characterization, genetic evaluation, and phenotyping. Finally, bAVMs should be managed within a multidisciplinary framework, with clinical studies and research conducted collaboratively across multiple centers, harnessing the collective expertise and centralization of resources.
Collapse
Affiliation(s)
- Edgar A Samaniego
- Department of Neurology, Neurosurgery and Radiology, University of Iowa (E.A.S.)
| | - Guilherme Dabus
- Department of Neurosurgery, Baptist Health, Miami, FL (G.D.)
| | - Philip M Meyers
- Department of Radiology and Neurological Surgery, Columbia University, New York (P.M.M.)
| | - Peter T Kan
- Department of Neurological Surgery, University of Texas Medical Branch Galveston (P.T.K.)
| | - Juhana Frösen
- Department of Rehabilitation, Tampere University Hospital, Finland (J.F.)
| | | | - Babu G Welch
- Departments of Neurological Surgery and Radiology; The University of Texas Southwestern, Dallas (B.G.W.)
| | - Victor Volovici
- Department of Neurosurgery, Erasmus MC University Medical Centre, Rotterdam, the Netherlands (V.V.)
| | - Fernando Gonzalez
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD (F.G.)
| | - Johana Fifi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York (J.F., A.B.)
| | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago (F.T.C.)
| | - Brian L Hoh
- Department of Neurosurgery, College of Medicine, University of Florida, Gainesville (B.L.H.)
| | | | - Michael P Marks
- Interventional Neuroradiology Division, Stanford University Medical Center, Palo Alto, CA (M.P.M.)
| | - Alejandro Berenstein
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York (J.F., A.B.)
| | - Victor M Pereira
- Department of Neurosurgery, St. Michael's Hospital, Toronto, Canada (V.M.P.)
| | - Mark Bain
- Department of Neurological Surgery, Cleveland Clinic, OH (M.B.)
| | - Geoffrey P Colby
- Department of Neurosurgery, University of California Los Angeles (G.P.C.)
| | - Sandra Narayanan
- Neurointerventional Program and Comprehensive Stroke Program, Pacific Neuroscience Institute, Santa Monica, CA (S.N.)
| | - Satoshi Tateshima
- Division of Interventional Neuroradiology, Ronald Reagan UCLA Medical Center, Los Angeles (S.T.)
| | - Adnan H Siddiqui
- Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York (A.H.S.)
| | - Ajay K Wakhloo
- Department of Radiology, Tufts University School of Medicine, Boston, MA (A.K.W.)
| | - Adam S Arthur
- Department of Neurosurgery, Semmes-Murphey Clinic, University of Tennessee Health Science Center, Memphis (A.S.A.)
| | - Michael T Lawton
- Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (M.T.L.)
| |
Collapse
|
2
|
Tjoumakaris SI, Hanel R, Mocco J, Ali-Aziz Sultan M, Froehler M, Lieber BB, Coon A, Tateshima S, Altschul DJ, Narayanan S, El Naamani K, Taussky P, Hoh BL, Meyers P, Gounis MJ, Liebeskind DS, Volovici V, Toth G, Arthur A, Wakhloo AK. ARISE I Consensus Review on the Management of Intracranial Aneurysms. Stroke 2024; 55:1428-1437. [PMID: 38648283 DOI: 10.1161/strokeaha.123.046208] [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: 10/24/2023] [Accepted: 03/19/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Intracranial aneurysms (IAs) remain a challenging neurological diagnosis associated with significant morbidity and mortality. There is a plethora of microsurgical and endovascular techniques for the treatment of both ruptured and unruptured aneurysms. There is no definitive consensus as to the best treatment option for this cerebrovascular pathology. The Aneurysm, Arteriovenous Malformation, and Chronic Subdural Hematoma Roundtable Discussion With Industry and Stroke Experts discussed best practices and the most promising approaches to improve the management of brain aneurysms. METHODS A group of experts from academia, industry, and federal regulators convened to discuss updated clinical trials, scientific research on preclinical system models, management options, screening and monitoring, and promising novel device technologies, aiming to improve the outcomes of patients with IA. RESULTS Aneurysm, Arteriovenous Malformation, and Chronic Subdural Hematoma Roundtable Discussion With Industry and Stroke Experts suggested the incorporation of artificial intelligence to capture sequential aneurysm growth, identify predictors of rupture, and predict the risk of rupture to guide treatment options. The consensus strongly recommended nationwide systemic data collection of unruptured IA radiographic images for the analysis and development of machine learning algorithms for rupture risk. The consensus supported centers of excellence for preclinical multicenter trials in areas such as genetics, cellular composition, and radiogenomics. Optical coherence tomography and magnetic resonance imaging contrast-enhanced 3T vessel wall imaging are promising technologies; however, more data are needed to define their role in IA management. Ruptured aneurysms are best managed at large volume centers, which should include comprehensive patient management with expertise in microsurgery, endovascular surgery, neurology, and neurocritical care. CONCLUSIONS Clinical and preclinical studies and scientific research on IA should engage high-volume centers and be conducted in multicenter collaborative efforts. The future of IA diagnosis and monitoring could be enhanced by the incorporation of artificial intelligence and national radiographic and biologic registries. A collaborative effort between academic centers, government regulators, and the device industry is paramount for the adequate management of IA and the advancement of the field.
Collapse
Affiliation(s)
- Stavropoula I Tjoumakaris
- Department of Neurosurgery, Thomas Jefferson University at Sidney Kimmel Medical College, Philadelphia, PA (S.I.T., K.E.N.)
| | - Ricardo Hanel
- Baptist Neurological Institute, Jacksonville, FL (R.H.)
| | - J Mocco
- Department of Neurosurgery, Mount Sinai University Hospital, New York, NY (J.M.)
| | - M Ali-Aziz Sultan
- Department of Neurosurgery, Harvard Medical School, Boston, MA (M.A.-A.S.)
| | - Michael Froehler
- Department of Neurology, Vanderbilt University, Nashville, TN (M.F.)
| | - Barry B Lieber
- Department of Neurology, Tufts School of Medicine, Boston, MA (B.B.L.)
| | - Alexander Coon
- Department of Neurosurgery, Carondelet Neurological Institute of St. Joseph's and St. Mary's Hospitals in Tucson, AZ (A.C.)
| | - Satoshi Tateshima
- Department of Radiology (S.T.), University of California, Los Angeles
| | - David J Altschul
- Department of Neurological Surgery, Einstein Montefiore Medical Center, Bronx, NY (D.J.A.)
| | - Sandra Narayanan
- Department of Neurology, Pacific Neuroscience Institute, Santa Monica, CA (S.N.)
| | - Kareem El Naamani
- Department of Neurosurgery, Thomas Jefferson University at Sidney Kimmel Medical College, Philadelphia, PA (S.I.T., K.E.N.)
| | - Phil Taussky
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA (P.T.)
| | - Brian L Hoh
- Department of Neurosurgery, University of Florida, Gainesville (B.L.H.)
| | - Philip Meyers
- Department of Radiology, Saint Luke's Clinic, Boise, ID (P.M.)
| | - Matthew J Gounis
- Department of Radiology, University of Massachusetts, Worcester (M.J.G.)
| | | | - Victor Volovici
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Center, Rotterdam, the Netherlands (V.V.)
| | - Gabor Toth
- Department of Neurosurgery, Cleveland Clinic, OH (G.T.)
| | - Adam Arthur
- Department of Neurosurgery, Semmes Murphey Clinic, Memphis, TN (A.A.)
| | - Ajay K Wakhloo
- Department of Radiology, Tufts University School of Medicine, Boston, MA (A.K.W.)
| |
Collapse
|
3
|
Kan P, Fiorella D, Dabus G, Samaniego EA, Lanzino G, Siddiqui AH, Chen H, Khalessi AA, Pereira VM, Fifi JT, Bain MD, Colby GP, Wakhloo AK, Arthur AS. ARISE I Consensus Statement on the Management of Chronic Subdural Hematoma. Stroke 2024; 55:1438-1448. [PMID: 38648281 DOI: 10.1161/strokeaha.123.044129] [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: 10/23/2023] [Accepted: 01/10/2024] [Indexed: 04/25/2024]
Abstract
ARISE (Aneurysm/AVM/cSDH Roundtable Discussion With Industry and Stroke Experts) organized a one-and-a-half day meeting and workshop and brought together representatives from academia, industry, and government to discuss the most promising approaches to improve outcomes for patients with chronic subdural hematoma (cSDH). The emerging role of middle meningeal artery embolization in clinical practice and the design of current and potential future trials were the primary focuses of discussion. Existing evidence for imaging, indications, agents, and techniques was reviewed, and areas of priority for study and key questions surrounding the development of new and existing treatments for cSDH were identified. Multiple randomized, controlled trials have met their primary efficacy end points, providing high-level evidence that middle meningeal artery embolization is a potent adjunctive therapy to the standard (surgical and nonsurgical) management of neurologically stable cSDH patients in terms of reducing rates of disease recurrence. Pooled data analyses following the formal conclusion and publication of these trials will form a robust foundation upon which guidelines can be strengthened for cSDH treatment modalities and optimal patient selection, as well as delineate future lines of investigation.
Collapse
Affiliation(s)
- Peter Kan
- Department of Neurosurgery, The University of Texas Medical Branch, Galveston (P.K.)
| | - David Fiorella
- Department of Neurosurgery, Stony Brook University, NY (D.F.)
| | - Guilherme Dabus
- Interventional Neuroradiology and Neuroendovascular Surgery, Miami Neuroscience Institute and Miami Cardiac and Vascular Institute-Baptist Hospital, FL (G.D.)
| | - Edgar A Samaniego
- Department of Neurology, The University of Iowa Hospitals and Clinics (E.A.S.)
| | | | - Adnan H Siddiqui
- Department of Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, NY (A.H.S.)
| | - Huanwen Chen
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (H.C.)
| | - Alexander A Khalessi
- Department of Neurological Surgery, University of California, San Diego, La Jolla (A.A.K.)
| | - Vitor Mendes Pereira
- Division of Neuroradiology, Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, University Health Network, Toronto Western Hospital, ON, Canada (V.M.P.)
| | - Johanna T Fifi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY (J.T.F.)
| | - Mark D Bain
- Cerebrovascular Center, Departments of Neurology and Neurosurgery, Neurological Institute, Cleveland Clinic Foundation, OH (M.D.B.)
| | - Geoffrey P Colby
- Department of Neurosurgery, University of California Los Angeles David Geffen School of Medicine (G.P.C.)
| | - Ajay K Wakhloo
- Department of Interventional Neuroradiology, Lahey Hospital & Medical Center, Burlington, MA (A.K.W.)
| | - Adam S Arthur
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis (A.S.A.)
| |
Collapse
|
4
|
Hanel RA, Cortez GM, Coon AL, Kan P, Taussky P, Wakhloo AK, Welch BG, Dogan A, Bain M, De Vries J, Ebersole K, Meyers PM. Surpass Intracranial Aneurysm Embolization System Pivotal Trial to Treat Large or Giant Wide-Neck Aneurysms - SCENT: 3-year outcomes. J Neurointerv Surg 2023; 15:1084-1089. [PMID: 36375835 DOI: 10.1136/jnis-2022-019512] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/25/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND To report the 3-year safety and effectiveness of the Surpass Streamline flow diverter in the SCENT trial (Surpass Intracranial Aneurysm Embolization System Pivotal Trial to Treat Large or Giant Wide-Neck Aneurysms). METHODS The Surpass Streamline flow diverter device was evaluated in a multicenter, prospective, single-arm, non-randomized interventional trial including patients with uncoilable or previously treated but failed aneurysms of the intracranial internal carotid artery. 3-year outcomes were tabulated with descriptive statistics and compared with 1-year outcomes. RESULTS Of 180 patients in the modified intent-to-treat (mITT) cohort, 36-month clinical and angiographic follow-up was available in 134 and 117 cases, respectively. Effectiveness endpoint of complete aneurysm occlusion without clinically significant stenosis or retreatment was met in 71.8% (79/110, 95% CI 62.4% to 80.0%) of cases. Safety composite endpoint was 12.2% (22/180) over the 3-year period, with two major safety events (ipsilateral ischemic strokes) occurring between 12-36 months. Complete aneurysm occlusion was noted in 77.8% (91/117), and 99.1% (116/117) of the patients demonstrated adequate aneurysm occlusion (complete occlusion or neck residual). There were four cases (2.2%) of aneurysm rupture, all occurring within the first month of the index procedure. Target aneurysm retreatment rate was 2.8% (5/180). CONCLUSION The present findings support the long-term safety and effectiveness of the Surpass Streamline flow diverter device. TRIAL REGISTRATION NCT01716117.
Collapse
Affiliation(s)
- Ricardo A Hanel
- Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
| | - Gustavo M Cortez
- Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
| | - Alexander L Coon
- Carondelet Neurological Institute, Carondelet Saint Joseph's Hospital, Tucson, Arizona, USA
| | - Peter Kan
- Department of Neurosurgery, The University of Texas Medical Branch at Galveston School of Medicine, Galveston, Texas, USA
| | - Philipp Taussky
- Department of Neurosurgery, University of Utah Medical Center, Salt Lake City, Utah, USA
| | - Ajay K Wakhloo
- Neurointerventional Radiology, Lahey Clinic Medical Center, Burlington, Massachusetts, USA
| | - Babu G Welch
- Neurosurgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Aclan Dogan
- Interventional Neuroradiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Mark Bain
- Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Joost De Vries
- Neurosurgery, Radboud University Nijmegen, Nijmegen, Gelderland, The Netherlands
| | - Koji Ebersole
- Neurosurgery, Radiology, University of Kansas Medical Center Department of Neurosurgery, Kansas City, Kansas, USA
| | - Philip M Meyers
- Radiology and Neurological Surgery, Columbia University, New York, New York, USA
| |
Collapse
|
5
|
Vivanco-Suarez J, Rodriguez-Calienes A, Kan PT, Wakhloo AK, Pereira VM, Hanel R, Lopes DK, Galecio-Castillo M, Anil S, Farooqui M, Puri AS, Ortega-Gutierrez S. Flow Diverter Performance in Aneurysms Arising From the Posterior Communicating Artery: A Systematic Review and Meta-Analysis. Neurosurgery 2023; 93:764-772. [PMID: 37171169 DOI: 10.1227/neu.0000000000002517] [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: 01/19/2023] [Accepted: 03/10/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Flow diverters (FDs) have demonstrated a safe and effective profile. However, the use of FDs for posterior communicating artery (PComA) aneurysms remains controversial. OBJECTIVE To evaluate the safety and effectiveness of FDs for PComA aneurysms using a systematic review and meta-analysis of the literature. METHODS We performed a systematic search from inception until June 2022 for flow diversion in PComA aneurysms. Primary effectiveness was the rate of complete aneurysm occlusion defined by Raymond-Roy class 1. Primary safety outcomes were treatment-related ischemic/hemorrhagic (composite) events causing morbidity and mortality. Secondary safety was PComA patency at follow-up. Random-effects meta-analyses were used to calculate proportions, and statistical heterogeneity was assessed. RESULTS A total of 13 studies with 397 patients harboring 403 aneurysms were included. Mean age was 48 years, and the mean aneurysm size was 5.3 mm. Most aneurysms were unruptured (65%). Complete occlusion at final follow-up was 73% (CI 66%-79%), and adjunctive coils were used in 10% of aneurysms. Retreatment rate was 2% (CI 0%-9%). The primary safety composite outcome was 4% (CI 3%-7%), and mortality was 1%. PComA patency at final follow-up was 76% (CI 57%-89%). Subgroup analysis, patients with fetal PComAs had a lower complete occlusion rate (42% fetal PComA vs 77%, psubgroupdifference = <.01). CONCLUSION The performance of FDs in PComA aneurysms is comparable with outcomes found in other subtypes of supraclinoid aneurysms. Effectiveness was acceptable and safety favorable. However, effectiveness was suboptimal in patients with fetal-type PComAs; alternative treatments should be considered in these cases.
Collapse
Affiliation(s)
- Juan Vivanco-Suarez
- Department of Neurology, Neurosurgery & Radiology, University of Iowa Hospitals and Clinics, Iowa City , Iowa , USA
| | - Aaron Rodriguez-Calienes
- Department of Neurology, Neurosurgery & Radiology, University of Iowa Hospitals and Clinics, Iowa City , Iowa , USA
- Neuroscience, Clinical Effectiveness and Public Health Research Group, Universidad Científica del Sur, Lima , Peru
| | - Peter T Kan
- Department of Neurological Surgery, University of Texas Medical Branch Galveston, Galveston , Texas , USA
| | - Ajay K Wakhloo
- Department of Interventional Neuroradiology, Lahey Hospital & Medical Center, Burlington , Massachusetts , USA
| | - Vitor M Pereira
- Department of Neurosurgery, St Michael's Hospital, Toronto , Ontario , Canada
| | - Ricardo Hanel
- Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville , Florida , USA
| | - Demetrius Klee Lopes
- Department of Neurosurgery, Brain and Spine Institute, Advocate Aurora Health, Park Ridge , Illinois , USA
| | - Milagros Galecio-Castillo
- Department of Neurology, Neurosurgery & Radiology, University of Iowa Hospitals and Clinics, Iowa City , Iowa , USA
| | - Susan Anil
- Department of Neurology, Neurosurgery & Radiology, University of Iowa Hospitals and Clinics, Iowa City , Iowa , USA
| | - Mudassir Farooqui
- Department of Neurology, Neurosurgery & Radiology, University of Iowa Hospitals and Clinics, Iowa City , Iowa , USA
| | - Ajit S Puri
- Department of Radiology, University of Massachusetts Medical School, Worcester , Massachusetts , USA
| | - Santiago Ortega-Gutierrez
- Department of Neurology, Neurosurgery & Radiology, University of Iowa Hospitals and Clinics, Iowa City , Iowa , USA
| |
Collapse
|
6
|
Vivanco-Suarez J, Mendez-Ruiz A, Farooqui M, Bekelis K, Singer JA, Javed K, Altschul DJ, Fifi JT, Matsoukas S, Cooper J, Al-Mufti F, Gross B, Jankowitz B, Kan PT, Hafeez M, Orru E, Dajles A, Galecio-Castillo M, Zevallos CB, Wakhloo AK, Ortega-Gutierrez S. Safety and efficacy of the surpass streamline for intracranial aneurysms (SESSIA): A multi-center US experience pooled analysis. Interv Neuroradiol 2023; 29:589-598. [PMID: 35934939 PMCID: PMC10549718 DOI: 10.1177/15910199221118148] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/09/2022] [Accepted: 07/17/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND PURPOSE Flow diversion has established as standard treatment for intracranial aneurysms, the Surpass Streamline is the only FDA-approved braided cobalt/chromium alloy implant with 72-96 wires. We aimed to determine the safety and efficacy of the Surpass in a post-marketing large United States cohort. MATERIALS AND METHODS This is a retrospective multicenter study of consecutive patients treated with the Surpass for intracranial aneurysms between 2018 and 2021. Baseline demographics, comorbidities, and aneurysm characteristics were collected. Efficacy endpoint included aneurysm occlusion on radiographic follow-up. Safety endpoints were major ipsilateral ischemic stroke or treatment-related death. RESULTS A total of 277 patients with 314 aneurysms were included. Median age was 60 years, 202 (73%) patients were females. Hypertension was the most common comorbidity in 156 (56%) patients. The most common location of the aneurysms was the anterior circulation in 89% (279/314). Mean aneurysm dome width was 5.77 ± 4.75 mm, neck width was 4.22 ± 3.83 mm, and dome/neck ratio was 1.63 ± 1.26. Small-sized aneurysms were 185 (59%). Single device was used in 94% of the patients, mean number of devices per patient was 1.06. At final follow-up, complete obliteration rate was 81% (194/239). Major stroke and death were encountered in 7 (3%) and 6 (2%) cases, respectively. CONCLUSION This is the largest cohort study using a 72-96 wire flow diverter. The Surpass Streamline demonstrated a favorable safety and efficacy profile, making it a valuable option for treating not only large but also wide-necked small and medium-sized intracranial aneurysms.
Collapse
Affiliation(s)
- Juan Vivanco-Suarez
- Department of Neurology, Neurosurgery & Radiology, The University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Alan Mendez-Ruiz
- Department of Neurology, Neurosurgery & Radiology, The University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Mudassir Farooqui
- Department of Neurology, Neurosurgery & Radiology, The University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Kimon Bekelis
- Department of Neurological Surgery, Good Samaritan Hospital Medical Center, West Islip, NY, United States
| | - Justin A Singer
- Department of Neurological Surgery, Spectrum Health, Grand Rapids, MI, United States
| | - Kainaat Javed
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY, United States
| | - David J Altschul
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY, United States
| | - Johanna T Fifi
- Department of Neurological Surgery, The Mount Sinai Hospital, New York, NY, United States
| | - Stavros Matsoukas
- Department of Neurological Surgery, The Mount Sinai Hospital, New York, NY, United States
| | - Jared Cooper
- Department of Neurology, Neurosurgery & Radiology, Westchester Medical Center and New York Medical College, Valhalla, NY, United States
| | - Fawaz Al-Mufti
- Department of Neurology, Neurosurgery & Radiology, Westchester Medical Center and New York Medical College, Valhalla, NY, United States
| | - Bradley Gross
- Department of Endovascular Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Brian Jankowitz
- Department of Endovascular Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Peter T Kan
- Department of Neurological Surgery, University of Texas Medical Branch, Galveston, TX, United States
| | - Muhammad Hafeez
- Department of Neurological Surgery, University of Texas Medical Branch, Galveston, TX, United States
| | - Emanuele Orru
- Department of Interventional Neuroradiology, Lahey Hospital & Medical Center, Burlington, MA, United States
| | - Andres Dajles
- Department of Neurology, Neurosurgery & Radiology, The University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Milagros Galecio-Castillo
- Department of Neurology, Neurosurgery & Radiology, The University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Cynthia B Zevallos
- Department of Neurology, Neurosurgery & Radiology, The University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Ajay K Wakhloo
- Department of Interventional Neuroradiology, Lahey Hospital & Medical Center, Burlington, MA, United States
| | - Santiago Ortega-Gutierrez
- Department of Neurology, Neurosurgery & Radiology, The University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| |
Collapse
|
7
|
Siddiqui AH, Monteiro A, Hanel R, Kan P, Mohanty A, Cortez G, Rabinovich M, Matouk CC, Sujijantarat N, Romero CE, Stone JG, Ebersole KC, Fry L, Natarajan SK, Thomson BOA, Ortega-Gutierrez S, Vivanco-Suarez J, Wakhloo AK, Levy EI. 482 Triple Therapy Versus Dual Antiplatelet Therapy for Dolichoectatic Vertebrobasilar Fusiform Aneurysms Treated With Flow Diverters: The Last Frontier? Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
|
8
|
Siddiqui AH, Monteiro A, Hanel RA, Kan P, Mohanty A, Cortez GM, Rabinovich M, Matouk C, Sujijantarat N, Romero C, Stone J, Ebersole K, Fry L, Natarajan SK, Owusu-Adjei B, Ortega-Gutierrez S, Vivanco-Suarez J, Wakhloo AK, Levy EI. Triple therapy versus dual-antiplatelet therapy for dolichoectatic vertebrobasilar fusiform aneurysms treated with flow diverters. J Neurointerv Surg 2022:jnis-2022-019151. [DOI: 10.1136/jnis-2022-019151] [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] [Received: 05/10/2022] [Accepted: 08/04/2022] [Indexed: 11/03/2022]
Abstract
BackgroundDolichoectatic vertebrobasilar fusiform aneurysms (DVBFAs) have poor natural history when left untreated and high morbimortality when treated with microsurgery. Flow diversion (FD) with dual-antiplatelet therapy (DAPT) is feasible but carries high risk of perforator occlusion and progression of brainstem compression. Elaborate antithrombotic strategies are needed to preserve perforator patency while vessel remodeling occurs. We compared triple therapy (TT (DAPT plus oral anticoagulation)) and DAPT alone in patients with DVBFAs treated with FD.MethodsRetrospective comparison of DAPT and TT in patients with DVBFAs treated with FD at eight US centers.ResultsThe groups (DAPT=13, TT=14) were similar in age, sex, clinical presentation, baseline disability, and aneurysm characteristics. Radial access use was significantly higher in the TT group (71.4% vs 15.3%; P=0.006). Median number of flow diverters and adjunctive coiling use were non-different between groups. Acute ischemic stroke rate during the oral anticoagulation period was lower in the TT group than the DAPT group (7.1% vs 30.8%; P=0.167). Modified Rankin Scale score decline was significantly lower in the TT group (7.1% vs 69.2%; P=0.001). Overall rates of hemorrhagic complications (TT, 28.6% vs DAPT, 7.7%; P=0.162) and complete occlusion (TT, 25% vs DAPT, 54.4%; P=0.213) were non-different between the groups. Rate of moderate-to-severe disability at last follow-up was significantly lower in the TT group (21.4% vs 76.9%; P=0.007).ConclusionsPatients with DVBFAs treated with FD in the TT group had fewer ischemic strokes, less symptom progression, and overall better outcomes at last follow-up than similar patients in the DAPT group.
Collapse
|
9
|
Kan P, Mohanty A, Meyers PM, Coon AL, Wakhloo AK, Marosfoi M, Bain M, de Vries J, Ebersole K, Lanzino G, Taussky P, Hanel RA. Treatment of large and giant posterior communicating artery aneurysms with the Surpass streamline flow diverter: results from the SCENT trial. J Neurointerv Surg 2022:neurintsurg-2021-018189. [PMID: 35551072 DOI: 10.1136/neurintsurg-2021-018189] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 05/02/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The Surpass flow diverter was developed to treat intracranial aneurysms not amenable to standard treatment. Indications for use allow placement in the internal carotid artery to the terminus, including the communicating artery segment. METHODS The Surpass Intracranial Aneurysm Embolization System Pivotal Trial to Treat Large or Giant Wide Neck Aneurysms (SCENT) trial is an international, multicenter, prospective, non-randomized trial comparing the outcomes of Surpass flow diverter treatment with historic control designed to evaluate the effectiveness and safety of Surpass for the treatment of wide neck (≥4 mm) large or giant intracranial aneurysms ≥10 mm. The primary effectiveness endpoint is the percentage of subjects with 100% aneurysm occlusion without significant stenosis of the parent artery and without retreatment of the target aneurysm at 12 months. The primary safety endpoint is the percentage of subjects experiencing neurologic death or major ipsilateral stroke at 12 months. We report the effectiveness and safety of flow diversion in the subgroup of posterior communicating artery (PComA) aneurysms. RESULTS Of the 180 patients treated, 38 harbored a PComA aneurysm. Mean aneurysm size was 12.2 mm and mean neck width was 4.8 mm. The mean number of Surpass devices used was 1.1 per procedure, with 94.7% of aneurysms treated with one flow diverter. The 12 month primary effectiveness rate was 73.7% (28/38). At 36 months, 68.4% (26/38) of aneurysms remained completely occluded. The 12 month major ipsilateral stroke or neurological death rate was 10.5%. No patients with PComA occlusion after flow diverter placement (54.5%) had clinical sequelae. CONCLUSIONS SCENT demonstrated acceptable 12 month effectiveness of flow diversion in PComA aneurysms. Despite associated PComA occlusions in many cases, arterial occlusions were clinically silent. TRIAL REGISTRATION NUMBER URL: https://www. CLINICALTRIALS gov. Unique identifier: NCT01716117.
Collapse
Affiliation(s)
- Peter Kan
- Department of Neurosurgery, The University of Texas Medical Branch at Galveston School of Medicine, Galveston, Texas, USA
| | - Alina Mohanty
- Baylor College of Medicine Department of Neurosurgery, Houston, Texas, USA
| | - Philip M Meyers
- Radiology and Neurological Surgery, Columbia University, New York, New York, USA
| | - Alexander L Coon
- Carondelet Neurological Institute, Carondelet Saint Joseph's Hospital, Tucson, Arizona, USA
| | - Ajay K Wakhloo
- Neurointerventional Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Miklos Marosfoi
- Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Mark Bain
- Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Koji Ebersole
- Neurosurgery, Radiology, University of Kansas, Kansas City, Kansas, USA
| | | | - Philipp Taussky
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
| | - Ricardo A Hanel
- Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA
| |
Collapse
|
10
|
Abstract
The treatment of acute ischemic stroke continues to advance. The mainstay of treatment remains intravenous thrombolysis with alteplase. Recent studies demonstrated that later treatment with alteplase is beneficial in patients selected with advanced imaging techniques. Tenecteplase has been evaluated as an alternative thrombolytic drug and evidence suggests that it is as least as effective as alteplase and may lyse large vessel clots more effectively. Endovascular therapy with mechanical thrombectomy has now been shown to be beneficial up to 24 hours after stroke onset in carefully selected patients with proximal, large vessel occlusions. Ongoing studies are evaluating the effectiveness of thrombectomy in patients with more distal vessel occlusions and patients with proximal large vessel occlusions with larger ischemic core volumes and also in patients with milder neurological deficits. Cytoprotection is another potential acute stroke therapy that has not demonstrated efficacy in prior clinical trials. It should be reconsidered as an adjunct to reperfusion and a variety of new clinical trials can be envisioned to evaluate the potential benefits of cytoprotection in patients before and after reperfusion.
Collapse
Affiliation(s)
- Yunyun Xiong
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Y.X.).,Chinese Institute of Brain Research (Y.X.)
| | - Ajay K Wakhloo
- Department of Neurointerventional Radiology Beth Israel Lahey Health Medical Center, Tufts University School of Medicine, Burlington' MA (A.K.W.)
| | - Marc Fisher
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School' Boston' MA (M.F.)
| |
Collapse
|
11
|
Dmytriw AA, Dibas M, Phan K, Efendizade A, Ospel J, Schirmer C, Settecase F, Heran MKS, Kühn AL, Puri AS, Menon BK, Sivakumar S, Mowla A, Vela-Duarte D, Linfante I, Dabus GC, Regenhardt RW, D'Amato S, Rosenthal JA, Zha A, Talukder N, Sheth SA, Hassan AE, Cooke DL, Leung LY, Malek AM, Voetsch B, Sehgal S, Wakhloo AK, Goyal M, Wu H, Cohen J, Ghozy S, Turkel-Parella D, Farooq Z, Vranic JE, Rabinov JD, Stapleton CJ, Minhas R, Velayudhan V, Chaudhry ZA, Xavier A, Bullrich MB, Pandey S, Sposato LA, Johnson SA, Gupta G, Khandelwal P, Ali L, Liebeskind DS, Farooqui M, Ortega-Gutierrez S, Nahab F, Jillella DV, Chen K, Aziz-Sultan MA, Abdalkader M, Kaliaev A, Nguyen TN, Haussen DC, Nogueira RG, Haq IU, Zaidat OO, Sanborn E, Leslie-Mazwi TM, Patel AB, Siegler JE, Tiwari A. Acute ischaemic stroke associated with SARS-CoV-2 infection in North America. J Neurol Neurosurg Psychiatry 2022; 93:360-368. [PMID: 35078916 PMCID: PMC8804309 DOI: 10.1136/jnnp-2021-328354] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/22/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND To analyse the clinical characteristics of COVID-19 with acute ischaemic stroke (AIS) and identify factors predicting functional outcome. METHODS Multicentre retrospective cohort study of COVID-19 patients with AIS who presented to 30 stroke centres in the USA and Canada between 14 March and 30 August 2020. The primary endpoint was poor functional outcome, defined as a modified Rankin Scale (mRS) of 5 or 6 at discharge. Secondary endpoints include favourable outcome (mRS ≤2) and mortality at discharge, ordinal mRS (shift analysis), symptomatic intracranial haemorrhage (sICH) and occurrence of in-hospital complications. RESULTS A total of 216 COVID-19 patients with AIS were included. 68.1% (147/216) were older than 60 years, while 31.9% (69/216) were younger. Median [IQR] National Institutes of Health Stroke Scale (NIHSS) at presentation was 12.5 (15.8), and 44.2% (87/197) presented with large vessel occlusion (LVO). Approximately 51.3% (98/191) of the patients had poor outcomes with an observed mortality rate of 39.1% (81/207). Age >60 years (aOR: 5.11, 95% CI 2.08 to 12.56, p<0.001), diabetes mellitus (aOR: 2.66, 95% CI 1.16 to 6.09, p=0.021), higher NIHSS at admission (aOR: 1.08, 95% CI 1.02 to 1.14, p=0.006), LVO (aOR: 2.45, 95% CI 1.04 to 5.78, p=0.042), and higher NLR level (aOR: 1.06, 95% CI 1.01 to 1.11, p=0.028) were significantly associated with poor functional outcome. CONCLUSION There is relationship between COVID-19-associated AIS and severe disability or death. We identified several factors which predict worse outcomes, and these outcomes were more frequent compared to global averages. We found that elevated neutrophil-to-lymphocyte ratio, rather than D-Dimer, predicted both morbidity and mortality.
Collapse
Affiliation(s)
- Adam A Dmytriw
- Neuroradiology, Neurosurgery & Neurology Services, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mahmoud Dibas
- Neuroradiology, Neurosurgery & Neurology Services, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kevin Phan
- Neuroradiology, Neurosurgery & Neurology Services, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Aslan Efendizade
- Department of Neuroradiology, University Hospital Brooklyn, SUNY Downstate School of Medicine, Brooklyn, New York, USA
- Department of Neuroradiology, Kings County Hospital, NYC Health and Hospitals, Brooklyn, New York, USA
| | - Johanna Ospel
- Calgary Stroke Program, Cumming School of Medicine, Calgary, AB, Canada
| | - Clemens Schirmer
- Department of Neurosurgery & Neuroscience Institute, Geisinger Health, Geisinger Health, PA, USA
| | - Fabio Settecase
- Division of Neuroradiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Manraj K S Heran
- Division of Neuroradiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Anna Luisa Kühn
- Division of Neurointerventional Radiology, Department of Radiology, UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Ajit S Puri
- Division of Neurointerventional Radiology, Department of Radiology, UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Bijoy K Menon
- Calgary Stroke Program, Cumming School of Medicine, Calgary, AB, Canada
| | - Sanjeev Sivakumar
- Department of Medicine (Neurology), Prisma Health Upstate, USC, Greenville, SC, USA
| | - Askan Mowla
- Department of Neurological Surgery, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Daniel Vela-Duarte
- Neuroradiology & Neurology Services, Miami Baptist Medical Center, Miami, FL, USA
| | - Italo Linfante
- Neuroradiology & Neurology Services, Miami Baptist Medical Center, Miami, FL, USA
| | - Guilherme C Dabus
- Neuroradiology & Neurology Services, Miami Baptist Medical Center, Miami, FL, USA
| | - Robert W Regenhardt
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Salvatore D'Amato
- Neuroradiology, Neurosurgery & Neurology Services, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph A Rosenthal
- Neuroradiology, Neurosurgery & Neurology Services, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alicia Zha
- Department of Neurology, UT Health Science Center, Houston, TX, USA
| | - Nafee Talukder
- Department of Neurology, UT Health Science Center, Houston, TX, USA
| | - Sunil A Sheth
- Department of Neurology, UT Health Science Center, Houston, TX, USA
| | - Ameer E Hassan
- Department of Neurology, University of Texas Rio Grande Valley, Valley Baptist Medical Center, Harlingen, TX, USA
| | - Daniel L Cooke
- Department of Neurointerventional Radiology, University California San Francisco, San Francisco, CA, USA
| | - Lester Y Leung
- Departments of Neurology and Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Adel M Malek
- Departments of Neurology and Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Barbara Voetsch
- Departments of Neurology & Neurointerventional Radiology, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Siddharth Sehgal
- Departments of Neurology & Neurointerventional Radiology, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Ajay K Wakhloo
- Departments of Neurology & Neurointerventional Radiology, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Mayank Goyal
- Calgary Stroke Program, Cumming School of Medicine, Calgary, AB, Canada
| | - Hannah Wu
- Department of Neurology, Brookdale University Hospital & Medical Center, Brooklyn, NY, USA
- Department of Neurology & Neurosurgery, St. Francis Hospital, Roslyn, NY, USA
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
| | - Jake Cohen
- Department of Neurology, Brookdale University Hospital & Medical Center, Brooklyn, NY, USA
- Department of Neurology & Neurosurgery, St. Francis Hospital, Roslyn, NY, USA
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
| | - Sherief Ghozy
- Neuroradiology, Neurosurgery & Neurology Services, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David Turkel-Parella
- Department of Neurology, Brookdale University Hospital & Medical Center, Brooklyn, NY, USA
- Department of Neurology & Neurosurgery, St. Francis Hospital, Roslyn, NY, USA
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
| | - Zerwa Farooq
- Department of Neuroradiology, University Hospital Brooklyn, SUNY Downstate School of Medicine, Brooklyn, New York, USA
- Department of Neuroradiology, Kings County Hospital, NYC Health and Hospitals, Brooklyn, New York, USA
| | - Justin E Vranic
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - James D Rabinov
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher J Stapleton
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ramandeep Minhas
- Department of Neuroradiology, University Hospital Brooklyn, SUNY Downstate School of Medicine, Brooklyn, New York, USA
- Department of Neuroradiology, Kings County Hospital, NYC Health and Hospitals, Brooklyn, New York, USA
| | - Vinodkumar Velayudhan
- Department of Neuroradiology, University Hospital Brooklyn, SUNY Downstate School of Medicine, Brooklyn, New York, USA
- Department of Neuroradiology, Kings County Hospital, NYC Health and Hospitals, Brooklyn, New York, USA
| | - Zeshan Ahmed Chaudhry
- Department of Neuroradiology, University Hospital Brooklyn, SUNY Downstate School of Medicine, Brooklyn, New York, USA
- Department of Neuroradiology, Kings County Hospital, NYC Health and Hospitals, Brooklyn, New York, USA
| | - Andrew Xavier
- Department of Neurology, St Joseph Mercy Health System, Ann Arbor, MI, USA
- Department of Neurology, Sinai Grace Hospital, Detroit, MI, USA
| | - Maria Bres Bullrich
- Departments of Neurology & Neuroradiology, London Health Sciences Centre, London, Ontario, Canada
| | - Sachin Pandey
- Departments of Neurology & Neuroradiology, London Health Sciences Centre, London, Ontario, Canada
| | - Luciano A Sposato
- Departments of Neurology & Neuroradiology, London Health Sciences Centre, London, Ontario, Canada
| | - Stephen A Johnson
- Departments of Neurology & Neurosurgery, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Gaurav Gupta
- Departments of Neurology & Neurosurgery, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Priyank Khandelwal
- Departments of Neurology & Neurosurgery, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Latisha Ali
- Department of Neurology, UCLA Medical Center, University of California, Los Angeles, California, USA
| | - David S Liebeskind
- Department of Neurology, UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Mudassir Farooqui
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, IO, USA
| | | | - Fadi Nahab
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Dinesh V Jillella
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Karen Chen
- Neuroradiology, Neurosurgery & Neurology Services, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mohammad Ali Aziz-Sultan
- Neuroradiology, Neurosurgery & Neurology Services, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mohamad Abdalkader
- Departments of Neurology and Radiology, Boston University Medical Center, Boston, Massachusetts, USA
| | - Artem Kaliaev
- Departments of Neurology and Radiology, Boston University Medical Center, Boston, Massachusetts, USA
| | - Thanh N Nguyen
- Departments of Neurology and Radiology, Boston University Medical Center, Boston, Massachusetts, USA
| | - Diogo C Haussen
- Department of Neurology, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Raul G Nogueira
- Department of Neurology, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Israr Ul Haq
- Neuroscience Institute, Bon Secours Mercy Health St Vincent Hospital, Toledo, OH, USA
| | - Osama O Zaidat
- Neuroscience Institute, Bon Secours Mercy Health St Vincent Hospital, Toledo, OH, USA
- Department of Neuroscience, St Vincent Mercy Hospital, Toledo, Ohio, USA
| | - Emma Sanborn
- Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA
| | - Thabele M Leslie-Mazwi
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Aman B Patel
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - James E Siegler
- Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA
| | - Ambooj Tiwari
- Department of Neurology, Brookdale University Hospital & Medical Center, Brooklyn, NY, USA
- Department of Neurology & Neurosurgery, St. Francis Hospital, Roslyn, NY, USA
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
| |
Collapse
|
12
|
Marosfoi M, Orrù E, Rabinovich M, Newman S, Patel NV, Wakhloo AK. Endovascular Treatment of Intracranial Aneurysms. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00068-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
13
|
Adams HP, Adeoye O, Albers GW, Alexandrov AV, Amin-Hanjani S, An H, Anderson CS, Anrather J, Aparicio HJ, Arai K, Aronowski J, Atchaneeyasakul K, Audebert H, Auer RN, Awad IA, Ay H, Baltan S, Balu R, Behbahani M, Benavente OR, Bershad EM, Berthaud JV, Blackburn SL, Bonati LH, Bösel J, Bousser MG, Broderick JP, Brown MM, Brown W, Brust JC, Bushnell C, Canhão P, Caplan LR, Carrión-Penagos J, Castellanos M, Caunca MR, Chabriat H, Chamorro A, Chen J, Chen J, Chopp M, Christorforids G, Connolly ES, Cramer SC, Cucchiara BL, Czap AL, Dannenbaum MJ, Davis PH, Dawson TM, Dawson VL, Day AL, De Silva TM, de Sousa DA, Del Brutto VJ, del Zoppo GJ, Derdeyn CP, Di Tullio MR, Diener HC, Diringer MN, Dobkin BH, Dzialowski I, Elkind MS, Elm J, Feigin VL, Ferro JM, Field TS, Fischer M, Fornage M, Furie KL, Garcia-Bonilla L, Giannotta SL, Gobin YP, Goldberg MP, Goldstein LB, Gonzales NR, Greer DM, Grotta JC, Guo R, Gutierrez J, Harmel P, Howard G, Howard VJ, Hwang JY, Iadecola C, Jahan R, Jickling GC, Joutel A, Kasner SE, Katan M, Kellner CP, Khan M, Kidwell CS, Kim H, Kim JS, Kircher CE, Krings T, Krishnamurthi RV, Kurth T, Lansberg MG, Levy EI, Liebeskind DS, Liew SL, Lin DJ, Lisle B, Lo EH, Lyden PD, Maki T, Maragkos GA, Marosfoi M, McCullough LD, Meckler JM, Meschia JF, Messé SR, Mocco J, Mokin M, Mooney MA, Morgenstern LB, Moskowitz MA, Mullen MT, Nägel S, Nedergaard M, Neira JA, Newman S, Nicholson PJ, Norrving B, O’Donnell M, Ofengeim D, Ogata J, Ogilvy CS, Orrù E, Ortega-Gutiérrez S, Padrick MM, Parsha K, Parsons M, Patel NV, Patel VI, Pawlikowska L, Pérez A, Perez-Pinzon MA, Picard JM, Polster SP, Powers WJ, Puetz V, Putaala J, Rabinovich M, Ransom BR, Roa JA, Rosenberg GA, Rossitto CP, Rundek T, Russin JJ, Sacco RL, Safouris A, Samaniego EA, Sansing LH, Satani N, Sattenberg RJ, Saver JL, Savitz SI, Schmidt C, Seshadri S, Sharma VK, Sharp FR, Sheth KN, Siddiqi OK, Singhal AB, Sobey CG, Sommer CJ, Spetzler RF, Stapleton CJ, Strickland BA, Su H, Suarez JI, Takayama H, Tarsia J, Tatlisumak T, Thomas AJ, Thompson JW, Tsivgoulis G, Tournier-Lasserve E, Vidal G, Wakhloo AK, Weksler BB, Willey JZ, Wintermark M, Wong LK, Xi G, Xu J, Yaghi S, Yamaguchi T, Yang T, Yasaka M, Zahuranec DB, Zhang F, Zhang JH, Zheng Z, Zukin RS, Zweifler RM. Contributors. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.01002-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
14
|
Orru' E, Marosfoi M, Patel NV, Coon AL, Wald C, Repucci N, Nicholson P, Pereira VM, Wakhloo AK. International teleproctoring in neurointerventional surgery and its potential impact on clinical trials in the era of COVID-19: legal and technical considerations. J Neurointerv Surg 2021; 13:1022-1026. [PMID: 33443115 PMCID: PMC7754670 DOI: 10.1136/neurintsurg-2020-017053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/01/2020] [Accepted: 12/01/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Existing travel restrictions limit the mobility of proctors, significantly delaying clinical trials and the introduction of new neurointerventional devices. We aim to describe in detail technical and legal considerations regarding international teleproctoring, a tool that could waive the need for in-person supervision during procedures. METHODS International teleproctoring was chosen to provide remote supervision during the first three intracranial aneurysm treatments with a new flow diverter (currently subject of a clinical trial) in the US. Real-time, high-resolution transmission software streamed audiovisual data to a proctor located in Canada. The software allowed the transmission of images in a de-identified, HIPAA-compliant manner. RESULTS All three flow diverters were implanted as desired by operator and proctor and without complication. The proctor could swap between images from multiple sources and reported complete spatial and situational awareness, without any significant lag or delay in communication. Procedural times and radiologic dose were similar to those of uncomplicated, routine flow diversion cases at our institution. CONCLUSIONS International teleproctoring was successfully implemented in our clinical practice. Its first use provided important insights for establishing this tool in our field. With no clear horizon for lifting the current travel restrictions, teleproctoring has the potential to remove the need for proctor presence in the angiography suite, thereby allowing the field to advance through the continuation of trials and the introduction of new devices in clinical practice. In order for this tool to be used safely and effectively, highly reliable connection and high-resolution equipment is necessary, and multiple legal nuances have to be considered.
Collapse
Affiliation(s)
- Emanuele Orru'
- Neurointerventional Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Miklos Marosfoi
- Neurointerventional Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Neil V Patel
- Neurointerventional Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Alexander L Coon
- Carondelet Neurological Institute, Carondelet Saint Joseph's Hospital, Tucson, Arizona, USA
| | - Christoph Wald
- Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Nicholas Repucci
- Research Administration, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Patrick Nicholson
- Interventional Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Vitor M Pereira
- Interventional Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Ajay K Wakhloo
- Neurointerventional Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| |
Collapse
|
15
|
Dmytriw AA, Dibas M, Schirmer CM, Settecase F, Heran MKS, Efendizade A, Kühn AL, Puri AS, Ospel J, Menon B, Sivakumar S, Mowla A, Vela‐Duarte D, Linfante I, Dabus G, Regenhardt RW, Patel AB, Leslie‐Mazwi T, D’Amato S, Rosenthal J, Zha A, Talukder N, Sheth S, Cooke D, Leung LY, Malek A, Voetsch B, Sehgal S, Wakhloo AK, Wu H, Cohen J, Turkel‐Parella D, Xavier A, Tiwari A. Age and Acute Ischemic Stroke Outcome in North American Patients With COVID-19. J Am Heart Assoc 2021; 10:e021046. [PMID: 34219466 PMCID: PMC8483479 DOI: 10.1161/jaha.121.021046] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Acute ischemic stroke (AIS) in the context of COVID‐19 has received considerable attention for its propensity to affect patients of all ages. We aimed to evaluate the effect of age on functional outcome and mortality following an acute ischemic event. Methods and Results A prospectively maintained database from comprehensive stroke centers in Canada and the United States was analyzed for patients with AIS from March 14 to September 30, 2020 who tested positive for SARS‐CoV‐2. The primary outcome was Modified Rankin Scale score at discharge, and the secondary outcome was mortality. Baseline characteristics, laboratory values, imaging, and thrombectomy workflow process times were assessed. Among all 126 patients with COVID‐19 who were diagnosed with AIS, the median age was 63 years (range, 27–94). There were 35 (27.8%) patients with AIS in the aged ≤55 years group, 47 (37.3%) in the aged 56 to 70 group, and 44 (34.9%) in the aged >70 group. Intravenous tissue plasminogen activator and thrombectomy rates were comparable across these groups, (P=0.331 and 0.212, respectively). There was a significantly lower rate of mortality between each group favoring younger age (21.9% versus 45.0% versus 48.8%, P=0.047). After multivariable adjustment for possible confounders, a 1‐year increase in age was significantly associated with fewer instances of a favorable outcome of Modified Rankin Scale 0 to 2 (odds ratio [OR], 0.95; 95 CI%, 0.90–0.99; P=0.048) and higher mortality (OR, 1.06; 95 CI%, 1.02–1.10; P=0.007). Conclusions AIS in the context of COVID‐19 affects young patients at much greater rates than pre‐pandemic controls. Nevertheless, instances of poor functional outcome and mortality are closely tied to increasing age.
Collapse
|
16
|
Nguyen TN, Haussen DC, Qureshi MM, Yamagami H, Fujinaka T, Mansour OY, Abdalkader M, Frankel M, Qiu Z, Taylor A, Lylyk P, Eker OF, Mechtouff L, Piotin M, Lima FO, Mont'Alverne F, Izzath W, Sakai N, Mohammaden M, Al-Bayati AR, Renieri L, Mangiafico S, Ozretic D, Chalumeau V, Ahmad S, Rashid U, Hussain SI, John S, Griffin E, Thornton J, Fiorot JA, Rivera R, Hammami N, Cervantes-Arslanian AM, Dasenbrock HH, Vu HL, Nguyen VQ, Hetts S, Bourcier R, Guile R, Walker M, Sharma M, Frei D, Jabbour P, Herial N, Al-Mufti F, Ozdemir AO, Aykac O, Gandhi D, Chugh C, Matouk C, Lavoie P, Edgell R, Beer-Furlan A, Chen M, Killer-Oberpfalzer M, Pereira VM, Nicholson P, Huded V, Ohara N, Watanabe D, Shin DH, Magalhaes PS, Kikano R, Ortega-Gutierrez S, Farooqui M, Abou-Hamden A, Amano T, Yamamoto R, Weeks A, Cora EA, Sivan-Hoffmann R, Crosa R, Möhlenbruch M, Nagel S, Al-Jehani H, Sheth SA, Lopez Rivera VS, Siegler JE, Sani AF, Puri AS, Kuhn AL, Bernava G, Machi P, Abud DG, Pontes-Neto OM, Wakhloo AK, Voetsch B, Raz E, Yaghi S, Mehta BP, Kimura N, Murakami M, Lee JS, Hong JM, Fahed R, Walker G, Hagashi E, Cordina SM, Roh HG, Wong K, Arenillas JF, Martinez-Galdamez M, Blasco J, Rodriguez Vasquez A, Fonseca L, Silva ML, Wu TY, John S, Brehm A, Psychogios M, Mack WJ, Tenser M, Todaka T, Fujimura M, Novakovic R, Deguchi J, Sugiura Y, Tokimura H, Khatri R, Kelly M, Peeling L, Murayama Y, Winters HS, Wong J, Teleb M, Payne J, Fukuda H, Miyake K, Shimbo J, Sugimura Y, Uno M, Takenobu Y, Matsumaru Y, Yamada S, Kono R, Kanamaru T, Morimoto M, Iida J, Saini V, Yavagal D, Bushnaq S, Huang W, Linfante I, Kirmani J, Liebeskind DS, Szeder V, Shah R, Devlin TG, Birnbaum L, Luo J, Churojana A, Masoud HE, Lopez CY, Steinfort B, Ma A, Hassan AE, Al Hashmi A, McDermott M, Mokin M, Chebl A, Kargiotis O, Tsivgoulis G, Morris JG, Eskey CJ, Thon J, Rebello L, Altschul D, Cornett O, Singh V, Pandian J, Kulkarni A, Lavados PM, Olavarria VV, Todo K, Yamamoto Y, Silva GS, Geyik S, Johann J, Multani S, Kaliaev A, Sonoda K, Hashimoto H, Alhazzani A, Chung DY, Mayer SA, Fifi JT, Hill MD, Zhang H, Yuan Z, Shang X, Castonguay AC, Gupta R, Jovin TG, Raymond J, Zaidat OO, Nogueira RG. Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic. Stroke Vasc Neurol 2021; 6:542-552. [PMID: 33771936 PMCID: PMC8006491 DOI: 10.1136/svn-2020-000695] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/15/2020] [Accepted: 01/15/2021] [Indexed: 02/07/2023] Open
Abstract
Background During the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The study’s objective was to examine whether subarachnoid haemorrhage (SAH) hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines. Methods We conducted a cross-sectional, retrospective, observational study across 6 continents, 37 countries and 140 comprehensive stroke centres. Patients with the diagnosis of SAH, aneurysmal SAH, ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases, 10th Revision, codes. The 3-month cumulative volume, monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before (1 year and immediately before) and during the pandemic, defined as 1 March–31 May 2020. The prior 1-year control period (1 March–31 May 2019) was obtained to account for seasonal variation. Findings There was a significant decline in SAH hospitalisations, with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic, representing a relative decline of 22.5% (95% CI −24.3% to −20.7%, p<0.0001). Embolisation of ruptured aneurysms declined with 1170–1035 procedures, respectively, representing an 11.5% (95%CI −13.5% to −9.8%, p=0.002) relative drop. Subgroup analysis was noted for aneurysmal SAH hospitalisation decline from 834 to 626 hospitalisations, a 24.9% relative decline (95% CI −28.0% to −22.1%, p<0.0001). A relative increase in ruptured aneurysm coiling was noted in low coiling volume hospitals of 41.1% (95% CI 32.3% to 50.6%, p=0.008) despite a decrease in SAH admissions in this tertile. Interpretation There was a relative decrease in the volume of SAH hospitalisations, aneurysmal SAH hospitalisations and ruptured aneurysm embolisations during the COVID-19 pandemic. These findings in SAH are consistent with a decrease in other emergencies, such as stroke and myocardial infarction.
Collapse
Affiliation(s)
- Thanh N Nguyen
- Neurology, Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Diogo C Haussen
- Neurology, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA, USA
| | - Muhammad M Qureshi
- Radiology, Radiation Oncology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Hiroshi Yamagami
- Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Toshiyuki Fujinaka
- Neurosurgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | | | | | - Michael Frankel
- Neurology, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA, USA
| | - Zhongming Qiu
- Department of Neurology, Xinqiao Hospital, Chongqing, China
| | - Allan Taylor
- Neurosurgery, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Pedro Lylyk
- Neurosurgery, Interventional Neuroradiology, Clinica La Sagrada Familia, Buenos Aires, Argentina
| | - Omer F Eker
- Neuroradiologie, Neurologie Vasculaire, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Laura Mechtouff
- Neurologie Vasculaire, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Michel Piotin
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
| | | | | | - Wazim Izzath
- Neuroradiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Mahmoud Mohammaden
- Neurology, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA, USA
| | - Alhamza R Al-Bayati
- Neurology, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA, USA
| | - Leonardo Renieri
- Interventional Neurovascular Unit, University Hospital Careggi, Firenze, Toscana, Italy
| | - Salvatore Mangiafico
- Interventional Neurovascular Unit, University Hospital Careggi, Firenze, Toscana, Italy
| | - David Ozretic
- Neuroradiology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Vanessa Chalumeau
- Interventional Neuroradiology, Hopital Bicetre, Le Kremlin-Bicetre, France
| | - Saima Ahmad
- Stroke and Interventional Neuroradiology, Lahore General Hospital, Lahore, Pakistan
| | - Umair Rashid
- Stroke and Interventional Neuroradiology, Lahore General Hospital, Lahore, Pakistan
| | | | - Seby John
- Neurological Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Emma Griffin
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - John Thornton
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | | | - Rodrigo Rivera
- Neuroradiology, Instituto de Neurocirugia Dr Asengo, Santiago, Chile
| | - Nadia Hammami
- Interventional Neuroradiology, Institut National de Neurologie, Tunis, Tunisia
| | | | | | - Huynh Le Vu
- Stroke Center, Hue Central Hospital, Hue, Thua Thien Hue, Vietnam
| | - Viet Quy Nguyen
- Stroke Center, Hue Central Hospital, Hue, Thua Thien Hue, Vietnam
| | - Steven Hetts
- Radiology, University of California San Francisco, San Francisco, California, USA.,Interventional Neuroradiology, University of California San Francisco, San Francisco, California, USA
| | - Romain Bourcier
- Neuroradiologie Diagnostique et Interventionnelle, Hôpital Guillaume & René Laennec, CHU Nantes, Nantes, France
| | - Romain Guile
- Neuroradiologie Diagnostique et Interventionnelle, Hôpital Guillaume & René Laennec, CHU Nantes, Nantes, France
| | - Melanie Walker
- Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Malveeka Sharma
- Neurology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Don Frei
- Radiology, Swedish Medical Center, Englewood, Colorado, USA
| | - Pascal Jabbour
- Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Nabeel Herial
- Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Fawaz Al-Mufti
- Neurology, Neurosurgery, Westchester Medical Center Health Network, Valhalla, New York, USA
| | - Atilla Ozcan Ozdemir
- Stroke and Neurointervention Unit, Eskisehir OsmangaziUniversity, Eskisehir, Turkey
| | - Ozlem Aykac
- Stroke and Neurointervention Unit, Eskisehir OsmangaziUniversity, Eskisehir, Turkey
| | - Dheeraj Gandhi
- Radiology, Neurology, Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Chandril Chugh
- Interventional Neurology, MAX Superspecialty Hospital, Saket, New Delhi, India
| | - Charles Matouk
- Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Pascale Lavoie
- Neurosurgery, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, Quebec, Canada
| | - Randall Edgell
- Neurology, St Louis University School of Medicine, St Louis, Missouri, USA
| | - Andre Beer-Furlan
- Neurological Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Michael Chen
- Neurological Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Monika Killer-Oberpfalzer
- Neurology, Research Institute of Neurointervention, University Hospital Salzburg /Paracelsus Medical University, Salzburg, Austria
| | - Vitor Mendes Pereira
- Neurosurgery, Medical Imaging, Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Nicholson
- Neurosurgery, Medical Imaging, Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Vikram Huded
- Neurology, NH Mazumdar Shah Medical Center, Bangalore, India
| | - Nobuyuki Ohara
- Neurology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Daisuke Watanabe
- Stroke and Neurovascular Surgery, IMS Tokyo-Katsushika General Hospital, Tokyo, Japan
| | - Dong Hun Shin
- Gachon University, Seongnam, Korea (the Republic of)
| | - Pedro Sc Magalhaes
- Stroke Unit, Hospital Municipal Sao Jose, Joinville, Santa Catarina, Brazil
| | - Raghid Kikano
- Interventional Neuroradiology, Lau Medical Center, Beirut, Lebanon
| | | | - Mudassir Farooqui
- Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Amal Abou-Hamden
- Neurosurgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Tatsuo Amano
- Stroke and Cerebrovascular Medicine, Kyorin University, Mitaka, Tokyo, Japan
| | - Ryoo Yamamoto
- Neurology, Yokohama Brain and Spine Center, Yokohama, Japan
| | - Adrienne Weeks
- Neurosurgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Elena A Cora
- Radiology, QEII Health Sciences Centre, Dalhousie University, Dalhousie, Nova Scotia, Canada
| | | | - Roberto Crosa
- Centro Endovascular Neurologico Medica Uruguaya, Montevideo, Uruguay
| | - Markus Möhlenbruch
- Neuroradiology, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
| | - Simon Nagel
- Neurology, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
| | - Hosam Al-Jehani
- Neurosurgery, Interventional Radiology and Critical Care Medicine, King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University, Alkhobar, Saudi Arabia
| | - Sunil A Sheth
- Neurology, University of Texas McGovern Medical School, Houston, Texas, USA
| | | | - James E Siegler
- Neurology, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | | | - Ajit S Puri
- Neurointerventional Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Anna Luisa Kuhn
- Neurointerventional Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Gianmarco Bernava
- Interventional Neuroradiology, University Hospitals Geneva, Geneva, Switzerland
| | - Paolo Machi
- Interventional Neuroradiology, University Hospitals Geneva, Geneva, Switzerland
| | - Daniel G Abud
- Interventional Neuroradiology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Octavio M Pontes-Neto
- Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Ajay K Wakhloo
- Interventional Neuroradiology, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Barbara Voetsch
- Neurology, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Eytan Raz
- Radiology, NYU Langone Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Shadi Yaghi
- Neurology, NYU Langone Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Brijesh P Mehta
- Memorial Neuroscience Institute, Pembroke Pines, Florida, USA
| | - Naoto Kimura
- Neurosurgery, Iwate Prefectural Central Hospital, Morioka, Iwate, Japan
| | | | - Jin Soo Lee
- Ajou University Hospital, Suwon, Gyeonggi-do, South Korea
| | - Ji Man Hong
- Ajou University Hospital, Suwon, Gyeonggi-do, South Korea
| | - Robert Fahed
- Neurology, University of Ottawa, Ottawa, Ontario, Canada
| | - Gregory Walker
- Neurology, University of Ottawa, Ottawa, Ontario, Canada
| | - Eiji Hagashi
- Cerebrovascular Medicine, Saga-ken Medical Centre Koseikan, Saga, Japan
| | - Steve M Cordina
- Neurology, Neurosurgery, Radiology, University of South Alabama, Mobile, Alabama, USA
| | - Hong Gee Roh
- Konkuk University, Gwangjin-gu, Seoul, South Korea
| | - Ken Wong
- Interventional Neuroradiology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Juan F Arenillas
- Neurology, Hospital Clinico Universitario de Valladolid, Valladolid, Castilla y León, Spain
| | - Mario Martinez-Galdamez
- Interventional Neuroradiology, Hospital Clínico Universitario, Universidad de Valladolid, Valladolid, Spain
| | - Jordi Blasco
- INR, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
| | | | - Luisa Fonseca
- Stroke Unit, Department of Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - M Luis Silva
- Neuroradiology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Teddy Y Wu
- Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Simon John
- Neurosurgery, Christchurch Hospital, Christchurch, New Zealand
| | - Alex Brehm
- Interventional and Diagnostic Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Marios Psychogios
- Interventional and Diagnostic Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - William J Mack
- Neurosurgery, University of Southern California, Los Angeles, California, USA
| | - Matthew Tenser
- Neurosurgery, University of Southern California, Los Angeles, California, USA
| | - Tatemi Todaka
- Neurosurgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Kumamoto, Japan
| | - Miki Fujimura
- Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan
| | | | - Jun Deguchi
- Endovascular Neurosurgery, Nara City Hospital, Nara, Nara, Japan
| | - Yuri Sugiura
- Neurology, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | - Hiroshi Tokimura
- Neurosurgery and Stroke Center, Kagoshima City Hospital, Kagoshima, Kagoshima, Japan
| | | | - Michael Kelly
- Neurosurgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Lissa Peeling
- Neurosurgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Yuichi Murayama
- Neurosurgery, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | | | - Johnny Wong
- Neurosurgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Mohamed Teleb
- Neurosciences, Banner Desert Medical Center, Mesa, Arizona, USA
| | - Jeremy Payne
- Neurosciences, Banner Desert Medical Center, Mesa, Arizona, USA
| | - Hiroki Fukuda
- Neurology, Japanese Red Cross Matsue Hospital, Shimane, Japan
| | - Kosuke Miyake
- Neurology, Shiroyama Hospital, Habikino, Osaka, Japan
| | - Junsuke Shimbo
- Cerebrovascular Medicine, Niigata City General Hospital, Niigata, Niigata, Japan
| | | | - Masaaki Uno
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Japan
| | | | - Yuji Matsumaru
- Neurosurgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Satoshi Yamada
- Neurology, Stroke Center and Neuroendovascular Therapy, Saiseikai Central Hospital, Minato-ku, Tokyo, Japan
| | - Ryuhei Kono
- Neurology, Kinikyo Chuo Hospital, Sapporo, Hokkaido, Japan
| | - Takuya Kanamaru
- Cerebrovascular Medicine, NTT Medical Center Tokyo, Tokyo, Japan
| | - Masafumi Morimoto
- Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Yokohama, Japan
| | - Junichi Iida
- Neurosurgery, Osaka General Medical Center, Osaka, Japan
| | - Vasu Saini
- Neurology, Neurosurgery, University of Miami School of Medicine, Miami, Florida, USA
| | - Dileep Yavagal
- Neurology, Neurosurgery, University of Miami School of Medicine, Miami, Florida, USA
| | - Saif Bushnaq
- Neurology, Bon Secours Mercy Health System, Toledo, Ohio, USA
| | - Wenguo Huang
- Neurology, Maoming City Hospital, Guandong, China
| | - Italo Linfante
- Interventional Neuroradiology, Endovascular Neurosurgery, Miami Cardiac & Vascular Institute, Miami, Florida, USA
| | - Jawad Kirmani
- Neurology, Hackensack Meridian Health, Edison, New Jersey, USA
| | - David S Liebeskind
- Neurology, University of California Los Angeles, Los Angeles, California, USA
| | - Viktor Szeder
- Interventional Neuroradiology, University of California Los Angeles, Los Angeles, California, USA
| | - Ruchir Shah
- Neurology, Erlanger Medical Center, University of Tennessee, Chattanooga, Tennessee, USA
| | - Thomas G Devlin
- Neurology, Erlanger Medical Center, University of Tennessee, Chattanooga, Tennessee, USA
| | - Lee Birnbaum
- Neurology, Neurosurgery, Radiology, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Jun Luo
- Neurology, Mianyang 404 Hospital, Mianyang, Sichuan, China
| | | | - Hesham E Masoud
- Neurology, Neurosurgery, Radiology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Carlos Ynigo Lopez
- Neurology, Neurosurgery, Radiology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Brendan Steinfort
- Neurosurgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Alice Ma
- Neurosurgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Ameer E Hassan
- Neurosciences, The University of Texas Rio Grande Valley, Harlingen, Texas, USA
| | - Amal Al Hashmi
- Central Stroke Unit, Directorate of Neuroscience, Khoula Hospital, Ministry of Health, Muscat, Oman
| | | | - Maxim Mokin
- Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - Alex Chebl
- Neurology, Henry Ford Health System, Detroit, Michigan, USA
| | | | - Georgios Tsivgoulis
- Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Jane G Morris
- Neurology, Maine Medical Center, Portland, Maine, USA
| | - Clifford J Eskey
- Neuroradiology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Jesse Thon
- Neurology, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Leticia Rebello
- Neurology, Hospital Universitario de Brasilia, Brasilia, Distrito Federal, Brazil
| | - Dorothea Altschul
- Neurointerventional Neurosurgery, The Valley Hospital, Ridgewood, New Jersey, USA
| | - Oriana Cornett
- Neurosciences, Stroke Program, St Joseph's University Medical Center, Paterson, New Jersey, USA
| | - Varsha Singh
- Neurosciences, Stroke Program, St Joseph's University Medical Center, Paterson, New Jersey, USA
| | - Jeyaraj Pandian
- Neurology, Christian Medical College and Hospital Ludhiana, Ludhiana, Punjab, India
| | - Anirudh Kulkarni
- Neurology, Christian Medical College and Hospital Ludhiana, Ludhiana, Punjab, India
| | - Pablo M Lavados
- Vascular Neurology Unit, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Veronica V Olavarria
- Vascular Neurology Unit, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Kenichi Todo
- Neurology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuki Yamamoto
- Neurology, Tokushima University Hospital, Tokushima, Japan
| | | | - Serdar Geyik
- Istanbul Aydin University, Istanbul, İstanbul, Turkey
| | - Jasmine Johann
- Radiology, Swedish Medical Center, Englewood, Colorado, USA
| | - Sumeet Multani
- Neurology, Bayhealth Medical Center, Dover, Delaware, USA
| | - Artem Kaliaev
- Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Kazutaka Sonoda
- Neurology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Hiroyuki Hashimoto
- Division of Stroke, Department of Internal Medicine, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Adel Alhazzani
- Neurology Division, Department of Medicine, King Saud University, Riyadh, Riyadh Province, Saudi Arabia
| | - David Y Chung
- Neurology, Boston Medical Center, Boston, Massachusetts, USA
| | - Stephan A Mayer
- Neurology, Neurosurgery, Westchester Medical Center Health Network, Valhalla, New York, USA
| | - Johanna T Fifi
- Neurology, Mount Sinai Health System, New York, New York, USA
| | - Michael D Hill
- Neurology, Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Hao Zhang
- Neurology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zhengzhou Yuan
- Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Xianjin Shang
- Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China
| | | | - Rishi Gupta
- Neuroscience, WellStar Health System, Marietta, Georgia, USA
| | - Tudor G Jovin
- Neurology, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Jean Raymond
- Neuroradiologie Interventionelle, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Osama O Zaidat
- Neurology, Bon Secours Mercy Health System, Toledo, Ohio, USA
| | - Raul G Nogueira
- Neurology, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA, USA
| | | | | |
Collapse
|
17
|
Small JE, Macey MB, Wakhloo AK, Sehgal S. CTA Evaluation of Basilar Septations: An Entity Better Characterized as Aberrant Basilar Fenestrations. AJNR Am J Neuroradiol 2021; 42:701-707. [PMID: 33602748 DOI: 10.3174/ajnr.a7008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/05/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE A basilar artery intraluminal septation is an exceedingly rarely reported, presumed congenital abnormality. In our clinical practice, we have occasionally noticed an intraluminal band within the inferior aspect of the basilar artery on CTA. Furthermore, we have noticed, at times, the presence of a punctate calcification associated with this finding. We hypothesized that what previous studies have called "basilar septations" in fact represent miniature and thus aberrant basilar fenestrations. MATERIALS AND METHODS We retrospectively reviewed CTA studies obtained between January 1, 2017, and August 31, 2019. Identified intraluminal basilar abnormalities were classified as either basilar septations or basilar fenestrations. Association with other posterior circulation abnormalities was documented. RESULTS A total of 3509 studies were examined. A basilar intraluminal abnormality was evident in 80 patients (2.3%). Of these 80 patients, 59 were classified as having a basilar fenestration (1.7%) and 21 were classified as having basilar septations (0.6%). Associated calcification was evident in 3 of the basilar fenestration cases and 13 of the basilar septation cases. CONCLUSIONS Basilar septations most likely represent and should be referred to as aberrant basilar fenestrations. They should be interpreted as benign congenital incidental findings and should not be misinterpreted as focal dissections or arterial webs. Important variations in the morphology of aberrant basilar fenestrations exist, including areas of thinning, varying thickness, and nodularity. Therefore, when associated with calcification or nodularity, aberrant basilar fenestrations should not be confused with focal intraluminal thrombi or calcified or noncalcified emboli.
Collapse
Affiliation(s)
- J E Small
- From the Department of Neuroradiology (J.E.S., M.B.M.)
| | - M B Macey
- From the Department of Neuroradiology (J.E.S., M.B.M.)
| | - A K Wakhloo
- Interventional Interventional Neuroradiology (A.K.W.)
| | - S Sehgal
- Neurology (S.S.), Lahey Hospital and Medical Center, Burlington, Massachusetts
| |
Collapse
|
18
|
Meyers PM, Fifi JT, Cockroft KM, Miller TR, Given CA, Zomorodi AR, Jagadeesan BD, Mokin M, Kan P, Yao TL, Diaz O, Huddle D, Bellon RJ, Seinfeld J, Polifka AJ, Fiorella D, Chitale RV, Kvamme P, Morrow JT, Singer J, Wakhloo AK, Puri AS, Deshmukh VR, Hanel RA, Gonzalez LF, Woo HH, Aziz-Sultan MA. Safety of the APOLLO Onyx delivery microcatheter for embolization of brain arteriovenous malformations: results from a prospective post-market study. J Neurointerv Surg 2021; 13:935-941. [PMID: 33526480 DOI: 10.1136/neurintsurg-2020-016830] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/18/2020] [Accepted: 11/21/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Catheter retention and difficulty in retrieval have been observed during embolization of brain arteriovenous malformations (bAVMs) with the Onyx liquid embolic system (Onyx). The Apollo Onyx delivery microcatheter (Apollo) is a single lumen catheter designed for controlled delivery of Onyx into the neurovasculature, with a detachable distal tip to aid catheter retrieval. This study evaluates the safety of the Apollo for delivery of Onyx during embolization of bAVMs. METHODS This was a prospective, non-randomized, single-arm, multicenter, post-market study of patients with a bAVM who underwent Onyx embolization with the Apollo between May 2015 and February 2018. The primary endpoint was any catheter-related adverse event (AE) at 30 days, such as unintentional tip detachment or malfunction with clinical sequelae, or retained catheter. Procedure-related AEs (untoward medical occurrence, disease, injury, or clinical signs) and serious AEs (life threatening illness or injury, permanent physiological impairment, hospitalization, or requiring intervention) were also recorded. RESULTS A total of 112 patients were enrolled (mean age 44.1±17.6 years, 56.3% men), and 201 Apollo devices were used in 142 embolization procedures. The mean Spetzler-Martin grade was 2.38. The primary endpoint was not observed (0/112, 0%). The catheter tip detached during 83 (58.5%) procedures, of which 2 (2.4%) were unintentional and did not result in clinical sequelae. At 30 days, procedure related AEs occurred in 26 (23.2%) patients, and procedure-related serious AEs in 12 (10.7%). At 12 months, there were 3 (2.7%) mortalities, including 2 (1.8%) neurological deaths, none of which were device-related. CONCLUSION This study demonstrates the safety of Apollo for Onyx embolization of bAVMs. CLINICAL TRIAL REGISTRATION CNCT02378883.
Collapse
Affiliation(s)
- Philip M Meyers
- Departments of Radiology and Neurological Surgery, Columbia University, New York, New York, USA
| | - Johanna T Fifi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kevin M Cockroft
- Department of Neurosurgery, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Timothy R Miller
- Division of Interventional Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Curtis A Given
- Department of Radiology, Baptist Health Lexington, Lexington, Kentucky, USA
| | - Ali R Zomorodi
- Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Bharathi D Jagadeesan
- Department of Radiology, Neurosurgery and Neurology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Maxim Mokin
- Department of Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Tom L Yao
- Department of Neurosurgery, Norton Neuroscience Institute, Norton Healthcare, Louisville, Kentucky, USA
| | - Orlando Diaz
- Division of Interventional Neuroradiology, Houston Methodist Hospital, Houston, Texas, USA
| | - Daniel Huddle
- Department of Brain, Spine, Physical Medicine and Rehabilitation, UC Health Medical Group (UCHMG), Colorado Springs, Colorado, USA
| | - Richard J Bellon
- Department of Neurology, Swedish Medical Center, Englewood, Colorado, USA
| | - Joshua Seinfeld
- Department of Neurosurgery and Radiology, University of Colorado Medical Center, Aurora, Colorado, USA
| | - Adam J Polifka
- Department of Neurological Surgery, University of Florida, Gainesville, Florida, USA
| | - David Fiorella
- Department of Neurosurgery, Cerebrovascular Center, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Rohan V Chitale
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Peter Kvamme
- Department of Radiology, The University of Tennessee Medical Center, Knoxville, Tennessee, USA
| | - Jay T Morrow
- Neuroscience Institute, Division of Neurosurgery, Michigan State University, Spectrum Health, Grand Rapids, Michigan, USA
| | - Justin Singer
- Neuroscience Institute, Division of Neurosurgery, Michigan State University, Spectrum Health, Grand Rapids, Michigan, USA
| | - Ajay K Wakhloo
- Department of Neurointerventional Radiology, Beth Israel Lahey Health, Tufts School of Medicine, Burlington, Massachusetts, USA
| | - Ajit S Puri
- Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
| | | | - Ricardo A Hanel
- Baptist Health Research Institute, Lyerly Neurosurgery, Jacksonville, Florida, USA
| | | | - Henry H Woo
- Department of Neurosurgery and Radiology, Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, New York, USA
| | - Mohammad Ali Aziz-Sultan
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
19
|
McDougall CG, Johnston SC, Hetts SW, Gholkar A, Barnwell SL, Vazquez Suarez JC, Massó Romero J, Chaloupka JC, Bonafe A, Wakhloo AK, Tampieri D, Dowd CF, Fox AJ, Turk AS. Five-year results of randomized bioactive versus bare metal coils in the treatment of intracranial aneurysms: the Matrix and Platinum Science (MAPS) Trial. J Neurointerv Surg 2020; 13:930-934. [PMID: 33298509 DOI: 10.1136/neurintsurg-2020-016906] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/17/2020] [Accepted: 11/20/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND No randomized trial of intracranial aneurysm coiling has compared long-term efficacy of polymer-modified coils to bare metal coils (BMCs). We report 5-year results comparing Matrix2 coils to BMCs. The primary objective was to compare the rates of target aneurysm recurrence (TAR) at 12 months. Secondary objectives included angiographic outcomes at TAR or 12 months and TAR at 5 years. METHODS A total of 626 patients were randomized to BMCs or Matrix2 coils. Detailed methods and 1-year results have been published previously. RESULTS Of 580 patients eligible for 5-year follow-up, 431 (74.3%) completed follow-up or reached TAR. Matrix2 coils were non-inferior to BMCs (P=0.8) but did not confer any benefit. Core lab reported post-treatment residual aneurysm filling (Raymond III) correlated with TAR (P<0.0001) and with aneurysm hemorrhage after treatment (P<0.008). Repeat aneurysmal hemorrhage after treatment, but before hospital discharge, occurred in three patients treated for acutely ruptured aneurysms. Additionally, two patients treated for unruptured aneurysms experienced a first hemorrhage during follow-up. All five hemorrhages resulted from aneurysms with Raymond III residual aneurysm filling persisting after initial treatment. After 5 years follow-up, 2/626 (0.3%) patients are known to have had target aneurysm rupture following hospital discharge. The annualized rate of delayed hemorrhage after coiling was 2/398/5=0.001 (0.1%) per year for unruptured aneurysms and 0 for ruptured aneurysms. CONCLUSIONS After 5 years Matrix2 coils were non-inferior to BMCs but no benefit was demonstrated. Post-treatment residual angiographic aneurysm filling (Raymond III) is strongly associated with TAR (P<0.0001) and post-treatment aneurysmal hemorrhage (P=0.008).
Collapse
Affiliation(s)
- Cameron G McDougall
- Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - S Claiborne Johnston
- Dean's Office, University of Texas at Austin Dell Seton Medical Center, Austin, Texas, USA
| | - Steven W Hetts
- Interventional Neuroradiology, University of California San Francisco, San Francisco, California, USA
| | - Anil Gholkar
- Neuroradiology, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | - Stanley L Barnwell
- Neurological Surgery and Diagnostic Radiology, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Javier Massó Romero
- Interventional Neuroradiology, Hospital Universitario de Donostia, San Sebastian, Spain
| | - John C Chaloupka
- Neurosurgery and Radiology, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Alain Bonafe
- Neuroradiology, Hopital Gui de Chauliac, Montpellier, France
| | - Ajay K Wakhloo
- Neurointerventional Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | | | - Christopher F Dowd
- Radiology and Biomedical Imaging, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Allan J Fox
- Neuroradiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Aquilla S Turk
- Neurointerventional Surgery, Radiology, and Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | | |
Collapse
|
20
|
Dmytriw AA, Phan K, Schirmer C, Settecase F, Heran MKS, Efendizade A, Kühn AL, Puri AS, Menon BK, Dibas M, Sivakumar S, Mowla A, Leung LY, Malek AM, Voetsch B, Sehgal S, Wakhloo AK, Wu H, Xavier A, Tiwari A. Ischaemic stroke associated with COVID-19 and racial outcome disparity in North America. J Neurol Neurosurg Psychiatry 2020; 91:1362-1364. [PMID: 32801118 PMCID: PMC7684526 DOI: 10.1136/jnnp-2020-324653] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 07/29/2020] [Accepted: 08/02/2020] [Indexed: 01/06/2023]
Affiliation(s)
- Adam A Dmytriw
- Neuroradiology & Neurointervention Service, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
- Interventional Neuro Associates, Greenvale, NY 11548, USA
| | - Kevin Phan
- Interventional Neuro Associates, Greenvale, NY 11548, USA
| | - Clemens Schirmer
- Department of Neurosurgery & Neuroscience Institute, Geisinger, Wilkes-Barre, Pennsylvania, USA
| | - Fabio Settecase
- Division of Interventional Neuroradiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Manraj K S Heran
- Division of Interventional Neuroradiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Aslan Efendizade
- Department of Radiology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Anna Luisa Kühn
- Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester, MA, United States
| | - Ajit S Puri
- Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester, MA, United States
| | - Bijoy K Menon
- Calgary Stroke Program, Cumming School of Medicine, Calgary, AB, Canada
| | - Mahmoud Dibas
- Interventional Neuro Associates, Greenvale, NY 11548, USA
| | - Sanjeev Sivakumar
- Department of Medicine (Neurology), Prisma Health Upstate, USC, Greenville, SC, United States
| | - Ashkan Mowla
- Department of Neurological Surgery, University of Southern California, Los Angeles, CA, United States
| | - Lester Y Leung
- Department of Neurology, Tufts Medical Center, Boston, MA, United States
| | - Adel M Malek
- Departments of Neurosurgery, Tufts Medical Center, Boston, MA, United States
| | - Barbara Voetsch
- Department of Neurology, Lahey Hospital & Medical Center, Burlington, MA, United States
| | - Siddharth Sehgal
- Department of Neurology, Lahey Hospital & Medical Center, Burlington, MA, United States
| | - Ajay K Wakhloo
- Neurointerventional Radiology, Lahey Hospital & Medical Center, Burlington, MA, United States
| | - Hannah Wu
- Interventional Neuro Associates, Greenvale, NY 11548, USA
- Department of Neurology, Brookdale University Hospital, Brooklyn, NY, United States
- Department of Neurology, Jamaica Medical Center, Richmond Hill, NY, United States
| | - Andrew Xavier
- Department of Neurology, Sinai Grace Hospital, Detroit, MI, United States
- Department of Neurology, St. Joseph Mercy Health, Ann Arbor, MI, United States
| | - Ambooj Tiwari
- Interventional Neuro Associates, Greenvale, NY 11548, USA
- Department of Neurology, Brookdale University Hospital, Brooklyn, NY, United States
- Department of Neurology, Jamaica Medical Center, Richmond Hill, NY, United States
| |
Collapse
|
21
|
Lee JE, Mohanty A, Albuquerque FC, Couldwell WT, Levy EI, Benzel EC, Wakhloo AK, Hirsch JA, Fiorella D, Fargen KM, Burkhardt JK, Srinivasan VM, Johnson J, Mokin M, Kan P. Trends in academic productivity in the COVID-19 era: analysis of neurosurgical, stroke neurology, and neurointerventional literature. J Neurointerv Surg 2020; 12:1049-1052. [PMID: 32998982 PMCID: PMC7528313 DOI: 10.1136/neurintsurg-2020-016710] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/05/2020] [Accepted: 09/15/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Academic physicians aim to provide clinical and surgical care to their patients while actively contributing to a growing body of scientific literature. The coronavirus disease 2019 (COVID-19) pandemic has resulted in procedural-based specialties across the United States witnessing a sharp decline in their clinical volume and surgical cases. OBJECTIVE To assess the impact of COVID-19 on neurosurgical, stroke neurology, and neurointerventional academic productivity. METHODS The study compared the neurosurgical, stroke neurology, and neurointerventional academic output during the pandemic lockdown with the same time period in previous years. Editors from a sample of neurosurgical, stroke neurology, and neurointerventional journals provided the total number of original manuscript submissions, broken down by months, from the year 2016 to 2020. Manuscript submission was used as a surrogate metric for academic productivity. RESULTS 8 journals were represented. The aggregated data from all eight journals as a whole showed that a combined average increase of 42.3% was observed on original submissions for 2020. As the average yearly percent increase using the 2016-2019 data for each journal exhibited a combined average increase of 11.2%, the rise in the yearly increase for 2020 in comparison was nearly fourfold. For the same journals in the same time period, the average percent of COVID-19 related publications from January to June of 2020 was 6.87%. CONCLUSION There was a momentous increase in the number of original submissions for the year 2020, and its effects were uniformly experienced across all of our represented journals.
Collapse
Affiliation(s)
- Jae Eun Lee
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Alina Mohanty
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | | | - Elad I Levy
- Neurosurgery, Jacobs School of Medicine University at Buffalo, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Edward C Benzel
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ajay K Wakhloo
- Neurointerventional Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Joshua A Hirsch
- NeuroEndovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David Fiorella
- Department of Neurosurgery, Stony Brook University, Stony Brook, New York, USA
- Department of Radiology, Stony Brook University, Stony Brook, New York, USA
| | - Kyle M Fargen
- Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
- Department of Neurosurgery, Texas Children's Hospital, Houston, Texas, USA
| | | | - Jeremiah Johnson
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Maxim Mokin
- Department of Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - Peter Kan
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA
| |
Collapse
|
22
|
Dandapat S, Mendez-Ruiz A, Martínez-Galdámez M, Macho J, Derakhshani S, Foa Torres G, Pereira VM, Arat A, Wakhloo AK, Ortega-Gutierrez S. Review of current intracranial aneurysm flow diversion technology and clinical use. J Neurointerv Surg 2020; 13:54-62. [PMID: 32978269 DOI: 10.1136/neurintsurg-2020-015877] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/04/2020] [Accepted: 09/10/2020] [Indexed: 02/07/2023]
Abstract
Endovascular treatment of intracranial aneurysms (IAs) has evolved considerably over the past decades. The technological advances have been driven by the experience that coils fail to completely exclude all IAs from the blood circulation, the need to treat the diseased parent vessel segment leading to the aneurysm formation, and expansion of endovascular therapy to treat more complex IAs. Stents were initially developed to support the placement of coils inside wide neck aneurysms. However, early work on stent-like tubular braided structure led to a more sophisticated construct that then later was coined as a flow diverter (FD) and found its way into clinical application. Although FDs were initially used to treat wide-neck large and giant internal carotid artery aneurysms only amenable to surgical trap with or without a bypass or endovascular vessel sacrifice, its use in other types of IAs and cerebrovascular pathology promptly followed. Lately, we have witnessed an explosion in the application of FDs and subsequently their modifications leading to their ubiquitous use in endovascular therapy. In this review we aim to compile the available FD technology, evaluate the devices' peculiarities from the authors' perspective, and analyze the current literature to support initial and expanded indications, recognizing that this may be outdated soon.
Collapse
Affiliation(s)
- Sudeepta Dandapat
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Alan Mendez-Ruiz
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Mario Martínez-Galdámez
- Interventional Neuroradiology/Endovascular Neurosurgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Juan Macho
- Department of Diagnostic and Therapeutic Neuroradiology, Essex Center for Neurological Sciences, Queen's University Hospital, Romford, Greater London, UK.,Department of Interventional Neuroradiology, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
| | - Shahram Derakhshani
- Department of Diagnostic and Therapeutic Neuroradiology, Essex Center for Neurological Sciences, Queen's University Hospital, Romford, Greater London, UK
| | | | - Vitor M Pereira
- Division of Neuroradiology, Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Anil Arat
- Department of Radiology, Hacettepe University Hospitals, Ankara, Turkey
| | - Ajay K Wakhloo
- Department of Neurointerventional Radiology, Beth Israel Lahey Health, Tufts University School of Medicine, Burlington, Massachusetts, USA
| | - Santiago Ortega-Gutierrez
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA .,Department of Radiology and Neurosurgery, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| |
Collapse
|
23
|
Abdalkader M, Sathya A, Malek AM, Fifi JT, Norbash AM, Wakhloo AK, Nguyen TN. Roadmap for Resuming Elective Neuroendovascular Procedures Following the First COVID-19 Surge. J Stroke Cerebrovasc Dis 2020; 29:105177. [PMID: 32891495 PMCID: PMC7383144 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/08/2020] [Accepted: 07/16/2020] [Indexed: 01/05/2023] Open
Affiliation(s)
- Mohamad Abdalkader
- Departments of Radiology, Boston Medical Center, Boston University-School of Medicine, FGH Building, 3rd Floor, 820 Harrison Avenue, Boston, MA 02118, USA.
| | - Anvitha Sathya
- School of Medicine, Boston Medical Center, Boston University-School of Medicine, Boston, MA, USA
| | - Adel M Malek
- Department of Neurosurgery, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Johanna T Fifi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Ajay K Wakhloo
- Department of Radiology, Beth Israel Lahey Health, MA, USA
| | - Thanh N Nguyen
- Departments of Radiology, Boston Medical Center, Boston University-School of Medicine, FGH Building, 3rd Floor, 820 Harrison Avenue, Boston, MA 02118, USA; Neurology, Boston Medical Center, Boston University-School of Medicine, Boston, MA, USA; Neurosurgery, Boston Medical Center, Boston University-School of Medicine, Boston, MA, USA
| |
Collapse
|
24
|
Orru E, Rice H, De Villiers L, Klostranec JM, Wakhloo AK, Coon AL, Radovanovic I, Kortman H, Bhatia KD, Krings T, Pereira VM. First clinical experience with the new Surpass Evolve flow diverter: technical and clinical considerations. J Neurointerv Surg 2020; 12:974-980. [DOI: 10.1136/neurintsurg-2019-015734] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/21/2020] [Accepted: 01/27/2020] [Indexed: 11/04/2022]
Abstract
ObjectiveTo describe the results in patients treated with the Surpass Evolve (SE) device, the new generation of Surpass flow diverters.MethodsTwenty-five consecutive patients (20 women, average age 58 years), with anterior or posterior circulation aneurysms treated with SEs in two early-user centers, were included. Device properties and related technical properties, imaging and clinical follow-up data, and intraprocedural, early (<30 days) and delayed (>30 days) neurological complications, further divided into minor (silent/non-permanent) and major (permanent) complications, were recorded and analyzed.ResultsTwenty-nine SEs were successfully implanted in all subjects to treat 26 aneurysms using an 0.027" microcatheter with an average of 1.2 stents per patient. No intraprocedural thromboembolic or hemorrhagic complications were seen. At clinical follow-up, 24/25 (96%) patients had a modified Rankin Score of 0–2. Mortality was 0%. Imaging follow-up, available in 22/25 (88%) patients (median follow-up time 4 months), showed a complete aneurysm occlusion in 13/23 (57%) imaged lesions. Minor, transitory neurological deficits were recorded in 5/25 (20%) patients. One (4%) major complication was seen in one patient (4%) with a left-sided hemispheric stroke on postprocedural day 4 due to an acute stent thrombosis.ConclusionsPreliminary experience in patients demonstrates a good performance of the SE. This newly designed implant maintains the engineering characteristics of Surpass flow diverters, including precise placement due to its lower foreshortening and a high mesh density, yet can be deployed through a significantly lower-profile delivery system.
Collapse
|
25
|
De Macedo Rodrigues K, Kühn AL, Tamura T, Dabus G, Kan P, Marosfoi MG, Lozano JD, Perras M, Brooks C, Howk MC, Hou SY, Rex DE, Massari F, Gounis MJ, Wakhloo AK, Puri AS. Pipeline Embolization Device for Pericallosal Artery Aneurysms: A Retrospective Single Center Safety and Efficacy Study. Oper Neurosurg (Hagerstown) 2019; 14:351-358. [PMID: 28521024 DOI: 10.1093/ons/opx111] [Citation(s) in RCA: 13] [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] [Received: 09/07/2016] [Accepted: 04/11/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pericallosal artery aneurysm treatment may be challenging using traditional endovascular techniques. OBJECTIVE To demonstrate the feasibility, efficacy, and safety of endovascular treatment of pericallosal artery aneurysm using flow diverters. METHODS We performed a retrospective review of our institutional database from July 2013 through July 2016 and identified 7 subjects with a pericallosal artery aneurysm treated with the Pipeline embolization device (ev3 Neurovascular, Medtronic, Dublin, Ireland) and at least 1 follow-up angiogram. Technical feasibility, procedural complication, angiographic results, and clinical outcome were evaluated. RESULTS Placement of the Pipeline embolization device was successful in all cases without evidence of procedural complication. Five out of 7 subjects showed a complete aneurysm occlusion at 6- to 12-mo follow-up angiogram. The 2 subjects with persistent aneurysm filling showed decreased aneurysm sac volume on follow-up angiograms (96% and 60%). There was no evidence of in-implant stenosis or intimal hyperplasia. No thromboembolic or hemorrhagic complications were seen during the follow-up period. Only 1 patient had a transient change in Modified Rankin scale score from baseline as a result of different unrelated procedure. CONCLUSION Our preliminary results demonstrate feasibility of the use of flow diverter stent for treatment of aneurysms of the pericallosal artery with rate of aneurysm occlusion comparable to literature and without evidence of increased procedural or short-term morbidity. A long-term and larger cohort study is needed to validate our findings.
Collapse
Affiliation(s)
- Katyucia De Macedo Rodrigues
- Division of Neuroimaging and Interve-ntion and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, Massachusetts
| | - Anna Luisa Kühn
- Division of Neuroimaging and Interve-ntion and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, Massachusetts
| | - Takamitsu Tamura
- Division of Neuroimaging and Interve-ntion and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, Massachusetts
| | | | - Peter Kan
- Depa-rtment of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Miklos G Marosfoi
- Division of Neuroimaging and Interve-ntion and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, Massachusetts
| | - J Diego Lozano
- Division of Neuroimaging and Interve-ntion and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, Massachusetts
| | - Mary Perras
- Division of Neuroimaging and Interve-ntion and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, Massachusetts
| | - Christopher Brooks
- Division of Neuroimaging and Interve-ntion and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, Massachusetts
| | - Mary C Howk
- Division of Neuroimaging and Interve-ntion and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, Massachusetts
| | - Samuel Y Hou
- Division of Neuroimaging and Interve-ntion and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, Massachusetts
| | - David E Rex
- Division of Neuroimaging and Interve-ntion and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, Massachusetts
| | - Francesco Massari
- Division of Neuroimaging and Interve-ntion and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, Massachusetts
| | - Matthew J Gounis
- Division of Neuroimaging and Interve-ntion and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, Massachusetts
| | - Ajay K Wakhloo
- Division of Neuroimaging and Interve-ntion and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, Massachusetts
| | - Ajit S Puri
- Division of Neuroimaging and Interve-ntion and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, Massachusetts
| |
Collapse
|
26
|
Agnoletto GJ, Meyers PM, Coon A, Kan PTM, Wakhloo AK, Hanel RA. A Contemporary Review of Endovascular Treatment of Wide-Neck Large and Giant Aneurysms. World Neurosurg 2019; 130:523-529.e2. [DOI: 10.1016/j.wneu.2019.06.201] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 11/30/2022]
|
27
|
ten Brinck MFM, Jäger M, de Vries J, Grotenhuis JA, Aquarius R, Mørkve SH, Rautio R, Numminen J, Raj R, Wakhloo AK, Puri AS, Taschner CA, Boogaarts HD. Flow diversion treatment for acutely ruptured aneurysms. J Neurointerv Surg 2019; 12:283-288. [DOI: 10.1136/neurintsurg-2019-015077] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 08/04/2019] [Accepted: 08/07/2019] [Indexed: 11/04/2022]
Abstract
Background and purposeFlow diverters are sometimes used in the setting of acutely ruptured aneurysms. However, thromboembolic and hemorrhagic complications are feared and evidence regarding safety is limited. Therefore, in this multicenter study we evaluated complications, clinical, and angiographic outcomes of patients treated with a flow diverter for acutely ruptured aneurysms.MethodsWe conducted a retrospective observational study of 44 consecutive patients who underwent flow diverter treatment within 15 days after rupture of an intracranial aneurysm at six centers. The primary end point was good clinical outcome, defined as modified Rankin Scale score (mRS) 0–2. Secondary endpoints were procedure-related complications and complete aneurysm occlusion at follow-up.ResultsAt follow-up (median 3.4 months) 20 patients (45%) had a good clinical outcome. In 20 patients (45%), 25 procedure-related complications occurred. These resulted in permanent neurologic deficits in 12 patients (27%). In 5 patients (11%) aneurysm re-rupture occurred. Eight patients died resulting in an all-cause mortality rate of 18%. Procedure-related complications were associated with a poor clinical outcome (mRS 3–6; OR 5.1(95% CI 1.0 to 24.9), p=0.04). Large aneurysms were prone to re-rupture with rebleed rates of 60% (3/5) vs 5% (2/39) (p=0.01) for aneurysms with a size ≥20 mm and <20 mm, respectively. Follow-up angiography in 29 patients (median 9.7 months) showed complete aneurysm occlusion in 27 (93%).ConclusionFlow diverter treatment of ruptured intracranial aneurysms was associated with high rates of procedure-related complications including aneurysm re-ruptures. Complications were associated with poor clinical outcome. In patients with available angiographic follow-up, a high occlusion rate was observed.
Collapse
|
28
|
Affiliation(s)
- Philip M. Meyers
- From the Departments of Radiology and Neurological Surgery, Columbia University, New York, NY (P.M.M.)
| | - Alexander L. Coon
- From the Departments of Radiology and Neurological Surgery, Columbia University, New York, NY (P.M.M.)
| | - Peter T. Kan
- From the Departments of Radiology and Neurological Surgery, Columbia University, New York, NY (P.M.M.)
| | - Ajay K. Wakhloo
- From the Departments of Radiology and Neurological Surgery, Columbia University, New York, NY (P.M.M.)
| | - Ricardo A. Hanel
- From the Departments of Radiology and Neurological Surgery, Columbia University, New York, NY (P.M.M.)
| |
Collapse
|
29
|
Kühn AL, Kan P, Henninger N, Srinivasan V, de Macedo Rodrigues K, Wakhloo AK, Gounis MJ, Puri AS. Impact of age on cerebral aneurysm occlusion after flow diversion. J Clin Neurosci 2019; 65:23-27. [PMID: 31072739 DOI: 10.1016/j.jocn.2019.04.024] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/28/2019] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to evaluate safety and efficacy of the pipeline embolization device (PED) in different patient age groups with unruptured intracranial aneurysms (UIA). All patients with UIA treated with the PED between 2011 and 2017 were included. Based on their age, patients were trichotomized to: young (≤45 years), middle-aged (46 to <65 years) and older (≥65 years) groups. Patient's vascular risk factors, presenting symptoms and mRS on admission were collected. Follow-up imaging was evaluated for presence/absence of aneurysm occlusion. Clinical outcome at discharge, 3-9 months and 12-18 months was also documented when available. A total of 260 patients harboring 307 aneurysms (young = 57, middle-age = 144 and older age group = 64). Most aneurysms were located in the anterior circulation (94.8%). Overall morbidity and mortality was 2.3% each (6/260). At 3-9 months near complete to complete aneurysm occlusion was 82.5% (47/57) in the young age group, 82.6% (100/121) in the middle age, and 70.2% (40/57) in the older age group. At 12-18-month, near complete to complete occlusion was 100% in the young age group (32/32), 91.4% (64/70) in the middle age, and 78.4% (29/37) in the older age group. After adjustment for potential confounders, older age patients less frequently achieved near complete to complete occlusion by 3 years than younger subjects (p = 0.009, HR 1.34 95%, CI 1.08-1.66). Our results indicate feasibility and safety of PED across different age groups. Further study is required to determine age-related factors relating to aneurysm occlusion after PED to improve outcome and patient counseling.
Collapse
Affiliation(s)
- Anna Luisa Kühn
- Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, MA, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Nils Henninger
- Department of Neurology, University of Massachusetts, Worcester, MA, USA
| | - Visish Srinivasan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Katyucia de Macedo Rodrigues
- Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, MA, USA
| | - Ajay K Wakhloo
- Lahey Clinic and Medical Center, Department of Neurointerventional Radiology, Burlington, MA, USA
| | - Matthew J Gounis
- Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, MA, USA
| | - Ajit S Puri
- Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, MA, USA.
| |
Collapse
|
30
|
Abstract
Flow diverter malapposition has been described as a technical complication during endovascular procedures and can be associated with, potentially delayed, life-threatening aneurysm rupture or ischemic events. We performed a retrospective review of our flow diverter database to identify all patients in whom device malapposition was detected on follow-up angiogram immediately after device deployment. Feasibility and technical success of different endovascular approaches aiming to correct the inadequate vessel wall apposition were evaluated. Successful endovascular techniques for manipulation of the flow diverter included use of wires, catheters and additional flow diverter/stent devices. In our practice, we found six successful endovascular techniques for device manipulation, which allowed us to safely achieve good flow diverter wall apposition.
Collapse
Affiliation(s)
- Anna L Kühn
- 1 Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts, USA
| | - Katyucia de Macedo Rodrigues
- 1 Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts, USA
| | - Ajay K Wakhloo
- 2 Department of Interventional Neuroradiology, Lahey Clinic and Medical Center, Burlington, Massachusetts, USA
| | - Ajit S Puri
- 1 Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts, USA
| |
Collapse
|
31
|
Kühn AL, Kan P, Srinivasan V, Rex DE, de Macedo Rodrigues K, Howk MC, Wakhloo AK, Puri AS. Flow diverter for endovascular treatment of intracranial mirror segment internal carotid artery aneurysms. Interv Neuroradiol 2018; 25:4-11. [PMID: 30081693 DOI: 10.1177/1591019918792536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND To evaluate the feasibility and efficacy of the pipeline embolization device in the treatment of unruptured intracranial mirror segment aneurysms. METHODS Out of a total of 338 subjects, 14 were identified harboring a total of 32 internal carotid artery mirror segment aneurysms that were treated with the pipeline embolization device and were consecutively enrolled into our study. We collected data on patient demographics, modified Rankin scale (mRS) at admission, aneurysm characteristics, clinical outcome at discharge, 3-9 and at 12-18 months as well as angiography results at follow-up. RESULTS Patients' mean age was 52.9 years; baseline mRS was 0 in all subjects. Pipeline embolization device placement was successful in all cases. Post-treatment mRS remained 0 in 13/14 patients. One patient experienced a small intraparenchymal hemorrhage and subarachnoid hemorrhage, associated with a frontoparietal infarction resulting in right upper extremity weakness and aphasia (post-treatment mRS 3). His mRS evaluation remained stable at the 3-9-month follow-up. Three to 9-month follow-up angiography (13/14 subjects) showed complete aneurysm occlusion in 24/30 aneurysms (80%), near complete and partial occlusion in three of 30 (10%) aneurysms each. At the 9-month follow-up, one patient experienced a complete occlusion of the anterior temporal artery branch but did not present with any clinical deficits. No mRS changes were encountered over a median 6-month follow-up period. Mid-term follow-up angiography (12-18 months) available in eight of 14 subjects showed complete aneurysm occlusion in all patients. Mild intimal hyperplasia was observed in one patient. CONCLUSIONS Flow diversion technology can be used for the treatment of unruptured mirror segment aneurysms in selected patients.
Collapse
Affiliation(s)
- Anna Luisa Kühn
- 1 Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, USA
| | - Peter Kan
- 2 Department of Neurosurgery, Baylor College of Medicine, Houston, USA
| | - Visish Srinivasan
- 2 Department of Neurosurgery, Baylor College of Medicine, Houston, USA
| | - David E Rex
- 1 Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, USA
| | - Katyucia de Macedo Rodrigues
- 1 Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, USA
| | - Mary C Howk
- 1 Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, USA
| | - Ajay K Wakhloo
- 1 Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, USA
| | - Ajit S Puri
- 1 Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, USA
| |
Collapse
|
32
|
Mokin M, Chinea A, Primiani CT, Ren Z, Kan P, Srinivasan VM, Hanel R, Aguilar-Salinas P, Turk AS, Turner RD, Chaudry MI, Ringer AJ, Welch BG, Mendes Pereira V, Renieri L, Piano M, Elijovich L, Arthur AS, Cheema A, Lopes DK, Saied A, Baxter BW, Hawk H, Puri AS, Wakhloo AK, Shallwani H, Levy EI, Siddiqui AH, Dabus G, Linfante I. Treatment of blood blister aneurysms of the internal carotid artery with flow diversion. J Neurointerv Surg 2018; 10:1074-1078. [DOI: 10.1136/neurintsurg-2017-013701] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/07/2018] [Accepted: 02/08/2018] [Indexed: 11/03/2022]
Abstract
BackgroundBlood blister aneurysms (BBA) are a rare subset of intracranial aneurysms that represent a therapeutic challenge from both a surgical and endovascular perspective.ObjectiveTo report multicenter experience with flow diversion exclusively for BBA, located at non-branching segments along the anteromedial wall of the supraclinoidal internal carotid artery (ICA).MethodsConsecutive cases of BBA located at non-branching segments along the anteromedial wall of the supraclinoidal ICA treated with flow diversion were included in the final analysis.Results49 patients with 51 BBA of the ICA treated with devices to achieve the flow diversion effect were identified. 43 patients with 45 BBA of the ICA were treated with the pipeline embolization device and were included in the final analysis. Angiographic follow-up data were available for 30 patients (32 aneurysms in total); 87.5% of aneurysms (28/32) showed complete obliteration, 9.4% (3/32) showed reduced filling, and 3.1% (1/32) persistent filling. There was no difference between the size of aneurysm (≤2 mm vs >2 mm) or the use of adjunct coiling and complete occlusion of the aneurysm on follow-up (P=0.354 and P=0.865, respectively). Clinical follow-up data were available for 38 of 43 patients. 68% of patients (26/38) had a good clinical outcome (modified Rankin scale score of 0–2) at 3 months. There were 7 (16%) immediate procedural and 2 (5%) delayed complications, with 1 case of fatal delayed re-rupture after the initial treatment.ConclusionsOur data support the use of a flow diversion technique as a safe and effective therapeutic modality for BBA of the supraclinoid ICA.
Collapse
|
33
|
Kühn AL, Dabus G, Kan P, Wakhloo AK, Puri AS. Flow-diverter stents for endovascular management of non-fetal posterior communicating artery aneurysms-analysis on aneurysm occlusion, vessel patency, and patient outcome. Interv Neuroradiol 2018; 24:363-374. [PMID: 29471704 DOI: 10.1177/1591019918759735] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Use of flow-diversion technology in the treatment of incidental and recanalized posterior communicating artery (PComA) aneurysms. Methods Patients treated with the Pipeline embolization device (PED) for PComA aneurysms were identified and included in our retrospective analysis. We evaluated aneurysm characteristics, modified Rankin Scale score (mRS) on admission, angiography follow-up, and patient clinical outcome at discharge, at three to nine months, and at 12-18 months. Results We included 56 patients with a mean age of 56 years. Median mRS on admission was 0. All aneurysms involved the PComA and were either new findings or found to have shown recanalization at angiography follow-up from previous coil embolization or surgical clipping. Intraprocedural device foreshortening was observed in one case requiring additional placement of a self-expanding stent. One intraprocedural aneurysm rupture occurred because of a broken distal wire. This patient had an mRS of 4 after the procedure. Three- to nine-month and 12- to 18-month follow-up angiography showed near complete or complete aneurysm occlusion in most cases. Minimal to mild intimal hyperplasia was seen in five cases at three to nine months. PComA patency over time showed 29 of 46 initially patent vessels still patent at six months. Thirteen and seven PComAs showed progressive decrease in flow at three to nine months and 12-18 months, respectively. Median mRS remained 0 for all patients at three- to nine-month and 12- to 18-month follow-up. Conclusions Our preliminary results show that flow-diversion technology is an effective and safe treatment option. Larger studies with long-term follow-up are needed to validate our promising results.
Collapse
Affiliation(s)
- Anna Luisa Kühn
- 1 Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, MA, USA
| | - Guilherme Dabus
- 2 Department of Neurointerventional Surgery, Miami Cardiac & Vascular Institute and Baptist Neuroscience Center, Miami, FL, USA
| | - Peter Kan
- 3 Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Ajay K Wakhloo
- 1 Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, MA, USA
| | - Ajit S Puri
- 1 Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, MA, USA
| |
Collapse
|
34
|
Hou SY, Kühn AL, Puri AS, Wakhloo AK. Open-cell stent and use of cone-beam CT enables a safe and effective coil embolization of true ophthalmic artery and anterior choroidal artery aneurysms with preservation of parent vessel: Clinical and angiographic results. Interv Neuroradiol 2017; 24:135-139. [PMID: 29239687 DOI: 10.1177/1591019917747246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Treatment of true ophthalmic artery (OA) or anterior choroidal artery (AChA) aneurysms with preservation of the parent vessel may be challenging. Flow diverters have limitations when dealing with branch vessels arising from the aneurysm sac. Visual loss or AChA territory infarcts have been reported both for surgical and endovascular treatment. Methods We evaluated the safety and efficacy of an open-cell design, laser-cut, self-expanding Nitinol stent, and use of cone-beam computed tomography (CBCT) for stent-assisted coil embolization. Results A total of seven patients with unruptured OA or AChA aneurysms were enrolled in this prospective small case study and the data were analyzed retrospectively. A complete obliteration was achieved in all aneurysms immediately post-intervention or at six-month follow-up without any evidence for recanalization at up to three-year follow-up. All patients tolerated the procedure well and there was no change in baseline modified Rankin Scale. Conclusions Our study suggests that specific features of an open-cell stent allow a safe and effective treatment of OA or AChA aneurysms with a high technical success rate and excellent mid-term angiographic and clinical outcome. CBCT is a useful intraoperative imaging tool.
Collapse
Affiliation(s)
- Samuel Y Hou
- 1 Providence Neurovascular Center, St. Joseph's Medical Center, Burbank, CA, USA
| | - Anna Luisa Kühn
- 2 Division of Neuroimaging and Intervention and New England Center for Stroke Research, Department of Radiology, 12262 University of Massachusetts , Worcester, MA, USA
| | - Ajit S Puri
- 2 Division of Neuroimaging and Intervention and New England Center for Stroke Research, Department of Radiology, 12262 University of Massachusetts , Worcester, MA, USA
| | - Ajay K Wakhloo
- 2 Division of Neuroimaging and Intervention and New England Center for Stroke Research, Department of Radiology, 12262 University of Massachusetts , Worcester, MA, USA
| |
Collapse
|
35
|
van der Marel K, Vedantham S, van der Bom IMJ, Howk M, Narain T, Ty K, Karellas A, Gounis MJ, Puri AS, Wakhloo AK. Reduced Patient Radiation Exposure during Neurodiagnostic and Interventional X-Ray Angiography with a New Imaging Platform. AJNR Am J Neuroradiol 2017; 38:442-449. [PMID: 28104643 DOI: 10.3174/ajnr.a5049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 07/15/2016] [Accepted: 10/11/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Advancements in medical device and imaging technology as well as accruing clinical evidence have accelerated the growth of the endovascular treatment of cerebrovascular diseases. However, the augmented role of these procedures raises concerns about the radiation dose to patients and operators. We evaluated patient doses from an x-ray imaging platform with radiation dose-reduction technology, which combined image noise reduction, motion correction, and contrast-dependent temporal averaging with optimized x-ray exposure settings. MATERIALS AND METHODS In this single-center, retrospective study, cumulative dose-area product inclusive of fluoroscopy, angiography, and 3D acquisitions for all neurovascular procedures performed during a 2-year period on the dose-reduction platform were compared with a reference platform. Key study features were the following: The neurointerventional radiologist could select the targeted dose reduction for each patient with the dose-reduction platform, and the statistical analyses included patient characteristics and the neurointerventional radiologist as covariates. The analyzed outcome measures were cumulative dose (kerma)-area product, fluoroscopy duration, and administered contrast volume. RESULTS A total of 1238 neurointerventional cases were included, of which 914 and 324 were performed on the reference and dose-reduction platforms, respectively. Over all diagnostic and neurointerventional procedures, the cumulative dose-area product was significantly reduced by 53.2% (mean reduction, 160.3 Gy × cm2; P < .0001), fluoroscopy duration was marginally significantly increased (mean increase, 5.2 minutes; P = .0491), and contrast volume was nonsignificantly increased (mean increase, 15.3 mL; P = .1616) with the dose-reduction platform. CONCLUSIONS A significant reduction in patient radiation dose is achievable during neurovascular procedures by using dose-reduction technology with a minimal impact on workflow.
Collapse
Affiliation(s)
- K van der Marel
- From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts
| | - S Vedantham
- From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts
| | | | - M Howk
- From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts
| | - T Narain
- From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts
| | - K Ty
- From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts
| | - A Karellas
- From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts
| | - M J Gounis
- From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts
| | - A S Puri
- From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts
| | - A K Wakhloo
- From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts
| |
Collapse
|
36
|
Taschner CA, Vedantham S, de Vries J, Biondi A, Boogaarts J, Sakai N, Lylyk P, Szikora I, Meckel S, Urbach H, Kan P, Siekmann R, Bernardy J, Gounis MJ, Wakhloo AK. Surpass Flow Diverter for Treatment of Posterior Circulation Aneurysms. AJNR Am J Neuroradiol 2016; 38:582-589. [PMID: 28007769 DOI: 10.3174/ajnr.a5029] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/11/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Flow diverters for the treatment of posterior circulation aneurysms remain controversial. We aimed to identify factors contributing to outcome measures in patients treated with the Surpass flow diverter for aneurysms in this location. MATERIALS AND METHODS We conducted an observational study of 53 patients who underwent flow-diverter treatment for posterior circulation aneurysms at 15 centers. Key outcome measures were mortality, complete aneurysm occlusion, and modified Rankin Scale score at follow-up. RESULTS At follow-up (median, 11.3 months; interquartile range, 5.9-12.7 months), 9 patients had died, resulting in an all-cause mortality rate of 17.3% (95% CI, 7%-27.6%); 7 deaths (14%) were directly related to the procedure and none occurred in patients with a baseline mRS score of zero. After adjusting for covariates, a baseline mRS of 3-5 was more significantly (P = .003) associated with a higher hazard ratio for death than a baseline mRS of 0-2 (hazard ratio, 17.11; 95% CI, 2.69-109.02). After adjusting for follow-up duration, a 1-point increase in the baseline mRS was significantly (P < .001) associated with higher values of mRS at follow-up (odds ratio, 2.93; 95% CI, 1.79-4.79). Follow-up angiography in 44 patients (median, 11.3 months; interquartile range, 5.9-12.7 months) showed complete aneurysm occlusion in 29 (66%; 95% CI, 50.1%-79.5%). CONCLUSIONS Clinical results of flow-diverter treatment of posterior circulation aneurysms depend very much on patient selection. In this study, poorer outcomes were related to the treatment of aneurysms in patients with higher baseline mRS scores. Angiographic results showed a high occlusion rate for this subset of complex aneurysms.
Collapse
Affiliation(s)
- C A Taschner
- From the Department of Neuroradiology (C.A.T., S.M., H.U., J.B.), Medical Centre-University of Freiburg, Freiburg, Germany
| | | | - J de Vries
- Department of Neurosurgery (J.d.V., J.B.), Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - A Biondi
- Department of Neuroradiology and Endovascular Therapy (A.B.), University of Besançon, Besançon, France
| | - J Boogaarts
- From the Department of Neuroradiology (C.A.T., S.M., H.U., J.B.), Medical Centre-University of Freiburg, Freiburg, Germany.,Department of Neurosurgery (J.d.V., J.B.), Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - N Sakai
- Department of Neurosurgery (N.S.), Kobe City Medical Center General Hospital, Kobe, Japan
| | - P Lylyk
- Department of Neurosurgery (P.L.), Equipo de Neurocirugía Endovascular Radiología Intervencionista, Buenos Aires, Argentina
| | - I Szikora
- National Institute of Neurosciences (I.S.), Budapest, Hungary
| | - S Meckel
- From the Department of Neuroradiology (C.A.T., S.M., H.U., J.B.), Medical Centre-University of Freiburg, Freiburg, Germany
| | - H Urbach
- From the Department of Neuroradiology (C.A.T., S.M., H.U., J.B.), Medical Centre-University of Freiburg, Freiburg, Germany
| | - P Kan
- Department of Neurosurgery (P.K.), Baylor College of Medicine, Houston, Texas
| | - R Siekmann
- Department of Neuroradiology (R.S.), Klinikum Kassel, Kassel, Germany
| | - J Bernardy
- From the Department of Neuroradiology (C.A.T., S.M., H.U., J.B.), Medical Centre-University of Freiburg, Freiburg, Germany
| | - M J Gounis
- New England Center for Stroke Research (M.J.G.)
| | - A K Wakhloo
- Division of Neuroimaging and Intervention (A.K.W.), Departments of Radiology, Neurology, and Neurosurgery, University of Massachusetts Medical School, Worcester, Massachusetts
| |
Collapse
|
37
|
Kühn AL, Wakhloo AK, Gounis MJ, Kan P, de Macedo Rodrigues K, Lozano JD, Marosfoi MG, Perras M, Brooks C, Howk MC, Rex DE, Massari F, Puri AS. Use of self-expanding stents for better intracranial flow diverter wall apposition. Interv Neuroradiol 2016; 23:129-136. [PMID: 27956518 DOI: 10.1177/1591019916681981] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Flow diverter (FD) malapposition is associated with stroke-related complications. We document the use of self-expanding nitinol stents to remove/reduce the ledge of a FD deployed for aneurysm treatment. Methods We identified five patients who were treated with the Pipeline embolization device (PED) in conjunction with a Neuroform EZ stent for inadequate wall apposition of the ends of the FD at our institution between May 2014 and July 2015. Among other parameters, angiographic results, cone-beam computed tomography assessment of wall apposition and patient clinical outcome were evaluated. Results Incomplete device end apposition was seen in three cases, and precarious positioning of the distal end of the PED over the aneurysm neck was seen in two cases. In all five cases, successful treatment with good wall apposition and proper pinning of the PED distal edge was achieved using an additional Neuroform EZ stent. Appropriate aneurysm neck coverage and flow stagnation was seen in all cases. The combination of high radial outward force and open-cell design permits the Neuroform EZ stent to jail the malappositioned edges of the FD while maintaining good vessel-wall apposition itself and prevent migration of the PED. Short-term follow-up angiography showed device patency and complete aneurysm obliteration in all cases. Conclusions Preliminary results of this small case series suggest that the Neuroform EZ stent allows for effective treatment of FD malapposition in selected patients amenable for this endovascular approach. Long-term and larger cohort studies are needed to validate these results.
Collapse
Affiliation(s)
- Anna Luisa Kühn
- 1 Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, USA
| | - Ajay K Wakhloo
- 1 Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, USA
| | - Matthew J Gounis
- 1 Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, USA
| | - Peter Kan
- 2 Department of Neurosurgery, Baylor College of Medicine, USA
| | - Katyucia de Macedo Rodrigues
- 1 Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, USA
| | - J Diego Lozano
- 1 Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, USA
| | - Miklos G Marosfoi
- 1 Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, USA
| | - Mary Perras
- 1 Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, USA
| | - Christopher Brooks
- 1 Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, USA
| | - Mary C Howk
- 1 Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, USA
| | - David E Rex
- 1 Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, USA
| | - Francesco Massari
- 1 Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, USA
| | - Ajit S Puri
- 1 Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, USA
| |
Collapse
|
38
|
Kühn AL, de Macedo Rodrigues K, Lozano JD, Rex DE, Massari F, Tamura T, Howk M, Brooks C, L'Heureux J, Gounis MJ, Wakhloo AK, Puri AS. Use of the Pipeline embolization device for recurrent and residual cerebral aneurysms: a safety and efficacy analysis with short-term follow-up. J Neurointerv Surg 2016; 9:1208-1213. [PMID: 27888225 DOI: 10.1136/neurintsurg-2016-012772] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 10/30/2016] [Accepted: 11/02/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Evaluation of the safety and efficacy of the Pipeline embolization device (PED) when used as second-line treatment for recurrent or residual, pretreated ruptured and unruptured intracranial aneurysms (IAs). METHODS Retrospective review of our database to include all patients who were treated with a PED for recurrent or residual IAs following surgical clipping or coiling. We evaluated neurological outcome and angiograms at discharge, 6- and 12-months' follow-up and assessed intimal hyperplasia at follow-up. RESULTS Twenty-four patients met our inclusion criteria. Most IAs were located in the anterior circulation (n=21). No change of preprocedure modified Rankin Scale score was seen at discharge or at any scheduled follow-up. Complete or near-complete aneurysm occlusion on 6- and 12-month angiograms was seen in 94.4% (17/18 cases) and 93.3% (14/15 cases), respectively. Complete or near-complete occlusion was seen in 100% of previously ruptured and 85.7% (6/7 cases) and 83.3% (5/6 cases) of previously unruptured cases at the 6- and 12-months' follow-up, respectively. One case of moderate intimal hyperplasia was observed at 6 months and decreased to mild at the 12-months' follow-up. No difference in device performance was observed among pretreated unruptured or ruptured IAs. CONCLUSIONS Treatment of recurrent or residual IAs with a PED after previous coiling or clipping is feasible and safe. There is no difference in device performance between ruptured or unruptured IAs.
Collapse
Affiliation(s)
- Anna Luisa Kühn
- Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts, USA
| | - Katyucia de Macedo Rodrigues
- Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts, USA
| | - J Diego Lozano
- Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts, USA
| | - David E Rex
- Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts, USA
| | - Francesco Massari
- Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts, USA
| | - Takamitsu Tamura
- Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts, USA
| | - Mary Howk
- Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts, USA
| | - Christopher Brooks
- Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts, USA
| | - Jenna L'Heureux
- Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts, USA
| | - Matthew J Gounis
- Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts, USA
| | - Ajay K Wakhloo
- Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts, USA
| | - Ajit S Puri
- Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts, USA
| |
Collapse
|
39
|
Ansari SA, Kühn AL, Honarmand AR, Khan M, Hurley MC, Potts MB, Jahromi BS, Shaibani A, Gounis MJ, Wakhloo AK, Puri AS. Emergent Endovascular Management of Long-Segment and Flow-Limiting Carotid Artery Dissections in Acute Ischemic Stroke Intervention with Multiple Tandem Stents. AJNR Am J Neuroradiol 2016; 38:97-104. [PMID: 28059705 DOI: 10.3174/ajnr.a4965] [Citation(s) in RCA: 12] [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] [Received: 07/07/2016] [Accepted: 08/18/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Although most cervical dissections are managed medically, emergent endovascular treatment may become necessary in the presence of intracranial large-vessel occlusions, flow-limiting and long-segment dissections with impending occlusion, and/or hypoperfusion-related ischemia at risk of infarction. We investigated the role of emergent endovascular stenting of long-segment carotid dissections in the acute ischemic stroke setting. MATERIALS AND METHODS We retrospectively studied long-segment carotid dissections requiring stent reconstruction with multiple tandem stents (≥3 stents) and presenting with acute (<12 hours) ischemic stroke symptoms (NIHSS score, ≥4). We analyzed patient demographics, vascular risk factors, clinical presentations, imaging/angiographic findings, technical procedures/complications, and clinical outcomes. RESULTS Fifteen patients (mean age, 51.5 years) with acute ischemic stroke (mean NIHSS score, 15) underwent endovascular stent reconstruction for vessel and/or ischemic tissue salvage. All carotid dissections presented with >70% flow limiting stenosis and involved the distal cervical ICA with a minimum length of 3.5 cm. Carotid stent reconstruction was successful in all patients with no residual stenosis or flow limitation. Nine patients (60%) harbored intracranial occlusions, and 6 patients (40%) required intra-arterial thrombolysis/thrombectomy, achieving 100% TICI 2b-3 reperfusion. Two procedural complications were limited to thromboembolic infarcts from in-stent thrombus and asymptomatic hemorrhagic infarct transformation (7% morbidity, 0% mortality). Angiographic and ultrasound follow-up confirmed normal carotid caliber and stent patency, with 2 cases of <20% in-stent stenosis. Early clinical improvement resulted in a mean discharge NIHSS score of 6, and 9/15 (60%) patients achieved a 90-day mRS of ≤2. CONCLUSIONS Emergent stent reconstruction of long-segment and flow-limiting carotid dissections in acute ischemic stroke intervention is safe and effective, with favorable clinical outcomes, allowing successful thrombectomy, vessel salvage, restoration of cerebral perfusion, and/or prevention of recurrent thromboembolic stroke.
Collapse
Affiliation(s)
- S A Ansari
- From the Departments of Radiology, Neurology, and Neurological Surgery (S.A.A., A.R.H., M.C.H., M.B.P., B.S.J., A.S.), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - A L Kühn
- Division of Neuroimaging and Intervention (A.L.K., M.J.G., A.K.W., A.S.P.), Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts
| | - A R Honarmand
- From the Departments of Radiology, Neurology, and Neurological Surgery (S.A.A., A.R.H., M.C.H., M.B.P., B.S.J., A.S.), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - M Khan
- Department of Neurology (M.K.), Brown University, Providence, Rhode Island
| | - M C Hurley
- From the Departments of Radiology, Neurology, and Neurological Surgery (S.A.A., A.R.H., M.C.H., M.B.P., B.S.J., A.S.), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - M B Potts
- From the Departments of Radiology, Neurology, and Neurological Surgery (S.A.A., A.R.H., M.C.H., M.B.P., B.S.J., A.S.), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - B S Jahromi
- From the Departments of Radiology, Neurology, and Neurological Surgery (S.A.A., A.R.H., M.C.H., M.B.P., B.S.J., A.S.), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - A Shaibani
- From the Departments of Radiology, Neurology, and Neurological Surgery (S.A.A., A.R.H., M.C.H., M.B.P., B.S.J., A.S.), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - M J Gounis
- Division of Neuroimaging and Intervention (A.L.K., M.J.G., A.K.W., A.S.P.), Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts
| | - A K Wakhloo
- Division of Neuroimaging and Intervention (A.L.K., M.J.G., A.K.W., A.S.P.), Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts
| | - A S Puri
- Division of Neuroimaging and Intervention (A.L.K., M.J.G., A.K.W., A.S.P.), Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts
| |
Collapse
|
40
|
Marosfoi M, Langan ET, Strittmatter L, van der Marel K, Vedantham S, Arends J, Lylyk IR, Loganathan S, Hendricks GM, Szikora I, Puri AS, Wakhloo AK, Gounis MJ. In situ tissue engineering: endothelial growth patterns as a function of flow diverter design. J Neurointerv Surg 2016; 9:994-998. [DOI: 10.1136/neurintsurg-2016-012669] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 11/04/2022]
Abstract
BackgroundVascular remodeling in response to implantation of a tissue engineering scaffold such as a flow diverter (FD) leads to the cure of intracranial aneurysms. We hypothesize that the vascular response is dependent on FD design, and CD34+ progenitor cells play an important role in the endothelialization of the implant.MethodsSixteen rabbit aneurysms were randomly treated with two different single-layer braided FDs made of cobalt–chrome alloys. The FD-48 and FD-72 devices had 48 and 72 wires, respectively. Aneurysm occlusion rate was assessed during the final digital subtraction angiogram at 10, 20, 30, and 60 days (n=2 per device per time point). Implanted vessels were analyzed with scanning electron microscopy for tissue coverage, endothelialization, and immuno-gold labeling for CD34+ cells.ResultsComplete aneurysm occlusion rates were similar between the devices; however, complete or near complete occlusion was more frequently observed in aneurysms with neck ≤4.2 mm (p=0.008). Total tissue coverage at 10 days over the surface of the FD-48 and FD-72 devices was 56.4±11.6% and 76.6±3.6%, respectively. Endothelial cell growth over the surface was time-dependent for the FD-72 device (Spearman's r=0.86, p=0.013) but not for the FD-48 device (Spearman's r=−0.59, p=0.094). The endothelialization score was marginally correlated with the distance from the aneurysm neck for the FD-48 device (Spearman's r=1, p=0.083) but not for the FD-72 device (Spearman's r=0.8, p=0.33). CD34+ cells were present along the entirety of both devices at all time points.ConclusionsThis study gives preliminary evidence that temporal and spatial endothelialization is dependent on FD design. Circulating CD34+ progenitor cells contribute to endothelialization throughout the healing process.
Collapse
|
41
|
Tamura T, Rex DE, Marosfoi MG, Puri AS, Gounis MJ, Wakhloo AK. Trigeminocardiac reflex caused by selective angiography of the middle meningeal artery. J Neurointerv Surg 2016; 9:e10. [PMID: 27417184 DOI: 10.1136/neurintsurg-2016-012517.rep] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2016] [Indexed: 11/03/2022]
Abstract
We describe an interesting case of trigeminocardiac reflex (TCR) caused by selective angiography of the middle meningeal artery (MMA). A 28-year-old woman presented with a symptomatic meningioma. Preoperative tumour embolisation was performed. In the procedure, when selective MMA angiography was done with Omnipaque 300 mg I/mL for 3 mL by manual injection, the patient complained of flashing lights in her eye followed by vomiting and bradycardia down to 40 bpm without increased intracranial pressure signs. On selective MMA angiography, the choroidal crescent and arteries of the periorbital region were opacified by anastomosis from the MMA via the meningo-ophthalmic artery. We diagnosed that her symptoms were caused by selective MMA angiography leading to high pressure stimulation towards the ophthalmic nerve innervation around the orbit as a TCR. We suggest that the operator should be prepared to manage TCR during treatment with expected selective MMA angiography, and gentle low pressure contrast injection should be attempted.
Collapse
Affiliation(s)
- Takamitsu Tamura
- Division of Neuroimaging and Intervention and New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Neurosurgery, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - David E Rex
- Division of Neuroimaging and Intervention and New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Miklos G Marosfoi
- Division of Neuroimaging and Intervention and New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Ajit S Puri
- Division of Neuroimaging and Intervention and New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Matthew J Gounis
- Division of Neuroimaging and Intervention and New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Ajay K Wakhloo
- Division of Neuroimaging and Intervention and New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| |
Collapse
|
42
|
Tamura T, Rex DE, Marosfoi MG, Puri AS, Gounis MJ, Wakhloo AK. Trigeminocardiac reflex caused by selective angiography of the middle meningeal artery. BMJ Case Rep 2016; 2016:bcr-2016-012517. [PMID: 27382015 DOI: 10.1136/bcr-2016-012517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We describe an interesting case of trigeminocardiac reflex (TCR) caused by selective angiography of the middle meningeal artery (MMA). A 28-year-old woman presented with a symptomatic meningioma. Preoperative tumour embolisation was performed. In the procedure, when selective MMA angiography was done with Omnipaque 300 mg I/mL for 3 mL by manual injection, the patient complained of flashing lights in her eye followed by vomiting and bradycardia down to 40 bpm without increased intracranial pressure signs. On selective MMA angiography, the choroidal crescent and arteries of the periorbital region were opacified by anastomosis from the MMA via the meningo-ophthalmic artery. We diagnosed that her symptoms were caused by selective MMA angiography leading to high pressure stimulation towards the ophthalmic nerve innervation around the orbit as a TCR. We suggest that the operator should be prepared to manage TCR during treatment with expected selective MMA angiography, and gentle low pressure contrast injection should be attempted.
Collapse
Affiliation(s)
- Takamitsu Tamura
- Division of Neuroimaging and Intervention and New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA Department of Neurosurgery, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - David E Rex
- Division of Neuroimaging and Intervention and New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Miklos G Marosfoi
- Division of Neuroimaging and Intervention and New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Ajit S Puri
- Division of Neuroimaging and Intervention and New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Matthew J Gounis
- Division of Neuroimaging and Intervention and New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Ajay K Wakhloo
- Division of Neuroimaging and Intervention and New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| |
Collapse
|
43
|
Dabus G, Grossberg JA, Cawley CM, Dion JE, Puri AS, Wakhloo AK, Gonsales D, Aguilar-Salinas P, Sauvageau E, Linfante I, Hanel RA. Treatment of complex anterior cerebral artery aneurysms with Pipeline flow diversion: mid-term results. J Neurointerv Surg 2016; 9:147-151. [PMID: 27382125 DOI: 10.1136/neurintsurg-2016-012519] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 06/12/2016] [Accepted: 06/20/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND The off-label use of flow diverters in the treatment of distal aneurysms continues to be debated. OBJECTIVE To report our multicenter experience in the treatment of complex anterior cerebral artery aneurysms with the Pipeline embolization device (PED). METHODS The neurointerventional databases of the four participating institutions were retrospectively reviewed for aneurysms treated with PED between October 2011 and January of 2016. All patients treated for anterior cerebral artery aneurysms were included in the analysis. Clinical presentation, location, type, vessel size, procedural complications, clinical and imaging follow-up were included in the analysis. RESULTS Twenty patients (13 female) with 20 aneurysms met the inclusion criteria in our study. Fifteen aneurysms were classified as saccular and five as fusiform (mean size 7.3 mm). Thirteen aneurysms were located in the anterior communicating region (ACOM or A1/2 junction), six were A2-pericallosal, and one was located in the A1 segment. Six patients had presented previously with subarachnoid hemorrhage and had their aneurysms initially clipped or coiled. There was one minor event (a small caudate infarct) and one major event (intraparenchymal hemorrhage). Sixteen of the 20 patients had angiographic follow-up (mean 10 months). Eleven aneurysms were completely occluded, one had residual neck, and four had residual aneurysm filling. CONCLUSIONS The treatment of complex anterior cerebral artery aneurysms with the PED as an alternative for patients who are not good candidates for conventional methods is technically feasible and safe. Mid-term results are promising but larger series with long-term follow-up are required to assess its effectiveness.
Collapse
Affiliation(s)
- Guilherme Dabus
- Miami Cardiac & Vascular Institute, Florida International University, Miami, Florida, USA.,Baptist Neuroscience Center, Florida International University, Miami, Florida, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Jonathan A Grossberg
- Departments of Radiology and Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - C Michael Cawley
- Departments of Radiology and Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Jacques E Dion
- Departments of Radiology and Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Ajit S Puri
- Department of Radiology, University of Massachusetts, Worcester, Massachusetts, USA
| | - Ajay K Wakhloo
- Department of Radiology, University of Massachusetts, Worcester, Massachusetts, USA
| | - Douglas Gonsales
- Baptist Neurological Institute, Baptist Health System, Jacksonville, Florida, USA
| | | | - Eric Sauvageau
- Baptist Neurological Institute, Baptist Health System, Jacksonville, Florida, USA
| | - Italo Linfante
- Miami Cardiac & Vascular Institute, Florida International University, Miami, Florida, USA.,Baptist Neuroscience Center, Florida International University, Miami, Florida, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Ricardo A Hanel
- Baptist Neurological Institute, Baptist Health System, Jacksonville, Florida, USA
| |
Collapse
|
44
|
Kühn AL, Wakhloo AK, Lozano JD, Massari F, De Macedo Rodrigues K, Marosfoi MG, Perras M, Brooks C, Howk M, Rex DE, Gounis MJ, Puri AS. Two-year single-center experience with the ‘Baby Trevo’ stent retriever for mechanical thrombectomy in acute ischemic stroke. J Neurointerv Surg 2016; 9:541-546. [DOI: 10.1136/neurintsurg-2016-012454] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 05/13/2016] [Accepted: 05/17/2016] [Indexed: 11/03/2022]
Abstract
ObjectiveTo evaluate the safety and efficacy of the ‘Baby Trevo’ (Trevo XP ProVue 3×20 mm Retriever) stent retriever for large vessel occlusions (LVOs) in acute ischemic stroke (AIS).Materials and methodsWe retrospectively analyzed our stroke database and included all patients treated with the Baby Trevo for distal LVOs in AIS. Patient gender, mean age, vascular risk factors, National Institutes of Health Stroke Scale (NIHSS) score at presentation, and modified Rankin Scale (mRS) score at baseline and 90-day follow-up were documented. Reperfusion rates for the vessels treated were recorded using the Thrombolysis in Cerebral Infarction (TICI) classification. Occurrence of vasospasm and new or evolving infarcts in the treated vascular territory was documented.ResultsThirty-five subjects with a mean NIHSS score of 18 were included. The Baby Trevo device was used in 38 branches of the anterior and posterior circulations. TICI 2b/3 blood flow was restored after one single pass in 20/38 (52.6%) and after two or three passes in 11 vessels. The remaining vessels required either more than three passes, showed less than a TICI 2b/3 reperfusion (n=3), or demonstrated failure to retrieve the clot (n=4). TICI 2b/3 reperfusion was achieved in 30 patients (85.7%). No vessel injuries, rupture, or significant vasospasm were seen. Overall, a mRS score of ≤2 was seen in 56.5% of the subjects successfully treated with the Baby Trevo at 90 days and in 81.3% of surviving patients; seven patients died (20%).ConclusionsOur preliminary data suggest that the ‘Baby Trevo’ achieves a high recanalization rate without any significant risk. Larger cohort studies are needed to validate the clinical benefit.
Collapse
|
45
|
Lozano JD, Massari F, Howk MC, de Macedo Rodrigues K, Brooks C, Perras M, Rex DE, Wakhloo AK, Kühn AL, Puri AS. Utilization of a New Intracranial Support Catheter as an Intermediate Aspiration Catheter in the Treatment of Acute Ischemic Stroke: Technical Report on Initial Experience. Cureus 2016; 8:e617. [PMID: 27382525 PMCID: PMC4917373 DOI: 10.7759/cureus.617] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The endovascular management of acute ischemic stroke (AIS) due to emergency large vessel occlusion (ELVO) has become the standard of care after the recent publication of landmark randomized, controlled trials. Mechanical thrombectomy, in addition to intravenous thrombolysis (within 4.5 hours when eligible), is now part of the algorithm of the standard of care when treating AIS in patients with ELVO in the anterior circulation up to six hours after symptom onset. A newly introduced device, the Arc™ intracranial support catheter (Medtronic, Irvine, USA), is specifically designed for the introduction of neurointerventional devices into the cerebral vasculature and facilitates the delivery of microcatheters into smaller, more distal intracranial vessels. This technical report describes the use of the Arc™ intracranial support catheter in the setting of AIS.
Collapse
Affiliation(s)
- J Diego Lozano
- Division of Neuroimaging and Intervention, Department of Radiology, University of Massachusetts
| | - Francesco Massari
- Division of Neuroimaging and Intervention, Department of Radiology, University of Massachusetts
| | - Mary C Howk
- Division of Neuroimaging and Intervention, Department of Radiology, University of Massachusetts
| | | | - Christopher Brooks
- Division of Neuroimaging and Intervention, Department of Radiology, University of Massachusetts
| | - Mary Perras
- Division of Neuroimaging and Intervention, Department of Radiology, University of Massachusetts
| | - David E Rex
- Division of Neuroimaging and Intervention, Department of Radiology, University of Massachusetts
| | - Ajay K Wakhloo
- Division of Neuroimaging and Intervention, Department of Radiology, University of Massachusetts
| | - Anna Luisa Kühn
- Division of Neuroimaging and Intervention, Department of Radiology, University of Massachusetts
| | - Ajit S Puri
- Division of Neuroimaging and Intervention, Department of Radiology, University of Massachusetts
| |
Collapse
|
46
|
Massari F, Henninger N, Lozano JD, Patel A, Kuhn AL, Howk M, Perras M, Brooks C, Gounis MJ, Kan P, Wakhloo AK, Puri AS. ARTS (Aspiration-Retriever Technique for Stroke): Initial clinical experience. Interv Neuroradiol 2016; 22:325-32. [PMID: 26908591 DOI: 10.1177/1591019916632369] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 01/21/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND A new generation of highly navigable large-bore aspiration catheters and retriever devices for intracranial mechanical thrombectomy has markedly improved recanalization rates, time and clinical outcomes. We report collected clinical data utilizing a new technique based on combined large lumen aspiration catheter and partially resheathed stent retriever (ARTS: Aspiration (catheter)-(stent) Retriever Technique for Stroke). This technique is applied, especially in presence of bulky/rubbery emboli, when resistance is felt while retracting the stent retriever; at that point the entire assembly is locked and removed in-toto under continuous aspiration with additional flow arrest. METHODS A retrospective data analysis was performed to identify patients with large cerebral artery acute ischemic stroke treated with ARTS. The study was conducted between August 2013 and February 2015 at a single high volume stroke center. Procedural and clinical data were captured for analysis. RESULTS Forty-two patients (median age 66 years) met inclusion criteria for this study. The ARTS was successful in achieving Thrombolysis in Cerebral Infarction (TICI) ≥2b revascularization in 97.6% of cases (TICI 2b = 18 patients, TICI 3 = 23 patients). Patients' median National Institutes of Health Stroke Scale score at admission was 18 (6-40). A 3-month follow-up modified Rankin Scale value of 0-2 was achieved in 65.7% of the successfully treated patients (average 2.4). Two patients (4.8%) developed symptomatic intraparenchymal hemorrhages. Six procedure unrelated deaths were observed. CONCLUSIONS We found that ARTS is a fast, safe and effective method for endovascular recanalization of large vessel occlusions presenting within the context of acute ischemic stroke.
Collapse
Affiliation(s)
- Francesco Massari
- Division Neuroimaging and Intervention (NII) and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, USA
| | - Nils Henninger
- Departments of Neurology and Psychiatry, University of Massachusetts, Worcester, USA
| | - Juan Diego Lozano
- Division Neuroimaging and Intervention (NII) and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, USA
| | - Anand Patel
- Departments of Neurology and Psychiatry, University of Massachusetts, Worcester, USA
| | - Anna Luisa Kuhn
- Division Neuroimaging and Intervention (NII) and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, USA
| | - Mary Howk
- Division Neuroimaging and Intervention (NII) and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, USA
| | - Mary Perras
- Division Neuroimaging and Intervention (NII) and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, USA
| | - Christopher Brooks
- Division Neuroimaging and Intervention (NII) and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, USA
| | - Matthew J Gounis
- Division Neuroimaging and Intervention (NII) and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, USA
| | - Ajay K Wakhloo
- Division Neuroimaging and Intervention (NII) and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, USA
| | - Ajit S Puri
- Division Neuroimaging and Intervention (NII) and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, USA
| |
Collapse
|
47
|
van der Marel K, Brooks OW, King RM, Chueh JY, Marosfoi M, Langan E, Carniato SL, Nogueira RG, Wakhloo AK, Gounis MJ, Puri AS. Abstract TP261: Clot Integration Factor for
in-vitro
Quantification of Stent-retriever Configuration Using Cone-beam CT. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.tp261] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:
Mechanical thrombectomy using stent-retriever technology provides acute ischemic stroke patients with beneficial treatment of emergent large vessel occlusion. Still, the disparity between recanalization rates and clinical outcomes calls for enhanced device designs and treatment strategies with better reperfusion efficiency. Intuitively, sufficient device integration with the embolus is pursued to maximize chances of first-pass success, thereby limiting clot fragmentation and intimal trauma during extensive clot manipulation. Our aim was to develop an imaging-based measure of device integration in reproducible phantom experiments that could help identifying differences in aspects of thrombectomy procedures that may be related to angiographic and clinical outcomes.
Methods:
Deployment variations of the Trevo(TM) ProVue/XP retriever were tested in an in-vitro model system that mimicked a MCA-occlusion with a silicone vascular replica and two visible clot models (soft elastic, and hard inelastic) with 8 trials/group. High-resolution cone-beam CT imaging was performed prior to retriever retraction. An image processing pipeline was devised that used level-set segmentation, path-tracing, and Steiner circumellipse fitting to extract and determine the interior volumes of the clot and the three visible wires. Clot Integration Factor (CIF) was calculated as the ratio of the volume of clot-device intersection to the clot volume.
Results:
Example of the device, its wires, and the clot: Average clot volumes were 90.4±12.2mm3. CIF was significantly different for two deployment variations when the device engaged a hard clot (difference between means, 95%CI=[0.003,0.187], p=0.043), but not a soft clot model (95%CI=[-0.152,0.263], p=0.567).
Conclusion:
In-vitro imaging-based quantification of clot integration can detect differences in deployment configuration relative to a clot, which may support procedural and design improvements.
Collapse
Affiliation(s)
| | - Olivia W Brooks
- Dept of Radiology, Univ of Massachusetts Med Sch, Worcester, MA
| | - Robert M King
- Dept of Radiology, Univ of Massachusetts Med Sch, Worcester, MA
| | - Ju-Yu Chueh
- Dept of Radiology, Univ of Massachusetts Med Sch, Worcester, MA
| | - Miklos Marosfoi
- Dept of Radiology, Univ of Massachusetts Med Sch, Worcester, MA
| | - Erin Langan
- Dept of Radiology, Univ of Massachusetts Med Sch, Worcester, MA
| | | | | | - Ajay K Wakhloo
- Dept of Radiology, Univ of Massachusetts Med Sch, Worcester, MA
| | | | - Ajit S Puri
- Dept of Radiology, Univ of Massachusetts Med Sch, Worcester, MA
| |
Collapse
|
48
|
Adams HP, El Ahmadieh TY, Albers GW, Alexandrov AV, Anrather J, Arai K, Aronowski J(J, Auer RN, Awad IA, Ay H, Baltan S, Batjer HH, Benavente OR, Bendok BR, Bershad EM, Bonati LH, Bookland MJ, Bousser MG, Braca JA, Broderick JP, Brown MM, Brown WE, Brust JC, Bushnell C, Bösel J, Canhão P, Caplan LR, Castellanos M, Chamorro A, Chandler JP, Chen J, Chopp M, Chrissobolis S, Chabriat H, Cramer SC, Cucchiara BL, Dannenbaum MJ, Davis PH, Dawson TM, Dawson VL, Day AL, del Zoppo GJ, Diener HC, Di Tullio MR, Dobkin BH, Dzialowski I, Economos A, Eddleman CS, Elkind MS, Feigin VL, Ferro JM, Findlay JM, Furie KL, Fusco MR, Field TS, Geibprasert S, Gensic AP, Gobin YP, Goldberg MP, Goldstein LB, Gonzales NR, Gounis MJ, Greenberg SM, Gregson BA, Grotta JC, Gutierrez J, Hacke W, Hallenbeck JM, Haršány M, Heiferman DM, Homma S, Howard G, Howard VJ, Hwang JY, Iadecola C, Jahan R, Joutel A, Jüttler E, Kase CS, Kasner SE, Katan M, Khader Eliyas J, Khan M, Kim H, Kidwell CS, Kim JS, Krings T, Krishnamurthi R, Kurth T, Lamy C, Lansberg MG, Levy EI, Liebeskind DS, Lo EH, Loftus CM, Lyden PD, Mas JL, Massari F, Meckler JM, Mendelow AD, Meschia JF, Messé SR, Mitchel P, Morgenstern LB, Mokin M, Moskowitz MA, Mullen MT, Nedergaard M, Neugebauer H, Newell DW, Norrving B, O'Donnell M, Ofengeim D, Ogata J, Ogilvy CS, Pancioli AM, Parsha K, Parsons MW, Pawlikowska L, Pérez A, Perez-Pinzon MA, Powers WJ, Puetz V, Puri AS, Ransom BR, Roine RO, Rundek T, Russin JJ, Sacco RL, Spetzler RF, Sattenberg RJ, Saver JL, Savitz SI, Schönenberger S, Seshadri S, Sharma VK, Shi Y, Shoamanesh A, Silverboard G, Singhal AB, Sobey CG, Stapf C, Su H, Suarez JI, Sykora M, Tatlisumak T, El Tecle N, terBrugge KG, Thompson JW, Tilley BC, Tournier-Lasserve E, Tsivgoulis G, Vilela MD, von Kummer R, Wakhloo AK, Wagner KR, Warach S, Weksler BB, Werring D, Willey JZ, Wintermark M, Wolf PA, Wong LK, Woo D, Wright C, Xi G, Yamaguchi T, Yasaka M, Young WL, Zammar SG, Zahuranec DB, Zhang F, Zhang H, Zhang JH, Zhang ZG, Zukin RS, Zweifler RM. List of Contributors. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00090-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
49
|
Marosfoi MG, Korin N, Gounis MJ, Uzun O, Vedantham S, Langan ET, Papa AL, Brooks OW, Johnson C, Puri AS, Bhatta D, Kanapathipillai M, Bronstein BR, Chueh JY, Ingber DE, Wakhloo AK. Shear-Activated Nanoparticle Aggregates Combined With Temporary Endovascular Bypass to Treat Large Vessel Occlusion. Stroke 2015; 46:3507-13. [DOI: 10.1161/strokeaha.115.011063] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 09/29/2015] [Indexed: 01/03/2023]
Abstract
Background and Purpose—
The goal of this study is to combine temporary endovascular bypass (TEB) with a novel shear-activated nanotherapeutic (SA-NT) that releases recombinant tissue-type plasminogen activator (r-tPA) when exposed to high levels of hemodynamic stress and to determine if this approach can be used to concentrate r-tPA at occlusion sites based on high shear stresses created by stent placement.
Methods—
A rabbit model of carotid vessel occlusion was used to test the hypothesis that SA-NT treatment coupled with TEB provides high recanalization rates while reducing vascular injury. We evaluated angiographic recanalization with TEB alone, intra-arterial delivery of soluble r-tPA alone, or TEB combined with 2 doses of intra-arterial infusion of either the SA-NT or soluble r-tPA. Vascular injury was compared against stent-retriever thrombectomy.
Results—
Shear-targeted delivery of r-tPA using the SA-NT resulted in the highest rate of complete recanalization when compared with controls (
P
=0.0011). SA-NT (20 mg) had a higher likelihood of obtaining complete recanalization as compared with TEB alone (odds ratio 65.019, 95% confidence interval 1.77, >1000;
P
=0.0231), intra-arterial r-tPA alone (odds ratio 65.019, 95% confidence interval 1.77, >1000;
P
=0.0231), or TEB with soluble r-tPA (2 mg; odds ratio 18.78, 95% confidence interval 1.28, 275.05;
P
=0.0322). Histological analysis showed circumferential loss of endothelium restricted to the area where the TEB was deployed; however, there was significantly less vascular injury using a TEB as compared with stent-retriever procedure (odds ratio 12.97, 95% confidence interval 8.01, 21.02;
P
<0.0001).
Conclusions—
A novel intra-arterial, nanoparticle-based thrombolytic therapy combined with TEB achieves high rates of complete recanalization. Moreover, this approach reduces vascular trauma as compared with stent-retriever thrombectomy.
Collapse
Affiliation(s)
- Miklos G. Marosfoi
- From the New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester (M.G.M., M.J.G., S.V., E.T.L., O.W.B., A.S.P., J.-Y.C., A.K.W.); Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA (N.K., O.U., A.-L.P., C.J., D.B., M.K., B.R.B., D.E.I.); Department of Biomedical Engineering, Technion, Israel (N.K.); Vascular Biology Program, Boston Children’s Hospital and Harvard University, Boston, MA (D.E.I.); and Harvard John A
| | - Netanel Korin
- From the New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester (M.G.M., M.J.G., S.V., E.T.L., O.W.B., A.S.P., J.-Y.C., A.K.W.); Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA (N.K., O.U., A.-L.P., C.J., D.B., M.K., B.R.B., D.E.I.); Department of Biomedical Engineering, Technion, Israel (N.K.); Vascular Biology Program, Boston Children’s Hospital and Harvard University, Boston, MA (D.E.I.); and Harvard John A
| | - Matthew J. Gounis
- From the New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester (M.G.M., M.J.G., S.V., E.T.L., O.W.B., A.S.P., J.-Y.C., A.K.W.); Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA (N.K., O.U., A.-L.P., C.J., D.B., M.K., B.R.B., D.E.I.); Department of Biomedical Engineering, Technion, Israel (N.K.); Vascular Biology Program, Boston Children’s Hospital and Harvard University, Boston, MA (D.E.I.); and Harvard John A
| | - Oktay Uzun
- From the New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester (M.G.M., M.J.G., S.V., E.T.L., O.W.B., A.S.P., J.-Y.C., A.K.W.); Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA (N.K., O.U., A.-L.P., C.J., D.B., M.K., B.R.B., D.E.I.); Department of Biomedical Engineering, Technion, Israel (N.K.); Vascular Biology Program, Boston Children’s Hospital and Harvard University, Boston, MA (D.E.I.); and Harvard John A
| | - Srinivasan Vedantham
- From the New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester (M.G.M., M.J.G., S.V., E.T.L., O.W.B., A.S.P., J.-Y.C., A.K.W.); Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA (N.K., O.U., A.-L.P., C.J., D.B., M.K., B.R.B., D.E.I.); Department of Biomedical Engineering, Technion, Israel (N.K.); Vascular Biology Program, Boston Children’s Hospital and Harvard University, Boston, MA (D.E.I.); and Harvard John A
| | - Erin T. Langan
- From the New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester (M.G.M., M.J.G., S.V., E.T.L., O.W.B., A.S.P., J.-Y.C., A.K.W.); Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA (N.K., O.U., A.-L.P., C.J., D.B., M.K., B.R.B., D.E.I.); Department of Biomedical Engineering, Technion, Israel (N.K.); Vascular Biology Program, Boston Children’s Hospital and Harvard University, Boston, MA (D.E.I.); and Harvard John A
| | - Anne-Laure Papa
- From the New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester (M.G.M., M.J.G., S.V., E.T.L., O.W.B., A.S.P., J.-Y.C., A.K.W.); Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA (N.K., O.U., A.-L.P., C.J., D.B., M.K., B.R.B., D.E.I.); Department of Biomedical Engineering, Technion, Israel (N.K.); Vascular Biology Program, Boston Children’s Hospital and Harvard University, Boston, MA (D.E.I.); and Harvard John A
| | - Olivia W. Brooks
- From the New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester (M.G.M., M.J.G., S.V., E.T.L., O.W.B., A.S.P., J.-Y.C., A.K.W.); Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA (N.K., O.U., A.-L.P., C.J., D.B., M.K., B.R.B., D.E.I.); Department of Biomedical Engineering, Technion, Israel (N.K.); Vascular Biology Program, Boston Children’s Hospital and Harvard University, Boston, MA (D.E.I.); and Harvard John A
| | - Chris Johnson
- From the New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester (M.G.M., M.J.G., S.V., E.T.L., O.W.B., A.S.P., J.-Y.C., A.K.W.); Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA (N.K., O.U., A.-L.P., C.J., D.B., M.K., B.R.B., D.E.I.); Department of Biomedical Engineering, Technion, Israel (N.K.); Vascular Biology Program, Boston Children’s Hospital and Harvard University, Boston, MA (D.E.I.); and Harvard John A
| | - Ajit S. Puri
- From the New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester (M.G.M., M.J.G., S.V., E.T.L., O.W.B., A.S.P., J.-Y.C., A.K.W.); Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA (N.K., O.U., A.-L.P., C.J., D.B., M.K., B.R.B., D.E.I.); Department of Biomedical Engineering, Technion, Israel (N.K.); Vascular Biology Program, Boston Children’s Hospital and Harvard University, Boston, MA (D.E.I.); and Harvard John A
| | - Deen Bhatta
- From the New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester (M.G.M., M.J.G., S.V., E.T.L., O.W.B., A.S.P., J.-Y.C., A.K.W.); Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA (N.K., O.U., A.-L.P., C.J., D.B., M.K., B.R.B., D.E.I.); Department of Biomedical Engineering, Technion, Israel (N.K.); Vascular Biology Program, Boston Children’s Hospital and Harvard University, Boston, MA (D.E.I.); and Harvard John A
| | - Mathumai Kanapathipillai
- From the New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester (M.G.M., M.J.G., S.V., E.T.L., O.W.B., A.S.P., J.-Y.C., A.K.W.); Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA (N.K., O.U., A.-L.P., C.J., D.B., M.K., B.R.B., D.E.I.); Department of Biomedical Engineering, Technion, Israel (N.K.); Vascular Biology Program, Boston Children’s Hospital and Harvard University, Boston, MA (D.E.I.); and Harvard John A
| | - Ben R. Bronstein
- From the New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester (M.G.M., M.J.G., S.V., E.T.L., O.W.B., A.S.P., J.-Y.C., A.K.W.); Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA (N.K., O.U., A.-L.P., C.J., D.B., M.K., B.R.B., D.E.I.); Department of Biomedical Engineering, Technion, Israel (N.K.); Vascular Biology Program, Boston Children’s Hospital and Harvard University, Boston, MA (D.E.I.); and Harvard John A
| | - Ju-Yu Chueh
- From the New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester (M.G.M., M.J.G., S.V., E.T.L., O.W.B., A.S.P., J.-Y.C., A.K.W.); Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA (N.K., O.U., A.-L.P., C.J., D.B., M.K., B.R.B., D.E.I.); Department of Biomedical Engineering, Technion, Israel (N.K.); Vascular Biology Program, Boston Children’s Hospital and Harvard University, Boston, MA (D.E.I.); and Harvard John A
| | - Donald E. Ingber
- From the New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester (M.G.M., M.J.G., S.V., E.T.L., O.W.B., A.S.P., J.-Y.C., A.K.W.); Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA (N.K., O.U., A.-L.P., C.J., D.B., M.K., B.R.B., D.E.I.); Department of Biomedical Engineering, Technion, Israel (N.K.); Vascular Biology Program, Boston Children’s Hospital and Harvard University, Boston, MA (D.E.I.); and Harvard John A
| | - Ajay K. Wakhloo
- From the New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester (M.G.M., M.J.G., S.V., E.T.L., O.W.B., A.S.P., J.-Y.C., A.K.W.); Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA (N.K., O.U., A.-L.P., C.J., D.B., M.K., B.R.B., D.E.I.); Department of Biomedical Engineering, Technion, Israel (N.K.); Vascular Biology Program, Boston Children’s Hospital and Harvard University, Boston, MA (D.E.I.); and Harvard John A
| |
Collapse
|
50
|
Iannaccone F, De Beule M, De Bock S, Van der Bom IMJ, Gounis MJ, Wakhloo AK, Boone M, Verhegghe B, Segers P. A Finite Element Method to Predict Adverse Events in Intracranial Stenting Using Microstents: In Vitro Verification and Patient Specific Case Study. Ann Biomed Eng 2015; 44:442-52. [DOI: 10.1007/s10439-015-1505-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 11/05/2015] [Indexed: 11/28/2022]
|