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Baranoski JF, Catapano JS, Rutledge C, Cole TS, Majmundar N, Winkler EA, Srinivasan VM, Jadhav AP, Ducruet AF, Albuquerque FC. Endovascular Treatment of Cerebrovascular Lesions Using Nickel- or Nitinol-Containing Devices in Patients with Nickel Allergies. AJNR Am J Neuroradiol 2023; 44:939-942. [PMID: 37474263 PMCID: PMC10411833 DOI: 10.3174/ajnr.a7936] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 09/16/2022] [Accepted: 06/11/2023] [Indexed: 07/22/2023]
Abstract
Nickel is used in many cerebral endovascular treatment devices. However, nickel hypersensitivity is the most common metal allergy, and the relative risk of treatment in these patients is unknown. This retrospective analysis identified patients with nickel or metal allergies who underwent cerebral endovascular treatment with nickel-containing devices. Seven patients with nickel and/or other metal allergies underwent treatment with 9 nickel-containing devices. None experienced periprocedural complications. No patient received treatment with corticosteroids or antihistamines. At a mean clinical follow-up for all patients of 22.8 months (range, 10.5-38.0 months), no patients had symptoms attributable to nickel allergic reactions. The mean radiographic follow-up for all patients at 18.4 months (range, 2.5-37.5 months) showed successful treatment of the targeted vascular pathologies, with no evidence of in-stent stenosis or other allergic or hypersensitivity sequelae. The treatment of cerebrovascular lesions with a nickel-containing device resulted in no adverse outcomes among these patients and was safe and effective.
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Affiliation(s)
- J F Baranoski
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - J S Catapano
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - C Rutledge
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - T S Cole
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - N Majmundar
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - E A Winkler
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - V M Srinivasan
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - A P Jadhav
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - A F Ducruet
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - F C Albuquerque
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Catapano JS, Scherschinski L, Rumalla K, Srinivasan VM, Cole TS, Baranoski JF, Lawton MT, Jadhav AP, Ducruet AF, Albuquerque FC. Emergency Department Visits for Chronic Subdural Hematomas within 30 Days after Surgical Evacuation with and without Middle Meningeal Artery Embolization. AJNR Am J Neuroradiol 2022; 43:1148-1151. [PMID: 35863784 PMCID: PMC9575430 DOI: 10.3174/ajnr.a7572] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/16/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Middle meningeal artery embolization after surgical evacuation of a chronic subdural hematomas is associated with fewer treatment failures than surgical evacuation. We compared emergency department visits within 30 days for patients with chronic subdural hematomas with and without adjunctive middle meningeal artery embolization. MATERIALS AND METHODS All cases of chronic subdural hematoma treated from January 1, 2018, through December 31, 2020, were retrospectively reviewed. Treatment was classified as surgery only or surgery combined with middle meningeal artery embolization. The primary outcome was 30-day emergency department presentation and readmission. RESULTS Of 137 patients who met the study criteria, 28 (20%) underwent surgery combined with middle meningeal artery embolization. Of these 28 patients, 15 (54%) underwent planned middle meningeal artery embolization and 13 (46%) underwent embolization after surgical failure. The mean chronic subdural hematoma size at presentation in the group with surgery only (n = 109, 20.5 [SD, 6.9] mm) was comparable with that in the combined group (n = 28, 18.7 [SD, 4.5] mm; P = .16). A significantly higher percentage of the surgery-only group presented to the emergency department within 30 days compared with the combined group (32 of 109 [29%] versus 2 of 28 [7%] patients; P = .02). No significant difference was found with respect to readmission (16 [15%] versus 1 [4%] patient; P = .11). Nine patients (8%) in the surgery-only group were readmitted for significant reaccumulation or residual subdural hematoma compared with only 1 patient (4%) in the combined group (P = .40). CONCLUSIONS Surgical evacuation combined with middle meningeal artery embolization in patients with chronic subdural hematoma is associated with fewer 30-day emergency department visits compared with surgery alone.
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Affiliation(s)
- J S Catapano
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - L Scherschinski
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - K Rumalla
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - V M Srinivasan
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - T S Cole
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - J F Baranoski
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - M T Lawton
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - A P Jadhav
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - A F Ducruet
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - F C Albuquerque
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Srivatsan A, Srinivasan VM, Starke RM, Peterson EC, Yavagal DR, Hassan AE, Alawieh A, Spiotta AM, Saleem Y, Fargen KM, Wolfe SQ, de Leacy RA, Singh IP, Maier IL, Johnson JN, Burkhardt JK, Chen SR, Kan P. Early Postmarket Results with EmboTrap II Stent Retriever for Mechanical Thrombectomy: A Multicenter Experience. AJNR Am J Neuroradiol 2021; 42:904-909. [PMID: 33707283 DOI: 10.3174/ajnr.a7067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/23/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE EmboTrap II is a novel stent retriever with a dual-layer design and distal mesh designed for acute ischemic stroke emergent large-vessel occlusions. We present the first postmarket prospective multicenter experience with the EmboTrap II stent retriever. MATERIALS AND METHODS A prospective registry of patients treated with EmboTrap II at 7 centers following FDA approval was maintained with baseline patient characteristics, treatment details, and clinical/radiographic follow-up. RESULTS Seventy patients were treated with EmboTrap II (mean age, 69.9 years; 48.6% women). Intravenous thrombolysis was given in 34.3%, and emergent large-vessel occlusions were located in the ICA (n = 18), M1 (n = 38), M2 or M3 (n = 13), and basilar artery (n = 1). The 5 × 33 mm device was used in 88% of cases. TICI ≥ 2b recanalization was achieved in 95.7% (82.3% in EmboTrap II-only cases), and first-pass efficacy was achieved in 35.7%. The NIHSS score improved from a preoperative average of 16.3 to 12.1 postprocedure and to 10.5 at discharge. An average of 2.5 [SD, 1.8] passes was recorded per treatment, including non-EmboTrap attempts. Definitive treatment was performed with an alternative device (aspiration or stent retriever) in 9 cases (12.9%). Some hemorrhagic conversion was noted in 22.9% of cases, of which 4.3% were symptomatic. There were no device-related complications. CONCLUSIONS Initial postmarket results with the EmboTrap II stent retriever are favorable and comparable with those of other commercially available stent retrievers. Compared with EmboTrap II, the first-generation EmboTrap may have a higher first-pass efficacy; however, data are limited by retrospective case analysis, incomplete clinical follow-up, and small sample size, necessitating future trials.
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Affiliation(s)
- A Srivatsan
- From the Department of Neurosurgery and Neurology (A.S., V.M.S., Y.S., J.N.J., J.-K.B., P.K.), Baylor College of Medicine, Houston, Texas
| | - V M Srinivasan
- From the Department of Neurosurgery and Neurology (A.S., V.M.S., Y.S., J.N.J., J.-K.B., P.K.), Baylor College of Medicine, Houston, Texas
| | - R M Starke
- Department of Neurosurgery (R.M.S., E.C.P., D.R.Y.), University of Miami Miller School of Medicine, Miami, Florida
| | - E C Peterson
- Department of Neurosurgery (R.M.S., E.C.P., D.R.Y.), University of Miami Miller School of Medicine, Miami, Florida
| | - D R Yavagal
- Department of Neurosurgery (R.M.S., E.C.P., D.R.Y.), University of Miami Miller School of Medicine, Miami, Florida
| | - A E Hassan
- Department of Neurology and Radiology (A.E.H.), University of Texas Health Science Center San Antonio, San Antonio, Texas.,Department of Neurology (A.E.H.), University of Texas Rio Grande Valley, Harlingen, Texas
| | - A Alawieh
- Department of Neurosurgery (A.A., A.M.S.), Medical University of South Carolina, Charleston, South Carolina
| | - A M Spiotta
- Department of Neurosurgery (A.A., A.M.S.), Medical University of South Carolina, Charleston, South Carolina
| | - Y Saleem
- From the Department of Neurosurgery and Neurology (A.S., V.M.S., Y.S., J.N.J., J.-K.B., P.K.), Baylor College of Medicine, Houston, Texas
| | - K M Fargen
- Department of Neurosurgery (K.M.F., S.Q.W.), Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - S Q Wolfe
- Department of Neurosurgery (K.M.F., S.Q.W.), Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - R A de Leacy
- Department of Neurosurgery (R.A.d.L., I.P.S.), Mt. Sinai Icahn School of Medicine, New York, New York
| | - I P Singh
- Department of Neurosurgery (R.A.d.L., I.P.S.), Mt. Sinai Icahn School of Medicine, New York, New York
| | - I L Maier
- Department of Neurology (I.L.M.), University Medical Center Göttingen, Göttingen, Germany
| | - J N Johnson
- From the Department of Neurosurgery and Neurology (A.S., V.M.S., Y.S., J.N.J., J.-K.B., P.K.), Baylor College of Medicine, Houston, Texas
| | - J-K Burkhardt
- From the Department of Neurosurgery and Neurology (A.S., V.M.S., Y.S., J.N.J., J.-K.B., P.K.), Baylor College of Medicine, Houston, Texas
| | - S R Chen
- Department of Interventional Radiology (S.R.C.), MD Anderson Cancer Center, Houston, Texas
| | - P Kan
- From the Department of Neurosurgery and Neurology (A.S., V.M.S., Y.S., J.N.J., J.-K.B., P.K.), Baylor College of Medicine, Houston, Texas
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Srinivasan VM, Lazaro TT, Srivatsan A, Cooper P, Phillips M, Garcia R, Chen SR, Johnson JN, Burkhardt JK, Collins DE, Kan P. Applications of a Novel Microangioscope for Neuroendovascular Intervention. AJNR Am J Neuroradiol 2020; 42:347-353. [PMID: 33361372 DOI: 10.3174/ajnr.a6900] [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] [Received: 07/06/2020] [Accepted: 09/05/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Visualization in neuroendovascular intervention currently relies on biplanar fluoroscopy and contrast administration. With the advent of endoscopy, direct visualization of the intracranial intravascular space has become possible with microangioscopes. We analyzed the efficacy of our novel microangioscope to enable direct observation and inspection of the cerebrovasculature, complementary to a standard fluoroscopic technique. MATERIALS AND METHODS Iterations of microangioscopes were systematically evaluated for use in neurodiagnostics and neurointerventions in both live animal and human cadaveric models. Imaging quality, trackability, and navigability were assessed. Diagnostic procedures assessed included clot identification and differentiation, plaque identification, inspection for vessel wall injury, and assessment of stent apposition. Interventions performed included angioscope-assisted stent-retriever thrombectomy, clot aspiration, and coil embolization. RESULTS The microangioscope was found helpful in both diagnosis and interventions by independent evaluators. Mean ratings of the imaging quality on a 5-point scale ranged from 3.0 (clot identification) to 4.7 (Pipeline follow-up). Mean ratings for clinical utility ranged from 3.0 (aspiration thrombectomy) to 4.7 (aneurysm treatment by coil embolization and WEB device). CONCLUSIONS This fiber optic microangioscope can safely navigate and visualize the intravascular space in human cadaveric and in vivo animal models with satisfactory resolution. It has potential value in diagnostic and neurointerventional applications.
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Affiliation(s)
- V M Srinivasan
- From the Department of Neurosurgery (V.M.S., T.T.L., A.S., R.G., J.N.J., J.-K.B., P.K.)
| | - T T Lazaro
- From the Department of Neurosurgery (V.M.S., T.T.L., A.S., R.G., J.N.J., J.-K.B., P.K.)
| | - A Srivatsan
- From the Department of Neurosurgery (V.M.S., T.T.L., A.S., R.G., J.N.J., J.-K.B., P.K.)
| | - P Cooper
- Vena Medical (P.C., M.P.), Kitchener, Ontario, Canada
| | - M Phillips
- Vena Medical (P.C., M.P.), Kitchener, Ontario, Canada
| | - R Garcia
- From the Department of Neurosurgery (V.M.S., T.T.L., A.S., R.G., J.N.J., J.-K.B., P.K.)
| | - S R Chen
- Department of Interventional Radiology (S.R.C.), The MD Anderson Cancer Center, Houston, Texas
| | - J N Johnson
- From the Department of Neurosurgery (V.M.S., T.T.L., A.S., R.G., J.N.J., J.-K.B., P.K.)
| | - J-K Burkhardt
- From the Department of Neurosurgery (V.M.S., T.T.L., A.S., R.G., J.N.J., J.-K.B., P.K.)
| | - D E Collins
- Center for Comparative Medicine (D.E.C.) Baylor College of Medicine, Houston, Texas
| | - P Kan
- From the Department of Neurosurgery (V.M.S., T.T.L., A.S., R.G., J.N.J., J.-K.B., P.K.)
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