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Midtlien JP, Iyer AM, Jones BS, Kittel C, Hirsch JA, Fargen KM. Conflicts of interest and neurointerventional surgery. J Neurointerv Surg 2024; 16:537-540. [PMID: 37491382 DOI: 10.1136/jnis-2023-020646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 07/27/2023]
Affiliation(s)
- Jackson P Midtlien
- Neurological Surgery and Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Ankitha M Iyer
- Neurological Surgery and Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Brie S Jones
- Neurological Surgery and Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Carol Kittel
- Biostatistics, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Kyle M Fargen
- Neurological Surgery and Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Siddiqui A, Fargen KM, Vranic JE, Patel AB, Ogilvy CS, Thomas AJ, Mascitelli JR, Fifi JT, Mocco J, De Leacy RA. A core-lab adjudicated analysis of single-stent assisted coiling of wide-neck bifurcation aneurysms. J Neurointerv Surg 2024:jnis-2023-020995. [PMID: 38631905 DOI: 10.1136/jnis-2023-020995] [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: 09/30/2023] [Accepted: 04/07/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND AND PURPOSE Core-lab adjudicated data regarding the efficacy of the single-stent assisted aneurysm coiling technique 'L-stenting' are lacking. We present a multicenter, core-lab adjudicated study evaluating the safety and effectiveness of single-stent assisted coiling in the treatment of wide-neck bifurcation aneurysms (WNBAs). METHODS Consecutive patients who underwent L-stenting for WNBAs at three academic institutions between 2015 and 2019 were included in this retrospective study. Clinical safety and efficacy outcomes were gathered from the patient chart, and angiographic imaging was evaluated by core lab analysis. Safety and efficacy outcomes were summarized and predictors of safety and efficacy were calculated. RESULTS Of 128 patients treated, 124 had angiographic outcome data at last follow-up. Of those, 110 had adequate (core-lab adjudicated modified Raymond Roy (mRR) score of 1 or 2) occlusion (88.7%). During follow-up, 19 patients (14.8%) required retreatment. There were 17 complications experienced in 12 patients: intraoperative (n=8, 6.25%), perioperative (n=5, 3.9%), or delayed (n=6; n=4 attributed to device/procedure, 3.1%). Significant predictors of complete occlusion were smaller aneurysm size and use of the jailing technique (P=0.0276). Significant predictors of retreatment were larger size, neck size, and larger dome to neck ratio (P=0.0008). CONCLUSION This study provides multicenter, core-lab adjudicated angiographic data regarding the efficacy of single-stent assisted coiling for WNBAs. This study acts as a validated comparator for future studies investigating novel devices or techniques for treating this challenging subgroup of aneurysms.
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Affiliation(s)
| | - Kyle M Fargen
- Neurosurgery, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Justin E Vranic
- Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Aman B Patel
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | - Justin R Mascitelli
- Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Johanna T Fifi
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - J Mocco
- The Mount Sinai Health System, New York, New York, USA
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Sathya A, Nguyen TN, Klein P, Finitsis S, Setty BN, Dmytriw AA, Fargen KM, Hui FK, Weber P, Amans MR, Abdalkader M. Endovascular vs surgical treatment of sigmoid sinus diverticulum causing pulsatile tinnitus: A systematic review. Interv Neuroradiol 2024:15910199241231325. [PMID: 38515373 DOI: 10.1177/15910199241231325] [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] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION Sigmoid sinus diverticulum (SSD) has been increasingly reported as a cause of pulsatile tinnitus (PT). While both endovascular and surgical treatments have been used, there is a lack of consensus on the treatment modality to treat SSD. We conducted a systematic review of the available literature to compare the clinical outcomes and safety of endovascular versus surgical approaches for treating SSD. METHODS A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses to identify studies encompassing the management of SSD. Studies reporting the clinical outcomes and safety of endovascular or surgical treatments for SSD between January 2000 and January 2023 were included. Results were characterized using descriptive statistics. RESULTS Endovascular treatment (EVT) was reported by 17 articles, yielding 26 patients with 27 diverticula. Surgical treatment was reported by 20 articles, yielding 105 patients with 107 diverticula. EVT led to complete or near-complete resolution in all patients with SSD and PT. Complications occurred in 3.7% (1/27) with a return to baseline after 2 months. There were no permanent complications from EVT. Surgical treatment resulted in complete resolution in 77.6% (83/107) of cases, incomplete resolution in 11.2% (12/107), and no resolution in 11.2% (12/107). Significant complications occurred in 9.3% (10/107) of the surgical-treated patients. CONCLUSION EVT in patients with PT and venous diverticulum appears more effective and safer than surgical treatment, but large studies are lacking. Studies directly comparing endovascular and surgical treatment are needed.
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Affiliation(s)
- Anvitha Sathya
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Thanh N Nguyen
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurosurgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Piers Klein
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Stephanos Finitsis
- Department of Neuroradiology, Aristotle University of Thessaloniki, Ahepa Hospital, Thessaoniki, Greece
| | - Bindu N Setty
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Adam A Dmytriw
- Neurovascular Centre, Departments of Medical Imaging & Neurosurgery, St Michael's Hospital, Toronto, ON, Canada
| | - Kyle M Fargen
- Departments of Neurological Surgery and Radiology, Atrium Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Ferdinand K Hui
- Division of Neurointerventional Surgery, Neuroscience Institute, Queen's Medical Center, Honolulu, HI, USA
| | - Peter Weber
- Department of Otolaryngology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Matthew R Amans
- Departments of Radiology and Neurological Surgery, University of California, San Francisco, USA
| | - Mohamad Abdalkader
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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Coffman SA, Peterson K, Contillo N, Fargen KM, Wolfe SQ. A comprehensive review on the development of sporadic cerebral arteriovenous malformations: from Padget to next-generation sequencing. J Neurosurg 2024:1-10. [PMID: 38518283 DOI: 10.3171/2023.12.jns232233] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/26/2023] [Indexed: 03/24/2024]
Abstract
Cerebral arteriovenous malformations (AVMs) are a leading cause of intracerebral hemorrhage in both children and young adults. With the continued advancement of science and technology, the understanding of the pathophysiology behind the development of these lesions has evolved. From early theory published by Harvey Cushing and Percival Bailey in 1928, Tumors Arising from the Blood-vessels of the Brain: Angiomatous Malformations and Hemangioblastoma, which regarded AVMs as tumors arising from blood vessels, to the meticulous artistry of Dorcas Padget's embryological cataloguing of the cerebral vasculature in 1948, to the proliferative capillaropathy theory of Yaşargil in 1987, to Ramey's 2014 hierarchical model of vascular development, there have been multiple hypotheses of congenital, developmental, and genetic two-hit theories in the pathogenesis of AVMs. Most recent evidence implicates somatic KRAS mutations in the cerebral endothelium, producing an important understanding of the pathogenesis of this disease, which is critical to the development of targeted therapeutics. The authors present the historical progression of their understanding of AVM pathogenesis. They focus on the foundation laid by early pioneers, discussing embryological anatomy and vasculogenesis, the prominent theories of AVM development that have emerged over time, and culminate in an overview of the most current understanding of the pathogenesis of these complex vascular lesions and the clinical implications of our scientific progress.
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Affiliation(s)
- Stephanie A Coffman
- 1Department of Neurological Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina; and
| | - Keyan Peterson
- 2Department of Neurological Surgery, Vanderbilt University, Nashville, Tennessee
| | - Nicholas Contillo
- 1Department of Neurological Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina; and
| | - Kyle M Fargen
- 1Department of Neurological Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina; and
| | - Stacey Q Wolfe
- 1Department of Neurological Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina; and
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Fargen KM, Midtlien JP, Belanger K, Hepworth EJ, Hui FK. The Promise, Mystery, and Perils of Stenting for Symptomatic Internal Jugular Vein Stenosis: A Case Series. Neurosurgery 2024:00006123-990000000-01084. [PMID: 38477595 DOI: 10.1227/neu.0000000000002891] [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: 09/12/2023] [Accepted: 01/05/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Cerebral venous outflow disorders (CVDs) secondary to internal jugular vein (IJV) stenosis are becoming an increasingly recognized cause of significant cognitive and functional impairment in patients. There are little published data on IJV stenting for this condition. This study aims to report on procedural success. METHODS A single-center retrospective analysis was performed on patients with CVD that underwent IJV stenting procedures. RESULTS From 2019 to 2023, 29 patients with CVD underwent a total of 33 IJV stenting procedures. Most patients (20; 69%) had an underlying connective tissue disorder diagnosis. The mean age of the included patients was 36.3 years (SD 12.4), 24 were female (82.8%), and all were Caucasian except for 2 patients (27; 93.0%). Twenty-eight procedures (85%) involved isolated IJV stenting under conscious sedation, whereas 5 procedures (15%) involved IJV stenting and concomitant transverse sinus stenting under general anesthesia. Thirteen (39%) patients underwent IJV stenting after open IJV decompression and styloidectomy. Three patients had stents placed for stenosis below the C1 tubercle, one of which was for carotid compression. Periprocedural complications occurred in 11 (33%), including intracardiac stent migration in 1 patient, temporary shoulder pain/weakness in 5 (15%), and persistent and severe shoulder pain/weakness in 2 patients (6%). Approximately 75% of patients demonstrated improvement after stenting although only 12 patients (36%) had durable improvement over a mean follow-up of 4.5 months (range 6 weeks-3.5 years). CONCLUSION Our experience, along with early published studies, suggests that there is significant promise to IJV revascularization techniques in these patients; however, stenting carries a high complication rate, and symptom recurrence is common. Most neurointerventionalists should not be performing IJV stenting unless they have experience with these patients and understand technical nuances (stent sizing, anatomy, patient selection), which can maximize benefit and minimize risk.
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Affiliation(s)
- Kyle M Fargen
- Departments of Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Jackson P Midtlien
- Departments of Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Katherine Belanger
- Departments of Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Edward J Hepworth
- Division of Otolaryngology, Skull Base, Head & Neck Surgery, Sinus Solutions at Veros Clinical Services, Denver, Colorado, USA
| | - Ferdinand K Hui
- Division of Neurointerventional Surgery, Neuroscience Institute, Queen's Medical Center, Honolulu, Hawaii, USA
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Midtlien JP, Kittel C, Klever LA, Kiritsis NR, Aldridge JB, Fargen KM. Redefining treatment expectations: exploring mid- and long-term outcomes of venous sinus stenting in idiopathic intracranial hypertension. J Neurointerv Surg 2024:jnis-2023-021336. [PMID: 38453459 DOI: 10.1136/jnis-2023-021336] [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: 12/01/2023] [Accepted: 02/18/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Venous sinus stenting (VSS) is recognized as a safe and effective intervention for medically-refractory idiopathic intracranial hypertension (IIH). However, its long-term efficacy remains uncertain. METHODS This retrospective review analyzed a single-center database of adult patients with severe, medically-refractory IIH, who underwent VSS and had minimum 3-month follow-up (FU). Patients were divided into three groups based on post-stenting symptom trajectories: group 1 (sustained improvement without relapse), group 2 (temporary improvement with relapse), and group 3 (no improvement). RESULTS Of 178 patients undergoing VSS, the majority were female (94%), with a median opening pressure (OP) of 31 cm H2O and trans-stenosis gradient of 14 mm Hg. Of these, 153 (86%) received transverse sinus (TS) stenting, and 19 (11%) underwent concurrent TS and superior sagittal sinus stenting. At a mean FU of 166 days, 53 patients (30%) showed long-term improvement without relapse (group 1). Symptomatic recurrence was noted in 101 patients (57%; group 2) within a mean FU of 390 days. Despite recurrent headache and tinnitus, the average OP reduction was 9.6 cm H2O on repeat lumbar puncture, with 75% showing papilledema improvement or resolution post-VSS. Only 17% required further surgical intervention. CONCLUSIONS The most common clinical outcome post-VSS in IIH patients is initial symptomatic improvement followed by symptom recurrence in about 60% at a mean of 274 days, despite a consistent intracranial pressure reduction. These findings can guide physicians in setting realistic expectations with patients regarding VSS outcomes.
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Affiliation(s)
- Jackson P Midtlien
- Department of Neurological Surgery, Atrium Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Carol Kittel
- Biostatistics, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Lucas A Klever
- Department of Neurological Surgery, Atrium Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Nicholas R Kiritsis
- Department of Neurological Surgery, Atrium Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | | | - Kyle M Fargen
- Department of Neurological Surgery, Atrium Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
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Iyer AM, Midtlien JP, Kittel C, Fargen KM. Intensive care unit admission is not necessary after venous sinus stenting. J Neurointerv Surg 2024; 16:313-317. [PMID: 37197930 DOI: 10.1136/jnis-2023-020240] [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: 02/21/2023] [Accepted: 04/28/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Venous sinus stenting (VSS) has emerged as a safe and effective treatment option for idiopathic intracranial hypertension. Many physicians routinely admit patients to the intensive care unit (ICU) for close monitoring, but little data exists on whether this is necessary. METHODS Electronic medical records of consecutive patients who underwent VSS by the senior author from 2016 to 2022 at a single center were reviewed. RESULTS 214 patients were included. The mean (SD) age was 35.5 (11.6) and 196 (91.6%) patients were female. A total of 166 (77.6%) patients underwent transverse sinus stenting alone; 9 (4.2%) underwent superior sagittal sinus (SSS) stenting alone, 37 (17.3) concomitant transverse and SSS stenting, and 2 (0.9%) underwent stenting at alternate sites. All patients were planned admission to the regular ward (27.6%) or day hospital (72.4%). Twenty (9.3%) patients were discharged to home the same day as the procedure and 182 (85%) patients were discharged the following day. Major periprocedural complications were identified in 2 (0.93%) patients and minor complications were identified in 16 (7.4%). Only one patient with a subdural hematoma identified in the post-anesthesia care unit (PACU) had care escalated to the ICU. No severe complications were identified after the PACU stay. During the next 48 hours after discharge, 4 (1.9%) patients returned to any emergency room to be evaluated without requiring readmission. CONCLUSION Routine ICU admission following uncomplicated VSS is unnecessary. Overnight admission to a low-acuity ward, or even same-day discharge in select patients, appears to be a safe and cost-effective strategy.
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Affiliation(s)
- Ankitha M Iyer
- Department of Neurological Surgery and Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jackson P Midtlien
- Department of Neurological Surgery and Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Carol Kittel
- Division of Public Health Sciences, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Kyle M Fargen
- Department of Neurological Surgery and Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Midtlien JP, Curry BP, Chang E, Kiritsis NR, Aldridge JB, Fargen KM. Characterizing a new clinical phenotype: the co-existence of cerebral venous outflow and connective tissue disorders. Front Neurol 2024; 14:1305972. [PMID: 38269002 PMCID: PMC10806170 DOI: 10.3389/fneur.2023.1305972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/26/2023] [Indexed: 01/26/2024] Open
Abstract
Background There is increasing recognition of connective tissue disorders and their influence on disease in the general population. A conserved clinical phenotype involving connective tissue disorders and idiopathic intracranial hypertension (IIH) and associated cerebral venous outflow disorders (CVD) has not been previously described. Methods A single-institution retrospective review of a prospectively maintained database of patients with connective tissue disorders and CVD was performed. Results A total of 86 patients were identified. The majority of these patients carried a diagnosis of Ehlers-Danlos syndrome (55%) and most were non-obese (mean body mass index 29.7 kg/m2), Caucasian (90%) females (87%). Most prevalent presenting symptoms included pressure headache (98%), dizziness (90%), tinnitus (92%), and cognitive dysfunction (69%). Aside from CVD and IIH, the most common associated conditions were postural orthostatic tachycardia syndrome (POTS; 55.8%), cerebrospinal fluid (CSF) leaks (51.2%), dysautonomia (45.3%), cranio-cervical instability (37.2%), mast cell activation syndrome (25.6%), and tethered cord syndrome (23.3%). Allergies to medications (87.2%) and surgical tape (19.8%) were also frequent. Despite significantly lower opening pressures on lumbar puncture, headache severity and quality of life scores were reported with the same severity of classic IIH patients, suggesting an underlying hypersensitivity to intracranial pressures and cerebral venous congestion. Conclusion There is a rare but conserved clinical phenotype that has not been described previously that presents with severe IIH symptoms in predominantly young, non-obese Caucasian women with a high associated incidence of dysautonomia, POTS, craniocervical instability, and CSF leaks, among others.
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Affiliation(s)
- Jackson P. Midtlien
- Neurosurgery Department, Wake Forest School of Medicine, Winston-Salem, NC, United States
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Fargen KM, Kittel C, Curry BP, Hile CW, Wolfe SQ, Brown P, Mokin M, Rai AT, Chen M, Starke RM, Albuquerque FC, Ansari SA, Kan P, Spiotta AM, Dabus G, Leslie-Mazwi TM, Hirsch JA. Mechanical thrombectomy decision making and prognostication: Stroke treatment Assessments prior to Thrombectomy In Neurointervention (SATIN) study. J Neurointerv Surg 2023; 15:e381-e387. [PMID: 36609542 DOI: 10.1136/jnis-2022-019741] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 10/15/2022] [Accepted: 12/28/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Mechanical thrombectomy (MT) is the standard-of-care treatment for stroke patients with emergent large vessel occlusions. Despite this, little is known about physician decision making regarding MT and prognostic accuracy. METHODS A prospective multicenter cohort study of patients undergoing MT was performed at 11 comprehensive stroke centers. The attending neurointerventionalist completed a preprocedure survey prior to arterial access and identified key decision factors and the most likely radiographic and clinical outcome at 90 days. Post hoc review was subsequently performed to document hospital course and outcome. RESULTS 299 patients were enrolled. Good clinical outcome (modified Rankin Scale (mRS) score of 0-2) was obtained in 38% of patients. The most frequently identified factors influencing the decision to proceed with thrombectomy were site of occlusion (81%), National Institutes of Health Stroke Scale score (74%), and perfusion imaging mismatch (43%). Premorbid mRS score determination in the hyperacute setting accurately matched retrospectively collected data from the hospital admission in only 140 patients (46.8%). Physicians correctly predicted the patient's 90 day mRS tertile (0-2, 3-4, or 5-6) and final modified Thrombolysis in Ischemic Cerebral Infarction score preprocedure in only 44.2% and 44.3% of patients, respectively. Clinicians tended to overestimate the influence of occlusion site and perfusion imaging on outcomes, while underestimating the importance of pre-morbid mRS. CONCLUSIONS This is the first prospective study to evaluate neurointerventionalists' ability to accurately predict clinical outcome after MT. Overall, neurointerventionalists performed poorly in prognosticating patient 90 day outcomes, raising ethical questions regarding whether MT should be withheld in patients with emergent large vessel occlusions thought to have a poor prognosis.
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Affiliation(s)
- Kyle M Fargen
- Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Carol Kittel
- Division of Public Health Sciences, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Brian P Curry
- Neurological Surgery, Walter Reed Army Medical Center, Bethesda, Maryland, USA
| | - Connor W Hile
- Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Stacey Q Wolfe
- Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Patrick Brown
- Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Maxim Mokin
- Neurosurgery, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Ansaar T Rai
- Interventional Neuroradiology, West Virginia University Rockefeller Neuroscience Institute, Morgantown, West Virginia, USA
| | - Michael Chen
- Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Robert M Starke
- Department of Neurosurgery and Radiology, University of Miami School of Medicine, Miami, Florida, USA
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Sameer A Ansari
- Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Peter Kan
- Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Alejandro M Spiotta
- Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Guilherme Dabus
- Interventional Neuroradiology and Neuroendovascular Surgery, Miami Neuroscience Institute and Miami Cardiac and Vascular Institute-Baptist Hospital, Miami, Florida, USA
| | | | - Joshua A Hirsch
- NeuroEndovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
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Ray TR, Kellogg RT, Fargen KM, Hui F, Vargas J. The perils and promises of generative artificial intelligence in neurointerventional surgery. J Neurointerv Surg 2023; 16:4-7. [PMID: 37438101 DOI: 10.1136/jnis-2023-020353] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/14/2023]
Abstract
Generative artificial intelligence (AI) holds great promise in neurointerventional surgery by providing clinicians with powerful tools for improving surgical precision, accuracy of diagnoses, and treatment planning. However, potential perils include biases or inaccuracies in the data used to train the algorithms, over-reliance on generative AI without human oversight, patient privacy concerns, and ethical implications of using AI in medical decision-making. Careful regulation and oversight are needed to ensure that the promises of generative AI in neurointerventional surgery are realized while minimizing its potential perils.[ChatGPT authored summary using the prompt "In one paragraph summarize the promises and perils of generative AI in neurointerventional surgery".].
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Affiliation(s)
- Tyler R Ray
- Department of Mechanical Engineering, University of Hawaii at Mānoa College of Engineering, Honolulu, Hawaii, USA
| | - Ryan T Kellogg
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Kyle M Fargen
- Department of Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Ferdinand Hui
- Neurointerventional Surgery, Queen's Medical Center Neuroscience Institute, Honolulu, Hawaii, USA
| | - Jan Vargas
- Division of Neurosurgery, Prisma Health Upstate, Greenville, South Carolina, USA
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Ash M, Dimisko L, Chalhoub RM, Howard BM, Cawley CM, Matouk C, Pabaney A, Spiotta AM, Jabbour P, Maier I, Wolfe SQ, Rai AT, Kim JT, Psychogios MN, Mascitelli JR, Starke RM, Shaban A, Yoshimura S, De Leacy R, Kan P, Fragata I, Polifka AJ, Arthur AS, Park MS, Crosa RJ, Williamson R, Dumont TM, Levitt MR, Al Kasab S, Tjoumakaris SI, Liman J, Saad H, Samaniego EA, Fargen KM, Grossberg JA, Alawieh A. Comprehensive analysis of the impact of procedure time and the 'golden hour' in subpopulations of stroke thrombectomy patients. J Neurointerv Surg 2023:jnis-2023-020792. [PMID: 37875342 DOI: 10.1136/jnis-2023-020792] [Citation(s) in RCA: 1] [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: 07/10/2023] [Accepted: 09/19/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVE To evaluate the effect of procedure time on thrombectomy outcomes in different subpopulations of patients undergoing endovascular thrombectomy (EVT), given the recently expanded indications for EVT. METHODS This multicenter study included patients undergoing EVT for acute ischemic stroke at 35 centers globally. Procedure time was defined as time from groin puncture to successful recanalization (Thrombolysis in Cerebral Infarction score ≥2b) or abortion of procedure. Patients were stratified based on stroke location, use of IV tissue plasminogen activator (tPA), Alberta Stroke Program Early CT score, age group, and onset-to-groin time. Primary outcome was the 90-day modified Rankin Scale (mRS) score, with scores 0-2 designating good outcome. Secondary outcome was postprocedural symptomatic intracranial hemorrhage (sICH). Multivariate analyses were performed using generalized linear models to study the impact of procedure time on outcomes in each subpopulation. RESULTS Among 8961 patients included in the study, a longer procedure time was associated with higher odds of poor outcome (mRS score 3-6), with 10% increase in odds for each 10 min increment. When procedure time exceeded the 'golden hour', poor outcome was twice as likely. The golden hour effect was consistent in patients with anterior and posterior circulation strokes, proximal or distal occlusions, in patients with large core infarcts, with or without IV tPA treatment, and across age groups. Procedures exceeding 1 hour were associated with a 40% higher sICH rate. Posterior circulation strokes, delayed presentation, and old age were the variables most sensitive to procedure time. CONCLUSIONS In this work we demonstrate the universality of the golden hour effect, in which procedures lasting more than 1 hour are associated with worse clinical outcomes and higher rates of sICH across different subpopulations of patients undergoing EVT.
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Affiliation(s)
- Makenna Ash
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Laurie Dimisko
- Nell Hodgson Woodruff School of Nursing, Emory Healthcare, Atlanta, Georgia, USA
| | - Reda M Chalhoub
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Brian M Howard
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - C Michael Cawley
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Charles Matouk
- Department of Neurosurgery, Yale University, New Haven, Connecticut, USA
| | - Aqueel Pabaney
- Department of Neurosurgery, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Ilko Maier
- Department of Neurology, University Medicine Goettingen, Goettingen, NS, Germany
| | - Stacey Q Wolfe
- Department of Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Ansaar T Rai
- Department of Interventional Neuroradiology, West Virginia University Rockefeller Neuroscience Institute, Morgantown, West Virginia, USA
| | - Joon-Tae Kim
- Department of Neurosurgery and Radiology, Chonnam National University, Gwangju, Jeollanam-do, Korea
| | - Marios-Nikos Psychogios
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Justin R Mascitelli
- Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Robert M Starke
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- University of Miami School of Medicine, Miami, Florida, USA
| | - Amir Shaban
- Department of Neurology, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Reade De Leacy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Peter Kan
- Department of Neurosurgery, University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Isabel Fragata
- Department of Neuroradiology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Adam J Polifka
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Adam S Arthur
- Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Min S Park
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Roberto Javier Crosa
- Department of Endovascular Neurosurgery, Médica Uruguaya, Montevideo, Montevideo, Uruguay
| | - Richard Williamson
- Stroke and Cerebrovascular Center, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA
| | - Travis M Dumont
- Department of Surgery, Division of Neurosurgery, University of Arizona/Arizona Health Science Center, Tucson, Arizona, USA
| | - Michael R Levitt
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Sami Al Kasab
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Stavropoula I Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Jan Liman
- Department of Neurology, University Medicine Goettingen, Goettingen, NS, Germany
| | - Hassan Saad
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Edgar A Samaniego
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Kyle M Fargen
- Department of Neurosurgery, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Jonathan A Grossberg
- Department of Neurosurgery and Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ali Alawieh
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
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12
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Fargen KM, Wolfe SQ, Traunero JR, Iyer AM, Kittel C. A descriptive study of venous pressures and gradients while awake and both pre- and post-stent under anesthesia in patients with idiopathic intracranial hypertension. J Neurointerv Surg 2023; 15:1027-1033. [PMID: 36190942 DOI: 10.1136/jnis-2022-019337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/23/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND This study aims to explore factors that affect venous sinus pressures and associated gradients while awake and under general anesthesia (GA) both before and after venous sinus stenting (VSS) in patients with idiopathic intracranial hypertension (IIH). METHODS A retrospective analysis was performed examining pressures and gradients in patients with IIH having undergone awake venography followed by VSS under GA. RESULTS 174 patients were included. Compared with awake, GA superior sagittal sinus (SSS) pressures were 2.6 mmHg lower (p=0.01) resulting in a total cranial gradient reduction of 2.5 mmHg (p=0.002). The transverse-sigmoid gradient, the most commonly stented segment, did not differ under the two conditions (p=0.30). Regression analyses demonstrated that body mass index, gender, blood pressure, and end-tidal carbon dioxide content significantly affected venous pressures (all p<0.05). After stenting, mean total cranial gradients decreased by 13.2 mmHg while skull base gradients increased by 0.8 mmHg. Stenting resulted in an 84% mean reduction in the target gradient and a mean decrease in SSS pressures by 78% of the target gradient. When cardiopulmonary and anesthetic factors were optimized, GA had a limited effect on the target gradient in most patients (p=0.88). CONCLUSIONS This study is the largest series to date to report on cerebral venous pressure measurements and gradients recorded while awake and under GA both before and after VSS for IIH. In a well-controlled cardiorespiratory and anesthetic setting, GA venography may provide information that is not substantially inequivalent to that obtained while awake.
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Affiliation(s)
- Kyle M Fargen
- Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Stacey Q Wolfe
- Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Justin R Traunero
- Anesthesiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Ankitha M Iyer
- Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Carol Kittel
- Division of Public Health Sciences, Wake Forest University, Winston-Salem, North Carolina, USA
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13
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Alawieh AM, Chalhoub RM, Al Kasab S, Jabbour P, Psychogios MN, Starke RM, Arthur AS, Fargen KM, De Leacy R, Kan P, Dumont TM, Rai A, Crosa RJ, Maier I, Goyal N, Wolfe SQ, Cawley CM, Mocco J, Tjoumakaris SI, Howard BM, Dimisko L, Saad H, Ogilvy CS, Crowley RW, Mascitelli JR, Fragata I, Levitt MR, Kim JT, Park MS, Gory B, Polifka AJ, Matouk C, Grossberg JA, Spiotta AM. Multicenter investigation of technical and clinical outcomes after thrombectomy for distal vessel occlusion by frontline technique. J Neurointerv Surg 2023; 15:e93-e101. [PMID: 35918129 DOI: 10.1136/jnis-2022-019023] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/12/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Endovascular thrombectomy (EVT) is the standard-of-care for proximal large vessel occlusion (LVO) stroke. Data on technical and clinical outcomes in distal vessel occlusions (DVOs) remain limited. METHODS This was a retrospective study of patients undergoing EVT for stroke at 32 international centers. Patients were divided into LVOs (internal carotid artery/M1/vertebrobasilar), medium vessel occlusions (M2/A1/P1) and isolated DVOs (M3/M4/A2/A3/P2/P3) and categorized by thrombectomy technique. Primary outcome was a good functional outcome (modified Rankin Scale ≤2) at 90 days. Secondary outcomes included recanalization, procedure-time, thrombectomy attempts, hemorrhage, and mortality. Multivariate logistic regressions were used to evaluate the impact of technical variables. Propensity score matching was used to compare outcome in patients with DVO treated with aspiration versus stent retriever RESULTS: We included 7477 patients including 213 DVOs. Distal location did not independently predict good functional outcome at 90 days compared with proximal (p=0.467). In distal occlusions, successful recanalization was an independent predictor of good outcome (adjusted odds ratio (aOR) 5.11, p<0.05) irrespective of technique. Younger age, bridging therapy, and lower admission National Institutes of Health Stroke Scale (NIHSS) were also predictors of good outcome. Procedure time ≤1 hour or ≤3 thrombectomy attempts were independent predictors of good outcomes in DVOs irrespective of technique (aOR 4.5 and 2.3, respectively, p<0.05). There were no differences in outcomes in a DVO matched cohort of aspiration versus stent retriever. Rates of hemorrhage and good outcome showed an exponential relationship to procedural metrics, and were more dependent on time in the aspiration group and attempts in the stent retriever group. CONCLUSIONS Outcomes following EVT for DVO are comparable to LVO with similar results between techniques. Techniques may exhibit different futility metrics; stent retriever thrombectomy was influenced by attempts whereas aspiration was more dependent on procedure time.
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Affiliation(s)
- Ali M Alawieh
- Department of Neurosurgery, Emory University School of Medicine Atlanta, Atlanta, Georgia, USA
| | - Reda M Chalhoub
- Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sami Al Kasab
- Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Pascal Jabbour
- Neurological surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Marios-Nikos Psychogios
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Robert M Starke
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Adam S Arthur
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
- Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kyle M Fargen
- Neurosurgery, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Reade De Leacy
- Neurosurgery, Icahn School of Medicine at Mount Sinai, NEW YORK, New York, USA
| | - Peter Kan
- Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Travis M Dumont
- Department of Surgery, Division of Neurosurgery, University of Arizona/Arizona Health Science Center, Tucson, Arizona, USA
| | - Ansaar Rai
- Radiology, West Virginia University Hospitals, Morgantown, West Virginia, USA
| | | | - Ilko Maier
- Neurology, University Medicine Goettingen, Goettingen, NS, Germany
| | - Nitin Goyal
- Neurology, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Stacey Q Wolfe
- Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - C Michael Cawley
- Department of Neurosurgery, Emory University School of Medicine Atlanta, Atlanta, Georgia, USA
| | - J Mocco
- Neurosurgery, Icahn School of Medicine at Mount Sinai, NEW YORK, New York, USA
| | | | - Brian M Howard
- Department of Neurosurgery, Emory University School of Medicine Atlanta, Atlanta, Georgia, USA
- Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Hassan Saad
- Department of Neurosurgery, Emory University School of Medicine Atlanta, Atlanta, Georgia, USA
| | | | | | - Justin R Mascitelli
- Department of Neurosurgery, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Isabel Fragata
- Neuroradiology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Michael R Levitt
- Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Joon-Tae Kim
- Neurology, Chonnam National University, Gwangju, Jeollanam-do, Korea (the Republic of)
| | - Min S Park
- Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Benjamin Gory
- Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, Lorraine, France
| | - Adam J Polifka
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Charles Matouk
- Neurosurgery, Yale University, New Haven, Connecticut, USA
| | - Jonathan A Grossberg
- Department of Neurosurgery, Emory University School of Medicine Atlanta, Atlanta, Georgia, USA
| | - Alejandro M Spiotta
- Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
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14
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Schulze-Zachau V, Brehm A, Ntoulias N, Krug N, Tsogkas I, Blackham KA, Möhlenbruch MA, Jesser J, Cervo A, Kreiser K, Althaus K, Maslias E, Michel P, Saliou G, Riegler C, Nolte CH, Maier I, Jamous A, Rautio R, Ylikotila P, Fargen KM, Wolfe SQ, Castellano D, Boghi A, Kaiser DPO, Cuberi A, Kirschke JS, Schwarting J, Limbucci N, Renieri L, Al Kasab S, Spiotta AM, Fragata I, Rodriquez-Ares T, Maurer CJ, Berlis A, Moreu M, López-Frías A, Pérez-García C, Commodaro C, Pileggi M, Mascitelli J, Giordano F, Casagrande W, Purves CP, Bester M, Flottmann F, Kan PT, Edhayan G, Hofmeister J, Machi P, Kaschner M, Weiss D, Katan M, Fischer U, Psychogios MN. Incidence and outcome of perforations during medium vessel occlusion compared with large vessel occlusion thrombectomy. J Neurointerv Surg 2023:jnis-2023-020531. [PMID: 37524518 DOI: 10.1136/jnis-2023-020531] [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: 05/04/2023] [Accepted: 07/19/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Vessel perforation during thrombectomy is a severe complication and is hypothesized to be more frequent during medium vessel occlusion (MeVO) thrombectomy. The aim of this study was to compare the incidence and outcome of patients with perforation during MeVO and large vessel occlusion (LVO) thrombectomy and to report on the procedural steps that led to perforation. METHODS In this multicenter retrospective cohort study, data of consecutive patients with vessel perforation during thrombectomy between January 1, 2015 and September 30, 2022 were collected. The primary outcomes were independent functional outcome (ie, modified Rankin Scale 0-2) and all-cause mortality at 90 days. Binomial test, chi-squared test and t-test for unpaired samples were used for statistical analysis. RESULTS During 25 769 thrombectomies (5124 MeVO, 20 645 LVO) in 25 stroke centers, perforation occurred in 335 patients (1.3%; mean age 72 years, 62% female). Perforation occurred more often in MeVO thrombectomy (2.4%) than in LVO thrombectomy (1.0%, p<0.001). More MeVO than LVO patients with perforation achieved functional independence at 3 months (25.7% vs 10.9%, p=0.001). All-cause mortality did not differ between groups (overall 51.6%). Navigation beyond the occlusion and retraction of stent retriever/aspiration catheter were the two most common procedural steps that led to perforation. CONCLUSIONS In our cohort, perforation was approximately twice as frequent in MeVO than in LVO thrombectomy. Efforts to optimize the procedure may focus on navigation beyond the occlusion site and retraction of stent retriever/aspiration catheter. Further research is necessary in order to identify thrombectomy candidates at high risk of intraprocedural perforation and to provide data on the effectiveness of endovascular countermeasures.
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Affiliation(s)
- Victor Schulze-Zachau
- Diagnostic and Interventional Neuroradiology Department, Radiology and Nuclear Medicine Clinic, University Hospital Basel, Basel, Switzerland
| | - Alex Brehm
- Diagnostic and Interventional Neuroradiology Department, Radiology and Nuclear Medicine Clinic, University Hospital Basel, Basel, Switzerland
| | - Nikolaos Ntoulias
- Diagnostic and Interventional Neuroradiology Department, Radiology and Nuclear Medicine Clinic, University Hospital Basel, Basel, Switzerland
| | - Nadja Krug
- Diagnostic and Interventional Neuroradiology Department, Radiology and Nuclear Medicine Clinic, University Hospital Basel, Basel, Switzerland
| | - Ioannis Tsogkas
- Diagnostic and Interventional Neuroradiology Department, Radiology and Nuclear Medicine Clinic, University Hospital Basel, Basel, Switzerland
| | - Kristine Ann Blackham
- Diagnostic and Interventional Neuroradiology Department, Radiology and Nuclear Medicine Clinic, University Hospital Basel, Basel, Switzerland
| | - Markus A Möhlenbruch
- Vascular & Interventional Neuroradiology Section, Minimal Invasive NeuroTherapy Center, University Hospital Heidelberg, Heidelberg, Germany
| | - Jessica Jesser
- Vascular & Interventional Neuroradiology Section, Minimal Invasive NeuroTherapy Center, University Hospital Heidelberg, Heidelberg, Germany
| | - Amedeo Cervo
- Neuroradiology Department, Niguarda Hospital, Milan, Italy
| | - Kornelia Kreiser
- Radiology and Neuroradiology Clinic, RKU - Universitäts- und Rehabilitationskliniken Ulm gGmbH, Ulm, Germany
| | | | - Errikos Maslias
- Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- UNIL - Université de Lausanne, Lausanne, Switzerland
| | - Patrik Michel
- Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- UNIL - Université de Lausanne, Lausanne, Switzerland
| | - Guillaume Saliou
- UNIL - Université de Lausanne, Lausanne, Switzerland
- Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Christoph Riegler
- Department of Neurology with Experimental Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christian H Nolte
- Department of Neurology with Experimental Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ilko Maier
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Ala Jamous
- Department of Diagnostic & Interventional Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
| | - Riitta Rautio
- Department of Radiology, Turku University Hospital, Turku, Finland
| | | | - Kyle M Fargen
- Neurological Surgery and Radiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Stacey Q Wolfe
- Neurological Surgery and Radiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Davide Castellano
- Department of Interventional Radiology and Neuroradiology, Ospedale San Giovanni Bosco, Turin, Italy
| | - Andrea Boghi
- Department of Interventional Radiology and Neuroradiology, Ospedale San Giovanni Bosco, Turin, Italy
| | - Daniel P O Kaiser
- Department of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Ani Cuberi
- Department of Radiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Jan S Kirschke
- Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Julian Schwarting
- Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Nicola Limbucci
- Department of Neurovascular Intervention, Azienda Ospedaliero Universitaria Careggio, Florence, Italy
| | - Leonardo Renieri
- Department of Neurovascular Intervention, Azienda Ospedaliero Universitaria Careggio, Florence, Italy
| | - Sami Al Kasab
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Isabel Fragata
- Department of Neuroradiology, Centro Hospitalar Universitario de Lisboa Central EPE, Lisbon, Portugal
- NOVA Medical School, Lisbon, Portugal
| | - Tania Rodriquez-Ares
- Department of Neuroradiology, Centro Hospitalar Universitario de Lisboa Central EPE, Lisbon, Portugal
| | - Christoph Johannes Maurer
- Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Ansgar Berlis
- Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Manuel Moreu
- Neurointerventional Unit, Radiology Department, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | - Alfonso López-Frías
- Neurointerventional Unit, Radiology Department, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | - Carlos Pérez-García
- Neurointerventional Unit, Radiology Department, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | - Christian Commodaro
- Diagnostic and Interventional Neuroradiology Department, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland
| | - Marco Pileggi
- Diagnostic and Interventional Neuroradiology Department, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland
| | - Justin Mascitelli
- Department of Neurosurgery, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Flavio Giordano
- Unit of Interventional Neuroradiology, Department of Advanced Diagnostic and Therapeutic Technologies, Azienda Ospedaliera di Rilievo Nazionale Antonio Cardarelli, Naples, Italy
| | - Walter Casagrande
- Neurosurgery Department, Hospital General de Agudos Juan A Fernandez, Buenos Aires, Argentina
| | - Cynthia P Purves
- Neurosurgery Department, Hospital General de Agudos Juan A Fernandez, Buenos Aires, Argentina
| | - Maxim Bester
- Diagnostic and Interventional Neuroradiology Department, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fabian Flottmann
- Diagnostic and Interventional Neuroradiology Department, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter T Kan
- Department of Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Gautam Edhayan
- Department of Radiology, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Jeremy Hofmeister
- Department of Radiology and Medical Informatics, Geneva University Hospitals, Geneva, Switzerland
| | - Paolo Machi
- Department of Radiology and Medical Informatics, Geneva University Hospitals, Geneva, Switzerland
| | - Marius Kaschner
- Department of Diagnostic and Interventional Radiology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Daniel Weiss
- Department of Diagnostic and Interventional Radiology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Mira Katan
- Neurology Clinic, University Hospital Basel, Basel, Switzerland
| | - Urs Fischer
- Neurology Clinic, University Hospital Basel, Basel, Switzerland
| | - Marios-Nikos Psychogios
- Diagnostic and Interventional Neuroradiology Department, Radiology and Nuclear Medicine Clinic, University Hospital Basel, Basel, Switzerland
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15
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Chen M, Fargen KM, Mocco J, Siddiqui AH, Miyachi S, Mahadevan J, Ayudya SSN, Churojana A, Chryssidis S, De Villiers L, Rahman M, Dey SK, Zhang H, Wang D, Petrocelli S, Garbugino S, Kulcsar Z, Januel A, Kocer N, Manfre L, Tanaka M, Matsumaru Y, Suh SH, Yoon W, de Freitas C, Mont'Alverne F, Desal H, Caroff J, Lee W, Anil G, Harrichandparsad R, LeFeuvre D, Agid R, Orbach DB, Taylor A. World federation of interventional and therapeutic neuroradiology (WFITN) federation assembly neurointerventional surgery safety checklist. Interv Neuroradiol 2023:15910199231174550. [PMID: 37143331 DOI: 10.1177/15910199231174550] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
Over the last 10 years, there has been a rise in neurointerventional case complexity, device variety and physician distractions. Even among experienced physicians, this trend challenges our memory and concentration, making it more difficult to remember safety principles and their implications. Checklists are regarded by some as a redundant exercise that wastes time, or as an attack on physician autonomy. However, given the increasing case and disease complexity along with the number of distractions, it is even more important now to have a compelling reminder of safety principles that preserve habits that are susceptible to being overlooked because they seem mundane. Most hospitals have mandated a pre-procedure neurointerventional time-out checklist, but often it ends up being done in a cursory fashion for the primary purpose of 'checking off boxes'. There may be value in iterating the checklist to further emphasize safety and communication. The Federation Assembly of the World Federation of Interventional and Therapeutic Neuroradiology (WFITN) decided to construct a checklist for neurointerventional cases based on a review of the literature and insights from an expert panel.
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Affiliation(s)
- Michael Chen
- Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Kyle M Fargen
- Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - J Mocco
- The Mount Sinai Health System, New York, New York, USA
| | - Adnan H Siddiqui
- Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Shigeru Miyachi
- Department of Neurosurgery, Aichi Medical University, Nagakute, Japan
| | | | | | | | - Steve Chryssidis
- Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Laetitia De Villiers
- Interventional Neuroradiology, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Mohibur Rahman
- National Institute of Neurosciences & Hospital, Sher-E-Bangla Nagar, Bangladesh
| | | | - Hongqi Zhang
- Neurosurgery, Xuanwu Hospital, Beijing, Beijing, China
| | - Donghai Wang
- Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Sergio Petrocelli
- Interventional Neuroradiology, Sanatorio Parque, Rosario- Santa Fe, Argentina
| | - Silvia Garbugino
- Neurosurgery, Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina
| | - Zsolt Kulcsar
- Neuroradiology, Zurich University Hospital, Zurich, Switzerland
| | - Anne Januel
- University Hospital Centre Toulouse, Toulouse, Occitanie, France
| | - Naci Kocer
- Department of Radiology, Cerrahpasa Medical School, Istanbul, Turkey
| | - Luigi Manfre
- Department of Radiology, IOM Mediterranean Oncology Institute, Viagrande, Italy
| | | | - Yuji Matsumaru
- Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Sang Hyun Suh
- Radiology, Gangnam Severance Hospital Yonsei University, Seoul, Korea
| | - Woong Yoon
- Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Carlos de Freitas
- Sao Paulo State University Julio de Mesquita Filho - Rosana Campus, Rosana, Brazil
| | | | - Hubert Desal
- Neuroradiology, University Hospital of Nantes, Nantes, France
| | - Jildaz Caroff
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | - Wickly Lee
- National Neuroscience Institute, Singapore
| | - Gopinathan Anil
- Department of Diagnostic Imaging, National University Health System, National University Hospital, Singapore
- Interventional Neuroradiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rohen Harrichandparsad
- Neurosurgery, University of KwaZulu-Natal College of Health Sciences, Durban, South Africa
| | | | - Ronit Agid
- Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Darren B Orbach
- Neurointerventional Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Allan Taylor
- Neurosurgery, University of Cape Town, Cape Town, South Africa
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16
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Chen M, Fargen KM, Mocco J, Siddiqui AH, Miyachi S, Mahadevan J, Na Ayudya SS, Churojana A, Chryssidis S, De Villiers L, Rahman M, Dey SK, Zhang H, Wang D, Petrocelli S, Garbugino S, Kulcsar Z, Januel A, Kocer N, Manfre L, Tanaka M, Matsumaru Y, Suh SH, Yoon W, de Freitas C, Mont'Alverne F, Desal H, Caroff J, Lee W, Anil G, Harrichandparsad R, LeFeuvre D, Agid R, Orbach DB, Taylor A. World Federation of Interventional and Therapeutic Neuroradiology (WFITN) Federation Assembly neurointerventional surgery safety checklist. J Neurointerv Surg 2023:jnis-2023-020309. [PMID: 37147004 DOI: 10.1136/jnis-2023-020309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/14/2023] [Indexed: 05/07/2023]
Affiliation(s)
- Michael Chen
- Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Kyle M Fargen
- Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - J Mocco
- The Mount Sinai Health System, New York, New York, USA
| | - Adnan H Siddiqui
- Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Shigeru Miyachi
- Department of Neurosurgery, Aichi Medical University, Nagakute, Japan
| | | | | | | | - Steve Chryssidis
- Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Laetitia De Villiers
- Interventional Neuroradiology, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Mohibur Rahman
- National Institute of Neurosciences & Hospital, Sher-E-Bangla Nagar, Bangladesh
| | | | - Hongqi Zhang
- Neurosurgery, Xuanwu Hospital, Beijing, Beijing, China
| | - Donghai Wang
- Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Sergio Petrocelli
- Interventional Neuroradiology, Sanatorio Parque, Rosario- Santa Fe, Argentina
| | - Silvia Garbugino
- Neurosurgery, Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina
| | - Zsolt Kulcsar
- Neuroradiology, Zurich University Hospital, Zurich, Switzerland
| | - Anne Januel
- University Hospital Centre Toulouse, Toulouse, Occitanie, France
| | - Naci Kocer
- Department of Radiology, Cerrahpasa Medical School, Istanbul, Turkey
| | - Luigi Manfre
- Department of Radiology, IOM Mediterranean Oncology Institute, Viagrande, Italy
| | | | - Yuji Matsumaru
- Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Sang Hyun Suh
- Radiology, Gangnam Severance Hospital Yonsei University, Seoul, Korea (the Republic of)
| | - Woong Yoon
- Radiology, Chonnam National University Hospital, Gwangju, Korea (the Republic of)
| | - Carlos de Freitas
- Sao Paulo State University Julio de Mesquita Filho - Rosana Campus, Rosana, Brazil
| | | | - Hubert Desal
- Neuroradiology, University Hospital of Nantes, Nantes, France
| | - Jildaz Caroff
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | - Wickly Lee
- National Neuroscience Institute, Singapore
| | - Gopinathan Anil
- Department of Diagnostic Imaging, National University Health System, National University Hospital, Singapore
- Interventional Neuroradiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rohen Harrichandparsad
- Neurosurgery, University of KwaZulu-Natal College of Health Sciences, Durban, South Africa
| | | | - Ronit Agid
- Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Darren B Orbach
- Neurointerventional Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Allan Taylor
- Neurosurgery, University of Cape Town, Cape Town, South Africa
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17
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Fargen KM, Coffman S, Torosian T, Brinjikji W, Nye BL, Hui F. "Idiopathic" intracranial hypertension: An update from neurointerventional research for clinicians. Cephalalgia 2023; 43:3331024231161323. [PMID: 36924237 DOI: 10.1177/03331024231161323] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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] [Indexed: 03/18/2023]
Abstract
BACKGROUND The recognition of venous sinus stenosis as a contributing factor in the majority of patients with idiopathic intracranial hypertension coupled with increasing cerebral venography and venous sinus stenting experience have dramatically improved our understanding of the pathophysiologic mechanisms driving this disease. There is now a dense, growing body of research in the neurointerventional literature detailing anatomical and physiological mechanisms of disease which has not been widely disseminated among clinicians. METHODS A literature search was conducted, covering the most recent neurointerventional literature on idiopathic intracranial hypertension, the pathophysiology of idiopathic intracranial hypertension, and management strategies (including venous sinus stenting), and subsequently summarized to provide a comprehensive review of the most recently published studies on idiopathic intracranial hypertension pathophysiology and management. CONCLUSION Recent studies in the neurointerventional literature have greatly improved our understanding of the pathophysiologic mechanisms causing idiopathic intracranial hypertension and its associated conditions. The ability to make individualized, patient-specific treatment approaches has been made possible by advances in our understanding of how venous sinus stenosis and cerebral venous hypertension fundamentally contribute to idiopathic intracranial hypertension.
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Affiliation(s)
- Kyle M Fargen
- Neurological Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Stephanie Coffman
- Neurological Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Taron Torosian
- Neurological Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | | | - Barbara L Nye
- Neurology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Ferdinand Hui
- Interventional Radiology, John Hopkins Hospital, Baltimore, MD, USA
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18
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Affiliation(s)
- Kyle M Fargen
- Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Ferdinand Hui
- Neuroscience Institute, Division of Neurointerventional Surgery, Queen's Medical Center, Honolulu, Hawaii, USA
| | - Joshua A Hirsch
- Interventional Neuroradiology, Massachusetts General Hospital, Boston, Massachusetts, USA
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19
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Prasad A, Kobsa J, Kodali S, Bartolome D, Begunova L, Quispe-Orozco D, Farooqui M, Zevallos C, Ortega-Gutiérrez S, Anadani M, Almallouhi E, Spiotta AM, Giles JA, Keyrouz SG, Kim JT, Maier IL, Liman J, Psychogios MN, Riou-Comte N, Richard S, Gory B, Quintero Wolfe S, Brown PA, Fargen KM, Mistry EA, Fakhri H, Mistry A, Wong KH, Nascimento FA, Kan P, de Havenon A, Sheth KN, Petersen NH. Temporal profiles of systolic blood pressure variability and neurologic outcomes after endovascular thrombectomy. Eur Stroke J 2022; 7:365-375. [PMID: 36478756 PMCID: PMC9720854 DOI: 10.1177/23969873221106907] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/23/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Observational studies have found an increased risk of hemorrhagic transformation and worse functional outcomes in patients with higher systolic blood pressure variability (BPV). However, the time-varying behavior of BPV after endovascular thrombectomy (EVT) and its effects on functional outcome have not been well characterized. Patients and methods We analyzed data from an international cohort of patients with large-vessel occlusion stroke who underwent EVT at 11 centers across North America, Europe, and Asia. Repeated time-stamped blood pressure data were recorded for the first 72 h after thrombectomy. Parameters of BPV were calculated in 12-h epochs using five established methodologies. Systolic BPV trajectories were generated using group-based trajectory modeling, which separates heterogeneous longitudinal data into groups with similar patterns. Results Of the 2041 patients (age 69 ± 14, 51.4% male, NIHSS 15 ± 7, mean number of BP measurements 50 ± 28) included in our analysis, 1293 (63.4%) had a poor 90-day outcome (mRS ⩾ 3) or a poor discharge outcome (mRS ⩾ 3). We identified three distinct SBP trajectories: low (25%), moderate (64%), and high (11%). Compared to patients with low BPV, those in the highest trajectory group had a significantly greater risk of a poor functional outcome after adjusting for relevant confounders (OR 2.2; 95% CI 1.2-3.9; p = 0.008). In addition, patients with poor outcomes had significantly higher systolic BPV during the epochs that define the first 24 h after EVT (p < 0.001). Discussion and conclusions Acute ischemic stroke patients demonstrate three unique systolic BPV trajectories that differ in their association with functional outcome. Further research is needed to rapidly identify individuals with high-risk BPV trajectories and to develop treatment strategies for targeting high BPV.
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Affiliation(s)
- Ayush Prasad
- Department of Neurology, Yale
University School of Medicine, New Haven, CT, USA
| | - Jessica Kobsa
- Department of Neurology, Yale
University School of Medicine, New Haven, CT, USA
| | - Sreeja Kodali
- Department of Neurology, Yale
University School of Medicine, New Haven, CT, USA
| | - David Bartolome
- Department of Neurology, Yale
University School of Medicine, New Haven, CT, USA
| | - Liza Begunova
- Department of Neurology, Yale
University School of Medicine, New Haven, CT, USA
| | - Darko Quispe-Orozco
- Department of Neurology, University of
Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Mudassir Farooqui
- Department of Neurology, University of
Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Cynthia Zevallos
- Department of Neurology, University of
Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - Mohammad Anadani
- Departments of Neurology, Medical
University of South Carolina, Charleston, SC, USA
| | - Eyad Almallouhi
- Departments of Neurology, Medical
University of South Carolina, Charleston, SC, USA
| | - Alejandro M Spiotta
- Departments of Neurosurgery, Medical
University of South Carolina, Charleston, SC, USA
| | - James A Giles
- Department of Neurology, Washington
University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Salah G Keyrouz
- Department of Neurology, Washington
University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Joon-Tae Kim
- Department of Neurology, Chonnam
National University Medical School, Gwangju, South Korea
| | - Ilko L Maier
- Department of Neurology, University
Medical Center Göttingen, Göttingen, Germany
| | - Jan Liman
- Department of Neurology, University
Medical Center Göttingen, Göttingen, Germany
| | - Marios-Nikos Psychogios
- Department of Diagnostic and
Interventional Neuroradiology, University Clinic Basel, Basel, Switzerland
| | | | - Sébastien Richard
- Department of Neurology, University
Hospital of Nancy, Nancy, France
- Centre d’Investigation Clinique
Plurithématique, INSERM U1116, University Hospital of Nancy, Vandoeuvre-lès-Nancy,
France
| | - Benjamin Gory
- Department of Diagnostic and
Therapeutic Neuroradiology, University Hospital of Nancy, Nancy, France
- IADI, INSERM U1254, University of
Lorraine, Nancy, France
| | | | - Patrick A Brown
- Departments of Radiology, Wake Forest
School of Medicine, Winston-Salem, NC, USA
| | - Kyle M Fargen
- Departments of Neurosurgery, Wake
Forest School of Medicine, Winston-Salem, NC, USA
| | - Eva A Mistry
- Department of Neurology and
Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Hiba Fakhri
- Department of Neurology, Vanderbilt
University Medical Center, Nashville, TN
| | - Akshitkumar Mistry
- Department of Neurosurgery,
University of Louisville, Louisville, KY, USA
| | - Ka-Ho Wong
- Department of Neurology, University
of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Peter Kan
- Department of Neurology, Baylor
College of Medicine, Houston, TX, USA
| | - Adam de Havenon
- Department of Neurology, Yale
University School of Medicine, New Haven, CT, USA
| | - Kevin N Sheth
- Department of Neurology, Yale
University School of Medicine, New Haven, CT, USA
| | - Nils H Petersen
- Department of Neurology, Yale
University School of Medicine, New Haven, CT, USA
- Nils H Petersen, Division of Neurocritical
Care and Emergency Neurology, Department of Neurology, Yale Medical School, 15
York Street, LCI 1003, New Haven, CT 06510, USA.
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20
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Grossberg JA, Chalhoub RM, Al Kasab S, Pullmann D, Jabbour P, Psychogios M, Starke RM, Arthur AS, Fargen KM, De Leacy R, Kan P, Dumont T, Rai A, Crosa RJ, Naamani KE, Maier I, Goyal N, Wolfe SQ, Michael Cawley C, Mocco J, Hafeez M, Howard BM, Dimisko L, Saad H, Ogilvy CS, Webster Crowley R, Mascitelli J, Fragata I, Levitt M, Spiotta AM, Alawieh AM. Multicenter investigation of technical and clinical outcomes after thrombectomy for Proximal Medium Vessel Occlusion (pMeVO) by frontline technique. Interv Neuroradiol 2022:15910199221138139. [PMID: 36377352 DOI: 10.1177/15910199221138139] [Citation(s) in RCA: 1] [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: 02/17/2024] Open
Abstract
BACKGROUND Endovascular thrombectomy(EVT) is the standard of care for large vessel occlusion(LVO) stroke. Data on technical and clinical outcome in proximal medium vessel occlusions(pMeVOs) comparing frontline techniques remain limited. METHODS We report an international multicenter retrospective study of patients undergoing EVT for stroke at 32 centers between 2015-2021. Patients were divided into LVOs(ICA/M1/Vertebrobasilar) or pMeVOs(M2/A1/P1) and categorized by thrombectomy technique. Primary outcome was 90-day good functional outcome(mRS ≤ 2). Multivariate logistic regressions were used to evaluate the impact of technical variables on clinical outcomes. Propensity score matching was used to compare outcome in patients with pMeVO treated with aspiration versus stent-retriever. RESULTS In the cohort of 5977 LVO and 1287 pMeVO patients, pMeVO did not independently predict good-outcome(p = 0.55). In pMeVO patients, successful recanalization irrespective of frontline technique(aOR = 3.2,p < 0.05), procedure time ≤ 1-h(aOR = 2.2,p < 0.05), and thrombectomy attempts ≤ 4(aOR = 2.8,p < 0.05) were independent predictors of good-outcomes.In a propensity-matched cohort of aspiration versus stent-retriever pMeVO patients, there was no difference in good-outcomes. The rates of hemorrhage were higher(9%vs.4%,p < 0.01) and procedure time longer(51-min vs. 33-min,p < 0.01) with stent-retriever, while the number of attempts was higher with aspiration(2.5vs.2,p < 0.01). Rates of hemorrhage and good-outcome showed an exponential relationship to procedural metrics, and were more dependent on time in the aspiration group compared to attempts in the stent-retriever group. CONCLUSIONS Clinical outcomes following EVT for pMeVO are comparable to those in LVOs. The golden hour or 3-pass rules in LVO thrombectomy still apply to pMeVO thrombectomy. Different techniques may exhibit different futility metrics; SR thrombectomy was more influenced by attempts whereas aspiration was more dependent on procedure time.
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Affiliation(s)
- Jonathan A Grossberg
- Department of Neurosurgery, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Reda M Chalhoub
- Department of Neurosurgery, 2345Medical University of South Carolina, Charleston, SC, USA
| | - Sami Al Kasab
- Department of Neurosurgery, 2345Medical University of South Carolina, Charleston, SC, USA
| | - Dominika Pullmann
- Department of Neurosurgery, 2345Medical University of South Carolina, Charleston, SC, USA
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Robert M Starke
- Department of Neurosurgery, University of Miami Health System, Miami, FL, USA
| | - Adam S Arthur
- Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Clinic, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Kyle M Fargen
- Department of Neurosurgery, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Reade De Leacy
- Department of Neurosurgery, Mount Sinai Hospital, New York, NY, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor University, Houston, TX, USA
| | - Travis Dumont
- Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Ansaar Rai
- Department of Radiology, West Virginia School of Medicine, Morgantown, WV, USA
| | - Roberto J Crosa
- Department of Neurosurgery, Centro Endovascular Neurologico Medica Uruguaya, Montevideo, Uruguay
| | - Kareem E Naamani
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ilko Maier
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Nitin Goyal
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - C Michael Cawley
- Department of Neurosurgery, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - J Mocco
- Department of Neurosurgery, Mount Sinai Hospital, New York, NY, USA
| | - Muhammad Hafeez
- Department of Neurosurgery, Baylor University, Houston, TX, USA
| | - Brian M Howard
- Department of Neurosurgery, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Laurie Dimisko
- Department of Neurosurgery, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Hassan Saad
- Department of Neurosurgery, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Christopher S Ogilvy
- Department of Neurosurgery, Beth Israel Deaconess Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Justin Mascitelli
- Department of Neurosurgery, University of Texas San Antonio, San Antonio, TX, USA
| | - Isabel Fragata
- Neuroradiology Department, Hospital São José, Centro Hospitalar Lisboa Central, Lisbon, Portugal
| | - Michael Levitt
- Department of Neurosurgery, University of Washington, Seattle, WA, USA
| | - Alejandro M Spiotta
- Department of Neurosurgery, 2345Medical University of South Carolina, Charleston, SC, USA
| | - Ali M Alawieh
- Department of Neurosurgery, 12239Emory University School of Medicine, Atlanta, GA, USA
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21
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Ares WJ, Jankowitz BT, Kan P, Spiotta AM, Nakaji P, Wilson JD, Fargen KM, Ramos E, Leonardo J, Grandhi R. The neurosurgical marriage: evaluating the interplay of work life and home life from the perspective of partners of neurosurgical residents. J Neurosurg 2022; 138:1139-1146. [PMID: 36087329 DOI: 10.3171/2022.7.jns221493] [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: 06/24/2022] [Accepted: 07/15/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Burnout and work-life balance have been noted to be problems for residents across all fields of medicine, including neurosurgery. No studies to date have evaluated how these factors may contribute to issues outside of the hospital, specifically residents' home lives. This study aimed to evaluate the interplay between home life and work life of neurosurgical residents, specifically from the point of view of residents' significant others. METHODS Online surveys were distributed to the significant others of neurosurgical residents at 12 US neurosurgery residencies. Residents' partners were asked about relationship dynamics, their views on neurosurgery residency (work-life balance and burnout), and their views of neurosurgery as a career. RESULTS The majority of residents' significant others (84%) reported being satisfied with their relationship. Significant others who reported dissatisfaction with their relationship were more likely to report frustration with work-life balance and more likely to report their resident partner as having higher levels of burnout. CONCLUSIONS From the perspective of neurosurgery residents' significant others, higher perceived levels of burnout and lower satisfaction with work-life balance are correlated with lower levels of relationship satisfaction. These findings speak to the complex interplay of work life and home life and can be used to inform future interventions into improving the quality of life for both the resident and the significant other.
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Affiliation(s)
- William J Ares
- 1Department of Neurosurgery, Northshore University HealthSystem, Evanston, Illinois
| | - Brian T Jankowitz
- 2Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Peter Kan
- 3Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas
| | - Alejandro M Spiotta
- 4Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
| | - Peter Nakaji
- 5Department of Neurosurgery, Banner University Medical Center, Phoenix, Arizona
| | - Jason D Wilson
- 6Department of Neurosurgery, Louisiana State University Health, New Orleans, Louisiana
| | - Kyle M Fargen
- 7Department of Neurosurgery, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Edwin Ramos
- 8Division of Neurosurgery, University of Chicago Medicine, Chicago, Illinois
| | - Jody Leonardo
- 9Department of Neurosurgery, Allegheny Health Network, Pittsburgh, Pennsylvania; and
| | - Ramesh Grandhi
- 10Department of Neurosurgery, University of Utah Health, Salt Lake City, Utah
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22
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Abdalla RN, Ansari SA, Hurley MC, Attarian H, Fargen KM, Hirsch JA, Cantrell DR, Curl PK, Daves PR, Shaibani A. Correlation of Call Burden and Sleep Deprivation with Physician Burnout, Driving Crashes, and Medical Errors among US Neurointerventionalists. AJNR Am J Neuroradiol 2022; 43:1286-1291. [PMID: 36007952 PMCID: PMC9451637 DOI: 10.3174/ajnr.a7606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 04/06/2022] [Accepted: 06/27/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE High call frequency can lead to inadequate sleep, fatigue, and burnout, resulting in detrimental effects on physicians and patients. We aimed to assess the correlation between the frequency and burden of neurointerventional surgery calls and sleep deprivation with physician burnout, physical and driving safety, and fatigue-related medical errors. MATERIALS AND METHODS We sent an online questionnaire to the members of the 2 neurointerventional surgery societies comprising 50 questions and spanning 3 main topics: 1) overnight/weekend call burden, 2) sleeping patterns, and 3) Copenhagen Burnout Inventory. RESULTS One hundred sixty-four surveys were completed. Most (54%) neurointerventional surgeons reported burnout. Call burden of ≥1 every 3 days and being in practice >10 years were independent predictors of burnout. Thirty-nine percent reported falling asleep at the wheel, 23% reported a motor vehicle crash/near-crash, and 34% reported medical errors they considered related to call/work fatigue. On multivariate logistic regression, high call burden (called-in >3 times/week) was an independent predictor of sleeping at the wheel and motor vehicle crashes. Reporting <4 hours of uninterrupted sleep was an independent predictor of motor vehicle crashes and medical errors. Most neurointerventional surgeons recommended a maximum call frequency of once every 3 days. CONCLUSIONS Call frequency and burden, number of years in practice, and sleep deprivation are associated with burnout of neurointerventional surgeons, sleeping at the wheel, motor vehicle crashes, and fatigue-related medical errors. These findings contribute to the increasing literature on physician burnout and may guide future societal recommendations related to call burden in neurointerventional surgery.
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Affiliation(s)
- R N Abdalla
- From the Departments of Radiology (R.N.A., S.A.A., D.R.C., A.S.)
- Neurological Surgery (R.N.A., S.A.A., A.S.)
- Department of Radiology (R.N.A.), Ain Shams University, Cairo, Egypt
| | - S A Ansari
- From the Departments of Radiology (R.N.A., S.A.A., D.R.C., A.S.)
- Neurology (S.A.A.)
- Neurological Surgery (R.N.A., S.A.A., A.S.)
| | - M C Hurley
- Department of Radiology (M.C.H.), University of Chicago, Chicago, Illinois
| | - H Attarian
- Sleep Medicine (H.A.), Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - K M Fargen
- Department of Neurosurgery (K.M.F.), Wake Forest University, Winston-Salem, North Carolina
| | - J A Hirsch
- Department of Radiology (J.A.H.), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - D R Cantrell
- From the Departments of Radiology (R.N.A., S.A.A., D.R.C., A.S.)
| | - P K Curl
- Department of Radiology (P.K.C.), University of Washington, Seattle, Washington
| | - P R Daves
- Department of Finance (P.R.D.), University of Tennessee, Knoxville, Tennessee
| | - A Shaibani
- From the Departments of Radiology (R.N.A., S.A.A., D.R.C., A.S.)
- Neurological Surgery (R.N.A., S.A.A., A.S.)
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23
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Fargen KM, Kittel C, Amans MR, Brinjikji W, Hui F. A national survey of venous sinus stenting practices for idiopathic intracranial hypertension. J Neurointerv Surg 2022; 15:507-511. [PMID: 35428743 DOI: 10.1136/neurintsurg-2022-018832] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/31/2022] [Indexed: 11/04/2022]
Abstract
BackgroundLittle is currently known about physician opinions and preferences on venous sinus stenting (VSS) for idiopathic intracranial hypertension (IIH), practice patterns, or clinical volumes.MethodsA 19 question online survey was designed and distributed to physician members of the Society of Neurointerventional Surgery (SNIS).ResultsA total of 107 individual survey responses were obtained (14% of SNIS members). The majority of respondents (85%) indicated that they had performed at least one VSS procedure independently during their careers. Mean (SD) and median (range) career case volumes were 20.9 (33.8) and 10.0 (0.0–200.0), respectively. On a 1–10 scale, most respondents reported a high level of interest in treating IIH patients with VSS (median 8), a high level of comfort/expertise in treating IIH patients with VSS (median 9), and that VSS was effective in the long term reduction of symptoms and papilledema in IIH patients (median 8). Fifty-nine per cent of respondents reported increasing VSS volumes compared with previous years. A major complication during a VSS procedure, including two deaths, was reported by 11% of respondents.ConclusionsThis is the first study designed to understand the opinions and practices of neurointerventionists regarding VSS for IIH. Overall physician opinion on VSS was quite positive, supported by increasing procedural volumes reported by most over the past few years. However, only a small percentage of respondents had substantial experience with VSS and major complications were not rare.
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Affiliation(s)
- Kyle M Fargen
- Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Carol Kittel
- Neurological Surgery, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Matthew R Amans
- Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| | | | - Ferdinand Hui
- Neuroscience Institute, Queen's Medical Center, University of Hawaii, Honolulu, HI, USA
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24
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Petersen NH, Kodali S, Meng C, Li F, Nguyen CK, Peshwe KU, Strander S, Silverman A, Kimmel A, Wang A, Anadani M, Almallouhi E, Spiotta AM, Kim JT, Giles JA, Keyrouz SG, Farooqui M, Zevallos C, Maier IL, Psychogios MN, Liman J, Riou-Comte N, Richard S, Gory B, Wolfe SQ, Brown PA, Fargen KM, Mistry EA, Fakhri H, Mistry AM, Wong KH, de Havenon A, Nascimento FA, Kan P, Matouk C, Ortega-Gutiérrez S, Sheth KN. Blood Pressure Trajectory Groups and Outcome After Endovascular Thrombectomy: A Multicenter Study. Stroke 2022; 53:1216-1225. [PMID: 34781705 PMCID: PMC8960326 DOI: 10.1161/strokeaha.121.034408] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Elevated blood pressure after endovascular thrombectomy (EVT) has been associated with an increased risk of hemorrhagic transformation and poor functional outcomes. However, the optimal hemodynamic management after EVT remains unknown, and the blood pressure course in the acute phase of ischemic stroke has not been well characterized. This study aimed to identify patient subgroups with distinct blood pressure trajectories after EVT and study their association with radiographic and functional outcomes. METHODS This multicenter retrospective cohort study included consecutive patients with anterior circulation large-vessel occlusion ischemic stroke who underwent EVT. Repeated time-stamped blood pressure data were recorded for the first 72 hours after thrombectomy. Latent variable mixture modeling was used to separate subjects into five groups with distinct postprocedural systolic blood pressure (SBP) trajectories. The primary outcome was functional status, measured on the modified Rankin Scale 90 days after stroke. Secondary outcomes included hemorrhagic transformation, symptomatic intracranial hemorrhage, and death. RESULTS Two thousand two hundred sixty-eight patients (mean age [±SD] 69±15, mean National Institutes of Health Stroke Scale 15±7) were included in the analysis. Five distinct SBP trajectories were observed: low (18%), moderate (37%), moderate-to-high (20%), high-to-moderate (18%), and high (6%). SBP trajectory group was independently associated with functional outcome at 90 days (P<0.0001) after adjusting for potential confounders. Patients with high and high-to-moderate SBP trajectories had significantly greater odds of an unfavorable outcome (adjusted odds ratio, 3.5 [95% CI, 1.8-6.7], P=0.0003 and adjusted odds ratio, 2.2 [95% CI, 1.5-3.2], P<0.0001, respectively). Subjects in the high-to-moderate group had an increased risk of symptomatic intracranial hemorrhage (adjusted odds ratio, 1.82 [95% CI, 1-3.2]; P=0.04). No significant association was found between trajectory group and hemorrhagic transformation. CONCLUSIONS Patients with acute ischemic stroke demonstrate distinct SBP trajectories during the first 72 hours after EVT that have differing associations with functional outcome. These findings may help identify potential candidates for future blood pressure modulation trials.
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Affiliation(s)
- Nils H Petersen
- Department of Neurology, Yale University School of Medicine, New Haven, CT
| | - Sreeja Kodali
- Department of Neurology, Yale University School of Medicine, New Haven, CT
| | - Can Meng
- Yale Center for Analytical Sciences, Yale University School of Public Health, New Haven, CT
| | - Fangyong Li
- Yale Center for Analytical Sciences, Yale University School of Public Health, New Haven, CT
| | - Cindy Khanh Nguyen
- Department of Neurology, Yale University School of Medicine, New Haven, CT
| | - Krithika U. Peshwe
- Department of Neurology, Yale University School of Medicine, New Haven, CT
| | - Sumita Strander
- Department of Neurology, Yale University School of Medicine, New Haven, CT
| | - Andrew Silverman
- Department of Neurology, Yale University School of Medicine, New Haven, CT
| | - Alexandra Kimmel
- Department of Neurology, Yale University School of Medicine, New Haven, CT
| | - Anson Wang
- Department of Neurology, Yale University School of Medicine, New Haven, CT
| | - Mohammad Anadani
- Department of Neurology, Medical University of South Carolina, Charleston, SC
| | - Eyad Almallouhi
- Department of Neurology, Medical University of South Carolina, Charleston, SC
| | - Alejandro M. Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Medical School, Gwangju, South Korea
| | - James A. Giles
- Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Salah G. Keyrouz
- Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Mudassir Farooqui
- Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Cynthia Zevallos
- Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Ilko L. Maier
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Marios-Nikos Psychogios
- Department of Diagnostic and Interventional Neuroradiology, University Clinic Basel, Switzerland
| | - Jan Liman
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | | | - Sébastien Richard
- Department of Neurology, University Hospital of Nancy, Nancy, France,,Centre d’Investigation Clinique Plurithématique, INSERM U1116, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Benjamin Gory
- Department of Neuroradiology, University Hospital of Nancy, Nancy, France,,IADI, INSERM U1254, University of Lorraine, Nancy, France
| | | | - Patrick A. Brown
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kyle M. Fargen
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC
| | - Eva A. Mistry
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
| | - Hiba Fakhri
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
| | | | - Ka-Ho Wong
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT
| | - Adam de Havenon
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT
| | | | - Peter Kan
- Department of Neurology, Baylor College of Medicine, Houston, TX
| | - Charles Matouk
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT
| | | | - Kevin N Sheth
- Department of Neurology, Yale University School of Medicine, New Haven, CT
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25
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Zehri AH, Lee KE, Kartchner J, Arnel M, Martin T, Wolfe SQ, Fargen KM. Efficacy of dural venous sinus stenting in treating idiopathic intracranial hypertension with acute vision loss. Neuroradiol J 2022; 35:86-93. [PMID: 34224285 PMCID: PMC8826286 DOI: 10.1177/19714009211026923] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 02/03/2023] Open
Abstract
INTRODUCTION Dural venous sinus stenting (VSS) is an effective, durable treatment for patients with idiopathic intracranial hypertension (IIH) due to underlying venous sinus stenosis. However, the use of venous sinus stenting to treat IIH with acute vision loss has rarely been described. METHODS A retrospective chart analysis identified patients who received VSS for fulminant IIH, defined as acute (< 8 weeks) visual field loss to within the central 5° and/or a decrease in visual acuity to less than or equal to 20/50 in either eye in the presence of papilledema. RESULTS Ten patients were identified with average patient age of 31.0 years, and all except one were female. Mean body mass index was 41.2 kg/m2. All patients presented with vision loss and some with headache and tinnitus. The average trans-stenotic gradient pre-stenting was 28.7 mmHg (range 9-62 mmHg). All patients had diminished or resolved venous gradients immediately following the procedure. At mean follow-up of 60.5 weeks, 100% had improvements in papilledema, 80.0% had subjective vision improvement, 55.6% had headache improvement and 87.5% had tinnitus improvement. 90.0% had stable or improved visual acuity in both eyes with a mean post-stenting Snellen acuity of 20/30 and an average gain of 3 lines Snellen acuity post-stenting (95% confidence intervals 0.1185-0.4286, p = 0.0018). Two patients (20.0%) required further surgical treatment (cerebrospinal shunting and/or stenting) after their first stenting procedure. CONCLUSIONS This series suggests that VSS is feasible in patients presenting with IIH and acute vision loss with a fairly low complication rate and satisfactory clinical outcomes.
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Affiliation(s)
- Aqib H Zehri
- Department of Neurological Surgery,
Wake Forest Baptist Health, USA,Aqib Zehri, MD, 3072 Zacharys Keep Court,
Winston-Salem, NC 27103, USA.
| | - Katriel E Lee
- Department of Neurological Surgery,
Wake Forest Baptist Health, USA
| | - Jeff Kartchner
- Department of Ophthalmology, Wake
Forest Baptist Health, USA
| | - Madison Arnel
- Department of Neurological Surgery,
Wake Forest Baptist Health, USA
| | - Timothy Martin
- Department of Ophthalmology, Wake
Forest Baptist Health, USA
| | - Stacey Q Wolfe
- Department of Neurological Surgery,
Wake Forest Baptist Health, USA
| | - Kyle M Fargen
- Department of Neurological Surgery,
Wake Forest Baptist Health, USA
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26
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Fargen KM. The physician burnout conundrum: where do we go from here? J Neurointerv Surg 2022; 14:105-106. [PMID: 35042772 DOI: 10.1136/neurintsurg-2022-018651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Kyle M Fargen
- Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
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27
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Fargen KM, Couture DE. Cerebrospinal fluid disorders and shunts: it's time to move forward. Invited commentary on 'First-in-human endovascular treatment of hydrocephalus with a miniature biomimetic trans-dural shunt'. J Neurointerv Surg 2021; 14:851-852. [PMID: 34930801 DOI: 10.1136/neurintsurg-2021-018517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Kyle M Fargen
- Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Daniel E Couture
- Neurological Surgery, Wake Forest University, Winston-Salem, North Carolina, USA
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28
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Akbik F, Alawieh A, Dimisko L, Howard BM, Cawley CM, Tong FC, Nahab F, Samuels OB, Maier I, Feng W, Goyal N, Starke RM, Rai A, Fargen KM, Psychogios MN, Jabbour P, De Leacy R, Keyrouz SG, Dumont TM, Kan P, Liman J, Arthur AS, Wolfe SQ, Mocco J, Crosa RJ, Fox WC, Gory B, Spiotta AM, Grossberg JA. Bridging thrombolysis in atrial fibrillation stroke is associated with increased hemorrhagic complications without improved outcomes. J Neurointerv Surg 2021; 14:979-984. [PMID: 34819345 DOI: 10.1136/neurintsurg-2021-017954] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/27/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) associated ischemic stroke is associated with worse functional outcomes, less effective recanalization, and increased rates of hemorrhagic complications after intravenous thrombolysis (IVT). Conversely, AF is not associated with hemorrhagic complications or functional outcomes in patients undergoing mechanical thrombectomy (MT). This differential effect of MT and IVT in AF associated stroke raises the question of whether bridging thrombolysis increases hemorrhagic complications in AF patients undergoing MT. METHODS This international cohort study of 22 comprehensive stroke centers analyzed patients with large vessel occlusion (LVO) undergoing MT between June 1, 2015 and December 31, 2020. Patients were divided into four groups based on comorbid AF and IVT exposure. Baseline patient characteristics, complications, and outcomes were reported and compared. RESULTS 6461 patients underwent MT for LVO. 2311 (35.8%) patients had comorbid AF. In non-AF patients, bridging therapy improved the odds of good 90 day functional outcomes (adjusted OR (aOR) 1.29, 95% CI 1.03 to 1.60, p=0.025) and did not increase hemorrhagic complications. In AF patients, bridging therapy led to significant increases in symptomatic intracranial hemorrhage and parenchymal hematoma type 2 (aOR 1.66, 1.07 to 2.57, p=0.024) without any benefit in 90 day functional outcomes. Similar findings were noted in a separate propensity score analysis. CONCLUSION In this large thrombectomy registry, AF patients exposed to IVT before MT had increased hemorrhagic complications without improved functional outcomes, in contrast with non-AF patients. Prospective trials are warranted to assess whether AF patients represent a subgroup of LVO patients who may benefit from a direct to thrombectomy approach at thrombectomy capable centers.
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Affiliation(s)
- Feras Akbik
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA.,Department of Neurology, Emory University, Atlanta, Georgia, USA
| | - Ali Alawieh
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA.,Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Laurie Dimisko
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Brian M Howard
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - C Michael Cawley
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Frank C Tong
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Fadi Nahab
- Department of Neurology, Emory University, Atlanta, Georgia, USA
| | - Owen B Samuels
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Ilko Maier
- Neurology, University Medicine Goettingen, Goettingen, Germany
| | - Wuwei Feng
- Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - Nitin Goyal
- Semmes Murphey Clinic, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Robert M Starke
- Neurosurgery and Radiology, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Ansaar Rai
- Radiology, West Virginia University Hospitals, Morgantown, West Virginia, USA
| | - Kyle M Fargen
- Neurosurgery, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Marios N Psychogios
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Pascal Jabbour
- Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Reade De Leacy
- Neurosurgery, The Mount Sinai Health System, New York, New York, USA
| | - Saleh G Keyrouz
- Department of Neurology, Washington University at St. Louis, St Louis, Missouri, USA
| | - Travis M Dumont
- Surgery, Division of Neurosurgery, Banner University of Arizona Medical Center, Tucson, Arizona, USA
| | - Peter Kan
- Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Jan Liman
- Neurology, University Medical Center, Göttingen, Germany
| | - Adam S Arthur
- Semmes Murphey Clinic, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Stacey Q Wolfe
- Neurosurgery, Wake Forest University, Winston-Salem, North Carolina, USA
| | - J Mocco
- Neurosurgery, The Mount Sinai Health System, New York, New York, USA
| | | | - W Christopher Fox
- Neurosurgery, Mayo Clinic Hospital Jacksonville, Jacksonville, Florida, USA
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, CHRU-Nancy, Nancy, France.,INSERM, IADI, Université de Lorraine, Nancy, France
| | - Alejandro M Spiotta
- Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
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29
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Alawieh AM, Eid M, Anadani M, Sattur M, Maier IL, Feng W, Goyal N, Starke RM, Rai A, Fargen KM, Psychogios MN, De Leacy R, Grossberg JA, Keyrouz SG, Dumont TM, Kan P, Lena J, Liman J, Arthur AS, Elijovich L, Mccarthy DJ, Saini V, Wolfe SQ, Mocco J, Fifi JT, Nascimento FA, Giles JA, Allen M, Crosa R, Fox WC, Gory B, Spiotta AM. Thrombectomy Technique Predicts Outcome in Posterior Circulation Stroke—Insights from the STAR Collaboration. Neurosurgery 2021. [DOI: 10.1093/neuros/nyaa179_s037] [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: 11/13/2022] Open
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30
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Malisch TW, Ansari SA, Duckwiler GR, Fargen KM, Hetts SW, Marden FA, Patsalides A, Schirmer CM, Brook A, Fraser JF. Cessation and resumption of elective neurointerventional procedures during the coronavirus disease 2019 pandemic and future pandemics. Interv Neuroradiol 2021; 27:30-35. [PMID: 34747645 PMCID: PMC8575972 DOI: 10.1177/15910199211035900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
At the time of this writing, the coronavirus disease 2019 pandemic continues to be a global threat, disrupting usual processes, and protocols for delivering health care around the globe. There have been significant regional and national differences in the scope and timing of these disruptions. Many hospitals were forced to temporarily halt elective neurointerventional procedures with the first wave of the pandemic in the spring of 2020, in order to prioritize allocation of resources for acutely ill patients and also to minimize coronavirus disease 2019 transmission risks to non-acute patients, their families, and health care workers. This temporary moratorium on elective neurointerventional procedures is generally credited with helping to “flatten the curve” and direct scarce resources to more acutely ill patients; however, there have been reports of some delaying seeking medical care when it was in fact urgent, and other reports of patients having elective treatment delayed with the result of morbidity and mortality. Many regions have resumed elective neurointerventional procedures, only to now watch coronavirus disease 2019 positivity rates again climbing as winter of 2020 approaches. A new wave is now forecast which may have larger volumes of hospitalized coronavirus disease 2019 patients than the earlier wave(s) and may also coincide with a wave of patients hospitalized with seasonal influenza. This paper discusses relevant and practical elements of cessation and safe resumption of nonemergent neurointerventional services in the setting of a pandemic.
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Affiliation(s)
| | - Sameer A Ansari
- Departments of Radiology, Neurosurgery, and Neurology, Feinberg School of Medicine, 12244Northwestern University, USA
| | - Gary R Duckwiler
- Interventional Neuroradiology, David Geffen School of Medicine, University of California in Los Angeles, USA
| | - Kyle M Fargen
- Departments of Neurological Surgery and Radiology, 8676Wake Forest University, USA
| | - Steven W Hetts
- Departments of Radiology and Biomedical Engineering, University of California in San Francisco, USA
| | | | | | - Clemens M Schirmer
- Department of Neurosurgery and Neuroscience Institute, 2780Geisinger Health System and Geisinger Commonwealth School of Medicine, USA.,Research Institute of Neurointervention, Paracelsus Medical University, Austria
| | - Allan Brook
- Departments of Radiology and Neurosurgery, 2013Albert Einstein College of Medicine and Montefiore Medical Center, USA
| | - Justin F Fraser
- Departments of Neurological Surgery, Neurology, Radiology, and Neuroscience, University of Kentucky, USA
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31
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Mokin M, Waqas M, Fifi JT, De Leacy R, Fiorella D, Levy EI, Snyder K, Hanel RA, Woodward K, Chaudry I, Rai AT, Frei D, Delgado Almandoz JE, Kelly M, Arthur AS, Baxter BW, English J, Linfante I, Fargen KM, Turk A, Mocco J, Siddiqui AH. Intravenous alteplase has different effects on the efficacy of aspiration and stent retriever thrombectomy: analysis of the COMPASS trial. J Neurointerv Surg 2021; 14:992-996. [PMID: 34649935 DOI: 10.1136/neurintsurg-2021-017943] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/30/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND There is conflicting evidence on the utility of intravenous (IV) alteplase in patients with emergent large vessel occlusion (ELVO) treated with mechanical thrombectomy (MT). METHODS This was a post hoc analysis of the COMPASS: a trial of aspiration thrombectomy versus stent retriever thrombectomy as first-line approach for large vessel occlusion. We compared clinical, procedural and angiographic outcomes of patients with and without prior IV alteplase administration. RESULTS In the COMPASS trial, 235 patients had presented to the hospital within the first 4 hours of stroke symptom onset and were eligible for analysis. On univariate analysis, administration of IV alteplase prior to MT was found to be significantly associated with favorable outcomes (modified Rankin scale (mRS) 0-2 at 3 months; 55.6% vs 40.0% in the MT-only group, P=0.037). However, on multivariate analysis, only baseline (pre-stroke) mRS, admission National Institutes of Health Stroke Scale (NIHSS) score and age were identified as independent predictors of favorable outcomes at 3 months. We found higher final thrombolysis in cerebral infarction (TICI) 2b/3 rates in patients without the use of alteplase prior to the aspiration first approach (100.0% vs 87.9% in IV altepase +aspiration first MT, P=0.03). In the stent retriever first group, final TICI 2b/3 rates were identical in patients with and without IV alteplase administration (87.5% and 87.5%, P=1.0). CONCLUSIONS Prior administration of IV alteplase may adversely affect the efficacy of aspiration, but does not seem to influence the stent retriever first approach to MT in patients with anterior circulation ELVO.
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Affiliation(s)
- Maxim Mokin
- Department of Neurosurgery and Brain Repair, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Muhammad Waqas
- Department of Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Johanna T Fifi
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Reade De Leacy
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David Fiorella
- Department of Neurosurgery, Stony Brook University, Stony Brook, New York, USA
| | - Elad I Levy
- Department of Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Kenneth Snyder
- Department of Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Ricardo A Hanel
- Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA
| | - Keith Woodward
- Fort Sanders Regional Medical Center, Knoxville, Tennessee, USA
| | - Imran Chaudry
- Neurosurgery, Prisma Health Upstate, Greenville, South Carolina, USA
| | - Ansaar T Rai
- Interventional Neuroradiology, West Virginia University Rockefeller Neuroscience Institute, Morgantown, West Virginia, USA
| | - Donald Frei
- Interventional Neuroradiology, Radiology Imaging Associates, Englewood, Colorado, USA
| | | | - Michael Kelly
- Neurosurgery, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Adam S Arthur
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
| | | | - Joey English
- Neurology and Radiology, University of California San Francisco (UCSF), San Francisco, California, USA
| | - Italo Linfante
- Baptist Cardiac and Vascular Institute, Miami, Florida, USA
| | - Kyle M Fargen
- Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Aquilla Turk
- Neurosurgery, Prisma Health Upstate, Greenville, South Carolina, USA
| | - J Mocco
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
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32
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Affiliation(s)
- Kyle M Fargen
- Department of Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, NC 27157, USA
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33
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Burks JD, Chen SH, Luther EM, Almallouhi E, Al Kasab S, Jabbour PM, Wolfe SQ, Fargen KM, Arthur AS, Goyal N, Fragata I, Maier I, Matouk C, Grossberg J, Kan P, Schirmer C, Crowley RW, Ares W, Ogilvy CS, Rai AT, Levitt MR, Mokin M, Guerrero W, Park MS, Mascitelli J, Yoo A, Williamson RW, Grande A, Crosa R, Webb S, Psychogios M, Peterson EC, Yavagal DR, Spiotta AM, Starke RM. Effect of Hispanic Status in Mechanical Thrombectomy Outcomes After Ischemic Stroke: Insights From STAR. Stroke 2021; 52:e715-e719. [PMID: 34517765 DOI: 10.1161/strokeaha.120.033326] [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] [Indexed: 11/16/2022]
Abstract
Background and Purpose Epidemiological studies have shown racial and ethnic minorities to have higher stroke risk and worse outcomes than non-Hispanic Whites. In this cohort study, we analyzed the STAR (Stroke Thrombectomy and Aneurysm Registry) database, a multi-institutional database of patients who underwent mechanical thrombectomy for acute large vessel occlusion stroke to determine the relationship between mechanical thrombectomy outcomes and race. Methods Patients who underwent mechanical thrombectomy between January 2017 and May 2020 were analyzed. Data included baseline characteristics, vascular risk factors, complications, and long-term outcomes. Functional outcomes were assessed with respect to Hispanic status delineated as non-Hispanic White (NHW), non-Hispanic Black (NHB), or Hispanic patients. Multivariate analysis was performed to identify variables associated with unfavorable outcome or modified Rankin Scale ≥3 at 90 days. Results Records of 2115 patients from the registry were analyzed. Median age of Hispanic patients undergoing mechanical thrombectomy was 60 years (72–84), compared with 63 years (54–74) for NHB, and 71 years (60–80) for NHW patients (P<0.001). Hispanic patients had a higher incidence of diabetes (41%; P<0.001) and hypertension (82%; P<0.001) compared with NHW and NHB patients. Median procedure time was shorter in Hispanics (36 minutes) compared to NHB (39 minutes) and NHW (44 minutes) patients (P<0.001). In multivariate analysis, Hispanic patients were less likely to have favorable outcome (odds ratio, 0.502 [95% CI, 0.263–0.959]), controlling for other significant predictors (age, admission National Institutes Health Stroke Scale, onset to groin time, number of attempts, procedure time). Conclusions Hispanic patients are less likely to have favorable outcome at 90 days following mechanical thrombectomy compared to NHW or NHB patients. Further prospective studies are required to validate our findings.
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Affiliation(s)
- Joshua D Burks
- Department of Neurosurgery, University of Miami, FL (J.D.B., S.H.C., E.M.L., E.C.P., D.R.Y., R.M.S.)
| | - Stephanie H Chen
- Department of Neurosurgery, University of Miami, FL (J.D.B., S.H.C., E.M.L., E.C.P., D.R.Y., R.M.S.)
| | - Evan M Luther
- Department of Neurosurgery, University of Miami, FL (J.D.B., S.H.C., E.M.L., E.C.P., D.R.Y., R.M.S.)
| | - Eyad Almallouhi
- Department of Neurosurgery, Medical University of South Carolina, Charleston (E.A., S.A.K., A.M.S.)
| | - Sami Al Kasab
- Department of Neurosurgery, Medical University of South Carolina, Charleston (E.A., S.A.K., A.M.S.)
| | - Pascal M Jabbour
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA (P.M.J.)
| | - Stacey Q Wolfe
- Department of Neurosurgery, Wake Forrest School of Medicine, Winston-Salem, NC (S.Q.W., K.M.F.)
| | - Kyle M Fargen
- Department of Neurosurgery, Wake Forrest School of Medicine, Winston-Salem, NC (S.Q.W., K.M.F.)
| | - Adam S Arthur
- Department of Neurosurgery (A.S.A., N.G.), Semmes-Murphey Neurologic and Spine Clinic, Memphis, TN
| | - Nitin Goyal
- Department of Neurosurgery (A.S.A., N.G.), Semmes-Murphey Neurologic and Spine Clinic, Memphis, TN.,Neurology (N.G.), Semmes-Murphey Neurologic and Spine Clinic, Memphis, TN
| | - Isabel Fragata
- Department of Neuroradiology, Hospital Sao Jose Centro Hospitalar Lisboa Central, Lisboa, Portugal (I.F.)
| | - Ilko Maier
- Department of Neurology, University Medical Center Gottingen, Germany (I.M.)
| | - Charles Matouk
- Department of Neurosurgery, Yale University, New Haven, CT (C.M.)
| | | | - Peter Kan
- Department of Neurosurgery, Baylor School of Medicine, Houston, TX (P.K.)
| | - Clemens Schirmer
- Department of Neurosurgery, Geisinger Health System, Wilkes-Barre, PA (C.S.)
| | | | - William Ares
- Department of Neurosurgery, NorthShore University Health System, Evanston, IL (W.A.)
| | | | - Ansaar T Rai
- Department of Neuroradiology, University of West Virginia, Morgantown (A.T.R.)
| | - Michael R Levitt
- Department of Neurosurgery, University of Washington, Seattle (M.R.L.)
| | - Maxim Mokin
- Department of Neurosurgery, University of South Florida, Tampa (M.M., W.G.)
| | - Waldo Guerrero
- Department of Neurosurgery, University of South Florida, Tampa (M.M., W.G.)
| | - Min S Park
- Department of Neurosurgery, University of Virginia, Charlottesville (M.S.P.)
| | - Justin Mascitelli
- Department of Neurosurgery, University of Texas Health Sciences Center at San Antonio (J.M.)
| | - Albert Yoo
- Texas Stroke Institute, Fort Worth (A.Y.)
| | | | - Andrew Grande
- Department of Neurosurgery, University of Minnesota, Minneapolis (A.G.)
| | - Roberto Crosa
- Department of Neurosurgery Centro Endovascular Neurologico Medica Uruguaya Montevideo, Uruguay (R.C.)
| | - Sharon Webb
- Department of Neurosurgery, Bon Secours Health System, Greenville, SC (S.W.)
| | - Marios Psychogios
- Department of Radiology, University Hospital Basel, Switzerland (M.P.)
| | - Eric C Peterson
- Department of Neurosurgery, University of Miami, FL (J.D.B., S.H.C., E.M.L., E.C.P., D.R.Y., R.M.S.)
| | - Dileep R Yavagal
- Department of Neurosurgery, University of Miami, FL (J.D.B., S.H.C., E.M.L., E.C.P., D.R.Y., R.M.S.)
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston (E.A., S.A.K., A.M.S.)
| | - Robert M Starke
- Department of Neurosurgery, University of Miami, FL (J.D.B., S.H.C., E.M.L., E.C.P., D.R.Y., R.M.S.)
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Brown PA, Wolfe SQ, Fargen KM. Perspective: Correlation Between Intracranial Pressure and Venous Sinus Pressures in Idiopathic Intracranial Hypertension. World Neurosurg 2021; 152:235-236. [PMID: 34340283 DOI: 10.1016/j.wneu.2021.05.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Patrick A Brown
- Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Stacey Q Wolfe
- Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Kyle M Fargen
- Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
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35
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Gadgil N, Aldave G, Whitehead WE, Dmytriw AA, Chen K, Orbach D, Maier I, Behme D, Fargen KM, Elijovich L, Dornbos D, Spiotta A, Kan P. Endovascular Intervention for Refractory Pediatric Cerebral Venous Sinus Thrombosis. Pediatr Neurol 2021; 121:45-50. [PMID: 34147818 DOI: 10.1016/j.pediatrneurol.2021.05.004] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/18/2021] [Accepted: 05/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cerebral venous sinus thrombosis (CVST) is a rare but potentially morbid disease in the pediatric population, and the optimal treatment is not fully understood. Endovascular intervention for this condition has been rarely reported. METHODS The Stroke Thrombectomy and Aneurysm Registry was queried for patients aged less than or equal to 18 years undergoing endovascular treatment for CVST in the past 10 years. Clinical charts and radiographic data were retrospectively reviewed. Modified Rankin Score (mRS) at 90 days postprocedure was determined as the primary outcome. RESULTS A total of seven patients across five pediatric centers ranging from 7 to 16 years of age were identified with a mean follow-up of 28 months. All had underlying conditions predisposing to CVST. Endovascular intervention was undertaken due to neurological deterioration despite systemic anticoagulation; venous infarct was evident preoperatively in six of seven patients. Mechanical venous thrombectomy was attempted in all individuals, and intrasinus thrombolytic therapy was also performed in three cases. Six patients had favorable outcome with mRS 0 or 1 at 90 days postprocedure; one remained neurologically devastated. CONCLUSIONS Endovascular treatment by an experienced interventionalist may be safe and effective in severe cases of CVST in children failing frontline therapy. Children with radiographic or clinical progression despite anticoagulation may be considered for endovascular intervention in a timely manner.
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Affiliation(s)
- Nisha Gadgil
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Baylor College of Medicine/ Texas Children's Hospital, Houston, Texas
| | - Guillermo Aldave
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Baylor College of Medicine/ Texas Children's Hospital, Houston, Texas
| | - William E Whitehead
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Baylor College of Medicine/ Texas Children's Hospital, Houston, Texas
| | - Adam A Dmytriw
- Department of Neurointerventional Radiology, Boston Children's Hospital/ Harvard Medical School, Boston, Massachusetts
| | - Karen Chen
- Department of Neurointerventional Radiology, Boston Children's Hospital/ Harvard Medical School, Boston, Massachusetts
| | - Darren Orbach
- Department of Neurointerventional Radiology, Boston Children's Hospital/ Harvard Medical School, Boston, Massachusetts
| | - Ilko Maier
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Daniel Behme
- Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany
| | - Kyle M Fargen
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Caroline
| | - Lucas Elijovich
- Department of Neurology and Neurosurgery, Semmes-Murphey Clinic and University of Tennessee Health Science Center, Memphis, Tennessee
| | - David Dornbos
- Department of Neurological Surgery, Semmes-Murphey Clinic and University of Tennessee Health Science Center, Memphis, Tennessee
| | - Alejandro Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
| | - Peter Kan
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas.
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36
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Oravec CS, Tschoe C, Fargen KM, Kittel CA, Spiotta A, Almallouhi E, Starke RM, McCarthy DJ, Simon S, Zyck S, Gould GC, De Leacy R, Mocco J, Siddiqui A, Vaziri S, Fox WC, Fraser JF, Chitale R, Zipfel G, Huguenard A, Wolfe SQ. Trends in mechanical thrombectomy and decompressive hemicraniectomy for stroke: A multicenter study. Neuroradiol J 2021; 35:170-176. [PMID: 34269121 DOI: 10.1177/19714009211030526] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE Acute ischemic stroke has increasingly become a procedural disease following the demonstrated benefit of mechanical thrombectomy (MT) for emergent large vessel occlusion (ELVO) on clinical outcomes and tissue salvage in randomized trials. Given these data and anecdotal experience of decreased numbers of decompressive hemicraniectomies (DHCs) performed for malignant cerebral edema, we sought to correlate the numbers of strokes, thrombectomies, and DHCs performed over the timeline of the 2013 failed thrombolysis/thrombectomy trials, to the 2015 modern randomized MT trials, to post-DAWN and DEFUSE 3. MATERIALS AND METHODS This is a multicenter retrospective compilation of patients who presented with ELVO in 11 US high-volume comprehensive stroke centers. Rates of tissue plasminogen activator (tPA), thrombectomy, and DHC were determined by current procedural terminology code, and specificity to acute ischemic stroke confirmed by each institution. Endpoints included the incidence of stroke, thrombectomy, and DHC and rates of change over time. RESULTS Between 2013 and 2018, there were 55,247 stroke admissions across 11 participating centers. Of these, 6145 received tPA, 4122 underwent thrombectomy, and 662 patients underwent hemicraniectomy. The trajectories of procedure rates over time were modeled and there was a significant change in MT rate (p = 0.002) without a concomitant change in the total number of stroke admissions, tPA administration rate, or rate of DHC. CONCLUSIONS This real-world study confirms an increase in thrombectomy performed for ELVO while demonstrating stable rates of stroke admission, tPA administration and DHC. Unlike prior studies, increasing thrombectomy rates were not associated with decreased utilization of hemicraniectomy.
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Affiliation(s)
- Chesney S Oravec
- Department of Neurosurgery, Wake Forest Baptist Medical Center, USA
| | - Christine Tschoe
- Department of Neurosurgery, Wake Forest Baptist Medical Center, USA
| | - Kyle M Fargen
- Department of Neurosurgery, Wake Forest Baptist Medical Center, USA
| | - Carol A Kittel
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Justin F Fraser
- Departments of Neurological Surgery, Neurology, Radiology, and Neuroscience, University of Kentucky, USA
| | | | | | | | - Stacey Q Wolfe
- Department of Neurosurgery, Wake Forest Baptist Medical Center, USA
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37
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Lee KE, McMullen N, Kota H, Peterson K, Oravec C, Frey C, Kittel CA, Wolfe SQ, Fargen KM. Predictors of Citations in Neurosurgical Research: A 5-Year Follow-Up. World Neurosurg 2021; 153:e66-e75. [PMID: 34129967 DOI: 10.1016/j.wneu.2021.06.029] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/06/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Citation rates are an important measure for the impact of articles. This study is the most comprehensive analysis of predictors for scientific neurosurgical research articles. METHODS Scientific articles published in 13 neurosurgical journals in 2015 were selected. Data collected included article subject, level of evidence (LOE), journal impact factor (IF), authorship, contributing centers, and study design. Citation counts were collected for each article in Web of Science (WoS) and Google Scholar (GS) 2.5 and 5 years after publication and Scopus 5 years after publication. A generalized linear mixed-effects model using the predictors of search engine, LOE, number of centers, number of authors, and IF was constructed to predict total citation count at 5 years. RESULTS A total of 2867 articles generated 39,190 citations in WoS, 61,682 in GS, and 43,481 in Scopus. The median number of citations per article was 10 (interquartile range [IQR], 14) in WoS, 15 (IQR, 20) in GS, and 11 (IQR, 15) in Scopus. On average, for every 1 citation in WoS, Scopus and GS identified 1.11 and 1.58 citations, respectively. Significant predictors of citation count in all databases 5 years after publication included search engine, LOE, number of centers, number of authors, number of countries, journal IF, and the month of publication (P < 0.05). The article subject (e.g., tumor or spine) did not significantly predict citation counts. CONCLUSIONS In the most thorough analysis of citation predictors in the neurosurgical literature, search engine, LOE, number of centers, number of authors, number of countries, journal impact factor, and month of publication influenced citations 5 years after publication.
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Affiliation(s)
- Katriel E Lee
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
| | - Nathan McMullen
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Hari Kota
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Keyan Peterson
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Chesney Oravec
- Department of Neurosurgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Casey Frey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Carol A Kittel
- Division of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, North Carolina, USA
| | - Stacey Q Wolfe
- Department of Neurosurgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Kyle M Fargen
- Department of Neurosurgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
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38
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Al Kasab S, Almallouhi E, Alawieh A, Wolfe S, Fargen KM, Arthur AS, Goyal N, Dumont T, Kan P, Kim JT, De Leacy R, Maier I, Osbun J, Rai A, Jabbour P, Grossberg JA, Park MS, Starke RM, Crosa R, Spiotta AM. Outcomes of Rescue Endovascular Treatment of Emergent Large Vessel Occlusion in Patients With Underlying Intracranial Atherosclerosis: Insights From STAR. J Am Heart Assoc 2021; 10:e020195. [PMID: 34096337 PMCID: PMC8477850 DOI: 10.1161/jaha.120.020195] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Some emergent large vessel occlusions (ELVOs) are refractory to reperfusion because of underlying intracranial atherosclerosis (ICAS), often requiring rescue therapy (RT) with balloon angioplasty, stenting, or both. In this study, we investigate the safety, efficacy, and long‐term outcomes of RT in the setting of mechanical thrombectomy for ICAS‐related ELVO. Methods and Results We queried the databases of 10 thrombectomy‐capable centers in North America and Europe included in STAR (Stroke Thrombectomy and Aneurysm Registry). Patients with ELVO who underwent ICAS‐related RT were included. A matched sample was produced for variables of age, admission National Institute of Health Stroke Scale, Alberta Stroke Program Early CT Score, onset to groin puncture time, occlusion site, and final recanalization. Out of 3025 patients with MT, 182 (6%) patients required RT because of underlying ICAS. Balloon angioplasty was performed on 122 patients, and 117 patients had intracranial stenting. In the matched analysis, 141 patients who received RT matched to a similar number of controls. The number of thrombectomy passes was higher (3 versus 1, P<0.001), and procedural time was longer in the RT group (52 minutes versus 36 minutes, P=0.004). There was a higher rate of symptomatic hemorrhagic transformation in the RT group (7.8% versus 4.3%, P=0.211), however, the difference was not significant. There was no difference in 90‐day modified Rankin scale of 0 to 2 (44% versus 47.5%, P=0.543) between patients in the RT and control groups. Conclusions In patients with ELVO with underlying ICAS requiring RT, despite longer procedure time and a more thrombectomy passes, the 90 days favorable outcomes were comparable with patients with embolic ELVO.
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Affiliation(s)
- Sami Al Kasab
- Department of Neurology Medical University of South Carolina Charleston SC.,Department of Neurosurgery Medical University of South Carolina Charleston SC
| | - Eyad Almallouhi
- Department of Neurology Medical University of South Carolina Charleston SC.,Department of Neurosurgery Medical University of South Carolina Charleston SC
| | - Ali Alawieh
- Department of Neurosurgery Emory University School of Medicine Atlanta GA
| | - Stacey Wolfe
- Department of Neurosurgery Wake Forest School of Medicine Winston Salem NC
| | - Kyle M Fargen
- Department of Neurosurgery Wake Forest School of Medicine Winston Salem NC
| | - Adam S Arthur
- Department of Neurosurgery Semmes-Murphey Neurologic and Spine Clinic University of Tennessee Health Science Center Memphis TN
| | - Nitin Goyal
- Department of Neurosurgery Semmes-Murphey Neurologic and Spine Clinic University of Tennessee Health Science Center Memphis TN.,Department of Neurology University of Tennessee Health Science Center Memphis TN
| | - Travis Dumont
- Department of Neurosurgery University of Arizona Health Sciences Tucson AZ
| | - Peter Kan
- Department of Neurosurgery Baylor School of Medicine Houston TX
| | - Joon-Tae Kim
- Department of Neurology Chonnam National University Hospital Seoul South Korea
| | - Reade De Leacy
- Department of Neurosurgery Mount Sinai Health System New York NY
| | - Ilko Maier
- Department of Neurology University Medical Center Göttingen Göttingen Germany
| | - Joshua Osbun
- Department of Neurosurgery Washington University of School of Medicine St. Louis MO
| | - Ansaar Rai
- Department of Radiology West Virginia School of Medicine Morgantown WV
| | - Pascal Jabbour
- Department of Neurosurgery Thomas Jefferson University Hospitals Philadelphia PA
| | | | - Min S Park
- Department of Neurosurgery University of Virginia Charlottesville VA
| | - Robert M Starke
- Department of Neurosurgery University of Miami Health System Miami FL
| | - Roberto Crosa
- Department of Neurosurgery Endovascular Neurological Center Médica Uruguaya Montevideo Uruguay
| | - Alejandro M Spiotta
- Department of Neurosurgery Medical University of South Carolina Charleston SC
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39
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Milburn JM, Regenhardt RW, Fiehler J, Fargen KM, Hirsch JA. COVID-19 meets neurointervention on the pages of JNIS. J Neurointerv Surg 2021; 13:863-864. [PMID: 34083396 DOI: 10.1136/neurintsurg-2021-017722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2021] [Indexed: 11/04/2022]
Affiliation(s)
- James M Milburn
- Department of Radiology, Ochsner Health System, New Orleans, Louisiana, USA
| | - Robert W Regenhardt
- NeuroEndovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jens Fiehler
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Kyle M Fargen
- Department of Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Joshua A Hirsch
- NeuroEndovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
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40
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Townsend RK, Jost A, Amans MR, Hui F, Bender MT, Satti SR, Maurer R, Liu K, Brinjikji W, Fargen KM. Major complications of dural venous sinus stenting for idiopathic intracranial hypertension: case series and management considerations. J Neurointerv Surg 2021; 14:neurintsurg-2021-017361. [PMID: 33911014 DOI: 10.1136/neurintsurg-2021-017361] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 01/27/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Venous sinus stenting (VSS) is a safe, effective, and increasingly popular treatment option for selected patients with idiopathic intracranial hypertension (IIH). Serious complications associated with VSS are rarely reported. METHODS Serious complications after VSS were identified retrospectively from multicenter databases. The cases are presented and management strategies are discussed. RESULTS Six major acute and chronic complications after VSS were selected from a total of 811 VSS procedures and 1466 venograms for IIH. These included an acute subdural hematoma from venous extravasation, cases of both intraprocedural and delayed stent thrombosis, an ultimately fatal cerebellar hemorrhage resulting in acute obstructive hydrocephalus, venous microcatheter perforation during venography and manometry, and a patient who developed subarachnoid hemorrhage and subdural hematoma after cerebellar cortical vein perforation. The six cases are reviewed and learning points regarding complication avoidance and management are presented. CONCLUSION We report on six rare, major complications after VSS for IIH. Familiarity with these potential complications and appropriate timely management may allow for good clinical outcomes.
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Affiliation(s)
- Robert Kyle Townsend
- Neurological Surgery, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Alec Jost
- Wake Forest School of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Matthew R Amans
- Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| | - Ferdinand Hui
- Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Matthew T Bender
- Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| | | | - Robert Maurer
- Neurosurgery, Penn State Health Neurosurgery, Hershey, Pennsylvania, USA
| | - Kenneth Liu
- Neurosurgery, University of Southern California, Los Angeles, California, USA
| | | | - Kyle M Fargen
- Neurosurgery, Wake Forest University, Winston-Salem, North Carolina, USA
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41
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Al Kasab S, Almallouhi E, Alawieh A, Jabbour P, Sweid A, Starke RM, Saini V, Wolfe SQ, Fargen KM, Arthur AS, Goyal N, Pandhi A, Maier I, Grossberg JA, Howard BM, Tjoumakaris SI, Rai A, Park MS, Mascitelli JR, Psychogios MN, Spiotta AM. Alarming downtrend in mechanical thrombectomy rates in African American patients during the COVID-19 pandemic-Insights from STAR. J Neurointerv Surg 2021; 13:304-307. [PMID: 33408256 PMCID: PMC8895862 DOI: 10.1136/neurintsurg-2020-016946] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/11/2020] [Accepted: 12/12/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND The coronavirus disease (COVID-19) pandemic has affected stroke care globally. In this study, we aim to evaluate the impact of the current pandemic on racial disparities among stroke patients receiving mechanical thrombectomy (MT). METHODS We used the prospectively collected data in the Stroke Thrombectomy and Aneurysm Registry from 12 thrombectomy-capable stroke centers in the US and Europe. We included acute stroke patients who underwent MT between January 2017 and May 2020. We compared baseline features, vascular risk factors, location of occlusion, procedural metrics, complications, and discharge outcomes between patients presenting before (before February 2020) and those who presented during the pandemic (February to May 2020). RESULTS We identified 2083 stroke patients: of those 235 (11.3%) underwent MT during the COVID-19 pandemic. Compared with pre-pandemic, stroke patients who received MT during the pandemic had longer procedure duration (44 vs 38 min, P=0.006), longer length of hospitalization (6 vs 4 days, P<0.001), and higher in-hospital mortality (18.7% vs 11%, P<0.001). Importantly, there was a lower number of African American patients undergoing MT during the COVID-19 pandemic (609 (32.9%) vs 56 (23.8%); P=0.004). CONCLUSION The COVID-19 pandemic has affected the care process for stroke patients receiving MT globally. There is a significant decline in the number of African American patients receiving MT, which mandates further investigation.
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Affiliation(s)
- Sami Al Kasab
- Neurosurgery, Medical University of South
Carolina, Charleston, SC, USA
- Neurology,
Medical University of South Carolina, Charleston, SC, USA
| | | | - Eyad Almallouhi
- Neurosurgery, Medical University of South
Carolina, Charleston, SC, USA
- Neurology,
Medical University of South Carolina, Charleston, SC, USA
| | - Ali Alawieh
- Neurosurgery, Emory University, Atlanta, GA,
USA
- Microbiology and
Immunology, Medical University of South Carolina,
Charleston, SC, USA
| | - Pascal Jabbour
- Neurological
Surgery, Thomas Jefferson University Hospital,
Philadelphia, PA, USA
| | - Ahmad Sweid
- Neurological
Surgery, Thomas Jefferson University Hospital,
Philadelphia, PA, USA
| | - Robert M Starke
- Neurological
Surgery, University of Miami Miller School of
Medicine, Miami, FL, USA
| | - Vasu Saini
- Neurological
Surgery, University of Miami Miller School of
Medicine, Miami, FL, USA
| | - Stacey Q Wolfe
- Neurosurgery, Wake Forest School of Medicine,
Winston-Salem, NC, USA
| | - Kyle M Fargen
- Neurosurgery, Wake Forest University, Winston-Salem, NC, USA
| | - Adam S Arthur
- Neurosurgery, Semmes-Murphey Neurologic and Spine
Institute, Memphis, Tennessee, USA
- Neurosurgery, University of Tennessee Health Science
Center, Memphis, Tennessee, USA
| | - Nitin Goyal
- Neurosurgery, University of Tennessee Health Science
Center, Memphis, Tennessee, USA
| | - Abhi Pandhi
- Neurology, University of Tennessee Health Science Center
College of Medicine, Memphis,
Tennessee, USA
| | - Ilko Maier
- Neurology, University Medicine Goettingen,
Goettingen, NS, Germany
| | - Jonathan A Grossberg
- Neurosurgery and
Radiology, Emory University School of Medicine,
Atlanta, Georgia, USA
| | - Brian M Howard
- Neurosurgery, Emory University School of
Medicine, Atlanta, Georgia, USA
- Radiology and Imaging
Sciences, Emory University School of Medicine,
Atlanta, Georgia, USA
| | | | - Ansaar Rai
- Radiology, West Virginia University Hospitals,
Morgantown, West Virginia, USA
| | - Min S Park
- Neurosurgery, Barrow Neurological Institute,
Phoenix, Arizona, USA
| | - Justin R Mascitelli
- Neurosurgery, University of Texas Health Science Center at San
Antonio, San Antonio, Texas, USA
| | - Marios N Psychogios
- Department of
Neuroradiology, Clinic of Radiology and Nuclear Medicine,
University Hospital Basel, Basel, Switzerland
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42
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Fargen KM, Lee SK, Mokin M, Kayan Y, De Leacy R, Al-Mufti F, Ansari SA, Haranhalli N, Prestigiacomo CJ, Schirmer CM, Fraser JF, Hetts SW. Social media usage for neurointerventionalists: report of the Society of NeuroInterventional Surgery Standards and Guidelines Committee. J Neurointerv Surg 2021; 13:674-678. [PMID: 33722972 DOI: 10.1136/neurintsurg-2021-017278] [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: 01/04/2021] [Revised: 02/09/2021] [Accepted: 02/14/2021] [Indexed: 11/03/2022]
Abstract
The purpose of this publication is to provide a review of social media usage by neurointerventionalists. Using published literature and available local, regional, and national guidelines or laws, we reviewed data on social media usage as it pertains to neurointerventional surgery. Recommendations are provided based on the quality of information and conformity of medico-legal precedent and law. Social media is a growing entity as it is used both promotionally and educationally. Neurointerventionalists may post de-identified radiographic images with discussions, but should be conscientious and adhere to applicable laws and regulations, strict ethical codes, and institutional policies.
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Affiliation(s)
- Kyle M Fargen
- Neurosurgery, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Seon-Kyu Lee
- Radiology, Montefiore Hospital and Medical Center, Bronx, New York, USA
| | - Maxim Mokin
- Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - Yasha Kayan
- Interventional Neuroradiology, Abbot Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Reade De Leacy
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Fawaz Al-Mufti
- Neurology and Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Sameer A Ansari
- Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Neil Haranhalli
- Neurosurgery, Montefiore Hospital and Medical Center, Bronx, New York, USA
| | | | | | - Justin F Fraser
- Neurological Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Steven W Hetts
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
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43
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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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44
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Lee K, Kittel C, Aldridge JB, Wolfe SQ, Brown P, Fargen KM. Correlation between intracranial pressure and venous sinus pressures in patients undergoing cerebral venography and manometry. J Neurointerv Surg 2021; 13:1162-1166. [PMID: 33674395 DOI: 10.1136/neurintsurg-2020-017161] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 11/28/2020] [Revised: 01/08/2021] [Accepted: 01/09/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The pathophysiology of idiopathic intracranial hypertension (IIH) is complex but is directly related to cerebral venous hypertension. Few studies have simultaneously recorded venous sinus pressures and lumbar puncture (LP) opening pressure (OP) to understand the relationship between these factors without temporal confounding. METHODS A retrospective review was performed of patients with a known or suspected diagnosis of IIH who underwent cerebral venography with manometry followed immediately by LP. RESULTS 47 patients aged 16-68 years met inclusion criteria. 91.5% were female. Mean body mass index (BMI) was 33.3 kg/m2. Of the included patients, median OP was 21 cm H2O (IQR (15.5, 26.5)). Mean (SD) recorded superior sagittal sinus (SSS) and torcular pressures were 25.5 (16.5) mm Hg and 23.8 (16.6) mm Hg, respectively. Twenty patients (42.6%) were discovered to have a trans-stenosis gradient of 8 mm Hg or greater. Transverse sinus, torcula, and SSS pressures were all significantly predicted by OP. On regression analysis, torcular pressures were best predicted by OP of the three measured sites. For 17 patients with OP <20 cm H2O (36.2%), mean (SD) SSS and torcular pressures were 13.5 (4.2) mm Hg and 15.4 (6.7) mm Hg, respectively, suggesting that normally SSS pressures should measure <18 mm Hg (80th percentile) in non-pathologic conditions. CONCLUSIONS This is the first study to correlate venous sinus pressures and OP in patients with IIH with LP performed directly after manometry. In 47 patients, LP OP significantly predicted transverse sinus, torcula, and SSS pressures. Torcular pressures (mm Hg) were most accurately predicted by OP (cm H2O) in a nearly one-to-one relationship.
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Affiliation(s)
- Katriel Lee
- Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Carol Kittel
- Division of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, NC, USA
| | | | - Stacey Q Wolfe
- Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Patrick Brown
- Department of Radiology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Kyle M Fargen
- Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
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45
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Fargen KM. A unifying theory explaining venous sinus stenosis and recurrent stenosis following venous sinus stenting in patients with idiopathic intracranial hypertension. J Neurointerv Surg 2021; 13:587-592. [PMID: 33579755 DOI: 10.1136/neurintsurg-2020-017208] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Kyle M Fargen
- Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
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46
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Tschoe C, Kim TE, Fargen KM, Wolfe SQ. Cerebral arteriopathy in ACTA2 mutations: a spectrum of disease highlighted by a case of variable penetrance in two siblings. J Neurosurg Pediatr 2021; 27:446-451. [PMID: 33513575 DOI: 10.3171/2020.8.peds20391] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/17/2020] [Indexed: 11/06/2022]
Abstract
Until recently, cerebral arteriopathy due to heterozygous mutations of the ACTA2 gene was considered a variant of moyamoya disease. However, radiographic analysis of patients with these mutations reveals a distinctive angiographic appearance from that seen in moyamoya disease. Several heterozygous missense ACTA2 mutations have been implicated in the development of this distinct cerebrovascular entity; however, the penetrance and systemic manifestations of these mutations vary based on the location of the amino acid replacement within the α-smooth muscle actin protein. The severity of the phenotype may also differ among patients within a single mutation type. There is limited literature on the safety and efficacy of revascularization procedures for ACTA2 arteriopathy, which have been limited to those patients with known Arg179His mutations. The authors provide a review of the breadth of mutations within the ACTA2 literature and report a case of two siblings with de novo ACTA2 Arg258Cys mutations with differing clinical courses, highlighting the utility of indirect revascularization with 8-year follow-up data. This case highlights the importance of early recognition of the angiographic appearance of ACTA2 cerebral arteriopathy and performance of genetic testing, as the location of the mutation impacts clinical presentation and outcomes.
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Affiliation(s)
- Christine Tschoe
- Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Teddy E. Kim
- Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Kyle M. Fargen
- Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Stacey Q. Wolfe
- Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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47
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Li Y, Chen SH, Spiotta AM, Jabbour P, Levitt MR, Kan P, Griessenauer CJ, Arthur AS, Osbun JW, Park MS, Chalouhi N, Sweid A, Wolfe SQ, Fargen KM, Dumont AS, Dumont TM, Brunet MC, Sur S, Luther E, Strickland A, Yavagal DR, Peterson EC, Schirmer CM, Goren O, Dalal S, Weiner G, Rosengart A, Raper D, Chen CJ, Amenta P, Scullen T, Kelly CM, Young C, Nahhas M, Almallouhi E, Gunasekaran A, Pai S, Lanzino G, Brinjikji W, Abbasi M, Dornbos Iii D, Goyal N, Peterson J, El-Ghanem MH, Starke RM. Lower complication rates associated with transradial versus transfemoral flow diverting stent placement. J Neurointerv Surg 2021; 13:91-95. [PMID: 32487766 PMCID: PMC7708402 DOI: 10.1136/neurintsurg-2020-015992] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [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: 03/04/2020] [Revised: 04/25/2020] [Accepted: 04/28/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Currently, there are no large-scale studies in the neurointerventional literature comparing safety between transradial (TRA) and transfemoral (TFA) approaches for flow diversion procedures. This study aims to assess complication rates in a large multicenter registry for TRA versus TFA flow diversion. METHODS We retrospectively analyzed flow diversion cases for cerebral aneurysms from 14 institutions from 2010 to 2019. Pooled analysis of proportions was calculated using weighted analysis with 95% CI to account for results from multiple centers. Access site complication rate and overall complication rate were compared between the two approaches. RESULTS A total of 2,285 patients who underwent flow diversion were analyzed, with 134 (5.86%) treated with TRA and 2151 (94.14%) via TFA. The two groups shared similar patient and aneurysm characteristics. Crossover from TRA to TFA was documented in 12 (8.63%) patients. There were no access site complications in the TRA group. There was a significantly higher access site complication rate in the TFA cohort as compared with TRA (2.48%, 95% CI 2.40% to 2.57%, vs 0%; p=0.039). One death resulted from a femoral access site complication. The overall complications rate was also higher in the TFA group (9.02%, 95% CI 8.15% to 9.89%) compared with the TRA group (3.73%, 95% CI 3.13% to 4.28%; p=0.035). CONCLUSION TRA may be a safer approach for flow diversion to treat cerebral aneurysms at a wide range of locations. Both access site complication rate and overall complication rate were lower for TRA flow diversion compared with TFA in this large series.
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Affiliation(s)
- Yangchun Li
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Stephanie H Chen
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - Alejandro M Spiotta
- Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Pascal Jabbour
- Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Michael R Levitt
- Neurological Surgery, Radiology and Mechanical Engineering and Stroke and Applied Neuroscience Center, University of Washington, Seattle, Washington, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Christoph J Griessenauer
- Neurosurgery, Geisinger Health System, Danville, Pennsylvania, USA
- Research Institute of Neurointervention, Paracelsus Medical University Salzburg, Salzburg, Salzburg, Austria
| | - Adam S Arthur
- Department of Neurological Surgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
- Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Joshua W Osbun
- Neurosurgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
| | - Min S Park
- Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Nohra Chalouhi
- Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Ahmad Sweid
- Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Stacey Q Wolfe
- Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Kyle M Fargen
- Neurosurgery, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Aaron S Dumont
- Department of Neurological Surgery, Tulane University, New Orleans, Louisiana, USA
| | - Travis M Dumont
- Neurosurgery, Neurology and Medical Imaging, University of Arizona/Arizona Health Science Center, Tucson, Arizona, USA
| | - Marie-Christine Brunet
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - Samir Sur
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Evan Luther
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - Allison Strickland
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - Dileep R Yavagal
- Neurology and Neurosurgery, University of Miami, Miami, Florida, USA
| | - Eric C Peterson
- Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Clemens M Schirmer
- Neurosurgery, Geisinger Health System, Danville, Pennsylvania, USA
- Research Institute of Neurointervention, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Oded Goren
- Neurosurgery, Geisinger, Danville, Pennsylvania, USA
| | - Shamsher Dalal
- Neurosurgery, Geisinger Health System, Danville, Pennsylvania, USA
| | - Gregory Weiner
- Neurosurgery, Geisinger Health System, Wilkes-Barre, Pennsylvania, USA
| | - Axel Rosengart
- Neurosurgery, Geisinger Health System, Danville, Pennsylvania, USA
| | - Daniel Raper
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Ching-Jen Chen
- Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Peter Amenta
- Neurological Surgery, Tulane Medical Center Downtown, New Orleans, Louisiana, USA
| | - Tyler Scullen
- Neurosurggery, Tulane University, New Orleans, Louisiana, USA
| | - Cory Michael Kelly
- Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Christopher Young
- Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Michael Nahhas
- Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Eyad Almallouhi
- Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Suhas Pai
- Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | | | - Mehdi Abbasi
- Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - David Dornbos Iii
- Neurosurgery, Semmes-Murphey Clinic, Memphis, Tennessee, USA
- Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
| | - Nitin Goyal
- Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Jeremy Peterson
- Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
| | - Mohammad H El-Ghanem
- Neurosurgery, Neurology and Medical Imaging, University of Arizona Health Sciences Center, Tucson, Arizona, USA
| | - Robert M Starke
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Radiology, University of Miami Miller School of Medicine, Miami, Florida, USA
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48
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Peterson KA, Kittel C, Lee KE, Garner R, Nechtman CM, Brown P, Wolfe SQ, Fargen KM. Angiographic cerebral venous sinus calibers and drainage patterns in patients with normal intracranial pressure and idiopathic intracranial hypertension. J Neurointerv Surg 2020; 13:958-963. [PMID: 33323500 DOI: 10.1136/neurintsurg-2020-016976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 10/12/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Normative venous sinus diameters are not well established. This study seeks to compare two-dimensional digital subtraction cerebral angiographic (DSA) venous sinus calibers for patients with normal intracranial pressure (ICP) and with idiopathic intracranial hypertension (IIH). METHODS Patients who underwent diagnostic cerebral angiography from 2016 to 2020 were retrospectively identified. Two independent reviewers measured venous sinus calibers from anteroposterior (AP) and lateral carotid injection delayed venous phase in patients from two groups (group 1: patients with normal ICP; group 2: patients with IIH) after receiving training in a standardized measurement protocol, with measurements obtained from the superior sagittal sinus (SSS) through the sigmoid sinuses (SS). RESULTS 97 patients from group 1 and 30 patients from group 2 were included. Interrater reliability was greater than 0.75 for all measured sites. Both groups had similar anatomical subtypes with most being right transverse sinus (TS) dominant or codominant. In group 1, men had significantly larger SSS on lateral view (p<0.001) and dominant TS calibers on AP view (p=0.02) compared with women. Both dominant TS measurements and SSS measurements (lateral plane) were significantly smaller among group 2 compared with group 1 (p<0.001 and 0.02, respectively). Patients with IIH had significantly larger dominant SS measurements (p=0.01). Bifid SSS anatomy was present in 9% of patients with mean caudal width 31 mm (range 19-49 mm). CONCLUSIONS This study is the first to provide two-dimensional DSA dural venous sinus calibers in patients with and without IIH and to compare anatomical drainage types and calibers among groups.
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Affiliation(s)
- Keyan A Peterson
- Department of Neurological Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Carol Kittel
- Division of Public Health Sciences, Department of Biostatistics, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Katriel E Lee
- Department of Neurological Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Rebecca Garner
- Department of Neurological Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Carl Mandel Nechtman
- Department of Neurological Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Patrick Brown
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Stacey Q Wolfe
- Department of Neurological Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Kyle M Fargen
- Department of Neurological Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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49
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Akbik F, Alawieh A, Cawley CM, Howard BM, Tong FC, Nahab F, Saad H, Dimisko L, Mustroph C, Samuels OB, Pradilla G, Maier I, Goyal N, Starke RM, Rai A, Fargen KM, Psychogios MN, Jabbour P, De Leacy R, Giles J, Dumont TM, Kan P, Arthur AS, Crosa RJ, Gory B, Spiotta AM, Grossberg JA. Differential effect of mechanical thrombectomy and intravenous thrombolysis in atrial fibrillation associated stroke. J Neurointerv Surg 2020; 13:883-888. [PMID: 33318066 DOI: 10.1136/neurintsurg-2020-016720] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/17/2020] [Accepted: 10/19/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) associated ischemic stroke has worse functional outcomes, less effective recanalization, and increased rates of hemorrhagic complications after intravenous thrombolysis (IVT). Limited data exist about the effect of AF on procedural and clinical outcomes after mechanical thrombectomy (MT). OBJECTIVE To determine whether recanalization efficacy, procedural speed, and clinical outcomes differ in AF associated stroke treated with MT. METHODS We performed a retrospective cohort study of the Stroke Thrombectomy and Aneurysm Registry (STAR) from January 2015 to December 2018 and identified 4169 patients who underwent MT for an anterior circulation stroke, 1517 (36.4 %) of whom had comorbid AF. Prospectively defined baseline characteristics, procedural outcomes, and clinical outcomes were reported and compared. RESULTS AF predicted faster procedural times, fewer passes, and higher rates of first pass success on multivariate analysis (p<0.01). AF had no effect on intracranial hemorrhage (aOR 0.69, 95% CI 0.43 to 1.12) or 90-day functional outcomes (aOR 1.17, 95% CI 0.91 to 1.50) after MT, although patients with AF were less likely to receive IVT (46% vs 54%, p<0.0001). CONCLUSIONS In patients treated with MT, comorbid AF is associated with faster procedural time, fewer passes, and increased rates of first pass success without increased risk of intracranial hemorrhage or worse functional outcomes. These results are in contrast to the increased hemorrhage rates and worse functional outcomes observed in AF associated stroke treated with supportive care and or IVT. These data suggest that MT negates the AF penalty in ischemic stroke.
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Affiliation(s)
- Feras Akbik
- Department of Neurology, Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Ali Alawieh
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - C Michael Cawley
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Brian M Howard
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Frank C Tong
- Department of Radiology, Emory University, Altanta, Georgia, USA
| | - Fadi Nahab
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Hassan Saad
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | | | | | - Owen B Samuels
- Department of Neurology, Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Gustavo Pradilla
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Ilko Maier
- Department of Neurology, University Medicine Goettingen, Goettingen, NS, Germany
| | - Nitin Goyal
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Robert M Starke
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami Beach, Florida, USA
| | - Ansaar Rai
- Radiology, West Virginia University Hospitals, Morgantown, West Virginia, USA
| | - Kyle M Fargen
- Neurosurgery, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Marios N Psychogios
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Reade De Leacy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - James Giles
- Department of Neurology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Travis M Dumont
- Department of Surgery, Division of Neurosurgery, University of Arizona/Arizona Health Science Center, Tucson, Arizona, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Adam S Arthur
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.,Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Roberto Javier Crosa
- Department of Endovascular Neurosurgery, Médica Uruguaya, Montevideo, Montevideo, Uruguay
| | - Benjamin Gory
- Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, Lorraine, France
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jonathan A Grossberg
- Department of Neurosurgery and Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
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Li Y, Chen SH, Spiotta AM, Jabbour P, Levitt MR, Kan P, Griessenauer CJ, Arthur AS, Osbun JW, Park MS, Chalouhi NE, Sweid A, Wolfe SQ, Fargen KM, Dumont AS, Dumont TM, Brunet MC, Sur S, Luther E, Strickland A, Yavagal DR, Peterson EC, Schirmer CM, Goren O, Dalal S, Weiner G, Rosengart A, Raper D, Chen CJ, Amenta PS, Scullen T, Kelly C, Young CC, Nahhas M, Almallouhi E, Gunasekaran A, Pai S, Lanzino G, Brinjikji W, Abbasi M, Dornbos D, Goyal N, Peterson JC, El-Ghanem M, Starke RM. Lower Complication Rates Associated with Transradial vs. Transfemoral Flow Diverting Stent Placement. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_237] [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: 11/13/2022] Open
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