Subjects -> PUBLIC ADMINISTRATION (Total: 284 journals)
    - MUNICIPAL GOVERNMENT (9 journals)
    - PUBLIC ADMINISTRATION (248 journals)
    - SECURITY (27 journals)

PUBLIC ADMINISTRATION (248 journals)                  1 2 | Last

Showing 1 - 200 of 357 Journals sorted by number of followers
Police Journal : Theory, Practice and Principles     Hybrid Journal   (Followers: 322)
Journal of Management & Organization     Full-text available via subscription   (Followers: 277)
Academy of Management Annals     Full-text available via subscription   (Followers: 93)
Journal of European Public Policy     Hybrid Journal   (Followers: 71)
Governance : An International Journal of Policy, Administration and Institutions     Hybrid Journal   (Followers: 55)
Public Administration Review     Hybrid Journal   (Followers: 53)
International Journal of Public Leadership     Hybrid Journal   (Followers: 51)
Journal of Public Administration Research and Theory     Hybrid Journal   (Followers: 46)
Public Administration     Hybrid Journal   (Followers: 41)
European Journal of Social Work     Hybrid Journal   (Followers: 35)
Social Policy & Administration     Hybrid Journal   (Followers: 31)
International Journal of Public Administration     Hybrid Journal   (Followers: 29)
Clinical Social Work Journal     Hybrid Journal   (Followers: 28)
Government Information Quarterly     Hybrid Journal   (Followers: 28)
Human Resource Development Quarterly     Hybrid Journal   (Followers: 28)
Journal of Public Administration     Full-text available via subscription   (Followers: 28)
Government and Opposition     Full-text available via subscription   (Followers: 27)
Cities     Hybrid Journal   (Followers: 26)
Public Choice     Hybrid Journal   (Followers: 26)
Human Service Organizations Management, Leadership and Governance     Hybrid Journal   (Followers: 24)
Public Policy and Administration     Hybrid Journal   (Followers: 24)
American Review of Public Administration     Hybrid Journal   (Followers: 24)
Journal of Public Administration and Governance     Open Access   (Followers: 24)
Public Policy And Administration     Open Access   (Followers: 24)
Journal of Nursing Management     Hybrid Journal   (Followers: 23)
Prison Journal     Hybrid Journal   (Followers: 22)
Evaluation     Hybrid Journal   (Followers: 21)
Public Administration and Development     Hybrid Journal   (Followers: 19)
The Review of International Organizations     Hybrid Journal   (Followers: 19)
Public Policy and Administration Research     Open Access   (Followers: 19)
Poverty & Public Policy     Hybrid Journal   (Followers: 17)
Law, Innovation and Technology     Hybrid Journal   (Followers: 16)
Public Policy     Full-text available via subscription   (Followers: 16)
Australian Social Work     Hybrid Journal   (Followers: 15)
Critical Policy Studies     Hybrid Journal   (Followers: 15)
Journal of Social Work Education     Hybrid Journal   (Followers: 15)
International Review of Public Administration     Hybrid Journal   (Followers: 15)
Administration     Open Access   (Followers: 15)
Journal of Public Administration and Policy Research     Open Access   (Followers: 15)
Electronic Government, an International Journal     Hybrid Journal   (Followers: 14)
Policy Sciences     Hybrid Journal   (Followers: 14)
Policy Studies     Hybrid Journal   (Followers: 14)
Journal of Comparative Policy Analysis : Research and Practice     Hybrid Journal   (Followers: 14)
Social Work Education: The International Journal     Hybrid Journal   (Followers: 14)
Public Personnel Management     Hybrid Journal   (Followers: 14)
Local Government Studies     Hybrid Journal   (Followers: 13)
Social Service Review     Full-text available via subscription   (Followers: 12)
Policy & Internet     Hybrid Journal   (Followers: 12)
Journal of Higher Education Outreach and Engagement     Open Access   (Followers: 12)
International Tax and Public Finance     Hybrid Journal   (Followers: 11)
Journal of Community Practice     Hybrid Journal   (Followers: 11)
International Journal of Public Sector Performance Management     Hybrid Journal   (Followers: 11)
Research on Economic Inequality     Hybrid Journal   (Followers: 10)
Politics and Governance     Open Access   (Followers: 10)
Citizenship Studies     Hybrid Journal   (Followers: 9)
Policy Studies Journal     Hybrid Journal   (Followers: 9)
Canadian Public Administration/Administration Publique Du Canada     Hybrid Journal   (Followers: 9)
eJournal of eDemocracy and Open Government     Open Access   (Followers: 9)
Asia Pacific Journal of Public Administration     Hybrid Journal   (Followers: 9)
Administrative Theory & Praxis     Full-text available via subscription   (Followers: 8)
Middle East Law and Governance     Hybrid Journal   (Followers: 8)
Frontiers in Public Health Services and Systems Research     Open Access   (Followers: 8)
Public Works Management & Policy     Hybrid Journal   (Followers: 7)
Publius: The Journal of Federalism     Hybrid Journal   (Followers: 7)
Gesundheitsökonomie & Qualitätsmanagement     Hybrid Journal   (Followers: 7)
Surveillance and Society     Open Access   (Followers: 7)
Public Sector     Full-text available via subscription   (Followers: 7)
State and Local Government Review     Hybrid Journal   (Followers: 7)
Journal of Entrepreneurship and Public Policy     Hybrid Journal   (Followers: 7)
Teaching Public Administration     Hybrid Journal   (Followers: 7)
Growth and Change     Hybrid Journal   (Followers: 6)
Journal of Developing Areas     Full-text available via subscription   (Followers: 6)
Just Policy: A Journal of Australian Social Policy     Full-text available via subscription   (Followers: 6)
PLOS Currents : Disasters     Open Access   (Followers: 6)
Public Organization Review     Hybrid Journal   (Followers: 5)
Law, Democracy & Development     Open Access   (Followers: 5)
Risk, Hazards & Crisis in Public Policy     Hybrid Journal   (Followers: 5)
NISPAcee Journal of Public Administration and Policy     Open Access   (Followers: 5)
Parliaments, Estates and Representation     Hybrid Journal   (Followers: 5)
European Journal of Government and Economics     Open Access   (Followers: 5)
Journal of Organisational Transformation & Social Change     Hybrid Journal   (Followers: 4)
Administrative Sciences     Open Access   (Followers: 4)
Commonwealth Journal of Local Governance     Open Access   (Followers: 4)
Singapore Economic Review, The     Hybrid Journal   (Followers: 4)
International Affairs and Global Strategy     Open Access   (Followers: 4)
Statistics and Public Policy     Open Access   (Followers: 4)
African Journal of Governance and Development     Open Access   (Followers: 4)
Africa’s Public Service Delivery and Performance Review     Open Access   (Followers: 4)
Policy & Governance Review     Open Access   (Followers: 4)
Journal of Governance and Public Policy     Open Access   (Followers: 4)
Journal of Public Budgeting, Accounting & Financial Management     Hybrid Journal   (Followers: 4)
Congress & the Presidency: A Journal of Capital Studies     Hybrid Journal   (Followers: 3)
International Journal of Environmental Policy and Decision Making     Hybrid Journal   (Followers: 3)
Electronic Journal of e-Government     Full-text available via subscription   (Followers: 3)
International Journal of Electronic Government Research     Full-text available via subscription   (Followers: 3)
International Journal of Information Systems for Crisis Response and Management     Full-text available via subscription   (Followers: 3)
Pittsburgh Tax Review     Open Access   (Followers: 3)
Nordic Tax Journal     Open Access   (Followers: 3)
Public Governance Research     Open Access   (Followers: 3)
Perspectives on Public Management and Governance     Full-text available via subscription   (Followers: 3)
Governance Journal     Open Access   (Followers: 3)
Études rurales     Open Access   (Followers: 2)
Gaceta Sanitaria     Open Access   (Followers: 2)
Accounting and the Public Interest     Full-text available via subscription   (Followers: 2)
Georgia Journal of Public Policy     Open Access   (Followers: 2)
Journal of Economic and Administrative Sciences     Hybrid Journal   (Followers: 2)
Regional Science Policy & Practice     Hybrid Journal   (Followers: 2)
Journal of Park and Recreation Administration     Full-text available via subscription   (Followers: 2)
Journal of Chinese Governance     Hybrid Journal   (Followers: 2)
European Policy Analysis     Hybrid Journal   (Followers: 2)
National Civic Review     Hybrid Journal   (Followers: 1)
Journal of Asian Public Policy     Hybrid Journal   (Followers: 1)
Cuadernos de Relaciones Laborales     Open Access   (Followers: 1)
Éthique publique     Open Access   (Followers: 1)
BAR. Brazilian Administration Review     Open Access   (Followers: 1)
Gestión y Política Pública     Open Access   (Followers: 1)
Federal Governance     Open Access   (Followers: 1)
Revista de Administração IMED     Open Access   (Followers: 1)
The Philanthropist     Open Access   (Followers: 1)
South Asian Journal of Macroeconomics and Public Finance     Hybrid Journal   (Followers: 1)
Studi Organizzativi     Full-text available via subscription   (Followers: 1)
Visión de futuro     Open Access   (Followers: 1)
Journal of Economics, Finance and Administrative Science     Open Access   (Followers: 1)
Journal of Development and Administrative Studies     Open Access   (Followers: 1)
In Vestigium Ire     Open Access   (Followers: 1)
Revista Desenvolvimento Social     Open Access   (Followers: 1)
Tendencias     Open Access   (Followers: 1)
Administory. Zeitschrift für Verwaltungsgeschichte     Open Access   (Followers: 1)
Journal of Social Studies     Open Access   (Followers: 1)
Jurnal Administrasi Publik : Public Administration Journal     Open Access   (Followers: 1)
Journal of Public Procurement     Hybrid Journal   (Followers: 1)
International Journal of Organization Theory and Behavior     Hybrid Journal   (Followers: 1)
Gestão Pública : Práticas e Desafios     Open Access   (Followers: 1)
Arbetsliv i omvandling     Open Access   (Followers: 1)
International Review of Public Policy     Open Access   (Followers: 1)
Journal of Public Affairs Education     Hybrid Journal   (Followers: 1)
Corrections : Policy, Practice and Research     Hybrid Journal   (Followers: 1)
Retos de la Dirección     Open Access  
Investigación Administrativa     Open Access  
Territory, Politics, Governance     Hybrid Journal  
International Journal of Community Well-Being     Hybrid Journal  
Molung Educational Frontier     Open Access  
Journal of Administrative and Management     Open Access  
FEU Academic Review     Open Access  
Dhammathas Academic Journal     Open Access  
Public Inspiration     Open Access  
Economic and Regional Studies / Studia Ekonomiczne i Regionalne     Open Access  
Jurnal Niara     Open Access  
Icelandic Review of Politics and Administration     Open Access  
Stat & Styring     Full-text available via subscription  
Revista de Direito da Administração Pública     Open Access  
Sosyoekonomi     Open Access  
ESPAÇO PÚBLICO : Revista do Mestrado Profissional em Políticas Públicas da UFPE     Open Access  
Revista de Administração     Open Access  
Administración Pública y Sociedad     Open Access  
Perspectivas em Políticas Públicas     Open Access  
JKAP (Jurnal Kebijakan dan Administrasi Publik)     Open Access  
Revista Iberoamericana de Estudios Municipales     Open Access  
Estado, Gobierno y Gestión Pública     Open Access  
Políticas Públicas     Open Access  
Revista Política y Estrategia     Open Access  
TEC Empresarial     Open Access  
Sinergia : Revista do Instituto de Ciências Econômicas, Administrativas e Contábeis     Open Access  
ECA Sinergia : Revista Especializada en Economía, Contabilidad y Administración     Open Access  
Revista Foco     Open Access  
Revue Gouvernance     Open Access  
Revista de Direito Sociais e Políticas Públicas     Open Access  
Revista Digital de Derecho Administrativo     Open Access  
Transylvanian Review of Administrative Sciences     Open Access  
Jurnal Bina Praja : Journal of Home Affairs Governance     Open Access  
Revista de Administração Geral     Open Access  
Jurnal Ilmiah Administrasi Publik     Open Access  
Cadernos Gestão Pública e Cidadania     Open Access  
Revista Eurolatinoamericana de Derecho Administrativo     Open Access  
Journal of Social and Administrative Sciences     Open Access  
Prawo Budżetowe Państwa i Samorządu     Open Access  
Law and Administration in Post-Soviet Europe     Open Access  
RACE - Revista de Administração, Contabilidade e Economia     Open Access  
Organizações & Sociedade     Open Access  
Rivista trimestrale di scienza dell'amministrazione     Full-text available via subscription  
FOR Rivista per la formazione     Full-text available via subscription  
Sri Lanka Journal of Development Administration     Open Access  
Wroclaw Review of Law, Administration & Economics     Open Access  
Journal of Science and Sustainable Development     Full-text available via subscription  
eJournal of Public Affairs     Open Access  
Administração Pública e Gestão Social     Open Access  
Revista Mexicana de Análisis Político y Administración Pública     Open Access  
Revista Brasileira de Administração Científica     Open Access  
Future Studies Research Journal : Trends and Strategies     Open Access  
REAd : Revista eletrônica de administração     Open Access  
Pyramides     Open Access  
Documentos y Aportes en Administración Pública y Gestión Estatal     Open Access  
Cuadernos de Administración     Open Access  
AQ - Australian Quarterly     Full-text available via subscription  
Orientación y Sociedad : Revista Internacional e Interdisciplinaria de Orientación Vocacional Ocupacional     Open Access  
Revista Panamericana de Salud Pública     Open Access  
EURE (Santiago) - Revista Latinoamericana de Estudios Urbano Regionales     Open Access  
Acta Universitatis Danubius. Administratio     Open Access  
Liinc em Revista     Open Access  
Ids Working Papers     Hybrid Journal  

        1 2 | Last

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Public Sector
Number of Followers: 7  
 
  Full-text available via subscription Subscription journal
ISSN (Print) 0110-5191
Published by RMIT Publishing Homepage  [297 journals]
  • Cerebral venous disorders: the path forward

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      Authors: Fargen, K. M; Hui, F, Hirsch, J. A.
      Pages: 309 - 309
      Abstract: Arterial diseases are well understood to be major causes of morbidity and mortality. High pressured arteries carry blood, oxygen, and other ‘fuels’ for organ function. In contrast, the waste clearance mechanisms for the body are much less understood. Increasingly, disorders of the body’s waste system are being investigated as they may be the etiology of conditions previously described as ‘idiopathic.’ It is now recognized that impairments in cerebral venous outflow may cause headaches and visual symptoms that are more than simply burdensome. Rather, they have been linked to potentially dramatic impairments in functional capacity, quality of life, and cognitive function that may be to varying extents reversible with treatment.1–3 On January 12–13, 2023, the newly formed Society of Neurointerventional Surgery (SNIS) Cerebral Venous and Cerebrospinal Fluid (CSF) Disorders Committee held its inaugural conference in Honolulu, Hawaii, USA. Roughly 30 attendees from three countries,...
      PubDate: 2023-03-14T03:57:28-07:00
      DOI: 10.1136/jnis-2023-020251
      Issue No: Vol. 15, No. 4 (2023)
       
  • Endovascular coiling versus neurosurgical clipping for treatment of
           ruptured and unruptured intracranial aneurysms during pregnancy and
           postpartum period

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      Authors: Garg, A; Elmashala, A, Roeder, H, Ortega-Gutierrez, S.
      Pages: 310 - 314
      Abstract: BackgroundSelection of appropriate surgical strategy for the treatment of intracranial aneurysms (IA) during pregnancy requires careful consideration of the potential risks to the mother and fetus. However, limited data guide treatment decisions in these patients. We compared the safety profiles of endovascular coiling (EC) and neurosurgical clipping (NC) performed for the treatment of ruptured and unruptured IA during pregnancy and the postpartum period.MethodsPregnancy-related or postpartum hospitalizations undergoing surgical intervention for IA were identified from the Nationwide Readmissions Database 2016–2018. Safety outcomes included periprocedural complications, in-hospital mortality, discharge disposition, and 30-day non-elective readmissions.ResultsThere were 348 pregnancy-related or postpartum hospitalizations that met the study inclusion criteria (mean±SD age 31.8±5.9 years). Among 168 patients treated for ruptured aneurysms, 115 (68.5%) underwent EC and 53 (31.5%) underwent NC; whereas among 180 patients treated for unruptured aneurysms, 140 (77.8%) underwent EC and 40 (22.2%) underwent NC. There were no statistically significant differences in the baseline characteristics between patients undergoing EC versus NC for either ruptured or unruptured aneurysm groups. The outcomes were statistically comparable between EC and NC for both ruptured and unruptured IA, except for a lower incidence of ischemic stroke in patients undergoing EC for ruptured aneurysms (OR 0.12, 95% CI 0.02 to 0.84).ConclusionsMost pregnant and postpartum patients are treated with EC for both ruptured and unruptured IA. For treatment of ruptured IA, EC is independently associated with a lower risk of perioperative ischemic stroke, but other in-hospital complications and mortality are comparable between EC and NC.
      Keywords: Editor''s choice, Hemorrhagic stroke
      PubDate: 2023-03-14T03:57:28-07:00
      DOI: 10.1136/neurintsurg-2022-018705
      Issue No: Vol. 15, No. 4 (2023)
       
  • Treatment of fusiform aneurysms with a pipeline embolization device: a
           multicenter cohort study

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      Authors: Turhon, M; Kang, H, Li, M, Liu, J, Zhang, Y, Zhang, Y, Huang, J, Luo, B, Liu, J, Zhang, H, Li, T, Song, D, Zhao, Y, Guan, S, Aximujiang, A, Maimaitili, A, Wang, Y, Feng, W, Wang, Y, Wan, J, Mao, G, Shi, H, Zhang, X, Gu, Y, Yang, X.
      Pages: 315 - 320
      Abstract: BackgroundIntracranial fusiform aneurysms are less common than saccular aneurysms, but are associated with higher mortality and morbidity. We conducted this study to determine the safety and efficacy of the pipeline embolization device (PED) to treat intracranial fusiform aneurysms.MethodsThis was a multicenter, retrospective, and observational study. Data for this study came from the PLUS study conducted from 2014 to 2019 across 14 centers in China. Univariate and multivariable logistic regression analyses were performed to evaluate predictors of the occlusion rate and complication.ResultsA total of 1171 consecutive patients with 1322 intracranial aneurysms participated in this study. Among the participants, 104 patients with 109 fusiform aneurysms were eligible for this analysis (mean age 49 years, 36.5% women, aneurysm mean size 14.7 mm, 55% in the posterior circulation, and 6% in the basilar artery). Mean follow-up time was 9.0 months (range 3–36 months). The last DSA angiographic follow-up was available for 85 patients, and 58 aneurysms (68.2%) were completely occluded. The overall complication rate and mortality were 17.3% and 2.8%, respectively. Multivariate analysis demonstrated that age (OR=1.007, p=0.037) and cerebral atherosclerosis (OR=1.441, p=0.002) were associated with incomplete occlusion of fusiform aneurysms after PED treatment.ConclusionPEDs may be an effective treatment for intracranial fusiform aneurysms, with a favorable occlusion rate. However, because these treatments have a relatively high rate of complications, PED treatment for fusiform aneurysms should be carefully and strictly controlled. Our analysis showed that PEDs with adjunctive coiling did not significantly improve the occlusion rate of fusiform aneurysms.
      Keywords: Hemorrhagic stroke
      PubDate: 2023-03-14T03:57:28-07:00
      DOI: 10.1136/neurintsurg-2021-018539
      Issue No: Vol. 15, No. 4 (2023)
       
  • Morphological characteristics associated with ruptured intracranial
           vertebral artery dissecting aneurysms

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      Authors: Han, J; Chen, J, Tong, X, Han, M, Peng, F, Niu, H, Liu, L, Liu, F, Liu, A.
      Pages: 321 - 324
      Abstract: ObjectiveMorphological risk factors for the rupture of intracranial vertebral artery dissecting aneurysms (IVADAs) have not been well characterized. In this study, we aim to identify morphological characteristics associated with IVADA rupture.MethodsWe conducted a retrospective study of 249 consecutive patients with single IVADAs (31 ruptured and 218 unruptured) admitted to Beijing Tiantan Hospital between January 2016 and December 2020. Various morphological parameters were measured using three-dimensional digital subtraction angiography images. Univariate and multivariate logistic regression analyses were performed to identify morphological characteristics associated with IVADA rupture.ResultsUnivariate regression analysis revealed that the coexistence of significant proximal and distal stenosis and posterior inferior cerebellar artery (PICA) involvement were associated with IVADA rupture, while the origin from the dominant vertebral artery was inversely associated with the rupture. Multivariate regression analysis demonstrated that the coexistence of significant proximal and distal stenosis (OR 22.00, 95% CI 5.60 to 86.70, p
      Keywords: Hemorrhagic stroke
      PubDate: 2023-03-14T03:57:28-07:00
      DOI: 10.1136/neurintsurg-2022-018744
      Issue No: Vol. 15, No. 4 (2023)
       
  • Distal cerebral vasospasm treatment following aneurysmal subarachnoid
           hemorrhage using the Comaneci device: technical feasibility and
           single-center preliminary results

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      Authors: Thiery, L; Carle, X, Testud, B, Boulouis, G, Habert, P, Tradi, F, Reyre, A, Lehmann, P, Dory-Lautrec, P, Stellmann, J.-P, Girard, N, Brunel, H, Hak, J.-F.
      Pages: 325 - 329
      Abstract: BackgroundBalloon-assisted mechanical angioplasty for cerebral vasospasm following aneurysmal subarachnoid hemorrhage (aSAH) has a number of limitations, including transient occlusion of the spastic blood vessel. Comaneci is an FDA-approved device for temporary coil embolization assistance which has recently also been approved for the treatment of distal symptomatic refractory vasospasm. We aimed to report the feasibility, efficacy and safety of our experience with Comaneci angioplasty for refractory distal vasospasm (up to the second segment of the cerebral arteries) following aSAH.MethodsThis is a retrospective analysis of a prospective series of 18 patients included between April 2019 and June 2021 with aSAH and symptomatic vasospasm refractory to medical therapy, who were treated using Comaneci-17-asssisted mechanical distal angioplasty. Immediate angiographic results, procedure-related complications, and clinical outcomes were assessed. Inter-rater reliability of the scores was determined using the intraclass correlation coefficient.ResultsComaneci-assisted distal angioplasty was performed in 18 patients, corresponding to 31 target arteries. All distal anterior segments were easily accessible with the Comaneci-17 device. Vasospasm improvement after Comaneci mechanical angioplasty was seen in 22 distal arteries (71%) (weighted Cohen’s kappa (w) 0.73, 95% CI 0.69 to 0.93). Vasospasm recurrence occurred in three patients (16.67%) and delayed cerebral infarction in three patients (16.67%), with a mean±SD delay between onset of symptoms and imaging follow-up (MRI/CT) of 32.61±8.93 days (w 0.98, 95% CI 0.88 to 1).ConclusionThis initial experience suggests that distal mechanical angioplasty performed with the Comaneci-17 device for refractory vasospasm following aSAH seems to be safe, with good feasibility and efficacy.
      Keywords: Hemorrhagic stroke
      PubDate: 2023-03-14T03:57:28-07:00
      DOI: 10.1136/neurintsurg-2022-018699
      Issue No: Vol. 15, No. 4 (2023)
       
  • Endovascular thrombectomy for anterior circulation stroke beyond 6 hours
           of onset in Sweden 2015 to 2020: rates and outcomes in a nationwide
           register-based study

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      Authors: Ullberg, T; von Euler, M, Wester, P, Arnberg, F, Norrving, B, Andersson, T, Wasselius, J.
      Pages: 330 - 335
      Abstract: BackgroundEndovascular thrombectomy (EVT) for ischemic stroke (IS) beyond 6 hours has been proven effective in randomized controlled trials. We present data on implementation and outcomes for EVT beyond 6 hours in Sweden.MethodsWe included all cases of anterior circulation IS caused by occlusion of the intracranial carotid artery, and the M1 or M2 segment of the middle cerebral artery, registered in two nationwide quality registers for stroke in 2015–2020. Three groups were defined from onset-to-groin-puncture (OTG) time: early window (
      Keywords: Open access, Ischemic stroke
      PubDate: 2023-03-14T03:57:28-07:00
      DOI: 10.1136/neurintsurg-2022-018670
      Issue No: Vol. 15, No. 4 (2023)
       
  • Association between time to treatment and clinical outcomes in
           endovascular thrombectomy beyond 6 hours without advanced imaging
           selection

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      Authors: Dhillon, P. S; Butt, W, Podlasek, A, McConachie, N, Lenthall, R, Nair, S, Malik, L, Bhogal, P, Makalanda, H. L. D, Spooner, O, Krishnan, K, Sprigg, N, Mortimer, A, Booth, T. C, Lobotesis, K, White, P, James, M. A, Bath, P, Dineen, R. A, England, T. J.
      Pages: 336 - 342
      Abstract: BackgroundThe effectiveness and safety of endovascular thrombectomy (EVT) in the late window (6–24 hours) for acute ischemic stroke (AIS) patients selected without advanced imaging is undetermined. We aimed to assess clinical outcomes and the relationship with time-to-EVT treatment beyond 6 hours of stroke onset without advanced neuroimaging.MethodsPatients who underwent EVT selected with non-contrast CT/CT angiography (without CT perfusion or MR imaging), between October 2015 and March 2020, were included from a national stroke registry. Functional and safety outcomes were assessed in both early (
      Keywords: Ischemic stroke
      PubDate: 2023-03-14T03:57:28-07:00
      DOI: 10.1136/neurintsurg-2021-018564
      Issue No: Vol. 15, No. 4 (2023)
       
  • Endovascular treatment of acute ischemic stroke in patients with
           pre-morbid disability: a meta-analysis

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      Authors: Bala, F; Beland, B, Mistry, E, Almekhlafi, M. A, Goyal, M, Ganesh, A.
      Pages: 343 - 349
      Abstract: BackgroundTrials of endovascular thrombectomy (EVT) for acute stroke have excluded patients with pre-morbid disability. Observational studies may help inform consideration of EVT in this population. We aimed to assess the effectiveness and safety of EVT in patients with pre-morbid disability.MethodsAccording to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched MEDLINE and Embase for studies describing outcomes in patients with pre-morbid disability (modified Rankin Scale (mRS) 2–5), treated with EVT or medical management (MM). Random-effects meta-analysis was used to pool outcomes including 90-day return to baseline mRS, symptomatic intracerebral hemorrhage (sICH), and 90-day mortality.ResultsWe analyzed 14 studies of patients with pre-morbid disability (mRS 2–5, 1373 EVT and 253 MM). The rate of return to baseline mRS was 30.0% (95% CI 25.3% to 34.7%) in patients treated with EVT. Compared with medical therapy, EVT was associated with a higher likelihood of return to baseline mRS (OR 2.37, 95% CI 1.39 to 4.04) and a trend towards lower mortality (OR 0.68, 95% CI 0.46 to 1.02), with similar odds of sICH (OR 1.01, 95% CI 0.49 to 2.08). In studies comparing patients with versus without pre-morbid disability treated with EVT, similar results were found except that pre-morbid disability, when defined more strictly as mRS 3–5, was associated with mortality (OR 3.49, p
      Keywords: Ischemic stroke
      PubDate: 2023-03-14T03:57:28-07:00
      DOI: 10.1136/neurintsurg-2021-018573
      Issue No: Vol. 15, No. 4 (2023)
       
  • Effects of endovascular therapy for mild stroke due to proximal or M2
           occlusions: meta-analysis

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      Authors: Lin, C.-H; Saver, J. L, Ovbiagele, B, Tang, S.-C, Lee, M, Liebeskind, D. S.
      Pages: 350 - 354
      Abstract: ObjectiveTo conduct a meta-analysis to evaluate the effect of endovascular therapy (EVT) in mild acute ischemic stroke (AIS) due to proximal versus distal occlusions.MethodsWe searched PubMed, Embase, the Cochrane Library, and clinicaltrials.gov from January 2000 to September 2021 to identify studies comparing EVT versus best medical management (BMM) in AIS with National Institutes of Health Stroke Scale (NIHSS) scores ≤5 due to proximal internal carotid artery (ICA) or M1 versus distal M2 occlusions. We included studies that reported the number of patients with proximal or distal occlusions separately and reported the number of patients with freedom of disability (modified Rankin Scale (mRS) score 0–1) or functional independence (mRS score 0–2) at 90 days in proximal or M2 occlusions, respectively. OR with 95% CI was used.ResultsWe identified six studies with 653 proximal ICA and M1 occlusion patients and 666 distal M2 occlusion patients. Pooled results showed EVT versus BMM was associated with a higher rate of being disability-free in patients with proximal occlusions (OR 1.58, 95% CI 1.09 to 2.30), but was associated with a lower rate of being disability-free in patients with M2 occlusions (OR 0.70, 95% CI 0.49 to 0.99). Effect of EVT in proximal versus distal occlusions was substantially different (P for interaction=0.002). A similar pattern was seen for functional independence (P for interaction=0.05).ConclusionsFor patients with mild AIS, observational data suggest that EVT may be beneficial for proximal ICA or M1 but not for distal M2 occlusions. Randomized trials are needed to confirm these findings.PROSPERO registration numberCRD42021281034.
      Keywords: Open access, Ischemic stroke
      PubDate: 2023-03-14T03:57:28-07:00
      DOI: 10.1136/neurintsurg-2022-018662
      Issue No: Vol. 15, No. 4 (2023)
       
  • Bifurcation occlusions and endovascular treatment outcome in acute
           ischemic stroke

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      Authors: Arrarte Terreros, N; Bruggeman, A. A. E, van Voorst, H, Konduri, P. R, Jansen, I. G. H, Kappelhof, M, Tolhuisen, M. L, Boodt, N, Dippel, D. W. J, van der Lugt, A, van Zwam, W. H, van Oostenbrugge, R. J, van der Worp, H. B, Emmer, B. J, Meijer, F. J. A, Roos, Y. B. W. E. M, van Bavel, E, Marquering, H. A, Majoie, C. B. L. M, MR CLEAN Registry investigators, Dippel, Lugt, Majoie, Roos, Oostenbrugge, Zwam, Boiten, Vos, Jansen, Mulder, Goldhoorn, Compagne, Kappelhof, Brouwer, Hartog, Hinsenveld, Roozenbeek, Es, Emmer, Coutinho, Schonewille, Wermer, Walderveen, Staals, Hofmeijer, Martens, Nijeholt, Bruijn, Dijk, Bart van der Worp, Lo, Dijk, Boogaarts, de Vries, Kort, Tuijl, Peluso, Fransen, Berg, Hasselt, Aerden, Dallinga, Uyttenboogaart, Eschgi, Bokkers, Schreuder, Heijboer, Keizer, Yo, Hertog, Bulut, Brouwers, Sprengers, Jenniskens, Berg, Yoo, Beenen, Postma, Roosendaal, Kallen, Wijngaard, Bot, Doormaal, Meijer, Ghariq, Proosdij, Menno Krietemeijer, Dinkelaar, Appelman, Hammer, Pegge, Hoorn, Vinke, Zwenneke Flach, Lingsma, Ghannouti, Sterrenberg, Pellikaan, Sprengers, Elfrink, Simons, Vossers, Meris, Vermeulen, Geerlings, Vemde, Simons, Messchendorp, Nicolaij, Bongenaar, Bodde, Kleijn, Lodico, Droste, Wollaert, Verheesen, Jeurrissen, Bos, Drabbe, Sandiman, Aaldering, Zweedijk, Vervoort, Ponjee, Romviel, Kanselaar, Barning, Venema, Chalos, Geuskens, Straaten, Ergezen, Harmsma, Muijres, Jong, Berkhemer, Boers, Huguet, Groot, Mens, Kranendonk, Treurniet, Tolhuisen, Alves, Weterings, Kirkels, Voogd, Schupp, Collette, Groot, LeCouffe, Konduri, Prasetya, Arrarte-Terreros, Ramos
      Pages: 355 - 362
      Abstract: BackgroundA thrombus in the M1 segment of the middle cerebral artery (MCA) can occlude this main stem only or extend into the M1-M2 bifurcation. The occlusion pattern may affect endovascular treatment (EVT) success, as a bifurcated thrombus may be more prone to fragmentation during retrieval.ObjectiveTo investigate whether bifurcated thrombus patterns are associated with EVT procedural and clinical outcomes.MethodsOcclusion patterns of MCA thrombi on CT angiography from MR CLEAN Registry patients were classified into three groups: main stem occlusion, bifurcation occlusion extending into one M2 branch, and bifurcation occlusion extending into both M2 branches. Procedural parameters, procedural outcomes (reperfusion grade and embolization to new territory), and clinical outcomes (24-48 hour National Institutes of Health Stroke Scale [NIHSSFU] score, change in NIHSS scores between 24 and 48 hours and baseline [NIHSS], and 90-day modified Rankin Scale [mRS] scores) were compared between occlusion patterns.ResultsWe identified 1023 patients with an MCA occlusion of whom 370 (36%) had a main stem occlusion, 151 (15%) a single branch, and 502 (49%) a double branch bifurcation occlusion. There were no statistically significant differences in retrieval method, procedure time, number of retrieval attempts, reperfusion grade, and embolization to new territory between occlusion patterns. Patients with main stem occlusions had lower NIHSSFU scores than patients with single (7 vs 11, p=0.01) or double branch occlusions (7 vs 9, p=0.04). However, there were no statistically significant differences in NIHSS or in 90-day mRS scores.ConclusionsIn our population, EVT procedural and long-term clinical outcomes were similar for MCA bifurcation occlusions and MCA main stem occlusions.
      Keywords: Open access, Ischemic stroke
      PubDate: 2023-03-14T03:57:28-07:00
      DOI: 10.1136/neurintsurg-2021-018560
      Issue No: Vol. 15, No. 4 (2023)
       
  • Endovascular treatment for isolated posterior cerebral artery occlusion
           stroke in the MR CLEAN registry

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      Authors: Brouwer, J; Ergezen, S, Mulder, M. J. H. L, Lycklama a Nijeholt, G. J, van Es, A. C. G. M, van der Lugt, A, Dippel, D. W. J, Majoie, C. B. L. M, Roos, Y. B. W. E. M, Coutinho, J. M, Emmer, B. J, on behalf of the MR CLEAN Registry investigators, Dippel, Lugt, Majoie, Roos, Oostenbrugge, Zwam, Boiten, Vos, Jansen, Mulder, Goldhoorn, Compagne, Kappelhof, Brouwer, Hartog, Hinsenveld, Dippel, Roozenbeek, Lugt, Majoie, Roos, Emmer, Coutinho, Schonewille, Vos, Wermer, Walderveen, Es, Staals, Oostenbrugge, Zwam, Hofmeijer, Martens, Nijeholt, Boiten, Bruijn, Dijk, Bart van der Worp, Lo, Dijk, Boogaarts, de Vries, Kort, Tuijl, Peluso, Fransen, Berg, Hasselt, Aerden, Dallinga, Uyttenboogaart, Eschgi, Bokkers, Schreuder, Heijboer, Keizer, Yo, Hertog, Sturm, Brouwers, Majoie, Zwam, Lugt, Walderveen, Sprengers, Jenniskens, Berg, Yoo, Beenen, Postma, Roosendaal, Kallen, Wijngaard, Es, Emmer, Martens, Yo, Vos, Bot, Doormaal, Meijer, Ghariq, Bokkers, Proosdij, Menno Krietemeijer, Peluso, Boogaarts, Lo, Dinkelaar, Appelman, Hammer, Pegge, Hoorn, Vinke, Cornelissen, Leij, Brans, Dippel, Lugt, Majoie, Roos, Oostenbrugge, Zwam, Nijeholt, Vos, Schonewille, Hofmeijer, Martens, Bart van der Worp, Lo, Oostenbrugge, Hofmeijer, Zwenneke Flach, Lingsma, Ghannouti, Sterrenberg, Pellikaan, Sprengers, Elfrink, Simons, Vossers, Meris, Vermeulen, Geerlings, Vemde, Simons, Messchendorp, Nicolaij, Bongenaar, Bodde, Kleijn, Lodico, Droste, Wollaert, Verheesen, Jeurrissen, Bos, Drabbe, Sandiman, Aaldering, Zweedijk, Vervoort, Ponjee, Romviel, Kanselaar, Barning, Venema, Chalos, Geuskens, Straaten, Ergezen, Harmsma, Muijres, Jong, Berkhemer, Boers, Huguet, Groot, Mens, Kranendonk, Treurniet, Tolhuisen, Alves, Weterings, Kirkels, Voogd, Schupp, Collette, Groot, LeCouffe, Konduri, Prasetya, Arrarte-Terreros, Ramos, Boodt, Pirson, Bruggeman
      Pages: 363 - 369
      Abstract: BackgroundEndovascular treatment (EVT) is standard of care in anterior circulation large vessel occlusions. In posterior circulation occlusions, data on EVT in isolated posterior cerebral artery (PCA) occlusions are limited, although PCA occlusions can cause severe neurological deficit.ObjectiveTo describe in a prospective study the clinical manifestations, outcomes, and safety of EVT in isolated PCA occlusions.MethodsWe used data (2014–2017) from the MR CLEAN Registry, a nationwide, prospective cohort of EVT-treated patients in the Netherlands. We included patients with acute ischemic stroke (AIS) due to an isolated PCA occlusion on CT angiography. Patients with concurrent occlusion of the basilar artery were excluded. Outcomes included change in National Institutes of Health Stroke Scale (NIHSS) score, modified Rankin Scale (mRS) score 0–3 after 90 days, mortality, expanded Thrombolysis in Cerebral Infarction (eTICI), and periprocedural complications.ResultsTwenty (12%) of 162 patients with posterior circulation occlusions had an isolated PCA occlusion. Median age was 72 years; 13 (65%) were women. Median baseline NIHSS score was 13 (IQR 5–21). Six (30%) patients were comatose. Twelve patients (60%) received IVT. Median NIHSS was –4 (IQR –11–+1). At follow-up, nine patients (45%) had mRS score 0–3. Seven (35%) died. eTICI 2b-3 was achieved in 13 patients (65%). Nine patients (45%) had periprocedural complications. No symptomatic intracranial hemorrhages (sICH) occurred.ConclusionsEVT should be considered in selected patients with AIS with an isolated PCA occlusion, presenting with moderate–severe neurological deficits, as EVT was technically feasible in most of our patients and about half had good clinical outcome. In case of lower NIHSS score, a more conservative approach seems warranted, since periprocedural complications are not uncommon. Nonetheless, EVT seems reasonably safe considering the absence of sICH in our study.
      Keywords: Ischemic stroke
      PubDate: 2023-03-14T03:57:28-07:00
      DOI: 10.1136/neurintsurg-2021-018505
      Issue No: Vol. 15, No. 4 (2023)
       
  • Hyperglycemic control in acute ischemic stroke patients undergoing
           endovascular treatment: post hoc analysis of the Stroke Hyperglycemia
           Insulin Network Effort trial

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      Authors: Bains, N. K; Huang, W, French, B. R, Siddiq, F, Gomez, C. R, Qureshi, A. I.
      Pages: 370 - 374
      Abstract: BackgroundHyperglycemia has been associated with poor outcomes in acute ischemic stroke patients undergoing endovascular treatment. We analyzed the effect of intensive glucose control on death and disability rates in patients with acute ischemic stroke undergoing endovascular treatment.MethodsWe analyzed the effect of intensive (serum glucose
      Keywords: Ischemic stroke
      PubDate: 2023-03-14T03:57:28-07:00
      DOI: 10.1136/neurintsurg-2021-018485
      Issue No: Vol. 15, No. 4 (2023)
       
  • Standard umbilical artery catheters used as diagnostic and
           neurointerventional guide catheters in the treatment of neonatal
           cerebrovascular malformations

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      Authors: Kappel, A. D; Orbach, D. B.
      Pages: 375 - 379
      Abstract: BackgroundVascular access in neonates is limited by the small size of the femoral artery and the risk of complications, including thrombosis and limb ischemia. Although umbilical artery access has been described, previous reports detail exchange of the umbilical artery catheter (UAC) for a conventional arterial sheath, which can be difficult and cumbersome. We aim to describe direct use of the UAC as the sheath and guide catheter in neonatal patients requiring endovascular treatment for life-threatening intracranial arteriovenous shunts.MethodsWe reviewed all cases between 2016 and 2021 of neonatal intervention using a direct UAC approach. We describe our technique of utilizing UACs for cerebral angiography and neurointerventions in newborns without catheter exchange, allowing for repeated, straightforward endovascular access in neonates across multiple interventions.ResultsSeven consecutive neonates underwent endovascular neurointerventional procedures for the treatment of life-threatening, high-flow arteriovenous shunts using a direct UAC access technique without procedural morbidity. Five of seven patients underwent more than one procedure in the neonatal period, between day 1 and day 10 of life.ConclusionsUse of the UAC itself as a diagnostic catheter for cerebral angiography or as a guide catheter for neurointerventions greatly facilitates endovascular interventions in newborns and is ideal for patients requiring multiple interventions in the neonatal period. This technique helps to mitigate the risk of neonatal femoral artery access and its complications, including thrombosis, dissection, spasm, stenosis, and limb ischemia.
      PubDate: 2023-03-14T03:57:28-07:00
      DOI: 10.1136/neurintsurg-2022-018764
      Issue No: Vol. 15, No. 4 (2023)
       
  • Prediction of cerebral aneurysm rupture using a point cloud neural network

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      Authors: Luo, X; Wang, J, Liang, X, Yan, L, Chen, X, He, J, Luo, J, Zhao, B, He, G, Wang, M, Zhu, Y.
      Pages: 380 - 386
      Abstract: ObjectiveAccurate prediction of cerebral aneurysm (CA) rupture is of great significance. We intended to evaluate the accuracy of the point cloud neural network (PC-NN) in predicting CA rupture using MR angiography (MRA) and CT angiography (CTA) data.Methods418 CAs in 411 consecutive patients confirmed by CTA (n=180) or MRA (n=238) in a single hospital were retrospectively analyzed. A PC-NN aneurysm model with/without parent artery involvement was used for CA rupture prediction and compared with ridge regression, support vector machine (SVM) and neural network (NN) models based on radiomics features. Furthermore, the performance of the trained PC-NN and radiomics-based models was prospectively evaluated in 258 CAs of 254 patients from five external centers.ResultsIn the internal test data, the area under the curve (AUC) of the PC-NN model trained with parent artery (AUC=0.913) was significantly higher than that of the PC-NN model trained without parent artery (AUC=0.851; p=0.041) and of the ridge regression (AUC=0.803; p=0.019), SVM (AUC=0.788; p=0.013) and NN (AUC=0.805; p=0.023) radiomics-based models. Additionally, the PC-NN model trained with MRA source data achieved a higher prediction accuracy (AUC=0.936) than that trained with CTA source data (AUC=0.824; p=0.043). In external data of prospective cohort patients, the AUC of PC-NN was 0.835, significantly higher than ridge regression (0.692; p
      Keywords: Neuroimaging
      PubDate: 2023-03-14T03:57:28-07:00
      DOI: 10.1136/neurintsurg-2022-018655
      Issue No: Vol. 15, No. 4 (2023)
       
  • Evaluation of time-resolved whole brain flat panel detector perfusion
           imaging using RAPID ANGIO in patients with acute stroke: comparison with
           CT perfusion imaging

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      Authors: Kurmann, C. C; Kaesmacher, J, Cooke, D. L, Psychogios, M, Weber, J, Lopes, D. K, Albers, G. W, Mordasini, P.
      Pages: 387 - 392
      Abstract: BackgroundIn contrast to conventional CT perfusion (CTP) imaging, flat panel detector CT perfusion (FD-CTP) imaging can be acquired directly in the angiosuite.ObjectiveTo evaluate time-resolved whole brain FD-CTP imaging and assess clinically important qualitative and quantitative perfusion parameters in correlation with previously acquired conventional CTP using the new RAPID for ANGIO software.MethodsWe included patients with internal carotid artery occlusions and M1 or M2 occlusions from six centers. All patients underwent mechanical thrombectomy (MT) with preinterventional conventional CTP and FD-CTP imaging. Quantitative performance was determined by comparing volumes of infarct core, penumbral tissue, and mismatch. Eligibility for MT according to the perfusion imaging criteria of DEFUSE 3 was determined for each case from both conventional CTP and FD-CTP imaging.ResultsA total of 20 patients were included in the final analysis. Conventional relative cerebral blood flow (rCBF) 6 s and CTP mismatch versus FD-CTP mismatch showed more variability (R2=0.57, and R2=0.33, respectively). Based on FD-CTP, 16/20 (80%) patients met the inclusion criteria for MT according to the DEFUSE 3 perfusion criteria, in contrast to 18/20 (90%) patients based on conventional CTP. The vessel occlusion could be correctly extrapolated from the hypoperfusion in 18/20 cases (90%).ConclusionsIn our multicenter study, time-resolved whole brain FD-CTP was technically feasible, and qualitative and quantitative perfusion results correlated with those obtained with conventional CTP.
      Keywords: Open access, Neuroimaging
      PubDate: 2023-03-14T03:57:28-07:00
      DOI: 10.1136/neurintsurg-2021-018464
      Issue No: Vol. 15, No. 4 (2023)
       
  • Assessment of three MR perfusion software packages in predicting final
           infarct volume after mechanical thrombectomy

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      Authors: Bani-Sadr, A; Cho, T.-H, Cappucci, M, Hermier, M, Ameli, R, Filip, A, Riva, R, Derex, L, De Bourguignon, C, Mechtouff, L, Eker, O. F, Nighoghossian, N, Berthezene, Y.
      Pages: 393 - 398
      Abstract: AimsTo evaluate the performance of three MR perfusion software packages (A: RAPID; B: OleaSphere; and C: Philips) in predicting final infarct volume (FIV).MethodsThis cohort study included patients treated with mechanical thrombectomy following an admission MRI and undergoing a follow-up MRI. Admission MRIs were post-processed by three packages to quantify ischemic core and perfusion deficit volume (PDV). Automatic package outputs (uncorrected volumes) were collected and corrected by an expert. Successful revascularization was defined as a modified Thrombolysis in Cerebral Infarction (mTICI) score ≥2B. Uncorrected and corrected volumes were compared between each package and with FIV according to mTICI score.ResultsNinety-four patients were included, of whom 67 (71.28%) had a mTICI score ≥2B. In patients with successful revascularization, ischemic core volumes did not differ significantly from FIV regardless of the package used for uncorrected and corrected volumes (p>0.15). Conversely, assessment of PDV showed significant differences for uncorrected volumes. In patients with unsuccessful revascularization, the uncorrected PDV of packages A (median absolute difference –40.9 mL) and B (median absolute difference –67.0 mL) overestimated FIV to a lesser degree than package C (median absolute difference –118.7 mL; p=0.03 and p=0.12, respectively). After correction, PDV did not differ significantly from FIV for all three packages (p≥0.99).ConclusionsAutomated MRI perfusion software packages estimate FIV with high variability in measurement despite using the same dataset. This highlights the need for routine expert evaluation and correction of automated package output data for appropriate patient management.
      Keywords: Neuroimaging
      PubDate: 2023-03-14T03:57:28-07:00
      DOI: 10.1136/neurintsurg-2022-018674
      Issue No: Vol. 15, No. 4 (2023)
       
  • Recent trends in high-volume Medicare stroke thrombectomy provider
           characteristics

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      Authors: Jayaraman, K; Santavicca, S, Hughes, D. R, Hirsch, J. A, Duszak,, R, Chatterjee, A. R.
      Pages: 399 - 401
      Abstract: BackgroundIntracranial mechanical thrombectomy (MT) is increasingly indicated for use in acute ischemic stroke patients. We analyzed recent trends in the characteristics and geographic distributions of physicians providing this service with frequency to Medicare beneficiaries.MethodsWe linked public data sources to elucidate and visualize trends in high-volume MT providers between 2016 and 2019.ResultsHigh-volume MT providers increased by 184% between 2016 and 2019. The number of neurosurgeons, neurologists, and radiologists in this physician population increased by 251%, 205%, and 139%, respectively. Male practitioners accounted for 96% of providers in the most recent year of analysis. International medical graduates accounted for roughly one-third of these physicians across all 4 years of analysis. As of 2019, the three states with the most high-volume MT providers were Florida, California, and Texas, accounting for 7%, 7%, and 6% of providers, respectively.ConclusionsHigh-volume providers of MT services for Medicare beneficiaries represent a dynamic and rapidly expanding subset of physicians with diverse specialty backgrounds.
      Keywords: Socioeconomics
      PubDate: 2023-03-14T03:57:28-07:00
      DOI: 10.1136/neurintsurg-2021-018611
      Issue No: Vol. 15, No. 4 (2023)
       
  • Antithrombotic therapies for neurointerventional surgery: a 2021 French
           comprehensive national survey

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      Authors: Caroff, J; Aubert, L, Lavenu-Bombled, C, Figueiredo, S, Habchi, K, Cortese, J, Eugene, F, Ognard, J, Tahon, F, Forestier, G, Ifergan, H, Zhu, F, Hak, J.-F, Reyre, A, Laubacher, M, Traore, A, Desilles, J. P, Derraz, I, Moreno, R, Bintner, M, Charbonnier, G, Le Bras, A, Veunac, L, Gariel, F, Redjem, H, Sedat, J, Tessier, G, Dumas, V, Gauberti, M, Chivot, C, Consoli, A, Bricout, N, Tuilier, T, Guedon, A, Pop, R, Thouant, P, Bellanger, G, Zannoni, R, Soize, S, Richter, J. S, Heck, O, Mihalea, C, Burel, J, Girot, J.-B, Shotar, E, Gazzola, S, Boulouis, G, Kerleroux, B, JENI Research Collaboration, Boucherit, Marnat, Aouni, Bolognini, Comby, Bretzner, Hanafi, Drai, Testud, Dargazanli, Liao, Hassen, Allard, Delvoye, Manceau, Alias, Lefebvre, Mihoc, Darcourt, Janot, L'Allinec, Papaxanthos, Chalumeau, Duranteau, Spelle
      Pages: 402 - 407
      Abstract: BackgroundNeurointerventionists lack guidelines for the use of antithrombotic therapies in their clinical practice; consequently, there is likely to be significant heterogeneity in antithrombotic use between centers. Through a nationwide survey, we aimed to obtain an exhaustive cross-sectional overview of antithrombotic use in neurointerventional procedures in France.MethodsIn April 2021, French neurointerventional surgery centers were invited to participate in a nationwide 51-question survey disseminated through an active trainee-led research collaborative network (the JENI-RC).ResultsAll 40 centers answered the survey. Fifty-one percent of centers reported using ticagrelor and 43% used clopidogrel as premedication before intracranial stenting. For flow diversion treatment, dual antiplatelet therapy was maintained for 3 or 6 months in 39% and 53% of centers, respectively, and aspirin was prescribed for 12 months or more than 12 months in 63% and 26% of centers, respectively. For unruptured aneurysms, the most common heparin bolus dose was 50 IU/kg (59%), and only 35% of centers monitored heparin activity for dose adjustment. Tirofiban was used in 64% of centers to treat thromboembolic complications. Fifteen percent of these comprehensive stroke centers reported using tenecteplase to treat acute ischemic strokes. Cangrelor appeared as an emergent drug in specific indications.ConclusionThis nationwide survey highlights the important heterogeneity in clinical practices across centers. There is a pressing need for trials and guidelines to further evaluate and harmonize antithrombotic regimens in the neurointerventional field.
      Keywords: Standard
      PubDate: 2023-03-14T03:57:28-07:00
      DOI: 10.1136/neurintsurg-2021-018601
      Issue No: Vol. 15, No. 4 (2023)
       
  • Transvenous Onyx embolization of a recurrent dural arteriovenous fistula
           through the deep venous system

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      Authors: Colasurdo, M; Srinivasan, V. M, Shaltoni, H, Kan, P.
      Pages: 408 - 408
      Abstract: Transarterial and, to a lesser extent, transvenous embolizations are commonly used in the treatment of cerebral dural arteriovenous fistulas (dAVFs).1 When the feeding artery is small and tortuous, leading to difficult or impossible safe navigation and effective embolization, transvenous embolization may be a safe alternative.2 3 The efficacy of transvenous strategies relies on successful navigation of the draining vein up to the arterial–venous connection of the fistula (‘foot of the vein’). This strategy has been shown to be an effective way of treating otherwise inaccessible dAVFs with low morbidity and improved occlusion rates.4 We present the transvenous coil and Onyx (Medtronic, Minnesota, USA) embolization technique for a previously treated and recurrent dAVF involving tentorial feeders from the inferolateral trunk (video 1). It is a unique case in which counterflow navigation into the draining vein was achieved through the deep venous system via the right basal vein of Rosenthal, with the use of balloon intermittent flow arrest. Video 1
      Keywords: Technical video
      PubDate: 2023-03-14T03:57:28-07:00
      DOI: 10.1136/neurintsurg-2022-018701
      Issue No: Vol. 15, No. 4 (2023)
       
  • Endovascular therapy may not be beneficial for patients with mild acute
           ischemic stroke compared to best medical management

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      Authors: Zheng, F; von Spreckelsen, N, Hu, W.
      Pages: 409 - 410
      Abstract: We read with great interest the meta-analysis by Lin et al on the comparison of the clinical effectiveness between endovascular therapy (EVT) and best medical management (BMM) in patients with mild acute ischemic stroke (AIS).1 The study is of profound academic importance, and there are some points that we would like to address. In the "Statistical analyses" section, the authors described how they pooled data across studies by using the fixed effects model based on an inverse variance method. Subsequently, in the "Results – Primary outcome" section, the authors stated that for AIS patients with National Institutes of Health Stroke Scale (NIHSS) scores ≤5, pooled results from the fixed effects model showed that EVT compared with BMM was associated with a higher rate of being disability-free in patients with proximal internal carotid artery (ICA) or first segment of middle cerebral artery (M1) occlusions (67.6% vs 60.6%; OR...
      PubDate: 2023-03-14T03:57:28-07:00
      DOI: 10.1136/neurintsurg-2022-019013
      Issue No: Vol. 15, No. 4 (2023)
       
  • Endovascular therapy might be a treatment option for mild stroke due to
           proximal occlusions but not M2 occlusions

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      Authors: Lin, C.-H; Saver, J. L, Lee, M.
      Pages: 409 - 409
      Abstract: We appreciate the letter from Zheng et al1 suggesting that the random effects model, not the fixed effects model, should be used to pool the results for our meta-analysis.2 In a sensitivity test, pooled results from the random effects model did not significantly show that endovascular therapy (EVT) compared with best medical management was associated with a higher rate of being disability free for patients with acute ischemic stroke (AIS) with National Institutes of Health Stroke Scale (NIHSS) scores of ≤5 due to proximal internal carotid artery (ICA) or middle cerebral artery M1 occlusions. However, the main point of this meta-analysis was to highlight the importance of knowledge about specific vessel occlusion sites in decision making for AIS with NIHSS scoresof ≤5 due to vessel occlusions in the anterior circulation, and the results obtained from the random effects model were consistent with the results obtained from the...
      PubDate: 2023-03-14T03:57:28-07:00
      DOI: 10.1136/neurintsurg-2022-019098
      Issue No: Vol. 15, No. 4 (2023)
       
 
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