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- 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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