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Peschillo S, Meling TR. Endovascular neurosurgery in Europe: an International Survey and future perspectives. J Neurosurg Sci 2024; 68:254-259. [PMID: 38635305 DOI: 10.23736/s0390-5616.24.06252-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
BACKGROUND Recent advancements in neurosurgery have transformed patient care through minimally invasive procedures and led to a notable surge in endovascular treatments. However, the regulatory landscape governing these procedures across European countries varies, impacting treatment access and collaboration. This paper discusses the results of a survey on European legislation regarding endovascular neurosurgery, exploring current practices and speculating on the field's future. METHODS An e-mail survey was distributed to 41 European countries, targeting European member societies within the EANS. Thirty-seven completed questionnaires were returned, providing insights into neuroendovascular treatment legislation and restrictions. RESULTS Legislation and certification varied across the surveyed countries, with only two countries prohibiting endovascular neurosurgery. Eight countries required specific fellowship programs. Resistance from radiologists was noted in many countries. CONCLUSIONS Despite growing support for neurosurgeons performing endovascular treatments in Europe, challenges persist. Specialized care, improved access, and a broadening spectrum of treatable conditions contribute to the argument for involvement of neurosurgeons.
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Affiliation(s)
- Simone Peschillo
- UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy -
| | - Torstein R Meling
- Department of Neurosurgery, The National Hospital of Denmark (Rigshospitalet), Copenhagen, Denmark
- Department of Neurological Surgery, C. Besta National Institute of Neurology, Milan, Italy
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2
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Grunwald IQ, Musialek P, Podlasek A, Sievert H, Mathias K, Guyler P, Hopkins LN. World Federation for Interventional Stroke Treatment (WIST) multispecialty training guidelines for endovascular stroke intervention: Time is brain! - Response to commentary by UKNG. Clin Radiol 2024; 79:e637-e639. [PMID: 38311524 DOI: 10.1016/j.crad.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 02/06/2024]
Affiliation(s)
- I Q Grunwald
- NHS Tayside, Dundee, UK; Tayside Innovation MedTech Ecosystem (TIME), Division of Imaging Science and Technology, School of Medicine, University of Dundee, UK; Cardiovascular Center Frankfurt, Sankt Katharinen, Frankfurt, Germany.
| | - P Musialek
- Jagiellonian University, Krakow, Poland; Stroke Thrombectomy-Capable Center, John Paul II Hospital, Krakow, Poland
| | - A Podlasek
- Tayside Innovation MedTech Ecosystem (TIME), Division of Imaging Science and Technology, School of Medicine, University of Dundee, UK
| | - H Sievert
- Cardiovascular Center Frankfurt, Sankt Katharinen, Frankfurt, Germany; Goethe University Frankfurt, Frankfurt, Germany
| | - K Mathias
- Asklepios Clinik St Georg - Klinische und Interventionelle Angiologie, Hamburg, Germany
| | - P Guyler
- East of England Regional Stroke Network, UK; Mid and South Essex University Hospitals Group, Southend University Hospital, Westcliff-on-Sea, UK
| | - L N Hopkins
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA; Jacobs Institute, Buffalo, NY, USA
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3
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Song J, Zaidi SAA, He L, Zhang S, Zhou G. Integrative Analysis of Machine Learning and Molecule Docking Simulations for Ischemic Stroke Diagnosis and Therapy. Molecules 2023; 28:7704. [PMID: 38067435 PMCID: PMC10707570 DOI: 10.3390/molecules28237704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/13/2023] [Accepted: 11/17/2023] [Indexed: 12/18/2023] Open
Abstract
Due to the narrow therapeutic window and high mortality of ischemic stroke, it is of great significance to investigate its diagnosis and therapy. We employed weighted gene coexpression network analysis (WGCNA) to ascertain gene modules related to stroke and used the maSigPro R package to seek the time-dependent genes in the progression of stroke. Three machine learning algorithms were further employed to identify the feature genes of stroke. A nomogram model was built and applied to evaluate the stroke patients. We analyzed single-cell RNA sequencing (scRNA-seq) data to discern microglia subclusters in ischemic stroke. The RNA velocity, pseudo time, and gene set enrichment analysis (GSEA) were performed to investigate the relationship of microglia subclusters. Connectivity map (CMap) analysis and molecule docking were used to screen a therapeutic agent for stroke. A nomogram model based on the feature genes showed a clinical net benefit and enabled an accurate evaluation of stroke patients. The RNA velocity and pseudo time analysis showed that microglia subcluster 0 would develop toward subcluster 2 within 24 h from stroke onset. The GSEA showed that the function of microglia subcluster 0 was opposite to that of subcluster 2. AZ_628, which screened from CMap analysis, was found to have lower binding energy with Mmp12, Lgals3, Fam20c, Capg, Pkm2, Sdc4, and Itga5 in microglia subcluster 2 and maybe a therapeutic agent for the poor development of microglia subcluster 2 after stroke. Our study presents a nomogram model for stroke diagnosis and provides a potential molecule agent for stroke therapy.
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Affiliation(s)
- Jingwei Song
- Department of Medical Cell Biology and Genetics, Guangdong Key Laboratory of Genomic Stability and Disease Prevention, Shenzhen Key Laboratory of Anti-Aging and Regenerative Medicine, and Shenzhen Engineering Laboratory of Regenerative Technologies for Orthopaedic Diseases, Health Sciences Center, Shenzhen University, Shenzhen 518060, China; (J.S.); (S.A.A.Z.); (L.H.)
| | - Syed Aqib Ali Zaidi
- Department of Medical Cell Biology and Genetics, Guangdong Key Laboratory of Genomic Stability and Disease Prevention, Shenzhen Key Laboratory of Anti-Aging and Regenerative Medicine, and Shenzhen Engineering Laboratory of Regenerative Technologies for Orthopaedic Diseases, Health Sciences Center, Shenzhen University, Shenzhen 518060, China; (J.S.); (S.A.A.Z.); (L.H.)
| | - Liangge He
- Department of Medical Cell Biology and Genetics, Guangdong Key Laboratory of Genomic Stability and Disease Prevention, Shenzhen Key Laboratory of Anti-Aging and Regenerative Medicine, and Shenzhen Engineering Laboratory of Regenerative Technologies for Orthopaedic Diseases, Health Sciences Center, Shenzhen University, Shenzhen 518060, China; (J.S.); (S.A.A.Z.); (L.H.)
| | - Shuai Zhang
- Brain Research Centre, Department of Biology, School of Life Sciences, Southern University of Science and Technology, Shenzhen 518055, China
| | - Guangqian Zhou
- Department of Medical Cell Biology and Genetics, Guangdong Key Laboratory of Genomic Stability and Disease Prevention, Shenzhen Key Laboratory of Anti-Aging and Regenerative Medicine, and Shenzhen Engineering Laboratory of Regenerative Technologies for Orthopaedic Diseases, Health Sciences Center, Shenzhen University, Shenzhen 518060, China; (J.S.); (S.A.A.Z.); (L.H.)
- Lungene Biotech Ltd., Shenzhen 518060, China
- Senotherapeutics Ltd., Hangzhou 311100, China
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4
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Routledge H, Curzen N. Percutaneous management of acute ischaemic stroke. Heart 2023; 109:794-800. [PMID: 36737223 DOI: 10.1136/heartjnl-2022-321604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
| | - Nick Curzen
- Wessex Cardiac Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Pawłowski K, Dziadkiewicz A, Podlasek A, Klaudel J, Mączkowiak A, Szołkiewicz M. Thrombectomy-Capable Stroke Centre-A Key to Acute Stroke Care System Improvement? Retrospective Analysis of Safety and Efficacy of Endovascular Treatment in Cardiac Cathlab. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2232. [PMID: 36767599 PMCID: PMC9915992 DOI: 10.3390/ijerph20032232] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/16/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
The optimal structure of the acute ischaemic stroke treatment network is unknown and eagerly sought. To make it most effective, different treatment and transportation strategies have been developed and investigated worldwide. Since only a fraction of acute stroke patients with large vessel occlusion are treated, a new entity-thrombectomy-capable stroke centre (TCSC)-was introduced to respond to the growing demand for timely endovascular treatment. The purpose of this study was to present the early experience of the first 70 patients treated by mechanical means in a newly developed cardiac Cathlab-based TCSC. The essential safety and efficacy measures were recorded and compared with those reported in the invasive arm of the HERMES meta-analysis-the largest published dataset on the subject. We found no significant differences in terms of clinical and safety outcomes, such as early neurological recovery, level of functional independence at 90 days, symptomatic intracranial haemorrhage, parenchymal haematoma type 2, and mortality. These encouraging results obtained in the small endovascular centre may be an argument for the introduction of the TCSC into operating stroke networks to increase patient access to timely treatment and to improve clinical outcomes.
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Affiliation(s)
- Krzysztof Pawłowski
- Department of Cardiology and Interventional Angiology, Kashubian Center for Heart and Vascular Diseases, Pomeranian Hospitals, 84-200 Wejherowo, Poland
| | - Artur Dziadkiewicz
- Department of Neurology and Stroke, Pomeranian Hospitals, 84-200 Wejherowo, Poland
| | - Anna Podlasek
- Tayside Innovation Medtech Ecosystem (TIME), University of Dundee, Dundee DD1 4HN, UK
- Precision Imaging Beacon, Radiological Sciences, University of Nottingham, Nottingham NG7 2RD, UK
| | - Jacek Klaudel
- Department of Invasive Cardiology, St. Adalbert’s Hospital, Copernicus PL, 80-070 Gdansk, Poland
| | - Alicja Mączkowiak
- Department of Neurology and Stroke, Pomeranian Hospitals, 84-200 Wejherowo, Poland
| | - Marek Szołkiewicz
- Department of Cardiology and Interventional Angiology, Kashubian Center for Heart and Vascular Diseases, Pomeranian Hospitals, 84-200 Wejherowo, Poland
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Commentary on "Outcomes of Stroke Thrombectomy Performed by Interventional Radiologists versus Neurointerventional Physicians". J Vasc Interv Radiol 2022; 33:627-630. [PMID: 35636832 DOI: 10.1016/j.jvir.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/16/2022] [Accepted: 04/01/2022] [Indexed: 11/20/2022] Open
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Carvalho de Campos Martins E, Luiz de Melo Bernardi F. Interventional Cardiologists in the Interdisciplinary Stroke Team: We Are Already Here, Contributing! JACC Cardiovasc Interv 2022; 15:559-561. [PMID: 35151609 DOI: 10.1016/j.jcin.2021.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/10/2021] [Indexed: 10/19/2022]
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