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Scullen TA, Lian MX, Jaikumar V, Gay JL, Lai PMR, McPheeters MJ, Housley SB, Raygor KP, Bouslama M, Khan HS, Siddiqui AH, Davies JM, Moreland DB, Levy EI. First Reported Series of Cerebral Angiography Performed at an Outpatient Center: Safety and Satisfaction Results. Neurosurgery 2024:00006123-990000000-01297. [PMID: 39041790 DOI: 10.1227/neu.0000000000003119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 06/07/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Ambulatory surgery centers (ASCs) are increasingly common venues for same-day neurosurgical procedures, allowing for cost-effective, high-quality patient care. We present the first and largest series of patients undergoing diagnostic cerebral angiography at an ASC to demonstrate the effectiveness, safety, and efficiency of outpatient endovascular care. METHODS We retrospectively reviewed data for consecutive patients who underwent diagnostic cerebral angiography at our ASC between January 1, 2024, and May 29, 2024. Data collected included vascular access approach, procedural duration, turnover time, and periprocedural complications. Using a standardized 2-week postprocedural survey, patients were asked to provide comments and rate their subjective satisfaction from a 1 to 5 scale, with "5" being completely satisfied. All cases were performed with a physician team comprising 1 attending neuroendovascular neurosurgery and 1 neuroendovascular fellow present. Fentanyl and midazolam were administered for conscious sedation in all cases. RESULTS Among the 67 patients included in this series, the mean procedural duration was 29.4 ± 8.6 minutes. The mean turnover time was 13.7 ± 3.6 minutes. Between transradial (46 of 67 [68.7%]) and transfemoral (21 of 67 [31.3%]) access site approaches, there were no statistically significant differences in mean procedural duration (29.4 ± 8.0 vs 29.2 ± 9.9 minutes, respectively; P = .72) or turnover time (14.0 ± 3.9 vs 12.9 ± 2.8 minutes, respectively; P = .4). No complications occurred periprocedurally or within the 2-week follow-up period. A total of 48 (71.6%) of 67 patients responded to the postprocedural survey, all of whom unanimously reported a score of "5." CONCLUSION We found that diagnostic cerebral angiography performed at our ASC was safe and effective for patient care. In addition, all survey respondents (71.6% of those provided the survey) reported highest levels of satisfaction. The integration of neuroendovascular procedures into ASCs potentially offers a cost-effective and highly efficient option in an evolving economic landscape.
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Affiliation(s)
- Tyler A Scullen
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Ming X Lian
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Vinay Jaikumar
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Jennifer L Gay
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Pui Man Rosalind Lai
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Jacobs Institute, Buffalo, New York, USA
| | - Matthew J McPheeters
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Steven B Housley
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Kunal P Raygor
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Mehdi Bouslama
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Hamid S Khan
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Jacobs Institute, Buffalo, New York, USA
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Jason M Davies
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Jacobs Institute, Buffalo, New York, USA
- Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Douglas B Moreland
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Jacobs Institute, Buffalo, New York, USA
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
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Qiu K, Liu X, Jia Z, Zhao L, Shi H, Liu S. Comparing Transbrachial and Transradial as Alternatives to Transfemoral Access for Large-Bore Neuro Stenting: Insights From a Propensity-Matched Study. Acad Radiol 2024:S1076-6332(24)00431-8. [PMID: 38991867 DOI: 10.1016/j.acra.2024.06.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/26/2024] [Accepted: 06/26/2024] [Indexed: 07/13/2024]
Abstract
RATIONALE AND OBJECTIVES This study aimed to evaluate the safety and effectiveness of transbrachial access (TBA) and transradial access (TRA) compared to transfemoral access (TFA) for large-bore neuro stenting (≥7 F). METHODS From January 2019 to January 2024, 4752 patients received large-bore neuro stenting in our center. The primary outcomes were procedural metrics. Safety outcomes were significant access site complications, including substantial hematoma, pseudoaneurysm, artery occlusion, and complications requiring treatment (medicine, intervention, or surgery). After propensity score matching with a ratio of 1:1:2 (TBA: TRA: TFA), adjusting for age, gender, aortic arch type, and neuro stenting as covariates, outcomes were compared between groups. RESULTS 46 TBA, 46 TRA and 92 TFA patients were enrolled. The mean age was 67.8 ± 11.2 years, comprising 127 (69.0%) carotid artery stenting and 57 (31.0%) vertebral artery stenting. The rates of technical success (TBA: 100%, TRA: 95.7%, TFA: 100%) and significant access site complications (TBA: 4.3%, TRA: 6.5%, TFA: 1.1%) were comparable between the groups (P > 0.05). Compared to TFA, the TRA cohort exhibited significant delays in angiosuite arrival to puncture time (14 vs. 8 min, P = 0.039), puncture to angiography completion time (19 vs. 11 min, P = 0.027), and procedural duration (42 vs. 29 min, P = 0.031). There were no substantial differences in procedural time metrics between TBA (10, 14, and 31 min, respectively) and TFA. CONCLUSION TBA and TRA as the primary access for large-bore neuro stenting are safe and effective. Procedural delays in TRA may favor TBA as the first-line alternative access to TFA.
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Affiliation(s)
- Kai Qiu
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
| | - Xinglong Liu
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
| | - Zhenyu Jia
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
| | - Linbo Zhao
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
| | - Haibin Shi
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
| | - Sheng Liu
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China.
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Charles JH, Desai S, Jean Paul A, Hassan A. Multimodal imaging approach for the diagnosis of intracranial atherosclerotic disease (ICAD): Basic principles, current and future perspectives. Interv Neuroradiol 2024; 30:105-119. [PMID: 36262087 PMCID: PMC10956456 DOI: 10.1177/15910199221133170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 09/29/2022] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To review the different imaging modalities utilized in the diagnosis of Intracranial Atherosclerotic Disease (ICAD) including their latest development and relevance in management of ICAD. METHODS A review of the literature was conducted through a search in google scholar, PubMed/Medline, EMBASE, Scopus, clinical trials.gov and the Cochrane Library. Search terms included, "imaging modalities in ICAD," "ICAD diagnostic," "Neuroimaging of ICAD," "Evaluation of ICAD". A summary and comparison of each modality's basic principles, advantages and disadvantages were included. RESULTS A total of 144 articles were identified and reviewed. The most common imaging used in ICAD diagnoses were DSA, CTA, MRA and TCD. They all had proven accuracy, their own benefits, and limitations. Newer modalities such as VWI, IVUS, OCT, PWI and CFD provide more detailed information regarding the vessel walls, plaque characteristics, and flow dynamics, which play a tremendous role in treatment guidance. In certain clinical scenarios, using more than one modality has been shown to be helpful in ICAD identification. The rapidly evolving software related to imaging studies, such as virtual histology, are very promising for the diagnostic and management of ICAD. CONCLUSIONS ICAD is a common cause of recurrent ischemic stroke. Its management can be both medical and/or procedural. Many different imaging modalities are used in its diagnosis. In certain clinical scenario, a combination of two more modalities can be critical in the management of ICAD. We expect that continuous development of imaging technique will lead to individualized and less invasive management with adequate outcome.
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Affiliation(s)
| | - Sohum Desai
- Department of Endovascular Surgical Neuroradiology, Valley Baptist Medical Center, Harlingen, Texas, USA
| | - Axler Jean Paul
- School of Medicine, State University of Haiti, Port Au Prince, Haiti
| | - Ameer Hassan
- Department of Endovascular Surgical Neuroradiology, Valley Baptist Medical Center, Harlingen, Texas, USA
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Batista S, Oliveira LDB, Diniz JBC, Pinheiro AC, Maia H, Duarte M, Andreão FF, Palavani LB, Bertani R, Almeida Filho JA, Besborodco RM, Hanel R. Transradial versus transfemoral approach in cerebral angiography: A meta-analysis. Interv Neuroradiol 2023:15910199231212520. [PMID: 37936392 DOI: 10.1177/15910199231212520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Cerebral angiography has two common access sites: Transradial approach and transfemoral approach. However, there's no definitive answer to which one is superior. OBJECTIVE Compare transradial approach and transfemoral approach for a cerebral angiography procedure. METHODS A systematic review of the literature of studies reporting both transradial approach and transfemoral approach results was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. PubMed, Cochrane Library, and Embase were queried. RESULTS The meta-analysis examined 18 studies comprising 9388 patients undergoing cerebral angiography. Among the patients, 4598 underwent transradial approach (48.9%) and 4790 underwent transfemoral approach (51.1%). Our results revealed no statistical differences between the approaches regarding procedure success, crossover to transfemoral approach, procedure and fluoroscopy time between both approaches in cerebral angiography. Total, major, and minor complications comparisons were more favorable to transradial approach for this procedure. CONCLUSION These findings suggest, despite the ultimate decision regarding the choice of access method might be influenced by the physician's experience and personal preference, the data distinctly lean toward transradial approach as the preferable option for cerebral angiography. The advantages of transradial approach, highlighted by its lower complication rates, especially major complications, suggest that its adoption could contribute to enhanced patient safety and procedural outcomes.
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Affiliation(s)
- Sávio Batista
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | - Agostinho Camara Pinheiro
- Department of Neurology, Massachusetts General Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Henrique Maia
- Faculty of Medicine, Estácio de Sá University, Rio de Janeiro, RJ, Brazil
| | - Matheus Duarte
- Faculty of Medicine, Faculty of Medicine of Teresópolis, Teresópolis, RJ, Brazil
| | - Filipi Fim Andreão
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Raphael Bertani
- Department of Neurosurgery, University of São Paulo, São Paulo, SP, Brazil
| | | | | | - Ricardo Hanel
- Department of Cerebrovascular and Endovascular Surgery, Baptist Neurologic Institute and Lyerly Neurosurgery, Jacksonville, FL, USA
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Yaser Arafath M, Bhatia V, Kumar A, Chauhan R, Prabhakar A, Gupta SK, Singh P. Adapting to transradial approach in cerebral angiography: Factors influencing successful cannulation. Neuroradiol J 2023; 36:163-168. [PMID: 35749090 PMCID: PMC10034707 DOI: 10.1177/19714009221111090] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To evaluate factors that influence the successful cannulation of intracranial vessels using a transradial approach. METHODS A total of 61 transradial diagnostic angiograms were evaluated in a tertiary care center from July 2020 to December 2021. We evaluated the learning curve and aortic arch vessel factors that may influence the cannulation of intracranial major vessels using a transradial approach. RESULTS Learning curve for the procedure was established after 21 cases. We were successful in cannulating the supra-aortic arteries except in 4 cases where we were unable to cannulate the left VA (vertebral artery). Significant positive correlation was seen between time to Sim (Simmons curve) formation and aortic arch diameter (p = .002). Significant positive correlation was also seen between left VA take-off angle and time to cannulate left VA (p = .001) and negative correlation was noted between left CCA (common carotid artery) take-off angle and time to cannulate left CCA (p = .001). CONCLUSION Transradial approach is a feasible and safe approach for performing cerebral angiography. Multiple factors can influence the procedure time and successful cannulation of intracranial vessels. With the availability of radial specific hardware in the future, procedural success and time taken to complete the procedure may improve.
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Affiliation(s)
- Mohamed Yaser Arafath
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and
Research, Chandigarh, India
| | - Vikas Bhatia
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and
Research, Chandigarh, India
| | - Ajay Kumar
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and
Research, Chandigarh, India
| | - Rajeev Chauhan
- Department of Anaesthesia, Post Graduate Institute of Medical Education and
Research, Chandigarh, India
| | - Anuj Prabhakar
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and
Research, Chandigarh, India
| | - SK Gupta
- Department of Neurosurgery, Post Graduate Institute of Medical Education and
Research, Chandigarh, India
| | - Paramjeet Singh
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and
Research, Chandigarh, India
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Uluc K, Ambady P, McIntyre MK, Tabb JP, Kersch CN, Nerison CS, Huddleston A, Liu JJ, Dogan A, Priest RA, Fu R, Prola Netto J, Siler DA, Muldoon LL, Gahramanov S, Neuwelt EA. Safety of intra-arterial chemotherapy with or without osmotic blood–brain barrier disruption for the treatment of patients with brain tumors. Neurooncol Adv 2022; 4:vdac104. [PMID: 35892048 PMCID: PMC9307096 DOI: 10.1093/noajnl/vdac104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Intra-arterial administration of chemotherapy with or without osmotic blood–brain barrier disruption enhances delivery of therapeutic agents to brain tumors. The aim of this study is to evaluate the safety of these procedures. Methods Retrospectively collected data from a prospective database of consecutive patients with primary and metastatic brain tumors who received intra-arterial chemotherapy without osmotic blood–brain barrier disruption (IA) or intra-arterial chemotherapy with osmotic blood–brain barrier disruption (IA/OBBBD) at Oregon Health and Science University (OHSU) between December 1997 and November 2018 is reported. Chemotherapy-related complications are detailed per Common Terminology Criteria for Adverse Events (CTCAE) guidelines. Procedure-related complications are grouped as major and minor. Results 4939 procedures (1102 IA; 3837 IA/OBBBD) were performed on 436 patients with various pathologies (primary central nervous system lymphoma [26.4%], glioblastoma [18.1%], and oligodendroglioma [14.7%]). Major procedure-related complications (IA: 12, 1%; IA/OBBBD: 27, 0.7%; P = .292) occurred in 39 procedures including 3 arterial dissections requiring intervention, 21 symptomatic strokes, 3 myocardial infarctions, 6 cervical cord injuries, and 6 deaths within 3 days. Minor procedure-related complications occurred in 330 procedures (IA: 41, 3.7%; IA/OBBBD: 289, 7.5%; P = .001). Chemotherapy-related complications with a CTCAE attribution and grade higher than 3 was seen in 359 (82.3%) patients. Conclusions We provide safety and tolerability data from the largest cohort of consecutive patients who received IA or IA/OBBBD. Our data demonstrate that IA or IA/OBBBD safely enhance drug delivery to brain tumors and brain around the tumor.
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Affiliation(s)
- Kutluay Uluc
- Department of Neurology, Oregon Health & Science University , Portland, Oregon , USA
| | - Prakash Ambady
- Department of Neurology, Oregon Health & Science University , Portland, Oregon , USA
| | - Matthew K McIntyre
- Department of Neurosurgery, Oregon Health & Science University , Portland, Oregon , USA
| | - John Philip Tabb
- Department of Neurosurgery, Oregon Health & Science University , Portland, Oregon , USA
| | - Cymon N Kersch
- Department of Neurology, Oregon Health & Science University , Portland, Oregon , USA
- Providence Portland Internal Medicine Residency Program , Providence, Portland, Oregon , USA
| | - Caleb S Nerison
- Western University of Health Sciences COMP-NW , Lebanon, Oregon , USA
| | - Amy Huddleston
- Department of Neurology, Oregon Health & Science University , Portland, Oregon , USA
| | - Jesse J Liu
- Department of Neurosurgery, Oregon Health & Science University , Portland, Oregon , USA
- Department of Interventional Radiology, Oregon Health & Science University , Portland, Oregon , USA
- Portland Veterans Affairs Medical Center , Portland, Oregon , USA
| | - Aclan Dogan
- Department of Neurosurgery, Oregon Health & Science University , Portland, Oregon , USA
| | - Ryan A Priest
- Department of Interventional Radiology, Oregon Health & Science University , Portland, Oregon , USA
| | - Rongwei Fu
- School of Public Health, Oregon Health & Science University , Portland, Oregon , USA
| | | | - Dominic A Siler
- Department of Neurosurgery, Oregon Health & Science University , Portland, Oregon , USA
| | - Leslie L Muldoon
- Department of Neurology, Oregon Health & Science University , Portland, Oregon , USA
| | - Seymur Gahramanov
- Capital Neurosurgery Specialists, Salem Health , Salem, Oregon , USA
| | - Edward A Neuwelt
- Department of Neurology, Oregon Health & Science University , Portland, Oregon , USA
- Department of Neurosurgery, Oregon Health & Science University , Portland, Oregon , USA
- Portland Veterans Affairs Medical Center , Portland, Oregon , USA
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