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Michiwaki Y, Yamane F, Itokawa H, Tanaka T, Shimoji K, Matsuno A. Hands-on neuroendovascular practice for nonselective undergraduate medical students increases interest and aspirations in pursuing neurosurgery as a specialization. Surg Neurol Int 2023; 14:414. [PMID: 38213451 PMCID: PMC10783694 DOI: 10.25259/sni_778_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/03/2023] [Indexed: 01/13/2024] Open
Abstract
Background The number of medical students aspiring to become neurosurgeons has decreased worldwide, mainly due to poor work-life balance among neurosurgeons; therefore, recruiting students for neurosurgery is essential to ensure the availability and appropriate quality of neurosurgical treatment. This study aimed to evaluate the efficacy of hands-on neuroendovascular practice for nonselective undergraduate medical students to determine whether this increases their interest in neurosurgery and contributes to their aspirations of becoming neurosurgeons. Methods Hands-on neuroendovascular practice for mechanical thrombectomy was performed by undergraduate 5th-year medical students during their 2-week clinical rotation in the Department of neurosurgery at our university hospital between April 2021 and March 2023. After the neurosurgery practice, a questionnaire about their understanding of neurosurgery and aspirations for this specialization before and after the practice was anonymously completed by all students. Results Overall, 153 students completed the questionnaire. Of these, 140 (91.5 %) showed increased interest in neurosurgery after participating in the hands-on practice. Through this practice, the number of students who considered neurosurgery as their first choice or one of their specialty choices increased from 8 (5.2%) to 12 (7.8%) (P = 0.3534) and from 19 (12.4%) to 52 (34.0%) (P < 0.0001), respectively. Furthermore, the number of students with no aspiration to become neurosurgeons decreased from 95 (62.1%) to 43 (28.1%) (P < 0.0001). Conclusion Hands-on neuroendovascular practice for nonselective undergraduate medical students effectively increased their interest in neurosurgery specialization and their desire to become neurosurgeons. Therefore, this practice can help recruit medical students for neurosurgery specialization.
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Affiliation(s)
- Yuhei Michiwaki
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita City, Chiba, Japan
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Altersberger VL, Wright PR, Schaedelin SA, De Marchis GM, Gensicke H, Engelter ST, Psychogios M, Kahles T, Goeldlin M, Meinel TR, Mordasini P, Kaesmacher J, von Hessling A, Vehoff J, Weber J, Wegener S, Salmen S, Sturzenegger R, Medlin F, Berger C, Schelosky L, Renaud S, Niederhauser J, Bonvin C, Schaerer M, Mono ML, Rodic B, Schwegler G, Peters N, Bolognese M, Luft AR, Cereda CW, Kägi G, Michel P, Carrera E, Arnold M, Fischer U, Nedeltchev K, Bonati LH. Effect of admission time on provision of acute stroke treatment at stroke units and stroke centers—An analysis of the Swiss Stroke Registry. Eur Stroke J 2022; 7:117-125. [DOI: 10.1177/23969873221094408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/29/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction: Rapid treatment of acute ischemic stroke (AIS) depends on sufficient staffing which differs between Stroke Centers and Stroke Units in Switzerland. We studied the effect of admission time on performance measures of AIS treatment and related temporal trends over time. Patients and methods: We compared treatment rates, door-to-image-time, door-to-needle-time, and door-to-groin-puncture-time in stroke patients admitted during office hours (Monday–Friday 8:00–17:59) and non-office hours at all certified Stroke Centers and Stroke Units in Switzerland, as well as secular trends thereof between 2014 and 2019, using data from the Swiss Stroke Registry. Secondary outcomes were modified Rankin Scale and mortality at 3 months. Results: Data were eligible for analysis in 31,788 (90.2%) of 35,261 patients. Treatment rates for IVT/EVT were higher during non-office hours compared with office hours in Stroke Centers (40.8 vs 36.5%) and Stroke Units (21.8 vs 18.5%). Door-to-image-time and door-to-needle-time increased significantly during non-office hours. Median (IQR) door-to-groin-puncture-time at Stroke Centers was longer during non-office hours compared to office hours (84 (59–116) vs 95 (66–130) minutes). Admission during non-office hours was independently associated with worse functional outcome (1.11 [95%CI: 1.04–1.18]) and increased mortality (1.13 [95%CI: 1.01–1.27]). From 2014 to 2019, median door-to-groin-puncture-time improved and the treatment rate for wake-up strokes increased. Discussion and Conclusion: Despite differences in staffing, patient admission during non-office hours delayed IVT to a similar, modest degree at Stroke Centers and Stroke Units. A larger delay of EVT was observed during non-office hours, but Stroke Centers sped up delivery of EVT over time. Patients admitted during non-office hours had worse functional outcomes, which was not explained by treatment delays.
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Affiliation(s)
- Valerian L Altersberger
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Patrick R Wright
- Clinical Trial Unit, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Sabine A Schaedelin
- Clinical Trial Unit, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Gian Marco De Marchis
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Henrik Gensicke
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurorehabilitation, University of Basel and University Department of Geriatic Medicine FELIX PLATTER, University of Basel, Switzerland
| | - Stefan T Engelter
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurorehabilitation, University of Basel and University Department of Geriatic Medicine FELIX PLATTER, University of Basel, Switzerland
| | - Marios Psychogios
- Department of Neuroradiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Timo Kahles
- Department of Neurology, Kantonsspital Aarau, Aarau, Switzerland
| | - Martina Goeldlin
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Thomas R Meinel
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Pasquale Mordasini
- University Institute of Diagnostic and Interventional Neuroradiology and University Institute of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital Inselspital Bern, and University of Bern, Bern, Switzerland
| | - Johannes Kaesmacher
- University Institute of Diagnostic and Interventional Neuroradiology and University Institute of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital Inselspital Bern, and University of Bern, Bern, Switzerland
| | | | - Jochen Vehoff
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Johannes Weber
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Susanne Wegener
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Stephan Salmen
- Department of Neurology, Spitalzentrum Biel, Biel, Switzerland
| | | | - Friedrich Medlin
- Department of Internal Medicine, Stroke Unit and Division of Neurology, HFR Fribourg, Cantonal Hospital, Fribourg, Switzerland
| | | | | | - Susanne Renaud
- Stroke Unit and Division of Neurology, Neuchatel Hospital Network, Neuchatel, Switzerland
| | | | | | | | | | - Biljana Rodic
- Cantonal Hospital Winterthur, Winterthur, Switzerland
| | | | - Nils Peters
- Stroke Center, Hirslanden Hospital Zurich, Zurich, Switzerland
| | | | - Andreas R Luft
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Cereneo Center for Neurology and Rehabilitation, Weggis, Switzerland
| | - Carlo W Cereda
- Stroke Center and Department of Neurology, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Georg Kägi
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Patrick Michel
- Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | | | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Urs Fischer
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | | | - Leo H Bonati
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
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3
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Oravec CS, Tschoe C, Fargen KM, Kittel CA, Spiotta A, Almallouhi E, Starke RM, McCarthy DJ, Simon S, Zyck S, Gould GC, De Leacy R, Mocco J, Siddiqui A, Vaziri S, Fox WC, Fraser JF, Chitale R, Zipfel G, Huguenard A, Wolfe SQ. Trends in mechanical thrombectomy and decompressive hemicraniectomy for stroke: A multicenter study. Neuroradiol J 2021; 35:170-176. [PMID: 34269121 DOI: 10.1177/19714009211030526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE Acute ischemic stroke has increasingly become a procedural disease following the demonstrated benefit of mechanical thrombectomy (MT) for emergent large vessel occlusion (ELVO) on clinical outcomes and tissue salvage in randomized trials. Given these data and anecdotal experience of decreased numbers of decompressive hemicraniectomies (DHCs) performed for malignant cerebral edema, we sought to correlate the numbers of strokes, thrombectomies, and DHCs performed over the timeline of the 2013 failed thrombolysis/thrombectomy trials, to the 2015 modern randomized MT trials, to post-DAWN and DEFUSE 3. MATERIALS AND METHODS This is a multicenter retrospective compilation of patients who presented with ELVO in 11 US high-volume comprehensive stroke centers. Rates of tissue plasminogen activator (tPA), thrombectomy, and DHC were determined by current procedural terminology code, and specificity to acute ischemic stroke confirmed by each institution. Endpoints included the incidence of stroke, thrombectomy, and DHC and rates of change over time. RESULTS Between 2013 and 2018, there were 55,247 stroke admissions across 11 participating centers. Of these, 6145 received tPA, 4122 underwent thrombectomy, and 662 patients underwent hemicraniectomy. The trajectories of procedure rates over time were modeled and there was a significant change in MT rate (p = 0.002) without a concomitant change in the total number of stroke admissions, tPA administration rate, or rate of DHC. CONCLUSIONS This real-world study confirms an increase in thrombectomy performed for ELVO while demonstrating stable rates of stroke admission, tPA administration and DHC. Unlike prior studies, increasing thrombectomy rates were not associated with decreased utilization of hemicraniectomy.
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Affiliation(s)
- Chesney S Oravec
- Department of Neurosurgery, Wake Forest Baptist Medical Center, USA
| | - Christine Tschoe
- Department of Neurosurgery, Wake Forest Baptist Medical Center, USA
| | - Kyle M Fargen
- Department of Neurosurgery, Wake Forest Baptist Medical Center, USA
| | - Carol A Kittel
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Justin F Fraser
- Departments of Neurological Surgery, Neurology, Radiology, and Neuroscience, University of Kentucky, USA
| | | | | | | | - Stacey Q Wolfe
- Department of Neurosurgery, Wake Forest Baptist Medical Center, USA
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4
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Morey JR, Zhang X, Yaeger KA, Fiano E, Marayati NF, Kellner CP, De Leacy RA, Doshi A, Tuhrim S, Fifi JT. Real-World Experience with Artificial Intelligence-Based Triage in Transferred Large Vessel Occlusion Stroke Patients. Cerebrovasc Dis 2021; 50:450-455. [PMID: 33849032 DOI: 10.1159/000515320] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 02/16/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Randomized controlled trials have demonstrated the importance of time to endovascular therapy (EVT) in clinical outcomes in large vessel occlusion (LVO) acute ischemic stroke. Delays to treatment are particularly prevalent when patients require a transfer from hospitals without EVT capability onsite. A computer-aided triage system, Viz LVO, has the potential to streamline workflows. This platform includes an image viewer, a communication system, and an artificial intelligence (AI) algorithm that automatically identifies suspected LVO strokes on CTA imaging and rapidly triggers alerts. We hypothesize that the Viz application will decrease time-to-treatment, leading to improved clinical outcomes. METHODS A retrospective analysis of a prospectively maintained database was assessed for patients who presented to a stroke center currently utilizing Viz LVO and underwent EVT following transfer for LVO stroke between July 2018 and March 2020. Time intervals and clinical outcomes were compared for 55 patients divided into pre- and post-Viz cohorts. RESULTS The median initial door-to-neuroendovascular team (NT) notification time interval was significantly faster (25.0 min [IQR = 12.0] vs. 40.0 min [IQR = 61.0]; p = 0.01) with less variation (p < 0.05) following Viz LVO implementation. The median initial door-to-skin puncture time interval was 25 min shorter in the post-Viz cohort, although this was not statistically significant (p = 0.15). CONCLUSIONS Preliminary results have shown that Viz LVO implementation is associated with earlier, more consistent NT notification times. This application can serve as an early warning system and a failsafe to ensure that no LVO is left behind.
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Affiliation(s)
- Jacob R Morey
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, New York, USA
| | - Xiangnan Zhang
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, New York, USA
| | - Kurt A Yaeger
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, New York, USA
| | - Emily Fiano
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, New York, USA
| | - Naoum Fares Marayati
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, New York, USA
| | - Christopher P Kellner
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, New York, USA
| | - Reade A De Leacy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, New York, USA
| | - Amish Doshi
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, New York, USA
| | - Stanley Tuhrim
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, New York, USA
| | - Johanna T Fifi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, New York, USA.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, New York, USA
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5
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Pérez-Pelegrí M, Biarnés C, Thió-Henestrosa S, Remollo S, Gimeno A, Cuba V, Teceño M, Martí-Navas M, Serena J, Pedraza S, Ruiz-Constantino JS, Puig J. Higher agreement in endovascular treatment decision-making than in parametric quantifications among automated CT perfusion software packages in acute ischemic stroke. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2021; 29:823-834. [PMID: 34334443 DOI: 10.3233/xst-210898] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Estimates of parameters used to select patients for endovascular thrombectomy (EVT) for acute ischemic stroke differ among software packages for automated computed tomography (CT) perfusion analysis. To determine impact of these differences in decision making, we analyzed intra-observer and inter-observer agreement in recommendations about whether to perform EVT based on perfusion maps from 4 packages. METHODS Perfusion CT datasets from 63 consecutive patients with suspected acute ischemic stroke were retrospectively postprocessed with 4 packages of Minerva, RAPID, Olea, and IntelliSpace Portal (ISP). We used Pearson correlation coefficients and Bland-Altman analysis to compare volumes of infarct core, penumbra, and mismatch calculated by Minerva and RAPID. We used kappa analysis to assess agreement among decisions of 3 radiologists about whether to recommend EVT based on maps generated by 4 packages. RESULTS We found significant differences between using Minerva and RAPID to estimate penumbra (67.39±41.37mL vs. 78.35±45.38 mL, p < 0.001) and mismatch (48.41±32.03 vs. 61.27±32.73mL, p < 0.001), but not of infarct core (p = 0.230). Pearson correlation coefficients were 0.94 (95%CI:0.90-0.96) for infarct core, 0.87 (95%CI:0.79-0.91) for penumbra, and 0.72 (95%CI:0.57-0.83) for mismatch volumes (p < 0.001). Limits of agreements were (-21.22-25.02) for infarct core volumes, (-54.79-32.88) for penumbra volumes, and (-60.16-34.45) for mismatch volumes. Final agreement for EVT decision-making was substantial between Minerva vs. RAPID (k = 0.722), Minerva vs. Olea (k = 0.761), and RAPID vs. Olea (k = 0.782), but moderate for ISP vs. the other three. CONCLUSIONS Despite quantitative differences in estimates of infarct core, penumbra, and mismatch using 4 software packages, their impact on radiologists' decisions about EVT is relatively small.
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Affiliation(s)
| | - Carles Biarnés
- Diagnostic Imaging Institute (IDI), Department of Radiology, Girona Biomedical Research Institute, (IDIBGI), Dr Josep Trueta University Hospital, Girona, Spain
| | - Santiago Thió-Henestrosa
- Department of Computer Science, Applied Mathematics and Statistics, University of Girona, Girona, Spain
| | - Sebastià Remollo
- Department of Radiology, Germans Triasi Pujol University Hospital, Badalona, Spain
| | - Alfredo Gimeno
- Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Víctor Cuba
- Department of Radiology, Bellvitge University Hospital, Barcelona, Spain
| | - Mikel Teceño
- Department of Neurology-IDIBGI, Dr Josep Trueta University Hospital, Girona, Spain
| | - Marian Martí-Navas
- Diagnostic Imaging Institute (IDI), Department of Radiology, Girona Biomedical Research Institute, (IDIBGI), Dr Josep Trueta University Hospital, Girona, Spain
| | - Joaquín Serena
- Department of Neurology-IDIBGI, Dr Josep Trueta University Hospital, Girona, Spain
| | - Salvador Pedraza
- Diagnostic Imaging Institute (IDI), Department of Radiology, Girona Biomedical Research Institute, (IDIBGI), Dr Josep Trueta University Hospital, Girona, Spain
| | | | - Josep Puig
- Diagnostic Imaging Institute (IDI), Department of Radiology, Girona Biomedical Research Institute, (IDIBGI), Dr Josep Trueta University Hospital, Girona, Spain
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Felbaum DR, Dowlati E, Mai JC, Liu AH, Schuette AJ, Bell R, Armonda RA. Letter: Realistic Expectations for Incorporating Dual-Trained Neurosurgeons in a Call Schedule. Neurosurgery 2020; 87:E615-E616. [PMID: 32860029 DOI: 10.1093/neuros/nyaa375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Affiliation(s)
- Daniel R Felbaum
- Department of Neurosurgery MedStar Georgetown University Hospital Washington, District of Columbia
- Department of Neurosurgery MedStar Washington Hospital Center Washington, District of Columbia
| | - Ehsan Dowlati
- Department of Neurosurgery MedStar Georgetown University Hospital Washington, District of Columbia
| | - Jeffrey C Mai
- Department of Neurosurgery MedStar Georgetown University Hospital Washington, District of Columbia
- Department of Neurosurgery MedStar Washington Hospital Center Washington, District of Columbia
| | - Ai-Hsi Liu
- Department of Radiology MedStar Washington Hospital Center Washington, District of Columbia
| | - A Jesse Schuette
- Division of Neurosurgery Walter Reed National Military Medical Center Bethesda, Maryland
| | - Randy Bell
- Division of Neurosurgery Walter Reed National Military Medical Center Bethesda, Maryland
| | - Rocco A Armonda
- Department of Neurosurgery MedStar Georgetown University Hospital Washington, District of Columbia
- Department of Neurosurgery MedStar Washington Hospital Center Washington, District of Columbia
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7
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Fargen KM, Leslie-Mazwi TM, Klucznik RP, Wolfe SQ, Brown P, Ansari SA, Dabus G, Spiotta AM, Mokin M, Hassan AE, Liebeskind D, Welch BG, Siddiqui AH, Hirsch JA. The professional and personal impact of the coronavirus pandemic on US neurointerventional practices: a nationwide survey. J Neurointerv Surg 2020; 12:927-931. [PMID: 32788389 PMCID: PMC7421723 DOI: 10.1136/neurintsurg-2020-016513] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Little is currently known about the effects of the coronavirus (COVID-19) pandemic on neurointerventional (NI) procedural volumes or its toll on physician wellness. METHODS A 37-question online survey was designed and distributed to physician members of three NI physician organizations. RESULTS A total of 151 individual survey responses were obtained. Reduced mechanical thrombectomy procedures compared with pre-pandemic were observed with 32% reporting a greater than 50% reduction in thrombectomy volumes. In concert with most (76%) reporting at least a 25% reduction in non-mechanical thrombectomy urgent NI procedures and a nearly unanimous (96%) cessation of non-urgent elective cases, 68% of physicians reported dramatic reductions (>50%) in overall NI procedural volume compared with pre-pandemic. Increased door-to-puncture times were reported by 79%. COVID-19-positive infections occurred in 1% of physician respondents: an additional 8% quarantined for suspected infection. Sixty-six percent of respondents reported increased career stress, 56% increased personal life/family stress, and 35% increased career burnout. Stress was significantly increased in physicians with COVID-positive family members (P<0.05). CONCLUSIONS This is the first study designed to understand the effects of the COVID-19 pandemic on NI physician practices, case volumes, compensation, personal/family stresses, and work-related burnout. Future studies examining these factors following the resumption of elective cases and relaxing of social distancing measures will be necessary to better understand these phenomena.
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Affiliation(s)
- Kyle M Fargen
- Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | | | | | - Stacey Q Wolfe
- Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Patrick Brown
- Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Sameer A Ansari
- Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Guilherme Dabus
- Interventional Neuroradiology and Neuroendovascular Surgery, Miami Neuroscience Institute and Miami Cardiac & Vascular Institute - Baptist Hospital, Miami, Florida, USA
| | - Alejandro M Spiotta
- Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Maxim Mokin
- Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - Ameer E Hassan
- Department of Neurology, University of Texas Rio Grande Valley, Treasure Hills, Harlingen, Texas, USA
| | | | - Babu G Welch
- Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Joshua A Hirsch
- NeuroEndovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
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8
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Tschoe C, Kittel C, Brown P, Hafeez M, Kan P, Alawieh A, Spiotta AM, Almallouhi E, Dumont TM, McCarthy DJ, Starke RM, De Leacy R, Wolfe SQ, Fargen KM. Impact of off-hour endovascular therapy on outcomes for acute ischemic stroke: insights from STAR. J Neurointerv Surg 2020; 13:693-696. [PMID: 32900909 DOI: 10.1136/neurintsurg-2020-016474] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/30/2020] [Accepted: 08/01/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND The off-hour effect has been observed in the medical care of acute ischemic stroke. However, it remains unclear if time of arrival affects revascularization rates and outcomes after endovascular therapy (EVT) for emergent large vessel occlusion (ELVO). We aimed to investigate the clinical outcomes of EVT between on-hour and off-hour admissions. METHODS Patients who underwent EVT for ELVO from January 2013 to June 2019 from the STAR Registry were included. Patients were grouped based on time of groin puncture: on-hour period (Monday through Friday, 7:00 am-4:59 pm) and off-hour period (overnight 5:00pm-6:59am and the weekends). Primary outcome was final modified Rankin Scale (mRS) at 90 days on mRS-shift analysis. RESULTS A total of 1919 patients were included in the study from six centers. The majority of patients (1169, 60.9%) of patients presented during the off-hour period. The mean age was 68.1 years and 50.5% were women. Successful reperfusion, as defined by a Thrombolysis In Cerebral Infarction (TICI) score of ≥2B, was achieved in 88.8% in the on-hour group and 88.0% in the off-hour group. Good clinical outcome (mRS 0-2) was obtained in 34.4% of off-hour patients and 37.7% of on-hour patients. On multivariable ordinal logistic regression analysis, time of presentation was not associated with worsened outcome (OR 1.150; 95% CI 0.96 to 1.37; P=0.122). Age, admission National Institutes of Health Stroke Scale (NIHSS), baseline mRS, and final TICI score were significantly associated with worse outcomes. CONCLUSION There is no statistical difference in functional outcome in acute ischemic stroke patients who underwent EVT during on-hours versus off-hours.
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Affiliation(s)
- Christine Tschoe
- Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Carol Kittel
- Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Patrick Brown
- Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Muhammad Hafeez
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Ali Alawieh
- Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alejandro M Spiotta
- Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Eyad Almallouhi
- Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Travis M Dumont
- Department of Surgery, Division of Neurosurgery, University of Arizona/Arizona Health Science Center, Tucson, Arizona, USA
| | - David J McCarthy
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - Robert M Starke
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - Reade De Leacy
- Radiology, Mount Sinai Health System, New York, New York, USA
| | - Stacey Q Wolfe
- Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Kyle M Fargen
- Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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9
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Kurogi A, Nishimura A, Nishimura K, Kada A, Onozuka D, Hagihara A, Ogasawara K, Shiokawa Y, Kitazono T, Arimura K, Iihara K. Temporal trends and geographical disparities in comprehensive stroke centre capabilities in Japan from 2010 to 2018. BMJ Open 2020; 10:e033055. [PMID: 32764079 PMCID: PMC7412582 DOI: 10.1136/bmjopen-2019-033055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Comprehensive stroke centre (CSC) capabilities are associated with reduced in-hospital mortality due to acute stroke. However, it remains unclear whether there are improving trends in the CSC capabilities or how hospital-related factors determine quality improvement. This study examined whether CSC capabilities changed in Japan between 2010 and 2018 and and whether any changes were influenced by hospital characteristics. DESIGN A hospital-based cross-sectional study. SETTING We sent out questionnaires to the training institutions of the Japan Neurosurgical Society and Japan Stroke Society in 2010, 2014 and 2018. PARTICIPANTS 749 hospitals in 2010, 532 hospitals in 2014 and 786 hospitals in 2018 participated in the J-ASPECT study, a nationwide survey of acute stroke care capacity for proper designation of a comprehensive stroke centre in Japan. MAIN OUTCOME MEASURES CSC capabilities were assessed using the validated scoring system (CSC score: 1-25 points) in 2010, 2014 and 2018 survey. The effect of hospital characteristics was examined using multiple logistic regression analysis. RESULTS Among the 323 hospitals that responded to all surveys, the implementation of 13 recommended items increased. The CSC score (median and IQR) was 16 (13-19), 18 (14-20) and 19 (15-21) for 2010, 2014 and 2018, respectively (p<0.001). There was a ≥20% increase in six items (eg, endovascular physicians, stroke unit and interventional coverage 24/7), and a ≤20% decrease in community education. A lower baseline CSC score (OR: 0.82, 95% CI 0.75 to 0.9), the number of beds≥500 (OR: 3.9, 95% CI 1.2 to 13.0) and the number of stroke physicians (7-9) (OR: 2.6, 95% CI 1.1 to 6.3) were associated with improved CSC capabilities, independent of geographical location. CONCLUSIONS There was a significant improvement in CSC capabilities between 2010 and 2018, which was mainly related to the availability of endovascular treatment and multidisciplinary care. Our findings may be useful to determine which hospitals should be targeted to improve CSC capabilities in a defined area.
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Affiliation(s)
- Ai Kurogi
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ataru Nishimura
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kunihiro Nishimura
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Akiko Kada
- Department of Clinical Trials and Research, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Daisuke Onozuka
- Department of Health Communication, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akihito Hagihara
- Department of Health Communication, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kuniaki Ogasawara
- Department of Neurosurgery, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Yoshiaki Shiokawa
- Department of Neurosurgery, Kyorin University Hospital, Mitaka, Tokyo, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Kyusyu University Graduate School of Medicine, Fukuoka, Japan
| | - Koichi Arimura
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Iihara
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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10
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Fargen KM, Leslie-Mazwi TM, Chen M, Hirsch JA. Physician, know thyself: implicit and explicit decision-making for mechanical thrombectomy in stroke. J Neurointerv Surg 2020; 12:952-956. [DOI: 10.1136/neurintsurg-2020-015973] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 01/02/2023]
Abstract
Few clinical situations in medical practice are as time-sensitive and and have such profound ramifications as selection of patients with acute stroke for mechanical thrombectomy (MT). Emergent large vessel occlusion has become a treatable disease with minimal numbers needed to treat to achieve a functional, long-term neurologic outcome. However, MT carries risk and many patients who are appropriately reperfused continue to have significant neurologic deficits and disability despite a successful procedure. The decision to offer or withhold MT can be complex. Frequently decisions must be made based on incomplete information or emergently while the physician is awoken from sleep or distracted while performing other procedures. A growing number of studies have examined cognitive errors and biases as they pertain to patient diagnosis and treatment in medicine. Dual process theory identifies two decision-making processes as system 1 ('implicit') and system 2 ('explicit') and describes the patterns through which decisions are formulated. The implicit system is the default pathway as it requires little effort or focus, uses mental short cuts, and is rapid; however, this pathway is subject to considerable bias and error. This manuscript reviews the mechanisms underlying the way in which physician decisions about MT are made, specifically highlighting prominent biases that may affect judgment, and reviews other important principles, such as confidence in decisions, aggressiveness to pursue MT, and strategies to improve decisions.
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11
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Dalsania AK, Kansagra AP. Strategies to reduce the impact of demand for concurrent endovascular thrombectomy. J Neurointerv Surg 2020; 12:1072-1075. [PMID: 32188761 DOI: 10.1136/neurintsurg-2020-015826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/23/2020] [Accepted: 02/25/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The rise in demand for endovascular thrombectomy (EVT) has increased the possibility that multiple patients with acute ischemic stroke may present concurrently and exceed local capacity to provide timely treatment. In this work, we quantitatively compared the efficacy of various strategies to mitigate demand in excess of capacity (DEC). METHODS Strategies evaluated included a backup neurointerventional team for 3 hours, 8 hours, or 24 hours per day; a separate pre-intervention imaging team; and a 30% decrease in procedure duration. For each strategy, empirical distributions were used to probabilistically generate arrival time and case duration for 16 000 independent trials repeated across a range of annual case volumes. DEC was calculated from time series representing the number of concurrent cases at each minute of the year for each trial at each case volume. RESULTS All strategies decreased DEC compared with baseline. At a representative volume of 250 cases per year, availability of a backup team for 3 hours, 8 hours, and 24 hours per day reduced DEC by 27.0%, 60.3%, and 97.2%, respectively, compared with baseline. Similarly, availability of a pre-intervention imaging team and a 30% decrease in procedure duration reduced DEC by 26.6% and 17.7%, respectively, compared with baseline. CONCLUSIONS A backup neurointerventional team, even if available only part time, was an effective strategy for decreasing DEC for EVT. Understanding the actual quantitative benefit of each strategy can facilitate rational cost-benefit analyses underlying the development of efficient and sustainable models of care.
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Affiliation(s)
| | - Akash P Kansagra
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri, USA .,Department of Neurological Surgery, Washington University School of Medicine, St Louis, Missouri, USA.,Department of Neurology, Washington University School of Medicine, St Louis, Missouri, USA
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12
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Williams MM, Leslie-Mazwi T, Hirsch JA, Kittel C, Spiotta A, De Leacy R, Mocco J, Albuquerque FC, Ducruet AF, Goyal N, Arthur AS, Kan P, Mokin M, Dumont TM, Reeves A, Wolfe SQ, Fargen K. Real-world effects of late window neurothrombectomy: procedure rates increase without night-time bias. J Neurointerv Surg 2019; 12:460-464. [PMID: 31723049 DOI: 10.1136/neurintsurg-2019-015223] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/23/2019] [Accepted: 10/01/2019] [Indexed: 01/13/2023]
Abstract
INTRODUCTION With the expansion of the interventional time window for stroke from emergent large vessel occlusion (ELVO), the rate of mechanical thrombectomy (MT) is expected to rise, potentially causing higher burnout rates and requiring hospitals to develop strategies for adequate coverage of these procedures. METHODS Neurointerventional physicians at 10 participating stroke centers prospectively recorded time requirements for all MT consultations over 30 consecutive 24-hour call periods, including both false positive consultations and MT procedures, during mid to late 2018. Consult start time, procedure start and end time, and data regarding commute to the hospital and delay in scheduled procedures were collected and compared with those from an identical prospective study performed in 2017. RESULTS Data were collected from a total of 300 days of call. A total of 166 procedures were performed (mean 0.55 per day), an increase from 0.32 per day in 2017. Overall mean MT direct time burden during each 24-hour call was 124 min (compared with 85 min in 2017). The percentage of consultations for thrombectomy varied based on time of day, with 87% of consults between the hours of midnight and 04:00 proceeding to thrombectomy compared with 37% between the hours of 16:00 and 20:00. CONCLUSIONS MT procedural volumes have increased from one every 5 days in 2016 to one every 2 days in 2018. The highest percentage of consults leading to thrombectomy occur in the early morning hours after midnight. Compared with similar data from 2016 and 2017, call demands continue to escalate, representing a significant demand on neurointerventional teams.
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Affiliation(s)
- Michelle Marie Williams
- Neurological Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Thabele Leslie-Mazwi
- Interventional Neuroradiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joshua A Hirsch
- Interventional Neuroradiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Carol Kittel
- Neurological Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Alejandro Spiotta
- Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Reade De Leacy
- Neurosurgery, Mount Sinai Hospital, New York City, New York, USA
| | - J Mocco
- Neurosurgery, Mount Sinai Hospital, New York City, New York, USA
| | | | - Andrew F Ducruet
- Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Nitin Goyal
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
| | - Adam S Arthur
- UT Dept Neurosurgery/Semmes-Murphey Clinic, Memphis, Tennessee, USA
| | - Peter Kan
- Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Maxim Mokin
- Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - Travis M Dumont
- Neurosurgery, University of Arizona/Arizona Health Science Center, Tucson, Arizona, USA
| | - Alan Reeves
- Neuroendovascular Division, Department of Radiology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Stacey Q Wolfe
- Neurological Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Kyle Fargen
- Neurological Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
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13
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Kim JG, Choi JC, Kim DJ, Bae HJ, Lee SJ, Park JM, Park TH, Cho YJ, Lee KB, Lee J, Kim DE, Cha JK, Kim JT, Lee BC. Effect of the Number of Neurointerventionalists on Off-Hour Endovascular Therapy for Acute Ischemic Stroke Within 12 Hours of Symptom Onset. J Am Heart Assoc 2019; 8:e011933. [PMID: 31625423 PMCID: PMC6898823 DOI: 10.1161/jaha.119.011933] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Off‐hour presentation can affect treatment delay and clinical outcomes in endovascular therapy (EVT) for acute ischemic stroke. We aimed to examine the treatment delays and clinical outcomes of EVT between on‐ and off‐hour admission and to evaluate the effect of hospital procedure volume and the number of neurointerventionalists on off‐hour EVT. Methods and Results From a multicenter registry, we identified patients who were treated with EVT within 12 hours of symptom. Annual hospital procedure volume was divided as low (<30), medium (30–60), and high (>60). The effect of the number of neurointerventionalists and annual hospital procedure volume on clinical outcome was estimated by the generalized estimation equation. Of the 31 133 stroke patients, 1564 patients met the eligibility criteria (mean age: 69±12 years; median baseline National Institutes of Health stroke scale score, 15 [interquartile range, 10–19]). Of 1564 patients, 893 (57.1%) arrived during off‐hour. The off‐hour patients had greater median door‐to‐puncture time (110 versus 95 minutes; P<0.001) compared with on‐hour patients. Despite the treatment delay, the functional outcome at 3 months did not differ between off‐ and on‐hour (odds ratio with 95% CI for 3‐month modified Rankin Scale 0–2, 0.99 [0.78–1.25]; P=0.90). The presence of three neurointerventionalists was significantly associated with favorable outcomes at 3 months during on‐ and off‐hour (2.07 [1.53–2.81]; P<0.001). The association was not observed for annual hospital procedural volume and the functional outcomes. Conclusions The number of neurointerventionalists was more crucial to effective around‐the‐clock EVT for acute stroke patients than hospital procedural volume.
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Affiliation(s)
- Joong-Goo Kim
- Department of Neurology Jeju National University Hospital Jeju Korea
| | - Jay Chol Choi
- Department of Neurology Jeju National University Hospital Jeju Korea.,School of Medicine Jeju National University Jeju Korea
| | - Duk Ju Kim
- School of Medicine Jeju National University Jeju Korea
| | - Hee-Joon Bae
- Department of Neurology Seoul National University Bundang Hospital Seoul National University College of Medicine Seongnam Korea
| | - Soo-Joo Lee
- Department of Neurology Eulji University Hospital Daejeon Korea
| | - Jong-Moo Park
- Department of Neurology Nowon Eulji Medical Center Eulji University Seoul Korea
| | - Tai Hwan Park
- Department of Neurology Seoul Medical Center Seoul Korea
| | - Yong-Jin Cho
- Department of Neurology Ilsan Paik Hospital Inje University Goyang Korea
| | - Kyung Bok Lee
- Department of Neurology Soonchunhyang University College of Medicine Seoul Korea
| | - Jun Lee
- Department of Neurology Yeungnam University Hospital Daegu Korea
| | - Dong-Eog Kim
- Department of Neurology Dongguk University Ilsan Hospital Goyang Korea
| | - Jae-Kwan Cha
- Department of Neurology Dong-A University College of Medicine Busan Korea
| | - Joon-Tae Kim
- Department of Neurology Chonnam National University Hospital Gwangju Korea
| | - Byung-Chul Lee
- Department of Neurology Hallym University Sacred Heart Hospital Anyang Korea
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14
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Albuquerque FC. All for One. J Neurointerv Surg 2019; 11:1063-1064. [PMID: 31604841 DOI: 10.1136/neurintsurg-2019-015478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2019] [Indexed: 11/04/2022]
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15
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Interventional Radiologists and Stroke: Responding to Neurointerventional Concerns. J Vasc Interv Radiol 2019; 30:1404-1406. [DOI: 10.1016/j.jvir.2019.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/05/2019] [Indexed: 11/19/2022] Open
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16
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Rumalla K, Ottenhausen M, Kan P, Burkhardt JK. Recent Nationwide Impact of Mechanical Thrombectomy on Decompressive Hemicraniectomy for Acute Ischemic Stroke. Stroke 2019; 50:2133-2139. [DOI: 10.1161/strokeaha.119.025063] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
The treatment of patients with acute ischemic stroke has been revolutionized by endovascular mechanical thrombectomy (MT), leading to dramatically improved outcomes. Here, we analyzed the impact of recent changes in stroke management on nationwide trends in patient characteristics, treatment modalities, and outcomes.
Methods—
The National Inpatient Sample was analyzed using
International Classification of Diseases, Ninth and Tenth Editions
, Clinical Modification codes to identify adult stroke patients with anterior-circulation, large-vessel occlusion in the pre- (2012–2014) and the post-MT trial period (2015–2016). Univariate and multivariable predictors of decompressive hemicraniectomy (DHC) were ascertained in patients developing malignant cerebral edema.
Results—
The nationwide query identified 519 320 adult stroke patients with annually increasing volume (92 320 to 129 340), stroke severity, and treatment at urban teaching centers. DHC was performed in 9.5% of patients developing malignant cerebral edema (n=33 530) and was associated with a high rate of discharge to long-term nursing care (65%) and mortality (23%). Over time, the rate of MT (3.4% to 9.8%) increased whereas the rate of DHC for malignant cerebral edema declined from 11.4% to 4.8% (
P
<0.001). In a binary logistic regression model controlling for potential confounders (eg, age, severity of illness), MT patients were 43% less likely to require DHC (odds ratio, 0.7; 95% CI, 0.6–0.9).
Conclusions—
Nationwide trends indicated that successful reperfusion of penumbra with MT in stroke patients leads to a declining indication for DHC whereas stroke volume increases over time.
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Affiliation(s)
- Kavelin Rumalla
- From the School of Medicine, University of Missouri-Kansas City (K.R.)
| | - Malte Ottenhausen
- Department of Neurosurgery, University Hospital Mainz, Germany (M.O.)
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., J.-K.B.)
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., J.-K.B.)
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17
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Chiu YC, Tang SC, Sun JT, Tsai LK, Hsieh MJ, Lee CW, Jeng JS, Lee YC, Chien YC, Wang YC, Chiang WC, Ma MHM. Using G-FAST to recognize emergent large vessel occlusion: a training program for a prehospital bypass strategy. J Neurointerv Surg 2019; 12:104-108. [PMID: 31337733 DOI: 10.1136/neurintsurg-2019-015171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 01/17/2023]
Abstract
INTRODUCTION The shorter the time between the onset of symptoms and reperfusion using endovascular thrombectomy, the better the functional outcome of patients. A training program was designed for emergency medical technicians (EMTs) to learn the gaze-face-arm-speech-time test (G-FAST) score for initiating a prehospital bypass strategy in an urban city. This study aimed to evaluate the effect of the training program on EMTs. METHODS All EMTs in the city were invited to join the training program. The program consisted of a 30 min lecture and a 20 min video which demonstrated the G-FAST evaluation. The participants underwent tests before and after the program. The tests included (1) a questionnaire of knowledge, attitudes, confidence, and behaviors towards stroke care; and (2) watching 10 different scenarios in a video and answering questions, including eight sub-questions of G-FAST parameters, and choosing a suitable receiving hospital. RESULTS In total, 1058 EMTs completed the training program. After the program, significant improvement was noted in knowledge, attitudes, and confidence, as well as scenario judgement. The performance of the EMTs in evaluating G-FAST criteria in comatose patients was relatively poor in the pre-test and improved significantly after the training course. Although the participants answered the G-FAST items correctly, they tended to overtriage the patients and refer them to higher-level hospitals. CONCLUSIONS A short training program can improve the ability to identify stroke patients and choose a suitable receiving hospital. A future training program could put further emphasis on how to evaluate comatose patients and choose a suitable receiving hospital.
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Affiliation(s)
- Yu-Chen Chiu
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Sung-Chun Tang
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Jen-Tang Sun
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Li-Kai Tsai
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Ju Hsieh
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chung-Wei Lee
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Jiann-Shing Jeng
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Ching Lee
- Department of Industrial Engineering and Engineering Management, National Tsing Hua University, Hsinchu, Taiwan
| | - Yu-Chun Chien
- Fire Department of the City of Taipei, Taipei, Taiwan
| | | | - Wen-Chu Chiang
- Department of Emergency Medicine, National Taiwan University Hospital YunlinBranch, Yunlin County, Taiwan
| | - Matthew Huei-Ming Ma
- Department of Emergency Medicine, National Taiwan University Hospital YunlinBranch, Yunlin County, Taiwan
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18
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Ospel JM, Kashani N, Goyal M, Menon BK, Campbell BCV, Fischer U, Turjman F, Mitchell P, Yoshimura S, Podlasek A, Rabinstein AA, Wilson AT, Kim BM, Baxter BW, Cherian MP, Heo JH, Foss M, Demchuk AM, Sylaja PN, Hill MD, Saposnik G, Almekhlafi MA. Time of day and endovascular treatment decision in acute stroke with relative endovascular treatment indication: insights from UNMASK EVT international survey. J Neurointerv Surg 2019; 12:122-126. [DOI: 10.1136/neurintsurg-2019-014976] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 11/03/2022]
Abstract
Background and purposeThe decision to proceed with endovascular thrombectomy should ideally be made independent of inconvenience factors, such as daytime. We assessed the influence of patient presentation time on endovascular therapy decision making under current local resources and assumed ideal conditions in acute ischemic stroke with level 2B evidence for endovascular treatment.Methods and materialsIn an international cross sectional survey, 607 stroke physicians from 38 countries were asked to give their treatment decisions to 10 out of 22 randomly assigned case scenarios. Eleven scenarios had level 2B evidence for endovascular treatment: 7 daytime scenarios (7:00 am–5:00 pm) and four night time cases (5:01 pm– 6:59 am). Participants provided their treatment approach assuming (A) there were no practice constraints and (B) under their current local resources. Endovascular treatment decisions in the 11 scenarios were analyzed according to presentation time with adjustment for patient and physician characteristics.ResultsParticipants selected endovascular therapy in 74.2% under assumed ideal conditions, and 70.7% under their current local resources of night time scenarios, and in 67.2% and 63.8% of daytime scenarios. Night time presentation did not increase the probability of a treatment decision against endovascular therapy under current local resources or assumed ideal conditions.ConclusionPresentation time did not influence endovascular treatment decision making in stroke patients in this international survey.
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Koopman MS, Berkhemer OA, Geuskens RREG, Emmer BJ, van Walderveen MAA, Jenniskens SFM, van Zwam WH, van Oostenbrugge RJ, van der Lugt A, Dippel DWJ, Beenen LF, Roos YBWEM, Marquering HA, Majoie CBLM. Comparison of three commonly used CT perfusion software packages in patients with acute ischemic stroke. J Neurointerv Surg 2019; 11:1249-1256. [DOI: 10.1136/neurintsurg-2019-014822] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/13/2019] [Accepted: 04/17/2019] [Indexed: 12/27/2022]
Abstract
Background and purposeCT perfusion (CTP) might support decision making in patients with acute ischemic stroke by providing perfusion maps of ischemic tissue. Currently, the reliability of CTP is hampered by varying results between different post-processing software packages. The purpose of this study is to compare ischemic core volumes estimated by IntelliSpace Portal (ISP) and syngo.via with core volumes as estimated by RAPID.MethodsThirty-five CTP datasets from patients in the MR CLEAN trial were post-processed. Core volumes were estimated with ISP using default settings and with syngo.via using three different settings: default settings (method A); additional smoothing filter (method B); and adjusted settings (method C). The results were compared with RAPID. Agreement between methods was assessed using Bland–Altman analysis and intraclass correlation coefficient (ICC). Accuracy for detecting volumes up to 25 mL, 50 mL, and 70 mL was assessed. Final infarct volumes were determined on follow-up non-contrast CT.ResultsMedian core volume was 50 mL with ISP, 41 mL with syngo.via method A, 20 mL with method B, 36 mL with method C, and 11 mL with RAPID. Agreement ranged from poor (ISP: ICC 0.41; method A: ICC 0.23) to good (method B: ICC 0.83; method C: ICC 0.85). The bias (1.8 mL) and limits of agreement (−27, 31 mL) were the smallest with syngo.via with additional smoothing (method B). Agreement for detecting core volumes ≤25 mL with ISP was 54% and 57%, 85% and 74% for syngo.via methods A, B, and C, respectively.ConclusionBest agreement with RAPID software is provided by syngo.via default settings with additional smoothing. Moreover, this method has the highest agreement in categorizing patients with small core volumes.
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Dalsania AK, Kansagra AP. Simultaneous patient presentation for endovascular thrombectomy in acute ischemic stroke. J Neurointerv Surg 2019; 11:1201-1204. [PMID: 31030186 DOI: 10.1136/neurintsurg-2019-014857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/02/2019] [Accepted: 04/08/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Increased demand for endovascular thrombectomy has increased the likelihood of simultaneous patient presentation leading to competing demand for time-critical treatment that could adversely impact patient outcomes. We aimed to quantify the occurrence of simultaneous patient presentation at different patient volumes. METHODS Empirical distributions for time of patient presentation and case duration were used to probabilistically generate arrival time and case duration for a set annual patient volume, ranging from 1 to 500 cases per year, for 16 000 independent trials at each volume. Time series were generated for each trial to represent the number of cases being performed at each minute of the year. Time series were used to calculate daily thrombectomy demand, annual concurrent demand, and hourly excess demand. RESULTS The patient volumes at which at least one annual occurrence of concurrent demand by two patients was 50% and 97.5% likely were 45 and 101, respectively. The volumes at which at least one annual occurrence of concurrent demand by three patients was 50% and 97.5% likely were 216 and 387, respectively. There was dramatic variation in the occurrence of excess demand by two or more patients throughout the day. CONCLUSIONS The occurrence of simultaneous presentation by multiple patients for endovascular thrombectomy varies with annual patient volume and time of day. Understanding these trends and the associated patient impact can inform intelligent strategies at regional and national levels for optimizing patient care within real-world financial and operational constraints.
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Affiliation(s)
| | - Akash P Kansagra
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri, USA.,Department of Neurological Surgery, Washington University School of Medicine, St Louis, Missouri, USA.,Department of Neurology, Washington University School of Medicine, St Louis, Missouri, USA
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21
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Fargen KM, Arthur AS, Leslie-Mazwi T, Garner RM, Aschenbrenner CA, Wolfe SQ, Ansari SA, Dabus G, Spiotta A, Mokin M, Linfante I, Mocco J, Hirsch JA. A survey of burnout and professional satisfaction among United States neurointerventionalists. J Neurointerv Surg 2019; 11:1100-1104. [PMID: 30975735 DOI: 10.1136/neurintsurg-2019-014833] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/11/2019] [Accepted: 03/14/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND The toll of burnout on healthcare is significant and associated with physician depression and medical errors. OBJECTIVE To assess the prevalence and risk factors for burnout among neurointerventionalists. METHODS A 39-question online survey containing questions about neurointerventional practice and the Maslach Burnout Inventory-Human Services Survey for medical personnel was distributed to members of major US neurointerventional physician societies. RESULTS 320 responses were received. Median (interquartile range) composite scores for emotional exhaustion were 25 (16-35), depersonalization 7 (4-12), and personal accomplishment 39 (35-44). 164/293 respondents (56%) met established criteria for burnout. There was no significant relationship between training background, practice setting, call frequency, or presence of a senior partner on burnout prevalence. Multiple logistic regression analysis showed that feeling underappreciated by hospital leadership (OR=3.71; p<0.001) and covering more than one hospital on call (OR=1.96; p=0.01) were strongly associated with burnout. Receiving additional compensation for a call was independently protective against burnout (OR= 0.70; p=0.005). CONCLUSIONS This survey of United States neurointerventional physicians demonstrated a self-reported burnout prevalence of 56%, which is similar to the national average among physicians across other specialties. Additional compensation for a call was a significant protective factor against burnout. In addition, feeling underappreciated by departmental or hospital leadership and covering more than one hospital while on call were associated with greater odds of burnout.
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Affiliation(s)
- Kyle M Fargen
- Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Adam S Arthur
- UT Department of Neurosurgery/Semmes-Murphey Clinic, Memphis, Tennessee, USA
| | | | - Rebecca M Garner
- Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Carol A Aschenbrenner
- Biostatistics, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Stacey Q Wolfe
- Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Sameer A Ansari
- Radiology, Neurology, and Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Guilherme Dabus
- Interventional Neuroradiology and Neuroendovascular Surgery, Miami Cardiac & Vascular Institute and Baptist Neuroscience Center, Miami, Florida, USA
| | - Alejandro Spiotta
- Neurosciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Maxim Mokin
- Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - Italo Linfante
- Baptist Cardiac and Vascular Institute, Miami, Florida, USA
| | - J Mocco
- The Mount Sinai Health System, New York, New York, USA
| | - Joshua A Hirsch
- Interventional Neuroradiology, Massachusetts General Hospital, Boston, Massachusetts, USA
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22
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The pincer movement of cost and quality in neurointerventional care: resource management as an imperative. J Neurointerv Surg 2019; 11:323-325. [DOI: 10.1136/neurintsurg-2019-014871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2019] [Indexed: 11/03/2022]
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23
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Ebashi R, Ogata A, Nishihara M, Inoue K, Yoshioka F, Takase Y, Masuoka J, Yakushiji Y, Irie H, Hara H, Abe T. Significance of simulated conventional images on dual energy CT after endovascular treatment for ischemic stroke. J Neurointerv Surg 2019; 11:898-902. [PMID: 30670626 DOI: 10.1136/neurintsurg-2018-014486] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 12/20/2018] [Accepted: 12/26/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND PURPOSE CT scans often reveal post-interventional cerebral hyperdensities (PCHDs) immediately after intra-arterial thrombectomy (IAT) for ischemic stroke. Dual energy CT (DE-CT) can indicate whether PCHDs are caused by hemorrhage or iodinated contrast. Hyperdense lesions, detected on DE-CT with the use of iodinated contrast, could be associated with delayed hemorrhagic transformation and poor outcome. However, the quantitative indicators in DE-CT for predicting delayed hemorrhagic transformation remain unclear. We assessed such indicators for predicting delayed hemorrhagic transformation. MATERIAL AND METHODS We retrospectively analyzed 52 consecutive acute ischemic stroke patients who underwent IAT. Simulated conventional CT (sCCT) images were obtained immediately after a DE-CT scan. Virtual, unenhanced, non-contrast (VNC) imaging was performed after reconstruction. Hounsfield units (HU) of the infarct areas observed on the sCCT were measured. The association of HU on sCCT with hemorrhage on VNC and delayed parenchymal hemorrhage (PH) was evaluated. RESULTS The HU of sCCT with hemorrhage on VNC was significantly higher than without it (377.9±385 HU vs 83.5±37.9 HU; P<0.0001). The cut-off index was 80 HU, which displayed 100% sensitivity, 63.8% specificity, 22.3% positive predictive value, and 100% negative predictive value (P=0.0001, area under the curve (AUC)=0.89). The HU with delayed PH was substantially higher than without it (250.8±382.2 HU vs 93.7±64.8 HU; P=0.01). The cut-off index was 78 HU, which showed 100% sensitivity, 61% specificity, 25% positive predictive value, and 100% negative predictive value (P=0.049, AUC=0.76). CONCLUSION sCCT images on DE-CT are useful for excluding intracerebral hemorrhage and delayed PH.
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Affiliation(s)
- Ryo Ebashi
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Atsushi Ogata
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Masashi Nishihara
- Department of Radiology, Faculty of Medicine, Saga University, Saga, Japan
| | - Kohei Inoue
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Fumitaka Yoshioka
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Yukinori Takase
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Jun Masuoka
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Yusuke Yakushiji
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Hiroyuki Irie
- Department of Radiology, Faculty of Medicine, Saga University, Saga, Japan
| | - Hideo Hara
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Tatsuya Abe
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
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Hirsch JA, Leslie-Mazwi T, Nicola GN, Milburn J, Kirsch C, Rosman DA, Gilligan C, Manchikanti L. Storm rising! The Obamacare exchanges will catalyze change: why physicians need to pay attention to the weather. J Neurointerv Surg 2018; 11:101-106. [DOI: 10.1136/neurintsurg-2018-014412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2018] [Indexed: 11/03/2022]
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25
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Albuquerque FC. From Spokane to McCall. J Neurointerv Surg 2018; 10:921-922. [DOI: 10.1136/neurintsurg-2018-014387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2018] [Indexed: 11/04/2022]
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26
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Fargen KM, Hirsch JA. Neurointerventionalists, stroke and burnout. J Neurointerv Surg 2018; 10:811-812. [DOI: 10.1136/neurintsurg-2018-014304] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2018] [Indexed: 11/04/2022]
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27
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Schramm P, Navia P, Papa R, Zamarro J, Tomasello A, Weber W, Fiehler J, Michel P, Pereira VM, Krings T, Gralla J, Santalucia P, Pierot L, Lo TH. ADAPT technique with ACE68 and ACE64 reperfusion catheters in ischemic stroke treatment: results from the PROMISE study. J Neurointerv Surg 2018; 11:226-231. [PMID: 30061367 PMCID: PMC6582710 DOI: 10.1136/neurintsurg-2018-014122] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/02/2018] [Accepted: 07/05/2018] [Indexed: 02/04/2023]
Abstract
Background and purpose The recent randomized trials demonstrated the benefit of mechanical thrombectomy in stroke therapy. However, treatment using different strategies is an ongoing area of investigation. The PROMISE study analyzed the safety and effectiveness of the Penumbra System with the ACE68 and ACE64 reperfusion catheters in aspiration thrombectomy of stroke, using A Direct Aspiration First Pass Technique (ADAPT). Methods PROMISE was a prospective study which enrolled 204 patients with intracranial anterior circulation large vessel occlusion (LVO) ischemic stroke in 20 centers from February 2016 to May 2017. Initial treatment was with the ACE68/ACE64 catheters within 6 hours of symptom onset. Imaging and safety review was performed by an independent Core Laboratory and a Clinical Events Committee. The primary angiographic outcome was revascularization to mTICI 2b-3 at immediate post-procedure and the primary clinical outcome was 90-day modified Rankin Scale (mRS) score ≤2. Safety assessment included device- and procedure-related serious adverse events (SAEs), symptomatic intracranial hemorrhage (sICH), mortality, and embolization of new territory (ENT). Results Enrolled patients had a median age of 74 (IQR 65–80) years and a median admission NIHSS of 16 (IQR 11–20). The post-procedure mTICI 2b-3 revascularization rate was 93.1% and the 90-day mRS 0–2 rate was 61%. Device- and procedure-related SAEs at 24 hours occurred in 1.5% and 3.4%, respectively, 90-day mortality was 7.5%, sICH occurred in 2.9% while ENT occurred in 1.5%. Conclusions For frontline therapy of LVO stroke, the ACE68/ACE64 catheters for aspiration thrombectomy were found to be safe and showed similar efficacy to randomized trials using other revascularization techniques. Clinical Trial Registration NCT02678169; Pre-results.
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Affiliation(s)
- Peter Schramm
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - Pedro Navia
- Radiology-Interventional Neuroradiology, Hospital Universitario Donostia, San Sebastian, Spain
| | - Rosario Papa
- Radiology, Universita degli Studi di Messina, Messina, Italy
| | - Joaquin Zamarro
- Interventional Neuroradiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Alejandro Tomasello
- Department of Radiology, Section of Interventional Neuroradiology, Barcelona, Spain.,Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Werner Weber
- Radiology and Neuroradiology, Ruhr-University Bochum, University Medical Center Langendreer, Bochum, Germany
| | - Jens Fiehler
- Department of Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | | | - Vitor M Pereira
- Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Timo Krings
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Jan Gralla
- Department for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Paola Santalucia
- IRCCS Centro Neurolesi Bonino Pulejo, Piemonte Hospital, Messina, Italy
| | | | - T H Lo
- Department of Interventional Radiology and Interventional Neuroradiology, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
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28
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Brouwer PA, Yeo LLL, Gounis MJ, Gontu VK. Size matters… but how do I know what size it is? J Neurointerv Surg 2018; 11:3-5. [PMID: 30042158 DOI: 10.1136/neurintsurg-2018-014146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Patrick A Brouwer
- Department of Neuroradiology, Karolinska University Hospital, Solna, Sweden.,Department of Clinical Neuroscience, Neurology, Karolinska Institute, Stockholm, Sweden
| | - Leonard L L Yeo
- Department of Neuroradiology, Karolinska University Hospital, Solna, Sweden.,Department of Clinical Neuroscience, Neurology, Karolinska Institute, Stockholm, Sweden.,Division of Neurology, Department of Medicine, National University Health System, National University Health System and Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Matthew J Gounis
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Vamsi Krishna Gontu
- Department of Neuroradiology, Karolinska University Hospital, Solna, Sweden.,Department of Clinical Neuroscience, Neurology, Karolinska Institute, Stockholm, Sweden
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29
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Ren Y, Kok HK, Zhou K, Maingard J, Chandra RV, Lee MJ, Barras CD, Brooks M, Albuquerque FC, Tarr RW, Hirsch JA, Asadi H. The 100 most cited articles in the Journal of NeuroInterventional Surgery. J Neurointerv Surg 2018; 10:1020-1028. [DOI: 10.1136/neurintsurg-2018-014079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 06/20/2018] [Indexed: 01/21/2023]
Abstract
BackgroundThe Journal of NeuroInterventional Surgery (JNIS) published its first volume in 2009. Over the ensuing years, JNIS flourished and has published a considerable number of high-profile articles. Citation analysis is a method of quantifying various metrics related to scholarly publications.ObjectiveTo apply citation analysis to the 100 most cited papers in the history of JNIS.MethodsThe most cited articles in JNIS were identified by using the Web of Science database. The top 100 articles were ranked according to their number of citations. Further information was obtained for each article, including citations per year, year of publication, authorship, article topics, and article type and level of evidence.ResultsThe total number of citations for the 100 most cited articles in JNIS ranged from 18 to 132 (median 26.0). Most articles (75%) were published between 2012 and 2015 and originated in the USA (79%). Eighteen authors have contributed five or more articles to the top 100 list. The most common topics are related to acute ischemic stroke and cerebral aneurysm.ConclusionsThis study highlights the influence of JNIS over its first decade by providing a comprehensive list of the 100 most cited articles and their authors as well as topics covered. This study also highlights the important factors driving the growth of JNIS.
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