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Baharvahdat H, Qoorchi Moheb Seraj F, Al-Raaisi A, Blanc R, Najafi S, Mirbolouk MH, Redjem H, Ebrahimnia F, Escalard S, Zabihyan S, Desilles JP, Mowla A, Boisseau W, Mazighi M, Smajda S, Piotin M. Long-term outcome of endovascular treatment for indirect carotid-cavernous fistulas. Neurosurg Focus 2024; 56:E5. [PMID: 38427986 DOI: 10.3171/2023.12.focus23795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/27/2023] [Indexed: 03/03/2024]
Abstract
OBJECTIVE Endovascular treatment (EVT) is the primary approach used to treat indirect carotid-cavernous fistulas (CCFs). In this study, the authors evaluated the immediate and long-term efficacy and safety of different endovascular techniques for indirect CCFs. METHODS The databases of two endovascular centers were retrospectively reviewed to collect the patients with indirect CCFs treated using endovascular techniques between 2013 and 2023. Demographics, clinical presentation, CCF features, EVT characteristics, and clinical and radiological outcomes were evaluated and analyzed. The analysis was performed to compare the clinical and radiological data between different endovascular approaches and different embolic materials. RESULTS Ninety-eight patients were included in the study. EVT was successful in 95 patients (96.9%). Immediate complete obliteration of the CCF was achieved in 93.9% of patients, with 98% undergoing embolization with liquid embolic agents (LEAs) and 95.6% undergoing coiling alone. Complete CCF obliteration was higher in the transvenous than in the transarterial approach (94.3% vs 75%, p = 0.010). At ≥ 6 months follow-up, complete CCF obliteration was achieved in all patients (100%). The rate of procedure-related complications was higher following LEAs than with coiling alone (32.0% vs 15.6%). New cranial nerve (CN) palsy was diagnosed in 26.0% and 2.2% after embolization with LEAs and coiling alone, respectively (p = 0.001), with complete CN palsy recovery in 78.6%. Procedure-related intracranial hemorrhage occurred in 3 patients (3.1%). Two patients experienced an ischemic stroke following Onyx migration into the internal carotid artery. Ocular symptoms improved in 93% (83/89) of the patients who were followed. CONCLUSIONS In this study, complete obliteration of an indirect CCF was achieved in more than 90% of patients. Despite the occurrence of some new postprocedural ocular CN palsy, ocular symptoms improved in most patients in long-term follow-up. The transvenous approach was the most effective method for treating the indirect CCF. Coiling was safer than LEAs for the embolization of the indirect CCF.
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Affiliation(s)
- Humain Baharvahdat
- 1Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
- 2Department of Neurosurgery, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Amira Al-Raaisi
- 1Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Raphael Blanc
- 1Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Sajjad Najafi
- 3Department of Neurosurgery, Mazandaran University of Medical Sciences, School of Medicine, Sari, Iran
| | | | - Hocine Redjem
- 1Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Feizollah Ebrahimnia
- 2Department of Neurosurgery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Simon Escalard
- 1Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Samira Zabihyan
- 2Department of Neurosurgery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Jean-Philipe Desilles
- 1Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Ashkan Mowla
- 5Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Willian Boisseau
- 1Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Mikael Mazighi
- 1Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Stanislas Smajda
- 1Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Michel Piotin
- 1Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
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Seraj FQM, Najafi S, Pahlavan H, Organji H, Baharvahdat H. Unilateral Oculomotor Nerve Palsy as a Rare Manifestation of Isolated Pre-Communicating Segment of Posterior Cerebral Artery Thrombosis. Neurointervention 2023; 18:195-199. [PMID: 37604592 PMCID: PMC10626041 DOI: 10.5469/neuroint.2023.00283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/05/2023] [Accepted: 08/05/2023] [Indexed: 08/23/2023] Open
Abstract
Ipsilateral mydriasis (IM) is usually not acute. However, the acute occurrence of unilateral dilated pupil may result in acute ischemic stroke. Herein, we present 3 patients with IM, lateral eye deviation, ptosis, and contralateral hemiparesis due to isolated occlusion of the pre-communicating segment of the posterior cerebral artery with preservation of the posterior communicating artery, which was successfully treated by emergent mechanical thrombectomy. In a 3-month follow-up, all patients were independent without any neurological deficits.
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Affiliation(s)
- Farid Qoorchi Moheb Seraj
- Section of Endovascular Neurosurgery, Department of Neurosurgery, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sajjad Najafi
- Section of Endovascular Neurosurgery, Department of Neurosurgery, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Neurosurgery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hashem Pahlavan
- Section of Endovascular Neurosurgery, Department of Neurosurgery, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Organji
- Section of Endovascular Neurosurgery, Department of Neurosurgery, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Humain Baharvahdat
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
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Behrooznia Z, Jangjoo A, Qoorchi Moheb Seraj F, Khadem-Rezaiyan M, Zandbaf T, Hassani S. Diabetic Markers, Five Years after Bariatric Surgery. Middle East J Dig Dis 2023; 15:270-276. [PMID: 38523888 PMCID: PMC10955987 DOI: 10.34172/mejdd.2023.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 09/18/2023] [Indexed: 03/26/2024] Open
Abstract
Background: Bariatric surgery delivers substantial weight loss for obese patients with comorbidities like diabetes mellitus. We aimed to investigate the impacts of bariatric surgery on diabetic markers after 5 years of follow-up. Methods: This is a retrospective study on patients with diabetes and a history of bariatric surgery between 2016-2017. The diabetic markers before and 5 years following surgery, including a lipid profile, glucose level, and the required antidiabetic medications, were evaluated. Results: 34 consecutive patients were included, 30 (88.2%) women, with a mean age of 52.71±8.53 years. The majority (65%) of surgeries were Roux-en-Y gastric bypass (RYGB), and the remaining were one anastomosis gastric bypass (OAGB) and sleeve gastrectomy (SG). The serum levels of diabetic markers reduced during follow-up (P=0.001), except for high-density lipoprotein levels and serum total cholesterol, which increased (P=0.011, P=0.838). Low-density lipoprotein levels reduced, but it was insignificant (P=0.194). Surgery types had affected the changes of diabetic markers (P>0.05). Demand for oral medication was reduced significantly, but insulin injection reduction was not significant (P=0.006 and P=0.099, respectively). Conclusion: Our study showed favorable bariatric surgery results on patients with diabetes in long-term follow-up. However, dyslipidemia is still a concern.
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Affiliation(s)
- Zahra Behrooznia
- Department of Internal Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Jangjoo
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farid Qoorchi Moheb Seraj
- Neurosurgical Department, NeuroVascular Section, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Khadem-Rezaiyan
- Department of Community Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Tooraj Zandbaf
- Department of General surgery, School of medicine, Mashhad Azad university of medical sciences, Mashhad, Iran
| | - Solmaz Hassani
- Endocrine Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Qoorchi Moheb Seraj F, Mirbolouk MH, Vaezi M, Ebrahimnia F, Gorji R, Najafi S, Pahlavan Shamsi H, Sadeghian Shahi A, Sasannejad P, Zabihyan S, Mowla A, Kheradmand D, Baharvahdat H. Safety of dual antiplatelet therapy in the acute phase of aneurysmal subarachnoid hemorrhage: a propensity score-matched study. Neurosurg Focus 2023; 55:E10. [PMID: 37778032 DOI: 10.3171/2023.7.focus23376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/26/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE With the evolution of neuroendovascular treatments, there is a great trend to treat acutely ruptured wide-necked aneurysms with stent-assisted coiling (SAC) and flow diverters (FDs), which inevitably requires dual antiplatelet therapy (DAPT). This therapy can increase the rate of hemorrhagic complications following other neurosurgical maneuvers, such as external ventricular drain (EVD) placement or removal. In this study, the authors aimed to evaluate the safety of DAPT in patients with aneurysmal subarachnoid hemorrhage (SAH) treated with SAC or FDs and the therapy's potential benefit in reducing cerebral ischemia and cerebral vasospasm. METHODS In this retrospective study, the authors reviewed the records of patients who had been admitted to their hospital with acute aneurysmal SAH and treated with SAC, FDs, and/or coiling between 2012 and 2022. Patients were classified into two groups: a DAPT group, including patients who had received DAPT for SAC or FDs, and a non-DAPT group, including patients who had not received any antiplatelet regimen and had been treated with coiling. Perioperative hemorrhagic and ischemic complications and clinical outcomes were compared between the two groups. RESULTS From among 938 cases of acute ruptured aneurysms treated during 10 years of study, 192 patients were included in this analysis, with 96 patients in each treatment group, after propensity score matching. All basic clinical and imaging characteristics were equivalent between the two groups except for the neck size of aneurysms (p < 0.001). EVD-related hemorrhage was significantly higher in the DAPT group than in the non-DAPT group (p = 0.035). In most patients, however, the EVD-related hemorrhage was insignificant. Parent artery or stent-induced thrombosis was higher in the DAPT group than in the non-DAPT group (p = 0.003). The rate of cerebral ischemia was slightly lower in the DAPT group than in the non-DAPT group (11.5% vs 15.6%, p = 0.399). In the multivariate analysis, cerebral ischemia, rebleeding before securing the aneurysm, extracranial hemorrhage, and cerebral vasospasm were the predictive factors of a poor clinical outcome (p < 0.001, p < 0.001, p = 0.038, and p = 0.038, respectively). CONCLUSIONS The DAPT regimen may be safe in the setting of acute aneurysmal SAH. Although EVD-related hemorrhage is more common in the DAPT group than the non-DAPT group, it is usually insignificant without any neurological deficit.
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Affiliation(s)
- Farid Qoorchi Moheb Seraj
- 1Neurosurgical Department, Neurovascular Section, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Hossein Mirbolouk
- 2Department of Neurosurgery, Firouzgar Hospital, Iran University of Medical Sciences, School of Medicine, Tehran, Iran
| | - Marjan Vaezi
- 2Department of Neurosurgery, Firouzgar Hospital, Iran University of Medical Sciences, School of Medicine, Tehran, Iran
| | - Feizollah Ebrahimnia
- 1Neurosurgical Department, Neurovascular Section, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Gorji
- 1Neurosurgical Department, Neurovascular Section, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sajjad Najafi
- 1Neurosurgical Department, Neurovascular Section, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
- 1Neurosurgical Department, Neurovascular Section, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
- 3Department of Neurosurgery, Emam Hospital, Mazandaran University of Medical Sciences, School of Medicine, Sari, Iran
| | - Hashem Pahlavan Shamsi
- 1Neurosurgical Department, Neurovascular Section, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Sadeghian Shahi
- 1Neurosurgical Department, Neurovascular Section, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Payam Sasannejad
- 1Neurosurgical Department, Neurovascular Section, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Samira Zabihyan
- 1Neurosurgical Department, Neurovascular Section, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ashkan Mowla
- 4Department of Neurological Surgery, Division of Stroke and Endovascular Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California; and
| | - Daniel Kheradmand
- 1Neurosurgical Department, Neurovascular Section, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Humain Baharvahdat
- 1Neurosurgical Department, Neurovascular Section, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
- 1Neurosurgical Department, Neurovascular Section, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
- 1Neurosurgical Department, Neurovascular Section, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
- 1Neurosurgical Department, Neurovascular Section, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
- 5Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
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Qoorchi Moheb Seraj F, Heravi-Faz N, Soltani A, Ahmadi SS, Shahbeiki F, Talebpour A, Afshari AR, Ferns GA, Bahrami A. Thymol has anticancer effects in U-87 human malignant glioblastoma cells. Mol Biol Rep 2022; 49:9623-9632. [PMID: 35997850 DOI: 10.1007/s11033-022-07867-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/11/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Thymol (2-isopropyl-5-methylphenol) is a colorless crystalline derivative of cymene, that possesses pleotropic pharmacological properties, including analgesic, antibacterial, antispasmodic, and anti-inflammatory activities. Thymol has also been recognized for its beneficial effect as an anti-tumor agent, but the precise mechanism for this has not been fully elucidated. We aimed to identifying whether thymol exerts anti-cancer activity in human U-87 malignant glioblastoma (GB) cells (U-87). METHODS AND RESULTS Cell viability and apoptosis was evaluated in U-87 cells treated with thymol at different concentrations. Reactive oxygen species (ROS) production, mRNA expressions of apoptosis-related genes and cell cycle characteristics were assessed. The cytotoxic activity of the co-exposure of thymol and temozolomide (TMZ) was also evaluated. The half-maximal inhibitory concentration (IC50) of thymol in the U-87 cells was 230 μM assessed at 24 h after exposure. Thymol did not exhibit any cytotoxic effects on normal L929 cells at this concentration. Thymol treatment increased the expression of Bax and p53, and also increased apoptotic cell death, and excessive generation of ROS. Moreover, the cytotoxic activity of thymol on the U-87 cells may be related to the arrest of the cell cycle at the G0/G1 interface. Combination therapy showed that the cytotoxic effects of thymol synergized with TMZ, and combined treatment had more cytotoxic potential compared to either of the agents alone. CONCLUSIONS Our data indicate the potential cytotoxic activities of thymol on U-87 cells. Further studies are required to evaluate the spectrum of the antitumor activity of thymol on GB cells.
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Affiliation(s)
- Farid Qoorchi Moheb Seraj
- Endovascular Section, Neurosurgical Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Niloofar Heravi-Faz
- Department of Molecular Genetics, Faculty of Sciences, Neyshabour branch, Islamic Azad University, Neyshabour, Iran
| | - Arash Soltani
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Sajad Ahmadi
- Department of Ophthalmology, Khatam Ol-Anbia Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Shahbeiki
- Department of Medical Laboratory Sciences, Mashhad branch, Islamic Azad University, Mashhad, Iran
| | - Amir Talebpour
- Cellular and Molecular Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Amir R Afshari
- Department of Physiology and Pharmacology, Faculty of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Gordon A Ferns
- Brighton & Sussex Medical School, Division of Medical Education, Falmer, Brighton, BN1 9PH, Sussex, UK
| | - Afsane Bahrami
- Clinical Research Development Unit, Faculty of Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. .,Clinical Research Development Unit of Akbar Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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Razavi SAS, Mirbolouk MH, Gorji R, Ebrahimnia F, Sasannejad P, Zabihyan S, Seraj FQM, Etemadrezaie H, Esmaeilzadeh M, Blanc R, Piotin M, Baharvahdat H. Endovascular treatment as the first-line approach for cure of low-grade brain arteriovenous malformation. Neurosurg Focus 2022; 53:E8. [PMID: 35901720 DOI: 10.3171/2022.4.focus22122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/18/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE While microsurgery has been proposed as the first-line treatment for patients with low-grade (Spetzler-Martin grade I or II) brain arteriovenous malformations (bAVMs), recent studies have shown promising results for endovascular treatment (EVT) as a single proper choice for the management of this group of bAVMs. In this study, the authors evaluated the safety and efficacy of EVT as a first-line strategy for curing low-grade bAVMs at their center. METHODS All patients with low-grade bAVMs managed primarily by EVT between 2015 and 2021 were enrolled in this study. Patients were evaluated and treated by the same team and followed with the same protocol. The primary endpoint was the efficacy of EVT on the cure of low-grade bAVMs. The second endpoint was the safety of EVT for the treatment of low-grade bAVMs, including procedural complications and long-term clinical outcomes. RESULTS A total of 109 patients were enrolled and represented in the study population. The mean patient age was 31.6 ± 14.8 years. Forty-eight AVMs (44%) were Spetzler-Martin grade I and 61 (56%) were grade II. Of 99 patients who completed their EVT sessions, complete exclusion was achieved in 89 patients (89.9%). Overall, complete exclusion was achieved in 59.6% of patients after a single EVT session. At the 6-month follow-up, 106 patients (97.2%) had a favorable outcome. Four patients (4.6%) experienced transient neurological deficits, and 1 patient (0.9%) had a permanent neurological deficit. CONCLUSIONS EVT can be offered as the first choice of treatment for select patients with low-grade bAVMs, with a high cure rate and low morbidity.
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Affiliation(s)
- Seyed Ali Shariat Razavi
- 1Section of Neurovascular Intervention, Neurosurgical Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran; and
| | - Mohammad Hossein Mirbolouk
- 1Section of Neurovascular Intervention, Neurosurgical Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran; and
| | - Reza Gorji
- 1Section of Neurovascular Intervention, Neurosurgical Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran; and
| | - Feizollah Ebrahimnia
- 1Section of Neurovascular Intervention, Neurosurgical Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran; and
| | - Payam Sasannejad
- 1Section of Neurovascular Intervention, Neurosurgical Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran; and
| | - Samira Zabihyan
- 1Section of Neurovascular Intervention, Neurosurgical Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran; and
| | - Farid Qoorchi Moheb Seraj
- 1Section of Neurovascular Intervention, Neurosurgical Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran; and
| | - Hamid Etemadrezaie
- 1Section of Neurovascular Intervention, Neurosurgical Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran; and
| | - Mahla Esmaeilzadeh
- 1Section of Neurovascular Intervention, Neurosurgical Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran; and
| | - Raphaël Blanc
- 2Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Michel Piotin
- 2Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Humain Baharvahdat
- 1Section of Neurovascular Intervention, Neurosurgical Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran; and.,2Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
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