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Chalouhi N, Tjoumakaris S, Phillips JLH, Starke RM, Hasan D, Wu C, Zanaty M, Kung D, Gonzalez LF, Rosenwasser R, Jabbour P. A single pipeline embolization device is sufficient for treatment of intracranial aneurysms. AJNR Am J Neuroradiol 2014; 35:1562-6. [PMID: 24788125 PMCID: PMC7964452 DOI: 10.3174/ajnr.a3957] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 01/15/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The Pipeline Embolization Device has emerged as an important treatment option for intracranial aneurysms. The number of devices needed to treat an aneurysm is uncertain and is the subject of vigorous debate. The purpose of this study was to compare rates of complications, aneurysm occlusion, and outcome in patients treated with a single-versus-multiple Pipeline Embolization Devices. MATERIAL AND METHODS One hundred seventy-eight patients were treated with the Pipeline Embolization Device at our institution. Patients were divided into 2 groups: a single-device group (n = 126) and a multiple-device group (n = 52). RESULTS There was no statistically significant difference between the 2 groups with respect to baseline characteristics except for age and aneurysm size (higher with multiple Pipeline Embolization Devices). Complications occurred more frequently with multiple (15%) versus a single device (5%, P = .03). In multivariate analysis, the use of multiple devices independently predicted complications. A similar proportion of patients achieved adequate aneurysm obliteration at follow-up in the single-device (84%) and the multiple-device groups (87%, P = .8). In multivariate analysis, age and follow-up time predicted obliteration. At follow-up, a significantly higher proportion of patients treated with a single device (97%) achieved a favorable outcome compared with those treated with multiple devices (89%, P = .03). In multivariate analysis, there was a strong trend for the use of a single device to predict favorable outcomes (P = .06). CONCLUSIONS Treatment with a single Pipeline Embolization Device provides similar occlusion rates with less complications and better overall outcomes. These findings suggest that a single Pipeline Embolization Device is sufficient for treatment of most intracranial aneurysms.
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Affiliation(s)
- N Chalouhi
- From the Department of Neurosurgery (N.C., S.T., J.L.H.P., R.M.S., C.W., M.Z., D.K., L.F.G., R.R., P.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - S Tjoumakaris
- From the Department of Neurosurgery (N.C., S.T., J.L.H.P., R.M.S., C.W., M.Z., D.K., L.F.G., R.R., P.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - J L H Phillips
- From the Department of Neurosurgery (N.C., S.T., J.L.H.P., R.M.S., C.W., M.Z., D.K., L.F.G., R.R., P.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - R M Starke
- From the Department of Neurosurgery (N.C., S.T., J.L.H.P., R.M.S., C.W., M.Z., D.K., L.F.G., R.R., P.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - D Hasan
- Department of Neurosurgery (D.H.), University of Iowa, Iowa City, Iowa
| | - C Wu
- From the Department of Neurosurgery (N.C., S.T., J.L.H.P., R.M.S., C.W., M.Z., D.K., L.F.G., R.R., P.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - M Zanaty
- From the Department of Neurosurgery (N.C., S.T., J.L.H.P., R.M.S., C.W., M.Z., D.K., L.F.G., R.R., P.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - D Kung
- From the Department of Neurosurgery (N.C., S.T., J.L.H.P., R.M.S., C.W., M.Z., D.K., L.F.G., R.R., P.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - L F Gonzalez
- From the Department of Neurosurgery (N.C., S.T., J.L.H.P., R.M.S., C.W., M.Z., D.K., L.F.G., R.R., P.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - R Rosenwasser
- From the Department of Neurosurgery (N.C., S.T., J.L.H.P., R.M.S., C.W., M.Z., D.K., L.F.G., R.R., P.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - P Jabbour
- From the Department of Neurosurgery (N.C., S.T., J.L.H.P., R.M.S., C.W., M.Z., D.K., L.F.G., R.R., P.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
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Abdullah MS, Wild G, Jacob V, Milford-Ward A, Ryad R, Zanaty M, Ali MH, el Nahas AM. Cytokines and the malnutrition of chronic renal failure. Miner Electrolyte Metab 1997; 23:237-42. [PMID: 9387125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Malnutrition in uremic patients remains one of the major causes of morbidity and mortality. Its mediators remain largely unknown. Uremia is characterized by changes in circulating levels of catabolic cytokines and anabolic growth factors. The aim of this study was to investigate whether these changes are associated with the malnutrition of patients with chronic renal failure (CRF). We have studied the prevalence of malnutrition in a small group of patients (n = 20) with CRF (serum creatinine = 551 +/- 105 mumol/l, mean +/- SD) and 25 age-matched controls. Nutritional status was assessed by dietary diaries, subjective global assessment (SGA), and by measurement of anthropometric parameters. Regression analysis was applied to examine the relationship between biochemical and anthropometric parameters. Simultaneously, we have investigated changes in the circulating levels of catabolic cytokines [tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-1 beta and IL-6] and an anabolic growth factor [insulin-like growth factor-I (IGF-I)]. We observed a high prevalence of malnutrition as judged initially by SGA: 50% moderately malnourished and 15% severely malnourished. This was confirmed by anthropometric measurements. We noted a significant reduction in both triceps skinfold thickness (TST; 35% of patients < 25th centile) and midarm muscle circumference (MAMC, 65% of patients < 25th centile). We also noted a reduction in serum IGF-I in malnourished patients (IGF-I in well-nourished patients = 207 +/- 48 micrograms/l, in malnourished patients = 133 +/- 33 micrograms/l, p < 0.01). IGF-I correlated with TST (r = 0.71, p < 0.001) and MAMC (r = 0.47, p < 0.05). IGF-I had a high predictive value for TST (R2 = 51%, p < 0.001). In contrast, TNF-alpha levels were higher in malnourished patients: 19.5 +/- 30 pg/ml compared to 3.9 +/- 8 pg/ml in healthy patients (p < 0.001) and TNF-alpha showed a negative correlation with MAMC (r = -0.69, p < 0.01; R2 = 47%, p < 0.01). IL-1 beta levels were higher in CRF than in controls but did not correlate with nutritional parameters. No significant changes could be detected in serum IL-6. A significant percentage of predialysis patients with CRF suffer from some degree of malnutrition. This may be attributed in part to a fall in circulating anabolic growth factors and an increase in catabolic cytokines.
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Affiliation(s)
- M S Abdullah
- Sheffield Kidney Institute, Northern General Hospital Trust, Sheffield, UK
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