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Lim J, Aguirre AO, Rattani A, Baig AA, Monteiro A, Kuo CC, Siddiqi M, Im J, Housley SB, McPheeters MJ, Ciecierska SSK, Jaikumar V, Vakharia K, Davies JM, Snyder KV, Levy EI, Siddiqui AH. Thrombectomy outcomes for acute ischemic stroke in lower-middle income countries: A systematic review and analysis. World Neurosurg X 2024; 23:100317. [PMID: 38511159 PMCID: PMC10950731 DOI: 10.1016/j.wnsx.2024.100317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/21/2024] [Indexed: 03/22/2024] Open
Affiliation(s)
- Jaims Lim
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Alexander O. Aguirre
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Abbas Rattani
- Department of Radiation Oncology, Tufts University Medical Center, Boston, MA, USA
| | - Ammad A. Baig
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Andre Monteiro
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Cathleen C. Kuo
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Manhal Siddiqi
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Justin Im
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Steven B. Housley
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Matthew J. McPheeters
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | | | - Vinay Jaikumar
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Kunal Vakharia
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Jason M. Davies
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
- Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Jacobs Institute, Buffalo, NY, USA
| | - Kenneth V. Snyder
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Jacobs Institute, Buffalo, NY, USA
| | - Elad I. Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Jacobs Institute, Buffalo, NY, USA
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Adnan H. Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Jacobs Institute, Buffalo, NY, USA
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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Lim J, Monteiro A, Ruggiero N, Baig AA, Aguirre AO, McPheeters MJ, Waqas M, Vakharia K, Snyder KV, Siddiqui AH, Levy EI, Davies JM. Mechanical Thrombectomy versus Best Medical Management for Acute Ischemic Stroke in Elderly Patients: A Cost-Effectiveness Analysis. World Neurosurg 2023:S1878-8750(23)00485-0. [PMID: 37037370 DOI: 10.1016/j.wneu.2023.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 12/05/2022] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVE To determine the cost-effectiveness of mechanical thrombectomy (MT) versus best medical management (BMM) in patients ≥80 years. METHODS We performed a systematic literature review to identify comparative studies of MT vs BMM with or without intravenous tissue-type plasminogen activator (IV tPA) in patients ≥80 years. Clinical data including outcomes and mortality categorized as modified Rankin scale (mRS) scores 0-2, 3-5, and 6 were collected from identified studies, and effectiveness scores were assigned to each outcome. Costs associated with stroke outcomes were derived from previous literature, including costs associated with initial and follow-up imaging, hospitalization, physicians/associated personnel, and MT. TreeAge Pro software (Williamstown, MA) was used to construct a cost-effectiveness analysis model of clinical data from studies and costs derived from the literature. RESULTS The review identified 1 relevant comparative study. The cost model demonstrated total annual cumulative overall per-patient costs of $30,064.21 for BMM with IV tPA and $21,940.36 for BMM without IV tPA. Overall effectiveness scores were 0.61 and 0.62, respectively. MT had a cumulative total annual per-patient cost of $47,849.54 and an overall effectiveness score of 0.40. The cost-effectiveness ratios of total cumulative patient cost-to-overall outcome effectiveness score for the three treatments were: BMM with IV tPA=$49,285.59, BMM without IV tPA=$35,387.58, and MT=$119,623.85. BMM with or without IV tPA was found to be more cost-effective than MT. CONCLUSIONS This study utilized stroke outcomes data for patients ≥80 years to conduct a cost-effectiveness analysis. MT was found to be less cost-effective than BMM with and without IV tPA.
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Affiliation(s)
- Jaims Lim
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Andre Monteiro
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Nicco Ruggiero
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Ammad A Baig
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Alexander O Aguirre
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Matthew J McPheeters
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Muhammad Waqas
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Kunal Vakharia
- Department of Neurosurgery, University of South Florida, Tampa Bay, Florida, USA
| | - Kenneth V Snyder
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Jason M Davies
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
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McPheeters MJ. Book Review: Neurotrauma: In Multiple-Choice Questions. Neurosurgery 2022; 91:e7-e8. [PMID: 36948640 DOI: 10.1227/neu.0000000000002019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 03/21/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Matthew J McPheeters
- Department of Neurosurgery, State University of New York, University at Buffalo, Buffalo, New York, USA
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4
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McPheeters MJ. Book Review: Management of Subarachnoid Hemorrhage. Neurosurgery 2022; 90:e157-e158. [PMID: 37150544 DOI: 10.1227/neu.0000000000001994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/04/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Matthew J McPheeters
- Department of Neurosurgery, State University of New York, University at Buffalo, Buffalo, New York, USA
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McPheeters MJ. Book Review: Radial Access for Neurointervention. Neurosurgery 2022; 90:e63-e64. [PMID: 36948601 DOI: 10.1227/neu.0000000000001824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 10/17/2021] [Indexed: 11/19/2022] Open
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Tso MK, Rajah GB, Dossani RH, Meyer MJ, McPheeters MJ, Vakharia K, Waqas M, Snyder KV, Levy EI, Siddiqui AH, Davies JM. Learning curves for transradial access versus transfemoral access in diagnostic cerebral angiography: a case series. J Neurointerv Surg 2021; 14:174-178. [PMID: 34078647 DOI: 10.1136/neurintsurg-2021-017460] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 02/23/2021] [Accepted: 05/19/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The perception of a steep learning curve associated with transradial access has resulted in its limited adoption in neurointervention despite the demonstrated benefits, including decreased access-site complications. OBJECTIVE To compare learning curves of transradial versus transfemoral diagnostic cerebral angiograms obtained by five neurovascular fellows as primary operator. METHODS The first 100-150 consecutive transradial and transfemoral angiographic scans performed by each fellow between July 2017 and March 2020 were identified. Mean fluoroscopy time per artery injected (angiographic efficiency) was calculated as a marker of technical proficiency and compared for every 25 consecutive procedures performed (eg, 1-25, 26-50, 51-75). RESULTS We identified 1242 diagnostic angiograms, 607 transradial and 635 transfemoral. The radial cohort was older (64.3 years vs 62.3 years, p=0.01) and demonstrated better angiographic efficiency (3.4 min/vessel vs 3.7 min/vessel, p=0.03). For three fellows without previous endovascular experience, proficiency was obtained between 25 and 50 transfemoral angiograms. One fellow achieved proficiency after performing 25-50 transradial angiograms; and the two other fellows, in <25 transradial angiograms. The two fellows with previous experience had flattened learning curves for both access types. Two patients experienced transient neurologic symptoms postprocedure. Transradial angiograms were associated with significantly fewer access-site complications (3/607, 0.5% vs 22/635, 3.5%, p<0.01). Radial-to-femoral conversion occurred in 1.2% (7/607); femoral-to-radial conversion occurred in 0.3% (2/635). Over time, the proportion of transradial angiographic procedures increased. CONCLUSION Technical proficiency improved significantly over time for both access types, typically requiring between 25 and 50 diagnostic angiograms to achieve asymptomatic improvement in efficiency. Reduced access-site complications and decreased fluoroscopy time were benefits associated with transradial angiography.
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Affiliation(s)
- Michael K Tso
- Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Gary B Rajah
- Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Rimal H Dossani
- Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Michael J Meyer
- Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Matthew J McPheeters
- Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Kunal Vakharia
- Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Muhammad Waqas
- Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Kenneth V Snyder
- Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA.,Department of Neurosurgery and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Elad I Levy
- Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA.,Department of Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA.,Department of Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Jason M Davies
- Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA .,Department of Neurosurgery and Bioinformatics and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
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Tso MK, Meyer M, Dossani R, Rajah GB, Waqas M, McPheeters MJ, Vakharia K, Davies J, Snyder KV, Levy EI, Siddiqui AH. Systematic Review of Balloon Angioplasty for Vasospasm After Subarachnoid Hemorrhage. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tso MK, Waqas M, Dossani RHH, Rajah GB, Rho K, Rai H, McPheeters MJ, Vakharia K, Snyder KV, Levy EI, Siddiqui AH, Davies J. Predictors of Transradial Failure in Neurointerventional Procedures. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Munich SA, Vakharia K, McPheeters MJ, Waqas M, Tso MK, Levy EI, Snyder KV, Siddiqui AH, Davies JM. Transition to Transradial Access for Mechanical Thrombectomy—Lessons Learned and Comparison to Transfemoral Access in a Single-Center Case Series. Oper Neurosurg (Hagerstown) 2020; 19:701-707. [DOI: 10.1093/ons/opaa230] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/03/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Trends in mechanical thrombectomy have emphasized larger bore aspiration catheters that may be difficult to deploy from a radial access point due to size constraints or need to obtain sheathless access. As such, many neurointerventionists are reticent to attempt thrombectomy through transradial access (TRA) for fear of worse outcomes.
OBJECTIVE
To explore whether mechanical thrombectomy could be achieved safely and effectively through the transradial route.
METHODS
We retrospectively analyzed the records of patients undergoing mechanical thrombectomy at our academic institute between January 2018 and January 2019, which corresponded to a time when we began to transition to TRA for neurointerventions, including mechanical thrombectomy. We compared the procedural details and clinical outcomes of patients undergoing mechanical thrombectomy using TRA with those using transfemoral access (TFA).
RESULTS
During the study period, 44 patients underwent mechanical thrombectomy with TRA and 129 with TFA. There was no statistically significant difference in door-to-access time, door-to-reperfusion time, or first-pass recanalization rate. There was no significant difference in modified Rankin Scale (mRS) score at discharge, mRS score at last follow-up, or length of stay. There were 7 access-site complications in the TFA group and none in the TRA group. One patient in the TRA group required crossover to TFA.
CONCLUSION
Mechanical thrombectomy can be performed safely and effectively from a TRA site without compromising recanalization times or rates. TRA has superior access-site complication profiles compared to TFA.
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Affiliation(s)
- Stephan A Munich
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - Kunal Vakharia
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - Matthew J McPheeters
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - Muhammad Waqas
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - Michael K Tso
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York
- Jacobs Institute, Buffalo, New York
| | - Kenneth V Snyder
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York
- Jacobs Institute, Buffalo, New York
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York
- Jacobs Institute, Buffalo, New York
| | - Jason M Davies
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York
- Jacobs Institute, Buffalo, New York
- Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
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Vakharia K, Munich SA, Waqas M, McPheeters MJ, Levy EI. Dual Microwire Rail Technique to Advance a Microcatheter Past the Ostium of a Dissecting Carotid Artery Aneurysm for Flow Diverter Deployment: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2020; 18:E230-E231. [PMID: 31504887 DOI: 10.1093/ons/opz251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 02/01/2019] [Accepted: 06/07/2019] [Indexed: 11/14/2022] Open
Abstract
Flow diversion using a Pipeline embolization device (PED; Medtronic, Dublin, Ireland) is an effective therapy for treating cavernous aneurysms. Currently, flow diverters require a 0.027-inch microcatheter for deployment. To navigate across these aneurysms, a 0.014-inch microwire is used, which often does not offer a sturdy enough rail to advance a 0.027-inch microcatheter past dissecting artery aneurysm ostia. We present a patient with a right cavernous dissecting carotid artery aneurysm. A step off between the 0.027-inch VIA microcatheter (MicroVention Terumo, Tustin, California) and 0.014-inch Synchro 2 microwire (Stryker Neurovascular, Fremont, California) resulted in difficulty with navigation of the microcatheter across the dissected portion of the aneurysm. A dual microwire rail technique involving two 0.014-inch Synchro 2 microwires was used to advance the VIA microcatheter past the dissecting artery aneurysm ostia for PED deployment. The introduction of the second microwire eliminated the step off between the microwire and microcatheter, providing a stronger rail and easier navigation of the microcatheter, without aggressive pushing. Postembolization runs showed optimal wall apposition and contrast stasis within the aneurysm, with successful flow diversion of the aneurysm. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary.
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Affiliation(s)
- Kunal Vakharia
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - Stephan A Munich
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - Muhammad Waqas
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Matthew J McPheeters
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.,Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York
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Munich SA, Waqas M, Vakharia K, McPheeters MJ, Siddiqui AH. Use of Intra-Arterial Tissue Plasminogen Activator in Acute Stroke: Video Case. Neurosurgery 2020; 85:S72. [PMID: 31197333 DOI: 10.1093/neuros/nyz044] [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: 08/06/2018] [Accepted: 01/29/2019] [Indexed: 11/14/2022] Open
Abstract
This video illustrates access to tortuous distal intracranial vasculature and the use of intra-arterial (IA) tissue plasminogen activator (tPA) for the revascularization of small vessel occlusion. IA tPA is a reasonable approach for distal arterial occlusion resistant to intravenous tPA or mechanical thrombectomy. In this video, the patient had a posterior circulation stroke with elevated time-to-peak in the cerebellar hemispheres. He had received intravenous tPA in the emergency room but ataxia and dysarthria symptoms persisted. Cerebral angiography showed right superior cerebellar artery (SCA) occlusion. Although his NIHSS score was low, his symptoms were disabling. While not standard of care, discussion with patients about potential options is crucial; and we believe that mechanical and localized therapies in these circumstances may be beneficial. A Velocity microcatheter (Penumbra, Alameda, California) was initially used to attempt SCA access but was unsuccessful. A second attempt was made with a Headway Duo (MicroVention, Aliso Viejo, California)-a smaller, more pliant microcatheter better suited to the acute turn in the SCA. A 2 mg IA tPA dose was administered at the occlusion site. A direct aspiration first-pass technique (ADAPT) and stent retriever were thought to be too aggressive in a small SCA. The proximal vessel was recanalized, and the microcatheter was advanced to the distal occlusion site before IA administration of another 2 mg of tPA. Post-tPA runs showed excellent SCA revascularization. For occlusion of small intracranial vessels where IV tPA is ineffective and mechanical thrombectomy is unsafe, local administration of IA tPA can be an effective therapy. Consent was obtained from the patient prior to performing the procedure. Institutional review board approval is not required for the report of a single case.
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Affiliation(s)
- Stephan A Munich
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Muhammad Waqas
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Kunal Vakharia
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Matthew J McPheeters
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Adnan H Siddiqui
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.,Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.,Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York.,Jacobs Institute, Buffalo, New York
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Munich SA, Vakharia K, McPheeters MJ, Tso MK, Waqas M, Snyder KV, Siddiqui AH, Davies JM, Levy EI. Make Clipping Great Again: Microsurgery for Cerebral Aneurysms by Dual-Trained Neurosurgeons. World Neurosurg 2020; 137:e454-e461. [PMID: 32058116 DOI: 10.1016/j.wneu.2020.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 11/16/2019] [Revised: 01/31/2020] [Accepted: 02/01/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Despite an increasing focus on endovascular treatment of cerebral aneurysms, microsurgical clipping remains an integral part of management. We evaluated the safety and effectiveness of microsurgical clipping performed by dual-trained neurosurgeons at our institute, which has adopted an endovascular first approach. METHODS We retrospectively reviewed clinical and radiographic data of 412 aneurysms in 375 patients treated with microsurgical clipping. Univariate and multivariate analyses were performed to identify predictive outcome factors. We defined favorable outcome as a modified Rankin Scale (mRS) score of 0-2 at last clinical follow-up; unfavorable outcome was an mRS score of 3-6. We compared outcomes in our series with those of seminal aneurysm clipping series. RESULTS Clipping of 330 of 351 unruptured aneurysms (94.01%) was associated with favorable outcome during the follow-up period (mean, 26.5 months). On univariate analysis, older patient age, intraoperative rupture, and higher baseline mRS scores were associated with unfavorable outcome in the unruptured cohort. On multivariate analysis, older age, higher baseline mRS scores, and posterior circulation aneurysm location were predictive of unfavorable outcome. Clipping of 46 of 61 ruptured aneurysms (75.4%) was associated with favorable outcome during the follow-up period (mean, 23.1 months). On univariate analysis, left-sided aneurysms, intraoperative rupture, and large aneurysm size were associated with unfavorable outcome in the ruptured cohort. On multivariate analysis, female sex was predictive of unfavorable outcome. CONCLUSIONS Our ruptured and unruptured cohort results compared favorably with those in seminal series. Treatment by neurosurgeons adept at both endovascular and microsurgical techniques may improve clinical outcomes.
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Affiliation(s)
- Stephan A Munich
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Kunal Vakharia
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Matthew J McPheeters
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Michael K Tso
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Muhammad Waqas
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Kenneth V Snyder
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA
| | - Jason M Davies
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA.
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13
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Munich SA, Vakharia K, McPheeters MJ, Tso MK, Siddiqui AH, Snyder KV, Davies JM, Levy EI. "Strokenomics": bending the cost curve in stroke care. J Neurosurg 2020:1-6. [PMID: 31978888 DOI: 10.3171/2019.11.jns191960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 07/18/2019] [Accepted: 11/19/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The mortality rates for stroke are decreasing, yet it remains a leading cause of disability and the principal neurological diagnosis in patients discharged to nursing homes. The societal and economic burdens of stroke are substantial, with the total annual health care costs of stroke expected to reach $240.7 billion by 2030. Mechanical thrombectomy has been shown to improve functional outcomes compared to medical therapy alone. Despite an incremental cost of $10,840 compared to medical therapy, the improvement in functional outcomes and decreased disability have contributed to the cost-effectiveness of the procedure. In this study the authors describe a physician-led device bundle purchase program implemented for the delivery of stroke care. METHODS The authors retrospectively reviewed the clinical and radiographic data and device-associated charges of 45 consecutive patients in whom a virtual "stroke bundle" model was used to purchase mechanical thrombectomy devices. RESULTS Use of the stroke bundle to purchase mechanical thrombectomy devices resulted in an average savings per case of $2900.93. Compared to the traditional model of charging for devices à la carte, this represented an average savings of 25.2% per case. The total amount of savings for these initial 45 cases was $130,542.00. Thrombolysis in Cerebral Infarction scale grade 2b or 3 recanalization occurred in 38 patients (84.4%) using these devices. CONCLUSIONS Purchasing devices through a bundled model resulted in substantial cost savings while maintaining the therapeutic efficacy of the procedure, further pushing the already beneficial long-term cost-benefit curve in favor of thrombectomy.
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Affiliation(s)
- Stephan A Munich
- Departments of1Neurosurgery
- 2Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo
| | - Kunal Vakharia
- Departments of1Neurosurgery
- 2Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo
| | - Matthew J McPheeters
- Departments of1Neurosurgery
- 2Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo
| | - Michael K Tso
- Departments of1Neurosurgery
- 2Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo
| | - Adnan H Siddiqui
- Departments of1Neurosurgery
- 2Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo
- 3Radiology
- 4Canon Stroke and Vascular Research Center, University at Buffalo; and
- 5Jacobs Institute, Buffalo, New York
| | - Kenneth V Snyder
- Departments of1Neurosurgery
- 2Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo
- 4Canon Stroke and Vascular Research Center, University at Buffalo; and
- 5Jacobs Institute, Buffalo, New York
- 6Neurology, and
| | - Jason M Davies
- Departments of1Neurosurgery
- 2Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo
- 4Canon Stroke and Vascular Research Center, University at Buffalo; and
- 5Jacobs Institute, Buffalo, New York
- 7Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
| | - Elad I Levy
- Departments of1Neurosurgery
- 2Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo
- 3Radiology
- 4Canon Stroke and Vascular Research Center, University at Buffalo; and
- 5Jacobs Institute, Buffalo, New York
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Shakir HJ, McPheeters MJ, Shallwani H, Pittari JE, Reynolds RM. The Prevalence of Burnout Among US Neurosurgery Residents. Neurosurgery 2019; 83:582-590. [PMID: 29088408 DOI: 10.1093/neuros/nyx494] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 09/08/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Burnout is a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment. Its prevalence among US physicians exceeds 50% and is higher among residents/fellows. This is important to the practice of neurosurgery, as burnout is associated with adverse physical health, increased risk of substance abuse, and increased medical errors. To date, no study has specifically addressed the prevalence of burnout among neurosurgery residents. OBJECTIVE To determine and compare the prevalence of burnout among US neurosurgery residents with published rates for residents/fellows and practicing physicians from other specialties. METHODS We surveyed 106 US neurosurgery residency training programs to perform a descriptive analysis of the prevalence of burnout among residents. Data on burnout among control groups were used to perform a cross-sectional analysis. Nonparametric tests assessed differences in burnout scores among neurosurgery residents, and the 2-tailed Fisher's exact test assessed burnout between neurosurgery residents and control populations. RESULTS Of approximately 1200 US neurosurgery residents, 255 (21.3%) responded. The prevalence of burnout was 36.5% (95% confidence interval: 30.6%-42.7%). There was no significant difference in median burnout scores between gender (P = .836), age (P = .183), or postgraduate year (P = .963) among neurosurgery residents. Neurosurgery residents had a significantly lower prevalence of burnout (36.5%) than other residents/fellows (60.0%; P < .001), early career physicians (51.3%; P < .001), and practicing physicians (53.5%; P < .001). CONCLUSION Neurosurgery residents have a significantly lower prevalence of burnout than other residents/fellows and practicing physicians. The underlying causes for these findings were not assessed and are likely multifactorial. Future studies should address possible causes of these findings.
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Affiliation(s)
- Hakeem J Shakir
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, State University of New York, Buffalo, New York
| | - Matthew J McPheeters
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, State University of New York, Buffalo, New York
| | - Hussain Shallwani
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, State University of New York, Buffalo, New York
| | - Joseph E Pittari
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - Renée M Reynolds
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York.,Department of Neurosurgery, Women and Children's Hospital of Buffalo at Kaleida Health; Buffalo, New York
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Vakharia K, Waqas M, Munich SA, McPheeters MJ, Levy EI. Management of Iatrogenic Internal Carotid Artery Dissection and Middle Cerebral Artery Restenosis during Endovascular Treatment of Acute Stroke: Video Case. Neurosurgery 2019; 85:S70-S71. [PMID: 31197330 DOI: 10.1093/neuros/nyz043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 08/06/2018] [Accepted: 01/29/2019] [Indexed: 11/14/2022] Open
Abstract
Iatrogenic dissection of the internal carotid artery (ICA) during endovascular approaches is challenging. This video illustrates a case of iatrogenic ICA dissection at the skull base during mechanical thrombectomy for M1 occlusion. This case was further complicated by post-thrombectomy M1 restenosis that did not improve with submaximal angioplasty. ICA dissection occurred while navigating the guide catheter into the distal cervical ICA over a 0.38 inch Glidewire (MicroVention-Terumo, Aliso Viejo, California). The dissection flap was crossed with a SofiaPlus intermediate catheter (MicroVention-Terumo), Velocity microcatheter (Penumbra, Alameda, California), and double-ended 0.18 inch wire. The M1 occlusion was crossed and treated with Solumbra technique by pulling a Solitaire stent-retriever (Medtronic, Dublin, Ireland) through a SofiaPlus aspiration catheter (MicroVention). Post-recanalization M1 stenosis was noted, which was believed to be due to underlying intracranial atherosclerotic disease because of the appearance of platelet aggregation instead of a typical vasospasm response to a stent-retriever. A noncompliant Gateway 2 × 12 mm balloon catheter (Stryker Neurovascular, Kalamazoo, Michigan) was used to cross the lesion and perform submaximal angioplasty. Next, the dissection was treated by advancing a NeuronMAX guide catheter (Penumbra) over the SofiaPlus into the vertical petrous carotid artery beyond the dissection flap and unsheathing a Wallstent (Stryker Neurovascular) across the flap. Because of progressive M1 restenosis, a Wingspan stent (Stryker Neurovascular) was deployed. Final runs demonstrated Thrombolysis in Cerebral Infarction 2C recanalization. Pre-stenting thrombectomy was chosen because the duration of symptoms was >48 h; thus, determining the risk of reperfusion hemorrhage by evaluating intracranial shunting before stenting was prudent. Reperfusion hemorrhage would complicate the antiplatelet agent therapy necessary for stent placement. Consent was obtained from the patient prior to performing the procedure. Institutional review board approval is not required for the report of a single case.
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Affiliation(s)
- Kunal Vakharia
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Muhammad Waqas
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Stephan A Munich
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Matthew J McPheeters
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Elad I Levy
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.,Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.,Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York
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Fanous AA, McPheeters MJ, Morr S, Gibbons KJ, Reynolds RM. Commentary: Synopsis of the Location and Type of Training for Current Department Chairs and Program Directors of Academic Neurosurgical Departments in the United States. Neurosurgery 2018; 83:E238-E243. [PMID: 30247667 DOI: 10.1093/neuros/nyy412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/02/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Andrew A Fanous
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, New York.,Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Matthew J McPheeters
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, New York.,Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York
| | - Simon Morr
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, New York.,Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York.,Department of Neurosurgery, Erie County Medical Center, Buffalo, New York
| | - Kevin J Gibbons
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, New York.,Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York
| | - Renée M Reynolds
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, New York.,Department of Neurosurgery, John R. Oishei Children's Hospital, Kaleida Health; Buffalo, New York
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McPheeters MJ, Talcott RD, Hubbard ME, Haines SJ, Hunt MA. Assessing the accuracy of neurological surgery resident case logs at a single institution. Surg Neurol Int 2017; 8:206. [PMID: 28966813 PMCID: PMC5609396 DOI: 10.4103/sni.sni_83_17] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 06/10/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Despite the importance of case logs in evaluating residents, no studies assess their accuracy in neurological surgery. Studies from other specialties reveal variations in reporting. This study assesses the accuracy of neurological surgery resident case logs at a single institution. METHODS Data was collected from three databases: billing data and two separate resident-managed case logs [department log and Accreditation Council for Graduate Medical Education (ACGME) case logs], containing records of procedures performed by 14 neurological surgery residents at a single institution over a 1-year period. The billing data was used as a proxy for a census of procedures performed during the study period. The difference between the number of procedures logged by residents and the number of procedures billed was calculated to determine the accuracy of the resident case logs. RESULTS Over the study period, 2150 procedures were billed at the institution, whereas 1749 procedures were logged in the ACGME case log and 1873 in the department log, representing an error rate of -18.65% and -12.88%, respectively. The error rate varied significantly (-1150% to +50.23%) between ACGME procedure categories. In 13 of the 22 ACGME procedure categories, the procedures were under-logged by residents in both resident-managed case logs. No category demonstrated over-logging in both case log systems. CONCLUSION Resident managed case logs are an incomplete representation of clinical work. The cause for inaccuracy is multifactorial. The authors suggested that further research is necessary to validate their results and to identify means by which the accuracy of case logs can be increased.
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Affiliation(s)
- Matthew J McPheeters
- Department of Neurosurgery, University at Buffalo, Buffalo General Medical Center, Buffalo, New York, USA
| | - Rachel D Talcott
- Department of Neurosurgery, University of Minnesota, Mayo Building, Minneapolis, Minnesota, USA
| | - Molly E Hubbard
- Department of Neurosurgery, University of Minnesota, Mayo Building, Minneapolis, Minnesota, USA
| | - Stephen J Haines
- Department of Neurosurgery, University of Minnesota, Mayo Building, Minneapolis, Minnesota, USA
| | - Matthew A Hunt
- Department of Neurosurgery, University of Minnesota, Mayo Building, Minneapolis, Minnesota, USA
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