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Elfil M, Morsi RZ, Ghozy S, Elmashad A, Siddiqui A, Al-Bayati AR, Alaraj A, Brook A, Kam AW, Chatterjee AR, Patsalides A, Waldau B, Prestigiacomo CJ, Matouk C, Schirmer CM, Altschul D, Parrella DT, Toth G, Jindal G, Shaikh HA, Dolia JN, Fifi JT, Fraser JF, DO JT, Amuluru K, Kim LJ, Harrigan M, Amans MR, Kole M, Mokin M, Abraham M, Jumaa M, Janjua N, Zaidat O, Youssef PP, Khandelwal P, Wang QT, Grandhi R, Hanel R, Kellogg RT, Ortega-Gutierrez S, Sheth S, Nguyen TN, Szeder V, Hu YC, Yoo AJ, Tanweer O, Jankowitz B, Heit JJ, Williamson R, Kass-Hout T, Crowley RW, El-Ghanem M, Al-Mufti F. Factors Affecting Selection of TraineE for Neurointervention (FASTEN). Interv Neuroradiol 2024:15910199241232726. [PMID: 38389309 DOI: 10.1177/15910199241232726] [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] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND AND IMPORTANCE Neurointervention is a very competitive specialty in the United States due to the limited number of training spots and the larger pool of applicants. The training standards are continuously updated to ensure solid training experiences. Factors affecting candidate(s) selection have not been fully established yet. Our study aims to investigate the factors influencing the selection process. METHODS A 52-question survey was distributed to 93 program directors (PDs). The survey consisted of six categories: (a) Program characteristics, (b) Candidate demographics, (c) Educational credentials, (d) Personal traits, (e) Research and extracurricular activities, and (f) Overall final set of characteristics. The response rate was 59.1%. As per the programs' characteristics, neurosurgery was the most involved specialty in running the training programs (69%). Regarding demographics, the need for visa sponsorship held the greatest prominence with a mean score of 5.9 [standard deviation (SD) 2.9]. For the educational credentials, being a graduate from a neurosurgical residency and the institution where the candidate's residency training is/was scored the highest [5.4 (SD = 2.9), 5.4 (SD = 2.5), respectively]. Regarding the personal traits, assessment by faculty members achieved the highest score [8.9 (SD = 1)]. In terms of research/extracurricular activities, fluency in English had the highest score [7.2 (SD = 1.9)] followed by peer-reviewed/PubMed-indexed publications [6.4 (SD = 2.2)]. CONCLUSION Our survey investigated the factors influencing the final decision when choosing the future neurointerventional trainee, including demographic, educational, research, and extracurricular activities, which might serve as valuable guidance for both applicants and programs to refine the selection process.
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Affiliation(s)
- Mohamed Elfil
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Rami Z Morsi
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Ahmed Elmashad
- Department of Neurology, Yale University, New Haven, CT, USA
| | - Adnan Siddiqui
- Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University of Buffalo, Buffalo, NY, USA
| | - Alhamza R Al-Bayati
- Department of Neurology and Neurosurgery, University of Pittsburg Medical Center, Pittsburg, PA, USA
| | - Ali Alaraj
- Department of Neurosurgery, University of Illinois, Chicago, IL, USA
| | - Allan Brook
- Department of Neurosurgery, Montefiore Medical Center and Children's Hospital at Montefiore (CHAM), Bronx, NY, USA
| | - Anthony W Kam
- Department of Radiology, Loyola University Medical Center, Stritch School of Medicine, Maywood, IL, USA
| | - Arindam Rano Chatterjee
- Interventional Neuroradiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Athos Patsalides
- Department of Neurosurgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine, Manhasset, NY, USA
| | - Ben Waldau
- Neurosurgery, University of California Davis, Sacramento, CA, USA
| | - Charles J Prestigiacomo
- Department of Neurological Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Charles Matouk
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | | | - David Altschul
- Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David T Parrella
- Interventional Neurology, Ascension Saint Thomas Hospital West, Nashville, TN, USA
| | - Gabor Toth
- Cerebrovascular Center, Cleveland Clinic, Cleveland, OH, USA
| | - Gaurav Jindal
- Division of Interventional Neuroradiology, Department of Radiology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Hamza A Shaikh
- Department of Radiology, Cooper University Hospital, Camden, NJ, USA
| | | | - Johanna T Fifi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Justin F Fraser
- Department of Neurological Surgery, University of Kentucky, Lexington, KY, USA
| | - Justin Thomas DO
- Department of Neurosurgery, McLaren Northern Hospital, Petoskey, MI, USA
| | - Krishna Amuluru
- Interventional Neuroradiology, Goodman Campbell Brain and Spine, Indianapolis, IN, USA
| | - Louis J Kim
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Mark Harrigan
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Matthew R Amans
- Departments of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Max Kole
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI, USA
| | - Max Mokin
- Neurosurgery, University of South Florida, Tampa, FL, USA
| | - Michael Abraham
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Mouhammad Jumaa
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Nazli Janjua
- Asia Pacific Comprehensive Stroke Institute, Pomona Valley Hospital Medical Center, Pomona, CA, USA
| | - Osama Zaidat
- Department of Endovascular Neurosurgery, Mercy Health St Vincent Medical Center, Toledo, OH, USA
| | - Patrick P Youssef
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Priyank Khandelwal
- Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Qingliang Tony Wang
- Departments of Neurology/Neurosurgery, Maimonides Medical Center/SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Ramesh Grandhi
- Department of Neurosurgery, Clinical Neuroscience Center, University of Utah, Salt Lake City, UT, USA
| | - Ricardo Hanel
- Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, FL, USA
| | - Ryan T Kellogg
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
| | | | - Sunil Sheth
- Department of Neurology, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Thanh N Nguyen
- Department of Neurology, Boston Medical Center, Boston, MA, USA
| | - Viktor Szeder
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Yin C Hu
- Department of Neurosurgery, UH Cleveland Medical Center, Cleveland, OH, USA
| | - Albert J Yoo
- Department of Radiology/Neurointervention, Texas Stroke Institute, Dallas-Fort Worth, TX, USA
| | - Omar Tanweer
- Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | | | - Jeremy J Heit
- Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA, USA
| | - Richard Williamson
- Department of Neurological Surgery, Allegheny Health Network, Pittsburgh, PA, USA
| | - Tareq Kass-Hout
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - Richard W Crowley
- Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Mohammad El-Ghanem
- Neuroendovascular Surgery, HCA Houston Northwest/University of Houston College of Medicine, Houston, TX, USA
| | - Fawaz Al-Mufti
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
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2
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Chivukula V, White R, Shields A, Davies J, Mokin M, Bednarek DR, Rudin S, Ionita C. Leveraging Patient-Specific Simulated Angiograms to Characterize Cerebral Aneurysm Hemodynamics using Computational Fluid Dynamics. Proc SPIE Int Soc Opt Eng 2022; 12036:120360S. [PMID: 35983495 PMCID: PMC9385184 DOI: 10.1117/12.2611473] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Cerebral aneurysms (CA) affect nearly 6% of the US population and its rupture is one of the major causes of hemorrhagic stroke. Neurointerventionalists performing endovascular therapy (ET) to treat CA rely on qualitative image sequences obtained under fluoroscopy guidance alone, and do not have access to crucial quantitative information regarding blood flow before, during and after treatment - partially contributing to a failure rate of up to 30%. Computational fluid dynamics (CFD) is a powerful tool that can provide a wealth of quantitative data; however, CFD has found limited utility in the clinic due to the challenges in obtaining hemodynamic boundary conditions for each patient. In this work, we present a novel CFD-based simulated angiogram approach (SAA) that resolves the blood flow physics and interaction between blood and injected contrast agent to extract quantitative hemodynamic parameters which can be used to design real-time parametric imaging analysis. The SAA enables correlating contrast agent transport to the underlying hemodynamic conditions via time-density curves (TDC) obtained at several points in the region of interest. The ability of the TDC and the SAA to provide critical hemodynamic parameters in and around CA anatomies, such as washout and local flow changes is explored and presented. This provides invaluable quantitative data to the clinician at the time of intervention, since it incorporates the physics of blood flow and correlates the contrast transport to hemodynamic parameters quantitatively - thereby enabling the clinician to take informed decisions that improve treatment outcomes.
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Affiliation(s)
- V Chivukula
- Biomedical Engineering, Florida Institute of Technology
| | - R White
- Biomedical Engineering, Florida Institute of Technology
| | - A Shields
- Medical Physics, State University of New York at Buffalo
- Canon Stroke and Vascular Research Center, State University of New York at Buffalo
| | - J Davies
- Department of Neurosurgery, State University of New York at Buffalo
| | - M Mokin
- Department of Neurology and Neurosurgery, University of South Florida
| | - D R Bednarek
- Medical Physics, State University of New York at Buffalo
- Canon Stroke and Vascular Research Center, State University of New York at Buffalo
| | - S Rudin
- Medical Physics, State University of New York at Buffalo
- Canon Stroke and Vascular Research Center, State University of New York at Buffalo
- Department of Neurosurgery, State University of New York at Buffalo
| | - C Ionita
- Medical Physics, State University of New York at Buffalo
- Canon Stroke and Vascular Research Center, State University of New York at Buffalo
- Department of Neurosurgery, State University of New York at Buffalo
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3
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Patel TR, Fricano S, Waqas M, Tso M, Dmytriw AA, Mokin M, Kolega J, Tomaszewski J, Levy EI, Davies JM, Snyder KV, Siddiqui AH, Tutino VM. Increased Perviousness on CT for Acute Ischemic Stroke is Associated with Fibrin/Platelet-Rich Clots. AJNR Am J Neuroradiol 2021; 42:57-64. [PMID: 33243895 PMCID: PMC7814781 DOI: 10.3174/ajnr.a6866] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/21/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Clot perviousness in acute ischemic stroke is a potential CT imaging biomarker for mechanical thrombectomy efficacy. We investigated the association among perviousness, clot cellular composition, and first-pass effect. MATERIALS AND METHODS In 40 mechanical thrombectomy-treated cases of acute ischemic stroke, we calculated perviousness as the difference in clot density on CT angiography and noncontrast CT. We assessed the proportion of fibrin/platelet aggregates, red blood cells, and white blood cells on clot histopathology. We tested for linear correlation between histologic components and perviousness, differences in components between "high" and "low" pervious clots defined by median perviousness, and differences in perviousness/composition between cases that did and did not achieve a first-pass effect. RESULTS Perviousness significantly positively and negatively correlated with the percentage of fibrin/platelet aggregates (P = .001) and the percentage of red blood cells (P = .001), respectively. Higher pervious clots had significantly greater fibrin/platelet aggregate content (P = .042). Cases that achieved a first-pass effect (n = 14) had lower perviousness, though not significantly (P = .055). The percentage of red blood cells was significantly higher (P = .028) and the percentage of fibrin/platelet aggregates was significantly lower (P = .016) in cases with a first-pass effect. There was no association between clot density on NCCT and clot composition or first-pass effect. Receiver operating characteristic analysis indicated that clot composition was the best predictor of first-pass effect (area under receiver operating characteristic curve: percentage of fibrin/platelet aggregates = 0.731, percentage of red blood cells = 0.706, perviousness = 0.668). CONCLUSIONS Clot perviousness on CT is associated with a higher percentage of fibrin/platelet aggregate content. Histologic data and, to a lesser degree, perviousness may have value in predicting first-pass outcome. Imaging metrics that more strongly reflect clot biology than perviousness may be needed to predict a first-pass effect with high accuracy.
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Affiliation(s)
- T R Patel
- From the Canon Stroke and Vascular Research Center (T.R.P., S.F., M.W., M.T., J.K., J.T., E.I.L., J.M.D., K.V.S., A.H.S., V.M.T.)
- Department of Mechanical and Aerospace Engineering (T.R.P., V.M.T.)
| | - S Fricano
- From the Canon Stroke and Vascular Research Center (T.R.P., S.F., M.W., M.T., J.K., J.T., E.I.L., J.M.D., K.V.S., A.H.S., V.M.T.)
- Pathology and Anatomical Sciences (S.F., J.K., J.T., V.M.T.)
| | - M Waqas
- From the Canon Stroke and Vascular Research Center (T.R.P., S.F., M.W., M.T., J.K., J.T., E.I.L., J.M.D., K.V.S., A.H.S., V.M.T.)
- Neurosurgery (M.W., M.T., E.I.L., J.M.D., K.V.S., A.H.S., V.M.T.)
| | - M Tso
- From the Canon Stroke and Vascular Research Center (T.R.P., S.F., M.W., M.T., J.K., J.T., E.I.L., J.M.D., K.V.S., A.H.S., V.M.T.)
- Neurosurgery (M.W., M.T., E.I.L., J.M.D., K.V.S., A.H.S., V.M.T.)
| | - A A Dmytriw
- Department of Medical Imaging (A.A.D.), University of Toronto, Toronto, Ontario, Canada
| | - M Mokin
- Department of Neurosurgery (M.M.), University of South Florida, Tampa, Florida
| | - J Kolega
- From the Canon Stroke and Vascular Research Center (T.R.P., S.F., M.W., M.T., J.K., J.T., E.I.L., J.M.D., K.V.S., A.H.S., V.M.T.)
- Pathology and Anatomical Sciences (S.F., J.K., J.T., V.M.T.)
| | - J Tomaszewski
- From the Canon Stroke and Vascular Research Center (T.R.P., S.F., M.W., M.T., J.K., J.T., E.I.L., J.M.D., K.V.S., A.H.S., V.M.T.)
- Pathology and Anatomical Sciences (S.F., J.K., J.T., V.M.T.)
| | - E I Levy
- From the Canon Stroke and Vascular Research Center (T.R.P., S.F., M.W., M.T., J.K., J.T., E.I.L., J.M.D., K.V.S., A.H.S., V.M.T.)
- Neurosurgery (M.W., M.T., E.I.L., J.M.D., K.V.S., A.H.S., V.M.T.)
| | - J M Davies
- From the Canon Stroke and Vascular Research Center (T.R.P., S.F., M.W., M.T., J.K., J.T., E.I.L., J.M.D., K.V.S., A.H.S., V.M.T.)
- Neurosurgery (M.W., M.T., E.I.L., J.M.D., K.V.S., A.H.S., V.M.T.)
- Biomedical Informatics (J.M.D.), University at Buffalo, Buffalo, New York
| | - K V Snyder
- From the Canon Stroke and Vascular Research Center (T.R.P., S.F., M.W., M.T., J.K., J.T., E.I.L., J.M.D., K.V.S., A.H.S., V.M.T.)
- Neurosurgery (M.W., M.T., E.I.L., J.M.D., K.V.S., A.H.S., V.M.T.)
| | - A H Siddiqui
- From the Canon Stroke and Vascular Research Center (T.R.P., S.F., M.W., M.T., J.K., J.T., E.I.L., J.M.D., K.V.S., A.H.S., V.M.T.)
- Neurosurgery (M.W., M.T., E.I.L., J.M.D., K.V.S., A.H.S., V.M.T.)
| | - V M Tutino
- From the Canon Stroke and Vascular Research Center (T.R.P., S.F., M.W., M.T., J.K., J.T., E.I.L., J.M.D., K.V.S., A.H.S., V.M.T.)
- Department of Mechanical and Aerospace Engineering (T.R.P., V.M.T.)
- Pathology and Anatomical Sciences (S.F., J.K., J.T., V.M.T.)
- Neurosurgery (M.W., M.T., E.I.L., J.M.D., K.V.S., A.H.S., V.M.T.)
- Biomedical Engineering (V.M.T.)
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4
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Burkhardt JK, Srinivasan V, Srivatsan A, Albuquerque F, Ducruet AF, Hendricks B, Gross BA, Jankowitz BT, Thomas AJ, Ogilvy CS, Maragkos GA, Enriquez-Marulanda A, Crowley RW, Levitt MR, Kim LJ, Griessenauer CJ, Schirmer CM, Dalal S, Piper K, Mokin M, Winkler EA, Abla AA, McDougall C, Birnbaum L, Mascitelli J, Litao M, Tanweer O, Riina H, Johnson J, Chen S, Kan P. Multicenter Postmarket Analysis of the Neuroform Atlas Stent for Stent-Assisted Coil Embolization of Intracranial Aneurysms. AJNR Am J Neuroradiol 2020; 41:1037-1042. [PMID: 32467183 DOI: 10.3174/ajnr.a6581] [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: 02/13/2020] [Accepted: 03/29/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The Neuroform Atlas is a new microstent to assist coil embolization of intracranial aneurysms that recently gained FDA approval. We present a postmarket multicenter analysis of the Neuroform Atlas stent. MATERIALS AND METHODS On the basis of retrospective chart review from 11 academic centers, we analyzed patients treated with the Neuroform Atlas after FDA exemption from January 2018 to June 2019. Clinical and radiologic parameters included patient demographics, aneurysm characteristics, stent parameters, complications, and outcomes at discharge and last follow-up. RESULTS Overall, 128 aneurysms in 128 patients (median age, 62 years) were treated with 138 stents. Risk factors included smoking (59.4%), multiple aneurysms (27.3%), and family history of aneurysms (16.4%). Most patients were treated electively (93.7%), and 8 (6.3%) underwent treatment within 2 weeks of subarachnoid hemorrhage. Previous aneurysm treatment failure was present in 21% of cases. Wide-neck aneurysms (80.5%), small aneurysm size (<7 mm, 76.6%), and bifurcation aneurysm location (basilar apex, 28.9%; anterior communicating artery, 27.3%; and middle cerebral artery bifurcation, 12.5%) were common. A single stent was used in 92.2% of cases, and a single catheter for both stent placement and coiling was used in 59.4% of cases. Technical complications during stent deployment occurred in 4.7% of cases; symptomatic thromboembolic stroke, in 2.3%; and symptomatic hemorrhage, in 0.8%. Favorable Raymond grades (Raymond-Roy occlusion classification) I and II were achieved in 82.9% at discharge and 89.5% at last follow-up. mRS ≤2 was determined in 96.9% of patients at last follow-up. The immediate Raymond-Roy occlusion classification grade correlated with aneurysm location (P < .0001) and rupture status during treatment (P = .03). CONCLUSIONS This multicenter analysis provides a real-world safety and efficacy profile for the treatment of intracranial aneurysms with the Neuroform Atlas stent.
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Affiliation(s)
- J-K Burkhardt
- From the Department of Neurosurgery (J.-K.B., V.S., A.S., O.T., J.J., S.C., P.K.), Baylor College of Medicine, Houston, Texas
| | - V Srinivasan
- From the Department of Neurosurgery (J.-K.B., V.S., A.S., O.T., J.J., S.C., P.K.), Baylor College of Medicine, Houston, Texas
| | - A Srivatsan
- From the Department of Neurosurgery (J.-K.B., V.S., A.S., O.T., J.J., S.C., P.K.), Baylor College of Medicine, Houston, Texas
| | - F Albuquerque
- Department of Neurosurgery (F.A., A.F.D., B.H.), Barrow Neurological Institute, Phoenix, Arizona
| | - A F Ducruet
- Department of Neurosurgery (F.A., A.F.D., B.H.), Barrow Neurological Institute, Phoenix, Arizona
| | - B Hendricks
- Department of Neurosurgery (F.A., A.F.D., B.H.), Barrow Neurological Institute, Phoenix, Arizona
| | - B A Gross
- Department of Neurological Surgery (B.A.G.), University of Pittsburgh Medical Center Presbyterian, Pittsburgh, Pennsylvania
| | - B T Jankowitz
- Department of Neurosurgery (B.T.J.), Cooper University, Camden, New Jersey
| | - A J Thomas
- Beth Israel Deaconess Medical Center (A.J.T., C.S.O., G.A.M.), Harvard Medical School, Boston, Massachusetts
| | - C S Ogilvy
- Beth Israel Deaconess Medical Center (A.J.T., C.S.O., G.A.M.), Harvard Medical School, Boston, Massachusetts
| | - G A Maragkos
- Beth Israel Deaconess Medical Center (A.J.T., C.S.O., G.A.M.), Harvard Medical School, Boston, Massachusetts
| | | | - R W Crowley
- Department of Neurosurgery (R.W.C.), Rush Medical College, Chicago, Illinois
| | - M R Levitt
- Department of Neurological Surgery (M.R.L., L.J.K.), University of Washington, Seattle, Washington
| | - L J Kim
- Department of Neurological Surgery (M.R.L., L.J.K.), University of Washington, Seattle, Washington
| | - C J Griessenauer
- Department of Neurosurgery (C.J.G., C.M.S., S.D.), Geisinger Health, Danville, Pennsylvania.,Research Institute of Neurointervention (C.J.G., C.M.S.), Paracelsus Medical University, Salzburg, Austria
| | - C M Schirmer
- Department of Neurosurgery (C.J.G., C.M.S., S.D.), Geisinger Health, Danville, Pennsylvania.,Research Institute of Neurointervention (C.J.G., C.M.S.), Paracelsus Medical University, Salzburg, Austria
| | - S Dalal
- Department of Neurosurgery (C.J.G., C.M.S., S.D.), Geisinger Health, Danville, Pennsylvania
| | - K Piper
- Department of Neurosurgery (K.P., M.M.), University of Southern Florida College of Public Health, Tampa, Florida
| | - M Mokin
- Department of Neurosurgery (K.P., M.M.), University of Southern Florida College of Public Health, Tampa, Florida
| | - E A Winkler
- Department of Neurological Surgery (E.A.W., A.A.A.), University of California, San Francisco, San Francisco, California
| | - A A Abla
- Department of Neurological Surgery (E.A.W., A.A.A.), University of California, San Francisco, San Francisco, California
| | - C McDougall
- Department of Neurosurgery (C.M., L.B., J.M.), University of Texas Health San Antonio, San Antonio, Texas
| | - L Birnbaum
- Department of Neurosurgery (C.M., L.B., J.M.), University of Texas Health San Antonio, San Antonio, Texas
| | - J Mascitelli
- Department of Neurosurgery (C.M., L.B., J.M.), University of Texas Health San Antonio, San Antonio, Texas
| | - M Litao
- Department of Neurosurgery (M.L., O.T., H.R.), NYU Langone Medical Center, New York, New York
| | - O Tanweer
- From the Department of Neurosurgery (J.-K.B., V.S., A.S., O.T., J.J., S.C., P.K.), Baylor College of Medicine, Houston, Texas.,Department of Neurosurgery (M.L., O.T., H.R.), NYU Langone Medical Center, New York, New York
| | - H Riina
- Department of Neurosurgery (M.L., O.T., H.R.), NYU Langone Medical Center, New York, New York
| | - J Johnson
- From the Department of Neurosurgery (J.-K.B., V.S., A.S., O.T., J.J., S.C., P.K.), Baylor College of Medicine, Houston, Texas
| | - S Chen
- From the Department of Neurosurgery (J.-K.B., V.S., A.S., O.T., J.J., S.C., P.K.), Baylor College of Medicine, Houston, Texas
| | - P Kan
- From the Department of Neurosurgery (J.-K.B., V.S., A.S., O.T., J.J., S.C., P.K.), Baylor College of Medicine, Houston, Texas
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5
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Tsivgoulis G, Goyal N, Katsanos AH, Malhotra K, Ishfaq MF, Pandhi A, Frohler MT, Spiotta AM, Anadani M, Psychogios M, Maus V, Siddiqui A, Waqas M, Schellinger PD, Groen M, Krogias C, Richter D, Saqqur M, Garcia-Bermejo P, Mokin M, Leker R, Cohen JE, Magoufis G, Psychogios K, Lioutas VA, Van Nostrand M, Sharma VK, Paciaroni M, Rentzos A, Shoirah H, Mocco J, Nickele C, Mitsias PD, Inoa V, Hoit D, Elijovich L, Arthur AS, Alexandrov AV. Intravenous thrombolysis for large vessel or distal occlusions presenting with mild stroke severity. Eur J Neurol 2020; 27:1039-1047. [PMID: 32149450 DOI: 10.1111/ene.14199] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 12/27/2019] [Accepted: 02/29/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE We investigated the effectiveness of intravenous thrombolysis (IVT) in acute ischaemic stroke (AIS) patients with large vessel or distal occlusions and mild neurological deficits, defined as National Institutes of Health Stroke Scale scores < 6 points. METHODS The primary efficacy outcome was 3-month functional independence (FI) [modified Rankin Scale (mRS) scores 0-2] that was compared between patients with and without IVT treatment. Other efficacy outcomes of interest included 3-month favorable functional outcome (mRS scores 0-1) and mRS score distribution at discharge and at 3 months. The safety outcomes comprised all-cause 3-month mortality, symptomatic intracranial hemorrhage (ICH), asymptomatic ICH and severe systemic bleeding. RESULTS We evaluated 336 AIS patients with large vessel or distal occlusions and mild stroke severity (mean age 63 ± 15 years, 45% women). Patients treated with IVT (n = 162) had higher FI (85.6% vs. 74.8%, P = 0.027) with lower mRS scores at hospital discharge (P = 0.034) compared with the remaining patients. No differences were detected in any of the safety outcomes including symptomatic ICH, asymptomatic ICH, severe systemic bleeding and 3-month mortality. IVT was associated with higher likelihood of 3-month FI [odds ratio (OR), 2.19; 95% confidence intervals (CI), 1.09-4.42], 3-month favorable functional outcome (OR, 1.99; 95% CI, 1.10-3.57), functional improvement at discharge [common OR (per 1-point decrease in mRS score), 2.94; 95% CI, 1.67-5.26)] and at 3 months (common OR, 1.72; 95% CI, 1.06-2.86) on multivariable logistic regression models adjusting for potential confounders, including mechanical thrombectomy. CONCLUSIONS Intravenous thrombolysis is independently associated with higher odds of improved discharge and 3-month functional outcomes in AIS patients with large vessel or distal occlusions and mild stroke severity. IVT appears not to increase the risk of systemic or symptomatic intracranial bleeding.
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Affiliation(s)
- G Tsivgoulis
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA.,Second Department of Neurology, National and Kapodistrian University of Athens, 'Attikon' University Hospital, Athens, Greece
| | - N Goyal
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Neurosurgery, University of Tennessee Health Science Center, Semmes-Murphey Neurologic and Spine Clinic, Memphis, TN, USA
| | - A H Katsanos
- Second Department of Neurology, National and Kapodistrian University of Athens, 'Attikon' University Hospital, Athens, Greece
| | - K Malhotra
- Charleston Division, Department of Neurology, West Virginia University, Charleston, WV, USA
| | - M F Ishfaq
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - A Pandhi
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - M T Frohler
- Cerebrovascular Program, Vanderbilt University, Nashville, TN, USA
| | - A M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | - M Anadani
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | - M Psychogios
- Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
| | - V Maus
- Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
| | - A Siddiqui
- Departments of Neurosurgery and Radiology, University at Buffalo, Buffalo, NY, USA
| | - M Waqas
- Departments of Neurosurgery and Radiology, University at Buffalo, Buffalo, NY, USA
| | - P D Schellinger
- Department of Neurology and Neurogeriatry, Johannes Wesling Medical Center Minden, University Clinic RUB, Minden, Germany
| | - M Groen
- Department of Neurology and Neurogeriatry, Johannes Wesling Medical Center Minden, University Clinic RUB, Minden, Germany
| | - C Krogias
- Department of Neurology, St Josef-Hospital, Ruhr University of Bochum, Bochum, Germany
| | - D Richter
- Department of Neurology, St Josef-Hospital, Ruhr University of Bochum, Bochum, Germany
| | - M Saqqur
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.,Department of Neurology, Hamad General Hospital, Doha, Qatar
| | - P Garcia-Bermejo
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - M Mokin
- Department of Neurosurgery, University of South Florida, Tampa, FL, USA
| | - R Leker
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - J E Cohen
- Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - G Magoufis
- Acute Stroke Unit, Metropolitan Hospital, Piraeus, Greece
| | - K Psychogios
- Acute Stroke Unit, Metropolitan Hospital, Piraeus, Greece
| | - V A Lioutas
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - M Van Nostrand
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - V K Sharma
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Neurology, National University Hospital, Singapore, Singapore
| | - M Paciaroni
- Stroke Unit, Divisione di Medicina Cardiovascolare, Università di Perugia, Perugia, Italy
| | - A Rentzos
- Department of Interventional and Diagnostic Neuroradiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - H Shoirah
- Department of Neurosurgery, Mount Sinai Medical Center, New York, NY, USA
| | - J Mocco
- Department of Neurosurgery, Mount Sinai Medical Center, New York, NY, USA
| | - C Nickele
- Department of Neurosurgery, University of Tennessee Health Science Center, Semmes-Murphey Neurologic and Spine Clinic, Memphis, TN, USA
| | - P D Mitsias
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA.,Department of Neurology, School of Medicine, University of Crete, Herakleion, Greece
| | - V Inoa
- Department of Neurosurgery, University of Tennessee Health Science Center, Semmes-Murphey Neurologic and Spine Clinic, Memphis, TN, USA
| | - D Hoit
- Department of Neurosurgery, University of Tennessee Health Science Center, Semmes-Murphey Neurologic and Spine Clinic, Memphis, TN, USA
| | - L Elijovich
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Neurosurgery, University of Tennessee Health Science Center, Semmes-Murphey Neurologic and Spine Clinic, Memphis, TN, USA
| | - A S Arthur
- Department of Neurosurgery, University of Tennessee Health Science Center, Semmes-Murphey Neurologic and Spine Clinic, Memphis, TN, USA
| | - A V Alexandrov
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
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6
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Rava RA, Snyder KV, Mokin M, Waqas M, Allman AB, Senko JL, Podgorsak AR, Shiraz Bhurwani MM, Hoi Y, Siddiqui AH, Davies JM, Levy EI, Ionita CN. Assessment of a Bayesian Vitrea CT Perfusion Analysis to Predict Final Infarct and Penumbra Volumes in Patients with Acute Ischemic Stroke: A Comparison with RAPID. AJNR Am J Neuroradiol 2020; 41:206-212. [PMID: 31948951 DOI: 10.3174/ajnr.a6395] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/04/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Brain CTP is used to estimate infarct and penumbra volumes to determine endovascular treatment eligibility for patients with acute ischemic stroke. We aimed to assess the accuracy of a Bayesian CTP algorithm in determining penumbra and final infarct volumes. MATERIALS AND METHODS Data were retrospectively collected for 105 patients with acute ischemic stroke (55 patients with successful recanalization [TICI 2b/2c/3] and large-vessel occlusions and 50 patients without interventions). Final infarct volumes were calculated using DWI and FLAIR 24 hours following CTP imaging. RAPID and the Vitrea Bayesian CTP algorithm (with 3 different settings) predicted infarct and penumbra volumes for comparison with final infarct volumes to assess software performance. Vitrea settings used different combinations of perfusion maps (MTT, TTP, CBV, CBF, delay time) for infarct and penumbra quantification. Patients with and without interventions were included for assessment of predicted infarct and penumbra volumes, respectively. RESULTS RAPID and Vitrea default setting had the most accurate final infarct volume prediction in patients with interventions ([Spearman correlation coefficient, mean infarct difference] default versus FLAIR: [0.77, 4.1 mL], default versus DWI: [0.72, 4.7 mL], RAPID versus FLAIR: [0.75, 7.5 mL], RAPID versus DWI: [0.75, 6.9 mL]). Default Vitrea and RAPID were the most and least accurate in determining final infarct volume for patients without an intervention, respectively (default versus FLAIR: [0.76, -0.4 mL], default versus DWI: [0.71, -2.6 mL], RAPID versus FLAIR: [0.68, -49.3 mL], RAPID versus DWI: [0.65, -51.5 mL]). CONCLUSIONS Compared with RAPID, the Vitrea default setting was noninferior for patients with interventions and superior in penumbra estimation for patients without interventions as indicated by mean infarct differences and correlations with final infarct volumes.
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Affiliation(s)
- R A Rava
- From the Departments of Biomedical Engineering (R.A.R., A.B.A., J.L.S., A.R.P., M.M.S.B., C.N.I.) .,Canon Stroke and Vascular Research Center (R.A.R., K.V.S., M.W., A.B.A., J.L.S., A.R.P., M.M.S.B., A.H.S., J.M.D., E.I.L., C.N.I.), Buffalo, New York
| | - K V Snyder
- Neurosurgery (K.V.S., M.W., A.R.P., A.H.S., J.M.D., E.I.L., C.N.I.).,Canon Stroke and Vascular Research Center (R.A.R., K.V.S., M.W., A.B.A., J.L.S., A.R.P., M.M.S.B., A.H.S., J.M.D., E.I.L., C.N.I.), Buffalo, New York
| | - M Mokin
- Department of Neurosurgery (M.M.), University of South Florida, Tampa, Florida
| | - M Waqas
- Neurosurgery (K.V.S., M.W., A.R.P., A.H.S., J.M.D., E.I.L., C.N.I.).,Canon Stroke and Vascular Research Center (R.A.R., K.V.S., M.W., A.B.A., J.L.S., A.R.P., M.M.S.B., A.H.S., J.M.D., E.I.L., C.N.I.), Buffalo, New York
| | - A B Allman
- From the Departments of Biomedical Engineering (R.A.R., A.B.A., J.L.S., A.R.P., M.M.S.B., C.N.I.).,Canon Stroke and Vascular Research Center (R.A.R., K.V.S., M.W., A.B.A., J.L.S., A.R.P., M.M.S.B., A.H.S., J.M.D., E.I.L., C.N.I.), Buffalo, New York
| | - J L Senko
- From the Departments of Biomedical Engineering (R.A.R., A.B.A., J.L.S., A.R.P., M.M.S.B., C.N.I.).,Canon Stroke and Vascular Research Center (R.A.R., K.V.S., M.W., A.B.A., J.L.S., A.R.P., M.M.S.B., A.H.S., J.M.D., E.I.L., C.N.I.), Buffalo, New York
| | - A R Podgorsak
- From the Departments of Biomedical Engineering (R.A.R., A.B.A., J.L.S., A.R.P., M.M.S.B., C.N.I.).,Neurosurgery (K.V.S., M.W., A.R.P., A.H.S., J.M.D., E.I.L., C.N.I.).,Medical Physics (A.R.P.).,Canon Stroke and Vascular Research Center (R.A.R., K.V.S., M.W., A.B.A., J.L.S., A.R.P., M.M.S.B., A.H.S., J.M.D., E.I.L., C.N.I.), Buffalo, New York
| | - M M Shiraz Bhurwani
- From the Departments of Biomedical Engineering (R.A.R., A.B.A., J.L.S., A.R.P., M.M.S.B., C.N.I.).,Canon Stroke and Vascular Research Center (R.A.R., K.V.S., M.W., A.B.A., J.L.S., A.R.P., M.M.S.B., A.H.S., J.M.D., E.I.L., C.N.I.), Buffalo, New York
| | - Y Hoi
- Canon Medical Systems USA (Y.H.), Tustin, California
| | - A H Siddiqui
- Neurosurgery (K.V.S., M.W., A.R.P., A.H.S., J.M.D., E.I.L., C.N.I.).,Canon Stroke and Vascular Research Center (R.A.R., K.V.S., M.W., A.B.A., J.L.S., A.R.P., M.M.S.B., A.H.S., J.M.D., E.I.L., C.N.I.), Buffalo, New York
| | - J M Davies
- Neurosurgery (K.V.S., M.W., A.R.P., A.H.S., J.M.D., E.I.L., C.N.I.).,Canon Stroke and Vascular Research Center (R.A.R., K.V.S., M.W., A.B.A., J.L.S., A.R.P., M.M.S.B., A.H.S., J.M.D., E.I.L., C.N.I.), Buffalo, New York
| | - E I Levy
- Neurosurgery (K.V.S., M.W., A.R.P., A.H.S., J.M.D., E.I.L., C.N.I.).,Canon Stroke and Vascular Research Center (R.A.R., K.V.S., M.W., A.B.A., J.L.S., A.R.P., M.M.S.B., A.H.S., J.M.D., E.I.L., C.N.I.), Buffalo, New York
| | - C N Ionita
- From the Departments of Biomedical Engineering (R.A.R., A.B.A., J.L.S., A.R.P., M.M.S.B., C.N.I.).,Neurosurgery (K.V.S., M.W., A.R.P., A.H.S., J.M.D., E.I.L., C.N.I.).,Canon Stroke and Vascular Research Center (R.A.R., K.V.S., M.W., A.B.A., J.L.S., A.R.P., M.M.S.B., A.H.S., J.M.D., E.I.L., C.N.I.), Buffalo, New York
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7
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Krebs JM, Shankar A, Setlur Nagesh SV, Davies JM, Snyder KV, Levy EI, Hopkins LN, Mokin M, Bednarek DR, Siddiqui AH, Rudin S. Flow-Pattern Details in an Aneurysm Model Using High-Speed 1000-Frames-per-Second Angiography. AJNR Am J Neuroradiol 2019; 40:1197-1200. [PMID: 31171521 DOI: 10.3174/ajnr.a6090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/25/2019] [Indexed: 11/07/2022]
Abstract
Traditional digital subtraction angiography provides rather limited evaluation of contrast flow dynamics when studying and treating intracranial brain aneurysms. A 1000-frames-per-second photon-counting x-ray detector was used to image detailed iodine-contrast flow patterns in an internal carotid artery aneurysm of a 3D-printed vascular phantom. High-speed imaging revealed differences in vortex and inflow patterns with and without a Pipeline Embolization Device flow diverter in more detail and clarity than could be seen in standard pulsed angiography. Improved temporal imaging has the potential to impact the outcomes of endovascular interventions by allowing clinicians to better understand and act on flow dynamics in real-time.
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Affiliation(s)
- J M Krebs
- From the Canon (formerly Toshiba) Stroke and Vascular Research Center (J.M.K., A.K., S.V.S.N., K.V.S., E.I.L., L.N.H., D.R.B., A.H.S., S.R.)
| | - A Shankar
- From the Canon (formerly Toshiba) Stroke and Vascular Research Center (J.M.K., A.K., S.V.S.N., K.V.S., E.I.L., L.N.H., D.R.B., A.H.S., S.R.)
| | - S V Setlur Nagesh
- From the Canon (formerly Toshiba) Stroke and Vascular Research Center (J.M.K., A.K., S.V.S.N., K.V.S., E.I.L., L.N.H., D.R.B., A.H.S., S.R.).,Departments of Neurosurgery (S.V.S.N., J.M.D., K.V.S., E.I.L., L.N.H., D.R.B., A.H.S., S.R.)
| | - J M Davies
- Department of Neurosurgery (J.M.D., K.V.S., E.I.L., L.N.H., A.H.S., S.R.), Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Departments of Neurosurgery (S.V.S.N., J.M.D., K.V.S., E.I.L., L.N.H., D.R.B., A.H.S., S.R.).,Bioinformatics (J.M.D.).,Jacobs Institute (J.M.D., K.V.S., E.I.L., L.N.H., A.H.S.), Buffalo, New York
| | - K V Snyder
- From the Canon (formerly Toshiba) Stroke and Vascular Research Center (J.M.K., A.K., S.V.S.N., K.V.S., E.I.L., L.N.H., D.R.B., A.H.S., S.R.).,Department of Neurosurgery (J.M.D., K.V.S., E.I.L., L.N.H., A.H.S., S.R.), Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Departments of Neurosurgery (S.V.S.N., J.M.D., K.V.S., E.I.L., L.N.H., D.R.B., A.H.S., S.R.).,Neurology (K.V.S.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York.,Jacobs Institute (J.M.D., K.V.S., E.I.L., L.N.H., A.H.S.), Buffalo, New York
| | - E I Levy
- From the Canon (formerly Toshiba) Stroke and Vascular Research Center (J.M.K., A.K., S.V.S.N., K.V.S., E.I.L., L.N.H., D.R.B., A.H.S., S.R.).,Department of Neurosurgery (J.M.D., K.V.S., E.I.L., L.N.H., A.H.S., S.R.), Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Departments of Neurosurgery (S.V.S.N., J.M.D., K.V.S., E.I.L., L.N.H., D.R.B., A.H.S., S.R.).,Radiology (E.I.L., L.N.H., D.R.B., A.H.S., S.R.).,Jacobs Institute (J.M.D., K.V.S., E.I.L., L.N.H., A.H.S.), Buffalo, New York
| | - L N Hopkins
- From the Canon (formerly Toshiba) Stroke and Vascular Research Center (J.M.K., A.K., S.V.S.N., K.V.S., E.I.L., L.N.H., D.R.B., A.H.S., S.R.).,Department of Neurosurgery (J.M.D., K.V.S., E.I.L., L.N.H., A.H.S., S.R.), Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Departments of Neurosurgery (S.V.S.N., J.M.D., K.V.S., E.I.L., L.N.H., D.R.B., A.H.S., S.R.).,Radiology (E.I.L., L.N.H., D.R.B., A.H.S., S.R.).,Jacobs Institute (J.M.D., K.V.S., E.I.L., L.N.H., A.H.S.), Buffalo, New York
| | - M Mokin
- Department of Neurosurgery and Brain Repair (M.M.), University of South Florida, Tampa, Florida
| | - D R Bednarek
- From the Canon (formerly Toshiba) Stroke and Vascular Research Center (J.M.K., A.K., S.V.S.N., K.V.S., E.I.L., L.N.H., D.R.B., A.H.S., S.R.).,Departments of Neurosurgery (S.V.S.N., J.M.D., K.V.S., E.I.L., L.N.H., D.R.B., A.H.S., S.R.).,Radiology (E.I.L., L.N.H., D.R.B., A.H.S., S.R.)
| | - A H Siddiqui
- From the Canon (formerly Toshiba) Stroke and Vascular Research Center (J.M.K., A.K., S.V.S.N., K.V.S., E.I.L., L.N.H., D.R.B., A.H.S., S.R.).,Department of Neurosurgery (J.M.D., K.V.S., E.I.L., L.N.H., A.H.S., S.R.), Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Departments of Neurosurgery (S.V.S.N., J.M.D., K.V.S., E.I.L., L.N.H., D.R.B., A.H.S., S.R.).,Radiology (E.I.L., L.N.H., D.R.B., A.H.S., S.R.).,Jacobs Institute (J.M.D., K.V.S., E.I.L., L.N.H., A.H.S.), Buffalo, New York
| | - S Rudin
- From the Canon (formerly Toshiba) Stroke and Vascular Research Center (J.M.K., A.K., S.V.S.N., K.V.S., E.I.L., L.N.H., D.R.B., A.H.S., S.R.) .,Departments of Biomedical Engineering (S.R.).,Mechanical and Aerospace Engineering (S.R.).,Electrical Engineering (S.R.), University at Buffalo, State University of New York, Buffalo, New York.,Department of Neurosurgery (J.M.D., K.V.S., E.I.L., L.N.H., A.H.S., S.R.), Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Departments of Neurosurgery (S.V.S.N., J.M.D., K.V.S., E.I.L., L.N.H., D.R.B., A.H.S., S.R.).,Radiology (E.I.L., L.N.H., D.R.B., A.H.S., S.R.)
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8
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Setlur Nagesh SV, Fennel V, Krebs J, Ionita C, Davies J, Bednarek DR, Mokin M, Siddiqui AH, Rudin S. High-Definition Zoom Mode, a High-Resolution X-Ray Microscope for Neurointerventional Treatment Procedures: A Blinded-Rater Clinical-Utility Study. AJNR Am J Neuroradiol 2019; 40:302-308. [PMID: 30591511 DOI: 10.3174/ajnr.a5922] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/12/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Quality of visualization of treatment devices during critical stages of endovascular interventions, can directly impact their safety and efficacy. Our aim was to compare the visualization of neurointerventional procedures and treatment devices using a 194-μm pixel flat panel detector mode and a 76-μm pixel complementary metal oxide semiconductor detector mode (high definition) of a new-generation x-ray detector system using a blinded-rater study. MATERIALS AND METHODS Deployment of flow-diversion devices for the treatment of internal carotid artery aneurysms was performed under flat panel detector and high-definition-mode image guidance in a neurointerventional phantom simulating patient cranium and tissue attenuation, embedded with 3D-printed intracranial vascular models, each with an aneurysm in the ICA segment. Image-sequence pairs of device deployments for each detector mode, under similar exposure and FOV conditions, were evaluated by 2 blinded experienced neurointerventionalists who independently selected their preferred image on the basis of visualization of anatomic features, image noise, and treatment device. They rated their selection as either similar, better, much better, or substantially better than the other choice. Inter- and intrarater agreement was calculated and categorized as poor, moderate, and good. RESULTS Both raters demonstrating good inter- and intrarater agreement selected high-definition-mode images with a frequency of at least 95% each and, on average, rated the high-definition images as much better than flat panel detector images with a frequency of 73% from a total of 60 image pairs. CONCLUSIONS Due to their higher resolution, high-definition-mode images are sharper and visually preferred compared with the flat panel detector images. The improved imaging provided by the high-definition mode can potentially provide an advantage during neurointerventional procedures.
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Affiliation(s)
- S V Setlur Nagesh
- From the Canon (formerly Toshiba) Stroke and Vascular Research Center (S.V.S.N., J.K., C.I., D.R.B., A.H.S., S.R.)
- Departments of Neurosurgery (S.V.S.N., V.F., C.I., J.D., D.R.B., A.H.S.)
| | - V Fennel
- Department of Neurosurgery (V.F., J.D.), Gates Vascular Institute at Kaleida Health, Buffalo, New York
- Departments of Neurosurgery (S.V.S.N., V.F., C.I., J.D., D.R.B., A.H.S.)
| | - J Krebs
- From the Canon (formerly Toshiba) Stroke and Vascular Research Center (S.V.S.N., J.K., C.I., D.R.B., A.H.S., S.R.)
| | - C Ionita
- From the Canon (formerly Toshiba) Stroke and Vascular Research Center (S.V.S.N., J.K., C.I., D.R.B., A.H.S., S.R.)
- Departments of Biomedical Engineering (C.I., S.R.)
- Departments of Neurosurgery (S.V.S.N., V.F., C.I., J.D., D.R.B., A.H.S.)
| | - J Davies
- Department of Neurosurgery (V.F., J.D.), Gates Vascular Institute at Kaleida Health, Buffalo, New York
- Departments of Neurosurgery (S.V.S.N., V.F., C.I., J.D., D.R.B., A.H.S.)
- Bioinformatics (J.D.)
- Jacobs Institute (J.D., A.H.S.), Buffalo, New York
| | - D R Bednarek
- From the Canon (formerly Toshiba) Stroke and Vascular Research Center (S.V.S.N., J.K., C.I., D.R.B., A.H.S., S.R.)
- Departments of Neurosurgery (S.V.S.N., V.F., C.I., J.D., D.R.B., A.H.S.)
- Radiology (D.R.B., A.H.S., S.R.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - M Mokin
- Department of Neurosurgery and Brain Repair (M.M.), University of South Florida, Tampa, Florida
| | - A H Siddiqui
- From the Canon (formerly Toshiba) Stroke and Vascular Research Center (S.V.S.N., J.K., C.I., D.R.B., A.H.S., S.R.)
- Departments of Neurosurgery (S.V.S.N., V.F., C.I., J.D., D.R.B., A.H.S.)
- Radiology (D.R.B., A.H.S., S.R.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
- Jacobs Institute (J.D., A.H.S.), Buffalo, New York
| | - S Rudin
- From the Canon (formerly Toshiba) Stroke and Vascular Research Center (S.V.S.N., J.K., C.I., D.R.B., A.H.S., S.R.)
- Departments of Biomedical Engineering (C.I., S.R.)
- Mechanical and Aerospace Engineering (S.R.)
- Electrical Engineering (S.R.), University at Buffalo, State University of New York; Buffalo, New York
- Radiology (D.R.B., A.H.S., S.R.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
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Mokin M, Gupta R, Guerrero W, Rose D, Burgin W, Sivakanthan S. P-009 ASPECTS Decay during Inter-facility Transfer in Patients with Large Vessel Occlusion Strokes and its Impact on Eligibility for Endovascular Procedures. J Neurointerv Surg 2016. [DOI: 10.1136/neurintsurg-2016-012589.51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Mokin M, Levy E, Siddqui A, Goyal M, Nogueira R, Yavagal D, Pereira V, Saver J. P-010 Association of Clot Burden Score with Radiographic and Clinical Outcomes Following Solitaire Stent Retriever Thrombectomy: Analysis of the SWIFT PRIME Trial. J Neurointerv Surg 2016. [DOI: 10.1136/neurintsurg-2016-012589.52] [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: 11/03/2022]
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Castonguay A, Nogueira R, English J, Satti S, Farid H, Veznedaroglu E, Binning M, Puri A, Vora N, Budzik R, Dabus G, Linfante I, Janardhan V, Alshekhlee A, Abraham M, Edgell R, Taqi M, El Khoury R, Mokin M, Mokin M, Majjhoo A, Kabbani M, Froehler M, Finch I, Ansari S, Novakovic R, Nguyen T, Zaidat O. O-004 Analysis of M2 Occlusions within TREVO Acute Ischemic Stroke (TRACK) stent-retriever Thrombectomy Registry. J Neurointerv Surg 2016. [DOI: 10.1136/neurintsurg-2016-012589.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Zaidat OO, Castonguay A, Haussen D, English J, Farid H, Veznedaroglu E, Binning M, Puri AS, Hou SY, Janardhan V, Vora N, Budzik RF, Alshekhlee A, Abraham MG, Edgell R, Taqi A, Lin E, Khoury R, Mokin M, Majjhoo AQ, Kabbani MR, Froehler MT, Finch I, Prabhakaran S, Novakovic R, Nguyen T, Mehta S, Quadri SA, Ramakrishnan P, Nogueira RG. Abstract WMP8: Results of Trevo Acute Ischemic Stroke Thrombectomy Registry: Predictors of Clinical Outcome. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.wmp8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose:
Recent randomized clinical trial (RCTs) demonstrated efficacy of mechanical thrombectomy using stent-retrievers in acute ischemic stroke (AIS) patients. The main purpose of TRevo ACute Ischemic StroKe (TRACK) stent-retriever thrombectomy multicenter registry is to demonstrate safety and efficacy in real life clinical practice.
Methods:
The investigator-initiated TRACK multicenter registry recruited 24 sites in north America to submit demographic, clinical, site-adjudicated angiographic, and outcome data on consecutive AIS patients treated with Trevo stent-retriever device as the first treatment option. Standard clinical safety (symptomatic intracranial hemorrhage (sICH), and mortality) and efficacy (revascularization and disability) outcomes and predictors of clinical outcome were analyzed.
Results:
624 patients were enrolled in the TRACK registry. Median age was 68 years (range 16-94, 118 (18.1%) >80), male gender was 51.4%, and 67.7% were white. The median National Institutes of Health Stroke Severity Scale (NIHSS) was 17 (IQR 13-22). Transfer cases were 50.6% with IV-rtPA use in 318 cases (51.3%). Median onset to groin puncture (OTG) time was 283 min (IQR 198.5-443), and groin puncture to revascularization was 66 min (IQR 37.5-103). Anterior circulation occlusion was 86.2% (MCA/M2 in 55.2% followed by ICA in 15.9% and M2 in 12.7%). Use of GA was in 389 cases (62.3%), number of passes were ≤ 3 in 92% of the cases (1: 45.2%, 2:28%, and 3:18.7%), 291 (46.7%) had BGC use. Rescue use was seen in 21.7%. Revascularization of ≥ TIMI 2 was 81.8% and ≥ TICI 2b was 70%. The primary outcome of mRS of ≥ 2 was 48.3% in the full cohort, and 50.6% in TREVO-2 like group. sICH and mortality were 7.2%, and 20.1% in the full cohort vs 6.9% and 17.5% in the TREVO-2 like group, respectively. The independent predictors of clinical outcome were lower baseline NIHSS, younger age, use of BGC, successful recanalization, and no general anesthesia (GA).
Conclusions:
The real life clinical practice Trevo registry demonstrated good clinical outcome and high rate of recanalization. Younger age, lower baseline NIHSS, use of balloon guide catheter, successful recanalization, and avoiding endotrachaeal GA independent predictors of good clinical outcome.
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Affiliation(s)
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- Riverside Radiology, Columbus, OH
| | | | | | | | | | | | - E Lin
- St Vincent Mercy Hosp, Toledo, OH
| | | | - M Mokin
- Univ of S Florida, Tampa, FL
| | | | | | | | - I Finch
- John Muir Med Cntr, Walnut Creek, CA
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Zaidat O, Castonguay A, Nogueira R, Ramakrishnan P, Haussen D, Lima A, English J, Farid H, Veznedaroglu E, Binning M, Puri A, Hou S, Janardhan V, Vora N, Budzik R, Alshekhlee A, Abraham M, Edgell R, Taqi M, Lin E, Khoury R, Mokin M, Majjhoo A, Kabbani M, Froehler M, Finch I, Prabhakaran S, Novakovic R, Nguyen T, Wesley J. O-008 final revascularization and clinical outcome results from the multicenter trevo stent-retriever acute stroke (track) post-marketing registry. J Neurointerv Surg 2015. [DOI: 10.1136/neurintsurg-2015-011917.8] [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: 11/04/2022]
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Castonguay A, Zaidat O, Nogueira R, Ramakrishnan P, Haussen D, Lima A, English J, Farid H, Veznedaroglu E, Binning M, Puri A, Hou S, Janardhan V, Vora N, Budzik R, Alshekhlee A, Abraham M, Edgell R, Taqi M, Lin E, Khoury R, Mokin M, Majjhoo A, Kabbani M, Froehler M, Finch I, Prabhakaran S, Novakovic R, Nguyen T. E-055 analysis of a mr clean-like group in the multicenter track registry. J Neurointerv Surg 2015. [DOI: 10.1136/neurintsurg-2015-011917.130] [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: 11/04/2022]
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Russ M, O'Hara R, Setlur Nagesh SV, Mokin M, Jimenez C, Siddiqui A, Bednarek D, Rudin S, Ionita C. Treatment Planning for Image-Guided Neuro-Vascular Interventions Using Patient-Specific 3D Printed Phantoms. Proc SPIE Int Soc Opt Eng 2015; 9417. [PMID: 26778878 DOI: 10.1117/12.2081997] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Minimally invasive endovascular image-guided interventions (EIGIs) are the preferred procedures for treatment of a wide range of vascular disorders. Despite benefits including reduced trauma and recovery time, EIGIs have their own challenges. Remote catheter actuation and challenging anatomical morphology may lead to erroneous endovascular device selections, delays or even complications such as vessel injury. EIGI planning using 3D phantoms would allow interventionists to become familiarized with the patient vessel anatomy by first performing the planned treatment on a phantom under standard operating protocols. In this study the optimal workflow to obtain such phantoms from 3D data for interventionist to practice on prior to an actual procedure was investigated. Patient-specific phantoms and phantoms presenting a wide range of challenging geometries were created. Computed Tomographic Angiography (CTA) data was uploaded into a Vitrea 3D station which allows segmentation and resulting stereo-lithographic files to be exported. The files were uploaded using processing software where preloaded vessel structures were included to create a closed-flow vasculature having structural support. The final file was printed, cleaned, connected to a flow loop and placed in an angiographic room for EIGI practice. Various Circle of Willis and cardiac arterial geometries were used. The phantoms were tested for ischemic stroke treatment, distal catheter navigation, aneurysm stenting and cardiac imaging under angiographic guidance. This method should allow for adjustments to treatment plans to be made before the patient is actually in the procedure room and enabling reduced risk of peri-operative complications or delays.
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Affiliation(s)
- M Russ
- Toshiba Stroke and Vascular Research Center, University of Buffalo, Buffalo, NY
| | - R O'Hara
- Toshiba Stroke and Vascular Research Center, University of Buffalo, Buffalo, NY
| | - S V Setlur Nagesh
- Toshiba Stroke and Vascular Research Center, University of Buffalo, Buffalo, NY
| | - M Mokin
- Toshiba Stroke and Vascular Research Center, University of Buffalo, Buffalo, NY
| | - C Jimenez
- Toshiba Stroke and Vascular Research Center, University of Buffalo, Buffalo, NY; University of Antioquia-GIB-Eafit, Medellin, Colombia
| | - A Siddiqui
- Toshiba Stroke and Vascular Research Center, University of Buffalo, Buffalo, NY
| | - D Bednarek
- Toshiba Stroke and Vascular Research Center, University of Buffalo, Buffalo, NY
| | - S Rudin
- Toshiba Stroke and Vascular Research Center, University of Buffalo, Buffalo, NY
| | - C Ionita
- Toshiba Stroke and Vascular Research Center, University of Buffalo, Buffalo, NY
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Mokin M, Setlur Nagesh SV, Ionita CN, Levy EI, Siddiqui AH. Comparison of modern stroke thrombectomy approaches using an in vitro cerebrovascular occlusion model. AJNR Am J Neuroradiol 2015; 36:547-51. [PMID: 25376809 DOI: 10.3174/ajnr.a4149] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE A new in vitro cerebrovascular occlusion model of the intracranial circulation was developed recently for testing thrombectomy devices. Using this model, we compared recanalization success associated with different modern endovascular thrombectomy approaches. MATERIALS AND METHODS Model experiments were performed in 4 thrombectomy test groups: 1) primary or direct Stentriever thrombectomy with a conventional guide catheter (control group), 2) primary Stentriever thrombectomy with a balloon-guide catheter, 3) combined Stentriever-continuous aspiration approach, and 4) direct aspiration alone. Successful recanalization was defined as a TICI score of 2b or 3. RESULTS Seventy-one thrombectomy experiments were conducted. Similar rates of TICI 2b-3 scores were achieved with balloon-guide and conventional guide catheters (P = .34). The combined Stentriever plus aspiration approach and the primary aspiration thrombectomy resulted in significantly higher rates of TICI 2b or 3 than the conventional guide-catheter approach in the control group (P = .008 and P = .0001, respectively). The primary Stentriever thrombectomy with the conventional guide catheter showed the highest rate of embolization to new territories (53%). CONCLUSIONS Data from our in vitro model experiments show that the Stentriever thrombectomy under continuous aspiration and primary aspiration thrombectomy approaches led to the highest degree of recanalization.
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Affiliation(s)
- M Mokin
- From the Departments of Neurosurgery (M.M., E.I.L., A.H.S.)
| | - S V Setlur Nagesh
- Biomedical Engineering (S.V.S.N., C.N.I.) Electrical Engineering (S.V.S.N.) Mechanical and Aerospace Engineering (S.V.S.N.)
| | - C N Ionita
- Biomedical Engineering (S.V.S.N., C.N.I.) Toshiba Stroke and Vascular Research Center (C.N.I., E.I.L., A.H.S.), University at Buffalo, State University of New York, Buffalo, New York
| | - E I Levy
- From the Departments of Neurosurgery (M.M., E.I.L., A.H.S.) Radiology (E.I.L., A.H.S.) Toshiba Stroke and Vascular Research Center (C.N.I., E.I.L., A.H.S.), University at Buffalo, State University of New York, Buffalo, New York
| | - A H Siddiqui
- From the Departments of Neurosurgery (M.M., E.I.L., A.H.S.) Radiology (E.I.L., A.H.S.) Toshiba Stroke and Vascular Research Center (C.N.I., E.I.L., A.H.S.), University at Buffalo, State University of New York, Buffalo, New York Jacobs Institute (A.H.S.), Buffalo, New York.
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Turk A, Spiotta A, Frei D, Mocco J, Baxter B, Siddiqui A, Mokin M, Dewan M, Turner R, Hawk H, Miranpuri B, Chaudry I. O-002 Initial Clinical Experience with the ADAPT technique: A Direct Aspiration first Pass Technique for Stroke Thrombectomy. J Neurointerv Surg 2013. [DOI: 10.1136/neurintsurg-2013-010870.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mokin M, Dumont T, Veznedaroglu E, Binning M, Liebman K, Fessler R, To CY, Turner R, Turk A, Chaudry I, Arthur A, Fox B, Hanel R, Tawk R, Kan P, Lanzino G, Lopes D, Chen M, Moftakhar R, Billingsley J, Ringer A, Snyder K, Hopkins N, Siddiqui A, Levy E. E-079 Retrospective multicentre analysis of treatment strategies and outcomes with Solitaire FF for acute ischaemic stroke after FDA approval. J Neurointerv Surg 2013. [DOI: 10.1136/neurintsurg-2013-010870.137] [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: 11/04/2022]
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Mokin M, Masud M, Dumont T, Kass-Hout T, Snyder K, Siddiqui A, Levy E. O-028 Outcomes in Patients with Acute Ischaemic Stroke from Proximal Intracranial Vessel Occlusion and NIHSS Score Below 8. J Neurointerv Surg 2013. [DOI: 10.1136/neurintsurg-2013-010870.28] [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: 11/04/2022]
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Mokin M, Kass-Hout T, Kass-Hout O, Dumont T, Kan P, Snyder K, Siddiqui A, Levy E. E-074 Intravenous thrombolysis and endovascular therapy for acute ischemic stroke with internal carotid artery occlusion: a systematic review of clinical outcomes. J Neurointerv Surg 2012. [DOI: 10.1136/neurintsurg-2012-010455c.74] [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: 11/04/2022]
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Kass-Hout T, Kass-Hout O, Mokin M, Al Masry M, Nourollahzadeh E, Siddiqui A, Levy E, Synder K. E-072 Wake up symptomatic stroke in acute brain ischemia (WASSABI) clinical trial. J Neurointerv Surg 2012. [DOI: 10.1136/neurintsurg-2012-010455c.72] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Kass-Hout O, Kass-Hout T, Mokin M, Siddiqui A, Levy E, Synder K. P-045 The role of bridging with intravenous thrombolysis in endovascular therapy of acute ischemic stroke. J Neurointerv Surg 2012. [DOI: 10.1136/neurintsurg-2012-010455b.45] [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: 11/04/2022]
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Kass-Hout T, Kass-Hout O, Al Masry M, Mokin M, Wack D, Nourollahzadeh E, Siddiqui A, Levy E, Synder K. E-071 CT perfusion as a tool to predict the risk of hemorrhagic transformation in ischemic stroke treated with tissue plasminogen activator: a single center experience. J Neurointerv Surg 2012. [DOI: 10.1136/neurintsurg-2012-010455c.71] [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: 11/03/2022]
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Nourollahzadeh E, Kass-Hout O, Mokin M, Aliotta R, Synder K, Siddiqui A, Levy E, Kass-Hout T. P-046 Correlation between recanalization rate and good clinical outcome in acute ischemic stroke, a meta-analysis. J Neurointerv Surg 2012. [DOI: 10.1136/neurintsurg-2012-010455b.46] [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: 11/04/2022]
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Kass-Hout T, Mokin M, Kass-Hout O, Darkhabani M, Orion D, Jahshan S, Yashar P, Levy E, Siddiqui A, Snyder K. P-005 Is bridging with intravenous thrombolysis of any benefit in endovascular therapy of acute ischemic stroke? J Neurointerv Surg 2011. [DOI: 10.1136/neurintsurg-2011-010097.39] [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: 11/04/2022]
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Abstract
The synaptic delivery of GluR4-containing AMPA receptors during in vitro classical conditioning of a neural correlate of an eyeblink response was examined by fluorescence imaging of punctate staining for glutamate receptor subunits and the presynaptic marker synaptophysin. There was a significant increase in GluR4-containing AMPA receptors to synaptic sites after conditioning as determined by colocalization of GluR4 subunit puncta with synaptophysin. Moreover, the trafficking of these receptor subunits requires NMDA receptor activation as it was blocked by D,L-2-amino-5-phosphonovaleric acid (AP-5). In contrast, colocalization of NR1 subunits with synaptophysin was stable regardless of whether the preparations had undergone conditioning or had been treated by AP-5. The enhanced colocalization of GluR4 and synaptophysin was accompanied by an increase in both the total number and size of puncta for both proteins, suggesting greater synthesis and aggregation during conditioning. Western blot analysis confirmed upregulation of synaptophysin and GluR4 following conditioning. These data support the hypothesis that GluR4-containing AMPA receptors are delivered to synaptic sites during conditioning. Further, they suggest coordinate presynaptic and postsynaptic modifications during in vitro classical conditioning.
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Affiliation(s)
- M Mokin
- Neuroscience Group, Division of Basic Biomedical Sciences, University of South Dakota School of Medicine, 414 East Clark Street, Vermillion 57069, USA
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