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Vranic JE, Dmytriw AA, Berglar IK, Alotaibi NM, Cancelliere NM, Stapleton CJ, Rabinov JD, Harker P, Gupta R, Bernstock JD, Koch MJ, Raymond SB, Mascitelli JR, Patterson TT, Seinfeld J, White A, Case D, Roark C, Gandhi CD, Al-Mufti F, Cooper J, Matouk C, Sujijantarat N, Devia DA, Ocampo-Navia MI, Villamizar-Torres DE, Puentes JC, Salem MM, Baig A, El Namaani K, Kühn AL, Pukenas B, Jankowitz BT, Burkhardt JK, Siddiqui A, Jabbour P, Singh J, Puri AS, Regenhardt RW, Mendes Pereira V, Patel AB. The Impact of Preprocedural Platelet Function Testing on Periprocedural Complication Rates Associated With Pipeline Flow Diversion: An International Multicenter Study. Neurosurgery 2024:00006123-990000000-01127. [PMID: 38634693 DOI: 10.1227/neu.0000000000002956] [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] [Received: 08/27/2023] [Accepted: 02/20/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Dual antiplatelet therapy (DAPT) is necessary to minimize the risk of periprocedural thromboembolic complications associated with aneurysm embolization using pipeline embolization device (PED). We aimed to assess the impact of platelet function testing (PFT) on reducing periprocedural thromboembolic complications associated with PED flow diversion in patients receiving aspirin and clopidogrel. METHODS Patients with unruptured intracranial aneurysms requiring PED flow diversion were identified from 13 centers for retrospective evaluation. Clinical variables including the results of PFT before treatment, periprocedural DAPT regimen, and intracranial complications occurring within 72 h of embolization were identified. Complication rates were compared between PFT and non-PFT groups. Differences between groups were tested for statistical significance using the Wilcoxon rank sum, Fisher exact, or χ 2 tests. A P -value <.05 was statistically significant. RESULTS 580 patients underwent PED embolization with 262 patients dichotomized to the PFT group and 318 patients to the non-PFT group. 13.7% of PFT group patients were clopidogrel nonresponders requiring changes in their pre-embolization DAPT regimen. Five percentage of PFT group [2.8%, 8.5%] patients experienced thromboembolic complications vs 1.6% of patients in the non-PFT group [0.6%, 3.8%] ( P = .019). Two (15.4%) PFT group patients with thromboembolic complications experienced permanent neurological disability vs 4 (80%) non-PFT group patients. 3.7% of PFT group patients [1.5%, 8.2%] and 3.5% [1.8%, 6.3%] of non-PFT group patients experienced hemorrhagic intracranial complications ( P > .9). CONCLUSION Preprocedural PFT before PED treatment of intracranial aneurysms in patients premedicated with an aspirin and clopidogrel DAPT regimen may not be necessary to significantly reduce the risk of procedure-related intracranial complications.
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Affiliation(s)
- Justin E Vranic
- Neuroendovascular Program, Departments of Radiology, Neurosurgery and Neurology, Massachusetts General Hospital, Harvard Medical School, BostonMassachusetts , USA
| | - Adam A Dmytriw
- Neuroendovascular Program, Departments of Radiology, Neurosurgery and Neurology, Massachusetts General Hospital, Harvard Medical School, BostonMassachusetts , USA
- Neurovascular Centre, Departments of Medical Imaging & Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto , Ontario , USA
| | - Inka K Berglar
- Neuroendovascular Program, Departments of Radiology, Neurosurgery and Neurology, Massachusetts General Hospital, Harvard Medical School, BostonMassachusetts , USA
| | - Naif M Alotaibi
- Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh , Saudi Arabia
| | - Nicole M Cancelliere
- Neurovascular Centre, Departments of Medical Imaging & Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto , Ontario , USA
| | - Christopher J Stapleton
- Neuroendovascular Program, Departments of Radiology, Neurosurgery and Neurology, Massachusetts General Hospital, Harvard Medical School, BostonMassachusetts , USA
| | - James D Rabinov
- Neuroendovascular Program, Departments of Radiology, Neurosurgery and Neurology, Massachusetts General Hospital, Harvard Medical School, BostonMassachusetts , USA
| | - Pablo Harker
- Departments of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati , Ohio , USA
| | - Rajiv Gupta
- Neuroendovascular Program, Departments of Radiology, Neurosurgery and Neurology, Massachusetts General Hospital, Harvard Medical School, BostonMassachusetts , USA
| | - Joshua D Bernstock
- Neuroendovascular Program, Departments of Radiology, Neurosurgery and Neurology, Massachusetts General Hospital, Harvard Medical School, BostonMassachusetts , USA
| | - Matthew J Koch
- Department of Neurosurgery, University of Florida, Gainesville , Florida , USA
| | - Scott B Raymond
- Department of Radiology, University of Vermont Medical Center, Burlington , Vermont , USA
| | - Justin R Mascitelli
- Department of Neurosurgery, University of Texas Health Science Center at San Antonio, Long School of Medicine, San Antonio , Texas , USA
| | - T Tyler Patterson
- Department of Neurosurgery, University of Texas Health Science Center at San Antonio, Long School of Medicine, San Antonio , Texas , USA
| | - Joshua Seinfeld
- Department of Neurosurgery, University of Colorado, Denver , Colorado , USA
| | - Andrew White
- Department of Neurosurgery, University of Colorado, Denver , Colorado , USA
| | - David Case
- Department of Neurosurgery, University of Colorado, Denver , Colorado , USA
| | - Christopher Roark
- Department of Neurosurgery, University of Colorado, Denver , Colorado , USA
| | - Chirag D Gandhi
- Departments of Neurosurgery and Neurology, Westchester Medical Center, Valhalla , New York , USA
| | - Fawaz Al-Mufti
- Departments of Neurosurgery and Neurology, Westchester Medical Center, Valhalla , New York , USA
| | - Jared Cooper
- Departments of Neurosurgery and Neurology, Westchester Medical Center, Valhalla , New York , USA
| | - Charles Matouk
- Department of Neurosurgery, Yale School of Medicine, New Haven , Connecticut , USA
| | | | - Diego A Devia
- Departments of Radiology & Neurosurgery, Hospital Universitario San Ignacio, Bogotá , Colombia
| | - Maria I Ocampo-Navia
- Departments of Radiology & Neurosurgery, Hospital Universitario San Ignacio, Bogotá , Colombia
| | | | - Juan C Puentes
- Departments of Radiology & Neurosurgery, Hospital Universitario San Ignacio, Bogotá , Colombia
| | - Mohamed M Salem
- Department of Radiology & Neurosurgery, University of Pennsylvania School of Medicine, Pennsylvania , Pennsylvania , USA
| | - Ammad Baig
- Department of Neurosurgery, State University of New York at Buffalo, Buffalo , New York , USA
| | - Kareem El Namaani
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
| | - Anna Luisa Kühn
- Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester , Massachusetts , USA
| | - Bryan Pukenas
- Department of Radiology & Neurosurgery, University of Pennsylvania School of Medicine, Pennsylvania , Pennsylvania , USA
| | - Brian T Jankowitz
- Department of Radiology & Neurosurgery, University of Pennsylvania School of Medicine, Pennsylvania , Pennsylvania , USA
| | - Jan Karl Burkhardt
- Department of Radiology & Neurosurgery, University of Pennsylvania School of Medicine, Pennsylvania , Pennsylvania , USA
| | - Adnan Siddiqui
- Department of Neurosurgery, State University of New York at Buffalo, Buffalo , New York , USA
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
| | - Jasmeet Singh
- Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester , Massachusetts , USA
| | - Ajit S Puri
- Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester , Massachusetts , USA
| | - Robert W Regenhardt
- Neuroendovascular Program, Departments of Radiology, Neurosurgery and Neurology, Massachusetts General Hospital, Harvard Medical School, BostonMassachusetts , USA
| | - Vitor Mendes Pereira
- Neurovascular Centre, Departments of Medical Imaging & Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto , Ontario , USA
| | - Aman B Patel
- Neuroendovascular Program, Departments of Radiology, Neurosurgery and Neurology, Massachusetts General Hospital, Harvard Medical School, BostonMassachusetts , USA
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2
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Salem MM, Kelmer P, Sioutas GS, Ostmeier S, Hoang A, Cortez G, El Naamani K, Abbas R, Hanel R, Tanweer O, Srinivasan VM, Jabbour P, Kan P, Jankowitz BT, Heit JJ, Burkhardt JK. Multicenter US clinical experience with the Scepter Mini balloon catheter. Interv Neuroradiol 2024:15910199241246135. [PMID: 38613371 DOI: 10.1177/15910199241246135] [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: 04/14/2024] Open
Abstract
INTRODUCTION Distal navigability and imprecise delivery of embolic agents are two limitations encountered during liquid embolization of cerebrospinal lesions. The dual-lumen Scepter Mini balloon (SMB) microcatheter was introduced to overcome these conventional microcatheters' limitations with few small single-center reports suggesting favorable results. METHODS A series of consecutive patients undergoing SMB-assisted endovascular embolization were extracted from prospectively maintained registries in seven North-American centers (November 2019 to September 2022). RESULTS Fifty-four patients undergoing 55 embolization procedures utilizing SMB were included (median age 58.5; 48.1% females). Cranial dural arteriovenous fistula embolization was the most common indication (54.5%) followed by cranial arteriovenous malformation (27.3%). Staged/pre-operative embolization was done in 36.4% of cases; and 83.6% of procedures using Onyx-18. Most procedures utilized a transarterial approach (89.1%), and SMB-induced arterial-flow arrest concurrently with transvenous embolization was used in 10.9% of procedures. Femoral access/triaxial setups were utilized in the majority of procedures (65.5% and 60%, respectively). The median vessel diameter where the balloon was inflated of 1.8 mm, with a median of 1.5 cc of injected embolic material per procedure. Technical failures occurred in 5.5% of cases requiring aborting/replacement with other devices without clinical sequelae in any of the patients, with SMB-related procedural complications of 3.6% without clinical sequelae. Radiographic imaging follow-up was available in 76.9% of the patients (median follow-up 3.8 months), with complete occlusion (100%) or >50% occlusion in 92.5% of the cases, and unplanned retreatments in 1.8%. CONCLUSION The SMB microcatheter is a useful new adjunctive device for balloon-assisted embolization of cerebrospinal lesions with a high technical success rate, favorable outcomes, and a reasonable safety profile.
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Affiliation(s)
- Mohamed M Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Paz Kelmer
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Georgios S Sioutas
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Sophie Ostmeier
- Department of Radiology and Neurosurgery, Stanford University, Stanford, CA, USA
| | - Alex Hoang
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Gustavo Cortez
- Department of Cerebrovascular and Endovascular Surgery, Baptist Neurological Institute and Lyerly Neurosurgery, Jacksonville, FL, USA
| | - Kareem El Naamani
- Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Rawad Abbas
- Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Ricardo Hanel
- Department of Cerebrovascular and Endovascular Surgery, Baptist Neurological Institute and Lyerly Neurosurgery, Jacksonville, FL, USA
| | - Omar Tanweer
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Peter Kan
- Department of Neurosurgery, University of Texas Medical Branch Galveston, Galveston, TX, USA
| | - Brian T Jankowitz
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Jeremy J Heit
- Department of Radiology and Neurosurgery, Stanford University, Stanford, CA, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
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3
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Sioutas GS, Shekhtman O, Dagli MM, Salem MM, Ajmera S, Kandregula S, Burkhardt JK, Srinivasan VM, Jankowitz BT. Middle meningeal artery patency after surgical evacuation for chronic subdural hematoma. Neurosurg Rev 2024; 47:145. [PMID: 38594307 DOI: 10.1007/s10143-024-02383-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/27/2024] [Accepted: 03/30/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Chronic subdural hematoma (CSDH) often requires surgical evacuation, but recurrence rates remain high. Middle meningeal artery (MMA) embolization (MMAE) has been proposed as an alternative or adjunct treatment. There is concern that prior surgery might limit patency, access, penetration, and efficacy of MMAE, such that some recent trials excluded patients with prior craniotomy. However, the impact of prior open surgery on MMA patency has not been studied. METHODS A retrospective analysis was conducted on patients who underwent MMAE for cSDH (2019-2022), after prior surgical evacuation or not. MMA patency was assessed using a six-point grading scale. RESULTS Of the 109 MMAEs (84 patients, median age 72 years, 20.2% females), 58.7% were upfront MMAEs, while 41.3% were after prior surgery (20 craniotomies, 25 burr holes). Median hematoma thickness was 14 mm and midline shift 3 mm. Hematoma thickness reduction, surgical rescue, and functional outcome did not differ between MMAE subgroups and were not affected by MMA patency or total area of craniotomy or burr-holes. MMA patency was reduced in the craniotomy group only, specifically in the distal portion of the anterior division (p = 0.005), and correlated with craniotomy area (p < 0.001). CONCLUSION MMA remains relatively patent after burr-hole evacuation of cSDH, while craniotomy typically only affects the frontal-distal division. However, MMA patency, evacuation method, and total area do not affect outcomes. These findings support the use of MMAE regardless of prior surgery and may influence future trial inclusion/exclusion criteria. Further studies are needed to optimize the timing and techniques for MMAE in cSDH management.
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Affiliation(s)
- Georgios S Sioutas
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Oleg Shekhtman
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mert Marcel Dagli
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mohamed M Salem
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sonia Ajmera
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sandeep Kandregula
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Brian T Jankowitz
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Salah WK, Findlay MC, Baker CM, Scoville JP, Bounajem MT, Ogilvy CS, Moore JM, Riina HA, Levy EI, Siddiqui AH, Spiotta AM, Cawley CM, Khalessi AA, Tanweer O, Hanel R, Gross BA, Kuybu O, Howard BM, Hoang AN, Baig AA, Khorasanizadeh M, Mendez Ruiz AA, Cortez G, Davies JM, Lang MJ, Thomas AJ, Tonetti DA, Khalife J, Sioutas GS, Carroll K, Abecassis ZA, Jankowitz BT, Ruiz Rodriguez J, Levitt MR, Kan PT, Burkhardt JK, Srinivasan V, Salem MM, Grandhi R. The Influence of Coagulopathy on Radiographic and Clinical Outcomes in Patients Undergoing Middle Meningeal Artery Embolization as Standalone Treatment for Non-acute Subdural Hematomas. J Neurotrauma 2024. [PMID: 38481125 DOI: 10.1089/neu.2023.0413] [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: 04/11/2024] Open
Abstract
Middle meningeal artery embolization (MMAE) is emerging as a safe and effective standalone intervention for non-acute subdural hematomas (NASHs); however, the risk of hematoma recurrence after MMAE in coagulopathic patients is unclear. To characterize the impact of coagulopathy on treatment outcomes, we analyzed a multi-institutional database of patients who underwent standalone MMAE as treatment for NASH. We classified 537 patients who underwent MMAE as a standalone intervention between 2019 and 2023 by coagulopathy status. Coagulopathy was defined as use of anticoagulation/antiplatelet agents or pre-operative thrombocytopenia (platelets <100,000/μL). Demographics, pre-procedural characteristics, in-hospital course, and patient outcomes were collected. Thrombocytopenia, aspirin use, antiplatelet agent use, and anticoagulant use were assessed using univariate and multivariate analyses to identify any characteristics associated with the need for rescue surgical intervention, mortality, adverse events, and modified Rankin Scale score at 90-day follow-up. Propensity score-matched cohorts by coagulopathy status with matching covariates adjusting for risk factors implicated in surgical recurrence were evaluated by univariate and multivariate analyses. Minimal differences in pre-operative characteristics between patients with and those without coagulopathy were observed. On unmatched and matched analyses, patients with coagulopathy had higher rates of requiring subsequent surgery than those without (unmatched: 9.9% vs. 4.3%; matched: 12.6% vs. 4.6%; both p < 0.05). On matched multivariable analysis, patients with coagulopathy had an increased odds ratio (OR) of requiring surgical rescue (OR 3.95; 95% confidence interval [CI] 1.68-9.30; p < 0.01). Antiplatelet agent use (ticagrelor, prasugrel, or clopidogrel) was also predictive of surgical rescue (OR 4.38; 95% CI 1.51-12.72; p = 0.01), and patients with thrombocytopenia had significantly increased odds of in-hospital mortality (OR 5.16; 95% CI 2.38-11.20; p < 0.01). There were no differences in follow-up radiographic and other clinical outcomes in patients with and those without coagulopathy. Patients with coagulopathy undergoing standalone MMAE for treatment of NASH may have greater risk of requiring surgical rescue (particularly in patients using antiplatelet agents), and in-hospital mortality (in thrombocytopenic patients).
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Affiliation(s)
- Walid K Salah
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | | | - Cordell M Baker
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Jonathan P Scoville
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Michael T Bounajem
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Christopher S Ogilvy
- Department of Neurological Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Justin M Moore
- Department of Neurological Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Howard A Riina
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
| | - Elad I Levy
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - C Michael Cawley
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Alexander A Khalessi
- Department of Neurological Surgery, University of California San Diego, La Jolla, California, USA
| | - Omar Tanweer
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Ricardo Hanel
- Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
| | - Bradley A Gross
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Okkes Kuybu
- Department of Neurosurgery, Penn Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brian M Howard
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Alex N Hoang
- Department of Neurosurgery, Houston Methodist, Houston, Texas, USA
| | - Ammad A Baig
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA
| | | | - Aldo A Mendez Ruiz
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Gustavo Cortez
- Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
| | - Jason M Davies
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA
| | - Michael J Lang
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ajith J Thomas
- Department of Neurosurgery, Cooper University Healthcare, Camden, New Jersey, USA
| | - Daniel A Tonetti
- Department of Neurosurgery, Cooper University Healthcare, Camden, New Jersey, USA
| | - Jane Khalife
- Department of Neurosurgery, Cooper University Healthcare, Camden, New Jersey, USA
| | - Georgios S Sioutas
- Department of Neurosurgery, Penn Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kate Carroll
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Zachary A Abecassis
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Brian T Jankowitz
- Department of Neurosurgery, Penn Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Juan Ruiz Rodriguez
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Michael R Levitt
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Peter T Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Penn Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Visish Srinivasan
- Department of Neurosurgery, Penn Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mohamed M Salem
- Department of Neurosurgery, Penn Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ramesh Grandhi
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
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5
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Zhang Y, Gao C, Luo J, Khan A, Salem‐Bekhit MM, Salem MM, Qi Z, Jiang B. Deciphering the role of wound healing genes in skin cutaneous melanoma: Insights into expression, methylation, mutations, and therapeutic implications. Int Wound J 2024; 21:e14807. [PMID: 38591163 PMCID: PMC11002634 DOI: 10.1111/iwj.14807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 04/10/2024] Open
Abstract
Skin Cutaneous Melanoma (SKCM) is a form of cancer that originates in the pigment-producing cells, known as melanocytes, of the skin. Delay wound healing is often correlated with the occurrence of and progression of SKCM. In this comprehensive study, we investigated the intricate roles of two important wound healing genes in SKCM, including Matrix Metalloproteinase-2 (MMP2) and Matrix Metalloproteinase-9 (MMP9). Through a multi-faceted approach, we collected clinical samples, conducted molecular experiments, including RT-qPCR, bisulphite sequencing, cell culture, cell Counting Kit-8, colony formation, and wound healing assays. Beside this, we also used various other databases/tools/approaches for additional analysis including, UALCAN, GEPIA, HPA, MEXPRESS, cBioPortal, KM plotter, DrugBank, and molecular docking. Our results revealed a significant up-regulation of MMP2 and MMP9 in SKCM tissues compared to normal counterparts. Moreover, promoter methylation analysis suggested an epigenetic regulatory mechanism. Validations using TCGA datasets and immunohistochemistry emphasized the clinical relevance of MMP2 and MMP9 dysregulation. Functional assays demonstrated their synergistic impact on proliferation and migration in SKCM cells. Furthermore, we identified potential therapeutic candidates, Estradiol and Calcitriol, through drug prediction and molecular docking analyses. These compounds exhibited binding affinities, suggesting their potential as MMP2/MMP9 inhibitors. Overall, our study elucidates the diagnostic, prognostic, and therapeutic implications of MMP2 and MMP9 in SKCM, shedding light on their complex interplay in SKCM occurrence and progression.
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Affiliation(s)
- Yulong Zhang
- Department of Traditional Chinese Medicine Oncology, Cancer CenterThe Fifth Affiliated Hospital of Sun Yat‐sen UniversityZhuhaiChina
| | - Chenxi Gao
- Department of Traditional Chinese Medicine Oncology, Cancer CenterThe Fifth Affiliated Hospital of Sun Yat‐sen UniversityZhuhaiChina
| | - Juncong Luo
- Department of OncologyThe Fifth Affiliated Hospital of Sun Yat‐sen UniversityZhuhaiChina
| | - Arsalan Khan
- Health DepartmentGovernment of Khyber PakhtunkhwaDera Ismail KhanPakistan
| | | | - Mohamed M. Salem
- College of MedicineHuazhong University of Science and TechnologyWuhanChina
| | - Zeng Qi
- Department of Traditional Chinese Medicine Oncology, Cancer CenterThe Fifth Affiliated Hospital of Sun Yat‐sen UniversityZhuhaiChina
| | - Bo Jiang
- Emergency DepartmentThe Fifth Affiliated Hospital of Sun Yat‐sen UniversityZhuhaiChina
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6
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Diestro JDB, Dibas M, Adeeb N, Regenhardt RW, Vranic JE, Guenego A, Lay SV, Renieri L, Balushi AA, Shotar E, Premat K, Namaani KE, Saliou G, Möhlenbruch MA, Lylyk I, Foreman PM, Vachhani JA, Župančić V, Hafeez MU, Rutledge C, Rai H, Tutino VM, Mirshahi S, Ghozy S, Harker P, Alotaibi NM, Rabinov JD, Ren Y, Schirmer CM, Goren O, Piano M, Kühn AL, Michelozzi C, Elens S, Starke RM, Hassan AE, Salehani A, Nguyen A, Jones J, Psychogios M, Spears J, Marotta T, Pereira V, Parra-Fariñas C, Bres-Bullrich M, Mayich M, Salem MM, Burkhardt JK, Jankowitz BT, Domingo RA, Huynh T, Tawk R, Ulfert C, Lubicz B, Panni P, Puri AS, Pero G, Griessenauer CJ, Asadi H, Siddiqui A, Ducruet AF, Albuquerque FC, Patel N, Kan P, Kalousek V, Lylyk P, Boddu S, Stapleton CJ, Knopman J, Jabbour P, Tjoumakaris S, Clarençon F, Limbucci N, Aziz-Sultan MA, Cuellar-Saenz HH, Cognard C, Patel AB, Dmytriw AA. Stent-assisted Woven EndoBridge device for the treatment of intracranial aneurysms: an international multicenter study. J Neurosurg 2024; 140:1071-1079. [PMID: 37862717 DOI: 10.3171/2023.8.jns235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 08/14/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVE The Woven EndoBridge (WEB) device is an intrasaccular flow disruptor designed for wide-necked bifurcation aneurysms. These aneurysms may require the use of a concomitant stent. The objective of this study was to determine the clinical and radiological outcomes of patients undergoing stent-assisted WEB treatment. In addition, the authors also sought to determine the predictors of a concomitant stent in aneurysms treated with the WEB device. METHODS The data for this study were taken from the WorldWideWEB Consortium, an international multicenter cohort including patients treated with the WEB device. Aneurysms were classified into two groups based on treatment: stent-assisted WEB and WEB device alone. The authors compared clinical and radiological outcomes of both groups. Univariable and multivariable binary logistic regression analyses were performed to determine factors that predispose to stent use. RESULTS The study included 691 intracranial aneurysms (31 with stents and 660 without stents) treated with the WEB device. The adequate occlusion status did not differ between the two groups at the latest follow-up (83.3% vs 85.6%, p = 0.915). Patients who underwent stenting had more thromboembolic (32.3% vs 6.5%, p < 0.001) and procedural (16.1% vs 3.0%, p < 0.001) complications. Aneurysms treated with a concomitant stent had wider necks, greater heights, and lower dome-to-neck ratios. Increasing neck size was the only significant predictor for stent use. CONCLUSIONS This study demonstrates that there is no difference in the degree of aneurysm occlusion between the two groups; however, complications were more frequent in the stent group. In addition, a wider aneurysm neck predisposes to stent assistance in WEB-treated aneurysms.
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Affiliation(s)
- Jose Danilo Bengzon Diestro
- 1Department of Radiology, Division of Diagnostic and Therapeutic Neuroradiology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Mahmoud Dibas
- 2Neuroradiology & Neurointervention Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nimer Adeeb
- 3Department of Neurosurgery and Neurointerventional Surgery, Louisiana State University, Shreveport, Louisiana
| | - Robert W Regenhardt
- 4Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Justin E Vranic
- 4Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Adrien Guenego
- 5Interventional Neuroradiology Department, Erasmus University Hospital, Brussels, Belgium
| | - Sovann V Lay
- 6Diagnostic and Therapeutic Neuroradiology Department, Toulouse Hospital Center, Purpan Hospital, Toulouse, France
| | - Leonardo Renieri
- 7Neurovascular Intervention, Careggi Hospital of Florence, Florence, Italy
| | - Ali Al Balushi
- 8Neurosurgery & Interventional Neuroradiology, NewYork-Presbyterian Hospital, Weill Cornell School of Medicine, New York, New York
| | - Eimad Shotar
- 9Department of Interventional Neuroradiology, Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, Paris, France
| | - Kévin Premat
- 9Department of Interventional Neuroradiology, Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, Paris, France
| | - Kareem El Namaani
- 10Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Guillaume Saliou
- 11Department of diagnostic Radiology and Interventional Radiology, Vaudois Hospital Center of Lausanne, Lausanne, Switzerland
| | - Markus A Möhlenbruch
- 12Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Ivan Lylyk
- 13Endovascular Neurosurgery and Interventional Radiology Team, La Sagrada Familia Clinic, Buenos Aires, Argentina
| | - Paul M Foreman
- 14Neurosurgery Department, Orlando Health Neuroscience and Rehabilitation Institute, Orlando, Florida
| | - Jay A Vachhani
- 14Neurosurgery Department, Orlando Health Neuroscience and Rehabilitation Institute, Orlando, Florida
| | - Vedran Župančić
- 15Department of Radiology, Subdivision of Interventional Neuroradiology, Clinical Hospital Center "Sisters of Mercy", Zagreb, Croatia
| | - Muhammad U Hafeez
- 16Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, Texas
| | - Caleb Rutledge
- 17Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Hamid Rai
- 18Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York
| | - Vincent M Tutino
- 18Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York
| | - Shervin Mirshahi
- 2Neuroradiology & Neurointervention Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sherief Ghozy
- 19Department of Neuroradiology, Mayo Clinic, Rochester, Minnesota
| | - Pablo Harker
- 4Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Naif M Alotaibi
- 4Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - James D Rabinov
- 4Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Yifan Ren
- 20Department of Radiology, Interventional Radiology and Neurointerventional Services, Austin Health, Melbourne, Australia
| | | | - Oded Goren
- 22Department of Neurosurgery, Geisinger, Danville, Pennsylvania
| | - Mariangela Piano
- 23Neuroradiology, ASST Great Metropolitan Hospital, Niguarda, Milan, Italy
| | - Anna L Kühn
- 24Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester, Massachusetts
| | | | - Stéphanie Elens
- 5Interventional Neuroradiology Department, Erasmus University Hospital, Brussels, Belgium
| | | | - Ameer E Hassan
- 27Department of Neuroscience, Valley Baptist Neuroscience Institute, Harlingen, Texas
| | - Arsalaan Salehani
- 28Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - Anh Nguyen
- 29Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Switzerland
| | - Jesse Jones
- 28Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - Marios Psychogios
- 29Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Switzerland
| | - Julian Spears
- 1Department of Radiology, Division of Diagnostic and Therapeutic Neuroradiology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Thomas Marotta
- 1Department of Radiology, Division of Diagnostic and Therapeutic Neuroradiology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Vitor Pereira
- 1Department of Radiology, Division of Diagnostic and Therapeutic Neuroradiology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Carmen Parra-Fariñas
- 1Department of Radiology, Division of Diagnostic and Therapeutic Neuroradiology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Maria Bres-Bullrich
- 30Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Michael Mayich
- 31Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Mohamed M Salem
- 32Department of Neurosurgery, University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania
| | - Jan-Karl Burkhardt
- 32Department of Neurosurgery, University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania
| | - Brian T Jankowitz
- 32Department of Neurosurgery, University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania
| | - Ricardo A Domingo
- 33Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Thien Huynh
- 33Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Rabih Tawk
- 33Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Christian Ulfert
- 12Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Boris Lubicz
- 5Interventional Neuroradiology Department, Erasmus University Hospital, Brussels, Belgium
| | - Pietro Panni
- 25Neurovascular Intervention, San Raffaele Hospital, Milan, Italy
| | - Ajit S Puri
- 24Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester, Massachusetts
| | - Guglielmo Pero
- 34Neurovascular Intervention, Niguarda Cà Granda Hospital, Milano, Italy
| | - Christoph J Griessenauer
- 35Department of Neurosurgery, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria; and
- 36Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Hamed Asadi
- 20Department of Radiology, Interventional Radiology and Neurointerventional Services, Austin Health, Melbourne, Australia
| | - Adnan Siddiqui
- 18Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York
| | - Andrew F Ducruet
- 17Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | | | - Nirav Patel
- 2Neuroradiology & Neurointervention Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Peter Kan
- 16Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, Texas
| | - Vladimir Kalousek
- 15Department of Radiology, Subdivision of Interventional Neuroradiology, Clinical Hospital Center "Sisters of Mercy", Zagreb, Croatia
| | - Pedro Lylyk
- 13Endovascular Neurosurgery and Interventional Radiology Team, La Sagrada Familia Clinic, Buenos Aires, Argentina
| | - Srikanth Boddu
- 8Neurosurgery & Interventional Neuroradiology, NewYork-Presbyterian Hospital, Weill Cornell School of Medicine, New York, New York
| | - Christopher J Stapleton
- 4Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Jared Knopman
- 8Neurosurgery & Interventional Neuroradiology, NewYork-Presbyterian Hospital, Weill Cornell School of Medicine, New York, New York
| | - Pascal Jabbour
- 10Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Frédéric Clarençon
- 9Department of Interventional Neuroradiology, Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, Paris, France
| | - Nicola Limbucci
- 7Neurovascular Intervention, Careggi Hospital of Florence, Florence, Italy
| | - Mohammad A Aziz-Sultan
- 2Neuroradiology & Neurointervention Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hugo H Cuellar-Saenz
- 3Department of Neurosurgery and Neurointerventional Surgery, Louisiana State University, Shreveport, Louisiana
| | - Christophe Cognard
- 6Diagnostic and Therapeutic Neuroradiology Department, Toulouse Hospital Center, Purpan Hospital, Toulouse, France
| | - Aman B Patel
- 4Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Adam A Dmytriw
- 2Neuroradiology & Neurointervention Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- 4Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
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7
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Dmytriw AA, Salim H, Musmar B, Aslan A, Cancelliere NM, McLellan RM, Algin O, Ghozy S, Dibas M, Lay SV, Guenego A, Renieri L, Carnevale J, Saliou G, Mastorakos P, Naamani KE, Shotar E, Premat K, Möhlenbruch M, Kral M, Doron O, Chung C, Salem MM, Lylyk I, Foreman PM, Vachhani JA, Shaikh H, Župančić V, Hafeez MU, Catapano J, Waqas M, Tutino VM, Ibrahim MK, Mohammed MA, Imamoglu C, Bayrak A, Rabinov JD, Ren Y, Schirmer CM, Piano M, Kühn AL, Michelozzi C, Elens S, Starke RM, Hassan AE, Ogilvie M, Sporns P, Jones J, Brinjikji W, Nawka MT, Psychogios M, Ulfert C, Diestro JDB, Pukenas B, Burkhardt JK, Huynh T, Martinez-Gutierrez JC, Essibayi MA, Sheth SA, Spiegel G, Tawk R, Lubicz B, Panni P, Puri AS, Pero G, Nossek E, Raz E, Killer-Oberfalzer M, Griessenauer CJ, Asadi H, Siddiqui A, Brook AL, Altschul D, Ducruet AF, Albuquerque FC, Regenhardt RW, Stapleton CJ, Kan P, Kalousek V, Lylyk P, Boddu S, Knopman J, Aziz-Sultan MA, Tjoumakaris SI, Clarençon F, Limbucci N, Cuellar-Saenz HH, Jabbour PM, Pereira VM, Patel AB, Adeeb N. Dual Layer vs Single Layer Woven EndoBridge Device in the Treatment of Intracranial Aneurysms: A Propensity Score-Matched Analysis. Neurosurg Rev 2024; 47:116. [PMID: 38483647 DOI: 10.1007/s10143-024-02341-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/26/2024] [Accepted: 03/03/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND The Woven EndoBridge (WEB) devices have been used for treating wide neck bifurcation aneurysms (WNBAs) with several generational enhancements to improve clinical outcomes. The original device dual-layer (WEB DL) was replaced by a single-layer (WEB SL) device in 2013. This study aimed to compare the effectiveness and safety of these devices in managing intracranial aneurysms. METHODS A multicenter cohort study was conducted, and data from 1,289 patients with intracranial aneurysms treated with either the WEB SL or WEB DL devices were retrospectively analyzed. Propensity score matching was utilized to balance the baseline characteristics between the two groups. Outcomes assessed included immediate occlusion rate, complete occlusion at last follow-up, retreatment rate, device compaction, and aneurysmal rupture. RESULTS Before propensity score matching, patients treated with the WEB SL had a significantly higher rate of complete occlusion at the last follow-up and a lower rate of retreatment. After matching, there was no significant difference in immediate occlusion rate, retreatment rate, or device compaction between the WEB SL and DL groups. However, the SL group maintained a higher rate of complete occlusion at the final follow-up. Regression analysis showed that SL was associated with higher rates of complete occlusion (OR: 0.19; CI: 0.04 to 0.8, p = 0.029) and lower rates of retreatment (OR: 0.12; CI: 0 to 4.12, p = 0.23). CONCLUSION The WEB SL and DL devices demonstrated similar performances in immediate occlusion rates and retreatment requirements for intracranial aneurysms. The SL device showed a higher rate of complete occlusion at the final follow-up.
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Affiliation(s)
- Adam A Dmytriw
- Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, 02114, USA.
| | - Hamza Salim
- Departement of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA
| | - Basel Musmar
- Departement of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA
| | - Assala Aslan
- Departement of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA
| | - Nicole M Cancelliere
- Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Rachel M McLellan
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, 02114, USA
| | - Oktay Algin
- Medical Faculty, Department of Radiology, Ankara University, Ankara, Turkey
| | - Sherief Ghozy
- Departments of Radiology and Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Mahmoud Dibas
- Departement of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA
| | - Sovann V Lay
- Service de Neuroradiologie Diagnostique Et Thérapeutique, Centre Hospitalier de Toulouse, Hôpital Purpan, Toulouse, France
| | - Adrien Guenego
- Service de Neuroradiologie Interventionnelle, Hôpital Universitaire Erasme, Brussels, Belgique
| | - Leonardo Renieri
- Interventistica Neurovascolare, Ospedale Careggi Di Firenze, Florence, Italy
| | - Joseph Carnevale
- Neurosurgery & Interventional Neuroradiology, Weill Cornell School of Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Guillaume Saliou
- Service de Radiodiagnostic Et Radiologie Interventionnelle, Centre Hospitalier Vaudois de Lausanne, Lausanne, Switzerland
| | | | - Kareem El Naamani
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Eimad Shotar
- Department de Neuroradiologie, Hôpital Pitié-Salpêtrière. Université Sorbonne, Paris, France
| | - Kevin Premat
- Department de Neuroradiologie, Hôpital Pitié-Salpêtrière. Université Sorbonne, Paris, France
| | - Markus Möhlenbruch
- Sektion Vaskuläre Und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Michael Kral
- Department of Neurosurgery, Christian Doppler University Hospital & Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Omer Doron
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, 02114, USA
| | - Charlotte Chung
- Departments of Radiology & Neurosurgery, NYU Langone Health Center, New York, NY, USA
| | - Mohamed M Salem
- Department of Neurosurgery, University of Pennsylvania Medical Center, Pennsylvania, PA, USA
| | - Ivan Lylyk
- Equipo de Neurocirugía Endovascular y Radiología Intervencionista, Clínica La Sagrada Familia, Buenos Aires, Argentina
| | - Paul M Foreman
- Neurosurgery Department, Orlando Health Neuroscience and Rehabilitation Institute, Orlando, FL, USA
| | - Jay A Vachhani
- Neurosurgery Department, Orlando Health Neuroscience and Rehabilitation Institute, Orlando, FL, USA
| | - Hamza Shaikh
- Departments of Radiology & Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Vedran Župančić
- Subdivision of Interventional Neuroradiology, Department of Radiology, Clinical Hospital Center 'Sisters of Mercy', Zagreb, Croatia
| | - Muhammad U Hafeez
- Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, TX, USA
| | - Joshua Catapano
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Muhammad Waqas
- Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY, USA
| | - Vincent M Tutino
- Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY, USA
| | - Mohamed K Ibrahim
- Departments of Radiology and Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Marwa A Mohammed
- Departments of Radiology and Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Cetin Imamoglu
- Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital of the Ministry of Health, Ankara, Turkey
| | - Ahmet Bayrak
- Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital of the Ministry of Health, Ankara, Turkey
| | - James D Rabinov
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, 02114, USA
| | - Yifan Ren
- Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, VIC, Australia
| | - Clemens M Schirmer
- Department of Neurosurgery and Radiology, Geisinger Health System, Danville, PA, USA
| | - Mariangela Piano
- Interventistica Neurovascolare, Ospedale Niguarda Cà Granda, Milan, Italy
| | - Anna L Kühn
- Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester, MA, USA
| | | | - Stéphanie Elens
- Interventistica Neurovascolare, Ospedale Careggi Di Firenze, Florence, Italy
| | - Robert M Starke
- Deparment of Neurosurgery, University of Miami, Miami, FL, USA
| | - Ameer E Hassan
- Deparment of Neuroscience, Valley Baptist Neuroscience Institute, Harlingen, TX, USA
| | - Mark Ogilvie
- Deparments of Neurosurgery and Radiology, University of Alabama, Birmingham, AL, USA
| | - Peter Sporns
- Department of Interventional Neuroradiology, Interventional Neuroradiology, University Hospital of Basel, Basel, Switzerland
| | - Jesse Jones
- Deparments of Neurosurgery and Radiology, University of Alabama, Birmingham, AL, USA
| | - Waleed Brinjikji
- Departments of Radiology and Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Marie T Nawka
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marios Psychogios
- Department of Interventional Neuroradiology, Interventional Neuroradiology, University Hospital of Basel, Basel, Switzerland
| | - Christian Ulfert
- Sektion Vaskuläre Und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Jose Danilo Bengzon Diestro
- Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Bryan Pukenas
- Department of Neurosurgery, University of Pennsylvania Medical Center, Pennsylvania, PA, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, University of Pennsylvania Medical Center, Pennsylvania, PA, USA
| | - Thien Huynh
- Departments of Radiology and Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
| | - Juan Carlos Martinez-Gutierrez
- Departments of Radiology, Neurology, and Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Muhammed Amir Essibayi
- Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sunil A Sheth
- Departments of Radiology, Neurology, and Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Gary Spiegel
- Departments of Radiology, Neurology, and Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Rabih Tawk
- Departments of Radiology and Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
| | - Boris Lubicz
- Interventistica Neurovascolare, Ospedale Careggi Di Firenze, Florence, Italy
| | - Pietro Panni
- Interventistica Neurovascolare, Ospedale San Raffaele Milano, Milan, Italy
| | - Ajit S Puri
- Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester, MA, USA
| | - Guglielmo Pero
- Interventistica Neurovascolare, Ospedale Niguarda Cà Granda, Milan, Italy
| | - Erez Nossek
- Departments of Radiology & Neurosurgery, NYU Langone Health Center, New York, NY, USA
| | - Eytan Raz
- Departments of Radiology & Neurosurgery, NYU Langone Health Center, New York, NY, USA
| | - Monika Killer-Oberfalzer
- Department of Neurosurgery, Christian Doppler University Hospital & Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Christoph J Griessenauer
- Department of Neurosurgery, Christian Doppler University Hospital & Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Hamed Asadi
- Departments of Radiology & Neurosurgery, NYU Langone Health Center, New York, NY, USA
| | - Adnan Siddiqui
- Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY, USA
| | - Allan L Brook
- Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David Altschul
- Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
| | | | - Robert W Regenhardt
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, 02114, USA
| | - Christopher J Stapleton
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, 02114, USA
| | - Peter Kan
- Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, TX, USA
| | - Vladimir Kalousek
- Subdivision of Interventional Neuroradiology, Department of Radiology, Clinical Hospital Center 'Sisters of Mercy', Zagreb, Croatia
| | - Pedro Lylyk
- Equipo de Neurocirugía Endovascular y Radiología Intervencionista, Clínica La Sagrada Familia, Buenos Aires, Argentina
| | - Srikanth Boddu
- Service de Radiodiagnostic Et Radiologie Interventionnelle, Centre Hospitalier Vaudois de Lausanne, Lausanne, Switzerland
| | - Jared Knopman
- Neurosurgery & Interventional Neuroradiology, Weill Cornell School of Medicine, New York Presbyterian Hospital, New York, NY, USA
| | | | | | - Frédéric Clarençon
- Department de Neuroradiologie, Hôpital Pitié-Salpêtrière. Université Sorbonne, Paris, France
| | - Nicola Limbucci
- Neurosurgery & Interventional Neuroradiology, Weill Cornell School of Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Hugo H Cuellar-Saenz
- Departement of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA
| | - Pascal M Jabbour
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Vitor Mendes Pereira
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, 02114, USA
| | - Aman B Patel
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, 02114, USA
| | - Nimer Adeeb
- Departement of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA
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8
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Theiss P, Ali AE, McGuire LS, Lanzino G, Ghozy S, Brinjikji W, Naamani KE, Amllay A, Tjoumakaris SI, Jabbour P, Salem MM, Burkhardt JK, Jankowitz BT, Abla A, Tonetti DA, Kan PT, Robledo A, Alaraj A. The natural history of aneurysms incompletely occluded by placement of a flow diverter: a multiinstitutional study. J Neurosurg 2024:1-6. [PMID: 38457799 DOI: 10.3171/2023.12.jns232221] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/14/2023] [Indexed: 03/10/2024]
Abstract
OBJECTIVE Treatment of intracranial aneurysms by flow diversion is safe and effective and is increasingly popular. However, the correct treatment paradigm for aneurysms incompletely treated by initial placement of a flow diverter has not been established, nor have the subsequent natural history and occlusion rates of such aneurysms. The authors sought to outline the natural history of such aneurysms, which to date have been considered partially treated. METHODS The authors retrospectively reviewed consecutive cases from 6 high-volume neurointerventional services, including all cases in which the first follow-up imaging after placement of a flow diverter showed incomplete occlusion of the aneurysm, and for which subsequent clinical and/or radiological follow-up was available. All included patients were treated with the Pipeline Flex embolization device or the Pipeline Flex embolization device with Shield Technology. Subsequent radiographic and clinical outcome data were collected and analyzed using the Kaplan-Meier survival function. RESULTS A total of 263 patients with persistently patent aneurysms on first follow-up imaging after flow diversion were identified. Of these, 204 had clinical follow-up and 152 had additional imaging follow-up. Of this final cohort, 148 aneurysms were unruptured, and 4 were ruptured. The average aneurysm size by maximum dimension was 10.8 mm. The average recorded follow-up was 27.8 months in the cohort, with some patients followed for as long as 9 years from treatment. Over the course of 403 person-years of follow-up, no delayed aneurysm ruptures were recorded. Both with and without retreatment, aneurysms showed a trend toward progressive occlusion over time. Complications related to device placement were low. CONCLUSIONS Aneurysms that have been incompletely treated by flow diversion have a benign natural history with progression toward occlusion over time, with or without retreatment.
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Affiliation(s)
- Peter Theiss
- 1Department of Neurosurgery, University of Illinois at Chicago, Illinois
| | - Ahmed Essam Ali
- 1Department of Neurosurgery, University of Illinois at Chicago, Illinois
| | | | | | - Sherief Ghozy
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | | | - Kareem El Naamani
- 3Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Abdelaziz Amllay
- 3Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | | | - Pascal Jabbour
- 3Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Mohamed M Salem
- 4Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jan-Karl Burkhardt
- 4Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian T Jankowitz
- 4Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Adib Abla
- 5Department of Neurosurgery, University of California at San Francisco, California; and
| | - Daniel A Tonetti
- 5Department of Neurosurgery, University of California at San Francisco, California; and
| | - Peter T Kan
- 6The University of Texas Medical Branch at Galveston, Texas
| | | | - Ali Alaraj
- 1Department of Neurosurgery, University of Illinois at Chicago, Illinois
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9
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Gajjar AA, Jain A, Le AHD, Salem MM, Jankowitz BT, Burkhardt JK. Cerebral Cavernous Malformations Patient Perception Analysis via Social Media. J Neurol Surg A Cent Eur Neurosurg 2024; 85:126-131. [PMID: 36481997 DOI: 10.1055/a-1994-9435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The rise of social media has allowed for individuals and patients to connect with each other and influence patient behavior. This study aimed to improve our understanding of the patients' experience with cerebral cavernous malformations (CCM) via social media. METHODS Instagram and Twitter were searched using terms of ("cavernoma," "cavernous malformations," "cavernous angioma," or "cav mal"). Public Instagram posts tagged with "#cavernoma" and "@cavernoma" identified 327 posts that directly included a patient's own experience. Twitter posts that included "#cavernoma" and "@cavernoma" were searched, yielding 75 after eliminating those that did not pertain to the patient's own experience. The posts and tweets were coded for relevant themes related to their experience with the disease. RESULTS Overall, more patients are using Instagram (n = 327) over Twitter (n = 84) to share their personal experience with CCM with a trend for male patients to use Twitter more compared to females with a female predominance in Instagram. A total of 277 of 327 (84.7%) Instagram posts and 67 of 84 (89.3%) Twitter posts were made after the patient's surgery. The most common theme on Instagram was focused on the postoperative rehabilitation process and mobility support (52.0 and 24.5%, respectively). Other common themes present on Twitter and Instagram were recounting symptoms and complications and life satisfaction (26.0 and 24.2%, respectively). Cavernoma patients prior to surgery were more likely to discuss on Instagram their symptoms (p = 0.001), fear of bleeding (p < 0.001), and mental health (p = 0.014). Postoperatively, cavernoma patients were more likely to discuss disability than they were preoperatively (p = 0.001). CONCLUSION Social media platforms offer a communication tool for patients with CCM patients to share their experience with other patients and the general public and portrays their personal experience with CCM. These platforms allow for physicians to better understand the patient experience following cavernoma surgery.
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Affiliation(s)
- Avi A Gajjar
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, United States
| | - Aditya Jain
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, United States
| | - Anthony Huy-Dinh Le
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, United States
| | - Mohamed M Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, United States
| | - Brian T Jankowitz
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, United States
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, United States
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Salem MM, Elmahy WA, Nasr DM. Effect of different intraoral scanning strategies on the marginal and internal fit of CAD-CAM inlay restorations: An in vitro study. J Prosthet Dent 2024; 131:518.e1-518.e9. [PMID: 38040555 DOI: 10.1016/j.prosdent.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 12/03/2023]
Abstract
STATEMENT OF PROBLEM Whether the scanning strategy of intraoral scanners (IOSs) affects the accuracy of the digital recording for an indirect ceramic inlay restoration is unclear. Furthermore, which strategy would be optimal and most effective is uncertain. PURPOSE The purpose of this in vitro study was to evaluate the impact of 3 different scanning strategies using the Carestream CS 3700 IOS on the marginal and internal fit of a mesio-occluso-distal (MOD) ceramic inlay restoration. MATERIAL AND METHODS A typodont master model (ANA-4 VCER; Frasaco) was used with a standardized preprepared MOD inlay maxillary first molar typodont tooth (ANA-4 ZP16 CER99-008; Frasaco) (N=30). These inlay preparations were scanned with the CS 3700 IOS using 3 different scanning strategies: linear, wave, and S-figure scanning strategies. Each scan strategy group was scanned 10 times for all groups to obtain 30 standard tessellation language (STL) files. Thirty restorations were milled from lithium disilicate CAD blocks (IPS e.max; Ivoclar AG) and cemented into their typodont-prepared inlay cavities. A single examiner used a stereomicroscope to measure the marginal and internal gaps at the predetermined points. A 1-way ANOVA was used for the statistical analysis, followed by the Tukey post hoc test with Bonferroni adjustment. All tests were 2-tailed (α=.05). RESULTS All scanning strategy groups demonstrated statistically significant differences for the marginal and internal fit of the inlay restorations (P<.001). Overall, the linear scanning strategy showed the lowest mean marginal and internal gap values (29.2 ±3.6 µm and 39.0 ±6.4 µm), followed by the wave scanning strategy, which had comparable mean marginal and internal gap values: 49.1 ±3.6 µm and 48.2 ±6.0 µm, respectively. The S-figure scan strategy had the highest mean marginal and internal gap values: 50.2 ±12.6 µm and 71.3 ±7.7 µm, respectively. CONCLUSIONS Inlay restorations scanned by the linear scan strategy had the best marginal and internal fit when scanned with the CS 3700 IOS.
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Affiliation(s)
- Mohamed M Salem
- Postgraduate student, Division of Operative Dentistry, Department of Conservative Dentistry, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
| | - Waleed A Elmahy
- Professor, Division of Operative Dentistry, Department of Conservative Dentistry, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Dina M Nasr
- Lecturer, Division of Operative Dentistry, Department of Conservative Dentistry, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Salem MM, Sioutas GS, Khalife J, Kuybu O, Caroll K, Nguyen Hoang A, Baig AA, Salih M, Khorasanizadeh M, Baker C, Mendez AA, Cortez G, Abecassis ZA, Rodriguez JFR, Davies JM, Narayanan S, Cawley CM, Riina HA, Moore JM, Spiotta AM, Khalessi AA, Howard BM, Hanel R, Tanweer O, Tonetti DA, Siddiqui AH, Lang MJ, Levy EI, Kan P, Jovin T, Grandhi R, Srinivasan VM, Ogilvy CS, Gross BA, Jankowitz BT, Thomas AJ, Levitt MR, Burkhardt JK. General Versus Nongeneral Anesthesia for Middle Meningeal Artery Embolization for Chronic Subdural Hematomas: Multicenter Propensity Score Matched Study. Neurosurgery 2024:00006123-990000000-01069. [PMID: 38412228 DOI: 10.1227/neu.0000000000002874] [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] [Received: 07/24/2023] [Accepted: 12/01/2023] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The choice of anesthesia type (general anesthesia [GA] vs nongeneral anesthesia [non-GA]) in middle meningeal artery embolization (MMAE) procedures for chronic subdural hematomas (cSDH) differs between institutions and left to care team discretion given lack of standard guidelines. We compare the outcomes of GA vs non-GA in MMAE. METHODS Consecutive patients receiving MMAE for cSDH at 14 North American centers (2018-2023) were included. Clinical, cSDH characteristics, and technical/clinical outcomes were compared between the GA/non-GA groups. Using propensity score matching (PSM), patients were matched controlling for age, baseline modified Rankin Scale, concurrent/prior surgery, hematoma thickness/midline shift, and baseline antiplatelet/anticoagulation. The primary end points included surgical rescue and radiographic success rates (≥50% reduction in maximum hematoma thickness with minimum 2 weeks of imaging). Secondary end points included technical feasibility, procedural complications, and functional outcomes. RESULTS Seven hundred seventy-eight patients (median age 73 years, 73.2% male patients) underwent 956 MMAE procedures, 667 (70.4%) were non-GA and 280 were GA (29.6%). After running 1:3 PSM algorithm, this resulted in 153 and 296 in the GA and non-GA groups, respectively. There were no baseline/procedural differences between the groups except radial access more significantly used in the non-GA group (P = .001). There was no difference between the groups in procedural technical feasibility, complications rate, length of stay, surgical rescue rates, or favorable functional outcome at the last follow-up. Subsequent 1:1 sensitivity PSM retained the same results. Bilateral MMAE procedures were more performed under non-GA group (75.8% vs 67.2%; P = .01); no differences were noted in clinical/radiographic outcomes between bilateral vs unilateral MMAE, except for longer procedure duration in the bilateral group (median 73 minutes [IQR 48.3-100] vs 54 minutes [39-75]; P < .0001). Another PSM analysis comparing GA vs non-GA in patients undergoing stand-alone MMAE retained similar associations. CONCLUSION We found no significant differences in radiological improvement/clinical outcomes between GA and non-GA for MMAE.
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Affiliation(s)
- Mohamed M Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Georgios S Sioutas
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Jane Khalife
- Department of Neurosurgery, Cooper University Health Care, Camden, New Jersey, USA
| | - Okkes Kuybu
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kate Caroll
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | - Alex Nguyen Hoang
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Ammad A Baig
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Mira Salih
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, Massachusetts, USA
| | - Mirhojjat Khorasanizadeh
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, Massachusetts, USA
| | - Cordell Baker
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
| | - Aldo A Mendez
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Gustavo Cortez
- Department of Cerebrovascular and Endovascular Surgery, Baptist Neurological Institute and Lyerly Neurosurgery, Jacksonville, Florida, USA
| | - Zachary A Abecassis
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | | | - Jason M Davies
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Sandra Narayanan
- Departments of Neurology and Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - C Michael Cawley
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Howard A Riina
- Department of Neurosurgery, NYU Langone Medical Center, New York, New York, USA
| | - Justin M Moore
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, Massachusetts, USA
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alexander A Khalessi
- Department of Neurosurgery, University of California-San Diego, La Jolla, California, USA
| | - Brian M Howard
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ricardo Hanel
- Department of Cerebrovascular and Endovascular Surgery, Baptist Neurological Institute and Lyerly Neurosurgery, Jacksonville, Florida, USA
| | - Omar Tanweer
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Daniel A Tonetti
- Department of Neurosurgery, Cooper University Health Care, Camden, New Jersey, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Michael J Lang
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Tudor Jovin
- Department of Neurosurgery, Cooper University Health Care, Camden, New Jersey, USA
| | - Ramesh Grandhi
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Christopher S Ogilvy
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, Massachusetts, USA
| | - Bradley A Gross
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Brian T Jankowitz
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Ajith J Thomas
- Department of Neurosurgery, Cooper University Health Care, Camden, New Jersey, USA
| | - Michael R Levitt
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
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Gajjar AA, Patel S, Patel SV, Goyal A, Sioutas GS, Gamel KL, Salem MM, Srinivasan VM, Jankowitz BT, Burkhardt JK. Readability of cerebrovascular diseases online educational material from major cerebrovascular organizations. J Neurointerv Surg 2024:jnis-2023-021205. [PMID: 38395602 DOI: 10.1136/jnis-2023-021205] [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: 11/06/2023] [Accepted: 02/05/2024] [Indexed: 02/25/2024]
Abstract
INTRODUCTION The internet is an essential resource for patients and their loved ones to understand their medical conditions, and professional medical organizations have taken great strides to develop educational material targeting patients. The average American reads at a seventh to eighth grade reading level, hence it is important to understand the readability of this medical information to ensure patients comprehend what is being presented. METHODS In January 2023, online patient education material was downloaded from major cerebrovascular healthcare organizations and assessed using eight assessments, including Bormuth Cloze Mean, Bormuth Grade Placement, Coleman-Liau (grade levels), Coleman-Liau (predictive cloze scores), Flesch Reading Ease (FRE), and Fry. RESULTS A total of 32 files were extracted from six organizations and analyzed across 15 readability measures. None of the organizations met the federal government guidelines for grade-level readability. This held constant across all measured tests. Two organizations had above a postgraduate level. The FRE graphs do not identify any organizations with material below a ninth grade reading level, while the American Association of Neurological Surgeons (AANS) and the Society of Interventional Radiology (SIR) have a postgraduate readability level. The Fry graphs show similar results, with AANS/CNS Cerebrovascular Section, Society of NeuroInterventional Surgery (SNIS), SIR, and AANS having college-level readability. The lowest readability across all measures is only at an early seventh grade reading level. CONCLUSIONS Current health literacy content for cerebrovascular patients is far above the recommended readability level. We provide straightforward suggestions for how major professional organizations should improve their informational material on cerebrovascular diseases to improve patient understanding.
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Affiliation(s)
- Avi A Gajjar
- Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Neurosurgery, Albany Medical College, Albany, New York, USA
| | - Shray Patel
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Shrey V Patel
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Aditya Goyal
- Neurosurgery, Albany Medical College, Albany, New York, USA
| | - Georgios S Sioutas
- Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Katherine L Gamel
- Campbell University School of Osteopathic Medicine, Buies Creek, North Carolina, USA
| | - Mohamed M Salem
- Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Brian T Jankowitz
- Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jan Karl Burkhardt
- Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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13
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Gajjar AA, Covell MM, Muhammad N, Kuo C, Sioutas GS, Salem MM, Fras SI, Jankowitz BT, Burkhardt JK, Srinivasan VM. Utilization and reimbursement of diagnostic cerebral angiograms: A Medicare trends analysis from 2013 to 2020. Interv Neuroradiol 2024:15910199241233333. [PMID: 38389425 DOI: 10.1177/15910199241233333] [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
INTRODUCTION Increasing life expectancy has caused growing concern about maintaining viable neurointerventional practices due to altered Medicare payment structures. This study analyzes the financial trends of three common diagnostic tests for cerebrovascular disease: cerebral digital subtraction angiography (DSA), computed tomography angiography (CTA), and magnetic resonance angiography (MRA). METHODS Medicare Part B National Summary Data files from 2013 to 2020 were queried by Current Procedural Terminology (CPT) codes for DSA (36221-36228), CTA (70496, 70498), and MRA (70544-70547, 70549). Inflation-adjusted charges and reimbursement were calculated using the U.S. City Average Consumer Price Index for Medical Services. Regression analysis was performed on charges, reimbursement, and volume. RESULTS A total of 1,519,245 diagnostic procedures were conducted between 2013 and 2020 (782,370 angiograms, 246,603 CTAs, and 490,272 MRAs). A total of $41.005 million was reimbursed by Medicare in 2020 for these diagnostic procedures. The annual percent change in volume for all procedures was -2.90%. From 2013 to 2020, inflation-adjusted: Medicare total physician reimbursement decreased for cerebral angiograms (-4.12%, p = 0.007), CTAs (-2.77%, p = 0.458), and MRAs (-9.06%, p < 0.001). Procedural volume billed to Medicare decreased for cerebral angiograms (-4.63%, p = 0.007) and MRAs (-2.94%, p = 0.0.81) and increased for CTAs (+3.15%, p = 0.004). The greatest increase in Medicare reimbursement (+66.75%) came from CPT code 36224, "place catheter carotid artery", and the greatest decrease in Medicare reimbursement (-8.66%) came from CPT code 36226, "place catheter vertebral artery." CONCLUSIONS This study provides an analysis of Medicare reimbursement trends for routine cerebrovascular angiogram techniques. The findings highlight a decline in Medicare reimbursements for neurointerventionalists.
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Affiliation(s)
- Avi A Gajjar
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael M Covell
- Department of Neurosurgery, School of Medicine, Georgetown University, Washington, D.C., USA
| | - Najib Muhammad
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Cathleen Kuo
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Georgios S Sioutas
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mohamed M Salem
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sebastian Ivan Fras
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Brian T Jankowitz
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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El Naamani K, Chen CJ, Jabre R, Saad H, Grossberg JA, Dmytriw AA, Patel AB, Khorasanizadeh M, Ogilvy CS, Thomas A, Monteiro A, Siddiqui A, Cortez GM, Hanel RA, Porto G, Spiotta AM, Piscopo AJ, Hasan DM, Ghorbani M, Weinberg J, Nimjee SM, Bekelis K, Salem MM, Burkhardt JK, Zetchi A, Matouk C, Howard BM, Lai R, Du R, Abbas R, Sioutas GS, Amllay A, Munoz A, Atallah E, Herial NA, Tjoumakaris SI, Gooch MR, Rosenwasser RH, Jabbour P. Direct Versus Indirect Revascularization for Moyamoya: a Large Multicenter Study. J Neurol Neurosurg Psychiatry 2024; 95:256-263. [PMID: 37673641 DOI: 10.1136/jnnp-2022-329176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/22/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Moyamoya is a chronic occlusive cerebrovascular disease of unknown etiology causing neovascularization of the lenticulostriate collaterals at the base of the brain. Although revascularization surgery is the most effective treatment for moyamoya, there is still no consensus on the best surgical treatment modality as different studies provide different outcomes. OBJECTIVE In this large case series, we compare the outcomes of direct (DR) and indirect revascularisation (IR) and compare our results to the literature in order to reflect on the best revascularization modality for moyamoya. METHODS We conducted a multicenter retrospective study in accordance with the Strengthening the Reporting of Observational studies in Epidemiology guidelines of moyamoya affected hemispheres treated with DR and IR surgeries across 13 academic institutions predominantly in North America. All patients who underwent surgical revascularization of their moyamoya-affected hemispheres were included in the study. The primary outcome of the study was the rate of symptomatic strokes. RESULTS The rates of symptomatic strokes across 515 disease-affected hemispheres were comparable between the two cohorts (11.6% in the DR cohort vs 9.6% in the IR cohort, OR 1.238 (95% CI 0.651 to 2.354), p=0.514). The rate of total perioperative strokes was slightly higher in the DR cohort (6.1% for DR vs 2.0% for IR, OR 3.129 (95% CI 0.991 to 9.875), p=0.052). The rate of total follow-up strokes was slightly higher in the IR cohort (8.1% vs 6.6%, OR 0.799 (95% CI 0.374 to 1.709) p=0.563). CONCLUSION Since both modalities showed comparable rates of overall total strokes, both modalities of revascularization can be performed depending on the patient's risk assessment.
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Affiliation(s)
- Kareem El Naamani
- Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Ching-Jen Chen
- Neurosurgery, The University of Texas Health Science Center, Houston, Texas, USA
| | - Roland Jabre
- Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Hassan Saad
- Neurosurgery, Emory University, Atlanta, Georgia, USA
| | | | - Adam A Dmytriw
- Neuroradiology and Neurointervention Service, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Medical Imaging, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Aman B Patel
- Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | - Ajith Thomas
- Neurosurgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Andre Monteiro
- Neurosurgery, University at Buffalo, Buffalo, New York, USA
| | - Adnan Siddiqui
- Neurosurgery, University at Buffalo, Buffalo, New York, USA
| | - Gustavo M Cortez
- Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA
| | - Ricardo A Hanel
- Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA
| | - Guilherme Porto
- Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alejandro M Spiotta
- Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Anthony J Piscopo
- Neurosurgery, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - David M Hasan
- Neurosurgery, Duke University, Durham, North Carolina, USA
| | - Mohammad Ghorbani
- Neurosurgery, Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Joshua Weinberg
- Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Shahid M Nimjee
- Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Kimon Bekelis
- Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Mohamed M Salem
- Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jan-Karl Burkhardt
- Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Akli Zetchi
- Neurosurgery, Yale University, New Haven, Connecticut, USA
| | - Charles Matouk
- Neurosurgery, Yale University, New Haven, Connecticut, USA
| | - Brian M Howard
- Neurological Surgery, Emory University, Atlanta, Georgia, USA
| | - Rosalind Lai
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Rose Du
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Rawad Abbas
- Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Georgios S Sioutas
- Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Abdelaziz Amllay
- Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Alfredo Munoz
- Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Elias Atallah
- Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Nabeel A Herial
- Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | | | - Michael Reid Gooch
- Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Robert H Rosenwasser
- Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Pascal Jabbour
- Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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Aboutaleb PE, Salem MM, Adibnia Y, Lee L, Green-LaRoche DM. A Survey of Burnout Among Neurocritical Care Practitioners. Neurocrit Care 2024; 40:328-336. [PMID: 37237140 PMCID: PMC10218767 DOI: 10.1007/s12028-023-01750-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 05/05/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Burnout is a growing problem among medical professionals, reaching a crisis proportion. It is defined by emotional exhaustion, cynicism, and career dissatisfaction and is triggered by a mismatch between the values of the person and the demands of the workplace. Burnout has not previously been examined thoroughly in the Neurocritical Care Society (NCS). The purpose of this study is to assess the prevalence, contributing factors, and potential interventions to reduce burnout within the NCS. METHODS A cross-sectional study of burnout was conducted using a survey distributed to members of the NCS. The electronic survey included personal and professional characteristic questions and the Maslach Burnout Inventory Human Services Survey for Medical Personnel (MBI). This validated measure assesses for emotional exhaustion (EE), depersonalization (DP), and personal achievement (PA). These subscales are scored as high, moderate, or low. Burnout (MBI) was defined as a high score in either EE or DP or a low score in PA. A Likert scale (0-6) was added to the MBI (which contained 22 questions) to provide summary data for the frequencies of each particular feeling. Categorical variables were compared using χ2 tests, and continuous variables were compared using t-tests. RESULTS A total of 82% (204 of 248) of participants completed the entire questionnaire; 61% (124 of 204) were burned out by MBI criteria. A high score in EE was present in 46% (94 of 204), a high score in DP was present in 42% (85 of 204), and a low score in PA was present in 29% (60 of 204). The variables feeling burned out now, feeling burned out in the past, not having an effective/responsive supervisor, thinking about leaving one's job due to burnout, and leaving one's job due to burnout were significantly associated with burnout (MBI) (p < 0.05). Burnout (MBI) was also higher among respondents early in practice (currently training/post training 0-5 years) than among respondents post training 21 or more years. In addition, insufficient support staff contributed to burnout, whereas improved workplace autonomy was the most protective factor. CONCLUSIONS Our study is the first to characterize burnout among a cross-section of physicians, pharmacists, nurses, and other practitioners in the NCS. A call to action and a genuine commitment by the hospital, organizational, local, and federal governmental leaders and society as a whole is essential to advocate for interventions to ameliorate burnout and care for our health care professionals.
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Affiliation(s)
- Pakinam E Aboutaleb
- Department of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Mohamed M Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Yasaman Adibnia
- Department of Neurology, Tufts Medical Center, Boston, MA, USA
| | - Lucia Lee
- Department of Anesthesia, Hospital for Special Surgery, New York, NY, USA
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Drexler R, Sauvigny T, Pantel TF, Ricklefs FL, Catapano JS, Wanebo JE, Lawton MT, Sanchin A, Hecht N, Vajkoczy P, Raygor K, Tonetti D, Abla A, El Naamani K, Tjoumakaris SI, Jabbour P, Jankowitz BT, Salem MM, Burkhardt JK, Wagner A, Wostrack M, Gempt J, Meyer B, Gaub M, Mascitelli JR, Dodier P, Bavinzski G, Roessler K, Stroh N, Gmeiner M, Gruber A, Figueiredo EG, da Silva Coelho ACS, Bervitskiy AV, Anisimov ED, Rzaev JA, Krenzlin H, Keric N, Ringel F, Park D, Kim MC, Marcati E, Cenzato M, Westphal M, Dührsen L. Global Outcomes for Microsurgical Clipping of Unruptured Intracranial Aneurysms: A Benchmark Analysis of 2245 Cases. Neurosurgery 2024; 94:369-378. [PMID: 37732745 PMCID: PMC10766286 DOI: 10.1227/neu.0000000000002689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/27/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Benchmarks represent the best possible outcome and help to improve outcomes for surgical procedures. However, global thresholds mirroring an optimal and reachable outcome for microsurgical clipping of unruptured intracranial aneurysms (UIA) are not available. This study aimed to define standardized outcome benchmarks in patients who underwent clipping of UIA. METHODS A total of 2245 microsurgically treated UIA from 15 centers were analyzed. Patients were categorized into low- ("benchmark") and high-risk ("nonbenchmark") patients based on known factors affecting outcome. The benchmark was defined as the 75th percentile of all centers' median scores for a given outcome. Benchmark outcomes included intraoperative (eg, duration of surgery, blood transfusion), postoperative (eg, reoperation, neurological status), and aneurysm-related factors (eg, aneurysm occlusion). Benchmark cutoffs for aneurysms of the anterior communicating/anterior cerebral artery, middle cerebral artery, and posterior communicating artery were determined separately. RESULTS Of the 2245 cases, 852 (37.9%) patients formed the benchmark cohort. Most operations were performed for middle cerebral artery aneurysms (53.6%), followed by anterior communicating and anterior cerebral artery aneurysms (25.2%). Based on the results of the benchmark cohort, the following benchmark cutoffs were established: favorable neurological outcome (modified Rankin scale ≤2) ≥95.9%, postoperative complication rate ≤20.7%, length of postoperative stay ≤7.7 days, asymptomatic stroke ≤3.6%, surgical site infection ≤2.7%, cerebral vasospasm ≤2.5%, new motor deficit ≤5.9%, aneurysm closure rate ≥97.1%, and at 1-year follow-up: aneurysm closure rate ≥98.0%. At 24 months, benchmark patients had a better score on the modified Rankin scale than nonbenchmark patients. CONCLUSION This study presents internationally applicable benchmarks for clinically relevant outcomes after microsurgical clipping of UIA. These benchmark cutoffs can serve as reference values for other centers, patient registries, and for comparing the benefit of other interventions or novel surgical techniques.
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Affiliation(s)
- Richard Drexler
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Sauvigny
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias F. Pantel
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Franz L. Ricklefs
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joshua S. Catapano
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - John E. Wanebo
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael T. Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Aminaa Sanchin
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nils Hecht
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Kunal Raygor
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Daniel Tonetti
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Adib Abla
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Kareem El Naamani
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Stavropoula I. Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Brian T. Jankowitz
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Pennsylvania Medicine, Philadelphia, Pennsylvania, USA
| | - Mohamed M. Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Pennsylvania Medicine, Philadelphia, Pennsylvania, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Pennsylvania Medicine, Philadelphia, Pennsylvania, USA
| | - Arthur Wagner
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Maria Wostrack
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Jens Gempt
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Michael Gaub
- Department of Neurosurgery, University of Texas Health and Science Center at San Antonio, San Antonio, Texas, USA
| | - Justin R. Mascitelli
- Department of Neurosurgery, University of Texas Health and Science Center at San Antonio, San Antonio, Texas, USA
| | - Philippe Dodier
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Gerhard Bavinzski
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Karl Roessler
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Nico Stroh
- Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Matthias Gmeiner
- Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Andreas Gruber
- Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Eberval G. Figueiredo
- Division of Neurological Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | | | - Harald Krenzlin
- Department of Neurosurgery, University Hospital Mainz, Mainz, Germany
| | - Naureen Keric
- Department of Neurosurgery, University Hospital Mainz, Mainz, Germany
| | - Florian Ringel
- Department of Neurosurgery, University Hospital Mainz, Mainz, Germany
| | - Dougho Park
- Department of Neurosurgery, Pohang Stroke and Spine Hospital, Pohang, Korea
| | - Mun-Chul Kim
- Department of Neurosurgery, Pohang Stroke and Spine Hospital, Pohang, Korea
| | - Eleonora Marcati
- Department of Neurosurgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marco Cenzato
- Department of Neurosurgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lasse Dührsen
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Salem MM, Darwish MA, Altarawneh AM, Alibwaini YA, Ghazy R, Hemeda OM, Zhou D, Trukhanova EL, Trukhanov AV, Trukhanov SV, Mostafa M. Investigation of the structure and dielectric properties of doped barium titanates. RSC Adv 2024; 14:3335-3345. [PMID: 38259985 PMCID: PMC10801699 DOI: 10.1039/d3ra05885a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
This work examined the influence of zirconium concentration on barium titanate (BZT) BaZrxTi1-xO3, with (x = 0, 0.15, 0.50, 0.75, and 1), produced by the tartrate precursor technique. The Fourier transform infrared (FTIR) spectra support the X-ray diffraction (XRD) results regarding formation of the perovskite structure. Grain size grows with Zr concentration, suggesting that the presence of Zr ions enlarges the grains. The transmission electron microscopy (TEM) images demonstrated that, due to their nano size, nanocrystallites are agglomerated in most images with irregular morphologies and average particle sizes from 20.75 nm to 63.75 nm. Increasing Zr content diminished the piezoelectric coefficient (d33) and the grain size. The value of d33 decreases by increasing Zr content, and there is an inverse relationship between grain size and d33. The remnant polarization of BZT increases with increasing Zr4+ content, which may be suitable for permanent memory device applications.
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Affiliation(s)
- Mohamed M Salem
- Physics Department, Faculty of Science, Tanta University Al-Geish St. Tanta 31527 Egypt
| | - Moustafa A Darwish
- Physics Department, Faculty of Science, Tanta University Al-Geish St. Tanta 31527 Egypt
| | - Aseel M Altarawneh
- Physics Department, Faculty of Science, Tanta University Al-Geish St. Tanta 31527 Egypt
| | - Yamen A Alibwaini
- Physics Department, Faculty of Science, Tanta University Al-Geish St. Tanta 31527 Egypt
- Faculty of Science and Information Technology, Jadara University Irbid 21110 Jordan
| | - Ryad Ghazy
- Physics Department, Faculty of Science, Tanta University Al-Geish St. Tanta 31527 Egypt
| | - Osama M Hemeda
- Physics Department, Faculty of Science, Tanta University Al-Geish St. Tanta 31527 Egypt
| | - Di Zhou
- Electronic Materials Research Laboratory, Key Laboratory of the Ministry of Education, International Center for Dielectric Research, School of Electronic Science and Engineering, Xi'an Jiaotong University Xi'an 710049 China
| | - Ekaterina L Trukhanova
- Smart Sensors Laboratory, Department of Electronic Materials Technology, National University of Science and Technology MISiS Moscow 119049 Russia
- Laboratory of Magnetic Films Physics, SSPA "Scientific and Practical Materials Research Centre of NAS of Belarus" 19, P. Brovki str. Minsk 220072 Belarus
| | - Alex V Trukhanov
- Smart Sensors Laboratory, Department of Electronic Materials Technology, National University of Science and Technology MISiS Moscow 119049 Russia
- Laboratory of Magnetic Films Physics, SSPA "Scientific and Practical Materials Research Centre of NAS of Belarus" 19, P. Brovki str. Minsk 220072 Belarus
| | - Sergei V Trukhanov
- Smart Sensors Laboratory, Department of Electronic Materials Technology, National University of Science and Technology MISiS Moscow 119049 Russia
- Laboratory of Magnetic Films Physics, SSPA "Scientific and Practical Materials Research Centre of NAS of Belarus" 19, P. Brovki str. Minsk 220072 Belarus
| | - Maha Mostafa
- Physics Department, Faculty of Science, Tanta University Al-Geish St. Tanta 31527 Egypt
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18
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Abbas R, Sweid A, Salem MM, Atallah E, Naamani KE, Amllay A, Sioutas GS, Sambangi A, Yudkoff CJ, Dougherty J, Weinberg JH, El-Hajj J, Alhussein A, Alhussein R, Herial NA, Tjoumakaris S, Gooch MR, Zarzour H, Schmidt RF, Rosenwasser RH, Jabbour P. Predictors of occlusion, long-term outcomes, and safety in a cohort of 674 aneurysms treated with the Pipeline embolization device. J Neurosurg 2024:1-9. [PMID: 38181513 DOI: 10.3171/2023.10.jns231837] [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: 08/09/2023] [Accepted: 10/27/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE By providing a more physiological approach to the treatment of intracranial aneurysms, the Pipeline embolization device (PED) has revolutionized the endovascular treatment of aneurysms. Although there are many flow diverters on the market, the authors report their experience with the PED, the first flow diverter to be approved by the Food and Drug Administration. They aimed to assess the efficacy and safety of PED flow diversion for the treatment of a wide range of aneurysms, as well as to look at factors affecting occlusion. METHODS This is a retrospective study of a prospectively maintained database of patients treated with the PED between January 2011 and December 2019. Charts were reviewed for patient, aneurysm, and procedure characteristics. The primary outcomes of interest were complication rates, occlusion outcomes (O'Kelly-Marotta grading scale), and functional outcomes (modified Rankin Scale [mRS]). Secondary outcomes included predictors of incomplete occlusion at 6 and 24 months of follow-up. RESULTS The study cohort included 581 patients with 674 aneurysms. Most aneurysms (90.5%) were in the anterior circulation and had a saccular morphology (85.6%). Additionally, 638 aneurysms (94.7%) were unruptured, whereas 36 (5.3%) were acutely ruptured. The largest mean aneurysm diameter was 8.3 ± 6.1 mm. Complications occurred at a rate of 5.5% (n = 32). The complete occlusion rate was 89.3% at 24 months' follow-up, and 94.8% of patients had a favorable neurological outcome (mRS score 0-2) at the last follow-up. On multivariate analysis, predictors of incomplete aneurysm occlusion at 6 months were hypertension (OR 1.7, p = 0.03), previous aneurysm treatment (OR 2.4, p = 0.001), and increasing aneurysm neck diameter (OR 1.2, p = 0.02), whereas a saccular morphology was protective (OR 0.5, p = 0.05). Predictors of incomplete occlusion at 24 months were increasing aneurysm neck diameter (OR 1.2, p = 0.01) and previous aneurysm treatment (OR 2.3, p = 0.01). CONCLUSIONS The study findings are corroborated by those of previous studies and trials. The complete occlusion rate was 89.3% at 24 months' follow-up, with 94.8% of patients having favorable functional outcomes (mRS score 0-2). Aneurysm treatment before PED deployment and an increasing aneurysm neck diameter increase the risk of incomplete occlusion at 6 and 24 months.
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Affiliation(s)
- Rawad Abbas
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Ahmad Sweid
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Mohamed M Salem
- 2Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania
| | - Elias Atallah
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Kareem El Naamani
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Abdelaziz Amllay
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Georgios S Sioutas
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Abhijeet Sambangi
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Clifford J Yudkoff
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Jaime Dougherty
- 3Rowan University School of Osteopathic Medicine, Stratford, New Jersey
| | - Joshua H Weinberg
- 4Department of Neurological Surgery, Ohio State College of Medicine, Columbus, Ohio; and
| | - Jad El-Hajj
- 5Saint George's University School of Medicine, St. George, Grenada
| | - Abdulaziz Alhussein
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Ruyof Alhussein
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Nabeel A Herial
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Stavropoula Tjoumakaris
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - M Reid Gooch
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Hekmat Zarzour
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Richard F Schmidt
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Robert H Rosenwasser
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Pascal Jabbour
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Elbarbary NK, Abdelmotilib NM, Salem-Bekhit MM, Salem MM, Singh S, Dandrawy MK. Antibacterial efficiency of apple vinegar marination on beef-borne Salmonella. Open Vet J 2024; 14:274-283. [PMID: 38633164 PMCID: PMC11018434 DOI: 10.5455/ovj.2024.v14.i1.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/15/2023] [Indexed: 04/19/2024] Open
Abstract
Background Salmonella-related foodborne illnesses are a significant public health concern. Naturally, antibacterial food components have been shown to limit microbial growth proliferation with various degrees of efficacy. Aims To examine the occurrence, microbial load, and effect of apple vinegar on Salmonella serovars in beef and beef products. Methods 150 beef and beef products were collected between March and May 2022. Total viable count (TVC), Enterobacteriaceae count (ENT), isolation and identification of Salmonella, and their virulence factors detection by multiplex PCR were determined, and an experimental study of the effect of natural apple vinegar marination on Salmonella spp. Results TVC was higher in meatballs (3.32 × 106 ± 1.07 × 106) while beef burgers (4.22 × 103 ± 0.71 × 103) had the highest ENT. Concerning the prevalence of Salmonella spp., meatball (46.7%) and beef burger (25.3%) samples were the highest contamination rate. The common serovars detected were Salmonella typhimurium (6%), Salmonella enteritidis (6%), and Salmonella infantis (4%). Based on the results of PCR, 12, 11, and 11 out of 18 samples of Salmonella isolates possess hila, stn, and invA genes. By immersing the inoculated steak meat in apple vinegar at different concentrations (50%, 70%, and 100%), the initial populations of the Salmonella strains after 12 hours were reduced to 0.38 × 102 ± 0.05 × 102 log CFU/ml; however, after 48 hours become the most reduction (0.31 × 102 ± 0.07 × 102 log CFU/ml) at a concentration of 100% apple vinegar. An enhancement in the sensory attributes was noted across all concentrations. Conclusion The consumed beef and beef products are contaminated with pathogenic bacteria such as Salmonella spp. Marinades made using apple vinegar concentrations of 50%, 75%, and 100% effectively minimized the prevalence of artificially inoculated Salmonella and extended the shelf life of preserved refrigerated beef products to 48 hours.
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Affiliation(s)
- Nady Khairy Elbarbary
- Food Hygiene and Control Department, Faculty of Veterinary Medicine, Aswan University, Aswan, Egypt
| | - Neveen M. Abdelmotilib
- Department of Food Technology, Arid Lands Cultivation Research Institute (ALCRI), City of Scientific Research and Technological Applications (SRTA-CITY), New Borg El-Arab City, Egypt
| | - Mounir M. Salem-Bekhit
- Kayyali Chair for Pharmaceutical Industries, Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mohamed M. Salem
- College of Medicine, Huazhong University of Science and Technology, Wuhan, China
| | - Soumya Singh
- College of Medicine, Huazhong University of Science and Technology, Wuhan, China
| | - Mohamed K. Dandrawy
- Food Hygiene and Control Department, Faculty of Veterinary Medicine, South Valley University, Qena, Egypt
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Benakli Y, Khenchouche A, Rabea S, Mansour AA, Salem-Bekhit MM, Taha EI, Salem MM, Singh S, Ould Ouali K, Benguerba Y, Houali K. Characterizing EBV-associated Gastric Carcinoma (EBVaGC): A deep dive into LMP1 expression patterns. Cell Mol Biol (Noisy-le-grand) 2023; 69:217-224. [PMID: 38158662 DOI: 10.14715/cmb/2023.69.13.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Indexed: 01/03/2024]
Abstract
Gastric cancer (GC) is a serious public health issue due to its frequency and severity. It is, for both sexes, one of the most common causes of cancer-related death and is a major contributor to the global burden of disease. Recent data show that Epstein-Barr virus (EBV) has been detected in different histopathological subtypes of gastric carcinoma and that EBV-associated gastric carcinoma (EBVaGC) represents about 10% of all cases. Moreover, the LMP1 protein characterizing the malignant transformation of cells in several cancer models seems to be very rarely expressed in this type of cancer. This study aimed to characterize EBVaGC in our population by detecting LMP1 in gastric carcinomas in about 30 selected patients. The results showed that in our population, nuclear staining predominates, showing that the antrum remains the most sampled site both for these pathologies and for LMP1 positivity (nuclear staining). In general, the LMP1 marking was negative for 22.58%, positive with a nuclear predominance at 64.52%, nuclear and cytoplasmic at 12.90%, and no positive marking for the cytoplasm. Results were not like the different studies on the expression of this oncogenic protein without EBVsCG, probably finding an explanation in the fact that our country is among the endemic regions for this herpes virus. In conclusion, the rate of LMP1 expression among gastric carcinomas does not seem similar to that observed in other countries. This study characterizing EBVaGC in Tizi-Ouzou, Algeria, reinforces the need for further studies to clarify the role of EBV (LMP1) and to explore its potential value as a predictive biomarker for the development of this type of cancer pathology.
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Affiliation(s)
- Yasmina Benakli
- Laboratory of Analytical Biochemistry of Biotechnology (LABAB), University Mouloud Mammeri Tizi-Ouzou, Algeria.
| | - Abdelhalim Khenchouche
- Département de Microbiologie, Faculté des Sciences de la Nature et de la Vie, Université Ferhat Abbas Sétif 1, Sétif 19000, Algeria.
| | - Sameh Rabea
- Department of Pharmaceutical Sciences. College of Pharmacy. AlMAAREFA University, Diriyah 13713 Riyadh, Saudi Arabia.
| | - Ahd A Mansour
- Medical Laboratory Science Department, Fakeeh College for Medical Sciences, P.O. Box 2537, Jeddah 21461, Saudi Arabia.
| | - Mounir M Salem-Bekhit
- Department of Pharmaceutics, College of Pharmacy, King Saud University, PO Box 2457, Riyadh 11451, Saudi Arabia.
| | - Ehab I Taha
- Department of Pharmaceutical Sciences. College of Pharmacy. AlMAAREFA University, Diriyah 13713 Riyadh, Saudi Arabia.
| | - Mohamed M Salem
- College of Medicine, Huazhong University of Science and Technology, China.
| | - Soumya Singh
- College of Medicine, Huazhong University of Science and Technology, China.
| | - Karima Ould Ouali
- Laboratory of Analytical Biochemistry of Biotechnology (LABAB), University Mouloud Mammeri Tizi-Ouzou, Algeria.
| | - Yacine Benguerba
- Laboratoire de Biopharmacie Et Pharmacotechnie (LBPT), Ferhat Abbas Setif 1 University, Setif, Algeria.
| | - Karim Houali
- Laboratory of Analytical Biochemistry of Biotechnology (LABAB), University Mouloud Mammeri Tizi-Ouzou, Algeria.
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Gouadfel K, Khenchouche A, Rabea S, Mansour AA, Salem-Bekhit MM, Ouhida S, Msela A, Salem MM, Erto A, Benguerba Y, Houali K. The potential role of Epstein-Barr Virus in breast cancer development. Cell Mol Biol (Noisy-le-grand) 2023; 69:241-249. [PMID: 38158663 DOI: 10.14715/cmb/2023.69.13.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Indexed: 01/03/2024]
Abstract
We are looking into viral components that may contribute to breast cancer in order to find possible therapeutic targets. The Epstein-Barr virus (EBV), which has been found to cause nasopharyngeal carcinoma and Burkitt lymphoma, is thought to play a role in breast cancer. Our series' patients had a median age of 49, with nearly half being under the age of 49. T2 tumors (two to five centimeters in size) make up the vast majority of our collection (60%). Six percent of our patients showed lymph node involvement, with roughly the same number in the N1 and N2 stages (41.17% each). Only 17.64% of people are at the N3 stage. SBR II tumors were the most common (90%). Only 20% of patients have HER2 overexpression, whereas 73.33% have ER expression. EBV was found in 23.33% of breast carcinomas (7 cases/30) after oncoprotein LMP1 expression, but normal surrounding tissues tested negative. We discovered that overexpression of the HER2 protein is inversely related to the two HRs' expression. They have no relationship with EBV infection and, consequently, LMP1 expression. LMP1 expression was not shown to be linked with patient age, tumor grade, tumor size, or lymph node invasion.
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Affiliation(s)
- Kahina Gouadfel
- Laboratoire LABAB. Université Mouloud Mammeri de Tizi-Ouzou, Algeria.
| | - Abdelhalim Khenchouche
- Département de microbiologie, Faculté des sciences de la nature et de la vie, Université F.A. Sétif 1, Algeria.
| | - Sameh Rabea
- Department of Pharmaceutical Sciences. College of Pharmacy. AlMAAREFA University, Diriyah 13713 Riyadh, Saudi Arabia.
| | - Ahd A Mansour
- Medical Laboratory Science Department, Fakeeh College for Medical Sciences, P.O. Box 2537, Jeddah 21461, Saudi Arabia.
| | - Mounir M Salem-Bekhit
- Department of Pharmaceutics, College of Pharmacy, King Saud University, PO Box 2457, Riyadh 11451, Saudi Arabia.
| | - Soraya Ouhida
- Laboratoire d'Anatomie pathologie. CHU Saadna Abdenour, Sétif, Algeria.
| | - Amine Msela
- Laboratoire LABAB. Université Mouloud Mammeri de Tizi-Ouzou, Algeria.
| | - Mohamed M Salem
- Faculty of Medicine, Huazhong University of Science and Technology, Wuhan, China.
| | - Alessandro Erto
- Dipartiment odi Ingegneria Chimica, dei Materialie della Produzione Industriale,Università degli Studidi Napoli FedericoII, P.leTecchio, 80,80125 Napoli, Italy.
| | - Yacine Benguerba
- Laboratoire de Biopharmacie Et Pharmacotechnie (LPBT), Ferhat Abbas Setif 1 University, Setif, Algeria.
| | - Karim Houali
- Laboratoire LABAB. Université Mouloud Mammeri de Tizi-Ouzou, Algeria.
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Gajjar AA, Covell MM, Salem MM, Sioutas GS, Hasan S, Dinh Le AH, Srinivasan VM, Burkhardt JK. Patient sentiment regarding stroke: Analysis of 2,992 social media posts. J Stroke Cerebrovasc Dis 2023; 32:107376. [PMID: 37813085 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/05/2023] [Accepted: 09/15/2023] [Indexed: 10/11/2023] Open
Abstract
INTRODUCTION Social media reflects personalized sentiment toward disease and increasingly impacts perceptions of treatment options. This study aims to assess patients experience with and perception of stroke through an analysis of social media posts. METHODS A variety of terms ("stroke", "stroke survivor", "stroke rehab", "stroke recovery") were used to search for possible qualified posts on Twitter and Instagram. Twitter posts containing "#stroke" and "@stroke" were identified, yielding 2,506 Twitter posts relating to the patient's own experience. Four hundred sixty-eight public Instagram posts marked under "#stroke" and "@stroke," including direct references to the patient's own experience, were analyzed. First vs. recurrent stroke was identified when possible. The posts were coded for themes relating to patient experience with the disease. RESULTS The most common Twitter theme was raising stroke awareness (23.4 %), while spreading positivity was the most common Instagram theme (66.7 %). Most Twitter posts (93.9 %) were from patients experiencing their first stroke, with only 6.1 % of the posts being about recurrent strokes. Women created the majority of Instagram (75.7 %) and Twitter (77.3 %) posts. Men were more likely to discuss mobility/functional outcomes (p = 0.001) and survival/death (p = 0.014), while women were more likely to recount symptoms (p = 0.014), depression (p = 0.002), fear (p<0.001), and mental health (p = 0.006). CONCLUSION Stroke patients most often describe their quality of life and discuss raising awareness via social media. Men and women differ in the most commonly shared aspects of their stroke experience. Gauging social media sentiment may guide physicians toward better counseling and psychosocial management of stroke patients.
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Affiliation(s)
- Avi A Gajjar
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Michael M Covell
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA; School of Medicine, Georgetown University, Washington, D.C., USA
| | - Mohamed M Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Georgios S Sioutas
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Sidra Hasan
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA; Department of Biology, Union College, Schenectady, New York, USA
| | - Anthony Huy Dinh Le
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA.
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Sioutas GS, Salem MM, Burkhardt JK, Srinivasan VM, Jankowitz BT. Comaneci-assisted coiling of a right posterior communicating artery aneurysm: an unusual case of coil retention. J Neurointerv Surg 2023; 15:1286. [PMID: 37015782 DOI: 10.1136/jnis-2022-020045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/19/2023] [Indexed: 04/06/2023]
Abstract
Although endovascular embolization has become the main treatment option for intracranial aneurysms,1 2 wide-necked intracranial aneurysms remain difficult to coil.3 Both stent- and balloon-assisted coiling are used for wide-necked aneurysms because they provide a scaffold that protects the parent vessel during coiling.4 5 However, stent-assisted coiling requires dual antiplatelet therapy, which increases the risk of bleeding, whereas balloon-assisted coiling temporarily obstructs blood flow.4 6 7 The Comaneci device (Rapid Medical, Yokneam, Israel) has recently received US Food and Drug Administration approval as a 'temporary coil embolization assist device'.5 It temporarily covers the aneurysm neck and allows safe coiling, avoiding the disadvantages mentioned above.6-8 A potential complication of Comaneci-assisted coiling is coil retention when it adheres to the device on recapture; this complication should be promptly recognized and managed.5 9 10 In this video, we present an unusual case of coil retention with the Comaneci device (Video 1). neurintsurg;15/12/1286/V1F1V1Video 1 .
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Affiliation(s)
- Georgios S Sioutas
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Mohamed M Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Brian T Jankowitz
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
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Jia Y, Chen F, Yan T, Zhang S, Salem MM, Singh S, Salem-Bekhit MM, Kumar SK, Ali MM. Influence of environmental risk factors on the development of wounds associated with squamous cell carcinoma. Int Wound J 2023; 21:e14506. [PMID: 38010070 PMCID: PMC10898377 DOI: 10.1111/iwj.14506] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023] Open
Abstract
The incidence of squamous cell carcinoma (SCC) is on the rise, making it a significant global health concern. Environmental risk factors are crucial to the development of SCC. This study sought to examine comprehensively the impact of these factors on the onset of SCC. We conducted a cross-sectional study involving 480 participants at Beijing tertiary care hospital. Utilizing structured questionnaires, data on demographics, environmental exposures, medical history and clinical characteristics were collected. The cohort was composed of 272 men (56.67%) and 208 women (43.33%). The majority (44.38%) were between ages of 41 and 60, and Type III skin predominated (34.79%). Most of the participants belonged to the middle socioeconomic class (60.83%). 'Vegetarian' dietary habits (46.67%) were prevalent, as was the 'Sedentary' lifestyle (49.79%). Regarding environmental exposures, moderate sun exposure of 3 to 5 h per day (54.58%) and UV protective eyewear (30.83%) were prevalent. The majority (69.58%) of respondents indicated 'Never' exposure to carcinogens. A variety of wound characteristics were observed, with 'non-smokers' (64.17%) dominating. Most SCC lesions were located on the extremities (40.21%), lasted less than 6 months (44.38%) and measured 1-3 cm (39.79%). The majority (54.58%) did not have a history of cutaneous injuries. Our research uncovered substantial relationships between SCC and numerous environmental variables, gender, Fitzpatrick skin type, occupation, duration of sun exposure, exposure to carcinogens, dietary practices, history of skin wounds, wound location, duration, size and depth were significantly associated with the onset of SCC. These results highlighted the complexity of SCC aetiology and need for individualized prevention and treatment strategies.
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Affiliation(s)
- Yulei Jia
- Beauty Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Fengchao Chen
- Beauty Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Tongtong Yan
- Beauty Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Siya Zhang
- Beauty Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Mohamed M Salem
- College of Medicine, Huazhong University of Science and Technology, Wuhan, China
| | - Soumya Singh
- College of Medicine, Huazhong University of Science and Technology, Wuhan, China
| | - Mounir M Salem-Bekhit
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Sanjay Kirshan Kumar
- Department of Clinical Sciences, Bahria University Health Sciences, Karachi, Pakistan
| | - Muhammad Mehr Ali
- Department of Basic Sciences, Northwest School of Medicine, Peshawar, Pakistan
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Chen H, Salem MM, Colasurdo M, Sioutas GS, Khalife J, Kuybu O, Carroll KT, Hoang AN, Baig AA, Salih M, Khorasanizadeh M, Baker C, Mendez Ruiz A, Cortez GM, Abecassis Z, Ruiz Rodríguez JF, Davies JM, Narayanan S, Cawley CM, Riina H, Moore J, Spiotta AM, Khalessi A, Howard BM, Hanel RA, Tanweer O, Tonetti D, Siddiqui AH, Lang M, Levy EI, Jovin TG, Grandhi R, Srinivasan VM, Levitt MR, Ogilvy CS, Jankowitz B, Thomas AJ, Gross BA, Burkhardt JK, Kan P. Standalone middle meningeal artery embolization versus middle meningeal artery embolization with concurrent surgical evacuation for chronic subdural hematomas: a multicenter propensity score matched analysis of clinical and radiographic outcomes. J Neurointerv Surg 2023:jnis-2023-020907. [PMID: 37932033 DOI: 10.1136/jnis-2023-020907] [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: 08/12/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Middle meningeal artery embolization (MMAE) has emerged as a promising therapy for chronic subdural hematomas (cSDHs). The efficacy of standalone MMAE compared with MMAE with concurrent surgery is largely unknown. METHODS cSDH patients who underwent successful MMAE from 14 high volume centers with at least 30 days of follow-up were included. Clinical and radiographic variables were recorded and used to perform propensity score matching (PSM) of patients treated with standalone MMAE or MMAE with concurrent surgery. Multivariable logistic regression models were used for additional covariate adjustments. The primary outcome was recurrence requiring surgical rescue, and the secondary outcome was radiographic failure defined as <50% reduction of cSDH thickness. RESULTS 722 MMAE procedures in 588 cSDH patients were identified. After PSM, 230 MMAE procedures remained (115 in each group). Median age was 73 years, 22.6% of patients were receiving anticoagulation medication, and 47.9% had no preoperative functional disability. Median midline shift was 4 mm and cSDH thickness was 16 mm, representing modestly sized cSDHs. Standalone MMAE and MMAE with surgery resulted in similar rates of surgical rescue (7.8% vs 13.0%, respectively, P=0.28; adjusted OR (aOR 0.73 (95% CI 0.20 to 2.40), P=0.60) and radiographic failure (15.5% vs 13.7%, respectively, P=0.84; aOR 1.08 (95% CI 0.37 to 2.19), P=0.88) with a median follow-up duration of 105 days. These results were similar across subgroup analyses and follow-up durations. CONCLUSIONS Standalone MMAE led to similar and durable clinical and radiographic outcomes as MMAE combined with surgery in select patients with moderately sized cSDHs and mild clinical disease.
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Affiliation(s)
- Huanwen Chen
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
- Neurology, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Mohamed M Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marco Colasurdo
- Interventional Radiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Georgios S Sioutas
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jane Khalife
- Department of Neurosurgery, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Okkes Kuybu
- Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Kansas, USA
| | - Kate T Carroll
- Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Alex Nguyen Hoang
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Ammad A Baig
- Neurosurgery, Buffalo State, The State University of New York, Buffalo, New York, USA
| | - Mira Salih
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Cordell Baker
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
| | - Aldo Mendez Ruiz
- Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Kansas, USA
| | | | - Zack Abecassis
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | | | - Jason M Davies
- Neurosurgery and Biomedical Engineering, Toshiba Stroke and Vascular Research Institute, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Sandra Narayanan
- Department of Neurology, Neurosurgery, UPMC, Pittsburgh, Pennsylvania, USA
| | | | | | - Justin Moore
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Alejandro M Spiotta
- Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alexander Khalessi
- Department of Neurological Surgery, University of California San Diego, La Jolla, California, USA
| | - Brian M Howard
- Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ricardo A Hanel
- Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA
| | - Omar Tanweer
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
| | - Daniel Tonetti
- Department of Neurosurgery, Cooper University Health Care, Camden, New Jersey, USA
| | - Adnan H Siddiqui
- Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Michael Lang
- Department of Neurosurgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Elad I Levy
- Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Tudor G Jovin
- Neurology, Cooper University Hospital, Camden, New Jersey, USA
| | - Ramesh Grandhi
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
| | | | - Michael R Levitt
- Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | | | - Brian Jankowitz
- Neurosurgery, University of Pennsylvania, Camden, Pennsylvania, USA
| | - Ajith J Thomas
- Department of Neurosurgery, Cooper University Health Care, Camden, New Jersey, USA
| | - Bradley A Gross
- Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jan Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Peter Kan
- Neurosurgery, University of Texas Medical Branch at Galveston, Galveston, Texas, USA
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Sioutas GS, Palepu C, Salem MM, Nia AM, Vivanco-Suarez J, Burkhardt JK, Jankowitz BT, Srinivasan VM. Postoperative de novo epilepsy after resection of brain arteriovenous malformations: A national database study of 536 patients. Epilepsia 2023; 64:2914-2921. [PMID: 37638560 DOI: 10.1111/epi.17765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE We aimed to assess the incidence and risk factors for de novo epilepsy after arteriovenous malformation (AVM) resection and compare them with a nonresection cohort after propensity score matching, utilizing a national database. METHODS Utilizing the TriNetX Research Network, we queried cases from January 1, 2004 to March 1, 2022. We included patients of all ages who underwent supratentorial AVM resection, presenting without seizures on or before surgery and without being on antiseizure medications at least 1 day before surgery. The primary outcome was seizures manifesting at least 6 weeks after surgery. Patient characteristics and outcomes were compared between the cohorts with and without postoperative epilepsy. Further cohorts were created to compare cohorts with and without embolization or rupture. After propensity score matching, we compared an additional cohort of patients with an AVM diagnosis who did not undergo resection. RESULTS Of the 536 patients (mean age = 38.9 ± 19.6, 52% females) presenting without seizure who underwent AVM resection, 99 (18.5%) developed de novo epilepsy, with a 1-year cumulative incidence of 13.8%. Patients with epilepsy had higher rates of intracerebral hemorrhage, and intracerebral hemorrhage was less common in the embolization cohort. Patients in the ruptured cohort were older and more often males. After propensity score matching with 18 588 patients with AVM diagnosis but no resection, each group consisted of 529 patients, and de novo epilepsy at 1 year was significantly higher in the AVM resection cohort compared to the nonresection cohort (11.5% vs. 3.4%, p < .001). SIGNIFICANCE This analysis of 536 patients provides evidence that de novo epilepsy after brain AVM resection occurs at a 1-year cumulative incidence of 13.8%, with a total of 19.4% developing de novo epilepsy. Intracerebral hemorrhage was inconsistently associated with postoperative de novo epilepsy. De novo epilepsy was significantly less frequent after AVM diagnosis without resection.
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Affiliation(s)
- Georgios S Sioutas
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Chandrasekhar Palepu
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Mohamed M Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Anna M Nia
- Department of Neurological Surgery, Montefiore/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Juan Vivanco-Suarez
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Brian T Jankowitz
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
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Mohammaden MH, Haussen DC, Al-Bayati AR, Hassan AE, Tekle W, Fifi JT, Matsoukas S, Kuybu O, Gross BA, Lang M, Narayanan S, Cortez GM, Hanel RA, Aghaebrahim A, Sauvageau E, Farooqui M, Ortega-Gutierrez S, Zevallos CB, Galecio-Castillo M, Sheth SA, Nahhas M, Salazar-Marioni S, Nguyen TN, Abdalkader M, Klein P, Hafeez M, Kan P, Tanweer O, Khaldi A, Li H, Jumaa M, Zaidi SF, Oliver M, Salem MM, Burkhardt JK, Pukenas B, Kumar R, Lai M, Siegler JE, Peng S, Alaraj A, Nogueira RG. General anesthesia vs procedural sedation for failed NeuroThrombectomy undergoing rescue stenting: intention to treat analysis. J Neurointerv Surg 2023; 15:e240-e247. [PMID: 36597943 DOI: 10.1136/jnis-2022-019376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/16/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is little data available to guide optimal anesthesia management during rescue intracranial angioplasty and stenting (ICAS) for failed mechanical thrombectomy (MT). We sought to compare the procedural safety and functional outcomes of patients undergoing rescue ICAS for failed MT under general anesthesia (GA) vs non-general anesthesia (non-GA). METHODS We searched the data from the Stenting and Angioplasty In Neuro Thrombectomy (SAINT) study. In our review we included patients if they had anterior circulation large vessel occlusion strokes due to intracranial internal carotid artery (ICA) or middle cerebral artery (MCA-M1/M2) segments, failed MT, and underwent rescue ICAS. The cohort was divided into two groups: GA and non-GA. We used propensity score matching to balance the two groups. The primary outcome was the shift in the degree of disability as measured by the modified Rankin Scale (mRS) at 90 days. Secondary outcomes included functional independence (90-day mRS0-2) and successful reperfusion defined as mTICI2B-3. Safety measures included symptomatic intracranial hemorrhage (sICH) and 90-day mortality. RESULTS Among 253 patients who underwent rescue ICAS, 156 qualified for the matching analysis at a 1:1 ratio. Baseline demographic and clinical characteristics were balanced between both groups. Non-GA patients had comparable outcomes to GA patients both in terms of the overall degree of disability (mRS ordinal shift; adjusted common odds ratio 1.29, 95% CI [0.69 to 2.43], P=0.43) and rates of functional independence (33.3% vs 28.6%, adjusted odds ratio 1.32, 95% CI [0.51 to 3.41], P=0.56) at 90 days. Likewise, there were no significant differences in rates of successful reperfusion, sICH, procedural complications or 90-day mortality among both groups. CONCLUSIONS Non-GA seems to be a safe and effective anesthesia strategy for patients undergoing rescue ICAS after failed MT. Larger prospective studies are warranted for more concrete evidence.
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Affiliation(s)
- Mahmoud H Mohammaden
- Neurology, Emory University, Atlanta, Georgia, USA
- Marcus Stroke and Neuroscience center, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Diogo C Haussen
- Neurology, Emory University, Atlanta, Georgia, USA
- Marcus Stroke and Neuroscience center, Grady Memorial Hospital, Atlanta, Georgia, USA
| | | | - Ameer E Hassan
- Neurology, University of Texas Rio Grande Valley, Harlingen, Texas, USA
| | - Wondwossen Tekle
- Neurology, University of Texas Rio Grande Valley, Harlingen, Texas, USA
| | - Johanna T Fifi
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stavros Matsoukas
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Okkes Kuybu
- Neurology, UPMC Stroke Institute, Pittsburgh, Pennsylvania, USA
| | | | - Michael Lang
- Neurosurgery, UPMC, Pittsburgh, Pennsylvania, USA
| | | | - Gustavo M Cortez
- Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA
| | - Ricardo A Hanel
- Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA
| | - Amin Aghaebrahim
- Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA
| | - Eric Sauvageau
- Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA
| | - Mudassir Farooqui
- Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Santiago Ortega-Gutierrez
- Neurology, Neurosurgery and Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Cynthia B Zevallos
- Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | | | - Sunil A Sheth
- Neurology, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Michael Nahhas
- Neurology, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | | | - Thanh N Nguyen
- Neurology and Radiology, Boston University School of Medicine, Boston, MA, USA
| | | | - Piers Klein
- Neurology and Radiology, Boston University School of Medicine, Boston, MA, USA
| | - Muhammad Hafeez
- Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Peter Kan
- Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | | | - Ahmad Khaldi
- Neurosurgery, WellStar Health System, Marietta, Georgia, USA
| | - Hanzhou Li
- Department of Neurosciences, WellStar Health System, Marietta, Georgia, USA
| | - Mouhammad Jumaa
- Neurology, The University of Toledo Medical Center, Toledo, Ohio, USA
| | - Syed F Zaidi
- Neurology, The University of Toledo Medical Center, Toledo, Ohio, USA
| | - Marion Oliver
- Neurology, The University of Toledo Medical Center, Toledo, Ohio, USA
| | - Mohamed M Salem
- Neurosurgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Jan-Karl Burkhardt
- Neurosurgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Bryan Pukenas
- Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rahul Kumar
- Cooper Hospital University Medical Center, Camden, New Jersey, USA
| | - Michael Lai
- Cooper Hospital University Medical Center, Camden, New Jersey, USA
| | - James E Siegler
- Cooper Hospital University Medical Center, Camden, New Jersey, USA
| | - Sophia Peng
- Neurosurgery, University of Illinois Medical Center at Chicago, Chicago, Illinois, USA
| | - Ali Alaraj
- Neurosurgery, University of Illinois Medical Center at Chicago, Chicago, Illinois, USA
| | - Raul G Nogueira
- Neurology, UPMC Stroke Institute, Pittsburgh, Pennsylvania, USA
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Salih M, Khorasanizadeh M, Salem MM, Baig AA, Kim H, Lucke-Wold B, Hoh BL, Jankowitz BT, Burkhardt JK, Siddiqui AH, Taussky P, Thomas AJ, Moore JM, Ogilvy CS. Effect of Chronic Anticoagulation on Outcomes of Endovascular Treatment for Unruptured Intracranial Aneurysms-A Propensity-Matched Multicenter Study. Neurosurgery 2023; 93:1007-1018. [PMID: 37255291 DOI: 10.1227/neu.0000000000002523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/21/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Endovascular treatment of unruptured intracranial aneurysms (UIAs) in patients receiving anticoagulant medications has not been well studied. Whether long-term anticoagulation (AC) use affects aneurysmal obliteration rates and treatment-related complications is unclear. METHODS Patients with endovascular treatment for UIA from 4 academic centers were identified and divided into AC and non-AC groups. Periprocedural complications, radiographic and clinical outcomes, and retreatment rates were compared between the 2 groups before and after propensity score matching. RESULTS The initial cohort consisted of 70 patients in the AC group and 355 in the non-AC group. After one-to-one nearest neighbor propensity matching, 38 pairs of patients were compared for periprocedural complications. The total number of complications were higher in the AC group yet not significant (18.4% vs 5.3%, P = .15). After adding imaging follow-up duration to matched variables, 36 pairs were obtained. There was no significant difference in Raymond-Roy occlusion rate between the 2 groups ( P = .74). However, retreatment rate trended higher in the AC group compared with the non-AC group (22.2% vs 5.6%, P = .09). When clinical follow-up duration was added among matched variables, 26 pairs of cases were obtained for long-term clinical outcomes. There was no significant difference in modified Rankin Scale score between the 2 groups ( P = .61). One-to-many nearest neighbor propensities matched analysis with bigger sample sizes yielded similar results. CONCLUSION The use of anticoagulants does not affect occlusion rates or long-term outcomes in endovascular treatment of UIAs. Retreatment rates were higher in the AC group; however, this was not statistically significant.
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Affiliation(s)
- Mira Salih
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston , Massachusetts , USA
| | - MirHojjat Khorasanizadeh
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston , Massachusetts , USA
| | - Mohamed M Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia , Pennsylvania , USA
| | - Ammad A Baig
- University at Buffalo Neurosurgery, Buffalo , New York , USA
| | - Hoon Kim
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston , Massachusetts , USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville , Florida , USA
| | - Brian L Hoh
- Department of Neurosurgery, University of Florida, Gainesville , Florida , USA
| | - Brian T Jankowitz
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia , Pennsylvania , USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia , Pennsylvania , USA
| | | | - Philipp Taussky
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston , Massachusetts , USA
| | - Ajith J Thomas
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston , Massachusetts , USA
| | - Justin M Moore
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston , Massachusetts , USA
| | - Christopher S Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston , Massachusetts , USA
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Tudor T, Sussman J, Sioutas GS, Salem MM, Muhammad N, Romeo D, Corral Tarbay A, Kim Y, Ng J, Rhodes IJ, Gajjar A, Hurst RW, Pukenas B, Bagley L, Choudhri OA, Zager EL, Srinivasan VM, Jankowitz BT, Burkhardt JK. Intraoperative angiography in neurosurgery: temporal trend, access site, and operative indication considerations from a 6-year institutional experience. J Neurointerv Surg 2023:jnis-2023-020709. [PMID: 37852753 DOI: 10.1136/jnis-2023-020709] [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: 06/20/2023] [Accepted: 09/25/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Historically, the transfemoral approach (TFA) has been the most common access site for cerebral intraoperative angiography (IOA). However, in line with trends in cardiac interventional vascular access preferences, the transradial approach (TRA) and transulnar approach (TUA) have been gaining popularity owing to favorable safety and patient satisfaction outcomes. OBJECTIVE To compare the efficacy and safety of TRA/TUA and TFA for cerebral and spinal IOA at an institutional level over a 6-year period. METHODS Between July 2016 and December 2022, 317 angiograms were included in our analysis, comprising 60 TRA, 10 TUA, 243 TFA, and 4 transpopliteal approach cases. Fluoroscopy time, contrast dose, reference air kerma, and dose-area products per target vessel catheterized were primary endpoints. Multivariate regression analyses were conducted to evaluate predictors of elevated contrast dose and radiation exposure and to assess time trends in access site selection. RESULTS Contrast dose and radiation exposure metrics per vessel catheterized were not significantly different between access site groups when controlling for patient position, operative region, 3D rotational angiography use, and different operators. Access site was not a significant independent predictor of elevated radiation exposure or contrast dose. There was a significant relationship between case number and operative indication over the study period (P<0.001), with a decrease in the proportion of cases for aneurysm treatment offset by increases in total cases for the management of arteriovenous malformation, AVF, and moyamoya disease. CONCLUSIONS TRA and TUA are safe and effective access site options for neurointerventional procedures that are increasingly used for IOA.
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Affiliation(s)
- Thilan Tudor
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jonathan Sussman
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Graduate Group in Genomics and Computational Biology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Georgios S Sioutas
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mohamed M Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Najib Muhammad
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dominic Romeo
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Antonio Corral Tarbay
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yohan Kim
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jinggang Ng
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Isaiah J Rhodes
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Avi Gajjar
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert W Hurst
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Bryan Pukenas
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Linda Bagley
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Omar A Choudhri
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eric L Zager
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brian T Jankowitz
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Messaoudi O, Benamar I, Azizi A, Albukhaty S, Khane Y, Sulaiman GM, Salem-Bekhit MM, Hamdi K, Ghoummid S, Zoukel A, Messahli I, Kerchich Y, Benaceur F, Salem MM, Bendahou M. Characterization of Silver Carbonate Nanoparticles Biosynthesized Using Marine Actinobacteria and Exploring of Their Antimicrobial and Antibiofilm Activity. Mar Drugs 2023; 21:536. [PMID: 37888471 PMCID: PMC10608482 DOI: 10.3390/md21100536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023] Open
Abstract
Bacterial resistance to different antimicrobial agents is growing with alarming speed, especially when bacterial cells are living in biofilm. Hybrid nanoparticles, synthesized through the green method, hold promise as a potential solution to this challenge. In this study, 66 actinomycete strains were isolated from three distinct marine sources: marine sediment, the algae Codium bursa, and the marine sponge Chondrosia reniformis. From the entirety of the isolated strains, one strain, S26, identified as Saccharopolyspora erythrea, was selected based on its taxonomic position and significant antimicrobial activity. Using the biomass of the selected marine Actinobacteria, the green synthesis of eco-friendly silver carbonate nanoparticles (BioAg2CO3NPs) is reported for the first time in this pioneering study. The BioAg2CO3NPs were characterized using different spectroscopic and microscopic analyses; the synthesized BioAg2CO3NPs primarily exhibit a triangular shape, with an approximate size of 100 nm. Biological activity evaluation indicated that the BioAg2CO3NPs exhibited good antimicrobial activity against all tested microorganisms and were able to remove 58% of the biofilm formed by the Klebsiella pneumoniae kp6 strain.
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Affiliation(s)
- Omar Messaoudi
- Department of Biology, Faculty of Science, University of Amar Telidji, Laghouat 03000, Algeria; (O.M.); (I.B.); (K.H.); (S.G.); (I.M.); (F.B.)
- Laboratory of Applied Microbiology in Food and Environment, Abou Bekr Belkaïd University, Tlemcen 13000, Algeria;
| | - Ibrahim Benamar
- Department of Biology, Faculty of Science, University of Amar Telidji, Laghouat 03000, Algeria; (O.M.); (I.B.); (K.H.); (S.G.); (I.M.); (F.B.)
- Laboratory of Applied Microbiology in Food and Environment, Abou Bekr Belkaïd University, Tlemcen 13000, Algeria;
| | - Ahmed Azizi
- Department of The Common Trunk Sciences and Technology, Faculty of Technology, University of Amar Telidji, Highway Ghardaia, P.O. Box G37 (M’kam), Laghouat 03000, Algeria;
| | - Salim Albukhaty
- Department of Chemistry, College of Science, University of Misan, Maysan 62001, Iraq
- College of Medicine, University of Warith Al-Anbiyaa, Karbala 56001, Iraq
| | - Yasmina Khane
- Faculty of Science and Technology, University of Ghardaia, BP455, Ghardaia 47000, Algeria;
| | - Ghassan M. Sulaiman
- Division of Biotechnology, Department of Applied Sciences, University of Technology, Baghdad 10066, Iraq;
| | - Mounir M. Salem-Bekhit
- Department of Pharmaceutics, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh 11451, Saudi Arabia;
| | - Kaouthar Hamdi
- Department of Biology, Faculty of Science, University of Amar Telidji, Laghouat 03000, Algeria; (O.M.); (I.B.); (K.H.); (S.G.); (I.M.); (F.B.)
| | - Sirine Ghoummid
- Department of Biology, Faculty of Science, University of Amar Telidji, Laghouat 03000, Algeria; (O.M.); (I.B.); (K.H.); (S.G.); (I.M.); (F.B.)
| | - Abdelhalim Zoukel
- Laboratory Physico-Chemistry of Materials, Laghouat University, Laghouat 03000, Algeria;
- Center for Scientific and Technical Research in Physicochemical Analysis (PTAPC-Laghouat-CRAPC), Laghouat 03000, Algeria
| | - Ilhem Messahli
- Department of Biology, Faculty of Science, University of Amar Telidji, Laghouat 03000, Algeria; (O.M.); (I.B.); (K.H.); (S.G.); (I.M.); (F.B.)
| | - Yacine Kerchich
- École Nationale Polytechnique (ENP), Laboratory of Environmental Science and Technology, El Harrach 16200, Algeria;
| | - Farouk Benaceur
- Department of Biology, Faculty of Science, University of Amar Telidji, Laghouat 03000, Algeria; (O.M.); (I.B.); (K.H.); (S.G.); (I.M.); (F.B.)
- Research Unit of Medicinal Plant (RUMP) Attached to Center of Biotechnology (CRBt, 3000, Constantine), Laghouat 03000, Algeria
| | - Mohamed M. Salem
- College of Medicine, Huazhong University of Science and Technology, Wuhan 430030, China;
| | - Mourad Bendahou
- Laboratory of Applied Microbiology in Food and Environment, Abou Bekr Belkaïd University, Tlemcen 13000, Algeria;
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Salem MM, Khorasanizadeh M, Nwajei F, Gomez-Paz S, Akamatsu Y, Jordan N, Maroufi SF, Thomas AJ, Ogilvy CS, Moore JM. Predictors of aneurysmal occlusion following intracranial aneurysms treatment with pipeline embolization device. Acta Neurochir (Wien) 2023; 165:2801-2809. [PMID: 37615726 DOI: 10.1007/s00701-023-05740-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/28/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE Pipeline embolization device (PED) is thought to induce aneurysmal occlusion through diversion of flow away from the aneurysmal sac with subsequent thrombosis and endothelialization. The impact of different factors especially hypertension (HTN)-a known predisposing factor to hypercoagulability and altered endothelial function-on aneurysmal occlusion after flow diversion has not been studied. We sought to determine predictors of aneurysmal occlusion following PED treatment focusing on impact of blood pressure. METHODS Database of patients with cerebral aneurysms treated with PED from 2013 to 2019 at our institution was retrospectively reviewed. Patients were defined as hypertensive if (1) they had a documented history of HTN requiring anti-HTN medications or (2) average systolic blood pressure on three measurements was > 130 mmHg. The primary outcome was aneurysm occlusion status at the last imaging follow-up. Multivariable logistic regression model was constructed to assess the effect of HTN on occlusion, controlling for age, smoking, aneurysmal size, fusiform morphology, posterior circulation location, and incorporated branches. RESULTS A total of 331 aneurysms in 294 patients were identified for this analysis. The mean age was 59 years (79.9% female). Fifty-five percent of the cohort were classified as hypertensive. When controlling for other potential confounders, hypertensive patients trended toward higher odds of achieving complete occlusion compared to non-hypertensive patients (OR = 2.05; 95% CI = 0.99-4.25; p = 0.052). Meanwhile, age (OR = 0.91; 95% CI = 0.88-0.95; p < 0.001) and an incorporated branch into an aneurysm (OR = 0.22; 95% CI = 0.08-0.58; p < 0.002) were associated with decreased odds for complete aneurysmal occlusion. CONCLUSION Hypertensive patients show a trend toward higher odds of achieving complete occlusion when controlling for potential confounders. The HTN-induced hypercoagulable state, enhanced endothelial activation, and altered extracellular matrix regulation might be the contributing factors. Further research is warranted to explore clinical implications of these findings.
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Affiliation(s)
- Mohamed M Salem
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - MirHojjat Khorasanizadeh
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Felix Nwajei
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Santiago Gomez-Paz
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Yosuke Akamatsu
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Noah Jordan
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Ajith J Thomas
- Department of Neurosurgery, Cooper University Hospital, Camden, NJ, USA
| | - Christopher S Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Justin M Moore
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Salem MM, Jankowitz BT, Burkhardt JK, Price LL, Zaidat OO. Comparative analysis of long term effectiveness of Neuroform Atlas stent versus low profile visualized intraluminal stent/Woven EndoBridge devices in treatment of wide necked intracranial aneurysms. J Neurointerv Surg 2023:jnis-2023-020716. [PMID: 37734932 DOI: 10.1136/jnis-2023-020716] [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: 06/20/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND We compared the outcomes of wide necked aneurysms (WNA) treated with the Neuroform Atlas with those treated with the low profile visualized intraluminal stent (LVIS) or the Woven EndoBridge (WEB). METHODS Objective, prospectively collected, core laboratory adjudicated data from published trials for the Neuroform Atlas, LVIS, and WEB devices were reviewed. ATLAS (Safety and Effectiveness of the Treatment of Wide Neck, Saccular Intracranial Aneurysms With the Neuroform Atlas Stent System) study patients were included if they met other studies' inclusion criteria. Outcomes included (1) primary effectiveness (complete aneurysmal occlusion without retreatment/>50% parent vessel stenosis), (2) primary safety, (3) complete aneurysmal occlusion, and (4) retreatment rates (outcomes evaluated at the 12 month follow-up). Matching adjusted indirect comparison analysis was used to compare outcomes. RESULTS Analytical samples included 141 ATLAS subjects meeting WEB-IT (Woven EndoBridge Intrasaccular Therapy Study) criteria (ATLAS/WEB-IT) and 241 meeting LVIS (Pivotal Study of the Low Profile Visualized Intraluminal Support) criteria (ATLAS/LVIS). ATLAS/WEB-IT exhibited significantly higher rates of primary effectiveness and complete occlusion versus WEB (86.6% vs 53.9 %, P<0.0001, and 90.3% vs 53.9%, P<0.0001, respectively). For LVIS, there was no significant differences in primary effectiveness rates between ATLAS and LVIS (84.2% vs 77.7%, respectively, P=0.12). However, ATLAS/LVIS had a significantly higher proportion of patients achieving complete occlusion than LVIS (88.1 vs 79.1, P=0.03). Retreatment rates and primary safety outcomes were not significantly different (P>0.05) for the Atlas versus other devices except for a lower retreatment rate for ATLAS/WEB-IT versus WEB-IT (2.4% vs 9.8%, P=0.01). CONCLUSION The Neuroform Atlas provided higher occlusion rates and similar retreatment rates in comparable datasets compared with LVIS and WEB devices when treating WNA.
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Affiliation(s)
- Mohamed M Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brian T Jankowitz
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lori Lyn Price
- Clinical Affairs, Stryker Neurovascular, Fremont, California, USA
| | - Osama O Zaidat
- Neuroscience, St Vincent Mercy Hospital, Toledo, Ohio, USA
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Mohammaden MH, Tarek MA, Aboul Nour H, Haussen DC, Fifi JT, Matsoukas S, Farooqui M, Ortega-Gutierrez S, Zevallos CB, Galecio-Castillo M, Hassan AE, Tekle W, Al-Bayati AR, Salem MM, Burkhardt JK, Pukenas B, Cortez GM, Hanel RA, Aghaebrahim A, Sauvageau E, Hafeez M, Kan P, Tanweer O, Jumaa M, Zaidi SF, Oliver M, Sheth SA, Nahhas M, Salazar-Marioni S, Khaldi A, Li H, Kuybu O, Abdalkader M, Klein P, Peng S, Alaraj A, Nguyen TN, Nogueira RG. Rescue intracranial stenting for failed posterior circulation thrombectomy: analysis from the Stenting and Angioplasty in NeuroThrombectomy (SAINT) study. J Neurointerv Surg 2023:jnis-2023-020676. [PMID: 37699704 DOI: 10.1136/jnis-2023-020676] [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: 06/06/2023] [Accepted: 08/21/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUNDS Recent trials have shown improved outcomes after mechanical thrombectomy (MT) for vertebrobasilar occlusion (VBO) stroke. However, there is a paucity of data regarding safety and outcomes of rescue intracranial stenting (RS) after failed MT (FRRS+) for posterior circulation stroke. We sought to compare RS to failed reperfusion without RS (FRRS-). METHODS This is a retrospective analysis of the Stenting and Angioplasty in NeuroThrombectomy (SAINT) study, a multicenter collaboration involving prospectively collected databases. Patients were included if they had posterior circulation stroke and failed MT. The cohort was divided into two groups: FRRS+ and FRRS- (defined as modified Thrombolysis In Cerebral Infarction (mTICI) score 0-2a). The primary outcome was a shift in the degree of disability as measured by the modified Rankin Scale (mRS) at 90 days. Secondary outcomes included mRS 0-2 and mRS 0-3 at 90 days. Safety measures included rates of symptomatic intracranial hemorrhage (sICH), procedural complications, and 90-day mortality. Sensitivity and subgroup analyses were performed to identify outcomes in a matched cohort and in those with VBO, respectively. RESULTS A total of 152 failed thrombectomies were included in the analysis. FRRS+ (n=84) was associated with increased likelihood of lower disability (acOR 2.24, 95% CI 1.04 to 4.95, P=0.04), higher rates of mRS 0-2 (26.8% vs 12.5%, aOR 4.43, 95% CI 1.22 to 16.05, P=0.02) and mRS 0-3 (35.4% vs 18.8%, aOR 3.13, 95% CI 1.08 to 9.10, P=0.036), and lower mortality (42.7% vs 59.4%, aOR 0.40, 95% CI 0.17 to 0.97, P=0.04) at 90 days compared with FRRS- (n=68). The rates of sICH and procedural complications were comparable between the groups. Sensitivity and subgroup analyses showed similar results. CONCLUSION In patients with posterior circulation stroke who had failed MT, RS resulted in better functional outcomes with comparable safety profile to procedure termination.
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Affiliation(s)
- Mahmoud H Mohammaden
- Neurology, South Valley University Faculty of Medicine, Qena, Egypt
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
- Neurology, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Mohamed A Tarek
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
- Neurology, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Hassan Aboul Nour
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
- Neurology, Grady Memorial Hospital, Atlanta, Georgia, USA
- Neurology and Neurosurgery, University of Kentucky, Lexington, Kentucky, USA
| | - Diogo C Haussen
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
- Neurology, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Johanna T Fifi
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stavros Matsoukas
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mudassir Farooqui
- Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Santiago Ortega-Gutierrez
- Neuroloy, Neurosurgery and Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | | | | | - Ameer E Hassan
- Department of Neurology, University of Texas Rio Grande Valley, Harlingen, Texas, USA
| | | | | | - Mohamed M Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jan Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Bryan Pukenas
- Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Ricardo A Hanel
- Neurosurgery, Lyerly Neurosurgery, Jacksonville, Florida, USA
| | | | - Eric Sauvageau
- Neurosurgery, Lyerly Neurosurgery, Jacksonville, Florida, USA
| | - Muhammad Hafeez
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Peter Kan
- Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Omar Tanweer
- Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Mouhammad Jumaa
- Neurology, University of Toledo - Health Science Campus, Toledo, Ohio, USA
| | - Syed F Zaidi
- Neurology, University of Toledo - Health Science Campus, Toledo, Ohio, USA
| | - Marion Oliver
- Department of Neurology, University of Toledo - Health Science Campus, Toledo, Ohio, USA
| | - Sunil A Sheth
- Neurology, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Michael Nahhas
- Department of Neurosurgery, University of Texas McGovern Medical School, Houston, Texas, USA
| | | | - Ahmad Khaldi
- Neurosurgery, WellStar Health System, Marietta, Georgia, USA
| | - Hanzhou Li
- Department of Neurosciences, WellStar Health System, Marietta, Georgia, USA
| | - Okkes Kuybu
- Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Piers Klein
- Neurology, Radiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Sophia Peng
- Neurosurgery, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Ali Alaraj
- Neurosurgery, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Thanh N Nguyen
- Neurology, Boston University Medical Center, Boston, Massachusetts, USA
| | - Raul G Nogueira
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Neurology, Neurosurgery, UPMC, Pittsburgh, Pennsylvania, USA
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Diestro JDB, Dibas M, Adeeb N, Regenhardt RW, Vranic JE, Guenego A, Lay SV, Renieri L, Al Balushi A, Shotar E, Premat K, El Naamani K, Saliou G, Möhlenbruch MA, Lylyk I, Foreman PM, Vachhani JA, Župančić V, Hafeez MU, Rutledge C, Rai H, Tutino VM, Mirshani S, Ghozy S, Harker P, Alotaibi NM, Rabinov JD, Ren Y, Schirmer CM, Goren O, Piano M, Kuhn AL, Michelozzi C, Elens S, Starke RM, Hassan A, Salehani A, Nguyen A, Jones J, Psychogios M, Spears J, Parra-Fariñas C, Bres Bullrich M, Mayich M, Salem MM, Burkhardt JK, Jankowitz BT, Domingo RA, Huynh T, Tawk R, Ulfert C, Lubicz B, Panni P, Puri AS, Pero G, Griessenauer CJ, Asadi H, Siddiqui A, Ducruet AF, Albuquerque FC, Du R, Kan P, Kalousek V, Lylyk P, Boddu SR, Stapleton CJ, Knopman J, Jabbour P, Tjoumakaris S, Clarençon F, Limbucci N, Aziz-Sultan MA, Cuellar-Saenz HH, Cognard C, Patel AB, Dmytriw AA. Intrasaccular flow disruption for ruptured aneurysms: an international multicenter study. J Neurointerv Surg 2023; 15:844-850. [PMID: 35868856 DOI: 10.1136/jnis-2022-019153] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/01/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The Woven EndoBridge (WEB) device is a novel intrasaccular flow disruptor tailored for bifurcation aneurysms. We aim to describe the degree of aneurysm occlusion at the latest follow-up, and the rate of complications of aneurysms treated with the WEB device stratified according to rupture status. METHODS Our data were taken from the WorldWideWeb Consortium, an international multicenter cohort including patients treated with the WEB device. Aneurysms were classified into two groups: ruptured and unruptured. We compared clinical and radiologic outcomes of both groups. Propensity score matching (PSM) was done to match according to age, gender, bifurcation, location, prior treatment, neck, height, dome width, daughter sac, incorporated branch, pretreatment antiplatelets, and last imaging follow-up. RESULTS The study included 676 patients with 691 intracranial aneurysms (529 unruptured and 162 ruptured) treated with the WEB device. The PSM analysis had 55 pairs. In both the unmatched (85.8% vs 84.3%, p=0.692) and matched (94.4% vs 83.3%, p=0.066) cohorts there was no significant difference in the adequate occlusion rate at the last follow-up. Likewise, there were no significant differences in both ischemic and hemorrhagic complications between the two groups. There was no documented aneurysm rebleeding after WEB device implantation. CONCLUSION There was no significant difference in both the radiologic outcomes and complications between unruptured and ruptured aneurysms. Our findings support the feasibility of treatment of ruptured aneurysms with the WEB device.
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Affiliation(s)
- Jose Danilo Bengzon Diestro
- Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mahmoud Dibas
- Neuroradiology & Neurointervention Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nimer Adeeb
- Department of Neurosurgery and Neurointerventional Surgery, Louisiana State University, Shreveport, Louisiana, USA
| | - Robert W Regenhardt
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Justin E Vranic
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Adrien Guenego
- Service de Neuroradiologie Interventionnelle, Hôpital Universitaire Erasme, Bruxelles, Belgique
| | - Sovann V Lay
- Service de Neuroradiologie Diagnostique et Thérapeutique, Centre Hospitalier de Toulouse, Hôpital Purpan, Toulouse, France
| | - Leonardo Renieri
- Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy
| | - Ali Al Balushi
- Neurosurgery & Interventional Neuroradiology, New York Presbyterian Hospital, Weill Cornell School of Medicine, New York, New York, USA
| | - Eimad Shotar
- Department of Interventional Neuroradiology, Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, Paris, France
| | - Kevin Premat
- Department of Interventional Neuroradiology, Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, Paris, France
| | - Kareem El Naamani
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Guillaume Saliou
- Service de radiodiagnostic et radiologie interventionnelle, Centre Hospitalier Vaudois de Lausanne, Lausanne, Switzerland
| | | | - Ivan Lylyk
- Equipo de Neurocirugía Endovascular y Radiología Intervencionista, Clínica La Sagrada Familia, Buenos Aires, Argentina
| | - Paul M Foreman
- Neurosurgery Department, Orlando Health Neuroscience and Rehabilitation Institute, Orlando, Florida, USA
| | - Jay A Vachhani
- Neurosurgery Department, Orlando Health Neuroscience and Rehabilitation Institute, Orlando, Florida, USA
| | - Vedran Župančić
- Subdivision of Interventional Neuroradiology, Department of Radiology, Clinical Hospital Center 'Sisters of Mercy', Zagreb, Croatia
| | - Muhammad U Hafeez
- Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, Texas, USA
| | - Caleb Rutledge
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Hamid Rai
- Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York, USA
| | - Vincent M Tutino
- Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York, USA
| | - Shervin Mirshani
- Neuroradiology & Neurointervention Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sherief Ghozy
- Department of Neuroradiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Pablo Harker
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Naif M Alotaibi
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - James D Rabinov
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yifan Ren
- Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, Melbourne, Victoria, Australia
| | | | - Oded Goren
- Department of Neurosurgery, Geisinger, Danville, Pennsylvania, USA
| | - Mariangela Piano
- Neuroradiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Anna Luisa Kuhn
- Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester, Massachusetts, USA
| | | | - Stephanie Elens
- Service de Neuroradiologie Interventionnelle, Hôpital Universitaire Erasme, Bruxelles, Belgique
| | - Robert M Starke
- Deparment of Neurosurgery, University of Miami, Miami, Florida, USA
| | - Ameer Hassan
- Deparment of Neuroscience, Valley Baptist Neuroscience Institute, Harlingen, Texas, USA
| | - Arsalaan Salehani
- Deparments of Neurosurgery and Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Anh Nguyen
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Jesse Jones
- Deparments of Neurosurgery and Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Marios Psychogios
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Julian Spears
- Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Division of Neurosurgery, University of Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Carmen Parra-Fariñas
- Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Maria Bres Bullrich
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Michael Mayich
- Departments of Medical Imaging, and Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Mohamed M Salem
- Department of Neurosurgery, University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Brian T Jankowitz
- Department of Neurosurgery, University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Ricardo A Domingo
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Thien Huynh
- Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - Rabih Tawk
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Christian Ulfert
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Boris Lubicz
- Service de Neuroradiologie Interventionnelle, Hôpital Universitaire Erasme, Bruxelles, Belgique
| | - Pietro Panni
- Interventistica Neurovascolare, Ospedale San Raffaele, Milano, Italy
| | - Ajit S Puri
- Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester, Massachusetts, USA
| | - Guglielmo Pero
- Interventistica Neurovascolare, Ospedale Niguarda Cà Granda, Milano, Italy
| | - Christoph J Griessenauer
- Department of Neurosurgery, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria, Salzburg, Austria
- Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Hamed Asadi
- Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, Melbourne, Victoria, Australia
| | - Adnan Siddiqui
- Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York, USA
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Rose Du
- Neuroradiology & Neurointervention Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, Canada
| | - Peter Kan
- Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, Texas, USA
| | - Vladimir Kalousek
- Subdivision of Interventional Neuroradiology, Department of Radiology, Clinical Hospital Center 'Sisters of Mercy', Zagreb, Croatia
| | - Pedro Lylyk
- Equipo de Neurocirugía Endovascular y Radiología Intervencionista, Clínica La Sagrada Familia, Buenos Aires, Argentina
| | - Srikanth Reddy Boddu
- Neurosurgery & Interventional Neuroradiology, New York Presbyterian Hospital, Weill Cornell School of Medicine, New York, New York, USA
| | - Christopher J Stapleton
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jared Knopman
- Neurosurgery & Interventional Neuroradiology, New York Presbyterian Hospital, Weill Cornell School of Medicine, New York, New York, USA
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Frédéric Clarençon
- Department of Interventional Neuroradiology, Hopitaux Universitaires Pitie Salpetriere-Charles Foix, Paris, France
| | - Nicola Limbucci
- Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy
| | - Mohammad A Aziz-Sultan
- Neuroradiology & Neurointervention Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Hugo H Cuellar-Saenz
- Department of Neurosurgery and Neurointerventional Surgery, Louisiana State University, Shreveport, Louisiana, USA
| | - Christophe Cognard
- Service de Neuroradiologie Diagnostique et Thérapeutique, Centre Hospitalier de Toulouse, Hôpital Purpan, Toulouse, France
| | - Aman B Patel
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Adam A Dmytriw
- Neuroradiology & Neurointervention Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Salem MM, Khalife J, Desai S, Sharashidze V, Badger C, Kuhn AL, Monteiro A, Salahuddin H, Siddiqui AH, Singh J, Levy EI, Lang M, Grandhi R, Thomas AJ, Lin LM, Tanweer O, Burkhardt JK, Puri AS, Gross BA, Nossek E, Hassan AE, Shaikh HA, Jankowitz BT. COManeci MechANical Dilation for vasospasm (COMMAND): multicenter experience. J Neurointerv Surg 2023; 15:864-870. [PMID: 36002289 DOI: 10.1136/jnis-2022-019272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/10/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND We report the largest multicenter experience to date of utilizing the Comaneci device for endovascular treatment of refractory intracranial vasospasm. METHODS Consecutive patients undergoing Comaneci mechanical dilatation for vasospasm were extracted from prospectively maintained registries in 11 North American centers (2020-2022). Intra-arterial vasodilators (IAV) were allowed, with the Comaneci device utilized after absence of vessel dilation post-infusion. Pre- and post-vasospasm treatment scores were recorded for each segment, with primary radiological outcome of score improvement post-treatment. Primary clinical outcome was safety/device-related complications, with secondary endpoints of functional outcomes at last follow-up. RESULTS A total of 129 vessels in 40 patients (median age 52 years; 67.5% females) received mechanical dilation, 109 of which (84.5%) exhibited pre-treatment severe-to-critical vasospasm (ie, score 3/4). Aneurysmal subarachnoid hemorrhage was the most common etiology of vasospasm (85%), with 65% of procedures utilizing Comaneci-17 (92.5% of patients received IAV). The most treated segments were anterior cerebral artery (34.9%) and middle cerebral artery (31%). Significant vasospasm drop (pre-treatment score (3-4) to post-treatment (0-2)) was achieved in 89.9% of vessels (96.1% of vessels experienced ≥1-point drop in score post-treatment). There were no major procedural/post-procedural device-related complications. Primary failure (ie, vessel unresponsive) was encountered in one vessel (1 patient) (1/129; 0.8%) while secondary failure (ie, recurrence in previously treated segment requiring retreatment in another procedure) occurred in 16 vessels (7 patients) (16/129; 12.4%), with median time-to-retreatment of 2 days. Favorable clinical outcome (modified Rankin Scale 0-2) was noted in 51.5% of patients (median follow-up 6 months). CONCLUSIONS The Comaneci device provides a complementary strategy for treatment of refractory vasospasm with reasonable efficacy/favorable safety. Future prospective trials are warranted.
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Affiliation(s)
- Mohamed M Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Jane Khalife
- Department of Neurosurgery, Cooper University Health Care, Camden, New Jersey, USA
| | - Sohum Desai
- Department of Neuroscience, Valley Baptist Medical Center, University of Texas Rio Grande Valley School of Medicine, Harlingen, Texas, USA
| | - Vera Sharashidze
- Department of Neurosurgery, New York University School of Medicine, New York, New York, USA
| | - Clint Badger
- Department of Neurosurgery, Cooper University Health Care, Camden, New Jersey, USA
| | - Anna L Kuhn
- Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
| | - Andre Monteiro
- Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Hisham Salahuddin
- Department of Neurology, Antelope Valley Medical Center, Lancaster, California, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Jasmeet Singh
- Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
| | - Elad I Levy
- Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Michael Lang
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ramesh Grandhi
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
| | - Ajith J Thomas
- Department of Neurosurgery, Cooper University Health Care, Camden, New Jersey, USA
| | - Li-Mei Lin
- Carondelet Neurological Institute, Carondelet Health Network, Tucson, Arizona, USA
| | - Omar Tanweer
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Ajit S Puri
- Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
| | - Bradley A Gross
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Erez Nossek
- Department of Neurosurgery, New York University School of Medicine, New York, New York, USA
| | - Ameer E Hassan
- Department of Neuroscience, Valley Baptist Medical Center, University of Texas Rio Grande Valley School of Medicine, Harlingen, Texas, USA
| | - Hamza A Shaikh
- Department of Neurosurgery, Cooper University Health Care, Camden, New Jersey, USA
| | - Brian T Jankowitz
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
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Kelmer P, Sioutas GS, Salem MM, Srinivasan VM, Burkhardt JK. Surgical Burr Hole Access for Direct Sinus Puncture and Transvenous Coil Embolization of a Complex Superior Sagittal Sinus Dural Arteriovenous Fistula. J Neurointerv Surg 2023:jnis-2023-020774. [PMID: 37611939 DOI: 10.1136/jnis-2023-020774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/27/2023] [Indexed: 08/25/2023]
Abstract
Dural arteriovenous fistulas (dAVFs) account for 10-15% of all cerebral vascular malformations,1 and their location around the superior sagittal sinus is rare with an incidence of 4-11% of all dAVFs.2 Endovascular transarterial or transvenous embolization are the treatment routes of choice for dAVFs,3 but in rare cases direct sinus access may be favorable.4 5 We present an unusual case of a complex superior sagittal sinus dAVF with multiple arterial feeders and an occluded posterior superior sagittal sinus segment which was challenging for classic embolization routes. A combined surgical and endovascular approach in the hybrid biplane operating room was performed and is shown in video 1 By using a direct surgical burr hole for sinus access anterior to the dAVF and the thrombosed sinus portion followed by transvenous coil embolization, the dAVF was cured in a minimally invasive and safe fashion.neurintsurg;jnis-2023-020774v1/V1F1V1Video 1Treatment of a complex superior sagittal sinus dural arteriovenous fistula by surgical burr hole access for direct sinus puncture and transvenous coil embolization.
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Affiliation(s)
| | - Georgios S Sioutas
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mohamed M Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jan Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Sioutas GS, Salem MM, Muhammad N, Romeo D, Corral Tarbay A, Kim Y, Sussman J, Ng JJ, Rhodes IJ, Gajjar A, Zager EL, Srinivasan VM, Burkhardt JK, Jankowitz BT, Choudhri OA. Feasibility and safety of transradial intraoperative angiography for neurosurgery: An institutional experience. Interv Neuroradiol 2023:15910199231196478. [PMID: 37593790 DOI: 10.1177/15910199231196478] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Transradial approach for neuroangiography is becoming increasingly popular because of the advantages demonstrated by interventional cardiology. Many advantages of radial access could be applied to intraoperative angiography. OBJECTIVE To report our institutional experience with transradial and transulnar intraoperative angiography, and evaluate its safety and feasibility. METHODS Intraoperative angiography through upper extremity vessels was attempted in 70 consecutive patients between April 2019 and December 2022. Data on patient characteristics and surgical indications, procedural variables, and complications were collected. RESULTS Of the 70 patients who underwent intraoperative angiography, 58.6% were female, and the mean age was 52.9 ± 14.0 years. The reason for surgery was aneurysm clipping in 42 (60.0%) cases. In total, 55 patients (78.6%) were positioned supine, 13 (18.6%) prone, and two (2.9%) were positioned three-quarters prone. Access was attempted via the radial artery in 60 (85.7%) patients and the ulnar artery in 10 (14.3%) patients. The procedure was successful in 69 of 70 cases (98.6%), as one required conversion to transfemoral approach due to significant spasm in the proximal right radial artery. The median fluoroscopy time was 8 min. No procedure was aborted, and no patient experienced access-site or angiography-related complications. Intraoperative angiography altered the surgical management in 3 (4.3%) cases. Re-access for follow-up angiography was unsuccessful in three (13.6%) of 22 due to radial artery occlusion. CONCLUSIONS Our institutional experience supports that transradial and transulnar intraoperative angiography is safe and feasible during neurovascular procedures for various indications and positions.
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Affiliation(s)
- Georgios S Sioutas
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Mohamed M Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Najib Muhammad
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Dominic Romeo
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Antonio Corral Tarbay
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Yohan Kim
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Jonathan Sussman
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Jinggang Jenny Ng
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Isaiah J Rhodes
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Avi Gajjar
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Eric L Zager
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Brian T Jankowitz
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Omar A Choudhri
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
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Romeo D, Salem MM, Sioutas GS, Corral Tarbay A, Ng JJ, Aboutaleb PE, Srinivasan VM, Pukenas B, Jankowitz BT, Burkhardt JK. The impact of Verapamil for radial access in diagnostic cerebrovascular angiograms: A retrospective case-control study. Interv Neuroradiol 2023:15910199231193932. [PMID: 37574785 DOI: 10.1177/15910199231193932] [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: 08/15/2023] Open
Abstract
INTRODUCTION Different combinations of medications are utilized during wrist access for radial artery (RA) or ulnar artery (UA) catheterization in neuroendovascular procedures to preclude vasospasm. These "cocktails" commonly include the calcium channel blocker Verapamil, without established benefit. We analyze outcomes in patients with and without Verapamil in their "cocktail" by using a case-control cohort of our single-center experience. METHODS A prospective log of consecutive patients who underwent diagnostic cerebral angiograms using RA/UA access was retrospectively reviewed, and patients were grouped into Verapamil and non-Verapamil cohorts. The primary outcomes assessed were the presence of forearm skin rashes (hives) and RA/UA spasms. Our initial management included Verapamil (5 mg) in the cocktail, but Verapamil was removed after we noticed the development of hives in multiple patients immediately following its injection. RESULTS A total of 221 patients underwent 241 RA/UA diagnostic cerebral angiograms and were included in our analysis. One hundred and forty-nine patients (61.8%) underwent catheterization with Verapamil and 92 (38.2%) were catheterized without it. Four of the 149 patients in the Verapamil group (2.7%) developed hives during the procedure and were treated with Benadryl (25 mg). Of the 92 patients who did not receive Verapamil, there were zero (0%) cases of hives and one (1.1%) case of vasospasm. CONCLUSION Verapamil in the "cocktail" for wrist access diagnostic cerebral angiograms was associated with periprocedural hives, but not associated with a significant reduction in spasm compared to the non-Verapamil group. Our findings suggest that the administration of prophylactic Verapamil for these procedures may not be necessary.
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Affiliation(s)
- Dominic Romeo
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Mohamed M Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Georgios S Sioutas
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Antonio Corral Tarbay
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Jinggang Jenny Ng
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Pakinam E Aboutaleb
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
- Department of Neuroradiology, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Bryan Pukenas
- Department of Neuroradiology, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Brian T Jankowitz
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
- Department of Neuroradiology, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
- Department of Neuroradiology, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
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Sioutas GS, Mannam SS, Corral Tarbay A, Nia AM, Salem MM, Vivanco-Suarez J, Burkhardt JK, Jankowitz BT, Srinivasan VM. Dexamethasone and Statins in Patients Undergoing Primary Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Propensity-Matched Study in the TriNetX Research Network. World Neurosurg 2023; 176:e83-e90. [PMID: 37164211 DOI: 10.1016/j.wneu.2023.04.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/28/2023] [Accepted: 04/29/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Middle meningeal artery embolization (MMAE) is an effective minimally invasive option for chronic subdural hematoma (cSDH). Dexamethasone and statins have been reported to improve the resolution of cSDH and reduce its recurrence. However, only 1 study has investigated the role of statins in patients treated with MMAE, and there is no such study on dexamethasone. Thus, we used the TriNetX research network to determine whether adding dexamethasone or statin along with primary MMAE is associated with a benefit in outcomes. METHODS We queried all primary MMAE cases for cSDH between January 1st, 2012, and July 1st, 2022, in the TriNetX research network. We included patients greater than or equal to 18 years old and separated them regarding statin and dexamethasone use around the time of MMAE. Outcomes were evaluated within 6 months and 3 years after MMAE, and analyses were performed before and after propensity score matching. RESULTS The study included 372 patients with chronic subdural hematoma who underwent MMAE and were on dexamethasone, 339 not on dexamethasone, 391 on statins, and 278 not on statins. After propensity score matching, the dexamethasone cohorts included 250 patients each and only headache remained more prevalent in the dexamethasone cohort at both 6 months (21.2% vs. 10.0%, P = 0.001) and 3 years (23.6% vs. 12.4%, P = 0.001). After propensity score matching, the statin cohorts included 150 patients each and no differences in outcomes were found at both 6 months and 3 months after MMAE. CONCLUSIONS Patients treated with primary MMAE and were on dexamethasone or statins had no differences in mortality and functional/provider dependence compared to those who were not on dexamethasone or statins. Patients on dexamethasone had a higher prevalence of headaches.
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Affiliation(s)
- Georgios S Sioutas
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Sneha Sai Mannam
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Antonio Corral Tarbay
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Anna M Nia
- Department of Neurological Surgery, Montefiore/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mohamed M Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Juan Vivanco-Suarez
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Brian T Jankowitz
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA.
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Sioutas GS, Vivanco-Suarez J, Shekhtman O, Matache IM, Salem MM, Burkhardt JK, Srinivasan VM, Jankowitz BT. Liquid embolic agents for middle meningeal artery embolization in chronic subdural hematoma: Institutional experience with systematic review and meta-analysis. Interv Neuroradiol 2023:15910199231183132. [PMID: 37322877 DOI: 10.1177/15910199231183132] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 06/17/2023] Open
Abstract
INTRODUCTION Chronic subdural hematoma (CSDH) is associated with high recurrence rates. Middle meningeal artery embolization (MMAE) has emerged as a promising treatment option. In this systematic review and meta-analysis, we aimed to assess the safety and efficacy of MMAE for CSDH using liquid embolic agents and compare them with particles. METHODS We systematically reviewed all studies describing MMAE for CSDH with liquid embolic agents, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Additionally, we included a cohort of patients from our institution using liquid and particle embolic agents. Data were analyzed using random-effects proportions and comparisons meta-analysis, and statistical heterogeneity was assessed. RESULTS A total of 18 studies with 507 cases of MMAE with liquid embolic agents (including our institutional experience) were included in the analysis. The success rate was 99% (95% confidence interval [CI]: 98-100%), all complications rate was 1% (95% CI: 0-5%), major complications rate was 0% (95% CI: 0-0%), and mortality rate was 1% (95% CI: 0-6%). The rate of hematoma size reduction was 97% (95% CI: 73-100%), complete resolution 64% (95% CI: 33-87%), radiographic recurrence 3% (95% CI: 1-7%), and reoperation 3% (95% CI: 1-7%). No significant differences in outcomes were found between liquid and particle embolic agents. Sensitivity analyses revealed that liquid embolic agents were associated with lower reoperation rates in upfront MMAE (risk ratio 0.13, 95% CI: 0.02-0.95). CONCLUSION MMAE with liquid embolic agents is safe and effective for the treatment of CSDH. Outcomes are comparable to particles, but liquids were associated with a decreased risk of reoperation in upfront MMAE. However, further studies are needed to support our findings.
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Affiliation(s)
- Georgios S Sioutas
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Juan Vivanco-Suarez
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Oleg Shekhtman
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Irina-Mihaela Matache
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
- Department of Physiology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Mohamed M Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Brian T Jankowitz
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
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Mohamed GA, Nogueira RG, Essibayi MA, Aboul-Nour H, Mohammaden M, Haussen DC, Ruiz AM, Gross BA, Kuybu O, Salem MM, Burkhardt JK, Jankowitz B, Siegler JE, Patel P, Hester T, Ortega-Gutierrez S, Farooqui M, Galecio-Castillo M, Nguyen TN, Abdalkader M, Klein P, Charles JH, Saini V, Yavagal DR, Jumah A, Alaraj A, Peng S, Hafeez M, Tanweer O, Kan P, Scaggiante J, Matsoukas S, Fifi JT, Mayer SA, Chebl AB. Tissue Clock Beyond Time Clock: Endovascular Thrombectomy for Patients With Large Vessel Occlusion Stroke Beyond 24 Hours. J Stroke 2023; 25:282-290. [PMID: 37282375 DOI: 10.5853/jos.2023.00017] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 01/02/2023] [Accepted: 03/10/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND AND PURPOSE Randomized trials proved the benefits of mechanical thrombectomy (MT) for select patients with large vessel occlusion (LVO) within 24 hours of last-known-well (LKW). Recent data suggest that LVO patients may benefit from MT beyond 24 hours. This study reports the safety and outcomes of MT beyond 24 hours of LKW compared to standard medical therapy (SMT). METHODS This is a retrospective analysis of LVO patients presented to 11 comprehensive stroke centers in the United States beyond 24 hours from LKW between January 2015 and December 2021. We assessed 90-day outcomes using the modified Rankin Scale (mRS). RESULTS Of 334 patients presented with LVO beyond 24 hours, 64% received MT and 36% received SMT only. Patients who received MT were older (67±15 vs. 64±15 years, P=0.047) and had a higher baseline National Institutes of Health Stroke Scale (NIHSS; 16±7 vs.10±9, P<0.001). Successful recanalization (modified thrombolysis in cerebral infarction score 2b-3) was achieved in 83%, and 5.6% had symptomatic intracranial hemorrhage compared to 2.5% in the SMT group (P=0.19). MT was associated with mRS 0-2 at 90 days (adjusted odds ratio [aOR] 5.73, P=0.026), less mortality (34% vs. 63%, P<0.001), and better discharge NIHSS (P<0.001) compared to SMT in patients with baseline NIHSS ≥6. This treatment benefit remained after matching both groups. Age (aOR 0.94, P<0.001), baseline NIHSS (aOR 0.91, P=0.017), Alberta Stroke Program Early Computed Tomography (ASPECTS) score ≥8 (aOR 3.06, P=0.041), and collaterals scores (aOR 1.41, P=0.027) were associated with 90-day functional independence. CONCLUSION In patients with salvageable brain tissue, MT for LVO beyond 24 hours appears to improve outcomes compared to SMT, especially in patients with severe strokes. Patients' age, ASPECTS, collaterals, and baseline NIHSS score should be considered before discounting MT merely based on LKW.
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Affiliation(s)
- Ghada A Mohamed
- Department of Neurology, Medical University of South Carolina (MUSC), Charleston, SC, USA
| | - Raul G Nogueira
- Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Muhammed Amir Essibayi
- Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Hassan Aboul-Nour
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Mahmoud Mohammaden
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Diogo C Haussen
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Aldo Mendez Ruiz
- Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Bradley A Gross
- Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Okkes Kuybu
- Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mohamed M Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Brian Jankowitz
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - James E Siegler
- Department of Neurology, Cooper University Medical Center, Camden, NJ, USA
| | - Pratit Patel
- Department of Neurology, Cooper University Medical Center, Camden, NJ, USA
| | - Taryn Hester
- Department of Neurology, Cooper University Medical Center, Camden, NJ, USA
| | | | - Mudassir Farooqui
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - Thanh N Nguyen
- Departments of Neurology and Radiology, Boston University School of Medicine, Boston, MA, USA
| | - Mohamad Abdalkader
- Departments of Neurology and Radiology, Boston University School of Medicine, Boston, MA, USA
| | - Piers Klein
- Departments of Neurology and Radiology, Boston University School of Medicine, Boston, MA, USA
| | - Jude H Charles
- Departments of Neurology and Radiology, Boston University School of Medicine, Boston, MA, USA
| | - Vasu Saini
- Department of Neurology, University of Miami, Miami, FL, USA
| | | | - Ammar Jumah
- Department of Neurology, Henry Ford Health, Detroit, MI, USA
| | - Ali Alaraj
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Sophia Peng
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Muhammad Hafeez
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Omar Tanweer
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor School of Medicine, Houston, TX, USA
| | - Jacopo Scaggiante
- Department of Neurosurgery, Baylor School of Medicine, Houston, TX, USA
| | - Stavros Matsoukas
- Department of Neurosurgery, Baylor School of Medicine, Houston, TX, USA
| | - Johanna T Fifi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, NYC, NY, USA
| | - Stephan A Mayer
- Departments of Neurology and Neurosurgery, Westchester Medical Center, Westchester, NY, USA
| | - Alex B Chebl
- Department of Neurology, Henry Ford Health, Detroit, MI, USA
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Vivanco-Suarez J, Salem MM, Sioutas GS, Covell MM, Jankowitz BT, Srinivasan VM, Burkhardt JK. Safety and efficacy of the p48 MW and p64 flow modulation devices: a systematic review and meta-analysis. Neurosurg Focus 2023; 54:E7. [PMID: 37127026 DOI: 10.3171/2023.2.focus22648] [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: 01/01/2023] [Accepted: 02/05/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Flow diverters (FDs) have demonstrated increasing safety and efficacy in treating various types of intracranial aneurysms. Although the underlying mechanism of action of all FDs is similar, differences are noted in their intrinsic characteristics, materials, and deployment techniques. The p64 flow modulation device (p64) and the newer p48 movable wire flow modulation device (p48 MW) are not yet available in the US but have been increasingly used mainly in Europe, demonstrating optimistic results. The authors performed a systematic review and meta-analysis of the literature to evaluate the safety and efficacy of the p64 and p48 MW FDs. METHODS A literature review (between January 1960 and November 2022) of the PubMed, Scopus, Embase, Web of Science, and Cochrane Central Register of Controlled Trials databases was conducted. The primary efficacy outcome was the proportion of complete angiographic occlusion at last follow-up. Complete occlusion was defined as Raymond-Roy class 1 and O'Kelly-Marotta grade D. The primary safety outcomes were the composite safety rate of ischemic and hemorrhagic events (intra- and postprocedure) and the all-cause mortality rate. Data were analyzed using a random-effects proportions meta-analysis, and statistical heterogeneity was assessed. RESULTS Twenty studies with 1781 patients harboring 1957 aneurysms were included in the analysis. Seventeen studies were conducted in Europe. Sixteen studies evaluated the performance of the p64 (MW). Patient ages ranged between 20 and 89 years, and most were female (78.7%). Aneurysm size ranged between 1 and 50 mm. Most aneurysms were unruptured (92.8%) and in the anterior circulation (93.1%). Single antiplatelet therapy pre- and postprocedure was used in 2 studies. Follow-up ranged from 2 to 14.5 months. For the p64 and p48 MW, complete angiographic occlusion rates were 77% (95% CI 68%-85%) and 67% (95% CI 49%-81%), adjunctive coil usage rates were 7% (95% CI 4%-12%) and 4% (95% CI 0%-24%), primary safety composite rates were 2% (95% CI 1%-4%) and 3% (95% CI 1%-11%), and mortality rates were 0.49% (95% CI 0%-1%) and 2% (95% CI 1%-6%), respectively. CONCLUSIONS The p64 and p48 MW have primarily been used in Europe thus far. This analysis found that both devices have an acceptable efficacy and favorable safety profile. However, further studies are needed to evaluate the efficacy and safety of prescribing a single antiplatelet regimen after implantation of the newer-generation FDs with antithrombotic coating surface modification.
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Affiliation(s)
- Juan Vivanco-Suarez
- 1Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania; and
| | - Mohamed M Salem
- 1Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania; and
| | - Georgios S Sioutas
- 1Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania; and
| | | | - Brian T Jankowitz
- 1Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania; and
| | - Visish M Srinivasan
- 1Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania; and
| | - Jan-Karl Burkhardt
- 1Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania; and
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Salem MM, Kuybu O, Nguyen Hoang A, Baig AA, Khorasanizadeh M, Baker C, Hunsaker JC, Mendez AA, Cortez G, Davies JM, Narayanan S, Cawley CM, Riina HA, Moore JM, Spiotta AM, Khalessi AA, Howard BM, Hanel R, Tanweer O, Levy EI, Grandhi R, Lang MJ, Siddiqui AH, Kan P, Ogilvy CS, Gross BA, Thomas AJ, Jankowitz BT, Burkhardt JK. Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: Predictors of Clinical and Radiographic Failure from 636 Embolizations. Radiology 2023; 307:e222045. [PMID: 37070990 DOI: 10.1148/radiol.222045] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
Background Knowledge regarding predictors of clinical and radiographic failures of middle meningeal artery (MMA) embolization (MMAE) treatment for chronic subdural hematoma (CSDH) is limited. Purpose To identify predictors of MMAE treatment failure for CSDH. Materials and Methods In this retrospective study, consecutive patients who underwent MMAE for CSDH from February 2018 to April 2022 at 13 U.S. centers were included. Clinical failure was defined as hematoma reaccumulation and/or neurologic deterioration requiring rescue surgery. Radiographic failure was defined as a maximal hematoma thickness reduction less than 50% at last imaging (minimum 2 weeks of head CT follow-up). Multivariable logistic regression models were constructed to identify independent failure predictors, controlling for age, sex, concurrent surgical evacuation, midline shift, hematoma thickness, and pretreatment baseline antiplatelet and anticoagulation therapy. Results Overall, 530 patients (mean age, 71.9 years ± 12.8 [SD]; 386 men; 106 with bilateral lesions) underwent 636 MMAE procedures. At presentation, the median CSDH thickness was 15 mm and 31.3% (166 of 530) and 21.7% (115 of 530) of patients were receiving antiplatelet and anticoagulation medications, respectively. Clinical failure occurred in 36 of 530 patients (6.8%, over a median follow-up of 4.1 months) and radiographic failure occurred in 26.3% (137 of 522) of procedures. At multivariable analysis, independent predictors of clinical failure were pretreatment anticoagulation therapy (odds ratio [OR], 3.23; P = .007) and an MMA diameter less than 1.5 mm (OR, 2.52; P = .027), while liquid embolic agents were associated with nonfailure (OR, 0.32; P = .011). For radiographic failure, female sex (OR, 0.36; P = .001), concurrent surgical evacuation (OR, 0.43; P = .009), and a longer imaging follow-up time were associated with nonfailure. Conversely, MMA diameter less than 1.5 mm (OR, 1.7; P = .044), midline shift (OR, 1.1; P = .02), and superselective MMA catheterization (without targeting the main MMA trunk) (OR, 2; P = .029) were associated with radiographic failure. Sensitivity analyses retained these associations. Conclusion Multiple independent predictors of failure of MMAE treatment for chronic subdural hematomas were identified, with small diameter (<1.5 mm) being the only factor independently associated with both clinical and radiographic failures. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Chaudhary and Gemmete in this issue.
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Affiliation(s)
- Mohamed M Salem
- From the Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104 (M.M.S., B.T.J., J.K.B.); Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pa (O.K., A.A.M., S.N., M.J.L., B.A.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, Tex (A.N.H., O.T., P.K.); Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (A.A.B., J.M.D., E.I.L., A.H.S.); Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, Mass (M.K., J.M.M., C.S.O., A.J.T.); Department of Neurosurgery, University of Utah, Salt Lake City, Utah (C.B., J.C.H., R.G.); Department of Cerebrovascular and Endovascular Surgery, Baptist Neurologic Institute and Lyerly Neurosurgery, Jacksonville, Fla (G.C., R.H.); Department of Neurosurgery, Emory University School of Medicine, Atlanta, Ga (C.M.C., B.M.H.); Department of Neurosurgery, NYU Langone Medical Center, New York, NY (H.A.R.); Department of Neurosurgery, Medical University of South Carolina, Charleston, SC (A.M.S.); Department of Neurosurgery, University of California-San Diego, La Jolla, Calif (A.A.K.); Department of Neurosurgery, University of Texas Medical Branch, Galveston, Tex (P.K.); and Department of Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ (A.J.T.)
| | - Okkes Kuybu
- From the Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104 (M.M.S., B.T.J., J.K.B.); Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pa (O.K., A.A.M., S.N., M.J.L., B.A.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, Tex (A.N.H., O.T., P.K.); Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (A.A.B., J.M.D., E.I.L., A.H.S.); Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, Mass (M.K., J.M.M., C.S.O., A.J.T.); Department of Neurosurgery, University of Utah, Salt Lake City, Utah (C.B., J.C.H., R.G.); Department of Cerebrovascular and Endovascular Surgery, Baptist Neurologic Institute and Lyerly Neurosurgery, Jacksonville, Fla (G.C., R.H.); Department of Neurosurgery, Emory University School of Medicine, Atlanta, Ga (C.M.C., B.M.H.); Department of Neurosurgery, NYU Langone Medical Center, New York, NY (H.A.R.); Department of Neurosurgery, Medical University of South Carolina, Charleston, SC (A.M.S.); Department of Neurosurgery, University of California-San Diego, La Jolla, Calif (A.A.K.); Department of Neurosurgery, University of Texas Medical Branch, Galveston, Tex (P.K.); and Department of Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ (A.J.T.)
| | - Alex Nguyen Hoang
- From the Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104 (M.M.S., B.T.J., J.K.B.); Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pa (O.K., A.A.M., S.N., M.J.L., B.A.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, Tex (A.N.H., O.T., P.K.); Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (A.A.B., J.M.D., E.I.L., A.H.S.); Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, Mass (M.K., J.M.M., C.S.O., A.J.T.); Department of Neurosurgery, University of Utah, Salt Lake City, Utah (C.B., J.C.H., R.G.); Department of Cerebrovascular and Endovascular Surgery, Baptist Neurologic Institute and Lyerly Neurosurgery, Jacksonville, Fla (G.C., R.H.); Department of Neurosurgery, Emory University School of Medicine, Atlanta, Ga (C.M.C., B.M.H.); Department of Neurosurgery, NYU Langone Medical Center, New York, NY (H.A.R.); Department of Neurosurgery, Medical University of South Carolina, Charleston, SC (A.M.S.); Department of Neurosurgery, University of California-San Diego, La Jolla, Calif (A.A.K.); Department of Neurosurgery, University of Texas Medical Branch, Galveston, Tex (P.K.); and Department of Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ (A.J.T.)
| | - Ammad A Baig
- From the Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104 (M.M.S., B.T.J., J.K.B.); Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pa (O.K., A.A.M., S.N., M.J.L., B.A.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, Tex (A.N.H., O.T., P.K.); Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (A.A.B., J.M.D., E.I.L., A.H.S.); Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, Mass (M.K., J.M.M., C.S.O., A.J.T.); Department of Neurosurgery, University of Utah, Salt Lake City, Utah (C.B., J.C.H., R.G.); Department of Cerebrovascular and Endovascular Surgery, Baptist Neurologic Institute and Lyerly Neurosurgery, Jacksonville, Fla (G.C., R.H.); Department of Neurosurgery, Emory University School of Medicine, Atlanta, Ga (C.M.C., B.M.H.); Department of Neurosurgery, NYU Langone Medical Center, New York, NY (H.A.R.); Department of Neurosurgery, Medical University of South Carolina, Charleston, SC (A.M.S.); Department of Neurosurgery, University of California-San Diego, La Jolla, Calif (A.A.K.); Department of Neurosurgery, University of Texas Medical Branch, Galveston, Tex (P.K.); and Department of Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ (A.J.T.)
| | - Mirhojjat Khorasanizadeh
- From the Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104 (M.M.S., B.T.J., J.K.B.); Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pa (O.K., A.A.M., S.N., M.J.L., B.A.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, Tex (A.N.H., O.T., P.K.); Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (A.A.B., J.M.D., E.I.L., A.H.S.); Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, Mass (M.K., J.M.M., C.S.O., A.J.T.); Department of Neurosurgery, University of Utah, Salt Lake City, Utah (C.B., J.C.H., R.G.); Department of Cerebrovascular and Endovascular Surgery, Baptist Neurologic Institute and Lyerly Neurosurgery, Jacksonville, Fla (G.C., R.H.); Department of Neurosurgery, Emory University School of Medicine, Atlanta, Ga (C.M.C., B.M.H.); Department of Neurosurgery, NYU Langone Medical Center, New York, NY (H.A.R.); Department of Neurosurgery, Medical University of South Carolina, Charleston, SC (A.M.S.); Department of Neurosurgery, University of California-San Diego, La Jolla, Calif (A.A.K.); Department of Neurosurgery, University of Texas Medical Branch, Galveston, Tex (P.K.); and Department of Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ (A.J.T.)
| | - Cordell Baker
- From the Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104 (M.M.S., B.T.J., J.K.B.); Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pa (O.K., A.A.M., S.N., M.J.L., B.A.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, Tex (A.N.H., O.T., P.K.); Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (A.A.B., J.M.D., E.I.L., A.H.S.); Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, Mass (M.K., J.M.M., C.S.O., A.J.T.); Department of Neurosurgery, University of Utah, Salt Lake City, Utah (C.B., J.C.H., R.G.); Department of Cerebrovascular and Endovascular Surgery, Baptist Neurologic Institute and Lyerly Neurosurgery, Jacksonville, Fla (G.C., R.H.); Department of Neurosurgery, Emory University School of Medicine, Atlanta, Ga (C.M.C., B.M.H.); Department of Neurosurgery, NYU Langone Medical Center, New York, NY (H.A.R.); Department of Neurosurgery, Medical University of South Carolina, Charleston, SC (A.M.S.); Department of Neurosurgery, University of California-San Diego, La Jolla, Calif (A.A.K.); Department of Neurosurgery, University of Texas Medical Branch, Galveston, Tex (P.K.); and Department of Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ (A.J.T.)
| | - Joshua C Hunsaker
- From the Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104 (M.M.S., B.T.J., J.K.B.); Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pa (O.K., A.A.M., S.N., M.J.L., B.A.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, Tex (A.N.H., O.T., P.K.); Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (A.A.B., J.M.D., E.I.L., A.H.S.); Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, Mass (M.K., J.M.M., C.S.O., A.J.T.); Department of Neurosurgery, University of Utah, Salt Lake City, Utah (C.B., J.C.H., R.G.); Department of Cerebrovascular and Endovascular Surgery, Baptist Neurologic Institute and Lyerly Neurosurgery, Jacksonville, Fla (G.C., R.H.); Department of Neurosurgery, Emory University School of Medicine, Atlanta, Ga (C.M.C., B.M.H.); Department of Neurosurgery, NYU Langone Medical Center, New York, NY (H.A.R.); Department of Neurosurgery, Medical University of South Carolina, Charleston, SC (A.M.S.); Department of Neurosurgery, University of California-San Diego, La Jolla, Calif (A.A.K.); Department of Neurosurgery, University of Texas Medical Branch, Galveston, Tex (P.K.); and Department of Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ (A.J.T.)
| | - Aldo A Mendez
- From the Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104 (M.M.S., B.T.J., J.K.B.); Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pa (O.K., A.A.M., S.N., M.J.L., B.A.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, Tex (A.N.H., O.T., P.K.); Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (A.A.B., J.M.D., E.I.L., A.H.S.); Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, Mass (M.K., J.M.M., C.S.O., A.J.T.); Department of Neurosurgery, University of Utah, Salt Lake City, Utah (C.B., J.C.H., R.G.); Department of Cerebrovascular and Endovascular Surgery, Baptist Neurologic Institute and Lyerly Neurosurgery, Jacksonville, Fla (G.C., R.H.); Department of Neurosurgery, Emory University School of Medicine, Atlanta, Ga (C.M.C., B.M.H.); Department of Neurosurgery, NYU Langone Medical Center, New York, NY (H.A.R.); Department of Neurosurgery, Medical University of South Carolina, Charleston, SC (A.M.S.); Department of Neurosurgery, University of California-San Diego, La Jolla, Calif (A.A.K.); Department of Neurosurgery, University of Texas Medical Branch, Galveston, Tex (P.K.); and Department of Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ (A.J.T.)
| | - Gustavo Cortez
- From the Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104 (M.M.S., B.T.J., J.K.B.); Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pa (O.K., A.A.M., S.N., M.J.L., B.A.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, Tex (A.N.H., O.T., P.K.); Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (A.A.B., J.M.D., E.I.L., A.H.S.); Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, Mass (M.K., J.M.M., C.S.O., A.J.T.); Department of Neurosurgery, University of Utah, Salt Lake City, Utah (C.B., J.C.H., R.G.); Department of Cerebrovascular and Endovascular Surgery, Baptist Neurologic Institute and Lyerly Neurosurgery, Jacksonville, Fla (G.C., R.H.); Department of Neurosurgery, Emory University School of Medicine, Atlanta, Ga (C.M.C., B.M.H.); Department of Neurosurgery, NYU Langone Medical Center, New York, NY (H.A.R.); Department of Neurosurgery, Medical University of South Carolina, Charleston, SC (A.M.S.); Department of Neurosurgery, University of California-San Diego, La Jolla, Calif (A.A.K.); Department of Neurosurgery, University of Texas Medical Branch, Galveston, Tex (P.K.); and Department of Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ (A.J.T.)
| | - Jason M Davies
- From the Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104 (M.M.S., B.T.J., J.K.B.); Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pa (O.K., A.A.M., S.N., M.J.L., B.A.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, Tex (A.N.H., O.T., P.K.); Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (A.A.B., J.M.D., E.I.L., A.H.S.); Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, Mass (M.K., J.M.M., C.S.O., A.J.T.); Department of Neurosurgery, University of Utah, Salt Lake City, Utah (C.B., J.C.H., R.G.); Department of Cerebrovascular and Endovascular Surgery, Baptist Neurologic Institute and Lyerly Neurosurgery, Jacksonville, Fla (G.C., R.H.); Department of Neurosurgery, Emory University School of Medicine, Atlanta, Ga (C.M.C., B.M.H.); Department of Neurosurgery, NYU Langone Medical Center, New York, NY (H.A.R.); Department of Neurosurgery, Medical University of South Carolina, Charleston, SC (A.M.S.); Department of Neurosurgery, University of California-San Diego, La Jolla, Calif (A.A.K.); Department of Neurosurgery, University of Texas Medical Branch, Galveston, Tex (P.K.); and Department of Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ (A.J.T.)
| | - Sandra Narayanan
- From the Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104 (M.M.S., B.T.J., J.K.B.); Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pa (O.K., A.A.M., S.N., M.J.L., B.A.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, Tex (A.N.H., O.T., P.K.); Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (A.A.B., J.M.D., E.I.L., A.H.S.); Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, Mass (M.K., J.M.M., C.S.O., A.J.T.); Department of Neurosurgery, University of Utah, Salt Lake City, Utah (C.B., J.C.H., R.G.); Department of Cerebrovascular and Endovascular Surgery, Baptist Neurologic Institute and Lyerly Neurosurgery, Jacksonville, Fla (G.C., R.H.); Department of Neurosurgery, Emory University School of Medicine, Atlanta, Ga (C.M.C., B.M.H.); Department of Neurosurgery, NYU Langone Medical Center, New York, NY (H.A.R.); Department of Neurosurgery, Medical University of South Carolina, Charleston, SC (A.M.S.); Department of Neurosurgery, University of California-San Diego, La Jolla, Calif (A.A.K.); Department of Neurosurgery, University of Texas Medical Branch, Galveston, Tex (P.K.); and Department of Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ (A.J.T.)
| | - C Michael Cawley
- From the Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104 (M.M.S., B.T.J., J.K.B.); Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pa (O.K., A.A.M., S.N., M.J.L., B.A.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, Tex (A.N.H., O.T., P.K.); Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (A.A.B., J.M.D., E.I.L., A.H.S.); Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, Mass (M.K., J.M.M., C.S.O., A.J.T.); Department of Neurosurgery, University of Utah, Salt Lake City, Utah (C.B., J.C.H., R.G.); Department of Cerebrovascular and Endovascular Surgery, Baptist Neurologic Institute and Lyerly Neurosurgery, Jacksonville, Fla (G.C., R.H.); Department of Neurosurgery, Emory University School of Medicine, Atlanta, Ga (C.M.C., B.M.H.); Department of Neurosurgery, NYU Langone Medical Center, New York, NY (H.A.R.); Department of Neurosurgery, Medical University of South Carolina, Charleston, SC (A.M.S.); Department of Neurosurgery, University of California-San Diego, La Jolla, Calif (A.A.K.); Department of Neurosurgery, University of Texas Medical Branch, Galveston, Tex (P.K.); and Department of Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ (A.J.T.)
| | - Howard A Riina
- From the Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104 (M.M.S., B.T.J., J.K.B.); Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pa (O.K., A.A.M., S.N., M.J.L., B.A.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, Tex (A.N.H., O.T., P.K.); Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (A.A.B., J.M.D., E.I.L., A.H.S.); Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, Mass (M.K., J.M.M., C.S.O., A.J.T.); Department of Neurosurgery, University of Utah, Salt Lake City, Utah (C.B., J.C.H., R.G.); Department of Cerebrovascular and Endovascular Surgery, Baptist Neurologic Institute and Lyerly Neurosurgery, Jacksonville, Fla (G.C., R.H.); Department of Neurosurgery, Emory University School of Medicine, Atlanta, Ga (C.M.C., B.M.H.); Department of Neurosurgery, NYU Langone Medical Center, New York, NY (H.A.R.); Department of Neurosurgery, Medical University of South Carolina, Charleston, SC (A.M.S.); Department of Neurosurgery, University of California-San Diego, La Jolla, Calif (A.A.K.); Department of Neurosurgery, University of Texas Medical Branch, Galveston, Tex (P.K.); and Department of Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ (A.J.T.)
| | - Justin M Moore
- From the Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104 (M.M.S., B.T.J., J.K.B.); Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pa (O.K., A.A.M., S.N., M.J.L., B.A.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, Tex (A.N.H., O.T., P.K.); Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (A.A.B., J.M.D., E.I.L., A.H.S.); Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, Mass (M.K., J.M.M., C.S.O., A.J.T.); Department of Neurosurgery, University of Utah, Salt Lake City, Utah (C.B., J.C.H., R.G.); Department of Cerebrovascular and Endovascular Surgery, Baptist Neurologic Institute and Lyerly Neurosurgery, Jacksonville, Fla (G.C., R.H.); Department of Neurosurgery, Emory University School of Medicine, Atlanta, Ga (C.M.C., B.M.H.); Department of Neurosurgery, NYU Langone Medical Center, New York, NY (H.A.R.); Department of Neurosurgery, Medical University of South Carolina, Charleston, SC (A.M.S.); Department of Neurosurgery, University of California-San Diego, La Jolla, Calif (A.A.K.); Department of Neurosurgery, University of Texas Medical Branch, Galveston, Tex (P.K.); and Department of Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ (A.J.T.)
| | - Alejandro M Spiotta
- From the Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104 (M.M.S., B.T.J., J.K.B.); Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pa (O.K., A.A.M., S.N., M.J.L., B.A.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, Tex (A.N.H., O.T., P.K.); Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (A.A.B., J.M.D., E.I.L., A.H.S.); Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, Mass (M.K., J.M.M., C.S.O., A.J.T.); Department of Neurosurgery, University of Utah, Salt Lake City, Utah (C.B., J.C.H., R.G.); Department of Cerebrovascular and Endovascular Surgery, Baptist Neurologic Institute and Lyerly Neurosurgery, Jacksonville, Fla (G.C., R.H.); Department of Neurosurgery, Emory University School of Medicine, Atlanta, Ga (C.M.C., B.M.H.); Department of Neurosurgery, NYU Langone Medical Center, New York, NY (H.A.R.); Department of Neurosurgery, Medical University of South Carolina, Charleston, SC (A.M.S.); Department of Neurosurgery, University of California-San Diego, La Jolla, Calif (A.A.K.); Department of Neurosurgery, University of Texas Medical Branch, Galveston, Tex (P.K.); and Department of Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ (A.J.T.)
| | - Alexander A Khalessi
- From the Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104 (M.M.S., B.T.J., J.K.B.); Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pa (O.K., A.A.M., S.N., M.J.L., B.A.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, Tex (A.N.H., O.T., P.K.); Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (A.A.B., J.M.D., E.I.L., A.H.S.); Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, Mass (M.K., J.M.M., C.S.O., A.J.T.); Department of Neurosurgery, University of Utah, Salt Lake City, Utah (C.B., J.C.H., R.G.); Department of Cerebrovascular and Endovascular Surgery, Baptist Neurologic Institute and Lyerly Neurosurgery, Jacksonville, Fla (G.C., R.H.); Department of Neurosurgery, Emory University School of Medicine, Atlanta, Ga (C.M.C., B.M.H.); Department of Neurosurgery, NYU Langone Medical Center, New York, NY (H.A.R.); Department of Neurosurgery, Medical University of South Carolina, Charleston, SC (A.M.S.); Department of Neurosurgery, University of California-San Diego, La Jolla, Calif (A.A.K.); Department of Neurosurgery, University of Texas Medical Branch, Galveston, Tex (P.K.); and Department of Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ (A.J.T.)
| | - Brian M Howard
- From the Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104 (M.M.S., B.T.J., J.K.B.); Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pa (O.K., A.A.M., S.N., M.J.L., B.A.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, Tex (A.N.H., O.T., P.K.); Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (A.A.B., J.M.D., E.I.L., A.H.S.); Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, Mass (M.K., J.M.M., C.S.O., A.J.T.); Department of Neurosurgery, University of Utah, Salt Lake City, Utah (C.B., J.C.H., R.G.); Department of Cerebrovascular and Endovascular Surgery, Baptist Neurologic Institute and Lyerly Neurosurgery, Jacksonville, Fla (G.C., R.H.); Department of Neurosurgery, Emory University School of Medicine, Atlanta, Ga (C.M.C., B.M.H.); Department of Neurosurgery, NYU Langone Medical Center, New York, NY (H.A.R.); Department of Neurosurgery, Medical University of South Carolina, Charleston, SC (A.M.S.); Department of Neurosurgery, University of California-San Diego, La Jolla, Calif (A.A.K.); Department of Neurosurgery, University of Texas Medical Branch, Galveston, Tex (P.K.); and Department of Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ (A.J.T.)
| | - Ricardo Hanel
- From the Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104 (M.M.S., B.T.J., J.K.B.); Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pa (O.K., A.A.M., S.N., M.J.L., B.A.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, Tex (A.N.H., O.T., P.K.); Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (A.A.B., J.M.D., E.I.L., A.H.S.); Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, Mass (M.K., J.M.M., C.S.O., A.J.T.); Department of Neurosurgery, University of Utah, Salt Lake City, Utah (C.B., J.C.H., R.G.); Department of Cerebrovascular and Endovascular Surgery, Baptist Neurologic Institute and Lyerly Neurosurgery, Jacksonville, Fla (G.C., R.H.); Department of Neurosurgery, Emory University School of Medicine, Atlanta, Ga (C.M.C., B.M.H.); Department of Neurosurgery, NYU Langone Medical Center, New York, NY (H.A.R.); Department of Neurosurgery, Medical University of South Carolina, Charleston, SC (A.M.S.); Department of Neurosurgery, University of California-San Diego, La Jolla, Calif (A.A.K.); Department of Neurosurgery, University of Texas Medical Branch, Galveston, Tex (P.K.); and Department of Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ (A.J.T.)
| | - Omar Tanweer
- From the Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104 (M.M.S., B.T.J., J.K.B.); Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pa (O.K., A.A.M., S.N., M.J.L., B.A.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, Tex (A.N.H., O.T., P.K.); Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (A.A.B., J.M.D., E.I.L., A.H.S.); Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, Mass (M.K., J.M.M., C.S.O., A.J.T.); Department of Neurosurgery, University of Utah, Salt Lake City, Utah (C.B., J.C.H., R.G.); Department of Cerebrovascular and Endovascular Surgery, Baptist Neurologic Institute and Lyerly Neurosurgery, Jacksonville, Fla (G.C., R.H.); Department of Neurosurgery, Emory University School of Medicine, Atlanta, Ga (C.M.C., B.M.H.); Department of Neurosurgery, NYU Langone Medical Center, New York, NY (H.A.R.); Department of Neurosurgery, Medical University of South Carolina, Charleston, SC (A.M.S.); Department of Neurosurgery, University of California-San Diego, La Jolla, Calif (A.A.K.); Department of Neurosurgery, University of Texas Medical Branch, Galveston, Tex (P.K.); and Department of Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ (A.J.T.)
| | - Elad I Levy
- From the Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104 (M.M.S., B.T.J., J.K.B.); Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pa (O.K., A.A.M., S.N., M.J.L., B.A.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, Tex (A.N.H., O.T., P.K.); Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (A.A.B., J.M.D., E.I.L., A.H.S.); Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, Mass (M.K., J.M.M., C.S.O., A.J.T.); Department of Neurosurgery, University of Utah, Salt Lake City, Utah (C.B., J.C.H., R.G.); Department of Cerebrovascular and Endovascular Surgery, Baptist Neurologic Institute and Lyerly Neurosurgery, Jacksonville, Fla (G.C., R.H.); Department of Neurosurgery, Emory University School of Medicine, Atlanta, Ga (C.M.C., B.M.H.); Department of Neurosurgery, NYU Langone Medical Center, New York, NY (H.A.R.); Department of Neurosurgery, Medical University of South Carolina, Charleston, SC (A.M.S.); Department of Neurosurgery, University of California-San Diego, La Jolla, Calif (A.A.K.); Department of Neurosurgery, University of Texas Medical Branch, Galveston, Tex (P.K.); and Department of Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ (A.J.T.)
| | - Ramesh Grandhi
- From the Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104 (M.M.S., B.T.J., J.K.B.); Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pa (O.K., A.A.M., S.N., M.J.L., B.A.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, Tex (A.N.H., O.T., P.K.); Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (A.A.B., J.M.D., E.I.L., A.H.S.); Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, Mass (M.K., J.M.M., C.S.O., A.J.T.); Department of Neurosurgery, University of Utah, Salt Lake City, Utah (C.B., J.C.H., R.G.); Department of Cerebrovascular and Endovascular Surgery, Baptist Neurologic Institute and Lyerly Neurosurgery, Jacksonville, Fla (G.C., R.H.); Department of Neurosurgery, Emory University School of Medicine, Atlanta, Ga (C.M.C., B.M.H.); Department of Neurosurgery, NYU Langone Medical Center, New York, NY (H.A.R.); Department of Neurosurgery, Medical University of South Carolina, Charleston, SC (A.M.S.); Department of Neurosurgery, University of California-San Diego, La Jolla, Calif (A.A.K.); Department of Neurosurgery, University of Texas Medical Branch, Galveston, Tex (P.K.); and Department of Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ (A.J.T.)
| | - Michael J Lang
- From the Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104 (M.M.S., B.T.J., J.K.B.); Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pa (O.K., A.A.M., S.N., M.J.L., B.A.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, Tex (A.N.H., O.T., P.K.); Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (A.A.B., J.M.D., E.I.L., A.H.S.); Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, Mass (M.K., J.M.M., C.S.O., A.J.T.); Department of Neurosurgery, University of Utah, Salt Lake City, Utah (C.B., J.C.H., R.G.); Department of Cerebrovascular and Endovascular Surgery, Baptist Neurologic Institute and Lyerly Neurosurgery, Jacksonville, Fla (G.C., R.H.); Department of Neurosurgery, Emory University School of Medicine, Atlanta, Ga (C.M.C., B.M.H.); Department of Neurosurgery, NYU Langone Medical Center, New York, NY (H.A.R.); Department of Neurosurgery, Medical University of South Carolina, Charleston, SC (A.M.S.); Department of Neurosurgery, University of California-San Diego, La Jolla, Calif (A.A.K.); Department of Neurosurgery, University of Texas Medical Branch, Galveston, Tex (P.K.); and Department of Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ (A.J.T.)
| | - Adnan H Siddiqui
- From the Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104 (M.M.S., B.T.J., J.K.B.); Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pa (O.K., A.A.M., S.N., M.J.L., B.A.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, Tex (A.N.H., O.T., P.K.); Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (A.A.B., J.M.D., E.I.L., A.H.S.); Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, Mass (M.K., J.M.M., C.S.O., A.J.T.); Department of Neurosurgery, University of Utah, Salt Lake City, Utah (C.B., J.C.H., R.G.); Department of Cerebrovascular and Endovascular Surgery, Baptist Neurologic Institute and Lyerly Neurosurgery, Jacksonville, Fla (G.C., R.H.); Department of Neurosurgery, Emory University School of Medicine, Atlanta, Ga (C.M.C., B.M.H.); Department of Neurosurgery, NYU Langone Medical Center, New York, NY (H.A.R.); Department of Neurosurgery, Medical University of South Carolina, Charleston, SC (A.M.S.); Department of Neurosurgery, University of California-San Diego, La Jolla, Calif (A.A.K.); Department of Neurosurgery, University of Texas Medical Branch, Galveston, Tex (P.K.); and Department of Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ (A.J.T.)
| | - Peter Kan
- From the Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104 (M.M.S., B.T.J., J.K.B.); Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pa (O.K., A.A.M., S.N., M.J.L., B.A.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, Tex (A.N.H., O.T., P.K.); Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (A.A.B., J.M.D., E.I.L., A.H.S.); Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, Mass (M.K., J.M.M., C.S.O., A.J.T.); Department of Neurosurgery, University of Utah, Salt Lake City, Utah (C.B., J.C.H., R.G.); Department of Cerebrovascular and Endovascular Surgery, Baptist Neurologic Institute and Lyerly Neurosurgery, Jacksonville, Fla (G.C., R.H.); Department of Neurosurgery, Emory University School of Medicine, Atlanta, Ga (C.M.C., B.M.H.); Department of Neurosurgery, NYU Langone Medical Center, New York, NY (H.A.R.); Department of Neurosurgery, Medical University of South Carolina, Charleston, SC (A.M.S.); Department of Neurosurgery, University of California-San Diego, La Jolla, Calif (A.A.K.); Department of Neurosurgery, University of Texas Medical Branch, Galveston, Tex (P.K.); and Department of Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ (A.J.T.)
| | - Christopher S Ogilvy
- From the Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104 (M.M.S., B.T.J., J.K.B.); Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pa (O.K., A.A.M., S.N., M.J.L., B.A.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, Tex (A.N.H., O.T., P.K.); Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (A.A.B., J.M.D., E.I.L., A.H.S.); Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, Mass (M.K., J.M.M., C.S.O., A.J.T.); Department of Neurosurgery, University of Utah, Salt Lake City, Utah (C.B., J.C.H., R.G.); Department of Cerebrovascular and Endovascular Surgery, Baptist Neurologic Institute and Lyerly Neurosurgery, Jacksonville, Fla (G.C., R.H.); Department of Neurosurgery, Emory University School of Medicine, Atlanta, Ga (C.M.C., B.M.H.); Department of Neurosurgery, NYU Langone Medical Center, New York, NY (H.A.R.); Department of Neurosurgery, Medical University of South Carolina, Charleston, SC (A.M.S.); Department of Neurosurgery, University of California-San Diego, La Jolla, Calif (A.A.K.); Department of Neurosurgery, University of Texas Medical Branch, Galveston, Tex (P.K.); and Department of Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ (A.J.T.)
| | - Bradley A Gross
- From the Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104 (M.M.S., B.T.J., J.K.B.); Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pa (O.K., A.A.M., S.N., M.J.L., B.A.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, Tex (A.N.H., O.T., P.K.); Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (A.A.B., J.M.D., E.I.L., A.H.S.); Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, Mass (M.K., J.M.M., C.S.O., A.J.T.); Department of Neurosurgery, University of Utah, Salt Lake City, Utah (C.B., J.C.H., R.G.); Department of Cerebrovascular and Endovascular Surgery, Baptist Neurologic Institute and Lyerly Neurosurgery, Jacksonville, Fla (G.C., R.H.); Department of Neurosurgery, Emory University School of Medicine, Atlanta, Ga (C.M.C., B.M.H.); Department of Neurosurgery, NYU Langone Medical Center, New York, NY (H.A.R.); Department of Neurosurgery, Medical University of South Carolina, Charleston, SC (A.M.S.); Department of Neurosurgery, University of California-San Diego, La Jolla, Calif (A.A.K.); Department of Neurosurgery, University of Texas Medical Branch, Galveston, Tex (P.K.); and Department of Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ (A.J.T.)
| | - Ajith J Thomas
- From the Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104 (M.M.S., B.T.J., J.K.B.); Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pa (O.K., A.A.M., S.N., M.J.L., B.A.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, Tex (A.N.H., O.T., P.K.); Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (A.A.B., J.M.D., E.I.L., A.H.S.); Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, Mass (M.K., J.M.M., C.S.O., A.J.T.); Department of Neurosurgery, University of Utah, Salt Lake City, Utah (C.B., J.C.H., R.G.); Department of Cerebrovascular and Endovascular Surgery, Baptist Neurologic Institute and Lyerly Neurosurgery, Jacksonville, Fla (G.C., R.H.); Department of Neurosurgery, Emory University School of Medicine, Atlanta, Ga (C.M.C., B.M.H.); Department of Neurosurgery, NYU Langone Medical Center, New York, NY (H.A.R.); Department of Neurosurgery, Medical University of South Carolina, Charleston, SC (A.M.S.); Department of Neurosurgery, University of California-San Diego, La Jolla, Calif (A.A.K.); Department of Neurosurgery, University of Texas Medical Branch, Galveston, Tex (P.K.); and Department of Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ (A.J.T.)
| | - Brian T Jankowitz
- From the Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104 (M.M.S., B.T.J., J.K.B.); Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pa (O.K., A.A.M., S.N., M.J.L., B.A.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, Tex (A.N.H., O.T., P.K.); Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (A.A.B., J.M.D., E.I.L., A.H.S.); Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, Mass (M.K., J.M.M., C.S.O., A.J.T.); Department of Neurosurgery, University of Utah, Salt Lake City, Utah (C.B., J.C.H., R.G.); Department of Cerebrovascular and Endovascular Surgery, Baptist Neurologic Institute and Lyerly Neurosurgery, Jacksonville, Fla (G.C., R.H.); Department of Neurosurgery, Emory University School of Medicine, Atlanta, Ga (C.M.C., B.M.H.); Department of Neurosurgery, NYU Langone Medical Center, New York, NY (H.A.R.); Department of Neurosurgery, Medical University of South Carolina, Charleston, SC (A.M.S.); Department of Neurosurgery, University of California-San Diego, La Jolla, Calif (A.A.K.); Department of Neurosurgery, University of Texas Medical Branch, Galveston, Tex (P.K.); and Department of Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ (A.J.T.)
| | - Jan-Karl Burkhardt
- From the Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104 (M.M.S., B.T.J., J.K.B.); Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pa (O.K., A.A.M., S.N., M.J.L., B.A.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, Tex (A.N.H., O.T., P.K.); Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (A.A.B., J.M.D., E.I.L., A.H.S.); Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, Mass (M.K., J.M.M., C.S.O., A.J.T.); Department of Neurosurgery, University of Utah, Salt Lake City, Utah (C.B., J.C.H., R.G.); Department of Cerebrovascular and Endovascular Surgery, Baptist Neurologic Institute and Lyerly Neurosurgery, Jacksonville, Fla (G.C., R.H.); Department of Neurosurgery, Emory University School of Medicine, Atlanta, Ga (C.M.C., B.M.H.); Department of Neurosurgery, NYU Langone Medical Center, New York, NY (H.A.R.); Department of Neurosurgery, Medical University of South Carolina, Charleston, SC (A.M.S.); Department of Neurosurgery, University of California-San Diego, La Jolla, Calif (A.A.K.); Department of Neurosurgery, University of Texas Medical Branch, Galveston, Tex (P.K.); and Department of Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ (A.J.T.)
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Vivanco-Suarez J, Sioutas GS, Matache IM, Muhammad N, Salem MM, Kandregula S, Jankowitz BT, Burkhardt JK, Srinivasan VM. Intraoperative angiography during neurosurgical procedures on patients in prone, three-quarters prone, and park-bench positions: tertiary single-center experience with systematic review and meta-analysis. J Neurointerv Surg 2023:jnis-2022-020035. [PMID: 37068942 DOI: 10.1136/jnis-2022-020035] [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: 12/26/2022] [Accepted: 03/25/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND There is limited evidence about the role and effectiveness of intraoperative angiography (IOA) during neurosurgical procedures with patients in prone, three-quarters prone, and park-bench positions. OBJECTIVE To carry out a systematic review and meta-analysis of the literature to evaluate the safety and efficacy of IOA during neurosurgical procedures. METHODS We reviewed (between January 1960 and July 2022) all studies in which IOAs were performed during neurosurgical procedures with patients in either prone, three-quarters prone, or park-bench positions. Additionally, a cohort of patients from our institutional experience was included. Efficacy outcomes were the rate of successful angiography and the rate of surgical adjustment/revision after IOA. Safety outcomes were the rate of angiography-related complications and mortality. Data were analyzed using a random-effects meta-analysis of proportions, and statistical heterogeneity was assessed. RESULTS A total of 26 studies with 142 patients plus 32 subjects from our institution were included in the analysis. The rate of successful intraoperative angiography was 98% (95% CI 94% to 99%; I2=0%). The rate of surgical adjustment/revision was 18% (95% CI 12% to 28%; I2=0%). The rate of complications related to the angiography was 1% (95% CI 0% to 5%; I2=0%). There were no deaths associated with IOA. CONCLUSION We found that IOA performed with patients in prone, three-quarters prone, and park-bench positions is feasible and safe with a non-negligible rate of intraoperative post-angiographical surgical adjustment/revision. Our findings suggest that the performance of IOA to complement vascular neurosurgical procedures might have a valuable role in favoring patient outcomes.
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Affiliation(s)
- Juan Vivanco-Suarez
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Georgios S Sioutas
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Irina-Mihaela Matache
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Physiology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Najib Muhammad
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mohamed M Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sandeep Kandregula
- Department of Neurosurgery, LSU Health Shreveport, Shreveport, Louisiana, USA
| | - Brian T Jankowitz
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Gajjar AA, Salem MM, Hou NY, Davis RM, Le AHD, Jankowitz BT, Burkhardt JK. What matters most to cerebral aneurysms patients: A digital analysis of 1127 social media posts. Interv Neuroradiol 2023:15910199231167914. [PMID: 37050848 DOI: 10.1177/15910199231167914] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 04/14/2023] Open
Abstract
INTRODUCTION Social media serves as a way for patients to post about their condition online, as well as for healthcare providers to disseminate information. Intrinsic bias exists exist when patients are given surveys by physicians or healthcare providers. We aim to investigate patient-centered social media posts regarding cerebral aneurysms on Instagram, Twitter, and TikTok. METHODS Posts that included "brain aneurysm", "#brainaneurysm", "#brainaneurysmsurvivor", and "#aneurysmsurvivor" were queried on Instagram, Twitter, and TikTok. Any posts unrelated to the patient experience were excluded. Five hundred and fourteen Instagram posts, fourty tweets, and five hundred seventy three TikTok posts about the patient experience were identified. Posts were coded for the relevant themes related to their experience with the disease. RESULTS Most posts made online were by women (892, 82.1%). Patients made the post most of the time (776, 67.5%), while other individuals posted less often (420, 36.5%). The most common themes on Instagram were survival (475, 87.3%), spreading positivity (385, 70.77%), and recovery/rehabilitation (329, 60.5%). TikTok users most often referred to survival (573, 97.1%), raising awareness (464. 78.6%), and spreading positivity (414, 70.2%). Patients were more likely to discuss pre-operative pain (p = 0.0382), postoperative pain (p < 0.0001), invisible illness (p = 0.0130), humor (p = 0.0028), recovery (p < 0.0001), angiograms (p < 0.0001), and resiliency (p < 0.0001) when compared to other individuals posting about a patients' experience. CONCLUSION Patients often focus on different aspects of their care than do other individuals. This may be useful for physicians discussing treatment plans and prognoses with the patient and their families.
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Affiliation(s)
- Avi A Gajjar
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Mohamed M Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Neo Y Hou
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Ryan Michael Davis
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Anthony Huy Dinh Le
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Brian T Jankowitz
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Jan Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
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Muhammad N, Sioutas GS, Gajjar A, Salem MM, Kandregula S, Srinivasan VM, Jankowitz BT, Burkhardt JK. Intraoperative angiography via popliteal artery access for spinal neurovascular lesions: an institutional experience and systematic review. J Neurointerv Surg 2023:jnis-2023-020071. [PMID: 37028944 DOI: 10.1136/jnis-2023-020071] [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: 01/17/2023] [Accepted: 03/22/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Intraoperative DSA is used to confirm complete obliteration of neurovascular pathologies. For spinal neurovascular lesions, femoral access can be challenging given the need to flip the patient after sheath placement. Similarly, radial access can be complicated by arch navigation difficulties. Vascular access via the popliteal artery represents an appealing alternative option; however, data regarding its utility and efficacy in these cases are limited. METHODS A retrospective series of four consecutive patients between July 2016 and August 2022 who underwent intraoperative spinal DSA via the popliteal artery was analyzed. Additionally, a systematic review was conducted to collect previously reported such cases. Collective patient demographics and operative details are presented to consolidate the available evidence supporting popliteal access. RESULTS Four patients met the inclusion criteria from our institution. The systematic review yielded six previously published studies reporting 16 additional transpopliteal access cases. Of the 20 total cases (mean±SD age 60.8±17.2 years), 60% were men. Most treated lesions were dural arteriovenous fistulas (80%) located in the thoracic spine (55%) or cervical spine (25%). The left popliteal artery was most accessed and the highest visualized level was the craniocervical junction. All outcomes were either stable or improving after surgery, and no complications were observed. CONCLUSIONS We report the safety and feasibility of transpopliteal access for intraoperative DSA in the prone position in four cases in addition to 16 previously reported cases in the literature. Our case series highlights popliteal artery access as an alternative to transfemoral or transradial access in this setting.
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Affiliation(s)
- Najib Muhammad
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Georgios S Sioutas
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Avi Gajjar
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Mohamed M Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | | | - Visish M Srinivasan
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Brian T Jankowitz
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
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Salih M, Salem MM, Ravina K, Stippler M, Papavassiliou E, Alterman RL, Thomas A, Moore JM, Ogilvy CS. 765 Outcome of Chronic Subdural Hematoma Management in Patients on Long Term Antiplatelet Therapy—A Propensity Score Matched Analysis. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_765] [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: 03/18/2023] Open
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Salem MM, Burkhardt JK. Letter: Commentary: The Pennsylvania Postmarket Multicenter Experience With Flow Redirection Endoluminal Device. Neurosurgery 2023; 92:e93-e94. [PMID: 36722945 DOI: 10.1227/neu.0000000000002395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/09/2022] [Indexed: 02/02/2023] Open
Affiliation(s)
- Mohamed M Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia , Pennsylvania , USA
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Khorasanizadeh M, Shutran M, Schirmer CM, Salem MM, Ringer AJ, Grandhi R, Mitha AP, Levitt MR, Jankowitz BT, Taussky P, Thomas AJ, Moore JM, Ogilvy CS. 396 North American Multicenter Experience of the Flow-Redirection Endoluminal Device (FRED) in the Treatment of Intracranial Aneurysms. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_396] [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: 03/18/2023] Open
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Salem MM, Ravindran K, Hoang AN, Doron O, Esparza R, Raper D, Jankowitz BT, Tanweer O, Lopes DK, Langer DJ, Nossek EZ, Burkhardt JK. 393 Sonolucent Cranioplasty for Real-Time Ultrasound Monitoring of Extra-to-Intracranial Bypass: Early Multicenter Experience of 44 Cases. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_393] [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: 03/18/2023] Open
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