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Diestro JDB, Adeeb N, Musmar B, Salim H, Aslan A, Cancelliere NM, McLellan RM, Algin O, Ghozy S, Lay SV, Guenego A, Renieri L, Carnevale J, Saliou G, Mastorakos P, El Naamani K, Shotar E, Premat K, Möhlenbruch M, Kral M, Bernstock JD, Doron O, Chung C, Salem MM, Lylyk I, Foreman PM, Vachhani JA, Shaikh H, Župančić V, Hafeez MU, Catapano J, Waqas M, 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, Nguyen A, Jones J, Brinjikji W, Nawka MT, Psychogios M, Ulfert C, Pukenas B, Burkhardt JK, Huynh T, Martinez-Gutierrez JC, Essibayi MA, Sheth SA, Spiegel G, Tawk RG, Lubicz B, Panni P, Puri AS, Pero G, Nossek E, Raz E, Killer-Oberpfalzer M, Griessenauer CJ, Asadi H, Siddiqui A, Brook AL, Altschul D, Spears J, Marotta TR, Ducruet AF, Albuquerque FC, Regenhardt RW, Stapleton CJ, Kan P, Kalousek V, Lylyk P, Boddu S, Knopman J, Aziz-Sultan MA, Tjoumakaris SI, Jabbour PM, Clarençon F, Limbucci N, Cuellar-Saenz HH, Mendes Pereira V, Patel AB, Dmytriw AA. Association of preprocedural antiplatelet use with decreased thromboembolic complications for intracranial aneurysms undergoing intrasaccular flow disruption. J Neurosurg 2024:1-8. [PMID: 38701528 DOI: 10.3171/2024.2.jns232918] [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: 12/20/2023] [Accepted: 02/23/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVE This study was conducted to investigate the impact of antiplatelet administration in the periprocedural period on the occurrence of thromboembolic complications (TECs) in patients undergoing treatment using the Woven EndoBridge (WEB) device for intracranial wide-necked bifurcation aneurysms. The primary objective was to assess whether the use of antiplatelets in the pre- and postprocedural phases reduces the likelihood of developing TECs, considering various covariates. METHODS A retrospective multicenter observational study was conducted within the WorldWideWEB Consortium and comprised 38 academic centers with endovascular treatment capabilities. Univariable and multivariable logistic regression analyses were performed to determine the association between antiplatelet use and TECs, adjusting for covariates. Missing predictor data were addressed using multiple imputation. RESULTS The study comprised two cohorts: one addressing general thromboembolic events and consisting of 1412 patients, among whom 103 experienced TECs, and another focusing on symptomatic thromboembolic events and comprising 1395 patients, of whom 50 experienced symptomatic TECs. Preprocedural antiplatelet use was associated with a reduced likelihood of overall TECs (OR 0.32, 95% CI 0.19-0.53, p < 0.001) and symptomatic TECs (OR 0.49, 95% CI 0.25-0.95, p = 0.036), whereas postprocedural antiplatelet use showed no significant association with TECs. The study also revealed additional predictors of TECs, including stent use (overall: OR 4.96, 95% CI 2.38-10.3, p < 0.001; symptomatic: OR 3.24, 95% CI 1.26-8.36, p = 0.015), WEB single-layer sphere (SLS) type (overall: OR 0.18, 95% CI 0.04-0.74, p = 0.017), and posterior circulation aneurysm location (symptomatic: OR 18.43, 95% CI 1.48-230, p = 0.024). CONCLUSIONS The findings of this study suggest that the preprocedural administration of antiplatelets is associated with a reduced likelihood of TECs in patients undergoing treatment with the WEB device for wide-necked bifurcation aneurysms. However, postprocedural antiplatelet use did not show a significant impact on TEC occurrence.
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Affiliation(s)
- Jose Danilo Bengzon Diestro
- 1Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Nimer Adeeb
- 2Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, Louisiana
| | - Basel Musmar
- 2Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, Louisiana
| | - Hamza Salim
- 2Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, Louisiana
| | - Assala Aslan
- 2Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, Louisiana
| | - Nicole M Cancelliere
- 1Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Rachel M McLellan
- 3Neuroendovascular Program, Massachusetts General Hospital and Brigham and Women's Hospital, Harvard University, Boston, Massachusetts
| | - Oktay Algin
- 4Ankara University, Medical Faculty, Department of Radiology, Ankara, Turkey
| | | | - Sovann V Lay
- 6Service de Neuroradiologie Diagnostique et Thérapeutique, Centre Hospitalier de Toulouse, Hôpital Purpan, Toulouse, France
| | - Adrien Guenego
- 7Service de Neuroradiologie Interventionnelle, Hôpital Universitaire Erasme, Bruxelles, Belgique
| | - Leonardo Renieri
- 8Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy
| | - Joseph Carnevale
- 9Neurosurgery & Interventional Neuroradiology, NewYork-Presbyterian Hospital, Weill Cornell School of Medicine, New York, New York
| | - Guillaume Saliou
- 10Service de radiodiagnostic et radiologie interventionnelle, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Panagiotis Mastorakos
- 11Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kareem El Naamani
- 11Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Eimad Shotar
- 12Département de Neuroradiologie, Hôpital Pitié-Salpêtrière, Université Sorbonne, Paris, France
| | - Kevin Premat
- 12Département de Neuroradiologie, Hôpital Pitié-Salpêtrière, Université Sorbonne, Paris, France
| | - Markus Möhlenbruch
- 13Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Germany
| | - Michael Kral
- 14Department of Neurosurgery, Christian Doppler University Hospital and Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Joshua D Bernstock
- 3Neuroendovascular Program, Massachusetts General Hospital and Brigham and Women's Hospital, Harvard University, Boston, Massachusetts
| | - Omer Doron
- 3Neuroendovascular Program, Massachusetts General Hospital and Brigham and Women's Hospital, Harvard University, Boston, Massachusetts
| | - Charlotte Chung
- Departments of15Radiology and
- 39Neurosurgery, NYU Langone Health Center, New York, New York
| | - Mohamed M Salem
- 16Department of Neurosurgery, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
| | - Ivan Lylyk
- 17Equipo de Neurocirugía Endovascular y Radiología Intervencionista, Clínica La Sagrada Familia, Buenos Aires, Argentina
| | - Paul M Foreman
- 18Department of Neurosurgery, Orlando Health Neuroscience and Rehabilitation Institute, Orlando, Florida
| | - Jay A Vachhani
- 18Department of Neurosurgery, Orlando Health Neuroscience and Rehabilitation Institute, Orlando, Florida
| | - Hamza Shaikh
- Departments of19Radiology and
- 40Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Vedran Župančić
- 20Department of Radiology, Subdivision of Interventional Neuroradiology, Clinical Hospital Center Sisters of Mercy, Zagreb, Croatia
| | - Muhammad U Hafeez
- 21Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, Texas
| | - Joshua Catapano
- 22Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Muhammad Waqas
- 23Department of Neurosurgery, State University of New York at Buffalo, New York
| | - Mohamed K Ibrahim
- Departments of5Radiology and
- 38Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Marwa A Mohammed
- Departments of5Radiology and
- 38Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Cetin Imamoglu
- 37Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital of the Ministry of Health, Ankara, Turkey
| | - Ahmet Bayrak
- 37Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital of the Ministry of Health, Ankara, Turkey
| | - James D Rabinov
- 3Neuroendovascular Program, Massachusetts General Hospital and Brigham and Women's Hospital, Harvard University, Boston, Massachusetts
| | - Yifan Ren
- 24Department of Radiology, Interventional Radiology and Neurointerventional Services, Austin Health, Melbourne, Victoria, Australia
| | - Clemens M Schirmer
- Departments of25Neurosurgery and
- 41Radiology, Geisinger Hospital, Danville, Pennsylvania
| | - Mariangela Piano
- 26Interventistica Neurovascolare, Ospedale Niguarda Cà Granda, Milano, Italy
| | - Anna L Kühn
- 27Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester, Massachusetts
| | | | - Stéphanie Elens
- 8Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy
| | | | - Ameer E Hassan
- 30Department of Neuroscience, Valley Baptist Neuroscience Institute, Harlingen, Texas
| | - Mark Ogilvie
- Departments of31Neurosurgery and
- 42Radiology, University of Alabama at Birmingham, Alabama
| | - Anh Nguyen
- 32Department of Neuroradiology, University Hospital of Basel, Switzerland
| | - Jesse Jones
- Departments of31Neurosurgery and
- 42Radiology, University of Alabama at Birmingham, Alabama
| | - Waleed Brinjikji
- Departments of5Radiology and
- 38Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Marie T Nawka
- 33Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marios Psychogios
- 32Department of Neuroradiology, University Hospital of Basel, Switzerland
| | - Christian Ulfert
- 13Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Germany
| | - Bryan Pukenas
- 16Department of Neurosurgery, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
| | - Jan-Karl Burkhardt
- 16Department of Neurosurgery, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
| | - Thien Huynh
- Departments of34Radiology and
- 43Neurosurgery, Mayo Clinic, Jacksonville, Florida
| | | | - Muhammed Amir Essibayi
- 36Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York; and
| | - Sunil A Sheth
- Departments of35Radiology
- 44Neurology, and
- 45Neurosurgery, University of Texas Health Science Center at Houston, Texas
| | - Gary Spiegel
- Departments of35Radiology
- 44Neurology, and
- 45Neurosurgery, University of Texas Health Science Center at Houston, Texas
| | - Rabih G Tawk
- Departments of34Radiology and
- 43Neurosurgery, Mayo Clinic, Jacksonville, Florida
| | - Boris Lubicz
- 8Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy
| | - Pietro Panni
- 28Interventistica Neurovascolare, Ospedale San Raffaele, Milano, Italy
| | - Ajit S Puri
- 27Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester, Massachusetts
| | - Guglielmo Pero
- 26Interventistica Neurovascolare, Ospedale Niguarda Cà Granda, Milano, Italy
| | - Erez Nossek
- Departments of15Radiology and
- 39Neurosurgery, NYU Langone Health Center, New York, New York
| | - Eytan Raz
- Departments of15Radiology and
- 39Neurosurgery, NYU Langone Health Center, New York, New York
| | - Monika Killer-Oberpfalzer
- 14Department of Neurosurgery, Christian Doppler University Hospital and Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Christoph J Griessenauer
- 14Department of Neurosurgery, Christian Doppler University Hospital and Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Hamed Asadi
- Departments of15Radiology and
- 39Neurosurgery, NYU Langone Health Center, New York, New York
| | - Adnan Siddiqui
- 23Department of Neurosurgery, State University of New York at Buffalo, New York
| | - Allan L Brook
- 36Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York; and
| | - David Altschul
- 36Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York; and
| | - Julian Spears
- 1Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Thomas R Marotta
- 1Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Andrew F Ducruet
- 22Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | | | - Robert W Regenhardt
- 3Neuroendovascular Program, Massachusetts General Hospital and Brigham and Women's Hospital, Harvard University, Boston, Massachusetts
| | - Christopher J Stapleton
- 3Neuroendovascular Program, Massachusetts General Hospital and Brigham and Women's Hospital, Harvard University, Boston, Massachusetts
| | - Peter Kan
- 21Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, Texas
| | - Vladimir Kalousek
- 20Department of Radiology, Subdivision of Interventional Neuroradiology, Clinical Hospital Center Sisters of Mercy, Zagreb, Croatia
| | - Pedro Lylyk
- 17Equipo de Neurocirugía Endovascular y Radiología Intervencionista, Clínica La Sagrada Familia, Buenos Aires, Argentina
| | - Srikanth Boddu
- 10Service de radiodiagnostic et radiologie interventionnelle, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Jared Knopman
- 9Neurosurgery & Interventional Neuroradiology, NewYork-Presbyterian Hospital, Weill Cornell School of Medicine, New York, New York
| | - Mohammad A Aziz-Sultan
- 3Neuroendovascular Program, Massachusetts General Hospital and Brigham and Women's Hospital, Harvard University, Boston, Massachusetts
| | | | - Pascal M Jabbour
- 11Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Frédéric Clarençon
- 12Département de Neuroradiologie, Hôpital Pitié-Salpêtrière, Université Sorbonne, Paris, France
| | - Nicola Limbucci
- 9Neurosurgery & Interventional Neuroradiology, NewYork-Presbyterian Hospital, Weill Cornell School of Medicine, New York, New York
| | - Hugo H Cuellar-Saenz
- 1Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Vitor Mendes Pereira
- 1Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Aman B Patel
- 3Neuroendovascular Program, Massachusetts General Hospital and Brigham and Women's Hospital, Harvard University, Boston, Massachusetts
| | - Adam A Dmytriw
- 3Neuroendovascular Program, Massachusetts General Hospital and Brigham and Women's Hospital, Harvard University, Boston, Massachusetts
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Consoli A, Cancelliere NM, Charbonnier G, Nishi H, Vanek I, Marotta TR, Spears J, Pereira VM. Novel, braided, self-expandable stent designed for the treatment of pulsatile tinnitus caused by intracranial venous stenosis: first-in-human experience and long-term outcomes. J Neurointerv Surg 2024:jnis-2024-021458. [PMID: 38697807 DOI: 10.1136/jnis-2024-021458] [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: 01/05/2024] [Accepted: 04/17/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Pulsatile tinnitus (PT) can be a disabling clinical condition, which may be caused by a sigmoid/transverse sinus stenosis (STSS). Intracranial venous stenting with off-label carotid or peripheral venous stents has been used successfully to treat this condition. We present the results of a cohort of patients presenting with PT treated with a novel, dedicated, braided stent for the endovascular treatment of STSS. METHODS Twelve patients presenting with PT and associated STSS were treated at our institution (December 2022-June 2023). All clinical and procedural variables were prospectively collected. We used the Tinnitus Function Index (TFI) and the Tinnitus Handicap Inventory (THI) scores to assess the impact of PT on quality of life before and after the treatment (mean follow-up: 10.3 months). RESULTS Twelve women (mean age: 44±16.5 years) presenting with PT and STSS were treated. Mean pretreatment TFI/THI scores were 78.8/77. The BosStent was successfully deployed in all patients. We experienced no intraprocedural/postoperative complications. Intra-stent angioplasty was performed in three cases. All patients reported a complete resolution of PT symptoms within 1 month and remained stable and PT-free at the last follow-up (mean posttreatment TFI/THI score: 7.1/5, p<0001). CONCLUSIONS The BosStent was successfully used in a cohort of patients with PT without any intraprocedural complications. All the patients experienced a complete resolution of PT symptoms after 1 month, which was stable during the follow-up period. Further studies with larger populations will be necessary to investigate the safety and effectiveness of this novel stent for the treatment of PT with STSS.
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Affiliation(s)
- Arturo Consoli
- Diagnostic and Interventional Neuroradiology, Hospital Foch Department of Therapeutic and Interventional Neuroradiology, Suresnes, France
- RADIS Lab, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Nicole M Cancelliere
- RADIS Lab, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Guillaume Charbonnier
- RADIS Lab, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
- Neurology, Hôpital Jean Minjoz, Besancon, France
| | - Hidehisa Nishi
- RADIS Lab, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Irene Vanek
- Division of Neurosurgery, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Thomas R Marotta
- Interventional Neuroradiology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Julian Spears
- RADIS Lab, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
- Division of Neurosurgery, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Vitor M Pereira
- RADIS Lab, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
- Division of Neurosurgery, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
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3
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Radu RA, Costalat V, Romoli M, Musmar B, Siegler JE, Ghozy S, Khalife J, Salim H, Shaikh H, Adeeb N, Cuellar-Saenz HH, Thomas AJ, Kadirvel R, Abdalkader M, Klein P, Nguyen TN, Heit JJ, Regenhardt RW, Bernstock JD, Patel AB, Rabinov JD, Stapleton CJ, Cancelliere NM, Marotta TR, Mendes Pereira V, El Naamani K, Amllay A, Tjoumakaris SI, Jabbour P, Meyer L, Fiehler J, Faizy TD, Guerreiro H, Dusart A, Bellante F, Forestier G, Rouchaud A, Mounayer C, Kühn AL, Puri AS, Dyzmann C, Kan PT, Colasurdo M, Marnat G, Berge J, Barreau X, Sibon I, Nedelcu S, Henninger N, Ota T, Dofuku S, Yeo LLL, Tan BY, Gopinathan A, Martinez-Gutierrez JC, Salazar-Marioni S, Sheth S, Renieri L, Capirossi C, Mowla A, Chervak LM, Vagal A, Khandelwal P, Biswas A, Clarençon F, Elhorany M, Premat K, Valente I, Pedicelli A, Alexandre AM, Filipe JP, Varela R, Quintero-Consuegra M, Gonzalez NR, Ymd MA, Jesser J, Weyland C, Ter Schiphorst A, Yedavalli V, Harker P, Aziz Y, Gory B, Paul Stracke C, Hecker C, Killer-Oberpfalzer M, Griessenauer CJ, Hsieh CY, Liebeskind DS, Tancredi I, Fahed R, Lubicz B, Essibayi MA, Baker A, Altschul D, Scarcia L, Kalsoum E, Dmytriw AA, Guenego A. Outcomes with General Anesthesia Compared to Conscious Sedation for Endovascular Treatment of Medium Vessel Occlusions: Results of an International Multicentric Study. Clin Neuroradiol 2024:10.1007/s00062-024-01415-1. [PMID: 38687365 DOI: 10.1007/s00062-024-01415-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 04/14/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Optimal anesthetic strategy for the endovascular treatment of stroke is still under debate. Despite scarce data concerning anesthetic management for medium and distal vessel occlusions (MeVOs) some centers empirically support a general anesthesia (GA) strategy in these patients. METHODS We conducted an international retrospective study of MeVO cases. A propensity score matching algorithm was used to mitigate potential differences across patients undergoing GA and conscious sedation (CS). Comparisons in clinical and safety outcomes were performed between the two study groups GA and CS. The favourable outcome was defined as a modified Rankin Scale (mRS) 0-2 at 90 days. Safety outcomes were 90-days mortality and symptomatic intracranial hemorrhage (sICH). Predictors of a favourable outcome and sICH were evaluated with backward logistic regression. RESULTS After propensity score matching 668 patients were included in the CS and 264 patients in the GA group. In the matched cohort, either strategy CS or GA resulted in similar rates of good functional outcomes (50.1% vs. 48.4%), and successful recanalization (89.4% vs. 90.2%). The GA group had higher rates of 90-day mortality (22.6% vs. 16.5%, p < 0.041) and sICH (4.2% vs. 0.9%, p = 0.001) compared to the CS group. Backward logistic regression did not identify GA vs CS as a predictor of good functional outcome (OR for GA vs CS = 0.95 (0.67-1.35)), but GA remained a significant predictor of sICH (OR = 5.32, 95% CI 1.92-14.72). CONCLUSION Anaesthetic strategy in MeVOs does not influence favorable outcomes or final successful recanalization rates, however, GA may be associated with an increased risk of sICH and mortality.
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Affiliation(s)
- Răzvan Alexandru Radu
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.
- Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
| | - Vincent Costalat
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Michele Romoli
- Neurology and Stroke Unit, Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Basel Musmar
- Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Louisiana, LA, USA
| | - James E Siegler
- Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA
| | - Sherief Ghozy
- Departments of Neurological Surgery & Radiology, Mayo Clinic, Rochester, MN, USA
| | - Jane Khalife
- Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA
| | - Hamza Salim
- Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Louisiana, LA, USA
| | - Hamza Shaikh
- Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA
| | - Nimer Adeeb
- Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Louisiana, LA, USA
| | - Hugo H Cuellar-Saenz
- Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Louisiana, LA, USA
| | - Ajith J Thomas
- Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA
| | - Ramanathan Kadirvel
- Departments of Neurological Surgery & Radiology, Mayo Clinic, Rochester, MN, USA
| | - Mohamad Abdalkader
- Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA
| | - Piers Klein
- Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA
| | - Thanh N Nguyen
- Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA
| | - Jeremy J Heit
- Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA, USA
| | - Robert W Regenhardt
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Joshua D Bernstock
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Aman B Patel
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - James D Rabinov
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Christopher J Stapleton
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Nicole M Cancelliere
- Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Thomas R Marotta
- Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Vitor Mendes Pereira
- Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Kareem El Naamani
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Abdelaziz Amllay
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias D Faizy
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Radiology, Interventional Neuroradiology Section, University Medical Center Münster, Munster, Germany
| | - Helena Guerreiro
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Dusart
- Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium
| | - Flavio Bellante
- Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium
| | - Géraud Forestier
- University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France
| | - Aymeric Rouchaud
- University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France
| | - Charbel Mounayer
- University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France
| | - Anna Luisa Kühn
- Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Ajit S Puri
- Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Christian Dyzmann
- Neuroradiology Department, Sana Kliniken, Lübeck GmbH, Lübeck, Germany
| | - Peter T Kan
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Marco Colasurdo
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, TX, USA
- Department of Interventional Radiology, Oregon Health and Science University, 97239, Portland, OR, USA
| | - Gaultier Marnat
- Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France
| | - Jérôme Berge
- Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France
| | - Xavier Barreau
- Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France
| | - Igor Sibon
- Neurology Department, Bordeaux University Hospital, Bordeaux, France
| | - Simona Nedelcu
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Nils Henninger
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Takahiro Ota
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Shogo Dofuku
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Leonard L L Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Benjamin Yq Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Anil Gopinathan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Interventional Radiology, National University Hospital, Singapore, Singapore
| | | | | | - Sunil Sheth
- Department of Neurology, UTHealth McGovern Medical School, Houston, TX, USA
| | - Leonardo Renieri
- Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy
| | - Carolina Capirossi
- Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy
| | - Ashkan Mowla
- Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), North State St, Suite 3300, 1200, Los Angeles, CA, USA
| | - Lina M Chervak
- Department of Neurology and Radiology, University of Cincinnati, Cincinnati, USA
| | - Achala Vagal
- Department of Neurology and Radiology, University of Cincinnati, Cincinnati, USA
| | - Priyank Khandelwal
- Department of Endovascular Neurosurgery and Neuroradiology NJMS, Newark, NJ, USA
| | - Arundhati Biswas
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY, USA
| | - Frédéric Clarençon
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
- Division of Interventional Radiology, National University Hospital, Singapore, Singapore
| | - Mahmoud Elhorany
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
- Neurology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
- Division of Interventional Radiology, National University Hospital, Singapore, Singapore
| | - Kevin Premat
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
- Division of Interventional Radiology, National University Hospital, Singapore, Singapore
| | - Iacopo Valente
- UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A.Gemelli IRCCS Roma, Rome, Italy
| | - Alessandro Pedicelli
- UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A.Gemelli IRCCS Roma, Rome, Italy
| | - Andrea M Alexandre
- UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A.Gemelli IRCCS Roma, Rome, Italy
| | - João Pedro Filipe
- Department of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ricardo Varela
- Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | | | - Nestor R Gonzalez
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Markus A Ymd
- Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Jessica Jesser
- Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Charlotte Weyland
- Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Adrien Ter Schiphorst
- Department of Neurology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Vivek Yedavalli
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA
| | - Pablo Harker
- Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Yasmin Aziz
- Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Benjamin Gory
- Department of Interventional Neuroradiology, Nancy University Hospital, Nancy, France
- INSERM U1254, IADI, Université de Lorraine, 54511, Vandoeuvre-les-Nancy, France
| | - Christian Paul Stracke
- Department of Radiology, Interventional Neuroradiology Section, University Medical Center Münster, Munster, Germany
| | - Constantin Hecker
- Departments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Monika Killer-Oberpfalzer
- Departments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Christoph J Griessenauer
- Departments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Cheng-Yang Hsieh
- Neurology Department, Sin-Lau Hospital, Tainan, Taiwan, Province of China
| | - David S Liebeskind
- UCLA Stroke Center and Department of Neurology Department, UCLA, Los Angeles, California, USA
| | - Illario Tancredi
- Department of Medicine, Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Robert Fahed
- Department of Medicine, Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Boris Lubicz
- Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium
| | - Muhammed Amir Essibayi
- Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Amanda Baker
- 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
| | - Luca Scarcia
- Department of Neuroradiology, Henri Mondor Hospital, Creteil, France
| | - Erwah Kalsoum
- Department of Neuroradiology, Henri Mondor Hospital, Creteil, France
| | - Adam A Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA
- Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Adrien Guenego
- Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium
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4
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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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5
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Wang M, Henkes H, Ghozy S, Siegler JE, Shaikh H, Khalife J, Abdalkader M, Klein P, Nguyen TN, Heit JJ, Sweid A, Naamani KE, Regenhardt RW, Diestro JDB, Cancelliere NM, Amllay A, Meyer L, Dusart A, Bellante F, Forestier G, Rouchaud A, Saleme S, Mounayer C, Fiehler J, Kühn AL, Puri AS, Dyzmann C, Kan PT, Colasurdo M, Marnat G, Berge J, Barreau X, Sibon I, Nedelcu S, Henninger N, Weyland C, Marotta TR, Stapleton CJ, Rabinov JD, Ota T, Dofuku S, Yeo LL, Tan BYQ, Martinez-Gutierrez JC, Salazar-Marioni S, Sheth S, Renieri L, Capirossi C, Mowla A, Tjoumakaris SI, Jabbour P, Khandelwal P, Biswas A, Clarençon F, Elhorany M, Premat K, Valente I, Pedicelli A, Filipe JP, Varela R, Quintero-Consuegra M, Gonzalez NR, Möhlenbruch MA, Jesser J, Costalat V, Ter Schiphorst A, Yedavalli V, Harker P, Chervak LM, Aziz Y, Gory B, Stracke CP, Hecker C, Killer-Oberpfalzer M, Griessenauer CJ, Thomas AJ, Hsieh CY, Liebeskind DS, Radu RA, Alexandre AM, Tancredi I, Faizy TD, Patel AB, Pereira VM, Fahed R, Lubicz B, Dmytriw AA, Guenego A. Use of the pRESET LITE thrombectomy device in combined approach for medium vessel occlusions: A multicenter evaluation. Neuroradiology 2024; 66:631-641. [PMID: 38381145 DOI: 10.1007/s00234-024-03302-5] [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: 08/21/2023] [Accepted: 01/29/2024] [Indexed: 02/22/2024]
Abstract
PURPOSE Our purpose was to assess the efficacy and safety of the pRESET LITE stent retriever (Phenox, Bochum, Germany), designed for medium vessel occlusion (MeVO) in acute ischemic stroke (AIS) patients with a primary MeVO. METHODS We performed a retrospective analysis of the MAD MT Consortium, an integration of prospectively maintained databases at 37 academic institutions in Europe, North America, and Asia, of AIS patients who underwent mechanical thrombectomy with the pRESET LITE stent retriever for a primary MeVO. We subcategorized occlusions into proximal MeVOs (segments A1, M2, and P1) vs. distal MeVOs/DMVO (segments A2, M3-M4, and P2). We reviewed patient and procedural characteristics, as well as angiographic and clinical outcomes. RESULTS Between September 2016 and December 2021, 227 patients were included (50% female, median age 78 [65-84] years), of whom 161 (71%) suffered proximal MeVO and 66 (29%) distal MeVO. Using a combined approach in 96% of cases, successful reperfusion of the target vessel (mTICI 2b/2c/3) was attained in 85% of proximal MeVO and 97% of DMVO, with a median of 2 passes (IQR: 1-3) overall. Periprocedural complications rate was 7%. Control CT at day 1 post-MT revealed a hemorrhagic transformation in 63 (39%) patients with proximal MeVO and 24 (36%) patients with DMVO, with ECASS-PH type hemorrhagic transformations occurring in 3 (1%) patients. After 3 months, 58% of all MeVO and 63% of DMVO patients demonstrated a favorable outcome (mRS 0-2). CONCLUSION Mechanical thrombectomy using the pRESET LITE in a combined approach with an aspiration catheter appears effective for primary medium vessel occlusions across several centers and physicians.
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Affiliation(s)
- Maud Wang
- Department of Radiology, Leuven University Hospitals, Leuven, Belgium.
| | - Hans Henkes
- Neuroradiologische Klinik, Klinikum Stuttgart, Stuttgart, Germany
| | - Sherief Ghozy
- Departments of Neurologic Surgery & Radiology, Mayo Clinic, Rochester, MN, USA
| | - James E Siegler
- Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA
| | - Hamza Shaikh
- Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA
| | - Jane Khalife
- Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA
| | - Mohamad Abdalkader
- Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA
| | - Piers Klein
- Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA
| | - Thanh N Nguyen
- Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA
| | - Jeremy J Heit
- Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA, USA
| | - Ahmad Sweid
- Departments of Neurologic Surgery & Radiology, Mayo Clinic, Rochester, MN, USA
| | - Kareem El Naamani
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Robert W Regenhardt
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Jose Danilo Bengzon Diestro
- Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Nicole M Cancelliere
- Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Abdelaziz Amllay
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Dusart
- Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium
| | - Flavio Bellante
- Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium
| | - Géraud Forestier
- Department of Neuroradiology, CHU Limoges Dupuytren, Université de Limoges, Limoges, France
| | - Aymeric Rouchaud
- Department of Neuroradiology, CHU Limoges Dupuytren, Université de Limoges, Limoges, France
| | - Suzana Saleme
- Department of Neuroradiology, CHU Limoges Dupuytren, Université de Limoges, Limoges, France
| | - Charbel Mounayer
- Department of Neuroradiology, CHU Limoges Dupuytren, Université de Limoges, Limoges, France
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Luisa Kühn
- Department of Radiology, University of Massachusetts Memorial Hospital, Worcester, MA, USA
| | - Ajit S Puri
- Department of Radiology, University of Massachusetts Memorial Hospital, Worcester, MA, USA
| | - Christian Dyzmann
- Department of Neuroradiology, Sana Kliniken, Lübeck GmbH, Lübeck, Germany
| | - Peter T Kan
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Marco Colasurdo
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Gaultier Marnat
- Department of Interventional Neuroradiology, CHU Bordeaux, Bordeaux, France
| | - Jérôme Berge
- Department of Interventional Neuroradiology, CHU Bordeaux, Bordeaux, France
| | - Xavier Barreau
- Department of Interventional Neuroradiology, CHU Bordeaux, Bordeaux, France
| | - Igor Sibon
- Department of Neurology, CHU Bordeaux, Bordeaux, France
| | - Simona Nedelcu
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Nils Henninger
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Charlotte Weyland
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Thomas R Marotta
- Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Christopher J Stapleton
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - James D Rabinov
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Takahiro Ota
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Shogo Dofuku
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Leonard Ll Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Benjamin Y Q Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | | | | | - Sunil Sheth
- Department of Neurology, UTHealth McGovern Medical School, Houston, TX, USA
| | - Leonardo Renieri
- Interventistica Neurovascolare, Ospedale Careggi Di Firenze, Florence, Italy
| | - Carolina Capirossi
- Interventistica Neurovascolare, Ospedale Careggi Di Firenze, Florence, Italy
| | - Ashkan Mowla
- Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA
| | | | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Priyank Khandelwal
- Department of Endovascular Neurosurgery and Neuroradiology NJMS, Newark, NJ, USA
| | - Arundhati Biswas
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY, USA
| | - Frédéric Clarençon
- Department of Neuroradiology, Pitié-Salpêtrière University Hospitals, Sorbonne University- Paris VI, Paris, France
| | - Mahmoud Elhorany
- Department of Neuroradiology, Pitié-Salpêtrière University Hospitals, Sorbonne University- Paris VI, Paris, France
- Department of Neurology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Kevin Premat
- Department of Neuroradiology, Pitié-Salpêtrière University Hospitals, Sorbonne University- Paris VI, Paris, France
| | - Iacopo Valente
- UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Pedicelli
- UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - João Pedro Filipe
- Department of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário Do Porto, Porto, Portugal
| | - Ricardo Varela
- Department of Neurology, Centro Hospitalar Universitário Do Porto, Porto, Portugal
| | | | - Nestor R Gonzalez
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Markus A Möhlenbruch
- Sektion Vaskuläre Und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Jessica Jesser
- Sektion Vaskuläre Und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Vincent Costalat
- Department of Neuroradiology, Gui de Chauliac Hospital, CHU Montpellier, Montpellier, France
| | - Adrien Ter Schiphorst
- Department of Neurology, Gui de Chauliac Hospital, CHU Montpellier, Montpellier, France
| | - Vivek Yedavalli
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA
| | - Pablo Harker
- Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Lina M Chervak
- Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Yasmin Aziz
- Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Benjamin Gory
- Department of Interventional Neuroradiology, CHU Nancy, Nancy, France
| | - Christian Paul Stracke
- Department of Radiology, Interventional Neuroradiology Section, University Medical Center Münster, Münster, Germany
| | - Constantin Hecker
- Departments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Monika Killer-Oberpfalzer
- Departments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Christoph J Griessenauer
- Departments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Ajith J Thomas
- Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA
| | | | - David S Liebeskind
- Department of Neurology Department, UCLA Stroke Center, UCLA, Los Angeles, CA, USA
| | - Răzvan Alexandru Radu
- Department of Neuroradiology, Gui de Chauliac Hospital, CHU Montpellier, Montpellier, France
| | - Andrea M Alexandre
- UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Illario Tancredi
- Department of Radiology, Hôpital Civil Marie Curie, Charleroi, Belgium
| | - Tobias D Faizy
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Aman B Patel
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Vitor Mendes Pereira
- Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Robert Fahed
- Department of Medicine, Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON, Canada
| | - Boris Lubicz
- Department of Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium
| | - Adam A Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA
- Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Adrien Guenego
- Department of Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium
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6
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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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7
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Mendes Pereira V, Rice H, De Villiers L, Sourour N, Clarencon F, Spears J, Tomasello A, Hernandez D, Cancelliere NM, Liu XYE, Nicholson P, Costalat V, Gascou G, Mordasini P, Gralla J, Martínez-Galdámez M, Galvan Fernandez J, Killer-Oberpfalzer M, Liebeskind DS, Turner RD, Blanc R, Piotin M. Evaluation of effectiveness and safety of the CorPath GRX robotic system in endovascular embolization procedures of cerebral aneurysms. J Neurointerv Surg 2024; 16:405-411. [PMID: 37793795 PMCID: PMC10958306 DOI: 10.1136/jnis-2023-020161] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/07/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Robotic-assisted neurointervention was recently introduced, with implications that it could be used to treat neurovascular diseases. OBJECTIVE To evaluate the effectiveness and safety of the robotic-assisted platform CorPath GRX for treating cerebral aneurysms. METHODS This prospective, international, multicenter study enrolled patients with brain aneurysms that required endovascular coiling and/or stent-assisted coiling. The primary effectiveness endpoint was defined as successful completion of the robotic-assisted endovascular procedure without any unplanned conversion to manual treatment with guidewire or microcatheter navigation, embolization coil(s) or intracranial stent(s) deployment, or an inability to navigate vessel anatomy. The primary safety endpoint included intraprocedural and periprocedural events. RESULTS The study enrolled 117 patients (74.4% female) with mean age of 56.6 years from 10 international sites,. Headache was the most common presenting symptom in 40/117 (34.2%) subjects. Internal carotid artery was the most common location (34/122, 27.9%), and the mean aneurysm height and neck width were 5.7±2.6 mm and 3.5±1.4 mm, respectively. The overall procedure time was 117.3±47.3 min with 59.4±32.6 min robotic procedure time. Primary effectiveness was achieved in 110/117 (94%) subjects with seven subjects requiring conversion to manual for procedure completion. Only four primary safety events were recorded with two intraprocedural aneurysm ruptures and two strokes. A Raymond-Roy Classification Scale score of 1 was achieved in 71/110 (64.5%) subjects, and all subjects were discharged with a modified Rankin Scale score of ≤2. CONCLUSIONS This first-of-its-kind robotic-assisted neurovascular trial demonstrates the effectiveness and safety of the CorPath GRX System for endovascular embolization of cerebral aneurysm procedures. TRIAL REGISTRATION NUMBER NCT04236856.
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Affiliation(s)
- Vitor Mendes Pereira
- Division of Neurosurgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Hal Rice
- Department of Neurointervention, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Laetitia De Villiers
- Department of Neurointervention, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Nader Sourour
- Department of Interventional Neuroradiology, Hopital Universitaire Pitie Salpetriere, Paris, France
| | - Frédéric Clarencon
- Department of Interventional Neuroradiology, Hopital Universitaire Pitie Salpetriere, Paris, France
| | - Julian Spears
- Division of Neurosurgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Alejandro Tomasello
- Department of Neurointervention, Hospital Vall d'Hebron, Barcelona, Catalunya, Spain
| | - David Hernandez
- Department of Neurointervention, Hospital Vall d'Hebron, Barcelona, Catalunya, Spain
| | - Nicole M Cancelliere
- Division of Neurosurgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Xiao Yu Eileen Liu
- Division of Neurosurgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Nicholson
- Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Vincent Costalat
- Department of Neuroradiology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Gregory Gascou
- Department of Neuroradiology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Pasquale Mordasini
- Department of Diagnostic and Interventional Neuroradiology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Jan Gralla
- Department of Diagnostic and Interventional Neuroradiology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Mario Martínez-Galdámez
- Department of Interventional Neuroradiology and Endovascular Neurosurgery, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Jorge Galvan Fernandez
- Department of Interventional Neuroradiology and Endovascular Neurosurgery, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | | | | | - Raymond D Turner
- Division of Neurosurgery, Prisma Health, Greenville, South Carolina, USA
| | - Raphael Blanc
- Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France
| | - Michel Piotin
- Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France
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8
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Radu RA, Costalat V, Fahed R, Ghozy S, Siegler JE, Shaikh H, Khalife J, Abdalkader M, Klein P, Nguyen TN, Heit JJ, Sweid A, El Naamani K, Regenhardt RW, Diestro JDB, Cancelliere NM, Amllay A, Meyer L, Dusart A, Bellante F, Forestier G, Rouchaud A, Saleme S, Mounayer C, Fiehler J, Kühn AL, Puri AS, Dyzmann C, Kan PT, Colasurdo M, Marnat G, Berge J, Barreau X, Sibon I, Nedelcu S, Henninger N, Kyheng M, Marotta TR, Stapleton CJ, Rabinov JD, Ota T, Dofuku S, Yeo LLL, Tan BYQ, Martinez-Gutierrez JC, Salazar-Marioni S, Sheth S, Renieri L, Capirossi C, Mowla A, Tjoumakaris SI, Jabbour P, Khandelwal P, Biswas A, Clarençon F, Elhorany M, Premat K, Valente I, Pedicelli A, Pedro Filipe J, Varela R, Quintero-Consuegra M, Gonzalez NR, Möhlenbruch MA, Jesser J, Tancredi I, ter Schiphorst A, Yedavalli V, Harker P, Chervak LM, Aziz Y, Gory B, Paul Stracke C, Hecker C, Killer-Oberpfalzer M, Griessenauer CJ, Thomas AJ, Hsieh CY, Liebeskind DS, Alexandre AM, Faizy TD, Weyland C, Patel AB, Pereira VM, Lubicz B, Dmytriw AA, Guenego A. First pass effect as an independent predictor of functional outcomes in medium vessel occlusions: An analysis of an international multicenter study. Eur Stroke J 2024; 9:114-123. [PMID: 37885243 PMCID: PMC10916815 DOI: 10.1177/23969873231208276] [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: 07/12/2023] [Accepted: 09/15/2023] [Indexed: 10/28/2023] Open
Abstract
INTRODUCTION First pass effect (FPE), achievement of complete recanalization (mTICI 2c/3) with a single pass, is a significant predictor of favorable outcomes for endovascular treatment (EVT) in large vessel occlusion stroke (LVO). However, data concerning the impact on functional outcomes and predictors of FPE in medium vessel occlusions (MeVO) are scarce. PATIENTS AND METHODS We conducted an international retrospective study on MeVO cases. Multivariable logistic modeling was used to establish independent predictors of FPE. Clinical and safety outcomes were compared between the two study groups (FPE vs non-FPE) using logistic regression models. Good outcome was defined as modified Rankin Scale 0-2 at 3 months. RESULTS Eight hundred thirty-six patients with a final mTICI ⩾ 2b were included in this analysis. FPE was observed in 302 patients (36.1%). In multivariable analysis, hypertension (aOR 1.55, 95% CI 1.10-2.20) and lower baseline NIHSS score (aOR 0.95, 95% CI 0.93-0.97) were independently associated with an FPE. Good outcomes were more common in the FPE versus non-FPE group (72.8% vs 52.8%), and FPE was independently associated with favorable outcome (aOR 2.20, 95% CI 1.59-3.05). 90-day mortality and intracranial hemorrhage (ICH) were significantly lower in the FPE group, 0.43 (95% CI, 0.25-0.72) and 0.55 (95% CI, 0.39-0.77), respectively. CONCLUSION Over 2/3 of patients with MeVOs and FPE in our cohort had a favorable outcome at 90 days. FPE is independently associated with favorable outcomes, it may reduce the risk of any intracranial hemorrhage, and 3-month mortality.
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Affiliation(s)
- Răzvan Alexandru Radu
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Vincent Costalat
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Robert Fahed
- Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON, Canada
| | - Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - James E Siegler
- Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Hamza Shaikh
- Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Jane Khalife
- Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Mohamad Abdalkader
- Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA
| | - Piers Klein
- Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA
| | - Thanh N Nguyen
- Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA
| | - Jeremy J Heit
- Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA, USA
| | - Ahmad Sweid
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Kareem El Naamani
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Robert W Regenhardt
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Jose Danilo Bengzon Diestro
- Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael’s Hospital, Toronto, ON, Canada
| | - Nicole M Cancelliere
- Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael’s Hospital, Toronto, ON, Canada
| | - Abdelaziz Amllay
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Dusart
- Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium
| | - Flavio Bellante
- Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium
| | - Géraud Forestier
- University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France
| | - Aymeric Rouchaud
- University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France
| | - Suzana Saleme
- University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France
| | - Charbel Mounayer
- University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Luisa Kühn
- Department of Radiology, University of Massachusetts Memorial Hospital, Worcester, MA, USA
| | - Ajit S Puri
- Department of Radiology, University of Massachusetts Memorial Hospital, Worcester, MA, USA
| | - Christian Dyzmann
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Sana Klinik Lübeck, Lübeck, Germany
| | - Peter T Kan
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Marco Colasurdo
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Gaultier Marnat
- Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France
| | - Jérôme Berge
- Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France
| | - Xavier Barreau
- Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France
| | - Igor Sibon
- Neurology Department, Bordeaux University Hospital, Bordeaux, France
| | - Simona Nedelcu
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Nils Henninger
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Maéva Kyheng
- Department of Biostatistics, CHU Lille, Lille, France
| | - Thomas R Marotta
- Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael’s Hospital, Toronto, ON, Canada
| | - Christopher J Stapleton
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - James D Rabinov
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Takahiro Ota
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Shogo Dofuku
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Leonard LL Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Benjamin YQ Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Hospital, Singapore
| | | | | | - Sunil Sheth
- Department of Neurology, UTHealth McGovern Medical School, Houston, TX, USA
| | - Leonardo Renieri
- Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy
| | - Carolina Capirossi
- Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy
| | - Ashkan Mowla
- Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA
| | | | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Priyank Khandelwal
- Department of Endovascular Neurosurgery and Neuroradiology, NJMS, Newark, NJ, USA
| | - Arundhati Biswas
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY, USA
| | - Frédéric Clarençon
- Department of Neuroradiology, Pitié-Salpêtrière Hospital. Paris. France; GRC BioFast, Sorbonne University, Paris VI, France
| | - Mahmoud Elhorany
- Department of Neuroradiology, Pitié-Salpêtrière Hospital. Paris. France; GRC BioFast, Sorbonne University, Paris VI, France
- Neurology Department, Faculty of Medicine, Tanta University, Egypt
| | - Kevin Premat
- Department of Neuroradiology, Pitié-Salpêtrière Hospital. Paris. France; GRC BioFast, Sorbonne University, Paris VI, France
| | - Iacopo Valente
- UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A.Gemelli IRCCS, Roma, Italy
| | - Alessandro Pedicelli
- UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A.Gemelli IRCCS, Roma, Italy
| | - João Pedro Filipe
- Department of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ricardo Varela
- Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | | | - Nestor R Gonzalez
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Markus A Möhlenbruch
- Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Jessica Jesser
- Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Illario Tancredi
- Department of Radiology, Hôpital Civil Marie Curie, Charleroi, Belgium
| | - Adrien ter Schiphorst
- Department of Neurology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Vivek Yedavalli
- Division of Neuroradiology, Department of Radiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA
| | - Pablo Harker
- Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Lina M Chervak
- Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Yasmin Aziz
- Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Benjamin Gory
- Department of Interventional Neuroradiology, Nancy University Hospital, Nancy, France
| | - Christian Paul Stracke
- Department of Radiology, Interventional Neuroradiology Section, University Medical Center Münster, Münster, Germany
| | - Constantin Hecker
- Departments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Monika Killer-Oberpfalzer
- Departments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Christoph J Griessenauer
- Departments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Ajith J Thomas
- Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, USA
| | | | - David S Liebeskind
- UCLA Stroke Center and Department of Neurology Department, UCLA, Los Angeles, CA, USA
| | - Andrea M Alexandre
- UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A.Gemelli IRCCS, Roma, Italy
| | - Tobias D Faizy
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Charlotte Weyland
- Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Aman B Patel
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Vitor Mendes Pereira
- Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael’s Hospital, Toronto, ON, Canada
| | - Boris Lubicz
- Department of Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium
| | - Adam A Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA
- Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael’s Hospital, Toronto, ON, Canada
| | - Adrien Guenego
- Department of Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium
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9
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Dmytriw AA, Grewal S, Cancelliere NM, Patel AB, Pereira VM, Ren X. Treatment of a posterior cerebral artery aneurysm in the context of complex cardio-cerebrovascular variations using the Tubridge flow diverter. J Cerebrovasc Endovasc Neurosurg 2024; 26:65-70. [PMID: 37723100 PMCID: PMC10995469 DOI: 10.7461/jcen.2023.e2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/29/2023] [Accepted: 07/14/2023] [Indexed: 09/20/2023] Open
Abstract
We present a case of intracranial aneurysm located in the P1 segment of left posterior cerebral artery in the context of tetralogy of Fallot. Complex variations included right aortic arch with abnormal branching. Also, the bilateral vertebral arteries were absent, with a type I persistent proatlantal intersegmental artery of the left side. The aneurysm was treated with endovascular intervention with a Tubridge flow diverter and was noted to be completely cured on 6-month follow-up. We discuss the many considerations in this patient including developmental and modern-era treatment.
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Affiliation(s)
- Adam A. Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
- Neurovascular Centre, Departments of Medical Imaging & Neurosurgery, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Sahibjot Grewal
- Neurovascular Centre, Departments of Medical Imaging & Neurosurgery, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Nicole M. Cancelliere
- Neurovascular Centre, Departments of Medical Imaging & Neurosurgery, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Aman B. Patel
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
| | - Vitor Mendes Pereira
- Neurovascular Centre, Departments of Medical Imaging & Neurosurgery, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Xiaolu Ren
- Department of Neurosurgery and Laboratory of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, People’s Republic of China
- Institute of Neurology, Lanzhou University, Lanzhou, People’s Republic of China
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10
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Dmytriw AA, Musmar B, Salim H, Ghozy S, Siegler JE, Kobeissi H, Shaikh H, Khalife J, Abdalkader M, Klein P, Nguyen TN, Heit JJ, Regenhardt RW, Cancelliere NM, Bernstock JD, Naamani KE, Amllay A, Meyer L, Dusart A, Bellante F, Forestier G, Rouchaud A, Saleme S, Mounayer C, Fiehler J, Kühn AL, Puri AS, Dyzmann C, Kan PT, Colasurdo M, Marnat G, Berge J, Barreau X, Sibon I, Nedelcu S, Henninger N, Marotta TR, Stapleton CJ, Rabinov JD, Ota T, Dofuku S, Yeo LL, Tan BY, Gopinathan A, Martinez-Gutierrez JC, Salazar-Marioni S, Sheth S, Renieri L, Capirossi C, Mowla A, Chervak L, Vagal A, Adeeb N, Cuellar-Saenz HH, Tjoumakaris SI, Jabbour P, Khandelwal P, Biswas A, Clarençon F, Elhorany M, Premat K, Valente I, Pedicelli A, Filipe JP, Varela R, Quintero-Consuegra M, Gonzalez NR, Möhlenbruch MA, Jesser J, Costalat V, Ter Schiphorst A, Yedavalli V, Harker P, Aziz Y, Gory B, Stracke CP, Hecker C, Kadirvel R, Killer-Oberpfalzer M, Griessenauer CJ, Thomas AJ, Hsieh CY, Liebeskind DS, Alexandru Radu R, Alexandre AM, Tancredi I, Faizy TD, Fahed R, Weyland C, Lubicz B, Patel AB, Pereira VM, Guenego A. Incidence and clinical outcomes of perforations during mechanical thrombectomy for medium vessel occlusion in acute ischemic stroke: A retrospective, multicenter, and multinational study. Eur Stroke J 2024:23969873231219412. [PMID: 38409796 DOI: 10.1177/23969873231219412] [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: 02/28/2024] Open
Abstract
BACKGROUND Mechanical thrombectomy (MT) has revolutionized the treatment of acute ischemic stroke (AIS) due to large vessel occlusion (LVO), but its efficacy and safety in medium vessel occlusion (MeVO) remain less explored. This multicenter, retrospective study aims to investigate the incidence and clinical outcomes of vessel perforations (confirmed by extravasation during an angiographic series) during MT for AIS caused by MeVO. METHODS Data were collected from 37 academic centers across North America, Asia, and Europe between September 2017 and July 2021. A total of 1373 AIS patients with MeVO underwent MT. Baseline characteristics, procedural details, and clinical outcomes were analyzed. RESULTS The incidence of vessel perforation was 4.8% (66/1373). Notably, our analysis indicates variations in perforation rates across different arterial segments: 8.9% in M3 segments, 4.3% in M2 segments, and 8.3% in A2 segments (p = 0.612). Patients with perforation had significantly worse outcomes, with lower rates of favorable angiographic outcomes (TICI 2c-3: 23% vs 58.9%, p < 0.001; TICI 2b-3: 56.5% vs 88.3%, p < 0.001). Functional outcomes were also worse in the perforation group (mRS 0-1 at 3 months: 22.7% vs 36.6%, p = 0.031; mRS 0-2 at 3 months: 28.8% vs 53.9%, p < 0.001). Mortality was higher in the perforation group (30.3% vs 16.8%, p = 0.008). CONCLUSION This study reveals that while the occurrence of vessel perforation in MT for AIS due to MeVO is relatively rare, it is associated with poor functional outcomes and higher mortality. The findings highlight the need for increased caution and specialized training in performing MT for MeVO. Further prospective research is required for risk mitigation strategies.
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Affiliation(s)
- Adam A Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael's Hospital, University of Toronto, ON, Canada
| | - Basel Musmar
- Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA
| | - Hamza Salim
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA
| | - Sherief Ghozy
- Department of Neurological Surgery and Radiology, Mayo Clinic, Rochester, MN, USA
| | - James E Siegler
- Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA
| | - Hassan Kobeissi
- Department of Neurological Surgery and Radiology, Mayo Clinic, Rochester, MN, USA
| | - Hamza Shaikh
- Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA
| | - Jane Khalife
- Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA
| | - Mohamad Abdalkader
- Departments of Radiology and Neurology, Boston Medical Center, Boston, MA, USA
| | - Piers Klein
- Departments of Radiology and Neurology, Boston Medical Center, Boston, MA, USA
| | - Thanh N Nguyen
- Departments of Radiology and Neurology, Boston Medical Center, Boston, MA, USA
| | - Jeremy J Heit
- Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA, USA
| | - Robert W Regenhardt
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nicole M Cancelliere
- Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael's Hospital, University of Toronto, ON, Canada
| | - Joshua D Bernstock
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Kareem El Naamani
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Abdelaziz Amllay
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Dusart
- Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium
| | - Flavio Bellante
- Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium
| | - Géraud Forestier
- University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France
| | - Aymeric Rouchaud
- University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France
| | - Suzana Saleme
- University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France
| | - Charbel Mounayer
- University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Luisa Kühn
- Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Ajit S Puri
- Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Christian Dyzmann
- Neuroradiology Department, Sana Kliniken, Lübeck GmbH, Lübeck, Germany
| | - Peter T Kan
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Marco Colasurdo
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, TX, USA
- Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Gaultier Marnat
- Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France
| | - Jérôme Berge
- Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France
| | - Xavier Barreau
- Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France
| | - Igor Sibon
- Neurology Department, Bordeaux University Hospital, Bordeaux, France
| | - Simona Nedelcu
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Nils Henninger
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Thomas R Marotta
- Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael's Hospital, University of Toronto, ON, Canada
| | - Christopher J Stapleton
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - James D Rabinov
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Takahiro Ota
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan
| | - Shogo Dofuku
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan
| | - Leonard Ll Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Benjamin Yq Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Anil Gopinathan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | | | | | - Sunil Sheth
- Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy
| | - Leonardo Renieri
- Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy
| | - Carolina Capirossi
- Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy
| | - Ashkan Mowla
- Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lina Chervak
- Department of Neurology and Radiology, University of Cincinnati, Cincinnati, OH, USA
| | - Achala Vagal
- Department of Neurology and Radiology, University of Cincinnati, Cincinnati, OH, USA
| | - Nimer Adeeb
- Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA
| | - Hugo H Cuellar-Saenz
- Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA
| | | | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Priyank Khandelwal
- Department of Endovascular Neurosurgery and Neuroradiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Arundhati Biswas
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY, USA
| | - Frédéric Clarençon
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
- GRC BioFast, Sorbonne University, Paris VI, Paris, France
| | - Mahmoud Elhorany
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
- GRC BioFast, Sorbonne University, Paris VI, Paris, France
- Neurology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Kevin Premat
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
- GRC BioFast, Sorbonne University, Paris VI, Paris, France
| | - Iacopo Valente
- UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Florence, Italy
| | - Alessandro Pedicelli
- UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Florence, Italy
| | - João Pedro Filipe
- Department of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ricardo Varela
- Department of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | | | - Nestor R Gonzalez
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Markus A Möhlenbruch
- Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Jessica Jesser
- Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Vincent Costalat
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Adrien Ter Schiphorst
- Department of Neurology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Vivek Yedavalli
- INSERM U1254, IADI, Université de Lorraine, Vandoeuvre-les-Nancy, France
| | - Pablo Harker
- Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Yasmin Aziz
- Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Benjamin Gory
- Department of Interventional Neuroradiology, Nancy University Hospital, Nancy, France
- INSERM U1254, IADI, Université de Lorraine, Vandoeuvre-les-Nancy, France
| | - Christian Paul Stracke
- Department of Radiology, Interventional Neuroradiology Section, University Medical Center Münster, Münster, Germany
| | - Constantin Hecker
- Department of Neurology and Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Ramanathan Kadirvel
- Department of Neurological Surgery and Radiology, Mayo Clinic, Rochester, MN, USA
| | - Monika Killer-Oberpfalzer
- Department of Neurology and Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Christoph J Griessenauer
- Department of Neurology and Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Ajith J Thomas
- Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA
| | | | - David S Liebeskind
- UCLA Stroke Center and Department of Neurology Department, University of California, Los Angeles, Los Angeles, CA USA
| | - Răzvan Alexandru Radu
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Andrea M Alexandre
- UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Florence, Italy
| | - Illario Tancredi
- Department of Radiology, Hôpital Civil Marie Curie, Charleroi, Belgium
| | - Tobias D Faizy
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Robert Fahed
- Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON, Canada
| | - Charlotte Weyland
- Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Boris Lubicz
- Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium
| | - Aman B Patel
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Vitor Mendes Pereira
- Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael's Hospital, University of Toronto, ON, Canada
| | - Adrien Guenego
- Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium
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11
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Nishi H, Cancelliere NM, Rustici A, Charbonnier G, Chan V, Spears J, Marotta TR, Mendes Pereira V. Deep learning-based cerebral aneurysm segmentation and morphological analysis with three-dimensional rotational angiography. J Neurointerv Surg 2024; 16:197-203. [PMID: 37192786 DOI: 10.1136/jnis-2023-020192] [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: 02/16/2023] [Accepted: 04/14/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND The morphological assessment of cerebral aneurysms based on cerebral angiography is an essential step when planning strategy and device selection in endovascular treatment, but manual evaluation by human raters only has moderate interrater/intrarater reliability. METHODS We collected data for 889 cerebral angiograms from consecutive patients with suspected cerebral aneurysms at our institution from January 2017 to October 2021. The automatic morphological analysis model was developed on the derivation cohort dataset consisting of 388 scans with 437 aneurysms, and the performance of the model was tested on the validation cohort dataset consisting of 96 scans with 124 aneurysms. Five clinically important parameters were automatically calculated by the model: aneurysm volume, maximum aneurysm size, neck size, aneurysm height, and aspect ratio. RESULTS On the validation cohort dataset the average aneurysm size was 7.9±4.6 mm. The proposed model displayed high segmentation accuracy with a mean Dice similarity index of 0.87 (median 0.93). All the morphological parameters were significantly correlated with the reference standard (all P<0.0001; Pearson correlation analysis). The difference in the maximum aneurysm size between the model prediction and reference standard was 0.5±0.7 mm (mean±SD). The difference in neck size between the model prediction and reference standard was 0.8±1.7 mm (mean±SD). CONCLUSION The automatic aneurysm analysis model based on angiography data exhibited high accuracy for evaluating the morphological characteristics of cerebral aneurysms.
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Affiliation(s)
- Hidehisa Nishi
- Department of Surgery, Division of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada
- RADIS Lab, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Nicole M Cancelliere
- Department of Surgery, Division of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada
- RADIS Lab, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Ariana Rustici
- RADIS Lab, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Guillaume Charbonnier
- RADIS Lab, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Vanessa Chan
- RADIS Lab, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Julian Spears
- Department of Surgery, Division of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada
| | - Thomas R Marotta
- Department of Medical Imaging, St Michael's Hospital, Toronto, Ontario, Canada
| | - Vitor Mendes Pereira
- Department of Surgery, Division of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada
- RADIS Lab, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
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12
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Grewal SS, Hirsch JA, Cancelliere NM, Ghozy S, Pereira VM, Dmytriw AA. Efficacy and safety of percutaneous cement discoplasty in the management of degenerative spinal diseases: A systematic review and meta-analysis. Neuroradiol J 2023:19714009231212368. [PMID: 37920948 DOI: 10.1177/19714009231212368] [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: 11/04/2023] Open
Abstract
BACKGROUND Percutaneous cement discoplasty (PCD) is a minimally invasive procedure. We aim to explore the efficacy and indication(s) of PCD in patients with degenerative disc disease (DDD). METHODS The search was conducted across Ovid MEDLINE, Ovid Embase, and PubMed. Data on study design, patient demographics, pre- and post-procedure Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores, and complications were extracted. Inclusion criteria focused on adult patients with degenerative spinal diseases treated with cement discoplasty. The overall effect size was evaluated using a forest plot, and heterogeneity was assessed using the I2 statistic and chi-squared test. RESULTS The search strategy yielded six studies, which included 336 patients (73.8% female, 26.2% male) with a mean average age of 74.6 years. VAS scores were reported in all studies, showing a significant difference between pre- and post-PCD pain scores (Weighted Mean Difference [WMD]: -3.45; 95% CI: -3.83, -3.08; I2 = 15%; P < .001). ODI scores were reported in 83% of studies, with a significant difference between pre- and post-PCD scores (WMD: -22.22; 95% CI: -25.54, -18.89; I2 = 61%; p < .001). Complications reported included infections, thrombophlebitis, vertebral fractures, disc extrusion, and the need for further operations. CONCLUSIONS The analysis showed clinically significant improvements in pain and functional disability based on VAS and ODI scores. However, due to methodological limitations and a high risk of bias, the validity and generalizability of the findings are uncertain. Despite these issues, the results provide preliminary insights into PCD's potential efficacy and can guide future research to address current limitations.
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Affiliation(s)
- Sahibjot Singh Grewal
- Neurovascular Centre, Departments of Medical Imaging & Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Joshua A Hirsch
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nicole M Cancelliere
- Neurovascular Centre, Departments of Medical Imaging & Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Nuffield Department of Primary Care Health Sciences and Department for Continuing Education (EBHC program), Oxford University, Oxford, UK
| | - Vitor Mendes Pereira
- Neurovascular Centre, Departments of Medical Imaging & Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Adam A Dmytriw
- Neurovascular Centre, Departments of Medical Imaging & Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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13
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MacDonald DE, Cancelliere NM, Pereira VM, Steinman DA. Sensitivity of hostile hemodynamics to aneurysm geometry via unsupervised shape interpolation. Comput Methods Programs Biomed 2023; 241:107762. [PMID: 37598472 DOI: 10.1016/j.cmpb.2023.107762] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 06/19/2023] [Accepted: 08/10/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND AND OBJECTIVE Vessel geometry and hemodynamics are intrinsically linked, whereby geometry determines hemodynamics, and hemodynamics influence vascular remodeling. Both have been used for testing clinical outcomes, but geometry/morphology generally has less uncertainty than hemodynamics derived from medical image-based computational fluid dynamics (CFD). To provide clinical utility, CFD-based hemodynamic parameters must be robust to modeling errors and/or uncertainties, but must also provide useful information not more-easily extracted from shape alone. The objective of this study was to methodically assess the response of hemodynamic parameters to gradual changes in shape created using an unsupervised 3D shape interpolation method. METHODS We trained the neural network NeuroMorph on 3 patient-derived intracranial aneurysm surfaces (labelled A, B, C), and then generated 3 distinct morph sequences (A→B, B→C, C→A) each containing 10 interpolated surfaces. From high-fidelity CFD simulation of these, we calculated a variety of common reduced hemodynamic parameters, including many previously associated with aneurysm rupture, and analyzed their responses to changes in shape, and their correlations. RESULTS The interpolated surfaces demonstrate complex, gradual changes in branch angles, vessel diameters, and aneurysm morphology. CFD simulation showed gradual changes in aneurysm jetting characteristics and wall-shear stress (WSS) patterns, but demonstrated a range of responses from the reduced hemodynamic parameters. Spatially and temporally averaged parameters including time-averaged WSS, time-averaged velocity, and low-shear area (LSA) showed low variation across all morph sequences, while parameters of flow complexity such as oscillatory shear, spectral broadening, and spectral bandedness indices showed high variation between slightly-altered neighboring surfaces. Correlation analysis revealed a great deal of mutual information with easier-to-measure shape-based parameters. CONCLUSIONS In the absence of large clinical datasets, unsupervised shape interpolation provides an ideal laboratory for exploring the delicate balance between robustness and sensitivity of nominal hemodynamic predictors of aneurysm rupture. Parameters like time-averaged WSS and LSA that are highly "robust" may, as a result, be effectively redundant to morphological predictors, whereas more sensitive parameters may be too uncertain for practical clinical use. Understanding these sensitivities may help identify parameters that are capable of providing added value to rupture risk assessment.
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Affiliation(s)
- Daniel E MacDonald
- Department of Mechanical & Industrial Engineering, University of Toronto, 5 King's College Rd, Toronto, Ontario M5S 3G8, Canada
| | - Nicole M Cancelliere
- Department of Neurosurgery, St. Michael's Hospital, 36 Queen St E, Toronto, Ontario M5B 1W8, Canada
| | - Vitor M Pereira
- Department of Neurosurgery, St. Michael's Hospital, 36 Queen St E, Toronto, Ontario M5B 1W8, Canada
| | - David A Steinman
- Department of Mechanical & Industrial Engineering, University of Toronto, 5 King's College Rd, Toronto, Ontario M5S 3G8, Canada.
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14
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Cancelliere NM, van Nijnatten F, Hummel E, Withagen P, van de Haar P, Nishi H, Agid R, Nicholson P, Hallacoglu B, van Vlimmeren M, Pereira VM. Motion artifact correction for cone beam CT stroke imaging: a prospective series. J Neurointerv Surg 2023; 15:e223-e228. [PMID: 36564201 DOI: 10.1136/jnis-2021-018201] [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: 09/23/2021] [Accepted: 06/28/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Imaging assessment for acute ischemic stroke (AIS) patients in the angiosuite using cone beam CT (CBCT) has created increased interest since endovascular treatment became the first line therapy for proximal vessel occlusions. One of the main challenges of CBCT imaging in AIS patients is degraded image quality due to motion artifacts. This study aims to evaluate the prevalence of motion artifacts in CBCT stroke imaging and the effectiveness of a novel motion artifact correction algorithm for image quality improvement. METHODS Patients presenting with acute stroke symptoms and considered for endovascular treatment were included in the study. CBCT scans were performed using the angiosuite X-ray system. All CBCT scans were post-processed using a motion artifact correction algorithm. Motion artifacts were scored before and after processing using a 4-point scale. RESULTS We prospectively included 310 CBCT scans from acute stroke patients. 51% (n=159/310) of scans had motion artifacts, with 24% being moderate to severe. The post-processing algorithm improved motion artifacts in 91% of scans with motion (n=144/159), restoring clinical diagnostic capability in 34%. Overall, 76% of the scans were sufficient for clinical decision-making before correction, which improved to 93% (n=289/310) after post-processing with our algorithm. CONCLUSIONS Our results demonstrate that CBCT motion artifacts are significantly reduced using a novel post-processing algorithm, which improved brain CBCT image quality and diagnostic assessment for stroke. This is an important step on the road towards a direct-to-angio approach for endovascular thrombectomy (EVT) treatment.
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Affiliation(s)
- Nicole M Cancelliere
- Department of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada
- RADIS lab, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Medical Imaging, St Michael's Hospital, Toronto, Ontario, Canada
| | - Fred van Nijnatten
- Image Guided Therapy, Philips Healthcare, Best, Noord-Brabant, The Netherlands
| | - Eric Hummel
- Image Guided Therapy, Philips Healthcare, Best, Noord-Brabant, The Netherlands
| | - Paul Withagen
- Image Guided Therapy, Philips Healthcare, Best, Noord-Brabant, The Netherlands
| | - Peter van de Haar
- Image Guided Therapy, Philips Healthcare, Best, Noord-Brabant, The Netherlands
| | - Hidehisa Nishi
- RADIS lab, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
| | - Ronit Agid
- Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Bertan Hallacoglu
- Image Guided Therapy, Philips Healthcare, Best, Noord-Brabant, The Netherlands
| | | | - Vitor M Pereira
- Department of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada
- RADIS lab, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Medical Imaging, St Michael's Hospital, Toronto, Ontario, Canada
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15
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Siegler JE, Shaikh H, Khalife J, Oak S, Zhang L, Abdalkader M, Klein P, Nguyen TN, Kass‐Hout T, Morsi RZ, Heit JJ, Regenhardt RW, Diestro JDB, Cancelliere NM, Ghozy S, Sweid A, Naamani KE, Amllay A, Meyer L, Dusart A, Bellante F, Forestier G, Rouchaud A, Saleme S, Mounayer C, Fiehler J, Kühn AL, Puri AS, Dyzmann C, Kan PT, Colasurdo M, Marnat G, Berge J, Barreau X, Sibon I, Nedelcu S, Henninger N, Marotta TR, Das AS, Stapleton CJ, Rabinov JD, Ota T, Dofuku S, Yeo LL, Tan BY, Martinez‐Gutierrez JC, Salazar‐Marioni S, Sheth SA, Renieri L, Capirossi C, Mowla A, Tjoumakaris SI, Jabbour P, Khandelwal P, Biswas A, Clarençon F, Elhorany M, Premat K, Valente I, Pedicelli A, Filipe JP, Varela R, Quintero‐Consuegra M, Gonzalez NR, Möhlenbruch MA, Jesser J, Costalat V, Schiphorst AT, Yedavalli V, Harker P, Chervak LM, Aziz Y, Bullrich MB, Sposato L, Gory B, Hecker C, Killer‐Oberpfalzer M, Griessenauer CJ, Thomas AJ, Hsieh C, Liebeskind DS, Radu RA, Alexandre AM, Tancredi I, Faizy TD, Fahed R, Weyland C, Patel AB, Pereira VM, Lubicz B, Guenego A, Dmytriw AA. Aspiration Versus Stent‐Retriever as First‐Line Endovascular Therapy Technique for Primary Medium and Distal Intracranial Occlusions: A Propensity‐Score Matched Multicenter Analysis. SVIN 2023. [DOI: 10.1161/svin.123.000931] [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] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/05/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND
For acute proximal intracranial artery occlusions, contact aspiration may be more effective than stent‐retriever for first‐line reperfusion therapy. Due to the lack of data regarding medium vessel occlusion thrombectomy, we evaluated outcomes according to first‐line technique in a large, multicenter registry.
METHODS
Imaging, procedural, and clinical outcomes of patients with acute proximal medium vessel occlusions (M2, A1, or P1) or distal medium vessel occlusions (M3, A2, P2, or further) treated at 37 sites in 10 countries were analyzed according to first‐line endovascular technique (stent‐retriever versus aspiration). Multivariable logistic regression and propensity‐score matching were used to estimate the odds of the primary outcome, expanded Thrombolysis in Cerebral Infarction score of 2b–3 (“successful recanalization”), as well as secondary outcomes (first‐pass effect, expanded Thrombolysis in Cerebral Infarction 2c‐3, intracerebral hemorrhage, and 90‐day modified Rankin scale, 90‐day mortality) between treatment groups.
RESULTS
Of the 440 included patients (44.5% stent‐retriever versus 55.5% aspiration), those treated with stent‐retriever had lower baseline Alberta Stroke Program Early Computed Tomography Scale scores (median 8 versus 9;
P
<0.01), higher National Institutes of Health Stroke Scale scores (median 13 versus 11;
P
=0.02), and nonsignificantly fewer medium‐distal occlusions (M3, A2, P2, or other: 17.4% versus 23.8%;
P
=0.10). Use of a stent‐retriever was associated with 15% lower odds of successful recanalization (odds ratio [OR], 0.85; [95% CI 0.74–0.98];
P
=0.02), but this was not significant after multivariable adjustment in the total cohort (adjusted OR, 0.88; [95% CI 0.72–1.09];
P
=0.24), or in the propensity‐score matched cohort (n=105 in each group) (adjusted OR, 0.94; [95% CI 0.75–1.18];
P
=0.60). There was no significant association between technique and secondary outcomes in the propensity‐score matched adjusted models.
CONCLUSION
In this large, diverse, multinational medium vessel occlusion cohort, we found no significant difference in imaging or clinical outcomes with aspiration versus stent‐retriever thrombectomy.
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16
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Dmytriw AA, Ku J, Ghozy S, Grewal S, Cancelliere NM, Azzam AY, Regenhardt RW, Rabinov JD, Stapleton CJ, Patel K, Patel AB, Pereira VM, Tymianski M. Management of Adult Unruptured Brain Arteriovenous Malformations: An Updated Network Meta-Analysis. Neurointervention 2023:neuroint.2023.00171. [PMID: 37337397 DOI: 10.5469/neuroint.2023.00171] [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: 05/01/2023] [Accepted: 06/07/2023] [Indexed: 06/21/2023] Open
Abstract
The management of unruptured brain arteriovenous malformations (ubAVMs) is a complex challenge to neurovascular practitioners. This meta-analysis aimed to identify the optimal management of ubAVMs comparing conservative management, embolization, radiosurgery, microsurgical resection, and multimodality. The search strategy was developed a priori according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched the Ovid Medline, Embase, Web of Science, and Cochrane Library databases to identify relevant papers. Using R version 4.1.1., a frequentist network meta-analysis was conducted to compare different management modalities for the ubAVMs. Overall, the conservative group had the lowest risk of rupture (P-score=0.77), and the lowest rate of complications was found in the conservative group (P-score=1). Among different interventions, the multimodality group had the highest rupture risk (P-score=0.34), the lowest overall complications (P-score=0.75), the best functional improvement (P-score=0.65), and the lowest overall mortality (P-score=0.8). However, multimodality treatment showed a significantly higher risk of rupture (odds ratio [OR]=2.13; 95% confidence interval [95% CI]=1.18-3.86) and overall complication rate (OR=5.56; 95% CI=3.37-9.15) compared to conservative management; nevertheless, there were no significant differences in overall mortality or functional independence when considered independently. Conservative management is associated with the lowest rupture risk and complication rate overall. A multimodal approach is the best option when considering mortality rates and functional improvement in the context of existing morbidity/symptoms. Microsurgery, embolization, and radiosurgery alone are similar to the natural history in terms of functional improvement and mortality, but have higher complication rates.
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Affiliation(s)
- Adam A Dmytriw
- Neurovascular Centre, Departments of Medical Imaging & Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jerry Ku
- Departments of Neurosurgery & Interventional Neuroradiology, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Sherief Ghozy
- Department of Neuroradiology, Mayo Clinic, Rochester, MN, USA
| | - Sahibjot Grewal
- Neurovascular Centre, Departments of Medical Imaging & Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Nicole M Cancelliere
- Neurovascular Centre, Departments of Medical Imaging & Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Ahmed Y Azzam
- Department of Neuroradiology, Mayo Clinic, Rochester, MN, USA
| | - Robert W Regenhardt
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - James D Rabinov
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Christopher J Stapleton
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Krunal Patel
- Departments of Neurosurgery & Interventional Neuroradiology, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Aman B Patel
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Vitor Mendes Pereira
- Neurovascular Centre, Departments of Medical Imaging & Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Michael Tymianski
- Departments of Neurosurgery & Interventional Neuroradiology, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
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17
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Darcourt J, Brinjikji W, François O, Giraud A, Johnson CR, Patil S, Staessens S, Kadirvel R, Mohammaden MH, Pisani L, Rodrigues GM, Cancelliere NM, Pereira VM, Bozsak F, Doyle K, De Meyer SF, Messina P, Kallmes D, Cognard C, Nogueira RG. Identifying ex vivo acute ischemic stroke thrombus composition using electrochemical impedance spectroscopy. Interv Neuroradiol 2023:15910199231175377. [PMID: 37192738 DOI: 10.1177/15910199231175377] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Intra-procedural characterization of stroke thromboemboli might guide mechanical thrombectomy (MT) device choice to improve recanalization rates. Electrochemical impedance spectroscopy (EIS) has been used to characterize various biological tissues in real time but has not been used in thrombus. OBJECTIVE To perform a feasibility study of EIS analysis of thrombi retrieved by MT to evaluate: (1) the ability of EIS and machine learning to predict red blood cell (RBC) percentage content of thrombi and (2) to classify the thrombi as "RBC-rich" or "RBC-poor" based on a range of cutoff values of RBC. METHODS ClotbasePilot was a multicentric, international, prospective feasibility study. Retrieved thrombi underwent histological analysis to identify proportions of RBC and other components. EIS results were analyzed with machine learning. Linear regression was used to evaluate the correlation between the histology and EIS. Sensitivity and specificity of the model to classify the thrombus as RBC-rich or RBC-poor were also evaluated. RESULTS Among 514 MT,179 thrombi were included for EIS and histological analysis. The mean composition in RBC of the thrombi was 36% ± 24. Good correlation between the impedance-based prediction and histology was achieved (slope of 0.9, R2 = 0.53, Pearson coefficient = 0.72). Depending on the chosen cutoff, ranging from 20 to 60% of RBC, the calculated sensitivity for classification of thrombi ranged from 77 to 85% and the specificity from 72 to 88%. CONCLUSION Combination of EIS and machine learning can reliably predict the RBC composition of retrieved ex vivo AIS thrombi and then classify them into groups according to their RBC composition with good sensitivity and specificity.
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Affiliation(s)
- Jean Darcourt
- Department of Neuroradiology, University Hospital of Toulouse, Toulouse, France
- INSERM I2MC (Institut des Maladies Cardiovasculaires et Métaboliques) UMR 1048, Toulouse University Hospital, Toulouse, France
| | - Waleed Brinjikji
- Department of Neuroradiology, Mayo Clinic, Rochester, MN, USA
- Neurosurgery, Mayo Clinic Rochester, Rochester, MN, USA
| | | | | | - Collin R Johnson
- Department of Neuroradiology, Mayo Clinic, Rochester, MN, USA
- Neurosurgery, Mayo Clinic Rochester, Rochester, MN, USA
| | - Smita Patil
- Department of Physiology, Galway Neuroscience Centre, National University of Ireland Galway, Galway, Ireland
- CÚRAM - SFI Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Senna Staessens
- Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Belgium
| | - Ramanathan Kadirvel
- Department of Neuroradiology, Mayo Clinic, Rochester, MN, USA
- Neurosurgery, Mayo Clinic Rochester, Rochester, MN, USA
| | - Mahmoud H Mohammaden
- Department of Neurology, Grady Memorial Hospital and Emory University, Atlanta, GA, USA
| | - Leonardo Pisani
- Department of Neurology, Grady Memorial Hospital and Emory University, Atlanta, GA, USA
| | | | - Nicole M Cancelliere
- Department of Neurosurgery, Department of Neurosurgery, University of Toronto, Toronto, ON, Canada
| | - Vitor Mendes Pereira
- Department of Neurosurgery, Department of Neurosurgery, University of Toronto, Toronto, ON, Canada
| | | | - Karen Doyle
- Department of Physiology, Galway Neuroscience Centre, National University of Ireland Galway, Galway, Ireland
- CÚRAM - SFI Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Simon F De Meyer
- Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Belgium
| | | | - David Kallmes
- Department of Neuroradiology, Mayo Clinic, Rochester, MN, USA
- Neurosurgery, Mayo Clinic Rochester, Rochester, MN, USA
| | - Christophe Cognard
- Department of Neuroradiology, University Hospital of Toulouse, Toulouse, France
- INSERM I2MC (Institut des Maladies Cardiovasculaires et Métaboliques) UMR 1048, Toulouse University Hospital, Toulouse, France
| | - Raul G Nogueira
- Department of Neurology and Neurosurgery, University of Pittsburg Medical Center, UPMC Stroke Institute, Pittsburg, PA, USA
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18
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El Naamani K, Mastorakos P, Adeeb N, Lan M, Castiglione J, Khanna O, Diestro JDB, McLellan RM, Dibas M, Vranic JE, Aslan A, Cuellar-Saenz HH, Guenego A, Carnevale J, Saliou G, Ulfert C, Möhlenbruch M, Foreman PM, Vachhani JA, Hafeez MU, Waqas M, Tutino VM, Rabinov JD, Ren Y, Michelozzi C, Spears J, Panni P, Griessenauer CJ, Asadi H, Regenhardt RW, Stapleton CJ, Ghozy S, Siddiqui A, Patel NJ, Kan P, Boddu S, Knopman J, Aziz-Sultan MA, Zanaty M, Ghosh R, Abbas R, Amllay A, Tjoumakaris SI, Gooch MR, Cancelliere NM, Herial NA, Rosenwasser RH, Zarzour H, Schmidt RF, Pereira VM, Patel AB, Jabbour P, Dmytriw AA. Long-Term Follow-Up of Cerebral Aneurysms Completely Occluded at 6 Months After Intervention with the Woven EndoBridge (WEB) Device: a Retrospective Multicenter Observational Study. Transl Stroke Res 2023:10.1007/s12975-023-01153-5. [PMID: 37165289 DOI: 10.1007/s12975-023-01153-5] [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: 02/13/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 05/12/2023]
Abstract
The Woven EndoBridge (WEB) device has been widely used to treat intracranial wide neck bifurcation aneurysms. Initial studies have demonstrated that approximately 90% of patients have same or improved long-term aneurysm occlusion after the initial 6-month follow up. The aim of this study is to assess the long-term follow-up in aneurysms that have achieved complete occlusion at 6 months. We also compared the predictive value of different imaging modalities used. This is an analysis of a prospectively maintained database across 13 academic institutions. We included patients with previously untreated cerebral aneurysms embolized using the WEB device who achieved complete occlusion at first follow-up and had available long-term follow-up. A total of 95 patients with a mean age of 61.6 ± 11.9 years were studied. The mean neck diameter and height were 3.9 ± 1.3 mm and 6.0 ± 1.8 mm, respectively. The mean time to first and last follow-up was 5.4 ± 1.8 and 14.1 ± 12.9 months, respectively. Out of all the aneurysms that were completely occluded at 6 months, 84 (90.3%) showed complete occlusion at the final follow-up, and 11(11.5%) patients did not achieve complete occlusion. The positive predictive value (PPV) of complete occlusion at first follow was 88.4%. Importantly, this did not differ between digital subtraction angiography (DSA), magnetic resonance angiography (MRA), or computed tomography angiography (CTA). This study underlines the importance of repeat imaging in patients treated with the WEB device even if complete occlusion is achieved short term. Follow-up can be performed using DSA, MRA or CTA with no difference in positive predictive value.
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Affiliation(s)
- Kareem El Naamani
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Panagiotis Mastorakos
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Nimer Adeeb
- Departement of Neurosurgery and Neurointerventional Surgery, Louisiana State University, Shreveport, LA, USA
| | - Mathews Lan
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - James Castiglione
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Omaditya Khanna
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Jose Danilo Bengzon Diestro
- Neurovascular Centre, Departments of Medical Imaging & 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 Medical School, Boston, MA, USA
| | - Mahmoud Dibas
- Neurovascular Centre, Departments of Medical Imaging & Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Justin E Vranic
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Assala Aslan
- Departement of Neurosurgery and Neurointerventional Surgery, Louisiana State University, Shreveport, LA, USA
| | - Hugo H Cuellar-Saenz
- Departement of Neurosurgery and Neurointerventional Surgery, Louisiana State University, Shreveport, LA, USA
| | - Adrien Guenego
- Service de Neuroradiologie Interventionnelle, Hôpital Universitaire Erasme, Brussels, Belgium
| | - 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
| | - Christian Ulfert
- Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Markus Möhlenbruch
- Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - 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
| | - Muhammad U Hafeez
- Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, TX, 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
| | - James D Rabinov
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yifan Ren
- Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, VIC, Australia
| | | | - Julian Spears
- Neurovascular Centre, Departments of Medical Imaging & Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Pietro Panni
- Interventional Neuroradiology and Neurosurgery, San Raffaele University Hospital, Milan, Italy
| | - Christoph J Griessenauer
- Department of Neurosurgery, Christian Doppler University Hospital, Paracelsus Medical University Salzburg, Salzburg, Austria
- Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Hamed Asadi
- Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, VIC, Australia
| | - Robert W Regenhardt
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christopher J Stapleton
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sherief Ghozy
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Adnan Siddiqui
- Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY, USA
| | - Nirav J Patel
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Peter Kan
- Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, TX, USA
| | - Srikanth Boddu
- Neurosurgery & Interventional Neuroradiology, Weill Cornell School of Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Jared Knopman
- Neurosurgery & Interventional Neuroradiology, Weill Cornell School of Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Mohammad A Aziz-Sultan
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mario Zanaty
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Ritam Ghosh
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Rawad Abbas
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Abdelaziz Amllay
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | - Michael R Gooch
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Nicole M Cancelliere
- Neurovascular Centre, Departments of Medical Imaging & Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Nabeel A Herial
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Robert H Rosenwasser
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Hekmat Zarzour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Richard F Schmidt
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Vitor Mendes Pereira
- Neurovascular Centre, Departments of Medical Imaging & Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Aman B Patel
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Adam A Dmytriw
- Neurovascular Centre, Departments of Medical Imaging & Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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MacDonald DE, Cancelliere NM, Rustici A, Pereira VM, Steinman DA. Improving visualization of three-dimensional aneurysm features via segmentation with upsampled resolution and gradient enhancement (SURGE). J Neurointerv Surg 2022:neurintsurg-2022-018912. [PMID: 35728943 DOI: 10.1136/neurintsurg-2022-018912] [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: 03/16/2022] [Accepted: 06/10/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Intracranial aneurysm neck width tends to be overestimated when measured with three-dimensional rotational angiography (3DRA) compared with two-dimensional digital subtraction angiography (2D-DSA), owing to high curvature at the neck. This may affect morphological and hemodynamic analysis in support of treatment planning. We present and validate a method for extracting high curvature features, such as aneurysm ostia, during segmentation of 3DRA images. METHODS In our novel SURGE (segmentation with upsampled resolution and gradient enhancement) approach, the gradient of an upsampled image is sharpened before gradient-based watershed segmentation. Neck measurements were performed for both standard and SURGE segmentations of 3DRA for 60 consecutive patients and compared with those from 2D-DSA. Those segmentations were also qualitatively compared for surface topology and morphology. RESULTS Compared with the standard watershed method, SURGE reduced neck measurement error relative to 2D-DSA by >60%: median error was 0.49 mm versus 0.17 mm for SURGE, which is less than the average pixel resolution (~0.33 mm) of the 3DRA dataset. SURGE reduced neck width overestimations >1 mm from 13/60 to 5/60 cases. Relative to 2D-DSA, standard segmentations were overestimated by 16% and 93% at median and 95th percentiles, respectively, compared with only 6% and 37%, respectively, for SURGE. CONCLUSION SURGE provides operators with high-level control of the image gradient, allowing recovery of high-curvature features such as aneurysm ostia from 3DRA where conventional algorithms may fail. Compared with standard segmentation and tedious manual editing, SURGE provides a faster, easier, and more objective method for assessing aneurysm ostia and morphology.
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Affiliation(s)
- Daniel E MacDonald
- Department of Mechanical & Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | | | - Arianna Rustici
- Department of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada
| | - Vitor M Pereira
- Department of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada.,Departments of Medical Imaging and Surgery, University of Toronto, Toronto, Ontario, Canada
| | - David A Steinman
- Department of Mechanical & Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
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Mendes Pereira V, Nicholson P, Cancelliere NM, Liu XYE, Agid R, Radovanovic I, Krings T. Feasibility of robot-assisted neuroendovascular procedures. J Neurosurg 2021; 136:992-1004. [PMID: 34560642 DOI: 10.3171/2021.1.jns203617] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 10/02/2020] [Accepted: 01/27/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Geographic factors prevent equitable access to urgent advanced neuroendovascular treatments. Robotic technologies may enable remote endovascular procedures in the future. The authors performed a translational, benchtop-to-clinical study to evaluate the in vitro and clinical feasibility of the CorPath GRX Robotic System for robot-assisted endovascular neurointerventional procedures. METHODS A series of bench studies was conducted using patient-specific 3D-printed models to test the system's compatibility with standard neurointerventional devices, including microcatheters, microwires, coils, intrasaccular devices, and stents. Optimal baseline setups for various procedures were determined. The models were further used to rehearse clinical cases. Subsequent to these investigations, a prospective series of 6 patients was treated using robotic assistance for complex, wide-necked intracranial saccular aneurysms between November 2019 and February 2020. The technical success, incidence of periprocedural complications, and need for conversion to manual procedures were evaluated. RESULTS The ideal robotic setup for treatment of both anterior and posterior circulation aneurysms was determined to consist of an 80-cm guide catheter with a 115-cm-long intermediate catheter, a microcatheter between 150 and 170 cm in length, and a microwire with a minimum length of 300 cm. All coils, intrasaccular devices, and stents tested were compatible with the system and could be advanced or retracted safely and placed accurately. All 6 clinical procedures were technically successful, with all intracranial steps being performed robotically with no conversions to manual intervention or failures of the robotic system. There were no procedure-related complications or adverse clinical outcomes. CONCLUSIONS This study demonstrates the feasibility of robot-assisted neurointerventional procedures. The authors' results represent an important step toward enabling remote neuroendovascular care and geographic equalization of advanced endovascular treatments through so-called telestroke intervention.
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Affiliation(s)
- Vitor Mendes Pereira
- 1Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, University of Toronto; and.,2Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
| | - Patrick Nicholson
- 1Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, University of Toronto; and
| | - Nicole M Cancelliere
- 1Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, University of Toronto; and
| | - Xiao Yu Eileen Liu
- 1Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, University of Toronto; and
| | - Ronit Agid
- 1Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, University of Toronto; and
| | - Ivan Radovanovic
- 2Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
| | - Timo Krings
- 1Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, University of Toronto; and.,2Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
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21
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Nicholson P, Cancelliere NM, Bracken J, Hummel E, van Nijnatten F, Withagen P, van de Haar P, Hallacoglu B, van Vlimmeren M, Agid R, Krings T, Mendes Pereira V. Novel flat-panel cone-beam CT compared to multi-detector CT for assessment of acute ischemic stroke: A prospective study. Eur J Radiol 2021; 138:109645. [PMID: 33725654 DOI: 10.1016/j.ejrad.2021.109645] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Cone beam CT (CBCT) imaging assessment of acute ischemic stroke (AIS) patients with large-vessel occlusion (LVO) in the angiosuite may improve stroke workflow and decrease time to recanalization. In order for this workflow to gain widespread acceptance, current CBCT imaging needs further development to improve image quality. Our study aimed to compare the image quality of a new CBCT protocol performed directly in the angiosuite with imaging from multidetector CT as a gold standard. METHODS AIS patients with an LVO who were candidates for endovascular treatment were prospectively included in this study. Following conventional multidetector CT (MDCT), patients underwent unenhanced cone beam CT (XperCT, Philips) imaging in the angiosuite, using two different protocols: a standard 20.8 s XperCT and/or an improved 10.4 s XperCT protocol. Images were evaluated using both qualitative and quantitative methods. RESULTS We included 65 patients in the study. Patients received CBCT imaging prior to endovascular treatment; 18 patients were assessed with a standard 20.8 s protocol scans and 47 with a newer 10.4 s scan. The quantitative analysis showed that the mean contrast-to-noise ratio (CNR) was significantly higher for the newer 10.4 s protocol compared with the 20.8 s protocol (2.08 +/- 0.64 vs. 1.15 +/- 0.27, p < 0.004) and the mean image noise was significantly lower for the 10.4 s XperCTs when compared with the 20.8 s XperCTs (6.30 +/- 1.34 vs. 7.82 +/- 2.03, p=<0.003). Qualitative analysis, including 6 measures of image quality, demonstrated that 74.1 % of the 10.4 s XperCT scans were ranked as 'Acceptable' for assessing parenchymal imaging in AIS patients(scoring 3-5 points on a 5-point Likert-scale), compared with 32.4 % of the standard 20.8 s XperCT and 100 % of the MDCT scans. Compared to the MDCT studies, 83 % of the 10.4 s XperCT scans were deemed sufficient image quality for a direct-to-angiosuite selection, compared to only 11 % for the standard 20.8 s scans. The largest image quality improvements included grey/white matter differentiation (59 % improvement), and reduction of image noise and artefacts (63 % & 50 % improvement, respectively). CONCLUSIONS Continued advances in cone-beam CT allow marked improvements in image quality for the assessment of brain parenchyma, which supports a direct-to-angiosuite approach for AIS patients eligible for thrombectomy treatment.
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Affiliation(s)
- Patrick Nicholson
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Nicole M Cancelliere
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada.
| | - John Bracken
- Image Guided Therapy, Phillips Healthcare, Best, the Netherlands
| | - Erik Hummel
- Image Guided Therapy, Phillips Healthcare, Best, the Netherlands
| | | | - Paul Withagen
- Image Guided Therapy, Phillips Healthcare, Best, the Netherlands
| | | | | | | | - Ronit Agid
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Timo Krings
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Vitor Mendes Pereira
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
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Najafi M, Cancelliere NM, Brina O, Bouillot P, Vargas MI, Delattre BM, Pereira VM, Steinman DA. How patient-specific do internal carotid artery inflow rates need to be for computational fluid dynamics of cerebral aneurysms? J Neurointerv Surg 2020; 13:459-464. [PMID: 32732256 DOI: 10.1136/neurintsurg-2020-015993] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Computational fluid dynamics (CFD) has become a popular tool for studying 'patient-specific' blood flow dynamics in cerebral aneurysms; however, rarely are the inflow boundary conditions patient-specific. We aimed to test the impact of widespread reliance on generalized inflow rates. METHODS Internal carotid artery (ICA) flow rates were measured via 2D cine phase-contrast MRI for 24 patients scheduled for endovascular therapy of an ICA aneurysm. CFD models were constructed from 3D rotational angiography, and pulsatile inflow rates imposed as measured by MRI or estimated using an average older-adult ICA flow waveform shape scaled by a cycle-average flow rate (Qavg) derived from the patient's ICA cross-sectional area via an assumed inlet velocity. RESULTS There was good overall qualitative agreement in the magnitudes and spatial distributions of time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), and spectral power index (SPI) using generalized versus patient-specific inflows. Sac-averaged quantities showed moderate to good correlations: R2=0.54 (TAWSS), 0.80 (OSI), and 0.68 (SPI). Using patient-specific Qavg to scale the generalized waveform shape resulted in near-perfect agreement for TAWSS, and reduced bias, but not scatter, for SPI. Patient-specific waveform had an impact only on OSI correlations, which improved to R2=0.93. CONCLUSIONS Aneurysm CFD demonstrates the ability to stratify cases by nominal hemodynamic 'risk' factors when employing an age- and vascular-territory-specific recipe for generalized inflow rates. Qavg has a greater influence than waveform shape, suggesting some improvement could be achieved by including measurement of patient-specific Qavg into aneurysm imaging protocols.
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Affiliation(s)
- Mehdi Najafi
- Department of Mechanical & Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Nicole M Cancelliere
- Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Olivier Brina
- Department for Diagnostic and Interventional Neuroradiology, Hôpitaux Universitaires de Geneve, Geneva, Switzerland
| | - Pierre Bouillot
- Department for Diagnostic and Interventional Neuroradiology, Hôpitaux Universitaires de Geneve, Geneva, Switzerland
| | - Maria I Vargas
- Department for Diagnostic and Interventional Neuroradiology, Hôpitaux Universitaires de Geneve, Geneva, Switzerland
| | - Benedicte Ma Delattre
- Department for Diagnostic and Interventional Neuroradiology, Hôpitaux Universitaires de Geneve, Geneva, Switzerland
| | - Vitor M Pereira
- Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
- Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - David A Steinman
- Department of Mechanical & Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
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Cancelliere NM, Najafi M, Brina O, Bouillot P, Vargas MI, Lovblad KO, Krings T, Pereira VM, Steinman DA. 4D-CT angiography versus 3D-rotational angiography as the imaging modality for computational fluid dynamics of cerebral aneurysms. J Neurointerv Surg 2019; 12:626-630. [DOI: 10.1136/neurintsurg-2019-015389] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/06/2019] [Accepted: 11/07/2019] [Indexed: 11/03/2022]
Abstract
Background and purposeComputational fluid dynamics (CFD) can provide valuable information regarding intracranial hemodynamics. Patient-specific models can be segmented from various imaging modalities, which may influence the geometric output and thus hemodynamic results. This study aims to compare CFD results from aneurysm models segmented from three-dimensional rotational angiography (3D-RA) versus novel four-dimensional CT angiography (4D-CTA).MethodsFourteen patients with 16 cerebral aneurysms underwent novel 4D-CTA followed by 3D-RA. Endoluminal geometries were segmented from each modality using an identical workflow, blinded to the other modality, to produce 28 'original' models. Each was then minimally edited a second time to match length of branches, producing 28 additional 'matched' models. CFD simulations were performed using estimated flow rates for 'original' models (representing real-world experience) and patient-specific flow rates from 4D-CTA for 'matched' models (to control for influence of modality alone).ResultsOverall, geometric and hemodynamic results were consistent between models segmented from 3D-RA and 4D-CTA, with correlations improving after matching to control for operator-introduced variability. Despite smaller 4D-CTA parent artery diameters (3.49±0.97 mm vs 3.78±0.92 mm for 3D-RA; p=0.005) and sac volumes (157 (37–750 mm3) vs 173 (53–770 mm3) for 3D-RA; p=0.0002), sac averages of time-averaged wall shear stress (TAWSS), oscillatory shear (OSI), and high frequency fluctuations (measured by spectral power index, SPI) were well correlated between 3D-RA and 4D-CTA 'matched' control models (TAWSS, R2=0.91; OSI, R2=0.79; SPI, R2=0.90).ConclusionsOur study shows that CFD performed using 4D-CTA models produces reliable geometric and hemodynamic information in the intracranial circulation. 4D-CTA may be considered as a follow-up imaging tool for hemodynamic assessment of cerebral aneurysms.
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Berg P, Voß S, Janiga G, Saalfeld S, Bergersen AW, Valen-Sendstad K, Bruening J, Goubergrits L, Spuler A, Chiu TL, Tsang ACO, Copelli G, Csippa B, Paál G, Závodszky G, Detmer FJ, Chung BJ, Cebral JR, Fujimura S, Takao H, Karmonik C, Elias S, Cancelliere NM, Najafi M, Steinman DA, Pereira VM, Piskin S, Finol EA, Pravdivtseva M, Velvaluri P, Rajabzadeh-Oghaz H, Paliwal N, Meng H, Seshadhri S, Venguru S, Shojima M, Sindeev S, Frolov S, Qian Y, Wu YA, Carlson KD, Kallmes DF, Dragomir-Daescu D, Beuing O. Multiple Aneurysms AnaTomy CHallenge 2018 (MATCH)-phase II: rupture risk assessment. Int J Comput Assist Radiol Surg 2019; 14:1795-1804. [PMID: 31054128 DOI: 10.1007/s11548-019-01986-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 01/10/2019] [Accepted: 04/23/2019] [Indexed: 01/10/2023]
Abstract
PURPOSE Assessing the rupture probability of intracranial aneurysms (IAs) remains challenging. Therefore, hemodynamic simulations are increasingly applied toward supporting physicians during treatment planning. However, due to several assumptions, the clinical acceptance of these methods remains limited. METHODS To provide an overview of state-of-the-art blood flow simulation capabilities, the Multiple Aneurysms AnaTomy CHallenge 2018 (MATCH) was conducted. Seventeen research groups from all over the world performed segmentations and hemodynamic simulations to identify the ruptured aneurysm in a patient harboring five IAs. Although simulation setups revealed good similarity, clear differences exist with respect to the analysis of aneurysm shape and blood flow results. Most groups (12/71%) included morphological and hemodynamic parameters in their analysis, with aspect ratio and wall shear stress as the most popular candidates, respectively. RESULTS The majority of groups (7/41%) selected the largest aneurysm as being the ruptured one. Four (24%) of the participating groups were able to correctly select the ruptured aneurysm, while three groups (18%) ranked the ruptured aneurysm as the second most probable. Successful selections were based on the integration of clinically relevant information such as the aneurysm site, as well as advanced rupture probability models considering multiple parameters. Additionally, flow characteristics such as the quantification of inflow jets and the identification of multiple vortices led to correct predictions. CONCLUSIONS MATCH compares state-of-the-art image-based blood flow simulation approaches to assess the rupture risk of IAs. Furthermore, this challenge highlights the importance of multivariate analyses by combining clinically relevant metadata with advanced morphological and hemodynamic quantification.
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Affiliation(s)
| | - Samuel Voß
- University of Magdeburg, Magdeburg, Germany
| | | | | | | | | | | | | | | | | | | | | | - Benjamin Csippa
- Budapest University of Technology and Economics, Budapest, Hungary
| | - György Paál
- Budapest University of Technology and Economics, Budapest, Hungary
| | - Gábor Závodszky
- Budapest University of Technology and Economics, Budapest, Hungary
| | | | | | | | | | | | | | - Saba Elias
- Houston Methodist Research Institute, Houston, TX, USA
| | | | | | | | | | - Senol Piskin
- The University of Texas at San Antonio, San Antonio, TX, USA
| | - Ender A Finol
- The University of Texas at San Antonio, San Antonio, TX, USA
| | | | | | | | | | - Hui Meng
- State University of New York, Buffalo, NY, USA
| | | | | | | | | | | | - Yi Qian
- Macquarie University, Sydney, Australia
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Bouillot P, Brina O, Chnafa C, Cancelliere NM, Vargas MI, Radovanovic I, Krings T, Steinman DA, Pereira VM. Robust cerebrovascular blood velocity and flow rate estimation from 4D‐CTA. Med Phys 2019; 46:2126-2136. [DOI: 10.1002/mp.13454] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/27/2019] [Accepted: 02/13/2019] [Indexed: 01/22/2023] Open
Affiliation(s)
- Pierre Bouillot
- Departement of Neuroradiology Geneva University Hospitals Geneva Switzerland
- Department of Quantum Matter Physics University of Geneva Geneva Switzerland
| | - Olivier Brina
- Departement of Neuroradiology Geneva University Hospitals Geneva Switzerland
- Division of Neuroradiology Department of Medical Imaging Toronto Western Hospital University Health Network Toronto ON Canada
| | - Christophe Chnafa
- Biomedical Simulation Laboratory Department of Mechanical & Industrial Engineering University of Toronto Toronto ON Canada
| | - Nicole M. Cancelliere
- Division of Neuroradiology Department of Medical Imaging Toronto Western Hospital University Health Network Toronto ON Canada
| | - Maria I. Vargas
- Departement of Neuroradiology Geneva University Hospitals Geneva Switzerland
| | - Ivan Radovanovic
- Division of Neurosurgery Department of Surgery Toronto Western Hospital University Health Network Toronto ON Canada
| | - Timo Krings
- Division of Neuroradiology Department of Medical Imaging Toronto Western Hospital University Health Network Toronto ON Canada
| | - David A. Steinman
- Biomedical Simulation Laboratory Department of Mechanical & Industrial Engineering University of Toronto Toronto ON Canada
| | - Vitor M. Pereira
- Departement of Neuroradiology Geneva University Hospitals Geneva Switzerland
- Division of Neuroradiology Department of Medical Imaging Toronto Western Hospital University Health Network Toronto ON Canada
- Division of Neurosurgery Department of Surgery Toronto Western Hospital University Health Network Toronto ON Canada
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Liang L, Steinman DA, Brina O, Chnafa C, Cancelliere NM, Pereira VM. Towards the Clinical utility of CFD for assessment of intracranial aneurysm rupture – a systematic review and novel parameter-ranking tool. J Neurointerv Surg 2018; 11:153-158. [DOI: 10.1136/neurintsurg-2018-014246] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/10/2018] [Accepted: 09/13/2018] [Indexed: 11/04/2022]
Abstract
BackgroundIntracranial aneurysms (IAs) are vascular dilations on cerebral vessels that affect between 1%–5% of the general population, and can cause life-threatening intracranial hemorrhage when ruptured. Computational fluid dynamics (CFD) has emerged as a promising tool to study IAs in recent years, particularly for rupture risk assessment. However, despite dozens of studies, CFD is still far from clinical use due to large variations and frequent contradictions in hemodynamic results between studies.PurposeTo identify key gaps in the field of CFD for the study of IA rupture, and to devise a novel tool to rank parameters based on potential clinical utility.MethodsA Pubmed search identified 231 CFD studies for IAs. Forty-six studies fit our inclusion criteria, with a total of 2791 aneurysms. For included studies, study type, boundary conditions, solver resolutions, parameter definitions, geometric and hemodynamic parameters used, and results found were recorded.Data synthesisAspect ratio, aneurysm size, low wall shear stress area, average wall shear stress, and size ratio were the parameters that correlate most strongly with IA rupture.LimitationsSignificant differences in parameter definitions, solver spatial and temporal resolutions, number of cycles between studies as well as frequently missing information such as inlet flow rates were identified. A greater emphasis on prospective studies is also needed.ConclusionsOur recommendations will help increase standardization and bridge the gaps in the CFD community, and expedite the process of making CFD clinically useful in guiding the treatment of IAs.
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Berg P, Saalfeld S, Janiga G, Brina O, Cancelliere NM, Machi P, Pereira VM. Virtual stenting of intracranial aneurysms: A pilot study for the prediction of treatment success based on hemodynamic simulations. Int J Artif Organs 2018; 41:698-705. [PMID: 29783867 DOI: 10.1177/0391398818775521] [Citation(s) in RCA: 12] [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: 11/16/2022]
Abstract
Endovascular treatment of intracranial aneurysms using flow-diverting devices has revolutionized the treatment of large and complex lesions due to its minimally invasive nature and potential clinical outcomes. However, incomplete or delayed occlusion and persistent intracranial aneurysm growth are still an issue for up to one-third of the patients. We evaluated two patients with intracranial aneurysm located at the internal carotid artery who were treated with flow-diverting devices and had opposite outcomes. Both patients presented with similar aneurysms and were treated with the same device, but after a 1-year follow-up, one case presented with complete occlusion (Case 1) and the other required further treatment (Case 2). To reproduce the interventions, virtual stents were deployed and blood flow simulations were carried out using the respective patient-specific geometries. Afterward, hemodynamic metrics such as aneurysmal inflow reduction, wall shear stresses, oscillatory shear, and inflow concentration indices were quantified. The hemodynamic simulations reveal that for both cases, the neck inflow was clearly reduced due to the therapy (Case 1: 19%, Case 2: 35%). In addition, relevant hemodynamic parameters such as time-averaged wall shear stress (Case 1: 35.6%, Case 2: 57%) and oscillatory shear (Case 1: 33.1%, Case 2: 26.7%) were decreased considerably. However, although stronger relative reductions occurred in the unsuccessful case, the absolute flow values in the successful case were approximately halved. The findings demonstrate that a high relative effect of endovascular devices is not necessarily associated with the desired treatment outcome. Instead, it appears that a successful intracranial aneurysm therapy requires a certain patient-specific inflow threshold.
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Affiliation(s)
- Philipp Berg
- 1 Department of Fluid Dynamics and Technical Flows, University of Magdeburg, Magdeburg, Germany.,2 Forschungscampus STIMULATE, Magdeburg, Germany
| | - Sylvia Saalfeld
- 2 Forschungscampus STIMULATE, Magdeburg, Germany.,3 Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Gábor Janiga
- 1 Department of Fluid Dynamics and Technical Flows, University of Magdeburg, Magdeburg, Germany.,2 Forschungscampus STIMULATE, Magdeburg, Germany
| | - Olivier Brina
- 4 Interventional Neuroradiology Unit, University Hospital of Geneva, Geneva, Switzerland
| | - Nicole M Cancelliere
- 5 Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Paolo Machi
- 4 Interventional Neuroradiology Unit, University Hospital of Geneva, Geneva, Switzerland
| | - Vitor M Pereira
- 5 Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.,6 Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
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Cancelliere NM, Ferguson AV. Subfornical organ neurons integrate cardiovascular and metabolic signals. Am J Physiol Regul Integr Comp Physiol 2016; 312:R253-R262. [PMID: 28003212 DOI: 10.1152/ajpregu.00423.2016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 10/03/2016] [Revised: 12/20/2016] [Accepted: 12/20/2016] [Indexed: 12/13/2022]
Abstract
The subfornical organ (SFO) is a critical circumventricular organ involved in the control of cardiovascular and metabolic homeostasis. Despite the plethora of circulating signals continuously sensed by the SFO, studies investigating how these signals are integrated are lacking. In this study, we use patch-clamp techniques to investigate how the traditionally classified "cardiovascular" hormone ANG II, "metabolic" hormone CCK and "metabolic" signal glucose interact and are integrated in the SFO. Sequential bath application of CCK (10 nM) and ANG (10 nM) onto dissociated SFO neurons revealed that 63% of responsive SFO neurons depolarized to both CCK and ANG; 25% depolarized to ANG only; and 12% hyperpolarized to CCK only. We next investigated the effects of glucose by incubating and recording neurons in either hypoglycemic, normoglycemic, or hyperglycemic conditions and comparing the proportions of responses to ANG (n = 55) or CCK (n = 83) application in each condition. A hyperglycemic environment was associated with a larger proportion of depolarizing responses to ANG (χ2, P < 0.05), and a smaller proportion of depolarizing responses along with a larger proportion of hyperpolarizing responses to CCK (χ2, P < 0.01). Our data demonstrate that SFO neurons excited by CCK are also excited by ANG and that glucose environment affects the responsiveness of neurons to both of these hormones, highlighting the ability of SFO neurons to integrate multiple metabolic and cardiovascular signals. These findings have important implications for this structure's role in the control of various autonomic functions during hyperglycemia.
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Affiliation(s)
| | - Alastair V Ferguson
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
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Abstract
The mechanisms involved in cardiovascular regulation, such as vascular tone, fluid volume and blood osmolarity, are quite often mediated by signals circulating in the periphery, such as angiotensin II and sodium concentration. Research has identified areas within the lamina terminalis (LT), specifically the sensory circumventricular organs (CVOs), the subfornical organ and the organum vasculosum of the lamina terminalis, as playing crucial roles detecting and integrating information derived from these circulating signals. The median preoptic nucleus (MnPO) is a third integrative structure within the LT that influences cardiovascular homeostasis, although to date, its role is not as clearly elucidated. More recent studies have demonstrated that the CVOs are not only essential in the detection of traditional cardiovascular signals but also signals primarily considered to be important in the regulation of metabolic, reproductive and inflammatory processes that have now also been implicated in cardiovascular regulation. In this review, we highlight the critical roles played by the LT in the detection and integration of circulating signals that provide critical feedback control information contributing to cardiovascular regulation.
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Affiliation(s)
- Nicole M Cancelliere
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, K7L 3N6, Canada
| | - Emily A E Black
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, K7L 3N6, Canada
| | - Alastair V Ferguson
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, K7L 3N6, Canada.
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