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Beaman C, Molaie A, Ghochani Y, Fukuda K, Peterson C, Kaneko N, Nour M, Szeder V, Colby GP, Tateshima S, Jahan R, Duckwiler G. Clinical presentation and treatment of 26 spinal epidural arteriovenous fistulas: a single-center experience. J Neurointerv Surg 2024:jnis-2024-021471. [PMID: 38569885 DOI: 10.1136/jnis-2024-021471] [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: 01/10/2024] [Accepted: 03/14/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Spinal epidural arteriovenous fistulas (SEDAVFs) are rarely diagnosed vascular malformations that can cause spinal cord compression and congestive myelopathy. METHODS This is a single-center, retrospective case series of patients with SEDAVFs who underwent observation or treatment at UCLA medical center between 1993 and 2023. RESULTS Between 1993 and 2023 a total of 26 patients at UCLA were found to have a SEDAVF. The median age at treatment was 59 years (range 4 months to 91 years). Compared with sacral, lumbar, and thoracic SEDAVFs, patients with cervical SEDAVF were younger (41 years vs 63 years, P=0.016) and more likely to be female (66.7% vs 14.3%, P=0.006). Possible triggers for development of SEDAVFs may be prior spinal surgery or trauma (n=4), turning the neck (n=1), lifting a heavy box (n=1), a prolonged period of bending over (n=1), and neurofibromatosis type 1 (n=1). Of the 22 patients treated endovascularly, 18 (82%) were angiographically cured on the first attempt without complications. One patient underwent surgical treatment alone and had a failed surgery on the first attempt, and developed a surgical site infection after the second successful attempt at treatment. Of the 16 patients with adequate clinical follow-up, 11 (69%) demonstrated early improved clinical outcome (eg, improved strength on examination, absent bruit). CONCLUSIONS SEDAVFs are a rarely diagnosed disease that can be treated effectively and safely with endovascular embolization in most cases. Patients with sacral, lumbar, and thoracic SEDAVFs were older and more often male compared to patients with cervical SEDAVFs.
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Affiliation(s)
- Charles Beaman
- Department of Radiology, UCLA Medical Center, Los Angeles, California, USA
| | - Amir Molaie
- Department of Neurology, UCLA Medical Center, Los Angeles, California, USA
| | - Yasmin Ghochani
- Department of Neurology, UCLA Medical Center, Los Angeles, California, USA
| | - Keiko Fukuda
- Department of Radiology, UCLA Medical Center, Los Angeles, California, USA
| | - Catherine Peterson
- Department of Radiology, UCLA Medical Center, Los Angeles, California, USA
| | - Naoki Kaneko
- Department of Radiology, UCLA Medical Center, Los Angeles, California, USA
| | - May Nour
- Department of Radiology, UCLA Medical Center, Los Angeles, California, USA
| | - Viktor Szeder
- Department of Radiology, UCLA Medical Center, Los Angeles, California, USA
| | - Geoffrey P Colby
- Departments of Neurosurgery and Radiology, UCLA Medical Center, Los Angeles, California, USA
| | - Satoshi Tateshima
- Department of Radiology, UCLA Medical Center, Los Angeles, California, USA
| | - Reza Jahan
- Department of Radiology, UCLA Medical Center, Los Angeles, California, USA
| | - Gary Duckwiler
- Department of Radiology, UCLA Medical Center, Los Angeles, California, USA
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2
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Pionteck A, Abderezaei J, Fillingham P, Chuang YC, Sakai Y, Belani P, Rigney B, De Leacy R, Fifi JT, Chien A, Colby GP, Jahan R, Duckwiler G, Sayre J, Holdsworth SJ, Mossa-Basha M, Levitt MR, Mocco J, Kurt M, Nael K. Intracranial aneurysm wall displacement depicted by amplified Flow predicts growth. J Neurointerv Surg 2024:jnis-2023-021227. [PMID: 38320850 DOI: 10.1136/jnis-2023-021227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/21/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND Abnormal intracranial aneurysm (IA) wall motion has been associated with IA growth and rupture. Recently, a new image processing algorithm called amplified Flow (aFlow) has been used to successfully track IA wall motion by combining the amplification of cine and four-dimensional (4D) Flow MRI. We sought to apply aFlow to assess wall motion as a potential marker of IA growth in a paired-wise analysis of patients with growing versus stable aneurysms. METHODS In this retrospective case-control study, 10 patients with growing IAs and a matched cohort of 10 patients with stable IAs who had baseline 4D Flow MRI were included. The aFlow was used to amplify and extract IA wall displacements from 4D Flow MRI. The associations of aFlow parameters with commonly used risk factors and morphometric features were assessed using paired-wise univariate and multivariate analyses. RESULTS aFlow quantitative results showed significantly (P=0.035) higher wall motion displacement depicted by mean±SD 90th% values of 2.34±0.72 in growing IAs versus 1.39±0.58 in stable IAs with an area under the curve of 0.85. There was also significantly (P<0.05) higher variability of wall deformation across IA geometry in growing versus stable IAs depicted by the dispersion variables including 121-150% larger standard deviation ([Formula: see text]) and 128-161% wider interquartile range [Formula: see text]. CONCLUSIONS aFlow-derived quantitative assessment of IA wall motion showed greater wall motion and higher variability of wall deformation in growing versus stable IAs.
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Affiliation(s)
- Aymeric Pionteck
- Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Javid Abderezaei
- Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Patrick Fillingham
- Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Ya-Chen Chuang
- Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Yu Sakai
- Diagnostic, Molecular and Interventional Radiology, Mount Sinai Health System, New York, New York, USA
| | - Puneet Belani
- Diagnostic, Molecular and Interventional Radiology, Mount Sinai Health System, New York, New York, USA
| | - Brian Rigney
- Diagnostic, Molecular and Interventional Radiology, Mount Sinai Health System, New York, New York, USA
| | - Reade De Leacy
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Johanna T Fifi
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Aichi Chien
- Radiological Sciences, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Geoffrey P Colby
- Neurosurgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Reza Jahan
- Radiological Sciences, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Gary Duckwiler
- Radiological Sciences, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - James Sayre
- Radiological Sciences, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | | | - Mahmud Mossa-Basha
- Radiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Michael R Levitt
- Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - J Mocco
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mehmet Kurt
- Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Kambiz Nael
- Diagnostic, Molecular and Interventional Radiology, Mount Sinai Health System, New York, New York, USA
- Radiological Sciences, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
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3
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Tavakkol E, Kihira S, McArthur M, Polson JS, Zhang H, Arnold CW, Yoo BY, Linetsky M, Salehi B, Ledbetter LN, Kim CJ, Jahan R, Duckwiler GR, Saver JL, Liebeskind D, Nael K. Automated Assessment of DWI-FLAIR Mismatch in Patients with Acute Ischemic Stroke: Added Value to Routine Clinical Practice. AJNR Am J Neuroradiol 2024:ajnr.A8170. [PMID: 38290738 DOI: 10.3174/ajnr.a8170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
BACKGROUND AND PURPOSE DWI-FLAIR mismatch is used to determine thrombolytic eligibility in patients with acute ischemic stroke (AIS) when time since stroke onset (TSS) is unknown. Commercial software packages have been developed for automated DWI-FLAIR classification. We aimed to use e-Stroke software (Brainomix, Oxford, UK) for automated classification of DWI-FLAIR mismatch in a cohort of patients with AIS and in a comparative analysis with two expert neuroradiologists. MATERIALS AND METHODS In this retrospective study, patients with AIS who had MRI and known TSS were included. DWI-FLAIR mismatch was evaluated by two neuroradiologists blinded to TSS and automatically by e-Stroke software. After 4 weeks, the neuroradiologists reevaluated the MRIs, this time equipped with automated predicted e-Stroke results as a computer assisted tool (CAT). Diagnostic performances of e-Stroke software and neuroradiologists were evaluated for prediction of DWI-FLAIR mismatch status. RESULTS A total of 157 patients met inclusion criteria. A total of 82 patients (52%) had TSS ≤ 4.5 hours. Using consensus reads, 81 patients (51.5%) had DWI-FLAIR mismatch. The diagnostic accuracy (AUC/sensitivity/specificity) of e-Stroke software for determination of DWI-FLAIR mismatch was 0.72/90.0/53.9. The diagnostic accuracy (AUC/sensitivity/specificity) for neuroradiologist 1 and 2 was 0.76/69.1/84.2 and was 0.82/91.4/73.7 respectively, both significantly (p<0.05) improved to 0.83/79.0/86.8 and 0.89/92.6/85.5 respectively following the use of e-Stroke predictions as CAT. The interrater agreement (K) for determination of DWI-FLAIR status was improved from 0.49 to 0.57 following the use of CAT. CONCLUSIONS Automated quantitative approach for DWI-FLAIR mismatch provides comparable results to human experts and can improve diagnostic accuracies of expert neuroradiologists in determination of DWI-FLAIR status.ABBREVIATIONS: AIS: Acute ischemic stroke; CAT: Computer assisted tool; TSS: Time since stroke onset.
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Affiliation(s)
- Elham Tavakkol
- From the Department of Radiological Sciences (E.T., S.K., M.M., J.P., H.Z., C.A., B.Y., M.L., B.S., L.L., C.K., R.J., G.D., K.N.), Department of Neurology (J.S., D.S.L.), University of California, Los Angeles, USA
| | - Shingo Kihira
- From the Department of Radiological Sciences (E.T., S.K., M.M., J.P., H.Z., C.A., B.Y., M.L., B.S., L.L., C.K., R.J., G.D., K.N.), Department of Neurology (J.S., D.S.L.), University of California, Los Angeles, USA
| | - Mark McArthur
- From the Department of Radiological Sciences (E.T., S.K., M.M., J.P., H.Z., C.A., B.Y., M.L., B.S., L.L., C.K., R.J., G.D., K.N.), Department of Neurology (J.S., D.S.L.), University of California, Los Angeles, USA
| | - Jennifer Sara Polson
- From the Department of Radiological Sciences (E.T., S.K., M.M., J.P., H.Z., C.A., B.Y., M.L., B.S., L.L., C.K., R.J., G.D., K.N.), Department of Neurology (J.S., D.S.L.), University of California, Los Angeles, USA
| | - Haoyue Zhang
- From the Department of Radiological Sciences (E.T., S.K., M.M., J.P., H.Z., C.A., B.Y., M.L., B.S., L.L., C.K., R.J., G.D., K.N.), Department of Neurology (J.S., D.S.L.), University of California, Los Angeles, USA
| | - Corey W Arnold
- From the Department of Radiological Sciences (E.T., S.K., M.M., J.P., H.Z., C.A., B.Y., M.L., B.S., L.L., C.K., R.J., G.D., K.N.), Department of Neurology (J.S., D.S.L.), University of California, Los Angeles, USA
| | - Bryan Y Yoo
- From the Department of Radiological Sciences (E.T., S.K., M.M., J.P., H.Z., C.A., B.Y., M.L., B.S., L.L., C.K., R.J., G.D., K.N.), Department of Neurology (J.S., D.S.L.), University of California, Los Angeles, USA
| | - Michael Linetsky
- From the Department of Radiological Sciences (E.T., S.K., M.M., J.P., H.Z., C.A., B.Y., M.L., B.S., L.L., C.K., R.J., G.D., K.N.), Department of Neurology (J.S., D.S.L.), University of California, Los Angeles, USA
| | - Banafsheh Salehi
- From the Department of Radiological Sciences (E.T., S.K., M.M., J.P., H.Z., C.A., B.Y., M.L., B.S., L.L., C.K., R.J., G.D., K.N.), Department of Neurology (J.S., D.S.L.), University of California, Los Angeles, USA
| | - Luke N Ledbetter
- From the Department of Radiological Sciences (E.T., S.K., M.M., J.P., H.Z., C.A., B.Y., M.L., B.S., L.L., C.K., R.J., G.D., K.N.), Department of Neurology (J.S., D.S.L.), University of California, Los Angeles, USA
| | - Christine J Kim
- From the Department of Radiological Sciences (E.T., S.K., M.M., J.P., H.Z., C.A., B.Y., M.L., B.S., L.L., C.K., R.J., G.D., K.N.), Department of Neurology (J.S., D.S.L.), University of California, Los Angeles, USA
| | - Reza Jahan
- From the Department of Radiological Sciences (E.T., S.K., M.M., J.P., H.Z., C.A., B.Y., M.L., B.S., L.L., C.K., R.J., G.D., K.N.), Department of Neurology (J.S., D.S.L.), University of California, Los Angeles, USA
| | - Gary R Duckwiler
- From the Department of Radiological Sciences (E.T., S.K., M.M., J.P., H.Z., C.A., B.Y., M.L., B.S., L.L., C.K., R.J., G.D., K.N.), Department of Neurology (J.S., D.S.L.), University of California, Los Angeles, USA
| | - Jeffrey L Saver
- From the Department of Radiological Sciences (E.T., S.K., M.M., J.P., H.Z., C.A., B.Y., M.L., B.S., L.L., C.K., R.J., G.D., K.N.), Department of Neurology (J.S., D.S.L.), University of California, Los Angeles, USA
| | - David Liebeskind
- From the Department of Radiological Sciences (E.T., S.K., M.M., J.P., H.Z., C.A., B.Y., M.L., B.S., L.L., C.K., R.J., G.D., K.N.), Department of Neurology (J.S., D.S.L.), University of California, Los Angeles, USA
| | - Kambiz Nael
- From the Department of Radiological Sciences (E.T., S.K., M.M., J.P., H.Z., C.A., B.Y., M.L., B.S., L.L., C.K., R.J., G.D., K.N.), Department of Neurology (J.S., D.S.L.), University of California, Los Angeles, USA
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4
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McArthur MA, Tavakkol E, Bahr-Hosseini M, Jahan R, Duckwiler GR, Saver JL, Liebeskind DS, Nael K. Overestimation of ischemic core on baseline MRI in acute stroke. Interv Neuroradiol 2024:15910199231224500. [PMID: 38258456 DOI: 10.1177/15910199231224500] [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: 01/24/2024] Open
Abstract
BACKGROUND AND PURPOSE In patients with acute ischemic stroke (AIS), overestimation of ischemic core on MRI-DWI has been described primarily in regions with milder reduced diffusion. We aimed to assess the possibility of ischemic core overestimation on pretreatment MRI despite using more restricted reduced diffusion (apparent diffusion coefficient (ADC) ≤620 × 10-6 mm2/s) in AIS patients with successful reperfusion. MATERIALS AND METHODS In this retrospective single institutional study, AIS patients who had pretreatment MRI underwent successful reperfusion and had follow-up MRI to determine the final infarct volume were reviewed. Pretreatment ischemic core and final infarction volumes were calculated. Ghost core was defined as overestimation of final infarct volume by baseline MRI of >10 mL. Baseline clinical, demographic, and treatment-related factors in this cohort were reviewed. RESULTS A total of 6/156 (3.8%) patients had overestimated ischemic core volume on baseline MRI, with mean overestimation of 65.6 mL. Three out of six patients had pretreatment ischemic core estimation of >70 mL, while the final infarct volume was <70 mL. All six patients had last known well-to-imaging <120 min, median (IQR): 65 (53-81) minutes. CONCLUSIONS Overestimation of ischemic core, known as ghost core, is rare using severe ADC threshold (≤620 × 10-6 mm2/s), but it does occur in nearly 1 of every 25 patients, confined to hyperacute patients imaged within 120 min of symptom onset. Awareness of this phenomenon carries implications for treatment and trial enrollment.
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Affiliation(s)
- M A McArthur
- Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, USA
| | - E Tavakkol
- Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, USA
| | - M Bahr-Hosseini
- Department of Neurology, University of California, Los Angeles, Los Angeles, USA
| | - R Jahan
- Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, USA
| | - G R Duckwiler
- Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, USA
| | - J L Saver
- Department of Neurology, University of California, Los Angeles, Los Angeles, USA
| | - D S Liebeskind
- Department of Neurology, University of California, Los Angeles, Los Angeles, USA
| | - K Nael
- Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, USA
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5
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Peeters SF, Colby GP, Kim WJ, Bae WI, Sparks H, Reitz K, Tateshima S, Jahan R, Szeder V, Nour M, Duckwiler GR, Vinuela F, Martin NA, Wang AC. Arterial Bypass in the Treatment of Complex Middle Cerebral Artery Aneurysms: Lessons Learned from Forty Patients. World Neurosurg 2024; 181:e261-e272. [PMID: 37832639 DOI: 10.1016/j.wneu.2023.10.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 10/07/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVE Complex middle cerebral artery (MCA) aneurysms incorporating parent or branching vessels are often not amenable to standard microsurgical clipping or endovascular embolization treatments. We aim to discuss the treatment of such aneurysms via a combination of surgical revascularization and aneurysm exclusion based on our institutional experience. METHODS Thirty-four patients with complex MCA aneurysms were treated with bypass and aneurysm occlusion, 5 with surgical clipping or wrapping only, and 1 with aneurysm excision and primary reanastomosis. Bypasses included superficial temporal artery (STA)-MCA, double-barrel STA-MCA, occipital artery-MCA, and external carotid artery-MCA. After bypass, aneurysms were treated by surgical clipping, Hunterian ligation, trapping, or coil embolization. RESULTS The average age at diagnosis was 46 years. Of the aneurysms, 67% were large and most involved the MCA bifurcation. Most bypasses performed were STA-MCA bypasses, 12 of which were double-barrel. There were 2 wound-healing complications. All but 2 of the aneurysms treated showed complete occlusion at the last follow-up. There were 3 hemorrhagic complications, 3 graft thromboses, and 4 ischemic insults. The mean follow-up was 73 months. Of patients, 83% reported stable or improved symptoms from presentation and 73% reported a functional status (Glasgow Outcome Scale score 4 or 5) at the latest available follow-up. CONCLUSIONS Cerebral revascularization by bypass followed by aneurysm or parent artery occlusion is an effective treatment option for complex MCA aneurysms that cannot be safely treated by standard microsurgical or endovascular techniques. Double-barrel bypass consisting of 2 STA branches to 2 MCA branches yields adequate flow replacement in most cases.
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Affiliation(s)
- Sophie F Peeters
- Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Geoffrey P Colby
- Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Wi Jin Kim
- Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Whi Inh Bae
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Hiro Sparks
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Kara Reitz
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Satoshi Tateshima
- Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Reza Jahan
- Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Viktor Szeder
- Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - May Nour
- Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Gary R Duckwiler
- Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Fernando Vinuela
- Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Neil A Martin
- Department of Neurosurgery, Pacific Neuroscience Institute, Santa Monica, California, USA
| | - Anthony C Wang
- Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
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6
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Peeters SM, Colby GP, Kim WJ, Bae WI, Sparks H, Reitz K, Tateshima S, Jahan R, Szeder V, Nour M, Duckwiler GR, Vinuela F, Martin NA, Wang AC. Proximal Internal Carotid Artery Occlusion and Extracranial-Intracranial Bypass for Treatment of Fusiform and Giant Internal Carotid Artery Aneurysms. World Neurosurg 2023; 180:e494-e505. [PMID: 37774787 DOI: 10.1016/j.wneu.2023.09.097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVE To discuss the treatment of intracranial fusiform and giant internal carotid artery (ICA) aneurysms via revascularization based on our institutional experience. METHODS An institutional review board-approved retrospective analysis was performed of patients with unruptured fusiform and giant intracranial ICA aneurysms treated from November 1991 to May 2020. All patients were evaluated for extracranial-intracranial (EC-IC) bypass and ICA occlusion. RESULTS Thirty-eight patients were identified. Initially, patients failing preoperative balloon test occlusion were treated with superficial temporal artery (STA)-middle cerebral artery (MCA) bypass and concurrent proximal ICA ligation. We then treated them with STA-MCA bypass, followed by staged balloon test occlusion, and, if they passed, endovascular ICA coil occlusion. We treat all surgical medically uncomplicated patients with double-barrel STA-MCA bypass and concurrent proximal ICA ligation. The mean length of follow-up was 99 months. Symptom stability or improvement was noted in 85% of patients. Bypass graft patency was 92.1%, and all surviving patients had patent bypasses at their last angiogram. Aneurysm occlusion was complete in 90.9% of patients completing proximal ICA ligation. Three patients experienced ischemic complications and 4 patients experienced hemorrhagic complications. CONCLUSIONS Not all fusiform intracranial ICA aneurysms require intervention, except when life-threatening rupture risk is high or symptomatic management is necessary to preserve function and quality of life. EC-IC bypass can augment the safety of proximal ICA occlusion. The rate of complete aneurysm occlusion with this treatment is 90.9%, and long-term bypass graft-related complications are rare. Perioperative stroke is a major risk, and continued evolution of treatment is required.
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Affiliation(s)
- Sophie M Peeters
- Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Geoffrey P Colby
- Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Wi Jin Kim
- Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Whi Inh Bae
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Hiro Sparks
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Kara Reitz
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Satoshi Tateshima
- Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Reza Jahan
- Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Viktor Szeder
- Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - May Nour
- Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Gary R Duckwiler
- Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Fernando Vinuela
- Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Neil A Martin
- Pacific Neuroscience Institute, Santa Monica, California, USA
| | - Anthony C Wang
- Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
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7
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Shahrouki P, Kihira S, Tavakkol E, Qiao JX, Vagal A, Khatri P, Bahr-Hosseini M, Colby GP, Jahan R, Duckwiler G, Szeder V, Ledbetter L, Cai S, Salehi B, Doshi AH, Belani P, Fifi JT, De Leacy R, Mocco J, Saver JL, Liebeskind DS, Nael K. Automated assessment of ischemic core on non-contrast computed tomography: a multicenter comparative analysis with CT perfusion. J Neurointerv Surg 2023:jnis-2023-020954. [PMID: 37918907 DOI: 10.1136/jnis-2023-020954] [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: 08/26/2023] [Accepted: 10/13/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Application of machine learning (ML) algorithms has shown promising results in estimating ischemic core volumes using non-contrast CT (NCCT). OBJECTIVE To assess the performance of the e-Stroke Suite software (Brainomix) in assessing ischemic core volumes on NCCT compared with CT perfusion (CTP) in patients with acute ischemic stroke. METHODS In this retrospective multicenter study, patients with anterior circulation large vessel occlusions who underwent pretreatment NCCT and CTP, successful reperfusion (modified Thrombolysis in Cerbral Infarction ≥2b), and post-treatment MRI, were included from three stroke centers. Automated calculation of ischemic core volumes was obtained on NCCT scans using ML algorithm deployed by e-Stroke Suite and from CTP using Olea software (Olea Medical). Comparative analysis was performed between estimated core volumes on NCCT and CTP and against MRI calculated final infarct volume (FIV). RESULTS A total of 111 patients were included. Estimated ischemic core volumes (mean±SD, mL) were 20.4±19.0 on NCCT and 19.9±18.6 on CTP, not significantly different (P=0.82). There was moderate (r=0.40) and significant (P<0.001) correlation between estimated core on NCCT and CTP. The mean difference between FIV and estimated core volume on NCCT and CTP was 29.9±34.6 mL and 29.6±35.0 mL, respectively (P=0.94). Correlations between FIV and estimated core volume were similar for NCCT (r=0.30, P=0.001) and CTP (r=0.36, P<0.001). CONCLUSIONS Results show that ML-based estimated ischemic core volumes on NCCT are comparable to those obtained from concurrent CTP in magnitude and in degree of correlation with MR-assessed FIV.
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Affiliation(s)
- Puja Shahrouki
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Shingo Kihira
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Elham Tavakkol
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Joe X Qiao
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Achala Vagal
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Pooja Khatri
- Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Mersedeh Bahr-Hosseini
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Geoffrey P Colby
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Reza Jahan
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Gary Duckwiler
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Viktor Szeder
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Luke Ledbetter
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Stephen Cai
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Banafsheh Salehi
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Amish H Doshi
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Puneet Belani
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Johanna T Fifi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Reade De Leacy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - J Mocco
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jeffrey L Saver
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - David S Liebeskind
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Kambiz Nael
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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8
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Yedavalli V, Kihira S, Shahrouki P, Hamam O, Tavakkol E, McArthur M, Qiao J, Johanna F, Doshi A, Vagal A, Khatri P, Srinivasan A, Chaudhary N, Bahr-Hosseini M, Colby GP, Nour M, Jahan R, Duckwiler G, Arnold C, Saver JL, Mocco J, Liebeskind DS, Nael K. CTP-based estimated ischemic core: A comparative multicenter study between Olea and RAPID software. J Stroke Cerebrovasc Dis 2023; 32:107297. [PMID: 37738915 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107297] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND AND PURPOSE CTP is increasingly used to assess eligibility for endovascular therapy (EVT) in patients with large vessel occlusions (LVO). There remain variability and inconsistencies between software packages for estimation of ischemic core. We aimed to use heterogenous data from four stroke centers to perform a comparative analysis for CTP-estimated ischemic core between RAPID (iSchemaView) and Olea (Olea Medical). METHODS In this retrospective multicenter study, patients with anterior circulation LVO who underwent pretreatment CTP, successful EVT (defined TICI ≥ 2b), and follow-up MRI included. Automated CTP analysis was performed using Olea platform [rCBF < 25% and differential time-to-peak (dTTP)>5s] and RAPID (rCBF < 30%). The CTP estimated core volumes were compared against the final infarct volume (FIV) on post treatment MRI-DWI. RESULTS A total of 151 patients included. The CTP-estimated ischemic core volumes (mean ± SD) were 18.7 ± 18.9 mL on Olea and 10.5 ± 17.9 mL on RAPID significantly different (p < 0.01). The correlation between CTP estimated core and MRI final infarct volume was r = 0.38, p < 0.01 for RAPID and r = 0.39, p < 0.01 for Olea. Both software platforms demonstrated a strong correlation with each other (r = 0.864, p < 0.001). Both software overestimated the ischemic core volume above 70 mL in 4 patients (2.6%). CONCLUSIONS Substantial variation between Olea and RAPID CTP-estimated core volumes exists, though rates of overcalling of large core were low and identical. Both showed comparable core volume correlation to MRI infarct volume.
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Affiliation(s)
- V Yedavalli
- Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - S Kihira
- David Geffen School of Medicine at the University of California - Los Angeles, United States
| | - P Shahrouki
- David Geffen School of Medicine at the University of California - Los Angeles, United States
| | - O Hamam
- Massachussetts General Hospital, Boston, MA, United States
| | - E Tavakkol
- David Geffen School of Medicine at the University of California - Los Angeles, United States
| | - M McArthur
- David Geffen School of Medicine at the University of California - Los Angeles, United States
| | - J Qiao
- David Geffen School of Medicine at the University of California - Los Angeles, United States
| | - Fifi Johanna
- Mount Sinai School of Medicine, New York, NY, United States
| | - A Doshi
- Mount Sinai School of Medicine, New York, NY, United States
| | - A Vagal
- University of Cincinnati School of Medicine, Cincinnati, OH, United States
| | - P Khatri
- University of Cincinnati School of Medicine, Cincinnati, OH, United States
| | - A Srinivasan
- University of Michigan School of Medicine, Ann Arbor, MI, United States
| | - N Chaudhary
- University of Michigan School of Medicine, Ann Arbor, MI, United States
| | - M Bahr-Hosseini
- David Geffen School of Medicine at the University of California - Los Angeles, United States
| | - G P Colby
- David Geffen School of Medicine at the University of California - Los Angeles, United States
| | - M Nour
- David Geffen School of Medicine at the University of California - Los Angeles, United States
| | - R Jahan
- David Geffen School of Medicine at the University of California - Los Angeles, United States
| | - G Duckwiler
- David Geffen School of Medicine at the University of California - Los Angeles, United States
| | - C Arnold
- David Geffen School of Medicine at the University of California - Los Angeles, United States
| | - J L Saver
- David Geffen School of Medicine at the University of California - Los Angeles, United States
| | - J Mocco
- Mount Sinai School of Medicine, New York, NY, United States
| | - D S Liebeskind
- David Geffen School of Medicine at the University of California - Los Angeles, United States
| | - K Nael
- David Geffen School of Medicine at the University of California - Los Angeles, United States
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9
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Tsui B, Chen IE, Nour M, Kihira S, Tavakkol E, Polson J, Zhang H, Qiao J, Bahr-Hosseini M, Arnold C, Tateshima S, Salamon N, Villablanca JP, Colby GP, Jahan R, Duckwiler G, Saver JL, Liebeskind DS, Nael K. Perfusion Collateral Index versus Hypoperfusion Intensity Ratio in Assessment of Collaterals in Patients with Acute Ischemic Stroke. AJNR Am J Neuroradiol 2023; 44:1249-1255. [PMID: 37827719 PMCID: PMC10631520 DOI: 10.3174/ajnr.a8002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 08/20/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND AND PURPOSE Perfusion-based collateral indices such as the perfusion collateral index and the hypoperfusion intensity ratio have shown promise in the assessment of collaterals in patients with acute ischemic stroke. We aimed to compare the diagnostic performance of the perfusion collateral index and the hypoperfusion intensity ratio in collateral assessment compared with angiographic collaterals and outcome measures, including final infarct volume, infarct growth, and functional independence. MATERIALS AND METHODS Consecutive patients with acute ischemic stroke with anterior circulation proximal arterial occlusion who underwent endovascular thrombectomy and had pre- and posttreatment MRI were included. Using pretreatment MR perfusion, we calculated the perfusion collateral index and the hypoperfusion intensity ratio for each patient. The angiographic collaterals obtained from DSA were dichotomized to sufficient (American Society of Interventional and Therapeutic Neuroradiology [ASITN] scale 3-4) versus insufficient (ASITN scale 0-2). The association of collateral status determined by the perfusion collateral index and the hypoperfusion intensity ratio was assessed against angiographic collaterals and outcome measures. RESULTS A total of 98 patients met the inclusion criteria. Perfusion collateral index values were significantly higher in patients with sufficient angiographic collaterals (P < .001), while there was no significant (P = .46) difference in hypoperfusion intensity ratio values. Among patients with good (mRS 0-2) versus poor (mRS 3-6) functional outcome, the perfusion collateral index of ≥ 62 was present in 72% versus 31% (P = .003), while the hypoperfusion intensity ratio of ≤0.4 was present in 69% versus 56% (P = .52). The perfusion collateral index and the hypoperfusion intensity ratio were both significantly predictive of final infarct volume, but only the perfusion collateral index was significantly (P = .03) associated with infarct growth. CONCLUSIONS Results show that the perfusion collateral index outperforms the hypoperfusion intensity ratio in the assessment of collateral status, infarct growth, and determination of functional outcomes.
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Affiliation(s)
- Brian Tsui
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Iris E Chen
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - May Nour
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
- Department of Neurology (M.N., M.B.-H., J.L.S., D.S.L.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Shingo Kihira
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Elham Tavakkol
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Jennifer Polson
- Department of Bioengineering (J.P., H.Z., C.A.), University of California, Los Angeles, Los Angeles, California
| | - Haoyue Zhang
- Department of Bioengineering (J.P., H.Z., C.A.), University of California, Los Angeles, Los Angeles, California
| | - Joe Qiao
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Mersedeh Bahr-Hosseini
- Department of Neurology (M.N., M.B.-H., J.L.S., D.S.L.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Corey Arnold
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
- Department of Bioengineering (J.P., H.Z., C.A.), University of California, Los Angeles, Los Angeles, California
| | - Satoshi Tateshima
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Noriko Salamon
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - J Pablo Villablanca
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Geoffrey P Colby
- Department of Neurosurgery (G.P.C.), University of California, Los Angeles, Los Angeles, California
| | - Reza Jahan
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Gary Duckwiler
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Jeffrey L Saver
- Department of Neurology (M.N., M.B.-H., J.L.S., D.S.L.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - David S Liebeskind
- Department of Neurology (M.N., M.B.-H., J.L.S., D.S.L.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Kambiz Nael
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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10
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Beaman C, Gautam A, Peterson C, Kaneko N, Ponce L, Saber H, Khatibi K, Morales J, Kimball D, Lipovac JR, Narsinh KH, Baker A, Caton MT, Smith ER, Nour M, Szeder V, Jahan R, Colby GP, Cord BJ, Cooke DL, Tateshima S, Duckwiler G, Waldau B. Robotic Diagnostic Cerebral Angiography: A Multicenter Experience of 113 Patients. J Neurointerv Surg 2023:jnis-2023-020448. [PMID: 37468266 DOI: 10.1136/jnis-2023-020448] [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] [Accepted: 06/14/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Neurointerventional robotic systems have potential to reduce occupational radiation, improve procedural precision, and allow for future remote teleoperation. A limited number of single institution case reports and series have been published outlining the safety and feasibility of robot-assisted diagnostic cerebral angiography. METHODS This is a multicenter, retrospective case series of patients undergoing diagnostic cerebral angiography at three separate institutions - University of California, Davis (UCD); University of California, Los Angeles (UCLA); and University of California, San Francisco (UCSF). The equipment used was the CorPath GRX Robotic System (Corindus, Waltham, MA). RESULTS A total of 113 cases were analyzed who underwent robot-assisted diagnostic cerebral angiography from September 28, 2020 to October 27, 2022. There were no significant complications related to use of the robotic system including stroke, arterial dissection, bleeding, or pseudoaneurysm formation at the access site. Using the robotic system, 88 of 113 (77.9%) cases were completed successfully without unplanned manual conversion. The principal causes for unplanned manual conversion included challenging anatomy, technical difficulty with the bedside robotic cassette, and hubbing out of the robotic system due to limited working length. For robotic operation, average fluoroscopy time was 13.2 min (interquartile range (IQR), 9.3 to 16.8 min) and average cumulative air kerma was 975.8 mGY (IQR, 350.8 to 1073.5 mGy). CONCLUSIONS Robotic cerebral angiography with the CorPath GRX Robotic System is safe and easily learned by novice users without much prior manual experience. However, there are technical limitations such as a short working length and an inability to support 0.035" wires which may limit its widespread adoption in clinical practice.
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Affiliation(s)
- Charles Beaman
- University of California Stroke Consortium Robotics Workgroup, California, California, USA
- Radiology, University of California Los Angeles, Los Angeles, California, USA
| | - Ayushi Gautam
- University of California Stroke Consortium Robotics Workgroup, California, California, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Catherine Peterson
- University of California Stroke Consortium Robotics Workgroup, California, California, USA
- Neurosurgery, University of California Davis, Sacramento, CA, USA
| | - Naoki Kaneko
- University of California Stroke Consortium Robotics Workgroup, California, California, USA
- Radiology, University of California Los Angeles, Los Angeles, California, USA
| | - Luciano Ponce
- Radiology, University of California Los Angeles, Los Angeles, California, USA
| | - Hamidreza Saber
- Radiology, University of California Los Angeles, Los Angeles, California, USA
| | - Kasra Khatibi
- Radiology, University of California Los Angeles, Los Angeles, California, USA
| | - Jose Morales
- Radiology, University of California Los Angeles, Los Angeles, California, USA
| | - David Kimball
- Radiology, University of California Los Angeles, Los Angeles, California, USA
| | | | - Kazim H Narsinh
- University of California Stroke Consortium Robotics Workgroup, California, California, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Amanda Baker
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - M Travis Caton
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Eric R Smith
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - May Nour
- Radiology, University of California Los Angeles, Los Angeles, California, USA
| | - Viktor Szeder
- Radiology, University of California Los Angeles, Los Angeles, California, USA
| | - Reza Jahan
- Radiology, University of California Los Angeles, Los Angeles, California, USA
| | - Geoffrey P Colby
- University of California Stroke Consortium Robotics Workgroup, California, California, USA
- Radiology, University of California Los Angeles, Los Angeles, California, USA
- Neurosurgery, University of California Los Angeles, Los Angeles, California, USA
| | - Branden J Cord
- University of California Stroke Consortium Robotics Workgroup, California, California, USA
- Neurosurgery, University of California Davis, Sacramento, CA, USA
| | - Daniel L Cooke
- University of California Stroke Consortium Robotics Workgroup, California, California, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Satoshi Tateshima
- Radiology, University of California Los Angeles, Los Angeles, California, USA
| | - Gary Duckwiler
- University of California Stroke Consortium Robotics Workgroup, California, California, USA
- Radiology, University of California Los Angeles, Los Angeles, California, USA
| | - Ben Waldau
- University of California Stroke Consortium Robotics Workgroup, California, California, USA
- Neurosurgery, University of California Davis, Sacramento, CA, USA
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11
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Islam MN, Habib MR, Khandakar MMH, Rashid MH, Sarker MAH, Bari MS, Islam MZ, Alam MK, Sarkar MM, Jahan R, Mahzabin R, Islam MA. Repeat breeding: prevalence and potential causes in dairy cows at different milk pocket areas of Bangladesh. Trop Anim Health Prod 2023; 55:120. [PMID: 36930420 DOI: 10.1007/s11250-023-03537-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: 07/16/2022] [Accepted: 03/06/2023] [Indexed: 03/18/2023]
Abstract
The objective of this study was to figure out the prevalence and probable causes of repeat breeding (RB) in dairy cows. Hence, a cross-sectional study was conducted on randomly selected 265 dairy farms in Sirajganj, Bogura, Rangpur, Satkhira, and Munshiganj districts of Bangladesh from December 2018 to February 2019. Data were collected through a direct interview method using a survey questionnaire. The reproductive organs of repeat breeder cows were examined for pathological, infectious, and functional reasons, and genital tract abnormalities. Additionally, the influence of nutrition, season, and age on the frequency of RB was recorded. The prevalence of RB was 28% among the 3824 cows investigated. Among the total repeat breeder cases, 72.54% of RB cases were found in Holstein-Friesian crossbred, 23.90% in Jersey crossbred, 1.50% in Sahiwal crossbred, and 2.06% in indigenous cows. The prevalence of RB was significantly highest (P < 0.01) in Satkhira (44.35%) and lowest in the Munshiganj district (15.87%). Data indicated that a major proportion of cows significantly (P < 0.05) faced RB problems due to functional causes (34.18%), followed by pathological causes (28.01%), genital tract abnormalities (21.32%), and infectious causes (16.49%). Furthermore, the cows were remarkably (P < 0.001) affected in RB during the summer season and nutritional deficient diseases like milk fever (70%). Age (3-7 years) had a significant (P < 0.001) effect on the RB occurrence (90%) in crossbred cows. However, particular focus should be given to systematic breeding, balanced nutrition, artificial inseminator efficiency, and hygienic inseminating tools to reduce RB incidence in high-yielding crossbred cows.
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Affiliation(s)
- M N Islam
- Department of Dairy Science, Bangladesh Agricultural University, Mymensingh, 2202, Bangladesh
- Bangladesh Milk Producer's Co-Operative Union Limited (Milk Vita), Tejgaon, Dhaka, 1208, Bangladesh
| | - M R Habib
- Department of Dairy Science, Bangladesh Agricultural University, Mymensingh, 2202, Bangladesh
| | - M M H Khandakar
- Department of Dairy Science, Bangladesh Agricultural University, Mymensingh, 2202, Bangladesh
| | - M H Rashid
- Department of Dairy Science, Bangladesh Agricultural University, Mymensingh, 2202, Bangladesh
| | - M A H Sarker
- Department of Dairy Science, Bangladesh Agricultural University, Mymensingh, 2202, Bangladesh
| | - M S Bari
- Department of Dairy Science, Bangladesh Agricultural University, Mymensingh, 2202, Bangladesh
| | - M Z Islam
- Department of Dairy Science, Bangladesh Agricultural University, Mymensingh, 2202, Bangladesh
| | - M K Alam
- Bangladesh Livestock Research Institute, Savar, Dhaka, Bangladesh
| | - M M Sarkar
- Palli Karma-Sahayak Foundation (PKSF), Agargaon, Dhaka, Bangladesh
| | - R Jahan
- Department of Animal Science, Bangladesh Agricultural University, Mymensingh, 2202, Bangladesh
| | - R Mahzabin
- Department of Animal Breeding and Genetics, Bangladesh Agricultural University, Mymensingh, 2202, Bangladesh
| | - M A Islam
- Department of Dairy Science, Bangladesh Agricultural University, Mymensingh, 2202, Bangladesh.
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12
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Bourcier R, Goyal M, Muir KW, Desal H, Dippel DWJ, Majoie CBLM, van Zwam WH, Jovin TG, Mitchell PJ, Demchuk AM, van Oostenbrugge RJ, Brown SB, Campbell B, White P, Hill MD, Saver JL, Weimar C, Jahan R, Guillemin F, Bracard S, Naggara O. Risk factors of unexplained early neurological deterioration after treatment for ischemic stroke due to large vessel occlusion: a post hoc analysis of the HERMES study. J Neurointerv Surg 2023; 15:221-226. [PMID: 35169030 DOI: 10.1136/neurintsurg-2021-018214] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 09/08/2021] [Accepted: 01/25/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Early neurological deterioration (END) after endovascular treatment (EVT) in patients with anterior circulation acute ischemic stroke (AIS) is associated with poor outcome. END may remain unexplained by parenchymal hemorrhage (UnEND). We aim to analyze the risk factors of UnEND in the medical management (MM) and EVT arms of the HERMES study. METHODS We conducted a post-hoc analysis of anterior AIS patients who underwent EVT for proximal anterior occlusions. Risk factors of UnEND, defined as a worsening of ≥4 points between baseline National Institutes of Health Stroke Scale (NIHSS) and NIHSS at 24 hours without hemorrhage, were compared between both arms using mixed logistic regression models adjusted for baseline characteristics. An interaction analysis between the EVT and MM arms for risk factors of UnEND was conducted. RESULTS Among 1723 patients assessable for UnEND, 160 patients experienced an UnEND (9.3%), including 9.1% (78/854) in the EVT arm and 9.4% (82/869) in the MM arm. There was no significant difference in the incidence of UnEND between the two study arms. In the EVT population, independent risk factors of UnEND were lower baseline NIHSS, higher baseline glucose, and lower collateral grade. In the MM population, the only independent predictor of UnEND was higher baseline glucose. However, we did not demonstrate an interaction between EVT and MM for baseline factors as risk factors of UnEND. UnEND was, similarly in both treatment groups, a significant predictor of unfavorable outcome in both the EVT (p<0.001) and MM (p<0.001) arms. CONCLUSIONS UnEND is not an uncommon event, with a similar rate which ever treatment arm is considered. In the clinical scenario of AIS due to large vessel occlusion, no patient-related factor seems to increase the risk for UnEND when treated by EVT compared with MM.
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Affiliation(s)
- Romain Bourcier
- Neuroradiology, Université de Nantes, Nantes, Pays de la Loire, France
| | - Mayank Goyal
- Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada
| | - Keith W Muir
- Centre for Stroke & Brain Imaging University of Glasgow, University of Glasgow, Glasgow, UK
| | - Hubert Desal
- Neuroradiology, University Hospital of Nantes, Nantes, France
| | | | - Charles B L M Majoie
- Radiology and Nuclear Medicine, Amsterdam UMC - Locatie AMC, Amsterdam, North Holland, The Netherlands
| | - Wim H van Zwam
- Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Tudor G Jovin
- Neurology, Cooper University Hospital, Camden, New Jersey, USA
| | - Peter J Mitchell
- Radiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Andrew M Demchuk
- Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Departments of Clinical Neuroscience and Radiology, Hotchkiss Brain Institute, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Bruce Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, Melbourne, Austria
| | - Philip White
- Institute for Ageing & Health, Newcastle University, Newcastle upon Tyne, UK.,Neuroradiology, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | - Michael D Hill
- Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Clinical Neurosciences, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Jeffrey L Saver
- Neurology, UCLA, Los Angeles, California, USA.,Comprehensive Stroke Center and Neurology, David Geffen School of Medicine, Los Angeles, California, USA
| | - Christian Weimar
- Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Duisburg, Nordrhein-Westfalen, Germany
| | - Reza Jahan
- Interventional Neuroradiology, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - Francis Guillemin
- CIC 1433 Epidémiologie clinique, University of Lorraine and University Hospital of Nancy, Nancy, France
| | - Serge Bracard
- Neuroradiology, University of Lorraine and University Hospital of Nancy, Nancy, France
| | - Olivier Naggara
- Department of Neuroradiology, Saint Anne Hospital Centre, Paris, Île-de-France, France
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13
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Kogan DR, Cote A, Chatfield F, Alfonso RC, Colby G, Johnson J, Szeder V, Raychev R, Tateshima S, Kaneko N, Jahan R, Duckwiler G, Saver JL, Sharma LK, Nour M, Liebeskind DS. Abstract 96: Independent Adjudication Of Get With The Guidelines Thrombectomy Imaging And Angiography Data Reveals Major Discrepancies. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Introduction:
The Get with the Guidelines - Stroke (GWTG-Stroke) registry has been collecting endovascular thrombectomy (EVT) data on acute stroke interventions since 2015. The key variables associated with EVT, solely based on local site documentation, have never been independently adjudicated. We conducted a detailed analysis of single center EVT data as entered in the GWTG-Stroke registry.
Methods:
Consecutive EVT cases entered into both GWTG-Stroke and an independent research database at a large academic comprehensive stroke center were sampled from 2020-2022. For each case, the following EMR and PACS imaging variables related to EVT efficacy and safety outcomes were compared between GWTG-Stroke and core lab independent readings, including: site of target occlusion (STO), first-pass time (FPT), time mTICI >=2b50 first documented (reperfusion time), final mTICI score (0, 1, 2a, 2b50, 3; FTICI), presence of post-intervention hemorrhagic transformation (HT), and subtype/extent of HT.
Results:
The GWTG-Stroke registry EVT-imaging data variables document only 6/30 (20%) of the common data elements (CDEs) recommended by NINDS and 6/34 (18%) recommended by the FDA. Of the 80 cases sampled, 29 (36%) had discrepancies between GWTG-Stroke recorded data and independent core lab findings. In 4 cases (5%), reperfusion time was incorrect. In another 4 cases (5%), FTICI was incorrect, even when using the gross 2b50/3 categories. In 1 case (1.3%) STO was incorrect. In 2 cases (2.5%) patient data was not reported to GWTG-Stroke. In 21 cases (26%), HT was documented as not present, when in fact it was. Of those, 3 cases (4%) were PH2, while 18 cases (23%) were IPH of PH1 or less, SAH or SDH.
Conclusions:
Detailed analysis of the GWTG-Stroke registry on EVT for acute ischemic stroke reveal major discrepancies in numerous variables. In addition, the majority of variables recommended by NINDS and FDA for routine collection in thrombectomy procedures are not captured in GWTG-Stroke. Even the minority of recommended thrombectomy CDEs currently captured in GWTG-Stroke further contain subject level discrepancies in imaging and angiography outcomes when centrally adjudicated.
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Affiliation(s)
- Daniel R Kogan
- Vascular Neurology, Univ of California Los Angeles, Los Angeles, CA
| | - Andre Cote
- Vascular Neurology, Univ of California Los Angeles, Los Angeles, CA
| | | | | | | | | | | | | | | | | | - Reza Jahan
- Univ of California Los Angeles, Los Angeles, CA
| | | | | | | | - May Nour
- Univ of California Los Angeles, Los Angeles, CA
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14
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Morales JM, Qadri S, Molaie A, Beaman C, Kimball D, Kaneko N, Tateshima S, Nour M, Szeder V, Jahan R, Liebeskind DS, Duckwiler G, Saver JL. Abstract TMP93: Middle Meningeal Artery Embolization - A Preliminary Analysis Of Efficacy In Acute Settings And Among Patients With Major Co-morbidities. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.tmp93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Introduction:
Middle meningeal artery (MMA) embolization is an therapy utilized in the management of subdural hematomas (SDH). Based on promising preliminary data, several clinical trials are underway to evaluate the efficacy of this endovascular approach in patients with chronic subdural hematomas. However, consensus for the efficacy of MMA embolization has not been well established in acute settings or among patients with major co-morbidities.
Methods:
Patient data were gathered from consecutive cases performed at UCLA between 05/02/2018 and 08/26/2022. Retrospective chart review was performed to determine inpatient/outpatient status, mortality, co-morbidities, and time-to-death. Primary statistical analyses were performed to determine the proportion of patients.
Results:
Among the 111 patients meeting study entry criteria, 44 (39.6%) had acute, inpatient MMA procedures performed and 66 (40.4%) had elective procedures in the setting of advanced or terminal diseases (e.g. malignancy, cirrhosis). After follow-up of median 31.9 months, mean 17.4 months years, 86 (77.5%) of patients were still living and 25 (22.5%) were deceased. The age for both deceased and living patients was the same, 71±13 vs 71±16.1 years old. Mortality during follow-up was more common among patients undergoing MMA as an inpatient (47.8% vs 6.1%). Among the 25 deceased patients, mortality occurred within 1 year in 64% and beyond 1 year in 36%. Co-morbidity frequencies among deceased compared with surviving patients were: 40% vs 22%; solid tumor cancer in 28% vs 14%; cirrhosis in 32% vs 6%; and hematologic malignancy in 4% vs 4%. Among those deceased, 14 of 25 (56%) were diagnosed with a major co-morbidity (hematologic condition, cancer, or liver cirrhosis) at the time of the procedure. Among those living, 19 of 86 (22.1%) were diagnosed with a major co-morbidity (hematologic condition, cancer, or liver cirrhosis) at the time of the procedure.
Conclusion:
Patients with SDH undergoing MMA embolization on an acute inpatient basis have a high, nearly 50%, rate of mortality within the next 0.5-2 years, while patients electively treated despite major co-morbidities have a substantially higher survival rate.
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Affiliation(s)
- Jose M Morales
- Radiology and Neurology, Univ of California - Los Angeles, Los Angeles, CA
| | - Sohaib Qadri
- Neurology, Univ of California - Los Angeles, Los Angeles, CA
| | - Amir Molaie
- Neurology, Univ of California - Los Angeles, Los Angeles, CA
| | - Charles Beaman
- Radiology, Univ of California - Los Angeles, Los Angeles, CA
| | - David Kimball
- Radiology, Univ of California Los Angeles, Los Angeles, CA
| | | | | | - May Nour
- UCLA Depts of Neurology-Radiology, Los Angeles, CA
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15
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Tavakkol E, Kihira S, McArthur M, Ann P, Polson J, Zhang H, Arnold C, Yoo B, Linetsky M, Ledbetter L, Salamon N, Jahan R, Duckwiler G, Saver JL, Liebeskind DS, Nael K. Abstract TP97: Automated Assessment Of DWI-FLAIR Mismatch To Predict Stroke-onset Time. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.tp97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background and Purpose:
DWI-FLAIR mismatch is used to determine thrombolytic eligibility in patients with acute ischemic stroke (AIS) when time-to-stroke symptom (TSS) is unknown. Advances in artificial intelligence and machine learning (ML) techniques have shown promising results in automated assessment of TSS. We aimed to use the e-Stroke software (Brainomix, Oxford, UK) to automatically classify DWI-FLAIR mismatch in a cohort of patients with AIS and in a comparative analysis with an expert neuroradiologist.
Methods:
In this retrospective study, consecutive patients with AIS who had pretreatment MRI, and known TSS were included. DWI-FLAIR mismatch was evaluated by an expert neuroradiologist blinded to TSS. e-Stroke software, which uses a combination of statistical methods and ML classification techniques was used to automatically classify DWI-FLAIR status. TSS was dichotomized using a 4.5 hr cutoff to assess the diagnostic performance of the radiologist vs. e-Stroke software.
Results:
Thus far 113 patients are included, 53 female, age (mean ± SD): 68.9 ± 17. TSS was 371±249 min (mean ± SD) and the infarct volume was 16.4±26.5 ml (mean ± SD). A total of 60 patients had TSS > 4.5 hrs while 53 had TSS < 4.5 hrs. Diagnostic performance (sensitivity/specificity/accuracy in %) for determination of TSS using DWI-FLAIR mismatch was 75/58.5/66.7 for the radiologist and 43/85/64 for e-Stroke software; without statistical difference (AUC: 0.66 for radiologist, 0.64 for e-Stroke; Delong test, p= 0.59). Subgroup analysis of infarctions of at least 1mL or higher, improved the diagnostic performance for both radiologist (83.8/59.4/71.6) and e-Stroke software (66.7/75.0/71.0), without statistical difference (AUC: 0.71 for radiologist and 0.71 for e-Stroke; Delong test, p= 0.96).
Conclusions:
Results show that fully automated quantitative approach for DWI-FLAIR mismatch provides similar diagnostic accuracies to expert neuroradiologist in determination of TSS.
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Affiliation(s)
| | | | | | | | | | | | | | - Bryan Yoo
- DAVID GEFFEN SCHOOL OF MEDICINE AT, Los Angeles, CA
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16
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Fukuda KA, Ghochani Y, Enzmann D, Arnold C, Liu X, Morales J, Kimball D, Beaman CB, Duckwiler G, Jahan R, Szeder V, Kaneko N, Nour M. Abstract WP20: Patterns Of Alert And Management Of Cerebral Aneurysms Using An Incidental Aneurysm Alert System. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.wp20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Introduction:
Incidentally discovered cerebral aneurysms are increasingly common as patients are more frequently imaged. To aid in this management, we developed an aneurysm alert system. Here we describe the effectiveness and outcomes of our Incidental Aneurysm Alert System (IAAS).
Methods:
IAAS received MRA and CTA reports from our Radiology department. Reports were parsed using natural language processing to identify ‘aneurysm’, automatically generating alerts for the interventional neuroradiologists. Background demographics, referral patterns, risk factors and management were then assessed.
Results:
From March to December 2020, 145 consecutive reports were reviewed. A 87% cerebral aneurysm detection accuracy rate resulted after excluding duplicates and non-vascular lesions, resulting in 117 unique cases. Median age was 65 and 65% were female. Most frequent races were 53% non-Hispanic White, 19% other, 9% Asian, 6% Black; 26% were of Hispanic ethnicity. The most common indication was acute stroke (29%). Of the detected aneurysms, 49% resulted in consultation with an interventionalist. Neurology was the most common referring specialty (37%). Of those referred, 49% underwent diagnostic and/or therapeutic angiography. Sixty eight percent who underwent cerebral angiography were intervened upon immediately or within 2 years of discovery. Seven percent were ruptured on discovery. Aneurysms were most frequently treated with flow diversion (37%), coiling (37%), and clipping (16%).Mean PHASES score of referred patients was 4.3, conferring 0.9-1.3% 5-year rupture risk. Asians and Hispanics had higher PHASES scores on presentation of 6.1 (1.7% 5-year rupture risk) and 5.2 (1.3% 5-year rupture risk) respectively, compared to Non-Hispanic Caucasians of 3.8 (0.9% 5-year rupture risk). For Hispanics, mean age was 55 and mean aneurysm size 9.8 mm as compared to 66 and 5.6 mm in non-Hispanic Caucasians. There were no significant differences in aneurysm risk factors.
Conclusions:
IAAS is an effective alerting system. Hispanics were younger with larger aneurysms on detection. IAAS may have potential value in connecting general physicians with cerebrovascular specialists, improving the management of incidentally discovered cerebral aneurysms.
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Affiliation(s)
- Keiko A Fukuda
- Neurology and Radiology, Univ of California, Los Angeles, Los Angeles, CA
| | | | - Dieter Enzmann
- Radiology, Univ of California, Los Angeles, Los Angeles, CA
| | - Corey Arnold
- Radiology, Univ of California, Los Angeles, Los Angeles, CA
| | - Xiang Liu
- Electrical and Computer Engineering, Univ of California, Los Angeles, Los Angeles, CA
| | - Jose Morales
- Radiology, Univ of California, Los Angeles, Los Angeles, CA
| | - David Kimball
- Radiology, Univ of California, Los Angeles, Los Angeles, CA
| | | | - Gary Duckwiler
- Radiology, Univ of California, Los Angeles, Los Angeles, CA
| | - Reza Jahan
- Radiology, Univ of California, Los Angeles, Los Angeles, CA
| | - Viktor Szeder
- Radiology, Univ of California, Los Angeles, Los Angeles, CA
| | - Naoki Kaneko
- Radiology, Univ of California, Los Angeles, Los Angeles, CA
| | - May Nour
- Neurology, Radiology, Univ of California, Los Angeles, Los Angeles, CA
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17
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Farooq S, Liebeskind DS, Jahan R, Yoo B, Rao NM, Nour M, Colby G, Sharma LK, Starkman S, Saver JL. Abstract TMP90: The Harm Sign As A Trial Biomarker Of Reperfusion Injury: Frequency, Determinants, And Outcomes In EVT Patients With Successful Reperfusion. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.tmp90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Introduction:
With successful reperfusion (SR, mTICI 2b-3) now being achieved in the great preponderance of patients undergoing endovascular thrombectomy (EVT), prevention of blood-brain barrier disruption and reperfusion injury is an emerging therapeutic target. For trials of agents to reduce BBB injury, the hyperintense acute reperfusion marker (HARM) sign is a potentially useful physiologic biomarker. However, past studies of HARM have generally failed to disaggregate non-EVT patients, EVT patients without SR, and EVT patients with SR.
Methods:
In a prospectively maintained database, we analyzed consecutive patients with SR (mTICI 2b-3) after EVT for anterior circulation large vessel occlusion undergoing post-gadolinium MRI scans at 3-6h and 24h after thrombectomy.
Results:
Among 48 SR patients meeting study entry criteria, the HARM sign was present in 65%. Patients with HARM sign, compared to those without, did not differ in age or NIHSS, but were more often female (54% vs 10%), more often had history of hypertension (65% vs 47%), and had higher initial SBP (156 vs 144). Patients with HARM sign more often received IV TPA (39% vs 29%), had longer time from onset to achievement of SR (median 352 vs 264 mins), underwent more passes (2.5 vs 1.9), and less often had complete (mTICI 3) reperfusion (13% vs 41%). With regard to outcomes, HARM patients more often had radiologic hemorrhage (75% vs 24%), less often were ambulatory at discharge (23% vs 59%), had less functional independence (mRS 0-2) at 90d (33% vs 59%), and had higher in-hospital mortality (16% vs 0%).
Conclusion:
The HARM sign is present in two-thirds of EVT patients with successful reperfusion; is associated with higher blood pressure, IV lytic therapy, longer time to reperfusion, more procedure manipulations, and less than complete macro-reperfusion; and is strongly associated with hemorrhagic transformation and worse clinical outcomes. The HARM sign is a promising biomarker for use in trials of treatments to avert reperfusion injury.
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Affiliation(s)
- Salman Farooq
- Neurology, Univ of Texas Health Science Cntr at Houston, Houston, TX
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18
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Khatibi K, Saber H, Patel S, Mejia LLP, Kaneko N, Szeder V, Nour M, Jahan R, Tateshima S, Colby G, Duckwiler G, Afshar Y. Aneurysmal subarachnoid hemorrhage in pregnancy: National trends of treatment, predictors, and outcomes. PLoS One 2023; 18:e0285082. [PMID: 37141265 PMCID: PMC10159186 DOI: 10.1371/journal.pone.0285082] [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: 12/02/2022] [Accepted: 04/16/2023] [Indexed: 05/05/2023] Open
Abstract
INTRODUCTION Aneurysmal subarachnoid hemorrhage (aSAH) is a rare event associated with significant pregnancy-associated maternal and neonatal morbidity and mortality. The optimal treatment strategy and clinical outcome of aSAH in pregnancy remains unclear. We aimed to investigate the treatment utilizations and outcomes of aSAH in pregnant people. METHODS Using the 2010-2018 National Inpatient Sample, we identified all birth hospitalizations of women between ages of 18 to 45 associated with subarachnoid hemorrhage and aneurysm treatment were included. Multivariate analyses were used to evaluate the effect of pregnancy state, mode of treatment of aneurysms, severity of subarachnoid hemorrhage on mortality and discharge destination of this cohort. Trends in mode of treatment utilized for aneurysmal treatment in this time interval was evaluated. RESULTS 13,351 aSAH with treatment were identified, of which 440 were associated with pregnancy. There was no significant difference in mortality or rate of discharge to home in pregnancy related hospitalization. Worse aSAH severity, chronic hypertension, and smaller hospital size was associated with significantly higher rate of mortality from aSAH during pregnancy. Worse aSAH severity was associated with lower rate of discharge to home. Like the non-pregnant cohort, the treatment of ruptured aneurysms in pregnancy are increasingly through endovascular approaches. The mode of treatment does not change the mortality or discharge destination. CONCLUSIONS Pregnancy does not alter mortality or the discharge destination for aSAH. Ruptured aneurysms during pregnancy are increasingly treated endovascularly. Mode of aneurysm treatment does not affect mortality or discharge destination in pregnancy.
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Affiliation(s)
- Kasra Khatibi
- Department of Neurosurgery, University of Southern California, Los Angeles, CA, United States of America
| | - Hamidreza Saber
- Department of Neurology, University of Texas at Austin, Austin, TX, United States of America
| | - Smit Patel
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, United States of America
| | | | - Naoki Kaneko
- Department of Radiology, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Viktor Szeder
- Department of Radiology, University of California Los Angeles, Los Angeles, CA, United States of America
| | - May Nour
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, United States of America
- Department of Radiology, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Reza Jahan
- Department of Radiology, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Satoshi Tateshima
- Department of Radiology, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Geoffrey Colby
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Gary Duckwiler
- Department of Radiology, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Yalda Afshar
- Department of Obstetrics and Gynecology, University of California Los Angeles, Los Angeles, CA, United States of America
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19
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Chen IE, Tsui B, Zhang H, Qiao JX, Hsu W, Nour M, Salamon N, Ledbetter L, Polson J, Arnold C, BahrHossieni M, Jahan R, Duckwiler G, Saver J, Liebeskind D, Nael K. Automated estimation of ischemic core volume on noncontrast-enhanced CT via machine learning. Interv Neuroradiol 2022:15910199221145487. [PMID: 36572984 DOI: 10.1177/15910199221145487] [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: 12/28/2022] Open
Abstract
BACKGROUND Accurate estimation of ischemic core on baseline imaging has treatment implications in patients with acute ischemic stroke (AIS). Machine learning (ML) algorithms have shown promising results in estimating ischemic core using routine noncontrast computed tomography (NCCT). OBJECTIVE We used an ML-trained algorithm to quantify ischemic core volume on NCCT in a comparative analysis to pretreatment magnetic resonance imaging (MRI) diffusion-weighted imaging (DWI) in patients with AIS. METHODS Patients with AIS who had both pretreatment NCCT and MRI were enrolled. An automatic segmentation ML approach was applied using Brainomix software (Oxford, UK) to segment the ischemic voxels and calculate ischemic core volume on NCCT. Ischemic core volume was also calculated on baseline MRI DWI. Comparative analysis was performed using Bland-Altman plots and Pearson correlation. RESULTS A total of 72 patients were included. The time-to-stroke onset time was 134.2/89.5 minutes (mean/median). The time difference between NCCT and MRI was 64.8/44.5 minutes (mean/median). In patients who presented within 1 hour from stroke onset, the ischemic core volumes were significantly (p = 0.005) underestimated by ML-NCCT. In patients presented beyond 1 hour, the ML-NCCT estimated ischemic core volumes approximated those obtained by MRI-DWI and with significant correlation (r = 0.56, p < 0.001). CONCLUSION The ischemic core volumes calculated by the described ML approach on NCCT approximate those obtained by MRI in patients with AIS who present beyond 1 hour from stroke onset.
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Affiliation(s)
- Iris E Chen
- Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Brian Tsui
- Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Haoyue Zhang
- Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Joe X Qiao
- Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - William Hsu
- Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - May Nour
- Department of Neurology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Noriko Salamon
- Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Luke Ledbetter
- Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Jennifer Polson
- Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Corey Arnold
- Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Mersedeh BahrHossieni
- Department of Neurology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Reza Jahan
- Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Gary Duckwiler
- Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Jeffrey Saver
- Department of Neurology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - David Liebeskind
- Department of Neurology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Kambiz Nael
- Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
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20
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Tsui B, Nour M, Chen I, Qiao JX, Salehi B, Yoo B, Colby GP, Salamon N, Villablanca P, Jahan R, Duckwiler G, Saver JL, Liebeskind DS, Nael K. MR Angiography in Assessment of Collaterals in Patients with Acute Ischemic Stroke: A Comparative Analysis with Digital Subtraction Angiography. Brain Sci 2022; 12:brainsci12091181. [PMID: 36138917 PMCID: PMC9497115 DOI: 10.3390/brainsci12091181] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/20/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
Collateral status has prognostic and treatment implications in acute ischemic stroke (AIS) patients. Unlike CTA, grading collaterals on MRA is not well studied. We aimed to evaluate the accuracy of assessing collaterals on pretreatment MRA in AIS patients against DSA. AIS patients with anterior circulation proximal arterial occlusion with baseline MRA and subsequent endovascular treatment were included. MRA collaterals were evaluated by two neuroradiologists independently using the Tan and Maas scoring systems. DSA collaterals were evaluated by using the American Society of Interventional and Therapeutic Neuroradiology grading system and were used as the reference for comparative analysis against MRA. A total of 104 patients met the inclusion criteria (59 female, age (mean ± SD): 70.8 ± 18.1). The inter-rater agreement (k) for collateral scoring was 0.49, 95% CI 0.37–0.61 for the Tan score and 0.44, 95% CI 0.26–0.62 for the Maas score. Total number (%) of sufficient vs. insufficient collaterals based on DSA was 49 (47%) and 55 (53%) respectively. Using the Tan score, 45% of patients with sufficient collaterals and 64% with insufficient collaterals were correctly identified in comparison to DSA, resulting in a poor agreement (0.09, 95% CI 0.1–0.28). Using the Maas score, only 4% of patients with sufficient collaterals and 93% with insufficient collaterals were correctly identified against DSA, resulting in poor agreement (0.03, 95% CI 0.06–0.13). Pretreatment MRA in AIS patients has limited concordance with DSA when grading collaterals using the Tan and Maas scoring systems.
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Affiliation(s)
- Brian Tsui
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
- Correspondence:
| | - May Nour
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Iris Chen
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Joe X. Qiao
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Banafsheh Salehi
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Bryan Yoo
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Geoffrey P. Colby
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Noriko Salamon
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Pablo Villablanca
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Reza Jahan
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Gary Duckwiler
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Jeffrey L. Saver
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - David S. Liebeskind
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Kambiz Nael
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
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21
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Samarage HM, Kim WJ, Zarrin D, Goel K, Chin-Hsiu Wang A, Johnson J, Kaneko N, Nour M, Szeder V, Tateshima S, Jahan R, Duckwiler G, Colby GP. The "Bright Falx" Sign-Midline Embolic Penetration Is Associated With Faster Resolution of Chronic Subdural Hematoma After Middle Meningeal Artery Embolization: A Case Series. Neurosurgery 2022; 91:389-398. [PMID: 35551167 DOI: 10.1227/neu.0000000000002038] [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: 09/22/2021] [Accepted: 04/03/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chronic subdural hematomas (CSDHs) are common in the elderly population and patients taking antiplatelet/anticoagulation medications. Middle meningeal artery (MMA) embolization has become an adjunctive treatment to observation and surgery. Despite many embolization techniques, best practices for optimal CSDH resolution remain unknown. OBJECTIVE To report a retrospective case series of MMA embolization for CSDHs regarding rate of hematoma improvement and the significance of distal embolic penetration into the falx. METHODS Retrospective chart review was performed on all patients who underwent MMA embolization for CSDHs between January 2017 and June 2021. Patient demographics, clinical presentation, anticoagulant use, and radiographic features were collected. Pre-embolization and postembolization computed tomography scans were analyzed for volumetric changes and assessed for midline penetration of embolic material in the falx. RESULTS MMA embolization was performed in 37 patients and 53 hemispheres. Older patients took longer to obtain complete resolution of CSDHs (r = 0.47, P = .03). Patients with larger pre-embolization (r = 0.57, P = .007) and postembolization (r = 0.56, P = .008) CSDH volumes took longer to completely resolve. Patients who had n-butyl cyanoacrylate embolization with midline penetration, as evidenced by the "bright falx" sign, had faster improvement rates than those who did not (5.64 cm3/d vs 1.2 cm3/d, P = .02). CONCLUSION Distal penetration of embolic material, particularly n-butyl cyanoacrylate, into the falx may lead to more rapid improvement of CSDH.
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Affiliation(s)
- Hasitha Milan Samarage
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA
| | - Wi Jin Kim
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA
| | - David Zarrin
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Keshav Goel
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Anthony Chin-Hsiu Wang
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA
| | - Jeremiah Johnson
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA
| | - Naoki Kaneko
- Department of Interventional Neuroradiology, University of California Los Angeles, Los Angeles, California, USA
| | - May Nour
- Department of Interventional Neuroradiology, University of California Los Angeles, Los Angeles, California, USA
| | - Viktor Szeder
- Department of Interventional Neuroradiology, University of California Los Angeles, Los Angeles, California, USA
| | - Satoshi Tateshima
- Department of Interventional Neuroradiology, University of California Los Angeles, Los Angeles, California, USA
| | - Reza Jahan
- Department of Interventional Neuroradiology, University of California Los Angeles, Los Angeles, California, USA
| | - Gary Duckwiler
- Department of Interventional Neuroradiology, University of California Los Angeles, Los Angeles, California, USA
| | - Geoffrey Philip Colby
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA.,Department of Interventional Neuroradiology, University of California Los Angeles, Los Angeles, California, USA
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22
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Raychev R, Sirakov S, Sirakov A, Saber H, Vinuela F, Jahan R, Nour M, Szeder V, Colby G, Duckwiler G, Tateshima S. Critical Angiographic and Sonographic Analysis of Intra Aneurysmal and Downstream Hemodynamic Changes After Flow Diversion. Front Neurol 2022; 13:813101. [PMID: 35356453 PMCID: PMC8960056 DOI: 10.3389/fneur.2022.813101] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/06/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionSuccessful treatment of intracranial aneurysms after flow diversion (FD) is dependent on the flow modulating effect of the device. We aimed to investigate the intra-aneurysmal and parent vessel hemodynamic changes, as well as the incidence of silent emboli following treatment with various FD devices.MethodsWe evaluated the appearance of the eclipse sign in nine distinct phases of cerebral angiography before and immediately after FD placement in correlation with aneurysm occlusion. Angiographic and clinical data of consecutive procedures were analyzed retrospectively. Patients who had successful FD procedure without adjunctive coiling, visible eclipse sign on post embolization angiography, and reliable follow-up angiographic data were included in the analysis. Detailed analysis of hemodynamic data from transcranial doppler after FD was performed in selected patients, such as monitoring for silent emboli.ResultsAmong all patients (N = 65) who met inclusion criteria, complete aneurysm occlusion at 12 months was achieved in 89% (58/65). Eclipse sign prior to FD was observed in 42% (27/65) with unchanged appearance in 4.6% (3/65) of the treated patients. None of these three patients achieved complete aneurysm occlusion. Among all analyzed variables, such as aneurysm size, device type used, age, and appearance of the eclipse sign pre- and post-FD, the most reliable predictor of permanent aneurysm occlusion at 12 months was earlier, prolonged, and sustained eclipse sign visibility in more than three angiographic phases in comparison to the baseline (p < 0.001). Elevation in flow velocities within the ipsilateral vascular territory was noted in 70% (9/13), and bilaterally in 54% (7/13) of the treated patients. None of the patients had silent emboli.ConclusionsIntra-aneurysmal and parent vessel hemodynamic changes after FD can be reliably assessed by the cerebral angiography and transcranial doppler with important implications for the prediction of successful treatment.
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Affiliation(s)
- Radoslav Raychev
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States
- *Correspondence: Radoslav Raychev
| | - Stanimir Sirakov
- Department of Radiology, University Hospital St. Ivan Rilski, Sofia, Bulgaria
| | - Alexander Sirakov
- Department of Radiology, University Hospital St. Ivan Rilski, Sofia, Bulgaria
| | - Hamidreza Saber
- Department of Radiology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Fernando Vinuela
- Department of Radiology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Reza Jahan
- Department of Radiology, University of California, Los Angeles, Los Angeles, CA, United States
| | - May Nour
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Viktor Szeder
- Department of Radiology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Geoffrey Colby
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Gary Duckwiler
- Department of Radiology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Satoshi Tateshima
- Department of Radiology, University of California, Los Angeles, Los Angeles, CA, United States
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23
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Phan A, Yoo B, Liebeskind DS, Sharma LK, Bahr Hosseini M, Jahan R, Duckwiler G, Tateshima S, Nour M, Szeder V, Colby G, Saver JL. Abstract TP108: Intracranial Artery Calcification: Frequency, Determinants, And Modification Of Outcomes From Endovascular Thrombectomy. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.tp108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Intracranial artery calcification (ICAC) is a common finding on CTA in patients presenting with LVO acute ischemic stroke and could potentially serve as a useful biomarker of intracranial atherosclerosis and altered intracranial vessel pliability in patients undergoing endovascular thrombectomy (EVT). However, ICAC frequency, determinants, and outcome associations have not been well delineated.
Methods:
In a prospectively maintained database, we analyzed consecutive patients undergoing CTA immediately prior to EVT from Mar 2016 - Aug 2020. Extent of ICAC in the intracranial ICA or VA proximal to the target vessel was scored using a validated grading scale (Babiarz et al, AJNR 2003: 5 levels for greatest calcific thickness and 5 levels for greatest circumferential extent). Example cases in Figure 1. Patients were stratified into low (0-2), medium (3-4), and high (5-6) ICAC groups.
Results:
Among 91 patients, mean age was 73, 54% female, and mean NIHSS 17. Median ICAC score was 3 [IQR 0-4]. Baseline characteristics associated with higher ICAC scores were: CAD (3.8 vs. 2.4,
p
= 0.02), HTN (3.1 vs. 2.1,
p
= 0.07), and age (
r
= 0.50, p < 0.001). There was a U-shaped association between ICAC score and successful reperfusion (mTICI 2b-3): 90.9%, 65.7%, and 95.0% in low, medium, and high ICAC score groups, respectively (
p
= 0.006). Need for rescue intervention (angioplasty/stenting, IA thrombolysis, or GpIIb/IIIa inhibitor) was higher in the high ICAC group: 5.9% vs. 5.6% vs. 28.6% (
p
= 0.01). Functional independence (mRS 0-2) at discharge (29.4% vs. 22.2% vs. 19.0%,
p
= 0.64) or 90 days (40.0% vs. 30.0% vs. 21.4%,
p
= 0.22) did not differ, nor did symptomatic intracranial hemorrhage (
p
= 0.96).
Conclusions:
Calcification of intracranial vessels is frequently seen on CTA in LVO patients and is associated with age and vascular risk factors. Degree of calcification has important associations with rates of successful reperfusion and need for rescue intervention during EVT.
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Affiliation(s)
| | | | | | | | | | | | | | | | - May Nour
- UCLA Depts of Neurology-Radiology, Los Angeles, CA
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24
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Adams HP, Adeoye O, Albers GW, Alexandrov AV, Amin-Hanjani S, An H, Anderson CS, Anrather J, Aparicio HJ, Arai K, Aronowski J, Atchaneeyasakul K, Audebert H, Auer RN, Awad IA, Ay H, Baltan S, Balu R, Behbahani M, Benavente OR, Bershad EM, Berthaud JV, Blackburn SL, Bonati LH, Bösel J, Bousser MG, Broderick JP, Brown MM, Brown W, Brust JC, Bushnell C, Canhão P, Caplan LR, Carrión-Penagos J, Castellanos M, Caunca MR, Chabriat H, Chamorro A, Chen J, Chen J, Chopp M, Christorforids G, Connolly ES, Cramer SC, Cucchiara BL, Czap AL, Dannenbaum MJ, Davis PH, Dawson TM, Dawson VL, Day AL, De Silva TM, de Sousa DA, Del Brutto VJ, del Zoppo GJ, Derdeyn CP, Di Tullio MR, Diener HC, Diringer MN, Dobkin BH, Dzialowski I, Elkind MS, Elm J, Feigin VL, Ferro JM, Field TS, Fischer M, Fornage M, Furie KL, Garcia-Bonilla L, Giannotta SL, Gobin YP, Goldberg MP, Goldstein LB, Gonzales NR, Greer DM, Grotta JC, Guo R, Gutierrez J, Harmel P, Howard G, Howard VJ, Hwang JY, Iadecola C, Jahan R, Jickling GC, Joutel A, Kasner SE, Katan M, Kellner CP, Khan M, Kidwell CS, Kim H, Kim JS, Kircher CE, Krings T, Krishnamurthi RV, Kurth T, Lansberg MG, Levy EI, Liebeskind DS, Liew SL, Lin DJ, Lisle B, Lo EH, Lyden PD, Maki T, Maragkos GA, Marosfoi M, McCullough LD, Meckler JM, Meschia JF, Messé SR, Mocco J, Mokin M, Mooney MA, Morgenstern LB, Moskowitz MA, Mullen MT, Nägel S, Nedergaard M, Neira JA, Newman S, Nicholson PJ, Norrving B, O’Donnell M, Ofengeim D, Ogata J, Ogilvy CS, Orrù E, Ortega-Gutiérrez S, Padrick MM, Parsha K, Parsons M, Patel NV, Patel VI, Pawlikowska L, Pérez A, Perez-Pinzon MA, Picard JM, Polster SP, Powers WJ, Puetz V, Putaala J, Rabinovich M, Ransom BR, Roa JA, Rosenberg GA, Rossitto CP, Rundek T, Russin JJ, Sacco RL, Safouris A, Samaniego EA, Sansing LH, Satani N, Sattenberg RJ, Saver JL, Savitz SI, Schmidt C, Seshadri S, Sharma VK, Sharp FR, Sheth KN, Siddiqi OK, Singhal AB, Sobey CG, Sommer CJ, Spetzler RF, Stapleton CJ, Strickland BA, Su H, Suarez JI, Takayama H, Tarsia J, Tatlisumak T, Thomas AJ, Thompson JW, Tsivgoulis G, Tournier-Lasserve E, Vidal G, Wakhloo AK, Weksler BB, Willey JZ, Wintermark M, Wong LK, Xi G, Xu J, Yaghi S, Yamaguchi T, Yang T, Yasaka M, Zahuranec DB, Zhang F, Zhang JH, Zheng Z, Zukin RS, Zweifler RM. Contributors. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.01002-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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25
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Jahan R, Saver JL. Endovascular Treatment of Acute Ischemic Stroke. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00067-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Jannat K, Hasan A, Bondhon TA, Mahboob T, Paul AK, Jahan R, Nissapatorn V, Pereira ML, Wiart C, Rahmatullah M. Can Costus afer be used for co-treatment of COVID-19, its symptoms and comorbidities? A novel approach for combating the pandemic and implications for sub-Saharan Africa. Trop Biomed 2021; 38:540-551. [PMID: 35001920 DOI: 10.47665/tb.38.4.097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Despite the huge loss of lives and massive disruption of the world economy by the COVID -19 pandemic caused by SARS -CoV-2, scientists are yet to come out with an effective therapeutic against this viral disease . Several vaccines have obtained 'emergency approval ', but difficulties are being faced in the even distribution of vaccines amongst high- and low- income countries . On top of it, comorbidities associated with COVID -19 like diabetes, hypertension and malaria can seriously impede the treatment of the main disease, thus increasing the fatality rate . This is more so in the context of sub -Saharan African and south Asian countries . Our objective was to demonstrate that a single plant containing different phytoconstituents may be used for treatment of COVID -19 and comorbidities . Towards initial selection of a plant, existing scientific literature was scanned for reported relevant traditional uses, phytochemicals and pharmacological activities of a number of plants and their phytoconstituents pertaining to treatment of COVID-19 symptoms and comorbidities. Molecular docking studies were then performed with phytochemicals of the selected plant and SARS-CoV-2 components - Mpro, and spike protein receptor binding domain and hACE2 interface using AutoDock V ina. We showed that crude extracts of an indigenous African plant, Costus afer having traditional antidiabetic and antimalarial uses, has phytochemicals with high binding affinities for Mpro, and /or spike protein receptor binding domain and hACE2 interface; the various phytochemicals with predicted high binding energies include aferoside C, dibutyl phthalate, nerolidol, suginal, and ± -terpinene, making them potential therapeutics for COVID -19. The results suggest that crude extracts and phytochemicals of C. afer can function as a treatment modality for COVID -19 and comorbidities like especially diabetes and malaria .
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Affiliation(s)
- K Jannat
- Department of Biotechnology & Genetic Engineering, University of Development Alternative, Lalmatia, Dhaka, Bangladesh
| | - A Hasan
- Department of Biotechnology & Genetic Engineering, University of Development Alternative, Lalmatia, Dhaka, Bangladesh
| | - T A Bondhon
- Department of Biotechnology & Genetic Engineering, University of Development Alternative, Lalmatia, Dhaka, Bangladesh
| | - T Mahboob
- School of Allied Health Sciences, World Union for Herbal Drug Discovery (WUHeDD) and Research Excellence Center for Innovation and Health Products (RECIHP), Walailak University, Nakhon Si Thammarat, Thailand
| | - A K Paul
- Department of Biotechnology & Genetic Engineering, University of Development Alternative, Lalmatia, Dhaka, Bangladesh
| | - R Jahan
- Department of Biotechnology & Genetic Engineering, University of Development Alternative, Lalmatia, Dhaka, Bangladesh
| | - V Nissapatorn
- School of Allied Health Sciences, World Union for Herbal Drug Discovery (WUHeDD) and Research Excellence Center for Innovation and Health Products (RECIHP), Walailak University, Nakhon Si Thammarat, Thailand
| | - M L Pereira
- CICECO-Aveiro Institute of Materials & Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - C Wiart
- School of Pharmacy, University of Nottingham Malaysia Campus, Selangor, Malaysia
| | - M Rahmatullah
- Department of Biotechnology & Genetic Engineering, University of Development Alternative, Lalmatia, Dhaka, Bangladesh
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27
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Mahboob M, Chavan SN, Nazir N, Mustaqim M, Jahan R, Tahseen Q. Description of a new and two known species of the insect–associated genus Oigolaimella Paramonov, 1952 (Nematoda: Diplogastridae) with a note on the biology, biogeography and relationship with congeners. ZOOL ANZ 2021. [DOI: 10.1016/j.jcz.2021.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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28
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Hagiwara A, Bydder M, Oughourlian TC, Yao J, Salamon N, Jahan R, Villablanca JP, Enzmann DR, Ellingson BM. Sodium MR Neuroimaging. AJNR Am J Neuroradiol 2021; 42:1920-1926. [PMID: 34446457 PMCID: PMC8583254 DOI: 10.3174/ajnr.a7261] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/28/2021] [Indexed: 12/26/2022]
Abstract
Sodium MR imaging has the potential to complement routine proton MR imaging examinations with the goal of improving diagnosis, disease characterization, and clinical monitoring in neurologic diseases. In the past, the utility and exploration of sodium MR imaging as a valuable clinical tool have been limited due to the extremely low MR signal, but with recent improvements in imaging techniques and hardware, sodium MR imaging is on the verge of becoming clinically realistic for conditions that include brain tumors, ischemic stroke, and epilepsy. In this review, we briefly describe the fundamental physics of sodium MR imaging tailored to the neuroradiologist, focusing on the basics necessary to understand factors that play into making sodium MR imaging feasible for clinical settings and describing current controversies in the field. We will also discuss the current state of the field and the potential future clinical uses of sodium MR imaging in the diagnosis, phenotyping, and therapeutic monitoring in neurologic diseases.
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Affiliation(s)
- A Hagiwara
- From the UCLA Brain Tumor Imaging Laboratory (A.H., M.B., T.C.O., J.Y., B.M.E.), Center for Computer Vision and Imaging Biomarkers
- Department of Radiological Sciences (A.H., M.B., J.Y., N.S., R.J., J.P.V., D.R.E., B.M.E.)
| | - M Bydder
- From the UCLA Brain Tumor Imaging Laboratory (A.H., M.B., T.C.O., J.Y., B.M.E.), Center for Computer Vision and Imaging Biomarkers
- Department of Radiological Sciences (A.H., M.B., J.Y., N.S., R.J., J.P.V., D.R.E., B.M.E.)
| | - T C Oughourlian
- From the UCLA Brain Tumor Imaging Laboratory (A.H., M.B., T.C.O., J.Y., B.M.E.), Center for Computer Vision and Imaging Biomarkers
- Neuroscience Interdepartmental Program (T.C.O., B.M.E.)
| | - J Yao
- From the UCLA Brain Tumor Imaging Laboratory (A.H., M.B., T.C.O., J.Y., B.M.E.), Center for Computer Vision and Imaging Biomarkers
- Department of Bioengineering (J.Y., B.M.E.), Henry Samueli School of Engineering and Applied Science, University of California Los Angeles, Los Angeles, California
- Department of Radiological Sciences (A.H., M.B., J.Y., N.S., R.J., J.P.V., D.R.E., B.M.E.)
| | - N Salamon
- Department of Radiological Sciences (A.H., M.B., J.Y., N.S., R.J., J.P.V., D.R.E., B.M.E.)
| | - R Jahan
- Department of Radiological Sciences (A.H., M.B., J.Y., N.S., R.J., J.P.V., D.R.E., B.M.E.)
| | - J P Villablanca
- Department of Radiological Sciences (A.H., M.B., J.Y., N.S., R.J., J.P.V., D.R.E., B.M.E.)
| | - D R Enzmann
- Department of Radiological Sciences (A.H., M.B., J.Y., N.S., R.J., J.P.V., D.R.E., B.M.E.)
| | - B M Ellingson
- From the UCLA Brain Tumor Imaging Laboratory (A.H., M.B., T.C.O., J.Y., B.M.E.), Center for Computer Vision and Imaging Biomarkers
- Department of Bioengineering (J.Y., B.M.E.), Henry Samueli School of Engineering and Applied Science, University of California Los Angeles, Los Angeles, California
- Department of Radiological Sciences (A.H., M.B., J.Y., N.S., R.J., J.P.V., D.R.E., B.M.E.)
- Neuroscience Interdepartmental Program (T.C.O., B.M.E.)
- Department of Psychiatry and Biobehavioral Sciences (B.M.E.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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29
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Akhter S, Jahan K, Afrose R, Jahan R, Fatema S, Dey S. Risk Association, Clinical Presentation and Management of Uterine Leiomyoma. Mymensingh Med J 2021; 30:907-912. [PMID: 34605455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Uterine leiomyoma is a common gynecological problem throughout the world. As 50% hysterectomies in black and 40% in Australians are performed due to fibroid, in our country also it is assumed that about 40%-50% hysterectomies are done due to fibroid uterus. Thus leiomyoma constitute a major public health cost to the community in terms of outpatient attendance and hospital cost for surgery. This is a descriptive type of cross sectional study among 50 patients having leiomyoma of uterus in the department of Obs and Gynae, BSMMU hospital from March 2011 to August 2011. The objective of the study is to find out the risk associated with leiomyoma, to find out the common presenting features of uterine leiomyoma and to find out best options for management. Study results showed that 62% patients were in the age group 36-45 years, 48%patients were in para1-2 group, 32% patients used combined oral contraceptive pill for contraception. Sixty percent (60%) patients presented with progressive menorrhagia and palpable mass was found in 62% cases. About 46% patients had associated medical conditions like hypertension, diabetes, obesity. Total abdominal hysterectomy was done in 32% cases. TAH with unilateral or bilateral salpingoophorectomy was done in 40% cases. Myomectomy was done in 20% cases. There is a scope for large scale study about risk factors of uterine leiomyoma like obesity, diabetes mellitus, hypertension, use of hormonal contraceptive, racial differences, different treatment modalities etc. Treatment should be individualized. However in this connection a good referral system and good communication has got a tremendous contribution in the proper management of such problems.
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Affiliation(s)
- S Akhter
- Dr Sharmin Akhter, Junior Consultant (Gynae), Model Family Planning Clinic, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh; E-mail:
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30
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Jahan R, Liebeskind DS, Zaidat OO, Mueller-Kronast NH, Froehler MT, Saver JL. Stent Retriever Thrombectomy for Anterior vs. Posterior Circulation Ischemic Stroke: Analysis of the STRATIS Registry. Front Neurol 2021; 12:706130. [PMID: 34504469 PMCID: PMC8421856 DOI: 10.3389/fneur.2021.706130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose: The benefits of mechanical thrombectomy (MT) in vertebrobasilar artery occlusions have not been well-studied. We compared clinical, procedural, and safety outcomes of MT for posterior circulation (PC) vs. anterior circulation (AC) occlusions among patients in the STRATIS registry. Methods: Data from STRATIS including patient demographics, procedural characteristics, and outcomes including symptomatic intracranial hemorrhage (sICH) at 24 h, serious adverse events (SAE), substantial reperfusion [modified thrombolysis in cerebral infarction (mTICI) 2b/3], 90-day functional independence [modified Rankin Scale (mRS) 0–2], and 90-day mortality were analyzed. Univariate logistic regression was used to calculate predictors of good clinical outcome. Results: Of 984 STRATIS patients, 43 (4.4%) patients with PC occlusions [mean age 63.0 ± 13.6, 25.6% (11/43) female] and 932 (94.7%) with AC occlusions [mean age 68.5 ± 14.8, 46.9% (437/932) female] were included for analysis. Median National Institutes of Health Stroke Scale (NIHSS) scores at baseline were 17.0 (13.0, 12.0) for the AC group and 12.0 (11.0, 24.0) for the PC group. Time from onset to procedure end was longer for the PC group [median (IQR): 322.0 min (255.0–421.0) vs. 271.0 min (207.0–360.0); p = 0.007]. PC and AC groups had similar rates of substantial reperfusion [89.2% (33/37) vs. 87.7% (684/780)], procedure-related SAE [0.0% (0/43) vs. 1.7% (16/932)], sICH [0.0% (0/38) vs. 1.5% (12/795)], 90-day functional independence [66.7% (26/39) vs. 55.9% (480/858)] and mortality [12.8% (5/39) vs. 15.8% (136/861)]. National Institutes of Health Stroke Scale score and patient sex were significant univariate predictors of good clinical outcome (p < 0.05). Conclusions: Despite longer reperfusion times, MT in PC stroke has similar rates of 90-day functional independence with no significant difference in procedure-related SAE, sICH, or mortality, supporting the use of MT in PC acute ischemic stroke (AIS). Clinical Trial Registration:https://www.clinicaltrials.gov, Identifier: NCT02239640.
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Affiliation(s)
- Reza Jahan
- Division of Interventional Neuroradiology, Department of Radiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - David S Liebeskind
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Osama O Zaidat
- Department of Neurology, Mercy Health St. Vincent Hospital, Toledo, OH, United States
| | | | - Michael T Froehler
- Cerebrovascular Program, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Jeffrey L Saver
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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31
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Paul AK, Jahan R, Bondhon TA, Jannat K, Hasan A, Rahmatullah M, Nissapatorn V, Pereira ML, Wiart C. Potential role of flavonoids against SARS-CoV-2 induced diarrhea. Trop Biomed 2021; 38:360-365. [PMID: 34508344 DOI: 10.47665/tb.38.3.079] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
COVID-19, caused by the SARS-CoV-2 virus, can lead to massive inflammation in the gastrointestinal tract causing severe clinical symptoms. SARS-CoV-2 infects lungs after binding its spike proteins with alveolar angiotensin-converting enzyme 2 (ACE2), and it also triggers inflammation in the gastrointestinal tract. SARS-CoV-2 invades the gastrointestinal tract by interacting with Toll-like receptor-4 (TLR4) that induces the expression of ACE2. The influx of ACE2 facilitates cellular binding of more SARS-CoV-2 and causes massive gastrointestinal inflammation leading to diarrhea. Diarrhea prior to COVID-19 infection or COVID-19-induced diarrhea reportedly ends up in a poor prognosis for the patient. Flavonoids are part of traditional remedies for gastrointestinal disorders. Preclinical studies show that flavonoids can prevent infectious diarrhea. Recent studies show flavonoids can inhibit the multiplication of SARS-CoV-2. In combination with vitamin D, flavonoids possibly activate nuclear factor erythroid-derived-2-related factor 2 that downregulates ACE2 expression in cells. We suggest that flavonoids have the potential to prevent SARS-CoV-2 induced diarrhea.
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Affiliation(s)
- A K Paul
- Department of Biotechnology & Genetic Engineering, University of Development Alternative, Lalmatia, Dhaka-1207, Bangladesh.,School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Australia
| | - R Jahan
- Department of Biotechnology & Genetic Engineering, University of Development Alternative, Lalmatia, Dhaka-1207, Bangladesh
| | - T A Bondhon
- Department of Biotechnology & Genetic Engineering, University of Development Alternative, Lalmatia, Dhaka-1207, Bangladesh
| | - K Jannat
- Department of Biotechnology & Genetic Engineering, University of Development Alternative, Lalmatia, Dhaka-1207, Bangladesh
| | - A Hasan
- Department of Biotechnology & Genetic Engineering, University of Development Alternative, Lalmatia, Dhaka-1207, Bangladesh
| | - M Rahmatullah
- Department of Biotechnology & Genetic Engineering, University of Development Alternative, Lalmatia, Dhaka-1207, Bangladesh
| | - V Nissapatorn
- School of Allied Health Sciences, World Union for Herbal Drug Discovery (WUHeDD), and Research Excellence Center for Innovation and Health Products (RECIHP), Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - M L Pereira
- CICECO - Aveiro Institute of Materials and Department of Medical Sciences, University of Aveiro, Aveiro 3810, Portugal
| | - C Wiart
- School of Pharmacy, University of Nottingham Malaysia Campus, Semenyih 43500, Selangor Darul Ehsan, Malaysia
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Bondhon TA, Fatima A, Jannat K, Hasan A, Jahan R, Nissapatorn V, Wiart C, Pereira ML, Rahmatullah M. In silico screening of Allium cepa phytochemicals for their binding abilities to SARS and SARS-CoV-2 3C-like protease and COVID-19 human receptor ACE-2. Trop Biomed 2021; 38:214-221. [PMID: 34172713 DOI: 10.47665/tb.38.2.060] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Corona virus SARS-CoV-2-induced viral disease (COVID-19) is a zoonotic disease that was initially transmitted from animals to humans. The virus surfaced towards the end of December 2019 in Wuhan, China where earlier SARS (Severe Acute Respiratory Syndrome) had also surfaced in 2003. Unlike SARS, SARS-CoV-2 (a close relative of the SARS virus) created a pandemic, and as of February 24 2021, caused 112,778,672 infections and 2,499,252 deaths world-wide. Despite the best efforts of scientists, no drugs against COVID-19 are yet in sight; five vaccines have received emergency approval in various countries, but it would be a difficult task to vaccinate twice the world population of 8 billion. The objective of the present study was to evaluate through in silico screening a number of phytochemicals in Allium cepa (onion) regarding their ability to bind to the main protease of COVID-19 known as the 3C-like protease or 3CLpro, (PDB ID: 6LU7), 3CLpro of SARS (PDB ID: 3M3V), and human angiotensin converting enzyme-2 (ACE-2), [PDB ID: 1R42], which functions as a receptor for entry of the virus into humans. Molecular docking (blind docking, that is docking not only against any target pocket) were done with the help of AutoDockVina. It was observed that of the twenty-two phytochemicals screened, twelve showed good binding affinities to the main protease of SARS-CoV-2. Surprisingly, the compounds also demonstrated good binding affinities to ACE-2. It is therefore very likely that the binding affinities shown by these compounds against both 3CLpro and ACE-2 merit further study for their potential use as therapeutic agents.
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Affiliation(s)
- T A Bondhon
- Department of Biotechnology and Genetic Engineering, University of Development Alternative, Lalmatia, Dhaka-1207, Bangladesh
| | - A Fatima
- Quest International University Perak, Ipoh, Malaysia
| | - K Jannat
- Department of Biotechnology and Genetic Engineering, University of Development Alternative, Lalmatia, Dhaka-1207, Bangladesh
| | - A Hasan
- Department of Biotechnology and Genetic Engineering, University of Development Alternative, Lalmatia, Dhaka-1207, Bangladesh
| | - R Jahan
- Department of Biotechnology and Genetic Engineering, University of Development Alternative, Lalmatia, Dhaka-1207, Bangladesh
| | - V Nissapatorn
- chool of Allied Health Sciences, World Union for Herbal Drug Discovery (WUHeDD), and Research Excellence Center for Innovation and Health Products (RECIHP), Walailak University, Nakhon Si Thammarat, Thailand
| | - C Wiart
- School of Pharmacy, University of Nottingham Malaysia Campus, Selangor, Malaysia
| | - M L Pereira
- CICECO-Aveiro Institute of Materials and Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - M Rahmatullah
- Department of Biotechnology and Genetic Engineering, University of Development Alternative, Lalmatia, Dhaka-1207, Bangladesh
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33
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Jahan R, Jahan K, Afrose R, Akhter S, Fatema S, Dey S, Khan MM. Obstetric Outcome of Multiple Pregnancy in a Medical College Hospital. Mymensingh Med J 2021; 30:633-637. [PMID: 34226448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The Incidence of twin and high order multiple gestation has increased significantly over the past 15 years primarily because of the availability and increased use of ovulation inducing drugs and assisted reproductive technology. Both maternal and perinatal mortality and morbidity is higher in multiple pregnancy than in singleton pregnancy. Proposed study is designed to determine the incidence and obstetric outcome of multiple pregnancy which is a high-risk pregnancy in a tertiary referral hospital. The purpose of this study is to evaluate obstetric outcome of multiple pregnancy. This prospective observational study was carried out in the Department of Obs and Gynae, Mymensingh Medical College Hospital, Mymensingh from December 2011 to May 2012. Patients were selected by purposive way. In this study it was observed that incidence of twin pregnancy was 1.66% common age group 30-35 years (48%), common in multipara (74%), no pregnancy crossed EDD. Family history of twin was 32% and unknown etiology 58%. Most common maternal complication was preterm labour (60%). Commonest mode of delivery was LSCS (64%), incidence of perinatal mortality 15%, 36% baby had birth weight in between 2.1-2.5kg, all the baby requiring admission in neonatal unit. This prospective observational study revealed that perinatal mortality was high in our center, there was no maternal mortality.
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Affiliation(s)
- R Jahan
- Dr Rownok Jahan, Registrar (Infertility), Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh; E-mail:
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34
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Lekovic GP, Ooi YC, Jahan R. Presigmoid Transpetrosal Approach for Superficial Temporal Artery to Distal Posterior Cerebral Artery Bypass and Trapping of Aneurysm. Oper Neurosurg (Hagerstown) 2021; 20:E234-E238. [PMID: 33432972 PMCID: PMC8133331 DOI: 10.1093/ons/opaa424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 09/27/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Aneurysms of the posterior cerebral artery (PCA) are uncommon, estimated at less than 1% of all cerebral aneurysms, and less than half occur distal to the P1/2 junction. Unfortunately, the conventional bypass approach for PCA aneurysms—primarily occipital artery to distal PCA cortical branches—has a history of unsatisfying results. CLINICAL PRESENTATION A 42-yr-old female presented with Fisher 3 Hunt-Hess 2 subarachnoid hemorrhage secondary to ruptured distal PCA aneurysm. She was initially evaluated by the endovascular service, but due to recent subarachnoid hemorrhage, endovascular treatment with flow diversion and/or vessel sacrifice was felt to be relatively contraindicated and the patient was referred for surgical evaluation for possible bypass. The patient subsequently underwent surgery for trapping of aneurysm and concomitant superficial artery to distal PCA bypass. CONCLUSION A novel approach for the treatment of a ruptured distal PCA aneurysm is described, consisting of posterior transpetrosal exposure and division of the tentorium with superficial temporal artery to P3 bypass.
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Affiliation(s)
- Gregory P Lekovic
- Division of Neurosurgery, House Institute, Los Angeles, California.,Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California
| | - Yinn Cher Ooi
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California
| | - Reza Jahan
- Department of Radiology, University of California, Los Angeles, Los Angeles, California
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35
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Zaidat OO, Liebeskind DS, Jadhav AP, Ortega-Gutierrez S, Nguyen TN, Haussen DC, Yavagal DR, Froehler MT, Jahan R, Nogueira RG, Yao TL, Alenzi BA, Bushnaq S, Mueller-Kronast NH. Impact of Age and Alberta Stroke Program Early Computed Tomography Score 0 to 5 on Mechanical Thrombectomy Outcomes: Analysis From the STRATIS Registry. Stroke 2021; 52:2220-2228. [PMID: 34078106 PMCID: PMC8240495 DOI: 10.1161/strokeaha.120.032430] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose: This study investigates clinical outcomes after mechanical thrombectomy in adult patients with baseline Alberta Stroke Program Early CT Score (ASPECTS) of 0 to 5. Methods: We included data from the STRATIS Registry (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke) from patients who underwent mechanical thrombectomy within 8 hours of symptom onset and had available ASPECTS data adjudicated by an independent core laboratory. Angiographic and clinical outcomes were collected, including successful reperfusion (modified Thrombolysis in Cerebral Infarction ≥2b), functional independence (modified Rankin Scale score 0–2), 90-day mortality, and symptomatic intracranial hemorrhage at 24 hours. Outcomes were stratified by ASPECTS scores and age. Results: Of the 984 patients enrolled, 763 had available ASPECTS data. Of these patients, 57 had ASPECTS of 0 to 5 with a median age of 63 years (interquartile range, 28–100), whereas 706 patients had ASPECTS of 6 to 10 with a median age of 70 years of age (interquartile range, 19–100). Ten patients had ASPECTS of 0 to 3 and 47 patients had ASPECTS of 4 to 5 at baseline. Successful reperfusion was achieved in 85.5% (47/55) in the ASPECTS of 0 to 5 group. Functional independence was achieved in 28.8% (15/52) in the ASPECTS of 0 to 5 versus 59.7% (388/650) in the 6 to 10 group (P<0.001). Mortality rates were 30.8% (16/52) in the ASPECTS of 0 to 5 and 13.4% (87/650) in the 6 to 10 group (P<0.001). sICH rates were 7.0% (4/57) in the ASPECTS of 0 to 5 and 0.9% (6/682) in the 6 to 10 group (P<0.001). No patients aged >75 years with ASPECTS of 0 to 5 (0/12) achieved functional independence versus 44.8% (13/29) of those age ≤65 (P=0.005). Conclusions: Patients <65 years of age with large core infarction (ASPECTS 0–5) have better rates of functional independence and lower rates of mortality compared with patients >75 years of age. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02239640.
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Affiliation(s)
- Osama O Zaidat
- Neuroscience Institute, St Vincent Mercy Hospital, Toledo, OH (O.O.Z., S.B.)
| | - David S Liebeskind
- Neurovascular Imaging Research Core and Stroke Center, Department of Neurology (D.S.L.), University of California Los Angeles
| | - Ashutosh P Jadhav
- Department of Neurology, University of Pittsburgh Medical Center, PA (A.P.J.)
| | - Santiago Ortega-Gutierrez
- Departments of Neurology, Neurosurgery and Radiology, University of Iowa Health Care, Carver College of Medicine (S.O.-G.)
| | - Thanh N Nguyen
- Division of Interventional Neuroradiology and Interventional Neurology, Boston Medical Center, MA (T.N.N.)
| | - Diogo C Haussen
- Department of Neurology, Emory University, Atlanta, GA (D.C.H., R.G.N.)
| | - Dileep R Yavagal
- Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine, FL (D.R.Y.)
| | - Michael T Froehler
- Cerebrovascular Program, Vanderbilt University Medical Center, Nashville, TN (M.T.F.)
| | - Reza Jahan
- Department of Radiology (R.J.), University of California Los Angeles
| | - Raul G Nogueira
- Department of Neurology, Emory University, Atlanta, GA (D.C.H., R.G.N.)
| | - Tom L Yao
- Norton Neuroscience Institute, Norton Healthcare, Louisville, KY (T.L.Y.)
| | - Bader A Alenzi
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus (B.A.A.)
| | - Saif Bushnaq
- Neuroscience Institute, St Vincent Mercy Hospital, Toledo, OH (O.O.Z., S.B.)
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36
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Vlasevska S, Garcia‐Ibanez L, Duval R, Holmes A, Jahan R, Basso K, Dalla‐Favera R, Pasqualucci L. CREBBP MEDIATED ACETYLATION OF KMT2D IN NORMAL AND TRANSFORMED GC B CELLS. Hematol Oncol 2021. [DOI: 10.1002/hon.42_2879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S. Vlasevska
- Columbia University Institute for Cancer Genetics New York, New York USA
| | - L. Garcia‐Ibanez
- Columbia University Institute for Cancer Genetics New York, New York USA
| | - R. Duval
- Columbia University Institute for Cancer Genetics New York, New York USA
| | - A.B. Holmes
- Columbia University Institute for Cancer Genetics New York, New York USA
| | - R. Jahan
- Columbia University Institute for Cancer Genetics New York, New York USA
| | - K. Basso
- Columbia University Institute for Cancer Genetics the Department of Pathology and Cell Biology and the Herbert Irving Comprehensive Cancer Center New York, New York USA
| | - R. Dalla‐Favera
- Columbia University Institute for Cancer Genetics the Department of Pathology and Cell Biology and the Herbert Irving Comprehensive Cancer Center New York, New York USA
| | - L. Pasqualucci
- Columbia University Institute for Cancer Genetics the Department of Pathology and Cell Biology and the Herbert Irving Comprehensive Cancer Center New York, New York USA
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Wong GJ, Yoo B, Liebeskind D, Baharvahdat H, Gornbein J, Jahan R, Szeder V, Duckwiler G, Tateshima S, Colby G, Nour M, Sharma L, Rao N, Hinman J, Starkman S, Saver JL. Frequency, Determinants, and Outcomes of Emboli to Distal and New Territories Related to Mechanical Thrombectomy for Acute Ischemic Stroke. Stroke 2021; 52:2241-2249. [PMID: 34011171 DOI: 10.1161/strokeaha.120.033377] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Gregory J Wong
- Department of Medicine, Washington University School of Medicine, St. Louis, MO (G.J.W.).,Department of Neurology and Neurological Sciences, Stanford University, CA (G.J.W.)
| | - Bryan Yoo
- Department of Radiology (B.Y.), UCLA, Los Angeles, CA
| | - David Liebeskind
- Department of Neurology (D.L., M.N., L.S., N.R., J.H., S.S., J.L.S.), UCLA, Los Angeles, CA
| | - Humain Baharvahdat
- Department of Neurosurgery, Mashhad University of Medical Sciences, Iran (H.B.)
| | - Jeffrey Gornbein
- Statistics Core, Department of Medicine (J.G.), UCLA, Los Angeles, CA
| | - Reza Jahan
- Division of Interventional Neuroradiology, Department of Radiology (R.J., V.S., G.D., S.T., G.C., M.N.), UCLA, Los Angeles, CA
| | - Viktor Szeder
- Division of Interventional Neuroradiology, Department of Radiology (R.J., V.S., G.D., S.T., G.C., M.N.), UCLA, Los Angeles, CA
| | - Gary Duckwiler
- Division of Interventional Neuroradiology, Department of Radiology (R.J., V.S., G.D., S.T., G.C., M.N.), UCLA, Los Angeles, CA
| | - Satoshi Tateshima
- Division of Interventional Neuroradiology, Department of Radiology (R.J., V.S., G.D., S.T., G.C., M.N.), UCLA, Los Angeles, CA
| | - Geoffrey Colby
- Division of Interventional Neuroradiology, Department of Radiology (R.J., V.S., G.D., S.T., G.C., M.N.), UCLA, Los Angeles, CA.,Department of Neurosurgery (G.C.), UCLA, Los Angeles, CA
| | - May Nour
- Department of Neurology (D.L., M.N., L.S., N.R., J.H., S.S., J.L.S.), UCLA, Los Angeles, CA.,Division of Interventional Neuroradiology, Department of Radiology (R.J., V.S., G.D., S.T., G.C., M.N.), UCLA, Los Angeles, CA
| | - Latisha Sharma
- Department of Neurology (D.L., M.N., L.S., N.R., J.H., S.S., J.L.S.), UCLA, Los Angeles, CA
| | - Neal Rao
- Department of Neurology (D.L., M.N., L.S., N.R., J.H., S.S., J.L.S.), UCLA, Los Angeles, CA
| | - Jason Hinman
- Department of Neurology (D.L., M.N., L.S., N.R., J.H., S.S., J.L.S.), UCLA, Los Angeles, CA
| | - Sidney Starkman
- Department of Neurology (D.L., M.N., L.S., N.R., J.H., S.S., J.L.S.), UCLA, Los Angeles, CA.,Department of Emergency Medicine (S.S.), UCLA, Los Angeles, CA
| | - Jeffrey L Saver
- Department of Neurology (D.L., M.N., L.S., N.R., J.H., S.S., J.L.S.), UCLA, Los Angeles, CA
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Tsui B, Chen I, Qiao J, Khatibi K, Ponce Mejia L, Liebeskind DS, Sharma LK, Tateshima S, Bahr Hosseini M, Colby G, Nour M, Salamon N, Saver J, Jahan R, Duckwiler G, Nael K. Abstract P348: Perfusion Collateral Index vs. Hypoperfusion Intensity Ratio in Assessment of Angiographic Collateral Scores in Patients With Acute Ischemic Stroke. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.p348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose:
In acute ischemic stroke (AIS), perfusion imaging, while not directly visualizing collateral vessels, can provide important insight into collateral robustness, indexed by perfusion lesion volume and by perfusion lesion heterogeneity. Two proposed perfusion lesion heterogeneity measures indexing collateral status are the Perfusion Collateral Index (PCI) and Hypoperfusion Intensity Ratio (HIR), but their accuracy compared with direct collateral assessment on DSA has been incompletely characterized.
Methods:
Consecutive AIS patients with anterior circulation large vessel occlusion who underwent pre-endovascular thrombectomy MRI perfusion imaging were included. MRI measures analyzed were: 1) Perfusion Collateral Index (
PCI)
- the volume of moderately hypoperfused tissue (arterial tissue delay time between 2 and 6 seconds: ATD
2-6sec
) multiplied by its corresponding relative cerebral blood volume using Olea software; 2) Hypoperfusion Intensity Ratio (HIR) ratio of moderate TMax >6 s lesion volume versus severe Tmax >10 s lesion volume with the RAPID software program. DSA collateral scores were evaluated by ASITN grading and dichotomized to inadequate (ASTIN <2) vs. adequate (ASTIN ≥3).
Results:
Among 48 patients meeting entry criteria, age (mean ± SD) was 70 (± 15.2), 54% were female, and NIHSS (median, IQR) was 15 (10-19). For HIR, there was no significant difference in score values in patients with adequate vs inadequate collaterals: 0.35 ± 0.20 vs 0.39 ± 0.25, p=0.68. ROC analysis using previously described cut-off of 0.4 resulted in an AUC of 0.52 and sensitivity/specificity of 71% / 33%. For PCI, score values were significantly higher in patients with adequate vs inadequate collaterals, 117 ± 61 vs. 57 ± 41, p=0.002. ROC analysis using previously described cut-off of 62 resulted in an AUC of 0.8 and sensitivity/specificity of 84% / 78%.
Conclusion:
Collateral status can be accurately assessed on perfusion MRI with the Perfusion Collateral Index, which outperformed the Hypoperfusion Intensity Ratio. MRI-PCI is an informative imaging biomarker of collateral status in patients with AIS.
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Affiliation(s)
- Brian Tsui
- Radiology, Ronald Reagan UCLA Med Cntr, Los Angeles, CA
| | - Iris Chen
- Radiology, Ronald Reagan UCLA Med Cntr, Los Angeles, CA
| | - Joe Qiao
- Radiology, Ronald Reagan UCLA Med Cntr, Los Angeles, CA
| | - Kasra Khatibi
- Radiology, Ronald Reagan UCLA Med Cntr, Los Angeles, CA
| | | | | | | | | | | | - Geoffrey Colby
- Neurosurgery, Ronald Reagan UCLA Med Cntr, Los Angeles, CA
| | - May Nour
- Neurology, Radiology, Ronald Reagan UCLA Med Cntr, Los Angeles, CA
| | | | - Jeffrey Saver
- Neurology, Ronald Reagan UCLA Med Cntr, Los Angeles, CA
| | - Reza Jahan
- Radiology, Ronald Reagan UCLA Med Cntr, Los Angeles, CA
| | | | - Kambiz Nael
- Ronald Reagan UCLA Med Cntr, Los Angeles, CA
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Khatibi K, Saber H, Ponce Mejia L, Kaneko N, Nour M, Colby G, Szeder V, Tateshima S, Jahan R, Duckwiler G, Afshar Y. Abstract MP10: Aneurysmal Subarachnoid Hemorrhage in Pregnancy: National Trends of Treatment and Outcomes. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.mp10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Aneurysmal subarachnoid hemorrhage (aSAH) is a rare event associated with significant pregnancy-associated maternal and neonatal morbidity and mortality. With advances in neurosurgical and neurocritical care, there have been significant improvement in survival and clinical outcome of patients with aSAH. We aimed to investigate the treatment utilizations and outcomes of aSAH in pregnancy.
Methods:
Retrospective analysis using the Nationwide Inpatient Sample identified women 18-45 years-old hospitalized between 2010-2015. We identified pregnancy state, subarachnoid hemorrhage, and aneurysm treatments in this cohort. The mode of aneurysm treatment, mortality, and discharge destination was compared in pregnant versus non-pregnant cohorts.
Results:
9,667 aSAH with treatment were identified, of which 341 were associated with pregnancy. Mortality in the pregnancy and non-pregnancy were not different (7.37% vs 7.39%, p=0.97). However, pregnancy-related admissions were more likely to be discharged to home or short-term facility (71.9% vs 63.8%, p=0.002). Endovascular treatment for aSAH was more prevalent in pregnancy vs non-pregnancy (73% vs 66.3%, p=0.004). During the study epoch, there was a significant increase in endovascular treatment in pregnancy related aSAH (p<0.001). Surgical clipping was associated with higher mortality in pregnancy compared to non-pregnancy (15.9% vs 6.8%, p<0.001). There was no difference in mortality following endovascular treatment in pregnancy vs non-pregnancy (6.1% vs 7.8%, p=0.26). Favorable discharge outcome was significantly higher for pregnancy vs non-pregnancy with endovascular treatment (75.8% vs 63.9%, p<0.001), whereas no significant difference was observed in rate of favorable outcome for pregnancy and non-pregnancy with surgical clipping (57.9% vs 61.2%, p=0.29).
Conclusions:
Pregnancy does not alter mortality from aSAH. Among interventions for aSAH, surgical clipping is associated with higher mortality in pregnancy compared to non-pregnancy. However, pregnancy is associated with more favorable discharge outcomes (vs controls) and no change in mortality in this cohort. Consideration for endovascular intervention with aSAH in this cohort should be considered.
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Raychev R, Saber H, Saver JL, Hinman JD, Brown S, Vinuela F, Duckwiler G, Jahan R, Tateshima S, Szeder V, Nour M, Colby GP, Restrepo L, Kim D, Bahr-Hosseini M, Ali L, Starkman S, Rao N, Nogueira RG, Liebeskind D. Impact of eloquent motor cortex-tissue reperfusion beyond the traditional thrombolysis in cerebral infarction (TICI) scoring after thrombectomy. J Neurointerv Surg 2021; 13:990-994. [PMID: 33443113 PMCID: PMC8526878 DOI: 10.1136/neurintsurg-2020-016834] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/03/2020] [Accepted: 11/05/2020] [Indexed: 11/29/2022]
Abstract
Background Targeted eloquence-based tissue reperfusion within the primary motor cortex may have a differential effect on disability as compared with traditional volume-based (thrombolysis in cerebral infarction, TICI) reperfusion after endovascular thrombectomy (EVT) in the setting of acute ischemic stroke (AIS). Methods We explored the impact of eloquent reperfusion (ER) within primary motor cortex (PMC) on clinical outcome (modified Rankin Scale, mRS) in AIS patients undergoing EVT. ER-PMC was defined as presence of flow on final digital subtraction angiography (DSA) within four main cortical branches, supplying the PMC (middle cerebral artery (MCA) – precentral, central, postcentral; anterior cerebral artery (ACA) – medial frontal branch arising from callosomarginal or pericallosal arteries) and graded as absent (0), partial (1), and complete (2). Prospectively collected data from two centers were analyzed. Multivariate analysis was conducted to assess the impact of ER-PMC on 90-day disability (mRS) among patients with anterior circulation occlusion who achieved partial reperfusion (TICI 2a and 2b). Results Among the 125 patients who met the study criteria, ER-PMC distribution was: absent (0) in 19/125 (15.2%); partial (1) in 52/125 (41.6%), and complete (2) in 54/125 (43.2%). TICI 2b was achieved in 102/125 (81.6%) and ER-PMC was substantially higher in those patients (P<0.001). In multivariate analysis, in addition to age and symptomatic intracranial hemorrhage, ER-PMC had a profound independent impact on 90-day disability (OR 6.10, P=0.001 for ER-PMC 1 vs 0 and OR 9.87, P<0.001 for ER-PMC 2 vs 0), while the extent of total partial reperfusion (TICI 2b vs 2a) was not related to 90-day mRS. Conclusions Eloquent PMC-tissue reperfusion is a key determinant of functional outcome, with a greater impact than volume-based (TICI) degree of partial reperfusion alone. PMC-targeted revascularization among patients with partial reperfusion may further diminish post-stroke disability after EVT.
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Affiliation(s)
- Radoslav Raychev
- Neurology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Hamidreza Saber
- Radiological Sciences, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Jeffrey L Saver
- Neurology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Jason D Hinman
- Neurology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Scott Brown
- BRIGHT Research Partners, Minneapolis, Minnesota, USA
| | - Fernando Vinuela
- Radiological Sciences, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Gary Duckwiler
- Radiological Sciences, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Reza Jahan
- Radiological Sciences, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Satoshi Tateshima
- Radiological Sciences, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Viktor Szeder
- Radiological Sciences, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - May Nour
- Neurology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.,Radiological Scieneces, University of Califronia Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Geoffrey P Colby
- Neurosurgery, University of California Los Angeles, Los Angeles, California, USA
| | - Lucas Restrepo
- Neurology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Doojin Kim
- Neurology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Mersedeh Bahr-Hosseini
- Neurology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Latisha Ali
- Neurology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Sidney Starkman
- Neurology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Neal Rao
- Neurology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Raul G Nogueira
- Neurology, Marcus Stroke & Neuroscience Center Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia, USA
| | - David Liebeskind
- Neurology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
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Ooi YC, Miremadi BB, Mukarram F, Kaneko N, Nour M, Colby G, Jahan R, Tateshima S, Duckwiler G, Saver J, Szeder V. Role of Intravenous Tissue Plasminogen Activator in Acute Ischemic Stroke with Large Vessel Occlusion. World Neurosurg 2021; 148:e321-e325. [PMID: 33444835 DOI: 10.1016/j.wneu.2020.12.142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/10/2020] [Revised: 12/27/2020] [Accepted: 12/27/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The goal of the present study was to determine the safety and efficacy of intravenous tissue plasminogen activator (IVT) in patients with acute ischemic stroke (AIS) with large vessel occlusion (LVO) undergoing mechanical thrombectomy (MT). METHODS We performed a retrospective analysis of prospectively collected data gathered during a 3-year period for all our patients with AIS and LVO. We analyzed the stroke outcomes and complications between patients who had received a combination of IVT and MT and those who had undergone MT only. Standardized selection criteria, including the uniform use of perfusion imaging, were used for selection for MT, irrespective of IVT administration. RESULTS Of the patients who had received IVT, 10% had had successful reperfusion found at initial angiography and did not require MT. A door-to-puncture time within 1 hour of presentation was achieved in 19% of both groups. IVT+MT was not associated with an increased incidence of intracranial hemorrhage (IVT+MT, 47.1%; MT, 49%). Of the 73 patients in IVT+MT group, 8 had developed access-site hematomas compared with 9 of the 95 patients in the MT group (28.6% vs. 26.5%; P = 0.85). The IVT+MT group had a lower proportion of patients with a modified Rankin scale score of 5-6 at 90 days compared with the MT group (36% vs. 56%; P = 0.024). Both groups showed statistically similar proportions of patients with a Thrombolysis in Cerebral Infarction scale score of ≥2c (IVT+MT, 50%; MT, 43%; P = 0.58). The IVT+MT group had a greater proportion of patients with Thrombolysis in Cerebral Infarction scale score of 2c (IVT+MT, 29.6%; MT, 16.8%; P = 0.068). CONCLUSIONS Administration of IVT before MT to patients with AIS with LVO resulted in reperfusion before MT in 10% of patients, reduced the incidence of mortality and severe disability at 90 days, did not affect the door-to-puncture time, and was associated with a similar incidence of systemic and intracranial hemorrhage compared with MT only.
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Affiliation(s)
- Yinn Cher Ooi
- Division of Interventional Neuroradiology, University of California, Los Angeles, Los Angeles, California, USA
| | | | - Faisal Mukarram
- Division of Interventional Neuroradiology, University of California, Los Angeles, Los Angeles, California, USA
| | - Naoki Kaneko
- Division of Interventional Neuroradiology, University of California, Los Angeles, Los Angeles, California, USA
| | - May Nour
- Division of Interventional Neuroradiology, University of California, Los Angeles, Los Angeles, California, USA
| | - Geoffrey Colby
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Reza Jahan
- Division of Interventional Neuroradiology, University of California, Los Angeles, Los Angeles, California, USA
| | - Satoshi Tateshima
- Division of Interventional Neuroradiology, University of California, Los Angeles, Los Angeles, California, USA
| | - Gary Duckwiler
- Division of Interventional Neuroradiology, University of California, Los Angeles, Los Angeles, California, USA
| | - Jeffrey Saver
- Department of Neurology, University of California, Los Angeles, Los Angeles, California, USA
| | - Viktor Szeder
- Division of Interventional Neuroradiology, University of California, Los Angeles, Los Angeles, California, USA
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Afrose R, Mirza TT, Sarker K, Shamsi S, Chowdhury UW, Shikha SS, Akhter S, Jahan R, Fatema S, Dey S. Effect of Amniotomy on Outcome of Spontaneous Labour. Mymensingh Med J 2021; 30:6-12. [PMID: 33397844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Intentional artificial rupture of the amniotic membranes during labour, called amniotomy or 'breaking of the water's, is one of the most commonly performed procedures in modern obstetric and midwifery practice. The primary aim of amniotomy is to speed up uterine contractions and therefore shorten the length of labour. However there are concerns regarding unintended adverse effects on the woman and baby. A prospective observational study was conducted to determine the effectiveness and safety of routine procedure of amniotomy to shorten the duration of labour (prolonged or not) in Mymensingh Medical College & Hospital, Mymensingh, Bangladesh from July 2011 to December 2011. One hundred low-risk women with spontaneous onset of labour at term with singleton fetus in cephalic presentation and intact amniotic membranes and a cervical dilatation between 4 and 5cm were conventionally assigned to have amniotomy during the course of labour. Maternal demographics, duration of labour (prolonged or not), maternal and perinatal outcome were considered as major outcome. Majority (49.0%) of the patients belonged to 21-25 years age group and primigravida was predominant and most of them had middle socio-economic conditions. More the three-fourth (89.0%) of the patients had head engaged. Rh-positive and negative were found 96.0% and 4.0% respectively. The primigravidae required 10.07±2.17 hours in 1st stage of labour and had 1.51±0.5 hours duration of 2nd stage of labour. In case of multi-gravidae it was 6.07±2.06 hours in 1st stage of and 1±0.5 hours in 2nd stage of labour. There was a marked reduction of amniotomy-delivery interval time in this study, which was 3 hours 40 minutes and whereas mean cervical dilatation was 4cm during amniotomy. Almost three fourth (72.0%) cases delivered vaginally among which, with episiotomy in 49.0% and without episiotomy in 23.0%. Instrumental delivery was in 9.0% of which 4.0% by forceps, 5.0% by vaccum extraction and 14.0% underwent LUCS. Still birth was found 2.0%, asphyxiated 3.0% and prenatal death 1.0%. In terms of referral to neonatal care unit it was found that 7.0% were asphyxiated. Asphyxia and low APGAR score was 4.0%, low birth weight 9.0%, instrumental delivery was 5.0%, Rh incompatibility was 2.0%. Only 1.0% babies needed admission to neonatal care unit and were intubated. So, Amniotomy significantly reduced the duration of the first stage of labour without affecting the oxytocin requirement, the rate of caesarean section and newborn outcome.
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Affiliation(s)
- R Afrose
- Dr Ruma Afrose, Junior Consultant (Obs & Gynae) & RS (Obs & Gynae), Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh; E-mail:
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Jahan R, Mishra B, Behera B, Mohapatra P, Praharaj A. Study of respiratory viruses and the co-infection with bacterial and fungal pathogens in acute exacerbation of chronic obstructive pulmonary diseases. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.1362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Saber H, Khatibi K, Szeder V, Tateshima S, Colby GP, Nour M, Jahan R, Duckwiler G, Liebeskind DS, Saver JL. Reperfusion Therapy Frequency and Outcomes in Mild Ischemic Stroke in the United States. Stroke 2020; 51:3241-3249. [PMID: 33081604 DOI: 10.1161/strokeaha.120.030898] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE More than half of patients with acute ischemic stroke have minor neurological deficits; however, the frequency and outcomes of reperfusion therapy in regular practice has not been well-delineated. METHODS Analysis of US National Inpatient Sample of hospitalizations with acute ischemic stroke and mild deficits (National Institutes of Health Stroke Scale [NIHSS] score 0-5) from October 1, 2016, to December 31, 2017. Patient- and hospital-level characteristics associated with use and outcome of reperfusion therapies were analyzed. Primary outcomes included excellent discharge disposition (discharge to home without assistance); poor discharge disposition (discharge to facility or death); in-hospital mortality; and radiological intracranial hemorrhage. RESULTS Among 179 710 acute ischemic stroke admissions with recorded NIHSS during the 15-month study period, 103 765 (57.7%) had mild strokes (47.3% women; median age, 69 [interquartile range, 59-79] years; median NIHSS score of 2 [interquartile range, 1-4]). Considering reperfusion therapies among strokes with documented NIHSS, mild deficit hospitalizations accounted for 40.0% of IVT and 10.7% of mechanical thrombectomy procedures. Characteristics associated with IVT and with mechanical thrombectomy utilization were younger age, absence of diabetes, higher NIHSS score, larger/teaching hospital status, and Western US region. Excellent discharge outcome occurred in 48.2% of all mild strokes, and in multivariable analysis, was associated with younger age, male sex, White race, lower NIHSS score, absence of diabetes, heart failure, and kidney disease, and IVT use. IVT was associated with increased likelihood of excellent outcome (odds ratio, 1.90 [95% CI, 1.71-2.13], P<0.001) despite an increased risk of intracranial hemorrhage (odds ratio, 1.41 [95% CI, 1.09-1.83], P<0.001). CONCLUSIONS In national US practice, more than one-half of acute ischemic stroke hospitalizations had mild deficits, accounting for 4 of every 10 IVT and 1 of every 10 mechanical thrombectomy treatments, and IVT use was associated with increased discharge to home despite increased intracranial hemorrhage.
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Affiliation(s)
- Hamidreza Saber
- Division of Interventional Neuroradiology, Department of Radiological Sciences (H.S., K.K., V.S., S.T., G.P.C., M.N., R.J., G.D.), University of California, Los Angeles (UCLA)
| | - Kasra Khatibi
- Division of Interventional Neuroradiology, Department of Radiological Sciences (H.S., K.K., V.S., S.T., G.P.C., M.N., R.J., G.D.), University of California, Los Angeles (UCLA)
| | - Viktor Szeder
- Division of Interventional Neuroradiology, Department of Radiological Sciences (H.S., K.K., V.S., S.T., G.P.C., M.N., R.J., G.D.), University of California, Los Angeles (UCLA)
| | - Satoshi Tateshima
- Division of Interventional Neuroradiology, Department of Radiological Sciences (H.S., K.K., V.S., S.T., G.P.C., M.N., R.J., G.D.), University of California, Los Angeles (UCLA)
| | - Geoffrey P Colby
- Division of Interventional Neuroradiology, Department of Radiological Sciences (H.S., K.K., V.S., S.T., G.P.C., M.N., R.J., G.D.), University of California, Los Angeles (UCLA).,Department of Neurosurgery (G.P.C.), University of California, Los Angeles (UCLA)
| | - May Nour
- Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (M.N., D.S.L., J.L.S.), University of California, Los Angeles (UCLA).,Division of Interventional Neuroradiology, Department of Radiological Sciences (H.S., K.K., V.S., S.T., G.P.C., M.N., R.J., G.D.), University of California, Los Angeles (UCLA)
| | - Reza Jahan
- Division of Interventional Neuroradiology, Department of Radiological Sciences (H.S., K.K., V.S., S.T., G.P.C., M.N., R.J., G.D.), University of California, Los Angeles (UCLA)
| | - Gary Duckwiler
- Division of Interventional Neuroradiology, Department of Radiological Sciences (H.S., K.K., V.S., S.T., G.P.C., M.N., R.J., G.D.), University of California, Los Angeles (UCLA)
| | - David S Liebeskind
- Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (M.N., D.S.L., J.L.S.), University of California, Los Angeles (UCLA)
| | - Jeffrey L Saver
- Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (M.N., D.S.L., J.L.S.), University of California, Los Angeles (UCLA)
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Moshayedi P, Liebeskind DS, Jadhav A, Jahan R, Lansberg M, Sharma L, Nogueira RG, Saver JL. Decision-Making Visual Aids for Late, Imaging-Guided Endovascular Thrombectomy for Acute Ischemic Stroke. J Stroke 2020; 22:377-386. [PMID: 33053953 PMCID: PMC7568977 DOI: 10.5853/jos.2019.03503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 06/22/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND PURPOSE Speedy decision-making is important for optimal outcomes from endovascular thrombectomy (EVT) for acute ischemic stroke (AIS). Figural decision aids facilitate rapid review of treatment benefits and harms, but have not yet been developed for late-presenting patients selected for EVT based on multimodal computed tomography or magnetic resonance imaging. METHODS For combined pooled study-level randomized trial (DAWN and DEFUSE 3) data, as well as each trial singly, 100 person-icon arrays (Kuiper-Marshall personographs) were generated showing beneficial and adverse effects of EVT for patients with AIS and large vessel occlusion using automated (algorithmic) and expert-guided joint outcome table specification. RESULTS Among imaging-selected patients 6 to 24 hours from last known well, for the full 7-category modified Rankin Scale (mRS), EVT had number needed to treat to benefit 1.9 (interquartile range [IQR], 1.9 to 2.1) and number needed to harm 40.0 (IQR, 29.2 to 58.3). Visual displays of treatment effects among 100 patients showed that, with EVT: 52 patients have better disability outcome, including 32 more achieving functional independence (mRS 0 to 2); three patients have worse disability outcome, including one more experiencing severe disability or death (mRS 5 to 6), mediated by symptomatic intracranial hemorrhage and infarct in new territory. Similar features were present in person-icon figures based on a 6-level mRS (levels 5 and 6 combined) rather than 7-level mRS, and based on the DAWN trial alone and DEFUSE 3 trial alone. CONCLUSIONS Personograph visual decision aids are now available to rapidly educate patients, family, and healthcare providers regarding benefits and risks of EVT for late-presenting, imaging-selected AIS patients.
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Affiliation(s)
- Pouria Moshayedi
- Department of Neurology and Comprehensive Stroke Center, University of California Los Angeles, Los Angeles, CA, USA
| | - David S Liebeskind
- Department of Neurology and Comprehensive Stroke Center, University of California Los Angeles, Los Angeles, CA, USA
| | - Ashutosh Jadhav
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Reza Jahan
- Department of Radiology and Comprehensive Stroke Center, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Latisha Sharma
- Department of Neurology and Comprehensive Stroke Center, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Jeffrey L Saver
- Department of Neurology and Comprehensive Stroke Center, University of California Los Angeles, Los Angeles, CA, USA
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Atchaneeyasakul K, Liebeskind DS, Jahan R, Starkman S, Sharma L, Yoo B, Avelar J, Rao N, Hinman J, Duckwiler G, Nour M, Szeder V, Tateshima S, Colby G, Hosseini MB, Raychev R, Kim D, Saver JL. Efficient Multimodal MRI Evaluation for Endovascular Thrombectomy of Anterior Circulation Large Vessel Occlusion. J Stroke Cerebrovasc Dis 2020; 29:105271. [PMID: 32992192 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/10/2020] [Accepted: 08/22/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND MRI and CT modalities are both current standard-of-care options for initial imaging in patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO). MR provides greater lesion conspicuity and spatial resolution, but few series have demonstrated multimodal MR may be performed efficiently. METHODS In a prospective comprehensive stroke center registry, we analyzed all anterior circulation LVO thrombectomy patients between 2012-2017 who: (1) arrived directly by EMS from the field, and (2) had initial NIHSS ≥6. Center imaging policy was multimodal MRI (including DWI/GRE/MRA w/wo PWI) as the initial evaluation in all patients without contraindications, and multimodal CT (including CT with CTA, w/wo CTP) in the remainder. RESULTS Among 106 EMS-arriving endovascular thrombectomy patients, initial imaging was MRI 62.3%, CT in 37.7%. MRI and CT patients were similar in age (72.5 vs 71.3), severity (NIHSS 16.4 v 18.2), and medical history, though MRI patients had longer onset-to-door times. Overall, door-to-needle (DTN) and door-to-puncture (DTP) times did not differ among MR and CT patients, and were faster for both modalities in 2015-2017 versus 2012-2014. In the 2015-2017 period, for MR-imaged patients, the median DTN 42m (IQR 34-55) surpassed standard (60m) and advanced (45m) national targets and the median DTP 86m (IQR 71-106) surpassed the standard national target (90m). CONCLUSIONS AIS-LVO patients can be evaluated by multimodal MR imaging with care speeds faster than national recommendations for door-to-needle and door-to-puncture times. With its more sensitive lesion identification and spatial resolution, MRI remains a highly viable primary imaging strategy in acute ischemic stroke patients, though further workflow efficiency improvements are desirable.
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Affiliation(s)
- Kunakorn Atchaneeyasakul
- RRMC-UCLA Comprehensive Stroke Center, 710 Westwood Plaza, Los Angeles 90095, CA ,United States.
| | - David S Liebeskind
- RRMC-UCLA Comprehensive Stroke Center, 710 Westwood Plaza, Los Angeles 90095, CA ,United States
| | - Reza Jahan
- RRMC-UCLA Comprehensive Stroke Center, 710 Westwood Plaza, Los Angeles 90095, CA ,United States
| | - Sidney Starkman
- RRMC-UCLA Comprehensive Stroke Center, 710 Westwood Plaza, Los Angeles 90095, CA ,United States
| | - Latisha Sharma
- RRMC-UCLA Comprehensive Stroke Center, 710 Westwood Plaza, Los Angeles 90095, CA ,United States
| | - Bryan Yoo
- RRMC-UCLA Comprehensive Stroke Center, 710 Westwood Plaza, Los Angeles 90095, CA ,United States
| | - Johanna Avelar
- RRMC-UCLA Comprehensive Stroke Center, 710 Westwood Plaza, Los Angeles 90095, CA ,United States
| | - Neal Rao
- RRMC-UCLA Comprehensive Stroke Center, 710 Westwood Plaza, Los Angeles 90095, CA ,United States
| | - Jason Hinman
- RRMC-UCLA Comprehensive Stroke Center, 710 Westwood Plaza, Los Angeles 90095, CA ,United States
| | - Gary Duckwiler
- RRMC-UCLA Comprehensive Stroke Center, 710 Westwood Plaza, Los Angeles 90095, CA ,United States
| | - May Nour
- RRMC-UCLA Comprehensive Stroke Center, 710 Westwood Plaza, Los Angeles 90095, CA ,United States
| | - Viktor Szeder
- RRMC-UCLA Comprehensive Stroke Center, 710 Westwood Plaza, Los Angeles 90095, CA ,United States
| | - Satoshi Tateshima
- RRMC-UCLA Comprehensive Stroke Center, 710 Westwood Plaza, Los Angeles 90095, CA ,United States
| | - Geoffrey Colby
- RRMC-UCLA Comprehensive Stroke Center, 710 Westwood Plaza, Los Angeles 90095, CA ,United States
| | - Mersedeh Bahr Hosseini
- RRMC-UCLA Comprehensive Stroke Center, 710 Westwood Plaza, Los Angeles 90095, CA ,United States
| | - Radoslav Raychev
- RRMC-UCLA Comprehensive Stroke Center, 710 Westwood Plaza, Los Angeles 90095, CA ,United States
| | - Doojin Kim
- RRMC-UCLA Comprehensive Stroke Center, 710 Westwood Plaza, Los Angeles 90095, CA ,United States
| | - Jeffrey L Saver
- RRMC-UCLA Comprehensive Stroke Center, 710 Westwood Plaza, Los Angeles 90095, CA ,United States
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- RRMC-UCLA Comprehensive Stroke Center, 710 Westwood Plaza, Los Angeles 90095, CA ,United States
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Seo WK, Liebeskind DS, Yoo B, Sharma L, Jahan R, Duckwiler G, Tateshima S, Nour M, Szeder V, Colby G, Starkman S, Rao N, Bahr Hosseini M, Saver JL. Predictors and Functional Outcomes of Fast, Intermediate, and Slow Progression Among Patients With Acute Ischemic Stroke. Stroke 2020; 51:2553-2557. [PMID: 32611286 DOI: 10.1161/strokeaha.120.030010] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We aimed to delineate the determinants of the initial speed of infarct progression and the association of speed of infarct progression (SIP) with procedural and functional outcomes. METHODS From a prospectively maintained stroke center registry, consecutive anterior circulation ischemic stroke patients with large artery occlusion, National Institutes of Health Stroke Scale score ≥4, and multimodal vessel, ischemic core, and tissue-at-risk imaging within 24 hours of onset were included. Initial SIP was calculated as ischemic core volume at first imaging divided by the time from stroke onset to imaging. RESULTS Among the 88 patients, SIP was median 2.2 cc/h (interquartile range, 0-8.7), ranging most widely within the first 6 hours after onset. Faster SIP was positively independently associated with a low collateral score (odds ratio [OR], 3.30 [95% CI, 1.25-10.49]) and arrival by emergency medical services (OR, 3.34 [95% CI, 1.06-10.49]) and negatively associated with prior ischemic stroke (OR, 0.12 [95% CI, 0.03-0.50]) and coronary artery disease (OR, 0.32 [95% CI, 0.10-1.00]). Among the 67 patients who underwent endovascular thrombectomy, slower SIP was associated with a shift to reduced levels of disability at discharge (OR, 3.26 [95% CI, 1.02-10.45]), increased substantial reperfusion by thrombectomy (OR, 8.30 [95% CI, 0.97-70.87]), and reduced radiological hemorrhagic transformation (OR, 0.34 [95% CI, 0.12-0.94]). CONCLUSIONS Slower SIP is associated with a high collateral score, prior ischemic stroke, and coronary artery disease, supporting roles for both collateral robustness and ischemic preconditioning in fostering tissue resilience to ischemia. Among patients undergoing endovascular thrombectomy, the speed of infarct progression is a major determinant of clinical outcome.
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Affiliation(s)
- Woo-Keun Seo
- Department of Neurology ad Stroke Senter, Samsung Medical Center & Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea (W.-K.S.)
| | - David S Liebeskind
- Department of Neurology and Comprehensive Stroke Center (D.S.L., L.S., M.N., S.S., N.R., M.B.H., J.L.S.), UCLA, Los Angeles, CA
| | | | - Latisha Sharma
- Department of Neurology and Comprehensive Stroke Center (D.S.L., L.S., M.N., S.S., N.R., M.B.H., J.L.S.), UCLA, Los Angeles, CA
| | - Reza Jahan
- Department of Radiology and Comprehensive Stroke Center (R.J., G.D., S.T., M.N., V.S.), UCLA, Los Angeles, CA
| | - Gary Duckwiler
- Department of Radiology and Comprehensive Stroke Center (R.J., G.D., S.T., M.N., V.S.), UCLA, Los Angeles, CA
| | - Satoshi Tateshima
- Department of Radiology and Comprehensive Stroke Center (R.J., G.D., S.T., M.N., V.S.), UCLA, Los Angeles, CA
| | - May Nour
- Department of Neurology and Comprehensive Stroke Center (D.S.L., L.S., M.N., S.S., N.R., M.B.H., J.L.S.), UCLA, Los Angeles, CA.,Department of Radiology and Comprehensive Stroke Center (R.J., G.D., S.T., M.N., V.S.), UCLA, Los Angeles, CA
| | - Viktor Szeder
- Department of Radiology and Comprehensive Stroke Center (R.J., G.D., S.T., M.N., V.S.), UCLA, Los Angeles, CA
| | - Geoffrey Colby
- Department of Neurosurgery and Comprehensive Stroke Center (G.C.), UCLA, Los Angeles, CA
| | - Sidney Starkman
- Department of Neurology and Comprehensive Stroke Center (D.S.L., L.S., M.N., S.S., N.R., M.B.H., J.L.S.), UCLA, Los Angeles, CA.,Department of Emergency Medicine and Comprehensive Stroke Center (S.S.), UCLA, Los Angeles, CA
| | - Neal Rao
- Department of Neurology and Comprehensive Stroke Center (D.S.L., L.S., M.N., S.S., N.R., M.B.H., J.L.S.), UCLA, Los Angeles, CA
| | - Mersedeh Bahr Hosseini
- Department of Neurology and Comprehensive Stroke Center (D.S.L., L.S., M.N., S.S., N.R., M.B.H., J.L.S.), UCLA, Los Angeles, CA
| | - Jeffrey L Saver
- Department of Neurology and Comprehensive Stroke Center (D.S.L., L.S., M.N., S.S., N.R., M.B.H., J.L.S.), UCLA, Los Angeles, CA
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48
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Mueller-Kronast N, Froehler MT, Jahan R, Zaidat O, Liebeskind D, Saver JL. Impact of EMS bypass to endovascular capable hospitals: geospatial modeling analysis of the US STRATIS registry. J Neurointerv Surg 2020; 12:1058-1063. [PMID: 32385089 PMCID: PMC7569363 DOI: 10.1136/neurintsurg-2019-015593] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/30/2020] [Accepted: 02/05/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Routing patients directly to endovascular capable centers (ECCs) would decrease time to mechanical thrombectomy (MT), but may delay intravenous thrombolysis (IVT). OBJECTIVE To study the clinical outcomes of patients with a stroke transferred directly to ECCs compared with those transferred to ECCs from non-endovascular capable centers (nECCs). METHODS Data from the STRATIS registry were analyzed to evaluate process and clinical outcomes under five routing policies: (1) transport to nearest nECC; (2) transport to STRATIS ECC over any distance or (3) within 20 miles; (4) transport to ideal ECC (iECC), over any distance or (5) within 20 miles. RESULTS Among 236 patients, 117 (49.6%) were transferred by ground, of whom 62 (53%) were transferred within 20 miles. Median MT start time was accelerated in all direct transport models. IVT start was prolonged with direct transport across all distances, but accelerated with direct transport to iECC ≤20 miles. With bypass limited to ≤20 miles, the median modeled EMS arrival to IVT interval decreased for both iECCs and ECCs (by 12 min and 6 min, respectively), and median EMS arrival to puncture time decreased by up to 94 min. In this cohort, no patient would have become ineligible for IVT. Bypass to iECC modeling under 20 miles showed a significant reduction in the level of disability at 3 months, with freedom from disability (modified Rankin Scale score 0-1) at 3 months increased by 12%. CONCLUSIONS Direct routing of patients with a large vessel occlusion to ECCs, especially when within 20 miles, may lead to better clinical outcomes by accelerating the start of MT without any delay of IVT. CLINICAL TRIAL REGISTRATION NUMBER http://www.clinicaltrials.gov. Unique identifier: NCT02239640.
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Affiliation(s)
| | - Michael T Froehler
- Cerebrovascular Program, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Reza Jahan
- Department of Radiology, University of California Los Angeles, Los Angeles, California, USA
| | | | - David Liebeskind
- Neurovascular Imaging Core and UCLA Stroke Center, Department of Neurology, University of California Los Angeles, Los Angeles, California, USA
| | - Jeffrey L Saver
- Department of Neurology, University of California Los Angeles, Los Angeles, California, USA
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49
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Baharvahdat H, Ooi YC, Khatibi K, Ponce Mejia LL, Kaneko N, Nour M, Szeder V, Jahan R, Tateshima S, Vinuela F, Duckwiler G, Colby G. Increased Rate of Successful First Passage Recanalization During Mechanical Thrombectomy for M2 Occlusion. World Neurosurg 2020; 139:e792-e799. [PMID: 32371079 DOI: 10.1016/j.wneu.2020.04.159] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mechanical thrombectomy (MT) is the standard of care for the treatment of acute ischemic stroke (AIS) caused by anterior circulation large-vessel occlusion. However, the true safety and efficacy of MT in medium-size vessel occlusions such as the M2 segment of the middle cerebral artery have yet to be completely defined. In this study, we analyze the safety and efficacy of MT in M2 occlusions compared with M1 occlusions. METHODS A retrospective analysis was performed of patients with AIS secondary to M1 and M2 occlusions between 2011 and 2018. The inclusion criteria were 1) AIS secondary to M1 or M2 occlusion, 2) MT performed by stentrieval technique alone, aspiration technique, or combined stentrieval-aspiration techniques. Basic patient characteristics, number of passages, first passage recanalization success (≥TICI [Thrombolysis in Cerebral Ischemia] grade 2b), total recanalization success, hemorrhagic complications (including intracerebral hemorrhage [ICH] and subarachnoid hemorrhage), and clinical outcomes were compared between both groups. RESULTS Two hundred and sixty patients met the inclusion criteria; 171 patients had M1 occlusion versus 89 with M2 occlusion. First passage recanalization success rate was significantly higher in the M2 group (55.1% vs. 39.2%; P = 0.015). Total recanalization success rate was higher in the M2 group but did not reach significance (83% vs. 75%; P = 0.128). Subarachnoid hemorrhage rate was significantly higher in the M2 group (25% vs. 12%; P = 0.010) but there was no difference for ICH complications (14.6% vs. 16.4%; P = 0.711). CONCLUSIONS MT for M2 occlusions has similar overall efficacy to that for M1 occlusions, but with higher first-pass successful recanalization rates. MT for M2 occlusions has a higher risk of associated subarachnoid hemorrhage.
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Affiliation(s)
- Humain Baharvahdat
- Department of Neurosurgery, University of California, Los Angeles, California, USA
| | - Yinn Cher Ooi
- Division of Interventional Neuroradiology, University of California, Los Angeles, California, USA.
| | - Kasra Khatibi
- Division of Interventional Neuroradiology, University of California, Los Angeles, California, USA
| | - Lucido L Ponce Mejia
- Division of Interventional Neuroradiology, University of California, Los Angeles, California, USA
| | - Naoki Kaneko
- Division of Interventional Neuroradiology, University of California, Los Angeles, California, USA
| | - May Nour
- Division of Interventional Neuroradiology, University of California, Los Angeles, California, USA
| | - Viktor Szeder
- Division of Interventional Neuroradiology, University of California, Los Angeles, California, USA
| | - Reza Jahan
- Division of Interventional Neuroradiology, University of California, Los Angeles, California, USA
| | - Satoshi Tateshima
- Division of Interventional Neuroradiology, University of California, Los Angeles, California, USA
| | - Fernando Vinuela
- Division of Interventional Neuroradiology, University of California, Los Angeles, California, USA
| | - Gary Duckwiler
- Division of Interventional Neuroradiology, University of California, Los Angeles, California, USA
| | - Geoffrey Colby
- Department of Neurosurgery, University of California, Los Angeles, California, USA
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50
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Bosson N, Gausche-Hill M, Saver JL, Sanossian N, Tadeo R, Clare C, Perez L, Williams M, Rasnake S, Nguyen PL, Taqui A, Evans-Cobb C, Gaffney D, Duckwiler G, Ganguly G, Sung G, Kaufman H, Rokos I, Tarpley J, Anotado J, Nour M, Jocson M, Ramezan N, Patel N, Lyden P, Jahan R, Burrus T, Mack W, Ajani Z. Increased Access to and Use of Endovascular Therapy Following Implementation of a 2-Tiered Regional Stroke System. Stroke 2020; 51:908-913. [DOI: 10.1161/strokeaha.119.027756] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
We quantified population access to endovascular-capable centers, timing, and rates of thrombectomy in Los Angeles County before and after implementing 2-tiered routing in a regional stroke system of care.
Methods—
In 2018, the Los Angeles County Emergency Medical Services Agency implemented transport of patients with suspected large vessel occlusions identified by Los Angeles Motor Scale ≥4 directly to designated endovascular-capable centers. We calculated population access to a designated endovascular-capable center within 30 minutes comparing 2016, before 2-tiered system planning began, to 2018 after implementation. We analyzed data from stroke centers in the region from 1 year before and after implementation to delineate changes in rates and speed of administration of tPA (tissue-type plasminogen activator) and thrombectomy and frequency of interfacility transfer.
Results—
With implementation of the 2-tier system, certified endovascular-capable hospitals increased from 4 to 19 centers, and within 30-minute access to endovascular care for the public in Los Angeles County, from 40% in 2016 to 93% in 2018. Comparing Emergency Medical Services–transported stroke patients in the first post-implementation year (N=3303) with those transported in the last pre-implementation year (N=3008), age, sex, and presenting deficit severity were similar. The frequency of thrombolytic therapy increased from 23.8% to 26.9% (odds ratio, 1.2 [95% CI, 1.05–1.3];
P
=0.006), and median first medical contact by paramedic-to-needle time decreased by 3 minutes ([95% CI, 0–5]
P
=0.03). The frequency of thrombectomy increased from 6.8% to 15.1% (odds ratio, 2.4 [95% CI, 2.0–2.9];
P
<0.0001), although first medical contact-to-puncture time did not change significantly, median decrease of 8 minutes ([95% CI, −4 to 20]
P
=0.2). The frequency of interfacility transfers declined from 3.2% to 1.0% (odds ratio, 0.3 [95% CI, 0.2–0.5];
P
<0.0001).
Conclusions—
After implementation of 2-tiered stroke routing in the most populous US county, thrombectomy access increased to 93% of the population, and the frequency of thrombectomy more than doubled, whereas interfacility transfers declined.
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Affiliation(s)
- Nichole Bosson
- From the Department of Emergency Medicine, Harbor-UCLA Medical Center and The Lundquist Institute, Torrance, CA (N.B., M.G.-H.)
- Los Angeles County Emergency Medical Services Agency, Santa Fe Springs, CA (N.B., M.G.-H., R.T., C.C., L.P., M.W., S.R., P.L.-N.)
- David Geffen School of Medicine at UCLA, Los Angeles, CA (N.B., M.G.-H., J.L.S.)
| | - Marianne Gausche-Hill
- From the Department of Emergency Medicine, Harbor-UCLA Medical Center and The Lundquist Institute, Torrance, CA (N.B., M.G.-H.)
- Los Angeles County Emergency Medical Services Agency, Santa Fe Springs, CA (N.B., M.G.-H., R.T., C.C., L.P., M.W., S.R., P.L.-N.)
- David Geffen School of Medicine at UCLA, Los Angeles, CA (N.B., M.G.-H., J.L.S.)
| | - Jeffrey L Saver
- David Geffen School of Medicine at UCLA, Los Angeles, CA (N.B., M.G.-H., J.L.S.)
- Ronald Reagan UCLA Medical Center, Los Angeles, CA (J.L.S.)
| | - Nerses Sanossian
- Keck University School of Medicine at USC, Los Angeles, CA (N.S.)
| | - Richard Tadeo
- Los Angeles County Emergency Medical Services Agency, Santa Fe Springs, CA (N.B., M.G.-H., R.T., C.C., L.P., M.W., S.R., P.L.-N.)
| | - Christine Clare
- Los Angeles County Emergency Medical Services Agency, Santa Fe Springs, CA (N.B., M.G.-H., R.T., C.C., L.P., M.W., S.R., P.L.-N.)
| | - Lorrie Perez
- Los Angeles County Emergency Medical Services Agency, Santa Fe Springs, CA (N.B., M.G.-H., R.T., C.C., L.P., M.W., S.R., P.L.-N.)
| | - Michelle Williams
- Los Angeles County Emergency Medical Services Agency, Santa Fe Springs, CA (N.B., M.G.-H., R.T., C.C., L.P., M.W., S.R., P.L.-N.)
| | - Sara Rasnake
- Los Angeles County Emergency Medical Services Agency, Santa Fe Springs, CA (N.B., M.G.-H., R.T., C.C., L.P., M.W., S.R., P.L.-N.)
| | - Phuong-Lan Nguyen
- Los Angeles County Emergency Medical Services Agency, Santa Fe Springs, CA (N.B., M.G.-H., R.T., C.C., L.P., M.W., S.R., P.L.-N.)
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