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Yoshida S, Kazekawa K, Kamatani K, Maruyama K, Takigawa K, Tashiro N, Hashiguchi Y, Yasaka M, Aikawa H, Go Y. Prediction of obliteration of unruptured cerebral aneurysm by residual aneurysm volume after flow diverter stent treatment. World Neurosurg X 2024; 22:100354. [PMID: 38469386 PMCID: PMC10926355 DOI: 10.1016/j.wnsx.2024.100354] [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: 11/10/2023] [Accepted: 02/21/2024] [Indexed: 03/13/2024] Open
Abstract
Introduction There is no methodology to predict aneurysm occlusion using residual volume after flow diverter stent treatment. We retrospectively examined whether residual aneurysm volume at 6 months postoperatively can predict the degree of aneurysm obliteration at 1 year after flow diverter stent treatment. Materials and Methods This single institution study included 101 consecutive patients who underwent flow diverter stent treatment for unruptured cerebral aneurysm. Based on pre-treatment aneurysm volume, the percentage residual volume was calculated 6 months postoperatively. The volume of the aneurysm was determined using the volume calculation function of the cerebral angiography equipment. 1 year postoperatively, patients were classified into two groups: the good obliteration group (GG; O'KellyMarotta [OKM] grading scale: C and D) and the poor obliteration group (PG; OKM: A and B). Statistical analysis was performed to determine if there was a difference in residual aneurysm volume percentage at 6 months postoperatively between the two groups. Results A total of 20 patients were studied: 6 in the GG and 14 in the PG. Mean residual aneurysm volume at 6 months postoperatively in the GG was 33.1% (±34.7), while that in the PG was 80.6% (±24.8) (P=0.018). A residual aneurysm volume of ≥35.2% at 6 months postoperatively was significantly associated with poor aneurysm obliteration at 1 year postoperatively (AUC=0.88, P=0.008). Conclusions Residual aneurysm volume percentage at 6 months after flow diverter stent treatment might be able to predict the likelihood of aneurysm occlusion at 1 year postoperatively.
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Affiliation(s)
- Shinichiro Yoshida
- Department of Neurosurgery, Fukuoka Neurosurgical Hospital, 5-3-1 Osa, Minamiku, Fukuoka, 811-1313, Japan
| | - Kiyoshi Kazekawa
- Department of Neurosurgery, Fukuoka Neurosurgical Hospital, 5-3-1 Osa, Minamiku, Fukuoka, 811-1313, Japan
| | - Kaisei Kamatani
- Department of Neurosurgery, Fukuoka Neurosurgical Hospital, 5-3-1 Osa, Minamiku, Fukuoka, 811-1313, Japan
| | - Kousei Maruyama
- Department of Neurosurgery, Fukuoka Neurosurgical Hospital, 5-3-1 Osa, Minamiku, Fukuoka, 811-1313, Japan
| | - Kousuke Takigawa
- Department of Neurosurgery, Fukuoka Neurosurgical Hospital, 5-3-1 Osa, Minamiku, Fukuoka, 811-1313, Japan
| | - Noriaki Tashiro
- Depatment of Cerebrovascular Medicine, Fukuoka Neurosurgical Hospital, 5-3-1 Osa, Minamiku, Fukuoka, 811-1313, Japan
| | - Yoshiya Hashiguchi
- Depatment of Cerebrovascular Medicine, Fukuoka Neurosurgical Hospital, 5-3-1 Osa, Minamiku, Fukuoka, 811-1313, Japan
| | - Masahiro Yasaka
- Depatment of Cerebrovascular Medicine, Fukuoka Neurosurgical Hospital, 5-3-1 Osa, Minamiku, Fukuoka, 811-1313, Japan
| | - Hiroshi Aikawa
- Department of Neurosurgery, Fukuoka Neurosurgical Hospital, 5-3-1 Osa, Minamiku, Fukuoka, 811-1313, Japan
| | - Yoshinori Go
- Department of Neurosurgery, Fukuoka Neurosurgical Hospital, 5-3-1 Osa, Minamiku, Fukuoka, 811-1313, Japan
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Hosseini EM, Zafarshamspour S, Ghasemi-Rad M, Benndorf G, Rasekhi A, Rafieossadat R. Endoluminal flow diversion as a primary treatment strategy for pediatric traumatic intracranial aneurysms: a case-based review of literature. Childs Nerv Syst 2024; 40:345-357. [PMID: 37750891 DOI: 10.1007/s00381-023-06161-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/18/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Traumatic intracranial aneurysms (TICAs) constitute a notable portion of pediatric intracranial aneurysms. Their unstable structure dictates a high incidence of rupture or mass effect from enlarging unruptured aneurysms, necessitating prompt diagnosis and treatment. TICAs often lack a true neck or are wide-necked, making them unsuitable for coil embolization and surgical clipping, and their fragile nature poses a risk of rupture during surgical and intrasaccular interventions. Endoluminal flow diverters (FD), deployed without requiring direct access to the aneurysmal sac, have emerged as an appealing sole treatment modality for TICAs. However, the clinical experience with this technique remains limited in the pediatric population. METHOD We describe the successful treatment of a paraclinoid TICA in a 4-year-old female using an endoluminal FD alone. Additionally, we conducted a literature review to assess the safety and effectiveness of this treatment modality in pediatric TICAs. RESULTS Endoluminal flow diversion led to complete aneurysm obliteration in our case, with no observed complication, at the 9-month follow-up. Our review of the previously reported pediatric TICAs managed by standalone flow diversion highlights this technique as safe, efficient, and promising as a sole treatment modality, particularly in the anterior circulation, with a high rate of persistent total obliteration and a low rate of complications. However, the requirement for long-term antiplatelet therapy with the possibility of frequent dose monitoring and adjustments warrants special attention when using endoluminal FDs. Until guidelines specifically addressing optimal antiplatelet therapy in children with intracranial FDs are formulated, adherence to existing protocols is imperative to avoid in-stent thrombosis. CONCLUSION Our literature review and personal experience indicate that endoluminal flow diversion can be a viable treatment approach for pediatric TICAs. However, prospective studies with extensive follow-ups are required to assess the durability of endoluminal FDs in treating pediatric TICAs, considering the long life expectancy of this demographic.
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Affiliation(s)
| | - Saber Zafarshamspour
- Department of Surgery, Rafsanjan University of Medical Sciences, Rafsanjan, Kerman, Iran
| | - Mohammad Ghasemi-Rad
- Department of Interventional Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Goetz Benndorf
- Department of Radiology, University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Alireza Rasekhi
- Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Rafieossadat
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.
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Won D, Workman C, Walker J, Zordani E, Bajaj P, Chen Z, Asthana S, Liu T, Christopher Malaisrie S, McCarthy DM, Adams JG, Lundberg A. When the economy falters, hearts suffer: Economic recessions as a social determinant of health in cardiovascular emergencies. Am J Emerg Med 2024; 76:155-163. [PMID: 38086181 DOI: 10.1016/j.ajem.2023.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 11/16/2023] [Accepted: 11/23/2023] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION While the relationships between cardiovascular disease (CVD), stress, and financial strain are well studied, the association between recessionary periods and macroeconomic conditions on incidence of disease-specific CVD emergency department (ED) visits is not well established. OBJECTIVES This retrospective observational study aimed to assess the relationship between macroeconomic trends and CVD ED visits. METHODS This study uses data from the National Hospital Ambulatory Care Survey (NHAMCS), Federal Reserve Economic Database (FRED), National Bureau of Economic Research (NBER), and CVD groupings from National Vital Statistics (NVS) and Center for Medicare and Medicaid Services (CMS) from 1999 to 2020 to analyze ED visits in relation to macroeconomic indicators and NBER defined recessions and expansions. RESULTS CVD ED visits grew by 79.7% from 1999 to 2020, significantly more than total ED visits (27.8%, p < 0.001). A national estimate of 213.2 million CVD ED visits, with 22.9 million visits in economic recessions were analyzed. A secondary group including a 6-month period before and after each recession (defined as a "broadened recession") was also analyzed to account for potential leading and lagging effects of the recession, with a total of 50.0 million visits. A significantly higher proportion of CVD ED visits related to heart failure (HF) and other acute ischemic heart diseases (IHD) was observed during recessionary time periods both directly and with a 6-month lead and lag (p < 0.05). The proportion of aortic aneurysm and dissection (AAA) and atherosclerosis (ASVD) ED visits was significantly higher (p = 0.024) in the recession period with a 6-month lead and lag. When controlled for common demographic factors, economic approximations of recession such as the CPI, federal funds rate, and real disposable income were significantly associated with increased CVD ED visits. CONCLUSION Macroeconomic trends have a significant relationship with the overall mix of CVD ED visits and represent an understudied social determinant of health.
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Affiliation(s)
- Daniel Won
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Connor Workman
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
| | - James Walker
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Elizabeth Zordani
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Pranav Bajaj
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Zhanlin Chen
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Shravan Asthana
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Tom Liu
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - S Christopher Malaisrie
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Danielle M McCarthy
- Division of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - James G Adams
- Division of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Alex Lundberg
- Division of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Hirai S, Ishikawa M, Sagawa H, Aoyama J, Fujita K, Fujii S, Wakabayashi H, Takahashi S, Sumita K. Ghost twisting of the dual-layer flow-diverting stent. Neuroradiology 2023; 65:1669-1672. [PMID: 37646792 DOI: 10.1007/s00234-023-03215-9] [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: 05/03/2023] [Accepted: 08/22/2023] [Indexed: 09/01/2023]
Abstract
The twisting phenomenon of the flow diverter stents rarely occurs, but it recently became relatively well-recognized. There have been few reports on single-layer flow diverters only. The Flow Redirection Endoluminal Device (FRED) (MicroVention, Tustin, California) has a unique design characterized by a braided dual-layer self-expanding stent. There have been no reports on the twisting phenomenon of FRED. This study reports two cases of acute in-stent blood flow disturbances after the deployment of FRED in a patient with intracranial aneurysms associated with "ghost twisting." In this phenomenon, the inner layer does not expand with the coning deformation, even though the outer layer is fully open. This was confirmed through high-resolution cone-beam computed tomography, but not conventional angiography. The two cases were successfully treated using balloon angioplasty and showed favorable outcomes. The structural issue of "ghost twisting" was a possible underlying factor for the ischemic complications associated with FRED deployment.
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Affiliation(s)
- Sakyo Hirai
- Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, 113-8519, Japan
| | - Mariko Ishikawa
- Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, 113-8519, Japan
| | - Hirotaka Sagawa
- Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, 113-8519, Japan
| | - Jiro Aoyama
- Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, 113-8519, Japan
| | - Kyohei Fujita
- Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, 113-8519, Japan
| | - Shoko Fujii
- Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, 113-8519, Japan
| | - Hikaru Wakabayashi
- Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, 113-8519, Japan
| | - Satoru Takahashi
- Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, 113-8519, Japan
| | - Kazutaka Sumita
- Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, 113-8519, Japan.
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Nedeljković N, Dobričić V, Bošković J, Vesović M, Bradić J, Anđić M, Kočović A, Jeremić N, Novaković J, Jakovljević V, Vujić Z, Nikolić M. Synthesis and Investigation of Anti-Inflammatory Activity of New Thiourea Derivatives of Naproxen. Pharmaceuticals (Basel) 2023; 16:ph16050666. [PMID: 37242450 DOI: 10.3390/ph16050666] [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: 04/10/2023] [Revised: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
The aim of the study was a synthesis and investigation of the dose-dependent anti-inflammatory effect of new thiourea derivatives of naproxen with selected aromatic amines and esters of aromatic amino acids. The results of the in vivo study indicate that derivatives of m-anisidine (4) and N-methyl tryptophan methyl ester (7) showed the most potent anti-inflammatory activity four hours after injection of carrageenan, with the percentage of inhibition of 54.01% and 54.12%, respectively. In vitro assays of COX-2 inhibition demonstrated that none of the tested compounds achieved 50% inhibition at concentrations lower than 100 µM. On the other hand, the aromatic amine derivatives (1-5) accomplished significant inhibition of 5-LOX, and the lowest IC50 value was observed for compound 4 (0.30 μM). High anti-edematous activity of compound 4 in the rat paw edema model, together with potent inhibition of 5-LOX, highlight this compound as a promising anti-inflammatory agent.
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Affiliation(s)
- Nikola Nedeljković
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica 69, 34000 Kragujevac, Serbia
| | - Vladimir Dobričić
- Department of Pharmaceutical Chemistry, University of Belgrade-Faculty of Pharmacy, Vojvode Stepe 450, 11221 Belgrade, Serbia
| | - Jelena Bošković
- Department of Pharmaceutical Chemistry, University of Belgrade-Faculty of Pharmacy, Vojvode Stepe 450, 11221 Belgrade, Serbia
| | - Marina Vesović
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica 69, 34000 Kragujevac, Serbia
| | - Jovana Bradić
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica 69, 34000 Kragujevac, Serbia
- Center of Excellence for Redox Balance Research in Cardiovascular and Metabolic Disorders, Svetozara Markovica 69, 34000 Kragujevac, Serbia
| | - Marijana Anđić
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica 69, 34000 Kragujevac, Serbia
- Center of Excellence for Redox Balance Research in Cardiovascular and Metabolic Disorders, Svetozara Markovica 69, 34000 Kragujevac, Serbia
| | - Aleksandar Kočović
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica 69, 34000 Kragujevac, Serbia
- Center of Excellence for Redox Balance Research in Cardiovascular and Metabolic Disorders, Svetozara Markovica 69, 34000 Kragujevac, Serbia
| | - Nevena Jeremić
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica 69, 34000 Kragujevac, Serbia
- Center of Excellence for Redox Balance Research in Cardiovascular and Metabolic Disorders, Svetozara Markovica 69, 34000 Kragujevac, Serbia
- 1st Moscow State Medical, University IM Sechenov, Trubetskaya 8/2, 119991 Moscow, Russia
| | - Jovana Novaković
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica 69, 34000 Kragujevac, Serbia
- Center of Excellence for Redox Balance Research in Cardiovascular and Metabolic Disorders, Svetozara Markovica 69, 34000 Kragujevac, Serbia
| | - Vladimir Jakovljević
- Center of Excellence for Redox Balance Research in Cardiovascular and Metabolic Disorders, Svetozara Markovica 69, 34000 Kragujevac, Serbia
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica 69, 34000 Kragujevac, Serbia
- Department of Human Pathology, 1st Moscow State Medical, University IM Sechenov, Trubetskaya 8/2, 119991 Moscow, Russia
| | - Zorica Vujić
- Department of Pharmaceutical Chemistry, University of Belgrade-Faculty of Pharmacy, Vojvode Stepe 450, 11221 Belgrade, Serbia
| | - Miloš Nikolić
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica 69, 34000 Kragujevac, Serbia
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Soydemir E, Gündoğmuş CA, Türeli D, Andaç Baltacıoğlu N, Bayri Y, Baltacıoğlu F. Safety and efficacy of flow diverter stents in the treatment of middle cerebral artery aneurysms: a single-center experience and follow-up data. Diagn Interv Radiol 2023; 29:350-358. [PMID: 36988000 PMCID: PMC10679704 DOI: 10.4274/dir.2022.211050] [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: 10/19/2021] [Accepted: 04/04/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE This study aims to evaluate the safety and efficacy of flow diverters (FDs) in the treatment of middle cerebral artery (MCA) aneurysms and share the follow-up (F/U) results. METHODS The treatment and F/U results of 76 MCA aneurysms treated with the flow re-direction endoluminal device (FRED), FRED Jr., and pipeline embolization device (PED) FD stents were evaluated retrospectively. The aneurysm occlusion rates were compared between FDs, and the integrated and jailed branches were evaluated through follow-ups. The oversizing of the stent was compared between occluded/non-occluded aneurysms and integrated branches. RESULTS The mean F/U duration was 32 ± 6.3 months, and the mean aneurysm diameter was 4.45 mm. A total of 61 (80.3%) aneurysms were wide-necked; 73 (96.1%) were saccular; 52 (68.4%) were located at the M1 segment; and 36 (45.6%) FREDs, 23 (29.1%) FRED Jr.s, and 19 (24.1%) PEDs were used for treatment. The overall occlusion rates for the 6-, 12-, 24-, 36-, and 60-month digital subtraction angiographies were 43.8%, 63.5%, 73.3%, 85.7%, and 87.5% respectively. The last F/U occlusion rates were 67.6% for FRED, 66.7% for PED, and 60.6% for FRED Jr. (P = 0.863). An integrated branch was covered with an FD during the treatment of 63 (82.8%) aneurysms. A total of six (10%) of the integrated branches were occluded without any symptoms at the last F/U appointment. The median oversizing was 0.45 (0-1.30) for occluded aneurysms, and 0.50 (0-1.40) for non-occluded aneurysms (P = 0.323). The median oversizing was 0.70 (0.45-1.10) in occluded integrated branches and 0.50 (0-1.40) in non-occluded branches (P = 0.131). In-stent stenosis was seen in 22 (30.1%) of the stents at the 6-month F/U and in only 2 (4.7%) at the 24-month F/U. Thus, none of the patients had any neurological deficits because of the in-stent stenosis. Severe in-stent stenosis was seen in two stents. CONCLUSION MCA aneurysms tend to be complex, with integrated branches and potentially wide necks. FD stents are safe and effective in the treatment of MCA aneurysms, and the patency of the side and jailed branches is preserved in most cases. Higher occlusion and lower in-stent stenosis rates are seen with longer F/U durations.
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Affiliation(s)
- Efe Soydemir
- Department of Radiology, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Cemal Aydın Gündoğmuş
- Department of Radiology, Marmara University Faculty of Medicine, İstanbul, Turkey
- Department of Radiology, Koç University Hospital, İstanbul, Turkey
| | - Derya Türeli
- Department of Radiology, Marmara University Faculty of Medicine, İstanbul, Turkey
| | | | - Yaşar Bayri
- Department of Neurosurgery, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Feyyaz Baltacıoğlu
- Department of Radiology, Marmara University Faculty of Medicine, İstanbul, Turkey
- Department of Radiology, VKV Amerikan Hospital, İstanbul, Turkey
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Simgen A, Roth C, Kulikovski J, Papanagiotou P, Roumia S, Dietrich P, Mühl-Benninghaus R, Kettner M, Reith W, Yilmaz U. Endovascular treatment of unruptured intracranial aneurysms with flow diverters: A retrospective long-term single center analysis. Neuroradiol J 2023; 36:76-85. [PMID: 35695038 PMCID: PMC9893170 DOI: 10.1177/19714009221108678] [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] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The introduction of flow diverters (FDs) in 2007 greatly enhanced the treatment of intracranial aneurysms. Here, we present our long-term clinical experience in treating unruptured intracranial aneurysms with FDs. METHODS 107 patients with unruptured aneurysms and treated with an FD between 2010 and 2019 were retrospectively reviewed. Aneurysm occlusion, procedural complications, and clinical outcome were evaluated. RESULTS Angiographic follow-up was available for 93 patients with a mean long-term follow-up time of 28.4 ± 21.6 months. Additional coiling was performed in 15.1% of patients (n = 14). Adequate aneurysm occlusion (Kamran grades 3 and 4) at long-term follow-up was achieved in 94.6% of patients (n = 88). 3.2% (n = 3) required endovascular retreatment since the last follow-up showed a lack of aneurysm occlusion (Kamran grade 0) due to a foreshortening of the FD. Incomplete opening of the FD and parent vessel occlusion was seen in 1.1% (n = 1) and 3.2% (n = 3) of patients, respectively. In-stent stenosis was observed in 57% (n = 53) of cases at short-term follow-up and 22.6% (n = 21) at long-term, which were moderate and asymptomatic overall. In-stent stenosis decreased significantly between short- and long-term follow-ups (31.4 ± 17.0% vs 9.7 ± 13.6%, respectively; p ≤ 0.001). Thromboembolic and hemorrhagic events occurred in 7.5% (n = 7) and 1.1% (n = 1) of patients, respectively. Good clinical outcome (modified Rankin scale: 0-2) was obtained in 97.8% (n = 91) leading to an overall treatment-related morbidity of 2.2% (n = 2). There was no procedural mortality. CONCLUSION Our study shows that FD treatment of unruptured intracranial aneurysms is effective and safe with high occlusion rates and low rates of permanent morbidity at long-term follow-up.
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Affiliation(s)
- Andreas Simgen
- Department of Neuroradiology, Saarland University
Hospital, Homburg/Saar, Germany
| | - Christian Roth
- Department of Neuroradiology, Saarland University
Hospital, Homburg/Saar, Germany
| | - Johann Kulikovski
- Department of Neuroradiology, Saarland University
Hospital, Homburg/Saar, Germany
| | | | - Safwan Roumia
- Department of Neuroradiology, Saarland University
Hospital, Homburg/Saar, Germany
| | - Philipp Dietrich
- Department of Neuroradiology, Saarland University
Hospital, Homburg/Saar, Germany
| | | | - Michael Kettner
- Department of Neuroradiology, Saarland University
Hospital, Homburg/Saar, Germany
| | - Wolfgang Reith
- Department of Neuroradiology, Saarland University
Hospital, Homburg/Saar, Germany
| | - Umut Yilmaz
- Department of Neuroradiology, Saarland University
Hospital, Homburg/Saar, Germany
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8
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Schwarz B, Ritt G, Eberle B. Estimation of Lens Stray Light with Regard to the Incapacitation of Imaging Sensors-Part 2: Validation. Sensors (Basel) 2022; 22:9447. [PMID: 36502145 PMCID: PMC9738133 DOI: 10.3390/s22239447] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/01/2022] [Accepted: 12/01/2022] [Indexed: 06/17/2023]
Abstract
Recently, we developed a simple theoretical model for the estimation of the irradiance distribution at the focal plane of commercial off-the-shelf (COTS) camera lenses in case of laser illumination. The purpose of such a model is to predict the incapacitation of imaging sensors when irradiated by laser light. The model is based on closed-form equations that comprise mainly standard parameters of the laser dazzle scenario and those of the main devices involved (laser source, camera lens and imaging sensor). However, the model also includes three non-standard parameters, which describe the scattering of light within the camera lens. In previous work, we have performed measurements to derive these typically unknown scatter parameters for a collection of camera lenses of the Double-Gauss type. In this publication, we compare calculations based on our theoretical model and the measured scatter parameters with the outcome of stray light simulations performed with the optical design software FRED in order to validate the reliability of our theoretical model and of the derived scatter parameters.
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9
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Salem MM, Elfil M, Aboutaleb PE, Dmytriw AA, Thomas AJ, Hassan AE, Mascitelli JR, Kan P, Jankowitz BT, Burkhardt JK. National Survey on Flow-Diverting Stents for Intracranial Aneurysms in the United States. World Neurosurg 2022; 166:e958-e967. [PMID: 35953041 DOI: 10.1016/j.wneu.2022.07.144] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/29/2022] [Accepted: 07/30/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The Pipeline Embolization Device (PED) has been the only flow-diverting device (FDD) approved by the Food and Drug Administration (FDA) in the U.S. market for nearly a decade, with more FDD choices in the United States following recent FDA approval of the Flow Redirection Endoluminal Device and Surpass. We sought to explore the integration patterns of these devices into practice by U.S. neurointerventionalists. METHODS A 34-question electronic survey was distributed to the U.S. neurointerventional community from different backgrounds (neurosurgery, neurology, radiology) through different organizational links, focusing on technical aspects of device selection and personal preferences/experiences regarding FDD in aneurysms treatment. RESULTS Responses were collected from 120 neurointerventionalists across the United States; operators from a neurosurgery background constituted the majority of respondents (47.5%; 85% of dual-trained). The largest age block was early-to mid-career operators (70.8% aged 36-50 years). Most participants (78.8%) treated a range of 25-100 aneurysms/year with FDDs, with 49.2% of respondents having all the FDA-approved FDDs available in their centers (80.8% academic practice). Femoral access was used by the 67.7% of respondents, without impact of FDD-device on access-type (89.2%). PED was the most commonly used device (70.9%), with 66.7% of respondents reporting using different FDD based on case specifics. Comparing devices preferences by training backgrounds, more neurosurgical operators endorsed PED as their most commonly used device, whereas more interventional neuroradiologists/neurologists reported Surpass and Flow Redirection Endoluminal Device as their most commonly used devices. CONCLUSIONS The results of this survey identify common themes in FDD choices among neurointerventionalists in the U.S. market, along with their integration patterns of the newly introduced devices into clinical practice.
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Affiliation(s)
- Mohamed M Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Mohamed Elfil
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Pakinam E Aboutaleb
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Adam A Dmytriw
- Neuroendovascular program, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
| | - Ajith J Thomas
- Department of Neurosurgery, Cooper University Hospital, Camden, New Jersey, USA
| | - Ameer E Hassan
- Department of Neurology, University of Texas Rio Grande Valley, Valley Baptist Medical Center, Harlingen, Texas, USA
| | - Justin R Mascitelli
- Department of Neurosurgery, University of Texas Health and Science Center at San Antonio, San Antonio, Texas, USA
| | - Peter Kan
- Department of Neurosurgery University of Texas Medical Branch Galveston, Texas, USA
| | - Brian T Jankowitz
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA.
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Housley SB, Cappuzzo JM, Waqas M, Monteiro A, Levy EI, Siddiqui AH. FRED flow diversion with LVIS protection of large posterior communicating artery aneurysm: the "FRELVIS" technique. Neurosurg Focus Video 2022; 7:V4. [PMID: 36425266 PMCID: PMC9664491 DOI: 10.3171/2022.7.focvid2262] [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] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/18/2022] [Indexed: 06/16/2023]
Abstract
Treatment of wide-necked posterior communicating artery (PCoA) aneurysms is extremely challenging, especially in fetal posterior cerebral artery (PCA) configurations. This technical video demonstrates the nuances of an innovative use of flow diversion to treat a recurrent wide-necked PCoA aneurysm. This middle-aged patient presented with recurrence of a previously ruptured, coil-embolized PCoA aneurysm. Initial attempts at Comaneci-assisted coiling were unsuccessful because the coil herniated into the middle cerebral artery (MCA). Therefore, a low-profile visualized intraluminal support (LVIS) was placed in the fetal PCA across the aneurysm ostium and a flow diverter was placed in the internal carotid artery and MCA to constitute a Y-construct. The video can be found here: https://stream.cadmore.media/r10.3171/2022.7.FOCVID2262.
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Affiliation(s)
- Steven B. Housley
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo
| | - Justin M. Cappuzzo
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo
| | - Muhammad Waqas
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo
| | - Andre Monteiro
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo
| | - Elad I. Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
- Canon Stroke and Vascular Research Center, University at Buffalo; and
- Jacobs Institute, Buffalo, New York
| | - Adnan H. Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
- Canon Stroke and Vascular Research Center, University at Buffalo; and
- Jacobs Institute, Buffalo, New York
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11
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Khorasanizadeh M, Shutran M, Schirmer CM, Salem MM, Ringer AJ, Grandhi R, Mitha AP, Levitt MR, Jankowitz BT, Taussky P, Thomas AJ, Moore JM, Ogilvy CS. North American multicenter experience with the Flow Redirection Endoluminal Device in the treatment of intracranial aneurysms. J Neurosurg 2022; 138:933-943. [PMID: 36087324 DOI: 10.3171/2022.7.jns221371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/21/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Flow diverters have revolutionized the endovascular treatment of intracranial aneurysms. Here, the authors present the first large-scale North American multicenter experience using the Flow Redirection Endoluminal Device (FRED) in the treatment of cerebral aneurysms. METHODS Consecutive cerebral aneurysms treated with FRED at 7 North American centers between June 2020 and November 2021 were included. Data collected included patient demographic characteristics, aneurysm characteristics, periprocedural and long-term complications, modified Rankin Scale (mRS) scores, and radiological follow-up. RESULTS In total, 133 aneurysms in 116 patients were treated with 123 FRED deployment procedures and included in this study. One hundred twenty-six aneurysms (94.7%) were unruptured, 117 (88.0%) saccular, and 123 (92.5%) located in anterior circulation. The mean (range) aneurysm maximal width and neck width sizes were 7.2 (1.5-42.5) mm and 4.1 (1.0-15.1) mm, respectively. Successful FRED deployment was achieved in 122 procedures (99.2%). Adjunctive coiling was used in 4 procedures (3.3%). Radiological follow-up was available for 101 aneurysms at a median duration of 7.0 months. At last follow-up, complete occlusion was observed in 55.4% of patients, residual neck in 8.9%, and filling aneurysm in 35.6%; among cases with radiological follow-up duration > 10 months, these values were 21/43 (48.8%), 3/43 (7.0%), and 19/43 (44.2%), respectively. On multivariate regression analysis, age (OR 0.93, p = 0.001) and aneurysm neck size (OR 0.83, p = 0.048) were negatively correlated with odds of complete occlusion at latest follow-up. The retreatment rate was 6/124 (4.8%). The overall complication rate was 31/116 (26.7%). Parent vessel occlusion, covered branch occlusion, and in-stent stenosis were detected in 9/99 (9.1%), 6/63 (9.5%), and 15/99 (15.2%) cases, respectively. The FRED-related, symptomatic, thromboembolic, and hemorrhagic complication rates were 22.4%, 12.9%, 6.9%, and 0.9% respectively. The morbidity rate was 10/116 patients (8.6%). There was 1 death due to massive periprocedural internal carotid artery stroke, and 3.6% of the patients had an mRS score > 2 at the last follow-up (vs 0.9% at baseline). CONCLUSIONS As the first large-scale North American multicenter FRED experience, this study confirmed the ease of successful FRED deployment but suggested lower efficacy and a higher rate of complications than reported by previous European and South American studies on FRED and other flow-diverting devices. The authors recommend judicious use of this device until future studies can better elucidate the long-term outcomes of FRED treatment.
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Affiliation(s)
- MirHojjat Khorasanizadeh
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Max Shutran
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | - Mohamed M Salem
- 3Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrew J Ringer
- 4Mayfield Clinic, TriHealth Neuroscience Institute, Good Samaritan Hospital, Cincinnati, Ohio
| | - Ramesh Grandhi
- 5Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Alim P Mitha
- 6Department of Clinical Neurosciences, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Michael R Levitt
- 7Department of Neurological Surgery, University of Washington, Seattle, Washington; and
| | - Brian T Jankowitz
- 3Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Philipp Taussky
- 5Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Ajith J Thomas
- 8Department of Neurological Surgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Justin M Moore
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Christopher S Ogilvy
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Yoshida S, Maruyama K, Kuwajima T, Hama Y, Morita H, Ota Y, Tashiro N, Hiraoka F, Kawano H, Yano S, Aikawa H, Go Y, Kazekawa K. Successful use of an LVIS device to treat unruptured distal aneurysm of the superior cerebellar artery at a vascular bifurcation. Surg Neurol Int 2022; 13:208. [PMID: 35673657 PMCID: PMC9168393 DOI: 10.25259/sni_201_2022] [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: 02/23/2022] [Accepted: 03/29/2022] [Indexed: 11/04/2022] Open
Abstract
Background Aneurysms of the distal superior cerebellar artery (SCA) account for only a small proportion of all cerebral aneurysms. Reports of the use of flow diverters (FDs) started to appear in 2013. We obtained good results from placement of a low-profile visualized intraluminal support device (LVIS) to treat unruptured distal aneurysm of the SCA at a vascular bifurcation. Case Description A 65-year-old man presented at our hospital with sudden peripheral facial nerve palsy and suspected subarachnoid hemorrhage. Investigational cerebral angiography revealed an aneurysm at the bifurcation of the caudal and rostral trunks of the SCA. An LVIS was placed with the aim of obtaining flow diversion, and cerebral angiography 6 months after this procedure showed disappearance of aneurysm with preservation of the distal SCA. Conclusion Twelve cases of the use of FDs to treat aneurysms of the SCA have been reported previously. However, none of those reports described FD use to treat an aneurysm at a vascular bifurcation, as in the present case. Our results suggested that LVIS placement with the aim of obtaining flow diversion may be useful for the treatment of aneurysms at such sites.
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Affiliation(s)
- Shinichiro Yoshida
- Department of Neurosurgery, Fukuoka Neurosurgical Hospital, Fukuoka, Japan
| | - Kousei Maruyama
- Department of Neurosurgery, Fukuoka Neurosurgical Hospital, Fukuoka, Japan
| | - Takuto Kuwajima
- Department of Neurosurgery, Fukuoka Neurosurgical Hospital, Fukuoka, Japan
| | - Yoshiaki Hama
- Department of Neurosurgery, Fukuoka Neurosurgical Hospital, Fukuoka, Japan
| | - Hiroya Morita
- Department of Neurosurgery, Fukuoka Neurosurgical Hospital, Fukuoka, Japan
| | - Yuichiro Ota
- Department of Neurosurgery, Fukuoka Neurosurgical Hospital, Fukuoka, Japan
| | - Noriaki Tashiro
- Department of Neurosurgery, Fukuoka Neurosurgical Hospital, Fukuoka, Japan
| | - Fumihiro Hiraoka
- Department of Neurosurgery, Fukuoka Neurosurgical Hospital, Fukuoka, Japan
| | - Hiroto Kawano
- Department of Neurosurgery, Fukuoka Neurosurgical Hospital, Fukuoka, Japan
| | - Shigetoshi Yano
- Department of Neurosurgery, Fukuoka Neurosurgical Hospital, Fukuoka, Japan
| | - Hiroshi Aikawa
- Department of Neurosurgery, Fukuoka Neurosurgical Hospital, Fukuoka, Japan
| | - Yoshinori Go
- Department of Neurosurgery, Go Neurosurgical Clinic, Fukuoka, Japan
| | - Kiyoshi Kazekawa
- Department of Neurosurgery, Fukuoka Neurosurgical Hospital, Fukuoka, Japan
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Suyama K, Nakahara I, Matsumoto S, Suyama Y, Morioka J, Hasebe A, Tanabe J, Watanabe S, Kuwahara K. Efficacy of the Flow Re-direction Endoluminal Device for cerebral aneurysms and causes of failed deployment. Neuroradiology 2021; 64:1213-1219. [PMID: 34775530 PMCID: PMC9117365 DOI: 10.1007/s00234-021-02858-w] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 11/08/2021] [Indexed: 11/29/2022]
Abstract
Purpose The Flow Re-direction Endoluminal Device (FRED) has recently become available for flow diversion in Japan. We have encountered cases that failed to deploy the FRED. In this study, we report our initial experience with the FRED for cerebral aneurysms and clarify the causes of failed FRED deployment. Methods A retrospective data analysis was performed to identify patients treated with the FRED between June 2020 and March 2021. Follow-up digital subtraction angiography was performed at 3 and 6 months and assessed using the O’Kelly-Marotta (OKM) grading scale. Results Thirty-nine aneurysms in 36 patients (average age: 54.4 years) were treated with the FRED. The average sizes of the dome and neck were 9.9 mm and 5.2 mm, respectively. In nine patients, additional coiling was performed. In one patient (2.6%), proximal vessel injury caused direct carotid-cavernous fistula during deployment. Ischaemic complications were encountered in one patient (2.6%) with transient symptoms. Angiographic follow-up at 6 months revealed OKM grade C or D in 86.6% of patients. FRED deployment was successful in 35 (92.1%) procedures. In the failure group, the differences between the FRED and the minimum vessel diameter (P = 0.04) and the rate of the parent vessel having an S-shaped curve (P = 0.04) were greater than those in the success group. Conclusions Flow diversion using the FRED is effective and safe for treating cerebral aneurysms. The use of the FRED for patients with an S-shaped curve in the parent vessel and oversizing of more than 2 mm should be considered carefully.
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Affiliation(s)
- Kenichiro Suyama
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, Japan.
| | - Ichiro Nakahara
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, Japan
| | - Shoji Matsumoto
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, Japan
| | - Yoshio Suyama
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, Japan
| | - Jun Morioka
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, Japan
| | - Akiko Hasebe
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, Japan
| | - Jun Tanabe
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, Japan
| | - Sadayoshi Watanabe
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, Japan
| | - Kiyonori Kuwahara
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, Japan
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Halim SA, Khan A, Al-Rawahi A, Al-Harrasi A; Zaheer-Ul-Haq. In silico data mining of large-scale databases for the virtual screening of human interleukin-2 inhibitors. Acta Pharm 2021; 71:33-56. [PMID: 32697741 DOI: 10.2478/acph-2021-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/08/2020] [Indexed: 01/19/2023]
Abstract
Interleukin-2 (IL-2) is involved in the activation and differentiation of T-helper cells. Uncontrolled activated T cells play a key role in the pathophysiology by stimulating inflammation and autoimmune diseases like arthritis, psoriasis and Crohn's disease. T cells activation can be suppressed either by preventing IL-2 production or blocking the IL-2 interaction with its receptor. Hence, IL-2 is now emerging as a target for novel therapeutic approaches in several autoimmune disorders. This study was carried out to set up an effective virtual screening (VS) pipeline for IL-2. Four docking/scoring approaches (FRED, MOE, GOLD and Surflex-Dock) were compared in the re-docking process to test their performance in producing correct binding modes of IL-2 inhibitors. Surflex-Dock and FRED were the best in predicting the native pose in its top-ranking position. Shapegauss and CGO scoring functions identified the known inhibitors of IL-2 in top 1, 5 and 10 % of library and differentiated binders from non-binders efficiently with average AUC of > 0.9 and > 0.7, resp. The applied docking protocol served as a basis for the VS of a large database that will lead to the identification of more active compounds against IL-2.
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15
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Hagemann LT, Ehrle S, Mizaikoff B. Optimizing the Analytical Performance of Substrate-Integrated Hollow Waveguides: Experiment and Simulation. Appl Spectrosc 2019; 73:1451-1460. [PMID: 31397586 DOI: 10.1177/0003702819867342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The goal of this technical note was to compare experimentally and via simulation of eight substrate-integrated hollow waveguide (iHWG) designs, and to predict promising future iHWG structures in lieu of experiments. The iHWGs differed in their geometry (i.e., inlet funnel cross-section and inner channel cross-section), as well as in their material properties (i.e., type of metal, polish of inner channel). Experimentally, calibration functions of isobutane as a model analyte were determined, and the analytical figures of merit, i.e., signal-to-noise ratio, limit of detection, were evaluated for each iHWG. Evaluation of the amount of radiation incident at the real-world and simulated detector revealed that experiment and simulation were in excellent agreement. While material and quality of the inner channel wall did not have a significant influence on the performance, the iHWG geometry profoundly affected the performance in terms of light throughput: Increasing the inlet funnel dimensions and the inner channel cross-section benefits light throughout, and thus, the analytical signal. Based on these results, simulations of not yet fabricated iHWGs were performed and promising new iHWG structures were suggested.
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Affiliation(s)
| | - Sonja Ehrle
- Institute of Analytical and Bioanalytical Chemistry, Ulm, Germany
| | - Boris Mizaikoff
- Institute of Analytical and Bioanalytical Chemistry, Ulm, Germany
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16
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Piano M, Valvassori L, Lozupone E, Pero G, Quilici L, Boccardi E. FRED Italian Registry: a multicenter experience with the flow re-direction endoluminal device for intracranial aneurysms. J Neurosurg 2019; 133:1-8. [PMID: 31075778 DOI: 10.3171/2019.1.jns183005] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/31/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The introduction of flow-diverter devices (FDDs) has revolutionized the endovascular treatment of intracranial aneurysms. Here the authors present their Italian multicenter experience using the flow re-direction endoluminal device (FRED) in the treatment of cerebral aneurysms, evaluating both short- and long-term safety and efficacy of this device. METHODS Between February 2013 and December 2014, 169 consecutive aneurysms treated using FRED in 166 patients were entered into this study across 30 Italian centers. Data collected included patient demographics, aneurysm location and characteristics, baseline angiography, adverse event and serious adverse event information, morbidity and mortality rates, and pre- and posttreatment modified Rankin Scale scores, as well as angiographic and cross-sectional CT/MRI follow-up at 3-6 months and/or 12-24 months per institutional standard of care. All images were reviewed and adjudicated by an independent core lab. RESULTS Of the 169 lesions initially entered into the study, 4 were later determined to be extracranial or nonaneurysmal by the core lab and were excluded, leaving 165 aneurysms in 162 patients treated in 163 procedures. Ninety-one (56.2%) patients were asymptomatic with aneurysms found incidentally. Of the 165 aneurysms, 150 (90.9%) were unruptured. One hundred thirty-four (81.2%) were saccular, 27 (16.4%) were fusiform/dissecting, and the remaining 4 (2.4%) were blister-like. One hundred thirty-seven (83.0%) arose from the anterior circulation.FRED deployment was impossible in 2/163 (1.2%) cases, and in an additional 4 cases (2.5%) the device was misdeployed. Overall mortality and morbidity rates were 4.3% and 7.3%, respectively, with rates of mortality and morbidity potentially related to FRED of up to 2.4% and 6.2%, respectively. Neuroimaging follow-up at 3-6 months showed complete or nearly complete occlusion of the aneurysm in 94% of cases, increasing to 96% at 12-24 months' follow-up. Aneurysmal sac shrinkage was observed in 78% of assessable aneurysms. CONCLUSIONS This preliminary experience using FRED for endovascular treatment of complex unruptured and ruptured aneurysms showed a high safety and efficacy profile that is comparable to those of other FDDs currently in use.
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Affiliation(s)
| | | | - Emilio Lozupone
- 2UOC Radiologia e Neuroradiologia, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Guglielmo Pero
- 1ASST Grande Ospedale Metropolitano Niguarda, Milan; and
| | - Luca Quilici
- 1ASST Grande Ospedale Metropolitano Niguarda, Milan; and
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Hubley L, Roberts J, Meyer J, Moggré A, Marsh S. Optical-Radiation-Calorimeter Refinement by Virtual-Sensitivity Analysis. Sensors (Basel) 2019; 19:E1167. [PMID: 30866546 DOI: 10.3390/s19051167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 02/26/2019] [Accepted: 02/26/2019] [Indexed: 11/16/2022]
Abstract
Digital holographic interferometry (DHI) radiation dosimetry has been proposed as an experimental metrology technique for measuring absorbed radiation doses to water with high spatial resolution via noninvasive optical calorimetry. The process involves digitally recording consecutive interference patterns resulting from variations in the refractive index as a function of the radiation-absorbed dose. Experiments conducted on prototype optical systems revealed the approach to be feasible but strongly dependent on environmental-influence quantities and setup configuration. A virtual dosimeter reflecting the prototype was created in a commercial optical modelling package. A number of virtual phantoms were developed to characterize the performance of the dosimeter under ideal conditions and with simulated disruptions in environmental-influence quantities, such as atmospheric and temperature perturbations as well as mechanical vibrations. Investigations into the error response revealed that slow drifts in atmospheric parameters and heat expansion caused the measured dose to vary between measurements, while atmospheric fluctuations and vibration contributed to system noise, significantly lowering the spatial resolution of the detector system. The impact of these effects was found to be largely mitigated with equalisation of the dosimeter's reference and object path lengths, and by miniaturising the detector. Equalising path lengths resulted in a reduction of 97.5% and 96.9% in dosimetric error introduced by heat expansion and atmospheric drift, respectively, while miniaturisation of the dosimeter was found to reduce its sensitivity to vibrations and atmospheric turbulence by up to 41.7% and 54.5%, respectively. This work represents a novel approach to optical-detector refinement in which metrics from medical imaging were adapted into software and applied to a a virtual-detector system. This methodology was found to be well-suited for the optimization of a digital holographic interferometer.
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Abstract
Flow diversion has become a well-accepted option for the treatment of cerebral aneurysms. Given the significant treatment effect of flow diverters, numerous options have emerged since the initial Pipeline embolization device studies. In this review, the authors describe the available flow diverters, both endoluminal and intrasaccular, addressing nuances of device design and function and presenting data on complications and outcomes, where available. They also discuss possible future directions of flow diversion.
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Affiliation(s)
- Gary Rajah
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Sandra Narayanan
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan
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Halim SA, Khan S, Khan A, Wadood A, Mabood F, Hussain J, Al-Harrasi A. Targeting Dengue Virus NS-3 Helicase by Ligand based Pharmacophore Modeling and Structure based Virtual Screening. Front Chem 2017; 5:88. [PMID: 29164104 PMCID: PMC5671650 DOI: 10.3389/fchem.2017.00088] [Citation(s) in RCA: 16] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 10/16/2017] [Indexed: 12/25/2022] Open
Abstract
Dengue fever is an emerging public health concern, with several million viral infections occur annually, for which no effective therapy currently exist. Non-structural protein 3 (NS-3) Helicase encoded by the dengue virus (DENV) is considered as a potential drug target to design new and effective drugs against dengue. Helicase is involved in unwinding of dengue RNA. This study was conducted to design new NS-3 Helicase inhibitor by in silico ligand- and structure based approaches. Initially ligand-based pharmacophore model was generated that was used to screen a set of 1201474 compounds collected from ZINC Database. The compounds matched with the pharmacophore model were docked into the active site of NS-3 helicase. Based on docking scores and binding interactions, 25 compounds are suggested to be potential inhibitors of NS3 Helicase. The pharmacokinetic properties of these hits were predicted. The selected hits revealed acceptable ADMET properties. This study identified potential inhibitors of NS-3 Helicase in silico, and can be helpful in the treatment of Dengue.
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Affiliation(s)
- Sobia A Halim
- Department of Biochemistry, Kinnaird College for Women, Lahore, Pakistan
| | - Shanza Khan
- Department of Biochemistry, Kinnaird College for Women, Lahore, Pakistan
| | - Ajmal Khan
- Department of Chemistry, COMSATS Institute of Information Technology, Abbottabad, Pakistan.,UoN Chair of Oman Medicinal Plants and Marine Products, University of Nizwa, Nizwa, Oman
| | - Abdul Wadood
- Department of Biochemistry, Shankar Campus, Abdul Wali Khan University Mardan, Mardan, Pakistan
| | - Fazal Mabood
- Department of Biological Sciences and Chemistry, College of Arts and Sciences, University of Nizwa, Nizwa, Oman
| | - Javid Hussain
- Department of Biological Sciences and Chemistry, College of Arts and Sciences, University of Nizwa, Nizwa, Oman
| | - Ahmed Al-Harrasi
- UoN Chair of Oman Medicinal Plants and Marine Products, University of Nizwa, Nizwa, Oman
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Mahboobani NR, Chong WH, Lam SSK, Siu JCW, Tan CB, Wong YC. Treatment of Intracranial Aneurysms with Flow Re-direction Endoluminal Device - A Single Centre Experience with Short-term Follow-up Results. Neurointervention 2017; 12:11-19. [PMID: 28316865 PMCID: PMC5355456 DOI: 10.5469/neuroint.2017.12.1.11] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 01/02/2017] [Indexed: 11/30/2022] Open
Abstract
Purpose A flow diverter (FD) is an effective treatment option for intracranial aneurysms. The Flow Re-direction Endoluminal Device (FRED) is a relatively new flow diverter with a unique dual-layer design. We report our experience and short-term results with the FRED. Materials and Methods We did a retrospective review of all consecutive cases in which the FRED was used to treat intracranial aneurysms at a single institution from March 2014 till December 2015. Clinical parameters, aneurysm characteristics, technical results and short-term outcomes were reviewed. Results Eleven intracranial aneurysms were treated with the FRED in 11 patients. The technical device deployment success rate was 100%. Immediate reduction in intra-aneurysmal flow after deployment was noted in 10 cases. The aneurysm occlusion rate at 6 months was 75%. There was 1 complication of in-stent thrombosis immediately after deployment. There was no side branch occlusion, delayed aneurysm rupture, stroke, or intraparenchymal haemorrhage. There was no neurological deficit, morbidity, or mortality. Conclusion The FRED is a new FD. It has shown to be safe and effective in our series. The unique dual-layer design of the device renders it to have technical advantages over other FDs. The 6-month aneurysm occlusion rate and complication profile of FRED are similar to other FDs.
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Affiliation(s)
| | - Wing Ho Chong
- Department of Radiology, Tuen Mun Hospital, Hong Kong
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21
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Briganti F, Leone G, Ugga L, Marseglia M, Solari D, Caranci F, Mariniello G, Maiuri F, Cappabianca P. Safety and efficacy of flow re-direction endoluminal device ( FRED) in the treatment of cerebral aneurysms: a single center experience. Acta Neurochir (Wien) 2016; 158:1745-55. [PMID: 27357157 DOI: 10.1007/s00701-016-2875-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 06/07/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Experience with the endovascular treatment of cerebral aneurysms by the Flow Re-Direction Endoluminal Device (FRED) is still limited. The aim of this study is to discuss the results and complications of this new flow diverter device (FDD). METHODS Between November 2013 and April 2015, 20 patients (15 female and five male) harboring 24 cerebral aneurysms were treated with FRED FDD in a single center. RESULTS Complete occlusion was obtained in 20/24 aneurysms (83 %) and partial occlusion in four (17 %). Intraprocedural technical complication occurred in one case (4 %) and post-procedural complications in three (12 %). None reported neurological deficits (mRS = 0). All FRED were patent at follow-up. No early or delayed aneurysm rupture, no subarachnoid (SAH) or intraparenchymal hemorrhage (IPH) no ischemic complications and no deaths occurred. CONCLUSIONS Endovascular treatment with FRED FDD is a safe treatment for unruptured cerebral aneurysms, resulting in a high rate of occlusion. The FRED is substantially equivalent to the other known FDDs, which show similar functions and technical profiles.
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Abstract
Endovascular therapy is now the treatment of choice for intracranial aneurysms (IAs) for its efficacy and safety profile. The use of flow diversion (FD) has recently expanded to cover many types of IAs in various locations. Some institutions even attempt FD as first line treatment for unruptured IAs. The most widely used devices are the pipeline embolization device (PED), the SILK flow diverter (SFD), the flow redirection endoluminal device (FRED), and Surpass. Many questions were raised regarding the long-term complications, the optimal regimen of dual antiplatelet therapy, and the durability of treatment effect. We reviewed the literature to address these questions as well as other concerns on FD when treating IAs.
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Affiliation(s)
- Mario Zanaty
- Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University , Philadelphia , PA, USA
| | - Nohra Chalouhi
- Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University , Philadelphia , PA, USA
| | - Stavropoula I Tjoumakaris
- Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University , Philadelphia , PA, USA
| | - Robert H Rosenwasser
- Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University , Philadelphia , PA, USA
| | - L Fernando Gonzalez
- Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University , Philadelphia , PA, USA
| | - Pascal Jabbour
- Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University , Philadelphia , PA, USA
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