المؤلفون: Mahmoud Dibas, Juan Vivanco‐Suarez, Aaron Rodriguez‐Calienes, Ricardo A. Hanel, Gabor Toth, Milagros Galecio‐Castillo, Vitor M. Pereira, David Altschul, Cristian Alva, Johanna T. Fifi, Peter T. Kan, Ajit S. Puri, Ajay K. Wakhloo, Priyank Khandelwal, Mudassir Farooqui, Santiago Ortega‐Gutierrez

المصدر: Stroke: Vascular and Interventional Neurology, Vol 3, Iss S2 (2023)

مصطلحات موضوعية: Neurology. Diseases of the nervous system, RC346-429, Diseases of the circulatory (Cardiovascular) system, RC666-701

الوصف: Introduction Flow diversion (FD) has emerged as an effective treatment option for intracranial aneurysms (IAs). However, there is limited evidence regarding its safety and efficacy specifically for distal aneurysms of the posterior circulation including posterior inferior cerebellar artery (PICA), anterior inferior cerebellar artery (AICA), superior cerebellar artery (SCA), and the P2 and P3 segment of the posterior cerebral artery (PCA). This study aimed to investigate the outcomes of FD for these aneurysms. Methods A retrospective analysis of a multicentric observational registry was performed between 2014 and 2022. Patients harboring distal aneurysms of the posterior circulation including the PICA, AICA, SCA, and PCA P2‐3 treated with FD were included. Aneurysms characteristics and outcomes were calculated for the total series and a comparison was performed between fusiform/dissecting versus saccular aneurysms. The primary outcome was complete occlusion at last imaging follow up which was defined as per the Raymond Roy occlusion scale. Additional outcomes included the retreatment rate, and thromboembolic and hemorrhagic complications Results Overall, 36 patients with 36 aneurysms were treated with FD with a median age in years of 60.0 (interquartile range [IQR]: 52.8‐65.3 years). Of those, 13 were fusiform/dissecting while 23 were saccular IAs. Complete occlusion was achieved in 78.1% for all IAs at a median follow‐up of 14.0 months (IQR: 9.3‐48.6 months). There was no significant difference in rates of complete occlusion between fusiform/dissecting (91.7%) and saccular aneurysms (70%, p=0.151). Thromboembolic and hemorrhagic complications were observed in four cases (11.1%), and retreatment was required for four IAs (11.4%). There was no significant difference in rates of thromboembolic and hemorrhagic complications, or retreatment between fusiform/dissecting and saccular IAs Conclusion This study suggests the safety and efficacy of FD for distal aneurysms of the posterior circulation. Further larger‐scale studies are warranted to confirm these findings and to explore the long‐term safety and efficacy of FD in this specific aneurysm population.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2694-5746Test

الوصول الحر: https://doaj.org/article/08dfbd773d5f470582ee8cc8fc42caaeTest

المؤلفون: Zachary Lodato, Ivo Bach, Humza Haque, Elan Meltzer, Priyank Khandelwal

المصدر: Stroke: Vascular and Interventional Neurology, Vol 3, Iss S2 (2023)

مصطلحات موضوعية: Neurology. Diseases of the nervous system, RC346-429, Diseases of the circulatory (Cardiovascular) system, RC666-701

الوصف: Introduction Cerebral angiography, essential in managing cerebrovascular disorders, exposes patients to ionizing radiation, with dose dependence on procedure complexity, patient's body habitus, and equipment used, raising safety concerns (1,2). Conversion from primary to secondary access site, influenced by anatomical variables, further increases procedure and fluoroscopy time (3). We propose using Computed Tomography Angiography (CTA) prior to DSA for anatomical insights, potentially reducing access site conversion, procedure time, and radiation dose/fluoroscopy time. This study evaluates the impact of pre‐procedural CTA on fluoroscopy time and access site conversion rates. Methods A retrospective chart review was conducted at a single center to collect data for this study. A total of 93 participants who received DSA were evaluated. Variables of interest included whether a CTA was performed prior to DSA, fluoroscopy time, fluoroscopy dose, time per vessel, dose per vessel, average number of vessels imaged, and the conversion rate from radial to femoral access. Descriptive statistics were used to summarize the data, and independent sample t‐tests were conducted to compare the means of continuous variables between the groups that received a CTA Neck prior to DSA and those that did not. All statistical analyses were performed using a significance level of 0.05. Results Out of 93 participants, 61 had a prior CTA neck and 32 did not. The non‐prior CTA group had slightly higher average fluoroscopy time (15.68 vs. 14.30 min, p=0.39) and dose (643.29 vs. 582.90, p=0.37), but lower time per vessel (3.42 vs. 3.65, p=0.58) and higher dose per vessel (162.80 vs. 145.01, p=0.63). They also imaged more vessels on average (4.81 vs. 4.33, p=0.09). Conversion percentage for non‐prior CTA was lower compared to the prior CTA group (6.25% vs. 6.56%) but not statistically significant. Standard deviation for all measures, except for time per vessel, was higher in the non‐prior CTA neck, indicating more variability in this group. Conclusion This retrospective analysis suggests that prior computed tomography angiography (CTA) might lead to reduced fluoroscopy times and dosage during procedures, but the results are not statistically significant at this stage. However, the study indicates that prior CTA cases had a higher percentage of access site conversions, though the sample size was small. Due to these findings, further investigation with a larger sample size is needed to explore these variables more thoroughly. If CTA before digital subtraction angiography (DSA) can indeed decrease procedure time, radiation exposure, and the need for access site conversion, it has the potential to significantly improve functional neurological outcomes. Moreover, it may reduce the occurrence of complications related to radiation exposure and decrease the overall costs associated with performing DSA and related neurointerventions.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2694-5746Test

الوصول الحر: https://doaj.org/article/1f45465de4ed4b10801dc68bf84760e2Test

المؤلفون: Juan Vivanco Suarez, Mahmoud Dibas, Aaron Rodriguez‐Calienes, Gustavo Cortez, Ricardo Hanel, Hidehisa Nishi, Vitor Pereira, Chaim Feigen, David Altschul, Stavros Matsoukas, Johanna Fifi, Muhammad Hafeez, Peter Kan, Anna Kühn, Ajit Puri, Margarita Rabinovic, Ajay Wakhloo, Priyank Khandelwal, Milagros Galecio‐Castillo, Mudassi Farooqui, Santiago Ortega‐Gutierrez

المصدر: Stroke: Vascular and Interventional Neurology, Vol 3, Iss S2 (2023)

مصطلحات موضوعية: Neurology. Diseases of the nervous system, RC346-429, Diseases of the circulatory (Cardiovascular) system, RC666-701

الوصف: Introduction Flow diverters have demonstrated reliable safety and effectiveness for the treatment of selected anterior circulation intracranial aneurysms. However, posterior circulation aneurysms comprise around 10‐15% of all aneurysms, and they frequently present atypical morphological and anatomical characteristics. Furthermore, these lesions have an increased risk of rupture (compared to those in the anterior circulation) with respect to size and higher treatment risks (regardless of the technique). Flow diversion in posterior circulation aneurysms has been described previously with inconsistent clinical and radiological results. Hence, we aimed to compare the safety and effectiveness of FDs in fusiform/dissecting vs. saccular aneurysms located in the vertebrobasilar vessels. Methods We performed a multicenter, retrospective cohort study including 9 centers. All patients treated with FDs for aneurysms located in the posterior circulation (vertebral and basilar arteries) between 2015 and 2022 were included. Patients were divided into two groups according to the morphology of the aneurysm (fusiform/dissecting vs. saccular). The effectiveness outcome was complete aneurysm occlusion (Raymond‐Roy Class 1) at the latest follow‐up. Safety outcomes included the incidence of ischemic/hemorrhagic and mortality. After adjusting for confounders multivariable logistic regressions were performed to compare outcomes of interest. Results A total of 147 patients with 147 aneurysms were included. The fusiform/dissecting group included 85 cases, while the saccular group 62. The saccular group had older patients (median age: fusiform/dissecting, 55 years [45‐64] vs. saccular, 63 years [51‐70.0]; p=.02). The number of female patients was not different between groups (fusiform/dissecting, 42% vs. saccular, 58%; p=.05). Clinical presentation, comorbidities, modified Fisher, and Hunt and Hess were similar. Baseline modified Rankin Score (mRS) was different (mRS 0‐2: fusiform/dissecting, 84% vs. saccular, 98%; p=.030). Previous endovascular treatment (p=.396) was similar. Aneurysm location (most were in the vertebral artery: fusiform/dissecting, 60% vs. saccular, 42%; p=.009) was different. Median aneurysm size (fusiform/dissecting, 10.0 mm [6.5‐18.8] vs. saccular, 5.9 [3.0‐10.0]; p=1 FD: fusiform/dissecting, 36% vs. saccular, 10%; p=

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2694-5746Test

الوصول الحر: https://doaj.org/article/cf2d10b39206481988d4e4f06dba2081Test

المؤلفون: Pradeep Joseph, Ivo Bach, Priyank Khandelwal

المصدر: Stroke: Vascular and Interventional Neurology, Vol 3, Iss S2 (2023)

مصطلحات موضوعية: Neurology. Diseases of the nervous system, RC346-429, Diseases of the circulatory (Cardiovascular) system, RC666-701

الوصف: Introduction Prior research has demonstrated mechanical thrombectomy (MT) to be a safe and effective treatment for stroke patients with a large vessel occlusion (LVO).1 However, MT has generally only been studied in a time window of less than 24 hours.2 To the best of the authors' knowledge, this case report is the first publication of a MT done months after the initial stroke event, in a patient with recurrent strokes and an evolving occlusion visualized in the middle cerebral artery (MCA). Methods The patient is a 55‐year‐old man with a past medical history of a left‐sided MCA stroke 2 months prior to current admission with multiple transient ischemic attacks (TIAs) on dual antiplatelet therapy (DAPT), with no persistent residual deficits. His first stroke was preceded by about 1 week of intermittent confusion and right arm tingling. MRI at the time showed an acute embolic infarct in left MCA territory, and a CTA showed a sub‐occlusive thrombus vs. atherosclerotic plaque in the superior branch of the left MCA. He was discharged on DAPT, but his prior symptoms began to recur on a weekly basis, lasting for a few minutes each time. The patient eventually presented on this admission to the ED with persistent dysarthria and word finding difficulties. Within 4 hours, his exam improved to an NIHSS of 0. An MRI without contrast showed a new acute punctate infarct in the posterior left lateral temporal cortex. CT angiogram showed a persistent left M2 occlusion which was confirmed by the diagnostic cerebral angiogram. CT Perfusion also showed a large penumbra in the same region. The decision was made to perform MT, and complete recanalization was achieved. On 2‐month follow‐up, the patient continues to report no new symptoms since the time of MT. Results The patient’s positive outcome thus far at 60 day follow up indicates that MT can prove safe and efficacious even in significantly delayed time windows. This also shows that the decision to proceed with MT ought not to depend on time interval and degree of collaterals alone, but also on the pattern of symptoms the patient is exhibiting. The recurrent TIAs and strokes our patient was having indicates that, although collaterals had formed in response to his sub‐occlusive thrombus in the MCA, they were still unable to provide full compensation for this lost blood flow, leading to the patient’s intermittent symptoms. Conclusion This report demonstrates that MT can be safely and effectively utilized even in significantly delayed time windows in patients with recurrent TIAs or strokes.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2694-5746Test

الوصول الحر: https://doaj.org/article/1644d5a66ab74142a1c37777989284c0Test

المؤلفون: Keyvan Heshmati, Maria Hernandez, Jai Shahani, Volodymyr Vulkanov, Priyank Khandelwal, Sushanth Aroor

المصدر: Stroke: Vascular and Interventional Neurology, Vol 3, Iss S2 (2023)

مصطلحات موضوعية: Neurology. Diseases of the nervous system, RC346-429, Diseases of the circulatory (Cardiovascular) system, RC666-701

الوصف: Introduction Large vessel occlusions (LVO) account for approximately 15 to 30% of acute ischemic strokes, necessitating rapid clinical recognition to facilitate timely endovascular team activation and reduce door‐to‐reperfusion time for mechanical thrombectomy (MT). Existing clinical LVO scales, such as RACE, FASTED, and VAN, designed for utilization by Emergency Medical Services (EMS), lack reliability and have not been widely adopted for pre‐activation of endovascular teams. Typically, endovascular team activation occurs after LVO confirmation through neuroimaging, highlighting the need for improved methods to identify LVO during early assessments by neurologists. Methods A prospective observational study was conducted at University Hospital, involving all stroke codes activated by the Emergency Department (ED) or EMS. Neurology residents responding to the codes performed initial assessments, encompassing patient history, physical examination, and NIH Stroke Scale (NIHSS) evaluations. Based on the onset and severity of symptoms, presence of cortical signs, and NIHSS scores, patients were classified into four categories: A) probable LVO and stroke, B) possible LVO and stroke, C) not LVO but probable stroke, and D) probable stroke mimic. All assessments were completed before CT scanning. Results Over a ten‐month period, 159 stroke codes were evaluated by neurology residents. Among these, 27 patients were diagnosed with LVO, while 132 patients had no LVO. The neurology residents classified 18 patients into the probable stroke group, demonstrating a sensitivity of 48%, specificity of 96%, a positive predictive value (PPV) of 72%, and a negative predictive value (NPV) of 90%. Combining the probable and possible stroke groups, the residents identified 34 patients with a sensitivity of 74%, specificity of 89%, a PPV of 5%, and an NPV of 94%. Regrettably, seven patients with LVO were misclassified as either stroke mimics or non‐LVO strokes. Among these cases, five patients presented with low NIHSS scores, two had LVO in the posterior circulation, and one developed an in‐stent thrombus. Conclusion Our study revealed that neurology residents' ability to predict LVO was comparable to other LVO prediction scales in terms of sensitivity and specificity, but significantly improved in PPV. With a PPV exceeding 70%, the clinical prediction of LVO by neurology residents proves to be a valuable tool for activating the endovascular team promptly. This approach holds promise for enhancing stroke care in both the emergency department and pre‐hospital ambulance‐based settings. Nevertheless, larger studies are warranted to validate and further refine these findings. Implementing the neurology residents' clinical judgment in LVO identification can potentially optimize patient outcomes and treatment timelines in acute ischemic strokes.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2694-5746Test

الوصول الحر: https://doaj.org/article/972c3780def24c5aae1cc5077e062983Test

المؤلفون: James E. Siegler, Hamza Shaikh, Jane Khalife, Solomon Oak, Linda Zhang, Mohamad Abdalkader, Piers Klein, Thanh N. Nguyen, Tareq Kass‐Hout, Rami Z. Morsi, Jeremy J. Heit, Robert W. Regenhardt, Jose Danilo Bengzon Diestro, Nicole M. Cancelliere, Sherief Ghozy, Ahmad Sweid, Kareem El Naamani, Abdelaziz Amllay, Lukas Meyer, Anne Dusart, Flavio Bellante, Géraud Forestier, Aymeric Rouchaud, Suzana Saleme, Charbel Mounayer, Jens Fiehler, Anna Luisa Kühn, Ajit S. Puri, Christian Dyzmann, Peter T. Kan, Marco Colasurdo, Gaultier Marnat, Jérôme Berge, Xavier Barreau, Igor Sibon, Simona Nedelcu, Nils Henninger, Thomas R. Marotta, Alvin S. Das, Christopher J. Stapleton, James D. Rabinov, Takahiro Ota, Shogo Dofuku, Leonard L.L. Yeo, Benjamin Y.Q. Tan, Juan Carlos Martinez‐Gutierrez, Sergio Salazar‐Marioni, Sunil A. Sheth, Leonardo Renieri, Carolina Capirossi, Ashkan Mowla, Stavropoula I. Tjoumakaris, Pascal Jabbour, Priyank Khandelwal, Arundhati Biswas, Frédéric Clarençon, Mahmoud Elhorany, Kevin Premat, Iacopo Valente, Alessandro Pedicelli, João Pedro Filipe, Ricardo Varela, Miguel Quintero‐Consuegra, Nestor R. Gonzalez, Markus A. Möhlenbruch, Jessica Jesser, Vincent Costalat, Adrien ter Schiphorst, Vivek Yedavalli, Pablo Harker, Lina M. Chervak, Yasmin Aziz, Maria Bres Bullrich, Luciano Sposato, Benjamin Gory, Constantin Hecker, Monika Killer‐Oberpfalzer, Christoph J. Griessenauer, Ajith J. Thomas, Cheng‐Yang Hsieh, David S. Liebeskind, Răzvan Alexandru Radu, Andrea M. Alexandre, Illario Tancredi, Tobias D. Faizy, Robert Fahed, Charlotte Weyland, Aman B. Patel, Vitor Mendes Pereira, Boris Lubicz, Adrien Guenego, Adam A. Dmytriw

المصدر: Stroke: Vascular and Interventional Neurology, Vol 3, Iss 6 (2023)

مصطلحات موضوعية: outcomes research, stroke, thrombectomy, Neurology. Diseases of the nervous system, RC346-429, Diseases of the circulatory (Cardiovascular) system, RC666-701

الوصف: Background For acute proximal intracranial artery occlusions, contact aspiration may be more effective than stent‐retriever for first‐line reperfusion therapy. Due to the lack of data regarding medium vessel occlusion thrombectomy, we evaluated outcomes according to first‐line technique in a large, multicenter registry. Methods Imaging, procedural, and clinical outcomes of patients with acute proximal medium vessel occlusions (M2, A1, or P1) or distal medium vessel occlusions (M3, A2, P2, or further) treated at 37 sites in 10 countries were analyzed according to first‐line endovascular technique (stent‐retriever versus aspiration). Multivariable logistic regression and propensity‐score matching were used to estimate the odds of the primary outcome, expanded Thrombolysis in Cerebral Infarction score of 2b–3 (“successful recanalization”), as well as secondary outcomes (first‐pass effect, expanded Thrombolysis in Cerebral Infarction 2c‐3, intracerebral hemorrhage, and 90‐day modified Rankin scale, 90‐day mortality) between treatment groups. Results Of the 440 included patients (44.5% stent‐retriever versus 55.5% aspiration), those treated with stent‐retriever had lower baseline Alberta Stroke Program Early Computed Tomography Scale scores (median 8 versus 9; P

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2694-5746Test

الوصول الحر: https://doaj.org/article/ba3e488b0a38477d9ab07c71dade0116Test

المؤلفون: James Lee, Taha Nisar, Muhammad Z Memon, Arundhati Biswas, Ivo Bach, Gaurav Gupta, Amit Singla, Ashish Sonig, Ajit Puri, Sudhakar R Satti, Santiago Ortega‐Gutierrez, Priyank Khandelwal

المصدر: Stroke: Vascular and Interventional Neurology, Vol 3, Iss S1 (2023)

مصطلحات موضوعية: Neurology. Diseases of the nervous system, RC346-429, Diseases of the circulatory (Cardiovascular) system, RC666-701

الوصف: Introduction Transradial access (TRA) for neuroendovascular interventions has been associated with multiple benefits, including decreased risk of complications, faster recovery times, and improved overall patient satisfaction in comparison to transfemoral access (TFA). We sought to assess the safety and suitability of an 088 catheter, in this case the Infinity guide catheter, to understand the optimal patient population for utilization in neurointerventions. To our knowledge, this is the first prospective study to investigate procedural characteristics and complications associated with the use of an 088 catheter. Methods After obtaining approval from our Institutional Review Board, prospective patients undergoing neurointerventional procedures at our institution, beginning from December 2020 to present, were serially enrolled after evaluation for suitability for TRA by ultrasound visualization and measurement of vessel diameter. A prospective Excel database was generated on an encrypted and password‐protected computer, with variables including patient demographics, co‐morbidities, procedure type, catheter specifics, vessel diameter, procedural characteristics, TRA to TFA conversion, and complications. Results 78 patients were enrolled over a 1.5 year study period (Table 1). The average patient age was 62.4 ± 16.1 years, with a moderate male predilection (46/78 (59%)). Procedure subtypes for enrolled patients included 36 (46.2%) patients who underwent stroke intervention, 6 (7.7%) aneurysm coil embolization, 9 (11.5%) aneurysm flow diversion, 5 (6.4%) carotid stenting, 5 (6.4%) AVM/AVF embolization, 4 (5.1%) tumor embolization, and 13 other procedures (9 (11.5%) MMA embolization, 3 (3.8%) vessel embolization, 1 (1.3%) aneurysm Onyx embolization). All procedures were performed via right radial access under direct ultrasound visualization. Average radial diameter was 2.97 ± 0.46mm and average fluoroscopy time was 48.99 ± 23.54 minutes. Parent vessel spasm was noted in 25/78 (32.1%) of cases and guide catheter kinking was noted in 4/78 (5.1%). TRA to TFA conversion was noted in 14/78 (17.9%) patients, primarily due to vessel tortuosity (57.1%; 8/14 cases). Minor complications included post‐procedural hand/wrist pain in 14/78 (17.9%) patients, and hand bruising in 6/78 (7.7%). Post‐operative vessel patency was noted in 71/78 (91%) of cases via ultrasound, with 57/78 (73.1%) having good pulsation noted on reverse Barbeau testing. No serious radial artery complications were noted. The overall rate of major complications was 7.7%, with two cases of ischemic stroke, contrast extravasation/intracerebral hemorrhage, and vessel rupture noted. Conclusions This prospective pilot study demonstrates the safety and suitability of the 088 Infinity guide catheter via TRA radial approach for neuroendovascular interventions. Further studies will be needed to assess the efficacy of the 088 Infinity in comparison to other 088 catheters, as well as the optimal settings by which we can minimize rates of TFA conversion and TRA‐related complications.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2694-5746Test

الوصول الحر: https://doaj.org/article/26e7b24224194864993d0e56ec0cb275Test

المؤلفون: Taha Nisar, Toluwalase Tofade, Shaul Shaulov, Sara Shapouran, Osama Abu‐hadid, Priyank Khandelwal

المصدر: Stroke: Vascular and Interventional Neurology, Vol 3, Iss S1 (2023)

مصطلحات موضوعية: Neurology. Diseases of the nervous system, RC346-429, Diseases of the circulatory (Cardiovascular) system, RC666-701

الوصف: Introduction Higher blood pressure (BP) is considered to be harmful in patients who undergo mechanical thrombectomy (MT), however, the impact of BP post‐MT based on comorbidities like anemia has not been well studied. We aim to determine the association of 24‐h post‐MT BP parameters with mortality depending on the anemia status. Methods We conducted a retrospective chart review of patients who underwent MT at a comprehensive stroke center from 7/2014 to 12/2020. Patients were dichotomized into anemic and non‐anemic groups based on the World Health Organization’s definition of anemia [hemoglobin < 12.0 g/dL in women and < 13.0 g/dL in men]. We performed a binary logistic regression analysis controlling for baseline parameters, with the 24‐h post‐MT BP parameters as predictors. The primary outcome was 3‐month mortality. Results 220 patients met the inclusion criteria. The 3‐month mortality rate was 27.27%. In the multivariable analysis, the 24‐h parameters of a lower mean DBP (65.53±9.73 vs. 71.94±10.16; OR, 0.92; 95% CI, 0.86‐0.98; P 0.007), lower mean MAP (85.7±8.65 vs. 91.38±10; OR, 0.93; 95% CI, 0.86‐0.99; P 0.02), a lower minimum DBP (49.27±10.51 vs. 55.1±11.23; OR, 0.93; 95% CI, 0.88‐0.99; P 0.019), a lower minimum MAP (68.96±9.54 vs. 74.73±10.47; OR, 0.93; 95% CI, 0.87‐0.99; P 0.023) were significantly associated with mortality in patients with anemia. There was no association between 24‐hour BP Parameters post‐MT and mortality in non‐anemic patients. Conclusions In our study, lower BP parameters were associated with higher 3‐month mortality in anemic patients, however, this effect was not found in non‐anemic patients. Anemia induces a relative hypoxic state in target tissue in the event of an increase in metabolic demand such as stroke. Higher BP post‐MT can potentially promote perfusion and thus is not associated with worse outcomes in anemic patients post‐MT, whereas in non‐anemic patients it may potentially lead to reperfusion injury.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2694-5746Test

الوصول الحر: https://doaj.org/article/3a9bdeb4e0ea43d29d5e6462b57272edTest

المؤلفون: Fadar O Otite, Smit Patel, Haydn Hoffman, Ameer Hassan, Osama O Zaidat, Santiago Ortega‐Gutierrez, Dileep Yavagal, Priyank Khandelwal

المصدر: Stroke: Vascular and Interventional Neurology, Vol 3, Iss S1 (2023)

مصطلحات موضوعية: Neurology. Diseases of the nervous system, RC346-429, Diseases of the circulatory (Cardiovascular) system, RC666-701

الوصف: Introduction The Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis (SAMMPRIS) trial published in 2010 showed aggressive medical therapy is superior to percutaneous transluminal angioplasty and stenting (PTAS) for intracranial atherosclerotic disease (ICAD). Following the pivotal positive mechanical thrombectomy (MT) trials in 2015, MT utilization in the United States (US) has increased. Rescue ICAD stenting may be needed in MT patients with underlying ICAD but it remains uncertain whether PTAS use for ICAD has changed over this time. The aim of this study is to describe national trends in the utilization of PTAS for ICAD in the US before and after SAMMPRIS and following the pivotal MT trials. Methods We used a constellation of International Classification of Diseases ninth and tenth revision diagnostic/procedural codes to identify all elective and non‐elective adult (> = 18 years) ICAD admissions with or without infarction containing concomitant codes for PTAS in the 2007–2019 National Inpatient Sample. Admissions containing codes for subarachnoid hemorrhage, unruptured intracranial aneurysms or benign intracranial hypertension were excluded. We combined weighted counts of PTAS admissions with annual US adult census data to obtain prevalence of PTAS. We used joinpoint regression to evaluate trends in PTAS use over time. Results Across the study period, there were 16,477 weighted admissions for ICAD undergoing PTAS in the US. 52.4% of these admissions were in patients 60–79years and 43.2% were in women. 74.3% of these admissions were non‐elective and this proportion increased over time (P = 0.019). 26.5% of all admissions had concurrent codes for MT but this proportion increased by almost ten‐fold over time from 4.3% in 2007 to 40.0% in 2019. On join point regression, PTAS utilization increased but insignificantly from 3.0/million population in 2007 to 5.7/million population in 2010 (Annualized percentage change, APC 11.2%, 95%CI ‐11.8 to 40.3, p = 0.290), declined also insignificantly from 2010–2013 (APC ‐13.2, 95%CI ‐48.4 to 45.8, p = 0.514) and increased significantly from 3.55/million in 2013 to 3.80/million in 2014 and exponentially across the rest of the period to 8.4 cases/million in 2019 (APC 15.4, 95%CI 9.2 to 22.0, p = 0.001). Upon stratification by admission type, most of the increase across the period 2013/2014 to 2019 occurred in non‐elective admissions (Figure 1). Utilization in elective admissions varied from 0.92 to 1.96 cases per million population but this did not change significantly across the study period. Conclusions PTAS utilization for ICAD declined in the US after SAMMPRIS but has increased following publication of pivotal MT trials mainly in non‐elective admissions. PTAS utilization increased significantly following publication of pivotal MT trials likely in ICAD patients who required rescue stenting.. Additional prospective studies are needed to determine the long‐term outcomes of concurrent PTAS and MT as this is not a group of patients that was studied in SAMMPRIS.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2694-5746Test

الوصول الحر: https://doaj.org/article/942605108781435ea2029297b27aae31Test

المؤلفون: James Lee, Milagros Galecio‐Castillo, Taha Nisar, Mudassir Farooqui, Andres Dajles, Christopher Talbot, Ashish Sonig, Amit Singla, Gaurav Gupta, Isaac J Abecassis, Stephan Munich, Leonardo Renieri, Robert M Starke, Dileep Yavagal, Santiago Ortega‐Gutierrez, Priyank Khandelwal, Alex Chebl, Ali Mohamud, Daniel Miller

المصدر: Stroke: Vascular and Interventional Neurology, Vol 3, Iss S1 (2023)

مصطلحات موضوعية: Neurology. Diseases of the nervous system, RC346-429, Diseases of the circulatory (Cardiovascular) system, RC666-701

الوصف: Introduction Continued advancements in the treatments for neurological disease have helped interventionalists to refine approaches that offer improved surgical efficacy and patient outcomes. Carotid‐artery stenting (CAS) is a safe and effective alternative to carotid endarterectomy (CEA), that allows for revascularization of the internal carotid artery (ICA) in a minimally‐invasive manner. Traditionally, the mainstay for CAS has been through the femoral artery; however, patients with carotid‐artery disease (CAD) often have concomitant peripheral artery disease which confer increased risk of significant life‐threatening access‐site complications, such as retroperitoneal hematoma and limb ischemia. Given this, CAS via the radial artery has become increasingly popular. This study seeks to investigate the safety and feasibility of the transradial approach (TRA), in comparison to the traditional transfemoral approach (TFA), for carotid‐artery stenting. Methods The authors conducted a retrospective analysis of all adult patients (age >18) who underwent carotid‐artery stenting via TRA or TFA over a 4‐year study period (2018‐2021) across 4 different international academic centers. Important variables, such as patient demographics, comorbidities, procedural details, results, and complications were collected. Statistical analysis was performed to assess the strength of association and correlation for these variables. Results A total of 313 patients were enrolled during the study period. CAS via TFA was attempted in 251 patients and via TRA in 62 patients, respectively. Overall, CAS via TRA was found to be successful in 48/62 (76%) patients, and via TFA in 246/251 (98%) patients. Baseline demographics were similar for the two groups, with a female gender predilection, median age of 69, and hypertension and hyperlipidemia serving as the most common medical comorbidities. 14/62 (22.6%) patients who underwent TRA were converted to TFA. Spasm of the radial artery, kinking of the catheter and severe tortuosity of the vessels were the primary reasons for access site conversion. A total of five major access site‐related complications, including two deaths, and seven minor complications were noted in the TFA cohort. No serious access related complications were noted in the TRA group. In the multivariate‐analysis, after adjusting for age, hyperlipidemia, chronic heart failure, combination of stent plus angioplasty and fluoroscopy times, there was no statistically significant difference observed among the 2 groups in terms of procedural (OR: 0.31; CI: 0.36‐2.69; P = 0.29) and overall access site complications (OR: 0.17, CI: 0.02‐1.98, P = 0.16). Conclusions TRA seems to be a safe alternative approach for carotid stenting. In our cohort, no serious access site‐related complications were noted with TRA in comparison to the TFA group. Continued improvements in terms of patient selection, sample size, as well as advances in technique and technology will help to further refine TRA for CAS. Further studies and analysis will need to be performed to delineate the crucial variables that contribute to improved functional outcomes for these patients.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2694-5746Test

الوصول الحر: https://doaj.org/article/cfdb910a82844dbb915eae930d1e8494Test