المؤلفون: Dmytriw, Adam A, Ghozy, Sherief, Sweid, Ahmad, Piotin, Michel, Bekelis, Kimon, Sourour, Nader, Raz, Eytan, Vela‐Duarte, Daniel, Linfante, Italo, Dabus, Guilherme, Kole, Max, Martínez‐Galdámez, Mario, Nimjee, Shahid M, Lopes, Demetrius K, Hassan, Ameer E, Kan, Peter, Ghorbani, Mohammad, Levitt, Michael R, Escalard, Simon, Missios, Symeon, Shapiro, Maksim, Clarençon, Fréderic, Elhorany, Mahmoud, Tahir, Rizwan A, Youssef, Patrick P, Pandey, Aditya S, Starke, Robert M, Naamani, Kareem El, Abbas, Rawad, Mansour, Ossama Y, Galvan, Jorge, Billingsley, Joshua T, Mortazavi, Abolghasem, Walker, Melanie, Dibas, Mahmoud, Settecase, Fabio, Heran, Manraj KS, Kuhn, Anna L, Puri, Ajit S, Menon, Bijoy K, Sivakumar, Sanjeev, Mowla, Ashkan, D'Amato, Salvatore, Zha, Alicia M, Cooke, Daniel, Vranic, Justin E, Regenhardt, Robert W, Rabinov, James D, Stapleton, Christopher J, Goyal, Mayank, Wu, Hannah, Cohen, Jake, Turkel‐Parella, David, Xavier, Andrew, Waqas, Muhammad, Tutino, Vincent, Siddiqui, Adnan, Gupta, Gaurav, Nanda, Anil, Khandelwal, Priyank, Tiu, Cristina, Portela, Pere C, de la Ossa, Natalia Perez, Urra, Xabier, Lera, Mercedes, Arenillas, Juan F, Ribo, Marc, Requena, Manuel, Piano, Mariangela, Pero, Guglielmo, Sousa, Keith, Al‐Mufti, Fawaz, Hashim, Zafar, Nayak, Sanjeev, Renieri, Leonardo, Du, Rose, Aziz‐Sultan, Mohamed A, Liebeskind, David, Nogueira, Raul G, Abdalkader, Mohamad, Nguyen, Thanh N, Vigilante, Nicholas, Siegler, James E, Grossberg, Jonathan A, Saad, Hassan, Gooch, Michael R, Herial, Nabeel A, Rosenwasser, Robert H, Tjoumakaris, Stavropoula, Patel, Aman B, Tiwari, Ambooj, Jabbour, Pascal, Investigators, North American Neurovascular COVID‐19 Consortium Society of Vascular and Interventional Neurology

المصدر: European Journal of Neurology. 29(11)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Neurosciences, Clinical Sciences, Stroke, Clinical Research, Good Health and Well Being, Brain Ischemia, COVID-19, Cross-Sectional Studies, Endovascular Procedures, Humans, Male, Retrospective Studies, Thrombectomy, Treatment Outcome, large vessel occlusion, morbidity, mortality, stroke, North American Neurovascular COVID-19 (NAN-C) Consortium &, Society of Vascular and Interventional Neurology (SVIN) Investigators, Neurology & Neurosurgery, Clinical sciences

الوصف: Background and purposePrevious studies suggest that mechanisms and outcomes in patients with COVID-19-associated stroke differ from those in patients with non-COVID-19-associated strokes, but there is limited comparative evidence focusing on these populations. The aim of this study, therefore, was to determine if a significant association exists between COVID-19 status with revascularization and functional outcomes following thrombectomy for large vessel occlusion (LVO), after adjustment for potential confounding factors.MethodsA cross-sectional, international multicenter retrospective study was conducted in consecutively admitted COVID-19 patients with concomitant acute LVO, compared to a control group without COVID-19. Data collected included age, gender, comorbidities, clinical characteristics, details of the involved vessels, procedural technique, and various outcomes. A multivariable-adjusted analysis was conducted.ResultsIn this cohort of 697 patients with acute LVO, 302 had COVID-19 while 395 patients did not. There was a significant difference (p

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/9h4007whTest

المؤلفون: Jabbour, Pascal, Dmytriw, Adam A, Sweid, Ahmad, Piotin, Michel, Bekelis, Kimon, Sourour, Nader, Raz, Eytan, Linfante, Italo, Dabus, Guilherme, Kole, Max, Martínez-Galdámez, Mario, Nimjee, Shahid M, Lopes, Demetrius K, Hassan, Ameer E, Kan, Peter, Ghorbani, Mohammad, Levitt, Michael R, Escalard, Simon, Missios, Symeon, Shapiro, Maksim, Clarençon, Frédéric, Elhorany, Mahmoud, Vela-Duarte, Daniel, Tahir, Rizwan A, Youssef, Patrick P, Pandey, Aditya S, Starke, Robert M, Naamani, Kareem El, Abbas, Rawad, Hammoud, Bassel, Mansour, Ossama Y, Galvan, Jorge, Billingsley, Joshua T, Mortazavi, Abolghasem, Walker, Melanie, Dibas, Mahmoud, Settecase, Fabio, Heran, Manraj KS, Kuhn, Anna L, Puri, Ajit S, Menon, Bijoy K, Sivakumar, Sanjeev, Mowla, Ashkan, D'Amato, Salvatore, Zha, Alicia M, Cooke, Daniel, Goyal, Mayank, Wu, Hannah, Cohen, Jake, Turkel-Parrella, David, Xavier, Andrew, Waqas, Muhammad, Tutino, Vincent M, Siddiqui, Adnan, Gupta, Gaurav, Nanda, Anil, Khandelwal, Priyank, Tiu, Cristina, Portela, Pere C, de la Ossa, Natalia Perez, Urra, Xabier, de Lera, Mercedes, Arenillas, Juan F, Ribo, Marc, Requena, Manuel, Piano, Mariangela, Pero, Guglielmo, De Sousa, Keith, Al-Mufti, Fawaz, Hashim, Zafar, Nayak, Sanjeev, Renieri, Leonardo, Aziz-Sultan, Mohamed A, Nguyen, Thanh N, Feineigle, Patricia, Patel, Aman B, Siegler, James E, Badih, Khodr, Grossberg, Jonathan A, Saad, Hassan, Gooch, M Reid, Herial, Nabeel A, Rosenwasser, Robert H, Tjoumakaris, Stavropoula, Tiwari, Ambooj

المصدر: Neurosurgery. 90(6)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Clinical Sciences, Neurosciences, Clinical Research, Brain Disorders, Stroke, Good Health and Well Being, Brain Ischemia, COVID-19, Cerebral Infarction, Humans, Retrospective Studies, Thrombectomy, Treatment Outcome, SARS-CoV-2, Central nervous system, Cerebrovascular disease, Hypercoagulable, Neurology & Neurosurgery, Clinical sciences, Biological psychology

الوصف: BackgroundThe mechanisms and outcomes in coronavirus disease (COVID-19)-associated stroke are unique from those of non-COVID-19 stroke.ObjectiveTo describe the efficacy and outcomes of acute revascularization of large vessel occlusion (LVO) in the setting of COVID-19 in an international cohort.MethodsWe conducted an international multicenter retrospective study of consecutively admitted patients with COVID-19 with concomitant acute LVO across 50 comprehensive stroke centers. Our control group constituted historical controls of patients presenting with LVO and receiving a mechanical thrombectomy between January 2018 and December 2020.ResultsThe total cohort was 575 patients with acute LVO; 194 patients had COVID-19 while 381 patients did not. Patients in the COVID-19 group were younger (62.5 vs 71.2; P < .001) and lacked vascular risk factors (49, 25.3% vs 54, 14.2%; P = .001). Modified thrombolysis in cerebral infarction 3 revascularization was less common in the COVID-19 group (74, 39.2% vs 252, 67.2%; P < .001). Poor functional outcome at discharge (defined as modified Ranklin Scale 3-6) was more common in the COVID-19 group (150, 79.8% vs 132, 66.7%; P = .004). COVID-19 was independently associated with a lower likelihood of achieving modified thrombolysis in cerebral infarction 3 (odds ratio [OR]: 0.4, 95% CI: 0.2-0.7; P < .001) and unfavorable outcomes (OR: 2.5, 95% CI: 1.4-4.5; P = .002).ConclusionCOVID-19 was an independent predictor of incomplete revascularization and poor outcomes in patients with stroke due to LVO. Patients with COVID-19 with LVO were younger, had fewer cerebrovascular risk factors, and suffered from higher morbidity/mortality rates.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/07q4v63kTest

المؤلفون: Shapiro, Maksim, Nossek, Erez, Sharashidze, Vera, Tanaka, Michihiro, Rutledge, Caleb, Chung, Charlotte, Khawaja, Ayaz, Riina, Howard, Nelson, Peter Kim, Raz, Eytan

مصطلحات موضوعية: Spine

الوصف: Understanding normal spinal arterial and venous anatomy, and spinal vascular disease, is impossible without flow-based methods. Development of practical spinal angiography led to site-specific categorization of spinal vascular conditions, defined by the ‘seat of disease’ in relation to the cord and its covers. This enabled identification of targets for highly successful surgical and endovascular treatments, and guided interpretation of later cross-sectional imaging. Spinal dural and epidural arteriovenous fistulas represent the most common types of spinal shunts. Although etiology is debated, anatomy provides excellent pathophysiologic correlation. A spectrum of fistulas, from foramen magnum to the sacrum, is now well-characterized. Most recently, use of cone beam CT angiography has yielded new insights into normal and pathologic anatomy, including venous outflow. It provides unrivaled visualization of the fistula and its relationship with spinal cord vessels, and is the first practical method to study normal and pathologic spinal veins in vivo—with multiple implications for both safety and efficacy of treatments. We advocate consistent use of cone beam CT imaging in modern spinal fistula evaluation. The role of open surgery is likely to remain undiminished, with increasing availability and use of hybrid operating rooms for practical intraoperative angiography enhancing safety and efficacy of complex surgery.

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العلاقة: http://jnis.bmj.com/cgi/content/short/16/6/615Test; http://dx.doi.org/10.1136/jnis-2022-019950Test

الإتاحة: https://doi.org/10.1136/jnis-2022-019950Test
http://jnis.bmj.com/cgi/content/short/16/6/615Test

المؤلفون: Raz, Eytan, Sharashidze, Vera, Nossek, Erez, Sahlein, Daniel H, Rostanski, Sara, Chung, Charlotte Y, Khawaja, Ayaz Mahmood, Nelson, Peter Kim, Shapiro, Maksim

مصطلحات موضوعية: Neuroimaging

الوصف: Background Current imaging algorithms for post-device evaluation are limited by either poor representation of the device or poor delineation of the treated vessel. Combining the high-resolution images from a traditional three-dimensional digital subtraction angiography (3D-DSA) protocol with the longer cone-beam computed tomography (CBCT) protocol may provide simultaneous visualization of both the device and the vessel content in a single volume, improving the accuracy and detail of the assessment. We aim here to review our use of this technique which we termed “SuperDyna”. Methods In this retrospective study, patients who underwent an endovascular procedure between February 2022 and January 2023 were identified. We analyzed patients who had both non-contrast CBCT and 3D-DSA post-treatment and collected information on pre-/post-blood urea nitrogen, creatinine, radiation dose, and the intervention type. Results In 1 year, SuperDyna was performed in 52 (of 1935, 2.6%) patients, of which 72% were women, median age 60 years. The most common reason for the addition of the SuperDyna was for post-flow diversion assessment (n=39). Renal function tests showed no changes. The average total procedure radiation dose was 2.8 Gy, with 4% dose and ~20 mL of contrast attributed to the additional 3D-DSA needed to generate the SuperDyna. Conclusions The SuperDyna is a fusion imaging method that combines high-resolution CBCT and contrasted 3D-DSA to evaluate intracranial vasculature post-treatment. It allows for more comprehensive evaluation of the device position and apposition, aiding in treatment planning and patient education.

وصف الملف: text/html

العلاقة: http://jnis.bmj.com/cgi/content/short/16/5/512Test; http://dx.doi.org/10.1136/jnis-2023-020357Test

الإتاحة: https://doi.org/10.1136/jnis-2023-020357Test
http://jnis.bmj.com/cgi/content/short/16/5/512Test

المؤلفون: Ali, Aryan, Shapiro, Maksim, Nossek, Erez, Esparza, Rogelio, Narayan, Vinayak, Sharashidze, Vera, Raz, Eytan

مصطلحات موضوعية: Technical video

الوصف: Patients with stroke symptoms due to acute basilar artery occlusion can benefit from endovascular thrombectomy.1 2 Several papers have reported unwanted events during thrombectomy procedures such as breakage, fragmentation, or even intravascular migration of the devices or catheter pieces. These papers also presented methods or techniques to retrieve defective devices such as a snare, retrievable stents, or balloons.3–6 Video 1 presents a case of basilar thrombectomy that was complicated with fragmentation and then distal migration of a Marksman microcatheter tip into the left posterior cerebral artery. The video shows the bailout technique that was used to retrieve the migrated catheter tip using a gentle/simple and posterior circulation-friendly technique—a technique based on fundamental neurointerventional concepts. Video 1 This video demonstrates the use of a bailout technique to retrieve a migrated microcatehter tip after basilar artery thrombectomy.

وصف الملف: text/html

العلاقة: http://jnis.bmj.com/cgi/content/short/16/2/217Test; http://dx.doi.org/10.1136/jnis-2022-019687Test

الإتاحة: https://doi.org/10.1136/jnis-2022-019687Test
http://jnis.bmj.com/cgi/content/short/16/2/217Test

المؤلفون: Meyer, Lukas, Stracke, Christian Paul, Broocks, Gabriel, Wallocha, Marta, Elsharkawy, Mohamed, Sporns, Peter B, Piechowiak, Eike I, Kaesmacher, Johannes, Maegerlein, Christian, Hernandez Petzsche, Moritz Roman, Zimmermann, Hanna, Naziri, Weis, Abdullayev, Nuran, Kabbasch, Christoph, Behme, Daniel, Thormann, Maximilian, Maus, Volker, Fischer, Sebastian, Möhlenbruch, Markus A, Weyland, Charlotte Sabine, Langner, Soenke, Ernst, Marielle, Jamous, Ala, Meila, Dan, Miszczuk, Milena, Siebert, Eberhard, Lowens, Stephan, Krause, Lars Udo, Yeo, Leonard LL, Tan, Benjamin Y Q, Gopinathan, Anil, Gory, Benjamin, Galvan Fernandez, Jorge, Schüller Arteaga, Miguel, Navia, Pedro, Raz, Eytan, Shapiro, Maksim, Arnberg, Fabian, Zelenák, Kamil, Martínez-Galdámez, Mario, Alexandrou, Maria, Kastrup, Andreas, Papanagiotou, Panagiotis, Dorn, Franziska, Kemmling, André, Psychogios, Marios-Nikos, Andersson, Tommy, Chapot, René, Fiehler, Jens, Hanning, Uta, From the TOPMOST Study Group, Roth, Christian, Politi, Maria

مصطلحات موضوعية: Ischemic stroke

الوصف: Background Numerous questions regarding procedural details of distal stroke thrombectomy remain unanswered. This study assesses the effect of anesthetic strategies on procedural, clinical and safety outcomes following thrombectomy for distal medium vessel occlusions (DMVOs). Methods Patients with isolated DMVO stroke from the TOPMOST registry were analyzed with regard to anesthetic strategies (ie, conscious sedation (CS), local (LA) or general anesthesia (GA)). Occlusions were in the P2/P3 or A2–A4 segments of the posterior and anterior cerebral arteries (PCA and ACA), respectively. The primary endpoint was the rate of complete reperfusion (modified Thrombolysis in Cerebral Infarction score 3) and the secondary endpoint was the rate of modified Rankin Scale score 0–1. Safety endpoints were the occurrence of symptomatic intracranial hemorrhage and mortality. Results Overall, 233 patients were included. The median age was 75 years (range 64–82), 50.6% (n=118) were female, and the baseline National Institutes of Health Stroke Scale score was 8 (IQR 4–12). DMVOs were in the PCA in 59.7% (n=139) and in the ACA in 40.3% (n=94). Thrombectomy was performed under LA±CS (51.1%, n=119) and GA (48.9%, n=114). Complete reperfusion was reached in 73.9% (n=88) and 71.9% (n=82) in the LA±CS and GA groups, respectively (P=0.729). In subgroup analysis, thrombectomy for ACA DMVO favored GA over LA±CS (aOR 3.07, 95% CI 1.24 to 7.57, P=0.015). Rates of secondary and safety outcomes were similar in the LA±CS and GA groups. Conclusion LA±CS compared with GA resulted in similar reperfusion rates after thrombectomy for DMVO stroke of the ACA and PCA. GA may facilitate achieving complete reperfusion in DMVO stroke of the ACA. Safety and functional long-term outcomes were comparable in both groups.

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العلاقة: http://jnis.bmj.com/cgi/content/short/16/3/230Test; http://dx.doi.org/10.1136/jnis-2023-020210Test

الإتاحة: https://doi.org/10.1136/jnis-2023-020210Test
http://jnis.bmj.com/cgi/content/short/16/3/230Test

المؤلفون: Sharashidze, Vera, Raz, Eytan, Nossek, Erez, Kvint, Svetlana, Riina, Howard, Rutledge, Caleb, Baranoski, Jacob, Khawaja, Ayaz, Chung, Charlotte, Nelson, Peter Kim, Shapiro, Maksim

المصدر: American Journal of Neuroradiology; Jul2024, Vol. 45 Issue 7, p893-898, 6p

المؤلفون: Shapiro, Maksim, Chung, Charlotte, Sharashidze, Vera, Nossek, Erez, Nelson, Peter Kim, Raz, Eytan

المصدر: Neurosurgery Clinics of North America; July 2024, Vol. 35 Issue: 3 p273-286, 14p

مستخلص: Comprehensive understanding of venous anatomy is a key factor in the approach to a multitude of conditions. Moreover, the venous system has become the center of attention as a new frontier for treatment of diseases such as idiopathic intracranial hypertension (IIH), arteriovenous malformation (AVM), pulsatile tinnitus, hydrocephalus, and cerebrospinal fluid (CSF) venous fistulas. Its knowledge is ever more an essential requirement of the modern brain physician. In this article, the authors explore the descriptive and functional anatomy of the venous system of the CNS in 5 subsections: embryology, dural sinuses, cortical veins, deep veins, and spinal veins.

المؤلفون: Mokin, Maxim, Pionessa, Donald, Koenigsknecht, Carmon, Gutierrez, Liza, Setlur Nagesh, Swetadri Vasan, Meess Tuttle, Karen M, Spengler, Mike, Akkad, Yousef, Vakharia, Kunal, Shapiro, Maksim, Gounis, Matthew J, Levy, Elad I, Siddiqui, Adnan H

المساهمون: Radiology

المصدر: Journal of neurointerventional surgery ; England

مصطلحات موضوعية: Artery, Catheter, Liquid Embolic Material, Subdural, Technique

الوصف: Background: Middle meningeal artery (MMA) embolization is a promising intervention as a stand-alone or adjunct treatment to surgery in patients with chronic subdural hematomas. There are currently no large animal models for selective access and embolization of the MMA for preclinical evaluation of this endovascular modality. Our objective was to introduce a novel in vivo model of selective MMA embolization in swine. Methods: Diagnostic cerebral angiography with selective microcatheter catheterization into the MMA was performed under general anesthesia in five swine. Anatomical variants in arterial meningeal supply were examined. In two animals, subsequent embolization of the MMA with a liquid embolic agent (Onyx-18) was performed, followed by brain tissue harvest and histological analysis. Results: The MMA was consistently localized as a branch of the internal maxillary artery just distal to the origin of the ascending pharyngeal artery. Additional meningeal supply was observed from the external ophthalmic artery, although not present consistently. MMA embolization with Onyx was technically successful and feasible. Histological analysis showed Onyx material within the MMA lumen. Conclusions: Microcatheter access into the MMA in swine with liquid embolic agent delivery represents a reproducible model of MMA embolization. Anatomical variations in the distribution of arterial supply to the meninges exist. This model has a potential application for comparing therapeutic effects of various embolic agents in a preclinical setting that closely resembles the MMA embolization procedure in humans.

العلاقة: Journal of NeuroInterventional Surgery; https://doi.org/10.1136/jnis-2024-021481Test; Mokin M, Pionessa D Jr, Koenigsknecht C, Gutierrez L, Setlur Nagesh SV, Meess Tuttle KM, Spengler M, Akkad Y, Vakharia K, Shapiro M, Gounis MJ, Levy EI, Siddiqui AH. A novel swine model of selective middle meningeal artery catheterization and embolization. J Neurointerv Surg. 2024 Feb 22:jnis-2024-021481. doi:10.1136/jnis-2024-021481. Epub ahead of print. PMID: 38388479.; http://hdl.handle.net/20.500.14038/53207Test

الإتاحة: https://doi.org/10.1136/jnis-2024-021481Test
https://doi.org/20.500.14038/53207Test
https://hdl.handle.net/20.500.14038/53207Test

المؤلفون: von Oiste, Grace G, Sangwon, Karl L, Chung, Charlotte, Narayan, Vinayak, Raz, Eytan, Shapiro, Maksim, Rutledge, Caleb, Nelson, Peter Kim, Ishida, Koto, Torres, Jose L, Rostanski, Sara K, Zhang, Cen, Yaghi, Shadi, Riina, Howard, Oermann, Eric K, Nossek, Erez

المصدر: World Neurosurg ; ISSN:1878-8769 ; Volume:182

مصطلحات موضوعية: Carotid bifurcation, Carotid web, Firth regression, Ischemic stroke, Machine learning, Principal component analysis

الوصف: To examine the usefulness of carotid web (CW), carotid bifurcation and their combined angioarchitectural measurements in assessing stroke risk.

العلاقة: https://doi.org/10.1016/j.wneu.2023.11.091Test; https://pubmed.ncbi.nlm.nih.gov/38006939Test

الإتاحة: https://doi.org/10.1016/j.wneu.2023.11.091Test
https://pubmed.ncbi.nlm.nih.gov/38006939Test