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  • Ducruet, Andrew F.  (182)
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  • 1
    Online Resource
    Online Resource
    Nationwide Trends in Carotid Endarterectomy and Carotid Artery Stenting in the Post-CREST Era
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Stroke Vol. 51, No. 2 ( 2020-02), p. 579-587
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 51, No. 2 ( 2020-02), p. 579-587
    Abstract: The CREST (Carotid Revascularization Endarterectomy Versus Stenting Trial) demonstrated equivalent composite outcomes between carotid endarterectomy (CEA) and carotid artery stenting (CAS) for treating carotid stenosis. We investigated nationwide trends in these procedures and associated periprocedural stroke, myocardial infarction, death, cost, and readmission rates since CREST outcomes were published. Methods— We queried the Nationwide Readmissions Database to identify patients undergoing CEA and CAS for asymptomatic and symptomatic carotid stenosis from 2010 to 2015. Patients were matched based on demographics, comorbidities, and severity of illness. Results— In total, 378 354 CEA and 57 273 CAS patients were treated during this 6-year period. CEA volume decreased by an average of 2669 procedures annually ( P =0.001) with stable CAS volume ( P =0.225). After matching, CEA patients had a higher rate of periprocedural stroke than CAS patients, driven by increased stroke risk in symptomatic CEA patients (8.1% versus 5.6%; odds ratio, 1.47 [CI, 1.29–1.68]; P 〈 0.001) but a lower rate of overall inpatient mortality (0.8% versus 1.4%; odds ratio, 0.57 [CI, 0.48–0.68]; P 〈 0.001). CEA patients were less likely to be readmitted within 30 days (7.2% versus 8.0%; odds ratio, 0.90 [CI, 0.84–0.96]; P =0.018) and 90 days (12.3% versus 14.1%; odds ratio, 0.86 [CI, 0.81–0.90]; P 〈 0.001), and mean hospital costs were lower for CEA compared with CAS ($14 433 versus $19 172; P 〈 0.001). Conclusions— The procedural treatment of carotid stenosis has changed dramatically in the post-CREST era. When matched for characteristics and illness severity, patients undergoing CEA had a higher rate of perioperative stroke than patients undergoing CAS, primarily among symptomatic patients. These findings are in contrast to the findings of CREST, which showed nearly twice the risk of stroke in CAS patients compared with CEA patients. CEA was associated with lower procedure cost and readmission rate.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.119.027388
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 1467823-8
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  • 2
    Online Resource
    Online Resource
    Flow‐Diversion for Complex Posterior Communicating Artery Aneurysms Associated With a Fetal Posterior Circulation
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Stroke: Vascular and Interventional Neurology Vol. 2, No. 3 ( 2022-05)
    Details
    In: Stroke: Vascular and Interventional Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 2, No. 3 ( 2022-05)
    Abstract: Flow‐diverting stents (FDSs) are effective in treating complex intracranial aneurysms, including posterior communicating artery aneurysms. However, some studies have suggested FDSs have limited efficacy for posterior communicating artery aneurysms associated with a fetal posterior communicating artery (FPCoA). Methods A retrospective analysis of patients with FPCoA aneurysms treated using FDS intervention alone was performed. Only aneurysms in which the FPCoA originated from the neck or dome of the aneurysm, which were therefore not amenable to standard coil embolization, were included. Results Stand‐alone, single‐device FDSs were placed in 16 patients with unruptured posterior communicating artery aneurysms associated with an FPCoA. The device was sized to ensure excellent wall apposition, with a focus on expanding the device across the aneurysm neck to optimize flow diversion. Excellent angiographic results were achieved in 12 patients (75%), and all patients had satisfactory clinical outcomes, with complete obliteration of the aneurysm in 10 (62.5%). No patients required additional treatment. Nine patients had complete patency of the FPCoA, 4 had mildly decreased flow, 2 had markedly diminished flow, and 1 had FPCoA occlusion. In all 7 cases with decreased FPCoA flow, there was coincident increased flow in the P1 segment of the posterior cerebral artery. No patient developed posterior circulation ischemia. Mean follow‐up was 19.9 months. Conclusion Contrary to previous reports, the placement of FDSs was found to be a safe and effective treatment option for FPCoA aneurysms. The deployment technique of maximizing device expansion across the neck of the aneurysm may contribute to successful outcomes. Treatment using an FDS may be particularly useful for complex FPCoAs.
    Type of Medium: Online Resource
    ISSN: 2694-5746
    URL: Article
    DOI: 10.1161/SVIN.121.000134
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 3144224-9
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  • 3
    Online Resource
    Online Resource
    Definitions of intracranial aneurysm size and morphology: A call for standardization
    Scientific Scholar ; 2021
    In:  Surgical Neurology International Vol. 12 ( 2021-10-06), p. 506-
    Details
    In: Surgical Neurology International, Scientific Scholar, Vol. 12 ( 2021-10-06), p. 506-
    Abstract: Intracranial aneurysms (IAs) are classified based on size (maximal dome diameter) as well as additional parameters such as neck diameter and dome-to-neck ratio (DNR). The neurosurgical literature includes a wide variety of definitions for both IA size and neck classifications. Standardizing the definitions of IA size and wide-neck classifications would help eliminate inconsistencies and potential misunderstandings of aneurysm morphology and rupture risk. Methods: We queried the MEDLINE (EBSCO) database using the terms “unruptured IA” and (“small” or “medium” or “large”) and filtered based on publication date, language, and scholarly journals. The resulting articles and their references were further screened for eligibility. This identified 286 records, of which 104 were excluded, leaving 182 articles for analysis. The review found several different IA size classifications and neck classifications. Results: A review of the existing literature describing size and neck classifications revealed 13 size classifications for small aneurysms, four classifications for medium aneurysms, 15 classifications for large aneurysms, and one classification for giant aneurysms. There were also seven different wide-neck classifications found. Conclusion: It is imperative that a standardization in classification be implemented to help interventionalists make the most informed decisions regarding emerging treatment options as new endovascular technologies and devices are emerging with indications based around these classifications. Based on the database findings, this article recommends standardized quantitative measurement ranges for IA size and neck classifications.
    Type of Medium: Online Resource
    ISSN: 2152-7806
    URL: Article
    DOI: 10.25259/SNI_576_2021
    Language: English
    Publisher: Scientific Scholar
    Publication Date: 2021
    detail.hit.zdb_id: 2567759-7
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  • 4
    Online Resource
    Online Resource
    Preoperative embolization versus no embolization for WHO grade I intracranial meningioma: a retrospective matched cohort study
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2021
    In:  Journal of Neurosurgery Vol. 134, No. 3 ( 2021-03), p. 693-700
    Details
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 134, No. 3 ( 2021-03), p. 693-700
    Abstract: The controversy continues over the clinical utility of preoperative embolization for reducing tumor vascularity of intracranial meningiomas prior to resection. Previous studies comparing embolization and nonembolization patients have not controlled for detailed tumor parameters before assessing outcomes. METHODS The authors reviewed the cases of all patients who underwent resection of a WHO grade I intracranial meningioma at their institution from 2008 to 2016. Propensity score matching was used to generate embolization and nonembolization cohorts of 52 patients each, and a retrospective review of clinical and radiological outcomes was performed. RESULTS In total, 52 consecutive patients who underwent embolization (mean follow-up 34.8 ± 31.5 months) were compared to 52 patients who did not undergo embolization (mean follow-up 32.8 ± 28.7 months; p = 0.63). Variables controlled for included patient age (p = 0.82), tumor laterality (p 〉 0.99), tumor location (p 〉 0.99), tumor diameter (p = 0.07), tumor invasion into a major dural sinus (p 〉 0.99), and tumor encasement around the internal carotid artery or middle cerebral artery (p 〉 0.99). The embolization and nonembolization cohorts did not differ in terms of estimated blood loss during surgery (660.4 ± 637.1 ml vs 509.2 ± 422.0 ml; p = 0.17), Simpson grade IV resection (32.7% vs 25.0%; p = 0.39), perioperative procedural complications (26.9% vs 19.2%; p = 0.35), development of permanent new neurological deficits (5.8% vs 7.7%; p = 0.70), or favorable modified Rankin Scale (mRS) score (a score of 0–2) at last follow-up (96.0% vs 92.3%; p = 0.43), respectively. When comparing the final mRS score to the preoperative mRS score, patients in the embolization group were more likely than patients in the nonembolization group to have an improvement in mRS score (50.0% vs 28.8%; p = 0.03). CONCLUSIONS After controlling for patient age, tumor size, tumor laterality, tumor location, tumor invasion into a major dural sinus, and tumor encasement of the internal carotid artery or middle cerebral artery, preoperative meningioma embolization intended to decrease tumor vascularity did not improve the surgical outcomes of patients with WHO grade I intracranial meningiomas, but it did lead to a greater chance of clinical improvement compared to patients not treated with embolization.
    Type of Medium: Online Resource
    ISSN: 0022-3085 , 1933-0693
    URL: Article
    DOI: 10.3171/2020.1.JNS19788
    RVK:
    XA 10000
    RVK:
    XA 55270
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2021
    detail.hit.zdb_id: 2026156-1
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  • 5
    Online Resource
    Online Resource
    Avoiding the Radial Paradox: Neuroendovascular Femoral Access Outcomes After Radial Access Adoption
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Neurosurgery Vol. 90, No. 3 ( 2022-03), p. 287-292
    Details
    In: Neurosurgery, Ovid Technologies (Wolters Kluwer Health), Vol. 90, No. 3 ( 2022-03), p. 287-292
    Type of Medium: Online Resource
    ISSN: 0148-396X , 1524-4040
    URL: Article
    DOI: 10.1227/NEU.0000000000001787
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 1491894-8
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  • 6
    Online Resource
    Online Resource
    A propensity-adjusted comparison of middle meningeal artery embolization versus conventional therapy for chronic subdural hematomas
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2021
    In:  Journal of Neurosurgery Vol. 135, No. 4 ( 2021-10), p. 1208-1213
    Details
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 135, No. 4 ( 2021-10), p. 1208-1213
    Abstract: Middle meningeal artery (MMA) embolization is a promising treatment strategy for chronic subdural hematomas (cSDHs). However, studies comparing MMA embolization and conventional therapy (surgical intervention and conservative management) are limited. The authors aimed to compare MMA embolization versus conventional therapy for cSDHs using a propensity-adjusted analysis. METHODS A retrospective study of all patients with cSDH who presented to a large tertiary center over a 2-year period was performed. MMA embolization was compared with surgical intervention and conservative management. Neurological outcome was assessed using the modified Rankin Scale (mRS). A propensity-adjusted analysis compared MMA embolization versus surgery and conservative management for all individual cSDHs. Primary outcomes included change in hematoma diameter, treatment failure, and complete resolution at last follow-up. RESULTS A total of 231 patients with cSDH met the inclusion criteria. Of these, 35 (15%) were treated using MMA embolization, and 196 (85%) were treated with conventional treatment. On the latest follow-up, there were no statistically significant differences between groups in the percentage of patients with worsening mRS scores. Of the 323 total cSDHs found in 231 patients, 41 (13%) were treated with MMA embolization, 159 (49%) were treated conservatively, and 123 (38%) were treated with surgical evacuation. After propensity adjustment, both surgery (OR 12, 95% CI 1.5–90; p = 0.02) and conservative therapy (OR 13, 95% CI 1.7–99; p = 0.01) were predictors of treatment failure and incomplete resolution on follow-up imaging (OR 6.1, 95% CI 2.8–13; p 〈 0.001 and OR 5.4, 95% CI 2.5–12; p 〈 0.001, respectively) when compared with MMA embolization. Additionally, MMA embolization was associated with a significant decrease in cSDH diameter on follow-up relative to conservative management (mean −8.3 mm, 95% CI −10.4 to −6.3 mm, p 〈 0.001). CONCLUSIONS This propensity-adjusted analysis suggests that MMA embolization for cSDH is associated with a greater extent of hematoma volume reduction with fewer treatment failures than conventional therapy.
    Type of Medium: Online Resource
    ISSN: 0022-3085 , 1933-0693
    URL: Article
    DOI: 10.3171/2020.9.JNS202781
    RVK:
    XA 10000
    RVK:
    XA 55270
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2021
    detail.hit.zdb_id: 2026156-1
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  • 7
    Online Resource
    Online Resource
    Telemedicine for Endovascular Neurosurgery Consultation During the COVID-19 Era: Patient Satisfaction Survey
    Elsevier BV ; 2022
    In:  World Neurosurgery Vol. 158 ( 2022-02), p. e577-e582
    Details
    In: World Neurosurgery, Elsevier BV, Vol. 158 ( 2022-02), p. e577-e582
    Type of Medium: Online Resource
    ISSN: 1878-8750
    URL: Article
    DOI: 10.1016/j.wneu.2021.11.023
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 2530041-6
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  • 8
    Online Resource
    Online Resource
    Comparison of nBCA and Onyx for Embolization of Spinal Dural Arteriovenous Fistulas
    Ovid Technologies (Wolters Kluwer Health) ; 2024
    In:  Stroke: Vascular and Interventional Neurology
    Details
    In: Stroke: Vascular and Interventional Neurology, Ovid Technologies (Wolters Kluwer Health)
    Abstract: Endovascular embolization can effectively treat spinal dural arteriovenous fistulas (SDAVFs). One factor limiting the success and durability of endovascular treatments is reliably casting and occluding the draining vein. We sought to compare the efficacies of n ‐butyl‐2‐cyanoacrylate (nBCA) and Onyx in the treatment of SDAVFs. METHODS We retrospectively analyzed patients with SDAVFs treated with endovascular embolization for whether a “durable cure” was achieved, defined as complete obliteration, clinical improvement, and sustained radiologic cure on follow‐up. We compared the outcomes of patients treated with Onyx to those treated with nBCA. RESULTS A total of 40 embolizations for SDAVFs were performed in 38 patients. All patients were treated exclusively with liquid embolysates: Onyx alone (n = 22), nBCA alone (n = 16), or nBCA and Onyx combined (n = 2). For 45% (10/22) of patients treated with Onyx only, complete obliteration of the fistula with casting of the vein was not achieved. These patients were referred for microsurgical ligation. For all 16 patients treated with nBCA only, complete obliteration of the fistula was achieved. All 16 patients exhibited a durable cure compared with 11 of 22 patients (50%) in the Onyx‐only group ( P  = 0.002). CONCLUSION nBCA may be superior to Onyx for the embolization of SDAVFs. nBCA embolization is safe and effective for a subset of SDAVFs. Prospective studies comparing SDAVF treatment strategies are warranted.
    Type of Medium: Online Resource
    ISSN: 2694-5746
    URL: Article
    DOI: 10.1161/SVIN.123.001019
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2024
    detail.hit.zdb_id: 3144224-9
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  • 9
    Online Resource
    Online Resource
    A comparative propensity-adjusted analysis of microsurgical versus endovascular treatment of unruptured ophthalmic artery aneurysms
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2022
    In:  Journal of Neurosurgery Vol. 136, No. 5 ( 2022-05-01), p. 1245-1250
    Details
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 136, No. 5 ( 2022-05-01), p. 1245-1250
    Abstract: Ophthalmic artery (OA) aneurysms are surgically challenging lesions that are now mostly treated using endovascular procedures. However, in specialized tertiary care centers with experienced neurosurgeons, controversy remains regarding the optimal treatment of these lesions. This study used propensity adjustment to compare microsurgical and endovascular treatment of unruptured OA aneurysms in experienced tertiary and quaternary settings. METHODS The authors retrospectively reviewed the medical records of all patients who underwent microsurgical treatment of an unruptured OA aneurysm at the University of California, San Francisco, from 1997 to 2017 and either microsurgical or endovascular treatment at Barrow Neurological Institute from 2011 to 2019. Patients were categorized into two cohorts for comparison: those who underwent open microsurgical clipping, and those who underwent endovascular flow diversion or coil embolization. Outcomes included neurological or visual outcomes, residual or recurrent aneurysms, retreatment, and severe complications. RESULTS A total of 345 procedures were analyzed: 247 open microsurgical clipping procedures (72%) and 98 endovascular procedures (28%). Of the 98 endovascular procedures, 16 (16%) were treated with primary coil embolization and 82 (84%) with flow diversion. After propensity adjustment, microsurgical treatment was associated with higher odds of a visual deficit (OR 8.5, 95% CI 1.1–64.9, p = 0.04) but lower odds of residual aneurysm (OR 0.06, 95% CI 0.01–0.28, p 〈 0.001) or retreatment (OR 0.12, 95% CI 0.02–0.58, p = 0.008) than endovascular therapy. No difference was found between the two cohorts with regard to worse modified Rankin Scale score, modified Rankin Scale score greater than 2, or severe complications. CONCLUSIONS Compared with endovascular therapy, microsurgical clipping of unruptured OA aneurysms is associated with a higher rate of visual deficits but a lower rate of residual and recurrent aneurysms. In centers experienced with both open microsurgical and endovascular treatment of these lesions, the treatment choice should be based on patient preference and aneurysm morphology.
    Type of Medium: Online Resource
    ISSN: 0022-3085 , 1933-0693
    URL: Article
    DOI: 10.3171/2021.5.JNS211149
    RVK:
    XA 10000
    RVK:
    XA 55270
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2022
    detail.hit.zdb_id: 2026156-1
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  • 10
    Online Resource
    Online Resource
    Propensity-adjusted analysis of ultra-early aneurysmal subarachnoid hemorrhage treatment and patient outcomes
    Springer Science and Business Media LLC ; 2023
    In:  Acta Neurochirurgica Vol. 165, No. 4 ( 2023-01-27), p. 993-1000
    Details
    In: Acta Neurochirurgica, Springer Science and Business Media LLC, Vol. 165, No. 4 ( 2023-01-27), p. 993-1000
    Type of Medium: Online Resource
    ISSN: 0942-0940
    URL: Article
    DOI: 10.1007/s00701-023-05497-7
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 1464215-3
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