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  • 1
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    Assessment of Discrepancies Between Follow-up Infarct Volume and 90-Day Outcomes Among Patients With Ischemic Stroke Who Received Endovascular Therapy
    American Medical Association (AMA) ; 2021
    In:  JAMA Network Open Vol. 4, No. 11 ( 2021-11-05), p. e2132376-
    Details
    In: JAMA Network Open, American Medical Association (AMA), Vol. 4, No. 11 ( 2021-11-05), p. e2132376-
    Type of Medium: Online Resource
    ISSN: 2574-3805
    URL: Article
    DOI: 10.1001/jamanetworkopen.2021.32376
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2021
    detail.hit.zdb_id: 2931249-8
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  • 2
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    Table_1.docx
    Frontiers Media SA ; 2021
    In:  Frontiers in Neurology Vol. 12 ( 2021-4-13)
    Details
    In: Frontiers in Neurology, Frontiers Media SA, Vol. 12 ( 2021-4-13)
    Abstract: Introduction: Penumbra SMART COIL® (SMART) System is a novel generation embolic coil with varying stiffness. The study purpose was to report real-world usage of the SMART System in patients with intracranial aneurysms (ICA) and non-aneurysm vascular lesions. Materials and Methods: The SMART Registry is a post-market, prospective, multicenter registry requiring ≥75% Penumbra Coils, including SMART, PC400, and/or POD coils. The primary efficacy endpoint was retreatment rate at 1-year and the primary safety endpoint was the procedural device-related serious adverse event rate. Results: Between June 2016 and August 2018, 995 patients (mean age 59.6 years, 72.1% female) were enrolled at 68 sites in the U.S. and Canada. Target lesions were intracranial aneurysms in 91.0% of patients; 63.5% were wide-neck and 31.8% were ruptured. Adjunctive devices were used in 55.2% of patients. Mean packing density was 32.3%. Procedural device-related serious adverse events occurred in 2.6% of patients. The rate of immediate post-procedure adequate occlusion was 97.1% in aneurysms and the rate of complete occlusion was 85.2% in non-aneurysms. At 1-year, the retreatment rate was 6.8%, Raymond Roy Occlusion Classification (RROC) I or II was 90.0% for aneurysms, and Modified Rankin Scale (mRS) 0-2 was achieved in 83.1% of all patients. Predictors of 1-year for RROC III or retreatment (incomplete occlusion) were rupture status ( P & lt; 0.0001), balloon-assisted coiling ( P = 0.0354), aneurysm size ( P = 0.0071), and RROC III immediate post-procedure ( P = 0.0086) in a model that also included bifurcation aneurysm ( P = 0.7788). Predictors of aneurysm retreatment at 1-year was rupture status ( P & lt; 0.0001). Conclusions: Lesions treated with SMART System coils achieved low long-term retreatment rates. Clinical Trial Registration: https://www.clinicaltrials.gov/ , identifier NCT02729740.
    Type of Medium: Online Resource
    ISSN: 1664-2295
    URL: Article
    URL: Article
    DOI: 10.3389/fneur.2021.637551
    DOI: 10.3389/fneur.2021.637551.s001
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2021
    detail.hit.zdb_id: 2564214-5
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  • 3
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    Technical Success and Early Efficacy in 851 Patients with Saccular Intracranial Aneurysms: A Subset Analysis of SMART, a Prospective, Multicenter Registry Assessing the Embolization of Neurovascular Lesions using the Penumbra SMART COIL System
    Elsevier BV ; 2021
    In:  World Neurosurgery Vol. 155 ( 2021-11), p. e323-e334
    Details
    In: World Neurosurgery, Elsevier BV, Vol. 155 ( 2021-11), p. e323-e334
    Type of Medium: Online Resource
    ISSN: 1878-8750
    URL: Article
    DOI: 10.1016/j.wneu.2021.08.043
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
    detail.hit.zdb_id: 2530041-6
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  • 4
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    Safety of the APOLLO Onyx delivery microcatheter for embolization of brain arteriovenous malformations: results from a prospective post-market study
    BMJ ; 2021
    In:  Journal of NeuroInterventional Surgery Vol. 13, No. 10 ( 2021-10), p. 935-941
    Details
    In: Journal of NeuroInterventional Surgery, BMJ, Vol. 13, No. 10 ( 2021-10), p. 935-941
    Abstract: Catheter retention and difficulty in retrieval have been observed during embolization of brain arteriovenous malformations (bAVMs) with the Onyx liquid embolic system (Onyx). The Apollo Onyx delivery microcatheter (Apollo) is a single lumen catheter designed for controlled delivery of Onyx into the neurovasculature, with a detachable distal tip to aid catheter retrieval. This study evaluates the safety of the Apollo for delivery of Onyx during embolization of bAVMs. Methods This was a prospective, non-randomized, single-arm, multicenter, post-market study of patients with a bAVM who underwent Onyx embolization with the Apollo between May 2015 and February 2018. The primary endpoint was any catheter-related adverse event (AE) at 30 days, such as unintentional tip detachment or malfunction with clinical sequelae, or retained catheter. Procedure-related AEs (untoward medical occurrence, disease, injury, or clinical signs) and serious AEs (life threatening illness or injury, permanent physiological impairment, hospitalization, or requiring intervention) were also recorded. Results A total of 112 patients were enrolled (mean age 44.1±17.6 years, 56.3% men), and 201 Apollo devices were used in 142 embolization procedures. The mean Spetzler–Martin grade was 2.38. The primary endpoint was not observed (0/112, 0%). The catheter tip detached during 83 (58.5%) procedures, of which 2 (2.4%) were unintentional and did not result in clinical sequelae. At 30 days, procedure related AEs occurred in 26 (23.2%) patients, and procedure-related serious AEs in 12 (10.7%). At 12 months, there were 3 (2.7%) mortalities, including 2 (1.8%) neurological deaths, none of which were device-related. Conclusion This study demonstrates the safety of Apollo for Onyx embolization of bAVMs. Clinical trial registration C NCT02378883 .
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/neurintsurg-2020-016830
    Language: English
    Publisher: BMJ
    Publication Date: 2021
    detail.hit.zdb_id: 2506028-4
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  • 5
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    Abstract P44: Final Outcomes in Patients With Ruptured Aneurysms From the SMART Registry
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Stroke Vol. 52, No. Suppl_1 ( 2021-03)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 52, No. Suppl_1 ( 2021-03)
    Abstract: Introduction: We report the durability of treatment with SMART COIL System at one-year in patients with ruptured aneurysms enrolled in the SMART registry. Materials and Methods: The SMART Registry is a prospective, multi-center registry study. Procedures must employ ≥75% of the SMART, PC400, or POD coils to meet registry criteria. Patients with ruptured aneurysms presenting prior to the procedure were included in this analysis. SMART Registry endpoints include retreatment rates at one year, procedural device-related serious adverse events (SAE), and the ability to achieve adequate occlusion at immediate post-procedure. Results: Of the 905 enrolled patients with aneurysms, 31.8% (288/905) of patients had ruptured aneurysms (74.0% female; mean age 58.0 ± 13.5 years). Ruptured aneurysms were small ( 〈 4 mm) in 16.7% (48/288), medium (≥4mm to 10mm) in 68.4% (197/288), large ( 〉 10 to 25 mm) in 14.6% (42/288), giant ( 〉 25) in 0.3% (1/288), and the mean size was 6.9 mm (SD 3.5 ). Hunt and Hess grade ≥3 was reported in 43.8% (123/281) of patients. The anterior cerebral artery had 33.7% (97/288) of all ruptured aneurysms and the internal carotid artery had 30.6% (88/288). Stent-assisted coiling and balloon-assisted coiling were performed in 7.6% (22/288) and 31.3% (90/288) of patients, respectively. Mean packing density for ruptured aneurysms was 33.4% (SD 20.9). In patients with ruptured aneurysms, retreatment rate at one year was 16.5% (33/200). Procedural device-related SAEs were observed in 3.1% subjects (9/288). Raymond Class I or II was observed in 84.6% (242/286) at immediate post-procedure and in 84.3% (161/191) at one year. The multivariate analysis showed that neck width ≥4 mm (OR 2.56, 95% CI 1.21-5.44, P=0.0144) and male gender (OR 2.17 95% CI 1.05-4.49, P=0.0376) were predictors of Raymond Class III or retreatment at one year. Conclusion: This analysis suggests that the SMART COIL System achieves adequate embolization and retreatment rates in ruptured aneurysms at one year.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.52.suppl_1.P44
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 1467823-8
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  • 6
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    Abstract 1122‐000087: Long‐Term Outcomes of Anterior Communicating Artery Aneurysm Treated with Coiling: Subset Analysis of SMART Registry
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Stroke: Vascular and Interventional Neurology Vol. 1, No. S1 ( 2021-11)
    Details
    In: Stroke: Vascular and Interventional Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 1, No. S1 ( 2021-11)
    Abstract: This meeting abstract was removed due to the OA licensing requirements of this journal. The full abstract is listed here : https://www.svin.org/files/SVIN_2021_Abstracts_for_Web.pdf
    Type of Medium: Online Resource
    ISSN: 2694-5746
    URL: Article
    DOI: 10.1161/SVIN.01.suppl_1.000087
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 3144224-9
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  • 7
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    Abstract Number ‐ 3: Large and Giant Aneurysms Outcome in the Multicenter Prospective Core Lab Adjudicated SMART Coils Registry
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Stroke: Vascular and Interventional Neurology Vol. 3, No. S1 ( 2023-03)
    Details
    In: Stroke: Vascular and Interventional Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 3, No. S1 ( 2023-03)
    Abstract: Endovascular coiling for intracerebral aneurysms has been evolving. Yet, large, and giant aneurysms (LAGA) remain a significant challenge for treatment and carry a high rate of morbidity and mortality. Previous studies have demonstrated 72–76% long‐term adequate occlusion and up to 34% retreatment rate in patients undergoing reconstructive treatment for LAGA. Methods The SMART registry, a prospective, multicenter outcome trial was used to identify patients with LAGA (Sac 10–24mm for large and ≥ 25mm for giant aneurysms) treated with the Penumbra SMART COIL® (SMART) system in the US and Canada. Patients’ characteristics and outcomes were then compared to patients with smaller aneurysms (SA) (Sac≤10mm). Primary effectiveness endpoint was aneurysm occlusion using Raymond‐Roy (RR) scale and safety endpoints included mortality and stroke outcomes. Fisher exact test and T‐test were used to compare categorical and continuous variables, respectively. P‐value  〈  0.05 was considered significant. Results A total of 131/903 (14.5%) patients had LAGA and 42 (32.1%) of those were ruptured. Patients with LAGA were older than SA (mean age: 61.9 vs 59.4, p = 0.04). Large aneurysms were mainly saccular in 75.6% of the cases (vs 87.7% of the ≤ 10 mm ones, p  〈  0.001). Fusiform LAGA were 8.4% (vs 1.4% of the ≤ 10 mm ones, p  〈  0.001). Furthermore, they are more likely to have wide neck (69.5% vs 59.7%, p = 0.042). They are less likely to have A‐Com aneurysm (10.7% vs 28%, p  〈  0.001), and more likely to have basilar tip aneurysms (3.1% vs 0.8%, p = 0.044) and cavernous aneurysms (4.6% vs 0.6%, p = 0.002) compared to patients with SA. Primary coiling was the main treatment modality for both SA and LAGA (43.3% vs 43.5%, respectively, p = 1.0). However, LAGA were more likely to be treated with flow diversion in addition to coiling (6.1% vs 1.0%, p  〈  0.001). Packing density was significantly lower in LAGA (mean (SD) = 21.2(13.1) vs 34.1(18.3), p  〈  0.001). Surprisingly, long‐term aneurysm RR occlusion Class I‐II on follow‐up imaging was 82.5% in LAGA vs 91.2% in SA, p = 0.016. Retreatment rates was 11.7% in LAGA vs 6.4% in SA, p = 0.063. mRS0‐2 score was 73.6% in LAGA vs 86.4% in SA, p = 0.007. All‐cause 1‐year mortality was 9.2% in LAGA vs 4.7% in SA, p = 0.054. Conclusions Despite challenges with treating Large and giant aneurysms, SMART coiling registry demonstrated high adequate aneurysm occlusion rate on follow‐up imaging, as well as a good independent functional outcome.
    Type of Medium: Online Resource
    ISSN: 2694-5746
    URL: Article
    DOI: 10.1161/SVIN.03.suppl_1.003
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
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  • 8
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    Aneurysms of the Lateral Spinal Artery: Report of Two Cases
    Ovid Technologies (Wolters Kluwer Health) ; 2001
    In:  Neurosurgery Vol. 48, No. 4 ( 2001-04-01), p. 949-954
    Details
    In: Neurosurgery, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. 4 ( 2001-04-01), p. 949-954
    Abstract: The goal of this report was to describe aneurysms arising from the lateral spinal artery. The locations of aneurysms contributing to subarachnoid hemorrhage (SAH) have been well characterized and are primarily in the circle of Willis or at the bifurcation points of the internal carotid artery or the vertebrobasilar system. Although the spinal arteries are also in direct communication with the subarachnoid space, aneurysms of these arteries that lead to SAH are rare. To date, only aneurysms of the anterior and posterior spinal arteries have been described. In this communication, we report two patients with aneurysms of the lateral spinal artery who presented with SAH. CLINICAL PRESENTATION Review of our neurointerventional database from 1997 to the present revealed two patients with lateral spinal artery aneurysms. The medical records, as well as the operative and radiological findings, were reviewed for both patients. In both cases, the lateral spinal arteries were involved as collateral pathways for occlusive vertebral lesions, suggesting hemodynamic stress as a cause. INTERVENTION Endovascular treatment was attempted in both cases and was successful in one; open surgery, with aneurysm resection, was performed in the other case. We review the vascular anatomic features of the spinal cord as they relate to the lateral spinal artery, as well as treatment options for lateral spinal artery aneurysms. CONCLUSION Lateral spinal artery aneurysms are a rare cause of SAH. Both endovascular and surgical treatment options are available.
    Type of Medium: Online Resource
    ISSN: 0148-396X , 1524-4040
    URL: Article
    DOI: 10.1097/00006123-200104000-00057
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2001
    detail.hit.zdb_id: 1491894-8
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  • 9
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    Data_Sheet_1.docx
    Frontiers Media SA ; 2022
    In:  Frontiers in Neurology Vol. 13 ( 2022-2-7)
    Details
    In: Frontiers in Neurology, Frontiers Media SA, Vol. 13 ( 2022-2-7)
    Abstract: Wide-necked middle cerebral artery bifurcation aneurysms pose specific challenges to endovascular management. Surgical clipping remains the standard treatment approach for these aneurysms in many centers. While recent data suggests the endovascular treatment may be comparable, a prospective datapoint has been lacking. Materials and Methods The Penumbra SMART registry, a prospective, multi-center, single-arm outcomes registry of Penumbra coil-treated aneurysms, was queried for endovascularly treated MCA bifurcation aneurysms with wide necks (dome:neck ratio & lt;2 or neck & gt;4 mm). Safety and efficacy outcomes were summarized for ruptured and unruptured aneurysms, including rupture, complication rate, and 1-year occlusion outcomes. Results Seventy-two aneurysms across 31 sites were enrolled. Of these, a total of 15 presented as ruptured aneurysms. Serious adverse events were reported in 21 (29.2%) of patients, with 8 (11.1%) attributed to the device/procedure. Immediately postoperatively, 75.0% of cases achieved “adequate” Raymond Roy Class I (40.3%) or II (34.7%) occlusion outcomes. Of the 72 patients treated, 60 (83.3%) underwent follow-up angiography at 1 year, and among these, 95.0% had 1-year occlusion outcomes of Raymond Roy Class I (71.7%) or II (23.3%). A total of 6 aneurysms (10.0%) were required or were planned for retreatment at the last follow-up. Conclusion This study represents the most significant prospective sample of endovascularly treated wide-neck MCA bifurcation aneurysms conducted to date. It supports the safety and efficacy of endovascular treatment of these aneurysms.
    Type of Medium: Online Resource
    ISSN: 1664-2295
    URL: Article
    URL: Article
    DOI: 10.3389/fneur.2022.830296
    DOI: 10.3389/fneur.2022.830296.s001
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2022
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  • 10
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    Epidemiology, Endovascular Treatment, and Prognosis of Cerebral Venous Thrombosis: US Center Study of 152 Patients
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Journal of the American Heart Association Vol. 6, No. 6 ( 2017-11-06)
    Details
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 6, No. 6 ( 2017-11-06)
    Abstract: Cerebral venous thrombosis is a rare cause of stroke that poses diagnostic, therapeutic, and prognostic challenges. Mainstay treatment is systemic anticoagulation, but endovascular treatment is increasingly advocated. Our objectives were to describe the epidemiology, treatment, and prognosis of 152 patients with cerebral venous thrombosis. Methods and Results This was a retrospective study of consecutive cerebral venous thrombosis cases from 2006 to 2013 at a comprehensive stroke center through hospital discharge. Predictors of full recovery (modified Rankin Scale scores 0–1) were analyzed with multiple logistic regression and presented as adjusted odds ratios ( AORs ) with 95% confidence intervals ( CIs ). The population was young (average age: 42 years), majority female (69%), and commonly presenting with cerebral edema (63%), and 72% were transferred in. All patients received systemic anticoagulation; 49% (n=73) required endovascular treatment. Reasons for requiring endovascular treatment included cerebral edema, herniation, or hemorrhagic infarct (n=38); neurologic decline (n=17); rethrombosis, persistent occlusion, or clot propagation (n=10); extensive clot burden (n=7); and persistent headache despite anticoagulation (n=1). There were 7 (10%) procedural complications. Recanalization was successful (61%), partial (30%), and unsuccessful (9%). Overall, 60% fully recovered. Positive predictors of full recovery included hormonal etiology, particularly for patients who were transferred in ( AOR : 7.06 [95% CI, 2.27–21.96], interaction P =0.03) and who had migraine history ( AOR : 4.87 [95% CI, 1.01–23.50], P =0.05), whereas negative predictors of full recovery were cerebral edema ( AOR : 0.11 [95% CI, 0.04–0.34], P 〈 0.001) and motor weakness ( AOR : 0.28 [95% CI, 0.09–0.96], P =0.04). Conclusions As one of the largest cohort studies, our findings suggest that cerebral edema, history of migraine, and hormonal etiology were prognostic and that endovascular treatment might be a safe and effective treatment for cerebral venous thrombosis when conventional management is inadequate.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    URL: Article
    DOI: 10.1161/JAHA.117.005480
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 2653953-6
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