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  • 1
    Online Resource
    Online Resource
    Delayed-Onset Cranial Nerve Palsy After Transvenous Embolization of Indirect Carotid Cavernous Fistulas
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Journal of Neuro-Ophthalmology Vol. 41, No. 4 ( 2021-12), p. e639-e643
    Details
    In: Journal of Neuro-Ophthalmology, Ovid Technologies (Wolters Kluwer Health), Vol. 41, No. 4 ( 2021-12), p. e639-e643
    Abstract: Carotid cavernous fistulas (CCF) often present with diplopia secondary to cranial nerve palsy (CNP). Immediate development of postoperative CNP has been described in the literature. This study described delayed-onset of CNP after complete and reconfirmed obliteration of the CCF and resolution of initial CNP. Methods: A retrospective analysis was performed on patients with indirect CCF between 1987 and 2006 at 4 academic endovascular centers. Details of the endovascular procedures, embolic agents used, and complications were studied. Partial or complete obliteration was determined. Immediate and delayed cranial nerve palsies were independently assessed. Results: A total of 267 patients with symptomatic indirect CCF underwent transvenous endovascular treatment. Four patients (1.5%) developed delayed abducens nerve (VI) palsy after complete resolution of presenting symptoms after embolization. Delayed presentation ranged between 3 and 13 months after complete resolution of initial double vision and cranial nerve palsies. Transvenous coil embolization through the inferior petrosal sinus was performed in all 4 affected patients. All had follow-up angiography confirming durable closure of their CCF. MRI did not show new mass lesions or abnormal soft tissue enhancement. In all 4 patients, their abducens nerve (VI) palsy remained. Conclusions: Delayed CNP can develop despite complete endovascular obliteration of the CCF. The cause of delayed CNP is not yet determined, but may represent fibrosis and ischemia. Long-term follow-up is needed even after complete neurological and radiological recovery is attained in the immediate perioperative period.
    Type of Medium: Online Resource
    ISSN: 1070-8022
    URL: Article
    DOI: 10.1097/WNO.0000000000001067
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2062798-1
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  • 2
    Online Resource
    Online Resource
    Mechanical thrombectomy after acute ischemic stroke in patients with left ventricular assist devices: A nationwide analysis
    SAGE Publications ; 2023
    In:  International Journal of Stroke Vol. 18, No. 2 ( 2023-02), p. 215-220
    Details
    In: International Journal of Stroke, SAGE Publications, Vol. 18, No. 2 ( 2023-02), p. 215-220
    Abstract: Left ventricular assist devices (LVADs) are an established, durable, and life-saving treatment option for patients with advanced heart failure. However, large vessel occlusions (LVOs) remain one of its most devastating embolic complications. Mechanical thrombectomy (MT) is safe and effective in the management of LVOs in the general population, but LVO trials largely excluded patients on mechanical circulatory support, and large-scale analyses of outcomes following these interventions in the LVAD population are lacking. Methods: Using the National Inpatient Sample, we identified all adult patients hospitalized with acute ischemic stroke (AIS) from 2005 to 2018. Regression models adjusting for patient demographics, hospital factors, and clinical severity were used to compare outcomes following MT in patients with and without LVAD. Subgroup analyses were also performed in LVAD patients experiencing stroke in the post-operative setting and stroke in the setting of pre-existing devices. Results: Of the 1,633,234 AIS hospitalizations identified, 794 occurred in patients with LVADs. Around 61% were post-operative. Post-stroke in-hospital mortality was higher among patients with LVADs (23.3% vs 7.23%, P  〈  0.001). Among those receiving MT, mortality was also higher in the LVAD population (31.0% vs 14.1%, P = 0.009), though this was largely driven by the post-operative LVAD subgroup. In multivariable analysis, only post-operative LVAD patients experienced greater odds of in-hospital death after MT (adjusted odds ratio (aOR): 8.66, confidence interval (CI):1.46–51.3); patients with pre-existing LVADs demonstrated no difference in post-MT mortality (aOR: 1.06; 95% CI: 0.29–3.91) or in odds of discharge home after MT (aOR 0.63, CI: 0.17–2.32). Conclusion: Our data suggest MT is not a futile treatment approach in patients with pre-existing LVADs and may result in similar rates of good outcomes. Additional research is needed to evaluate the long-term benefits of endovascular therapy after stroke in patients on LVAD support.
    Type of Medium: Online Resource
    ISSN: 1747-4930 , 1747-4949
    URL: Article
    DOI: 10.1177/17474930221097271
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
    detail.hit.zdb_id: 2211666-7
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  • 3
    Online Resource
    Online Resource
    Abstract 102: Microanatomy of Intracranial Human Thrombi by Single Nuclei Transcriptomics
    Ovid Technologies (Wolters Kluwer Health) ; 2024
    In:  Stroke Vol. 55, No. Suppl_1 ( 2024-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 55, No. Suppl_1 ( 2024-02)
    Abstract: Introduction: Microvascular dysfunction and inflammation are thought to underlie reperfusion failure following endovascular thrombectomy. Here we present the first study to produce a transcriptome-based cellular landscape of human intracranial thrombi highlighting the importance of cellular plasticity and intercellular communication at the site of occlusion. Methods: We performed single nuclei RNA-sequencing (snRNA-seq) on intracranial human thrombi harvested during revascularization. Unsupervised clustering, data visualization, differential expression and functional gene ontology/pathway analysis were utilized to deconvolve expression data into cell type-specific expression profiles. Thrombi snRNA-seq data were integrated with single cell RNA-seq data from symptomatic and asymptomatic human carotid plaques and healthy brain vasculature to contextualize thrombi in atherosclerotic disease, perform diffusion coefficient analysis, and identify ligand-receptor interactions. Results: Unbiased clustering identified six cellular populations in distinct effector states within the thrombus microenvironment. Functional gene ontology and pathway analysis revealed a monocyte subpopulation in a distinct endothelial-activation and neuroplasticity state, supporting the notion of cellular trans-differentiation and interconversion. Integration with carotid plaque data and diffusion coefficient analysis revealed shared transcriptional programs existing in a continuum, progressing from asymptomatic plaque to embolized thrombus. Ligand-receptor analysis identified macrophage mediated T-cell activation, pro-inflammatory response, immunological synapse stabilization, neuroplasticity, and monocyte trans-endothelial migration. Conclusion: Our novel application of snRNA-seq to thrombectomy specimens provides the highest resolution exploration of cellular differences and a best understanding of individual contextualized cell function to date. This detailed cellular landscape will facilitate mapping novel interventional targets with direct functional relevance and allow for greater personalization of post-reperfusion therapy.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.55.suppl_1.102
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2024
    detail.hit.zdb_id: 1467823-8
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  • 4
    Online Resource
    Online Resource
    Endovascular Thrombectomy for Large Vessel Occlusions in Covid-19 Patients : Technical Challenges and Lessons
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Neurosurgery Vol. 67, No. Supplement_1 ( 2020-12)
    Details
    In: Neurosurgery, Ovid Technologies (Wolters Kluwer Health), Vol. 67, No. Supplement_1 ( 2020-12)
    Type of Medium: Online Resource
    ISSN: 0148-396X
    URL: Article
    DOI: 10.1093/neuros/nyaa447_390
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 1491894-8
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  • 5
    Online Resource
    Online Resource
    Curative treatment for low-grade arteriovenous malformations
    BMJ ; 2020
    In:  Journal of NeuroInterventional Surgery Vol. 12, No. 1 ( 2020-01), p. 48-54
    Details
    In: Journal of NeuroInterventional Surgery, BMJ, Vol. 12, No. 1 ( 2020-01), p. 48-54
    Abstract: Spetzler-Martin (SM) grade I-II (low-grade) arteriovenous malformations (AVMs) are often considered safe for microsurgery or radiosurgery. The adjunctive use of preoperative embolization to reduce surgical risk in these AVMs remains controversial. Objective To assess the safety of combined treatment of grade I-II AVMs with preoperative embolization followed by surgical resection or radiosurgery, and determine the long-term functional outcomes. Methods With institutional review board approval, a retrospective analysis was carried out on patients with ruptured and unruptured SM I-II AVMs between 2002 and 2017. Details of the endovascular procedures, including number of arteries supplying the AVM, number of branches embolized, embolic agent(s) used, and complications were studied. Baseline clinical and imaging characteristics were compared. Functional status using the modified Rankin Scale (mRS) before and after endovascular and microsurgical treatments was compared. Results 258 SM I-II AVMs (36% SM I, 64% SM II) were identified in patients with a mean age of 38 ± 17 years. 48% presented with hemorrhage, 21% with seizure, 16% with headache, 10% with no symptoms, and 5% with clinical deficits. 90 patients (68%) in the unruptured group and 74 patients (59%) in the ruptured group underwent presurgical embolization (p = 0.0013). The mean number of arteries supplying the AVM was 1.44 and 1.41 in the unruptured and ruptured groups, respectively (p = 0.75). The mean number of arteries embolized was 2.51 in the unruptured group and 1.82 in the ruptured group (p = 0.003). n-Butyl cyanoacrylate and Onyx were the two most commonly used embolic agents. Four complications were seen in four patients (4/164 patients embolized): two peri-/postprocedural hemorrhage, one dissection, and one infarct. All patients undergoing surgery had a complete cure on postoperative angiography. Patients were followed up for a mean of 55 months. Good long-term outcomes (mRS score ≤ 2) were seen in 92.5% of patients with unruptured AVMs and 88.0% of those with ruptured AVMs. Permanent neurological morbidity occurred in 1.2%. Conclusions Curative treatment of SM I-II AVMs can be performed using endovascular embolization with microsurgical resection or radiosurgery in selected cases, with very low morbidity and high cure rates. Compared with other published series, these outcomes suggest that preoperative embolization is a safe and effective adjunct to definitive surgical treatment. Long-term follow-up showed that patients with low-grade AVMs undergoing surgical resection or radiosurgery have good functional outcomes.
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/neurintsurg-2019-015115
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 2506028-4
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  • 6
    Online Resource
    Online Resource
    Abstract 119: Elevating The Cerebrovascular Nurse Practitioner: Program Development With Neurosurgeon Champions
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Stroke Vol. 54, No. Suppl_1 ( 2023-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 54, No. Suppl_1 ( 2023-02)
    Abstract: Background: The cerebrovascular nurse practitioner (NP) continues to have an ever-evolving role, particularly in neurosurgical departments. Although more NPs are obtaining their doctorate degrees, further post professional education is needed to promote specialty clinical practice. Our team developed a 16-week comprehensive educational program that addresses the main disease processes of stroke and highlights the importance of collaboration with cerebrovascular neurosurgeons. Methods: Four clinical domains were identified- see table 1. Each week, a neurosurgeon gave a 1 hour lecture that reviewed neuroimaging and anatomy, pathophysiology, clinical care presentation, and preoperative and postoperative management. After all lectures were completed for each domain, a 1 hour journal club was held discussing the most recent stroke clinical practice guidelines. NPs were surveyed to report which domains were most clinically meaningful. Results: Our division delivered a comprehensive educational program, allowing the cerebrovascular NP to take on a more independent role in patient care. Of the sections presented in each clinical domain, neuroimaging and clinical management were reported as the most important section of the lectures by NPs. Discussion: The cerebrovascular NP plays a unique role on the clinical team, regardless if a patient is seen throughout the entire continuum as an elective case or treated emergently and later discharged to clinic. This program optimized evidence-based cerebrovascular practices, improved collaborating relationships between NP and surgeon, and promoted professional development. Future work will include course evaluation for on-boarding NPs and program implementation in other neurosurgical subspecialties.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.54.suppl_1.119
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 1467823-8
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  • 7
    Online Resource
    Online Resource
    Abstract TMP64: Outcomes After Mechanical Thrombectomy In Patients With Left Ventricular Assist Devices
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Stroke Vol. 53, No. Suppl_1 ( 2022-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 53, No. Suppl_1 ( 2022-02)
    Abstract: Background: Left ventricular assist devices (LVADs) are an established durable and lifesaving treatment option for patients with advanced heart failure. However, large vessel occlusions (LVOs) remain one of its most devastating embolic complications. Mechanical thrombectomy (MT) is safe and effective in the management of LVOs in the general population but LVO trials largely excluded patients on mechanical circulatory support and large-scale analyses of outcomes following these interventions in the LVAD population are lacking. Methods: Using the National Inpatient Sample (2012 - 2018) we identified all adult patients hospitalized with acute ischemic stroke (AIS). The presence of LVAD, the use of MT, and additional covariates were extracted. Descriptive statistics and multivariable regression models were used to compare outcomes following MT in patients with and without LVADs. Results: Of the 798,059 AIS hospitalizations identified, 366 occurred in patients with LVADs. LVAD patients were younger (mean age 59.6 [13.2] vs 70.1 [14.3] , p 〈 0.001), and were less often female (23.0% vs 50.9%, p 〈 0.001). In the general stroke population 2% were treated with MT vs 6% in LVAD-associated AIS. Post-stroke mortality was higher among LVAD patients (18.4% vs 6.22, p=0.000). However, among patients receiving MT, there was no significant difference in in-hospital mortality between LVAD and non-LVAD patients (23.1% vs 12.5%, p=0.104). In crude analysis and after adjusting for potential confounders there was no difference in odds of discharge to home after treatment with MT (Figure). Conclusion: Our data suggests MT is not a futile treatment approach in patients with LVADs and may result in similar rates of good outcomes. Additional research is needed to evaluate the long-term benefits of endovascular therapy after stroke in patients on LVAD support.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.53.suppl_1.TMP64
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 1467823-8
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  • 8
    Online Resource
    Online Resource
    Delayed Onset Cranial Nerve Palsy After Transvenous Embolization of Indirect Carotid Cavernous Fistulas
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Neurosurgery Vol. 67, No. Supplement_1 ( 2020-12)
    Details
    In: Neurosurgery, Ovid Technologies (Wolters Kluwer Health), Vol. 67, No. Supplement_1 ( 2020-12)
    Type of Medium: Online Resource
    ISSN: 0148-396X
    URL: Article
    DOI: 10.1093/neuros/nyaa447_322
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 1491894-8
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  • 9
    Online Resource
    Online Resource
    Stroke and mechanical thrombectomy in patients with COVID-19: technical observations and patient characteristics
    BMJ ; 2020
    In:  Journal of NeuroInterventional Surgery Vol. 12, No. 7 ( 2020-07), p. 648-653
    Details
    In: Journal of NeuroInterventional Surgery, BMJ, Vol. 12, No. 7 ( 2020-07), p. 648-653
    Abstract: COVID-19 infections have been shown to be associated with a range of thromboembolic disease. Objective To describe our endovascular experience in a consecutive series of patients with COVID-19 who presented with large vessel occlusions, and to describe unique findings in this population. Methods Mechanical thrombectomy was performed on five consecutive patients with COVID-19 with large vessel occlusions. A retrospective study of these patients was performed. Patient demographics, laboratory values, mechanical thrombectomy technique, and clinical and angiographic outcomes were reviewed. Results Four patients with COVID-19 presented with anterior circulation occlusions and one patient with COVID-19 presented with both anterior and posterior circulation occlusions. All patients had coagulation abnormalities. Mean patient age was 52.8 years. Three patients presented with an intracranial internal carotid artery occlusion. Two patients presented with an intracranial occlusion and a tandem thrombus in the carotid bulb. One patient presented with an occlusion in both the internal carotid and basilar arteries. Clot fragmentation and distal emboli to a new vascular territory were seen in two of five (40%) patients, and downstream emboli were seen in all five (100%) patients. Patient clinical outcome was generally poor in this series of patients with COVID-19 large vessel occlusion. Conclusion Our series of patients with COVID-19 demonstrated coagulation abnormalities, and compared with our previous experience with mechanical thrombectomy in large vessel occlusion, this group of patients were younger, had tandem or multiple territory occlusions, a large clot burden, and a propensity for clot fragmentation. These patients present unique challenges that make successful revascularization difficult.
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/neurintsurg-2020-016220
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 2506028-4
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