Pub Date : 2024-02-28DOI: 10.1177/15910199241235431
Khaled Gharaibeh, Nameer Aladamat, Mohammad Samara, Adam T Mierzwa, Ahsan Ali, Syed Zaidi, Mouhammad Jumaa
Objective: To assess the prognostic values of hyperdense sign on pretreatment non-contrast head CT scan for successful recanalization (mTICI ≥2b) and 90-day good functional outcome (mRs 0-2) in patients with acute ischemic stroke undergoing mechanical thrombectomy (MT).
Methods: Literature search on PubMed, EMBASE, and Cochrane databases from inception up to 1 November 2023 was conducted. Twelve studies which reported hyperdense sign, recanalization and clinical outcomes were included in qualitative synthesis and meta-analysis.
Results: Pooled analysis demonstrated a statistically significant association between successful recanalization and hyperdense sign-positive patients who underwent MT (odd ratios (OR) = 1.47, 95% confidence interval (CI) = 1.03-2.10, p = 0.04). No statistically significant association was demonstrated between presence of hyperdense sign and good functional outcome (OR = 1.04, 95% CI: 0.72-1.49, p = 0.85) or symptomatic intracranial hemorrhage sICH (OR: 1.80, 95% CI 0.72-4.47, p = 0.21).
Conclusions: This meta-analysis demonstrated that pre-intervention hyperdense sign on CT imaging might be useful in prediction of successful recanalization after MT.
{"title":"Hyperdense sign as a predictor for successful recanalization and clinical outcome in acute ischemic stroke: A systematic review and meta-analysis.","authors":"Khaled Gharaibeh, Nameer Aladamat, Mohammad Samara, Adam T Mierzwa, Ahsan Ali, Syed Zaidi, Mouhammad Jumaa","doi":"10.1177/15910199241235431","DOIUrl":"https://doi.org/10.1177/15910199241235431","url":null,"abstract":"<p><strong>Objective: </strong>To assess the prognostic values of hyperdense sign on pretreatment non-contrast head CT scan for successful recanalization (mTICI ≥2b) and 90-day good functional outcome (mRs 0-2) in patients with acute ischemic stroke undergoing mechanical thrombectomy (MT).</p><p><strong>Methods: </strong>Literature search on PubMed, EMBASE, and Cochrane databases from inception up to 1 November 2023 was conducted. Twelve studies which reported hyperdense sign, recanalization and clinical outcomes were included in qualitative synthesis and meta-analysis.</p><p><strong>Results: </strong>Pooled analysis demonstrated a statistically significant association between successful recanalization and hyperdense sign-positive patients who underwent MT (odd ratios (OR) = 1.47, 95% confidence interval (CI) = 1.03-2.10, <i>p</i> = 0.04). No statistically significant association was demonstrated between presence of hyperdense sign and good functional outcome (OR = 1.04, 95% CI: 0.72-1.49, <i>p</i> = 0.85) or symptomatic intracranial hemorrhage sICH (OR: 1.80, 95% CI 0.72-4.47, <i>p</i> = 0.21).</p><p><strong>Conclusions: </strong>This meta-analysis demonstrated that pre-intervention hyperdense sign on CT imaging might be useful in prediction of successful recanalization after MT.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139984279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-28DOI: 10.1177/15910199241234098
Jaims Lim, Brianna M Donnelly, Vinay Jaikumar, Marissa D Kruk, Cathleen C Kuo, Andre Monteiro, Manhal Siddiqi, Ammad A Baig, Devan Patel, Kunal P Raygor, Kenneth V Snyder, Jason M Davies, Elad I Levy, Adnan H Siddiqui
Background: Intracranial dural arteriovenous fistulas (dAVFs) are abnormal connections between arteries and veins within the dura mater. Various treatment modalities, such as surgical ligation, endovascular intervention, and radiosurgery, aim to close the fistulous connection. Although transvenous embolization (TVE) is the preferred method for carotid-cavernous fistulas, its description and outcomes for noncavernous dAVFs vary. This has prompted a systematic review and meta-analysis to comprehensively assess the effectiveness of TVE in treating noncavernous dAVFs, addressing variations in outcomes and techniques.
Methods: We searched PubMed and Embase, spanning from the earliest records to December 2022, to identify pertinent English-language articles detailing the utilization of TVE. We focused on specific procedural details, outcomes, and complications in patients older than 18 years. The data collected and analyzed comprised the sample size, number of fistulas, publication specifics, presenting symptoms, fistula grades, and pooled rates of embolizations, outcomes, follow-up information, and complications.
Results: From a total of 565 screened articles, 15 retrospective articles encompassing 166 patients spanning across seven countries met the inclusion criteria. Their Newcastle-Ottawa scores ranged from 6 to 8. Intraprocedural complication rate was 10% (95% confidence interval [CI] = 5.9-17.1) and in-hospital postprocedural complication rate was 5.4% (95% CI = 2.8-10.6). Prevalence of in-hospital mortality was 5.5% (95% CI = 2.9-10.6). Complication rate during follow-up was 8.6% (95% CI = 4.7-15.7) with fistula rupture occurring in 5.5% (95% CI = 2.6-11.6) of patients. Complete obliteration rate at final angiographic follow-up was 94.9% (95% CI = 90.3-99.9). Symptoms improved in 95% (95% CI = 89.8-100) of patients at final follow-up.
Conclusion: To our knowledge, we present the first meta-analysis assessing obliteration rates, outcomes, and complications of TVE for dAVFs. Our analysis highlights the higher (>90%) complete obliteration rates. Large prospective multicenter studies are needed to better define the utility of TVE for noncavernous dAVFs.
背景:颅内硬脑膜动静脉瘘(dAVFs)是硬脑膜内动脉和静脉之间的异常连接。各种治疗方法,如手术结扎、血管内介入治疗和放射外科手术,都旨在关闭瘘管连接。虽然经静脉栓塞(TVE)是治疗颈动脉-海绵瘘的首选方法,但对非海绵状硬脑膜瘘的描述和治疗效果却各不相同。这促使我们进行了一项系统性回顾和荟萃分析,以全面评估经静脉栓塞治疗非海绵状静脉瘘的有效性,同时解决结果和技术方面的差异:我们检索了 PubMed 和 Embase(从最早的记录到 2022 年 12 月),以确定详细介绍 TVE 使用情况的相关英文文章。我们重点关注了 18 岁以上患者的具体手术细节、结果和并发症。收集和分析的数据包括样本大小、瘘管数量、发表的具体内容、主要症状、瘘管等级以及栓塞率、结果、随访信息和并发症:共筛选出 565 篇文章,其中 15 篇回顾性文章符合纳入标准,涉及 7 个国家的 166 名患者。这些文章的纽卡斯尔-渥太华评分从6分到8分不等。术中并发症发生率为 10%(95% 置信区间 [CI] = 5.9-17.1),院内术后并发症发生率为 5.4%(95% 置信区间 [CI] = 2.8-10.6)。院内死亡率为5.5%(95% CI = 2.9-10.6)。随访期间的并发症发生率为8.6%(95% CI = 4.7-15.7),其中5.5%(95% CI = 2.6-11.6)的患者出现瘘管破裂。最终血管造影随访的完全阻塞率为94.9%(95% CI = 90.3-99.9)。最后随访时,95%(95% CI = 89.8-100)的患者症状得到改善:据我们所知,我们首次提出了一项荟萃分析,评估了TVE治疗dAVFs的阻塞率、疗效和并发症。我们的分析强调了较高的(>90%)完全阻塞率。我们需要进行大型前瞻性多中心研究,以更好地界定 TVE 对非海绵体后尿道狭窄的效用。
{"title":"Transvenous embolization of noncavernous dural arteriovenous fistulas (dAVFs): A systematic review and meta-analysis.","authors":"Jaims Lim, Brianna M Donnelly, Vinay Jaikumar, Marissa D Kruk, Cathleen C Kuo, Andre Monteiro, Manhal Siddiqi, Ammad A Baig, Devan Patel, Kunal P Raygor, Kenneth V Snyder, Jason M Davies, Elad I Levy, Adnan H Siddiqui","doi":"10.1177/15910199241234098","DOIUrl":"https://doi.org/10.1177/15910199241234098","url":null,"abstract":"<p><strong>Background: </strong>Intracranial dural arteriovenous fistulas (dAVFs) are abnormal connections between arteries and veins within the dura mater. Various treatment modalities, such as surgical ligation, endovascular intervention, and radiosurgery, aim to close the fistulous connection. Although transvenous embolization (TVE) is the preferred method for carotid-cavernous fistulas, its description and outcomes for noncavernous dAVFs vary. This has prompted a systematic review and meta-analysis to comprehensively assess the effectiveness of TVE in treating noncavernous dAVFs, addressing variations in outcomes and techniques.</p><p><strong>Methods: </strong>We searched PubMed and Embase, spanning from the earliest records to December 2022, to identify pertinent English-language articles detailing the utilization of TVE. We focused on specific procedural details, outcomes, and complications in patients older than 18 years. The data collected and analyzed comprised the sample size, number of fistulas, publication specifics, presenting symptoms, fistula grades, and pooled rates of embolizations, outcomes, follow-up information, and complications.</p><p><strong>Results: </strong>From a total of 565 screened articles, 15 retrospective articles encompassing 166 patients spanning across seven countries met the inclusion criteria. Their Newcastle-Ottawa scores ranged from 6 to 8. Intraprocedural complication rate was 10% (95% confidence interval [CI] = 5.9-17.1) and in-hospital postprocedural complication rate was 5.4% (95% CI = 2.8-10.6). Prevalence of in-hospital mortality was 5.5% (95% CI = 2.9-10.6). Complication rate during follow-up was 8.6% (95% CI = 4.7-15.7) with fistula rupture occurring in 5.5% (95% CI = 2.6-11.6) of patients. Complete obliteration rate at final angiographic follow-up was 94.9% (95% CI = 90.3-99.9). Symptoms improved in 95% (95% CI = 89.8-100) of patients at final follow-up.</p><p><strong>Conclusion: </strong>To our knowledge, we present the first meta-analysis assessing obliteration rates, outcomes, and complications of TVE for dAVFs. Our analysis highlights the higher (>90%) complete obliteration rates. Large prospective multicenter studies are needed to better define the utility of TVE for noncavernous dAVFs.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139984280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-22DOI: 10.1177/15910199241233020
William K Diprose, Michael T M Wang, Joseph Reidy, Alice Ma, James Brodie, Brendan Steinfort
Background: There is emerging interest in ophthalmic artery (OA) stenosis angioplasty for the treatment of age-related macular degeneration. Three-dimensional rotational angiography (3DRA) could be used during conventional angiography to determine the presence and severity of OA stenosis. In patients who had undergone 3DRA of the internal carotid artery, we aimed to assess the interrater agreement, prevalence, and risk factors for OA stenosis.
Methods: Consecutive patients from two centers who had undergone conventional angiography with 3DRA of the internal carotid arteries were enrolled in this study. 3DRAs were independently double read for the presence of OA stenosis, as defined as narrowing of the proximal OA of at least 50% when compared to the more distal "normal" OA. Interrater agreement for the evaluation of OA stenosis was assessed with the Cohen's kappa coefficient. Univariate and multivariable logistic regression were used to identify potential predictors of OA stenosis.
Results: Three hundred and two patients (97 men; mean ± SD 57.6 ± 13.4 years) were included in the analysis. Cohen's kappa coefficient (95% CI) was 0.877 (0.798-0.956). OA stenosis was present in 45 patients (14.9%). Multiple logistic regression demonstrated that female sex (odds ratio [OR] = 2.70, 95% confidence interval [CI] 1.18-6.09, p = 0.02) and smoking (OR = 2.11, 95% CI 1.10-4.06, p = 0.03) were significant risk factors for OA stenosis. Age, hypertension, diabetes, coronary artery disease, and subarachnoid hemorrhage were not associated with OA stenosis.
Conclusion: The evaluation of OA stenosis on 3DRA had excellent interrater agreement. OA stenosis was common and was associated with smoking and female sex.
背景:眼动脉(OA)狭窄血管成形术治疗老年性黄斑变性的兴趣日渐浓厚。三维旋转血管造影术(3DRA)可用于传统血管造影术,以确定是否存在OA狭窄及其严重程度。在颈内动脉接受过三维旋转血管造影术的患者中,我们旨在评估三者之间的一致性、OA狭窄的发生率和风险因素:本研究招募了来自两个中心的连续患者,他们都接受了常规血管造影术和颈内动脉 3DRA 检查。对 3DRA 进行独立双读,以确定是否存在 OA 狭窄,OA 狭窄的定义是与较远端 "正常 "的 OA 相比,近端 OA 至少狭窄 50%。用科恩卡帕系数评估了评估 OA 狭窄的相互间一致性。采用单变量和多变量逻辑回归确定 OA 狭窄的潜在预测因素:分析共纳入 32 名患者(97 名男性;平均 ± SD 57.6 ± 13.4 岁)。科恩卡帕系数(95% CI)为 0.877 (0.798-0.956)。45 名患者(14.9%)存在 OA 狭窄。多元逻辑回归显示,女性(几率比[OR] = 2.70,95% 置信区间[CI] 1.18-6.09,P = 0.02)和吸烟(OR = 2.11,95% 置信区间[CI] 1.10-4.06,P = 0.03)是导致 OA 狭窄的重要风险因素。年龄、高血压、糖尿病、冠状动脉疾病和蛛网膜下腔出血与 OA 狭窄无关:结论:3DRA 对 OA 狭窄的评估具有极佳的互评一致性。结论:3DRA 对 OA 狭窄的评估具有极佳的相互一致性,OA 狭窄很常见,与吸烟和女性性别有关。
{"title":"Ophthalmic artery stenosis on three-dimensional rotational angiography: Interrater agreement, prevalence, and risk factors.","authors":"William K Diprose, Michael T M Wang, Joseph Reidy, Alice Ma, James Brodie, Brendan Steinfort","doi":"10.1177/15910199241233020","DOIUrl":"https://doi.org/10.1177/15910199241233020","url":null,"abstract":"<p><strong>Background: </strong>There is emerging interest in ophthalmic artery (OA) stenosis angioplasty for the treatment of age-related macular degeneration. Three-dimensional rotational angiography (3DRA) could be used during conventional angiography to determine the presence and severity of OA stenosis. In patients who had undergone 3DRA of the internal carotid artery, we aimed to assess the interrater agreement, prevalence, and risk factors for OA stenosis.</p><p><strong>Methods: </strong>Consecutive patients from two centers who had undergone conventional angiography with 3DRA of the internal carotid arteries were enrolled in this study. 3DRAs were independently double read for the presence of OA stenosis, as defined as narrowing of the proximal OA of at least 50% when compared to the more distal \"normal\" OA. Interrater agreement for the evaluation of OA stenosis was assessed with the Cohen's kappa coefficient. Univariate and multivariable logistic regression were used to identify potential predictors of OA stenosis.</p><p><strong>Results: </strong>Three hundred and two patients (97 men; mean ± SD 57.6 ± 13.4 years) were included in the analysis. Cohen's kappa coefficient (95% CI) was 0.877 (0.798-0.956). OA stenosis was present in 45 patients (14.9%). Multiple logistic regression demonstrated that female sex (odds ratio [OR] = 2.70, 95% confidence interval [CI] 1.18-6.09, <i>p</i> = 0.02) and smoking (OR = 2.11, 95% CI 1.10-4.06, <i>p</i> = 0.03) were significant risk factors for OA stenosis. Age, hypertension, diabetes, coronary artery disease, and subarachnoid hemorrhage were not associated with OA stenosis.</p><p><strong>Conclusion: </strong>The evaluation of OA stenosis on 3DRA had excellent interrater agreement. OA stenosis was common and was associated with smoking and female sex.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139933703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-22DOI: 10.1177/15910199241233333
Avi A Gajjar, Michael M Covell, Najib Muhammad, Cathleen Kuo, Georgios S Sioutas, Mohamed M Salem, Sebastian Ivan Fras, Brian T Jankowitz, Jan-Karl Burkhardt, Visish M Srinivasan
Introduction: Increasing life expectancy has caused growing concern about maintaining viable neurointerventional practices due to altered Medicare payment structures. This study analyzes the financial trends of three common diagnostic tests for cerebrovascular disease: cerebral digital subtraction angiography (DSA), computed tomography angiography (CTA), and magnetic resonance angiography (MRA).
Methods: Medicare Part B National Summary Data files from 2013 to 2020 were queried by Current Procedural Terminology (CPT) codes for DSA (36221-36228), CTA (70496, 70498), and MRA (70544-70547, 70549). Inflation-adjusted charges and reimbursement were calculated using the U.S. City Average Consumer Price Index for Medical Services. Regression analysis was performed on charges, reimbursement, and volume.
Results: A total of 1,519,245 diagnostic procedures were conducted between 2013 and 2020 (782,370 angiograms, 246,603 CTAs, and 490,272 MRAs). A total of $41.005 million was reimbursed by Medicare in 2020 for these diagnostic procedures. The annual percent change in volume for all procedures was -2.90%. From 2013 to 2020, inflation-adjusted: Medicare total physician reimbursement decreased for cerebral angiograms (-4.12%, p = 0.007), CTAs (-2.77%, p = 0.458), and MRAs (-9.06%, p < 0.001). Procedural volume billed to Medicare decreased for cerebral angiograms (-4.63%, p = 0.007) and MRAs (-2.94%, p = 0.0.81) and increased for CTAs (+3.15%, p = 0.004). The greatest increase in Medicare reimbursement (+66.75%) came from CPT code 36224, "place catheter carotid artery", and the greatest decrease in Medicare reimbursement (-8.66%) came from CPT code 36226, "place catheter vertebral artery."
Conclusions: This study provides an analysis of Medicare reimbursement trends for routine cerebrovascular angiogram techniques. The findings highlight a decline in Medicare reimbursements for neurointerventionalists.
{"title":"Utilization and reimbursement of diagnostic cerebral angiograms: A Medicare trends analysis from 2013 to 2020.","authors":"Avi A Gajjar, Michael M Covell, Najib Muhammad, Cathleen Kuo, Georgios S Sioutas, Mohamed M Salem, Sebastian Ivan Fras, Brian T Jankowitz, Jan-Karl Burkhardt, Visish M Srinivasan","doi":"10.1177/15910199241233333","DOIUrl":"https://doi.org/10.1177/15910199241233333","url":null,"abstract":"<p><strong>Introduction: </strong>Increasing life expectancy has caused growing concern about maintaining viable neurointerventional practices due to altered Medicare payment structures. This study analyzes the financial trends of three common diagnostic tests for cerebrovascular disease: cerebral digital subtraction angiography (DSA), computed tomography angiography (CTA), and magnetic resonance angiography (MRA).</p><p><strong>Methods: </strong>Medicare Part B National Summary Data files from 2013 to 2020 were queried by Current Procedural Terminology (CPT) codes for DSA (36221-36228), CTA (70496, 70498), and MRA (70544-70547, 70549). Inflation-adjusted charges and reimbursement were calculated using the U.S. City Average Consumer Price Index for Medical Services. Regression analysis was performed on charges, reimbursement, and volume.</p><p><strong>Results: </strong>A total of 1,519,245 diagnostic procedures were conducted between 2013 and 2020 (782,370 angiograms, 246,603 CTAs, and 490,272 MRAs). A total of $41.005 million was reimbursed by Medicare in 2020 for these diagnostic procedures. The annual percent change in volume for all procedures was -2.90%. From 2013 to 2020, inflation-adjusted: Medicare total physician reimbursement decreased for cerebral angiograms (-4.12%, p = 0.007), CTAs (-2.77%, p = 0.458), and MRAs (-9.06%, p < 0.001). Procedural volume billed to Medicare decreased for cerebral angiograms (-4.63%, p = 0.007) and MRAs (-2.94%, p = 0.0.81) and increased for CTAs (+3.15%, p = 0.004). The greatest increase in Medicare reimbursement (+66.75%) came from CPT code 36224, \"place catheter carotid artery\", and the greatest decrease in Medicare reimbursement (-8.66%) came from CPT code 36226, \"place catheter vertebral artery.\"</p><p><strong>Conclusions: </strong>This study provides an analysis of Medicare reimbursement trends for routine cerebrovascular angiogram techniques. The findings highlight a decline in Medicare reimbursements for neurointerventionalists.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139933704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-22DOI: 10.1177/15910199241232726
Mohamed Elfil, Rami Z Morsi, Sherief Ghozy, Ahmed Elmashad, Adnan Siddiqui, Alhamza R Al-Bayati, Ali Alaraj, Allan Brook, Anthony W Kam, Arindam Rano Chatterjee, Athos Patsalides, Ben Waldau, Charles J Prestigiacomo, Charles Matouk, Clemens M Schirmer, David Altschul, David T Parrella, Gabor Toth, Gaurav Jindal, Hamza A Shaikh, Jaydevsinh N Dolia, Johanna T Fifi, Justin F Fraser, Justin Thomas DO, Krishna Amuluru, Louis J Kim, Mark Harrigan, Matthew R Amans, Max Kole, Max Mokin, Michael Abraham, Mouhammad Jumaa, Nazli Janjua, Osama Zaidat, Patrick P Youssef, Priyank Khandelwal, Qingliang Tony Wang, Ramesh Grandhi, Ricardo Hanel, Ryan T Kellogg, Santiago Ortega-Gutierrez, Sunil Sheth, Thanh N Nguyen, Viktor Szeder, Yin C Hu, Albert J Yoo, Omar Tanweer, Brian Jankowitz, Jeremy J Heit, Richard Williamson, Tareq Kass-Hout, Richard W Crowley, Mohammad El-Ghanem, Fawaz Al-Mufti
Background and importance: Neurointervention is a very competitive specialty in the United States due to the limited number of training spots and the larger pool of applicants. The training standards are continuously updated to ensure solid training experiences. Factors affecting candidate(s) selection have not been fully established yet. Our study aims to investigate the factors influencing the selection process.
Methods: A 52-question survey was distributed to 93 program directors (PDs). The survey consisted of six categories: (a) Program characteristics, (b) Candidate demographics, (c) Educational credentials, (d) Personal traits, (e) Research and extracurricular activities, and (f) Overall final set of characteristics. The response rate was 59.1%. As per the programs' characteristics, neurosurgery was the most involved specialty in running the training programs (69%). Regarding demographics, the need for visa sponsorship held the greatest prominence with a mean score of 5.9 [standard deviation (SD) 2.9]. For the educational credentials, being a graduate from a neurosurgical residency and the institution where the candidate's residency training is/was scored the highest [5.4 (SD = 2.9), 5.4 (SD = 2.5), respectively]. Regarding the personal traits, assessment by faculty members achieved the highest score [8.9 (SD = 1)]. In terms of research/extracurricular activities, fluency in English had the highest score [7.2 (SD = 1.9)] followed by peer-reviewed/PubMed-indexed publications [6.4 (SD = 2.2)].
Conclusion: Our survey investigated the factors influencing the final decision when choosing the future neurointerventional trainee, including demographic, educational, research, and extracurricular activities, which might serve as valuable guidance for both applicants and programs to refine the selection process.
{"title":"Factors Affecting Selection of TraineE for Neurointervention (FASTEN).","authors":"Mohamed Elfil, Rami Z Morsi, Sherief Ghozy, Ahmed Elmashad, Adnan Siddiqui, Alhamza R Al-Bayati, Ali Alaraj, Allan Brook, Anthony W Kam, Arindam Rano Chatterjee, Athos Patsalides, Ben Waldau, Charles J Prestigiacomo, Charles Matouk, Clemens M Schirmer, David Altschul, David T Parrella, Gabor Toth, Gaurav Jindal, Hamza A Shaikh, Jaydevsinh N Dolia, Johanna T Fifi, Justin F Fraser, Justin Thomas DO, Krishna Amuluru, Louis J Kim, Mark Harrigan, Matthew R Amans, Max Kole, Max Mokin, Michael Abraham, Mouhammad Jumaa, Nazli Janjua, Osama Zaidat, Patrick P Youssef, Priyank Khandelwal, Qingliang Tony Wang, Ramesh Grandhi, Ricardo Hanel, Ryan T Kellogg, Santiago Ortega-Gutierrez, Sunil Sheth, Thanh N Nguyen, Viktor Szeder, Yin C Hu, Albert J Yoo, Omar Tanweer, Brian Jankowitz, Jeremy J Heit, Richard Williamson, Tareq Kass-Hout, Richard W Crowley, Mohammad El-Ghanem, Fawaz Al-Mufti","doi":"10.1177/15910199241232726","DOIUrl":"https://doi.org/10.1177/15910199241232726","url":null,"abstract":"<p><strong>Background and importance: </strong>Neurointervention is a very competitive specialty in the United States due to the limited number of training spots and the larger pool of applicants. The training standards are continuously updated to ensure solid training experiences. Factors affecting candidate(s) selection have not been fully established yet. Our study aims to investigate the factors influencing the selection process.</p><p><strong>Methods: </strong>A 52-question survey was distributed to 93 program directors (PDs). The survey consisted of six categories: (a) Program characteristics, (b) Candidate demographics, (c) Educational credentials, (d) Personal traits, (e) Research and extracurricular activities, and (f) Overall final set of characteristics. The response rate was 59.1%. As per the programs' characteristics, neurosurgery was the most involved specialty in running the training programs (69%). Regarding demographics, the need for visa sponsorship held the greatest prominence with a mean score of 5.9 [standard deviation (SD) 2.9]. For the educational credentials, being a graduate from a neurosurgical residency and the institution where the candidate's residency training is/was scored the highest [5.4 (SD = 2.9), 5.4 (SD = 2.5), respectively]. Regarding the personal traits, assessment by faculty members achieved the highest score [8.9 (SD = 1)]. In terms of research/extracurricular activities, fluency in English had the highest score [7.2 (SD = 1.9)] followed by peer-reviewed/PubMed-indexed publications [6.4 (SD = 2.2)].</p><p><strong>Conclusion: </strong>Our survey investigated the factors influencing the final decision when choosing the future neurointerventional trainee, including demographic, educational, research, and extracurricular activities, which might serve as valuable guidance for both applicants and programs to refine the selection process.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139933702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-12DOI: 10.1177/15910199241233031
Ghazwan A Lafta
Endovascular neurointervention nowadays plays an important role in the effective treatment of different head and neck vascular pathologies using minimally invasive means. In Iraq, until recently, endovascular neurointervention field is nearly absent. A new hope was started when an advanced neurointerventional center was created to improve and develop this field in Iraq.
{"title":"Endovascular neurointervention in Iraq: Realistic obstacles, a hopeful start with \"Al-Hayat center\".","authors":"Ghazwan A Lafta","doi":"10.1177/15910199241233031","DOIUrl":"https://doi.org/10.1177/15910199241233031","url":null,"abstract":"<p><p>Endovascular neurointervention nowadays plays an important role in the effective treatment of different head and neck vascular pathologies using minimally invasive means. In Iraq, until recently, endovascular neurointervention field is nearly absent. A new hope was started when an advanced neurointerventional center was created to improve and develop this field in Iraq.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-12DOI: 10.1177/15910199241232465
Shingo Yamada, Kei Harada, Daichi Baba, Takatusugu Oshima, Koki Tanaka
Objectives: The optimal therapeutic methods for in-stent restenosis (ISR) after carotid artery stenting (CAS) remains controversial. This study aimed to use optical coherence tomography (OCT) to evaluate the in-stent architectures during endovascular angioplasty/stenting for ISR.
Materials and methods: Six lesions of ISR after CAS were evaluated by OCT during endovascular angioplasty/stenting.
Results: In one lesion, the OCT system could not be crossed because of elongation distal to the ISR lesion. In five lesions, pre-procedural OCT clearly revealed neointimal hyperplasia or neoatherosclerosis. The mean in-stent area stenosis was 84%. After regular balloon angioplasty, tissue compression and dissection of various sizes and layers were detected. After balloon angioplasty (with a mean balloon size of 5.4 mm), the minimum lumen area (from 1.7 ± 0.6 to 11.4 ± 5.3 mm2, p < 0.01) and the minimum in-stent area (12.7 ± 2.6 to 21.8 ± 5.0 mm2, p < 0.01) showed a significant increase. Additional stent was placed in one lesion that developed into a flap by dissection after balloon angioplasty. In another lesion in which sufficient dilatation was not achieved by balloon angioplasty, a major stroke occurred by acute occlusion of the ISR lesion 10 months later.
Conclusions: OCT can detect the in-stent architecture of ISR lesions after balloon angioplasty and additional stent placement. However, which dissection should be treated by additional stent remain problematic.
{"title":"Optical coherence tomography findings of balloon angioplasty/stenting for in-stent restenosis after carotid artery stenting.","authors":"Shingo Yamada, Kei Harada, Daichi Baba, Takatusugu Oshima, Koki Tanaka","doi":"10.1177/15910199241232465","DOIUrl":"https://doi.org/10.1177/15910199241232465","url":null,"abstract":"<p><strong>Objectives: </strong>The optimal therapeutic methods for in-stent restenosis (ISR) after carotid artery stenting (CAS) remains controversial. This study aimed to use optical coherence tomography (OCT) to evaluate the in-stent architectures during endovascular angioplasty/stenting for ISR.</p><p><strong>Materials and methods: </strong>Six lesions of ISR after CAS were evaluated by OCT during endovascular angioplasty/stenting.</p><p><strong>Results: </strong>In one lesion, the OCT system could not be crossed because of elongation distal to the ISR lesion. In five lesions, pre-procedural OCT clearly revealed neointimal hyperplasia or neoatherosclerosis. The mean in-stent area stenosis was 84%. After regular balloon angioplasty, tissue compression and dissection of various sizes and layers were detected. After balloon angioplasty (with a mean balloon size of 5.4 mm), the minimum lumen area (from 1.7 ± 0.6 to 11.4 ± 5.3 mm<sup>2</sup>, <i>p</i> < 0.01) and the minimum in-stent area (12.7 ± 2.6 to 21.8 ± 5.0 mm<sup>2</sup>, <i>p</i> < 0.01) showed a significant increase. Additional stent was placed in one lesion that developed into a flap by dissection after balloon angioplasty. In another lesion in which sufficient dilatation was not achieved by balloon angioplasty, a major stroke occurred by acute occlusion of the ISR lesion 10 months later.</p><p><strong>Conclusions: </strong>OCT can detect the in-stent architecture of ISR lesions after balloon angioplasty and additional stent placement. However, which dissection should be treated by additional stent remain problematic.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: Although reports of endovascular treatment for intracranial arterial stenosis have been increasing recently, their efficacy remains to be elucidated. This study aimed to investigate the changes in cerebral hemodynamics of severe middle cerebral artery (MCA) stenosis patients by performing CT perfusion (CTP) after endovascular treatment.
Methods: Subjects were those who underwent balloon angioplasty and stenting for symptomatic MCA M1 stenosis refractory to medical therapy at our hospital between 2008 and 2022. We included 36 patients (mean age 63.69 ± 15.24 years, 20 males) who underwent CTP before and within three weeks after treatment. The CTP parameters such as relative cerebral blood flow (rCBF), relative cerebral blood volume (rCBV), and relative mean transit time (rMTT) were calculated as ipsilateral values divided by contralateral value.
Results: Endovascular treatment consisted of 26 balloon angioplasty and 10 stenting procedures performed at an average of 1 month from onset. CTP was performed at an average of 5.5 days postoperatively. The mean overall stenosis rate decreased from 79.0% to 30.3%. In the balloon angioplasty group, it decreased from 77.6% to 35.3%, and in the stent group, it decreased from 82.7% to 17.5%. After treatment, rCBF and rMTT measured by CTP improved significantly (both p < 0.001), whereas there was no significant change in rCBV. The improvement rates of rCBF and rMTT were mild higher in the stent group, but not significantly so.
Conclusion: Balloon angioplasty and stenting for symptomatic MCA improved cerebral hemodynamics, resulting in significantly increased rCBF and decreased rMTT.
{"title":"Improvement of cerebral blood flow after balloon angioplasty and stenting for symptomatic middle cerebral artery stenosis.","authors":"Takashi Araga, Toshihiro Ueda, Tomohide Yoshie, Naoki Takao, Haruki Ohtsubo, Kentaro Tatsuno, Noriko Usuki, Satoshi Takaishi, Yoshihisa Yamano","doi":"10.1177/15910199241231148","DOIUrl":"https://doi.org/10.1177/15910199241231148","url":null,"abstract":"<p><strong>Objective: </strong>Although reports of endovascular treatment for intracranial arterial stenosis have been increasing recently, their efficacy remains to be elucidated. This study aimed to investigate the changes in cerebral hemodynamics of severe middle cerebral artery (MCA) stenosis patients by performing CT perfusion (CTP) after endovascular treatment.</p><p><strong>Methods: </strong>Subjects were those who underwent balloon angioplasty and stenting for symptomatic MCA M1 stenosis refractory to medical therapy at our hospital between 2008 and 2022. We included 36 patients (mean age 63.69 ± 15.24 years, 20 males) who underwent CTP before and within three weeks after treatment. The CTP parameters such as relative cerebral blood flow (rCBF), relative cerebral blood volume (rCBV), and relative mean transit time (rMTT) were calculated as ipsilateral values divided by contralateral value.</p><p><strong>Results: </strong>Endovascular treatment consisted of 26 balloon angioplasty and 10 stenting procedures performed at an average of 1 month from onset. CTP was performed at an average of 5.5 days postoperatively. The mean overall stenosis rate decreased from 79.0% to 30.3%. In the balloon angioplasty group, it decreased from 77.6% to 35.3%, and in the stent group, it decreased from 82.7% to 17.5%. After treatment, rCBF and rMTT measured by CTP improved significantly (both <i>p </i>< 0.001), whereas there was no significant change in rCBV. The improvement rates of rCBF and rMTT were mild higher in the stent group, but not significantly so.</p><p><strong>Conclusion: </strong>Balloon angioplasty and stenting for symptomatic MCA improved cerebral hemodynamics, resulting in significantly increased rCBF and decreased rMTT.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139708270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-08DOI: 10.1177/15910199241230356
Michelle Toruno, Omar Al-Janabi, Irem Karaman, Sherief Ghozy, Yigit Can Senol, Hassan Kobeissi, Ramanathan Kadirvel, Boyd Ashdown, David F Kallmes
Background: Cancer-related cerebral embolism due to direct tumor embolization results in a rare acute ischemic stroke with large vessel occlusion (LVO). Despite the established status of mechanical thrombectomy (MT) in LVO management, its effectiveness and safety remains inadequately explored in this specific patient group.
Methods: We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using the Nested Knowledge AutoLit software, encompassing databases like Embase, PubMed, Scopus, and Web of Science, from their inception up to 9 May 2023.
Results: In the review of 35 studies encompassing 37 cases, mean patient age was 52 years, and 30% were female. Cardiac myxoma (29.7%), cardiac papillary fibroelastoma (16.2%), and squamous cell carcinoma of the lung (8.1%) were the most frequent underlying cancers. The left middle cerebral artery was the most commonly affected occlusion site (24.3%). Of the patients, 67.5% underwent MT alone, while 32.5% received MT combined with intravenous thrombolysis. Successful reperfusion (thrombolysis in cerebral infarction (TICI) 2b-3) was achieved in 89.1% of cases, with 59.4% reaching TICI 3. Functional independence was observed in 29.7% of patients.
Conclusion: While limitations exist, this comprehensive study highlights the potential benefits of MT in a patient group historically excluded from major trials, warranting further investigation.
背景:肿瘤直接栓塞导致的癌症相关脑栓塞是一种罕见的大血管闭塞(LVO)急性缺血性卒中。尽管机械性血栓切除术(MT)在大血管闭塞治疗中的地位已经确立,但其在这一特殊患者群体中的有效性和安全性仍未得到充分探讨:我们根据《系统综述和荟萃分析首选报告项目》指南,使用 Nested Knowledge AutoLit 软件进行了一项系统综述,涵盖了 Embase、PubMed、Scopus 和 Web of Science 等数据库从开始到 2023 年 5 月 9 日的所有内容:在35项研究的37个病例中,患者平均年龄为52岁,30%为女性。心脏肌瘤(29.7%)、心脏乳头纤维瘤(16.2%)和肺鳞癌(8.1%)是最常见的潜在癌症。左侧大脑中动脉是最常见的闭塞部位(24.3%)。其中,67.5%的患者仅接受了脑中动脉介入治疗,32.5%的患者在接受脑中动脉介入治疗的同时接受了静脉溶栓治疗。89.1%的病例成功实现了再灌注(脑梗塞溶栓治疗(TICI)2b-3),其中59.4%达到了TICI 3,29.7%的患者实现了功能独立:虽然存在局限性,但这项全面的研究强调了MT对历来被排除在主要试验之外的患者群体的潜在益处,值得进一步研究。
{"title":"Mechanical thrombectomy for the treatment of large vessel occlusion due to cancer-related cerebral embolism: A systematic review.","authors":"Michelle Toruno, Omar Al-Janabi, Irem Karaman, Sherief Ghozy, Yigit Can Senol, Hassan Kobeissi, Ramanathan Kadirvel, Boyd Ashdown, David F Kallmes","doi":"10.1177/15910199241230356","DOIUrl":"https://doi.org/10.1177/15910199241230356","url":null,"abstract":"<p><strong>Background: </strong>Cancer-related cerebral embolism due to direct tumor embolization results in a rare acute ischemic stroke with large vessel occlusion (LVO). Despite the established status of mechanical thrombectomy (MT) in LVO management, its effectiveness and safety remains inadequately explored in this specific patient group.</p><p><strong>Methods: </strong>We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using the Nested Knowledge AutoLit software, encompassing databases like Embase, PubMed, Scopus, and Web of Science, from their inception up to 9 May 2023.</p><p><strong>Results: </strong>In the review of 35 studies encompassing 37 cases, mean patient age was 52 years, and 30% were female. Cardiac myxoma (29.7%), cardiac papillary fibroelastoma (16.2%), and squamous cell carcinoma of the lung (8.1%) were the most frequent underlying cancers. The left middle cerebral artery was the most commonly affected occlusion site (24.3%). Of the patients, 67.5% underwent MT alone, while 32.5% received MT combined with intravenous thrombolysis. Successful reperfusion (thrombolysis in cerebral infarction (TICI) 2b-3) was achieved in 89.1% of cases, with 59.4% reaching TICI 3. Functional independence was observed in 29.7% of patients.</p><p><strong>Conclusion: </strong>While limitations exist, this comprehensive study highlights the potential benefits of MT in a patient group historically excluded from major trials, warranting further investigation.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139708271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}