scholarly journals EP11 A possible follow-up protocol for the novel contour neurovascular system for intracranial aneurysm treatment in MRI and spectral CT

2021 ◽  
Author(s):  
J Madjidyar ◽  
JT Hensler ◽  
O Jansen ◽  
F Wodarg
Keyword(s):  
Intracranial Aneurysm ◽  
The Novel ◽  
Spectral Ct ◽  
Aneurysm Treatment

scholarly journals One and done? The effect of number of Pipeline embolization devices on aneurysm treatment outcomes

2019 ◽  
Vol 26 (2) ◽  
pp. 147-155
Author(s):  
Muhammad Waqas ◽  
Kunal Vakharia ◽  
Andrew D Gong ◽  
Hamid H Rai ◽  
Audrey Wack ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Thromboembolic Complication ◽  
Optimum Number ◽  
Complication Rates ◽  
Computed Tomographic ◽  
Aneurysm Treatment ◽  
Significant Difference ◽  
Angiographic Data ◽  
Aneurysm Occlusion

Background Controversy exists regarding the optimum number of flow diverters for the treatment of intracranial aneurysms. We explored the effect of the number of Pipeline embolization devices (PEDs; Medtronic, Dublin, Ireland) deployed on rates of aneurysm occlusion and complications. Methods Consecutive patients who underwent saccular intracranial aneurysm treatment solely with the PED were included in this retrospective study. Computed tomographic, magnetic resonance, or digital subtraction angiographic images at 6 and 12 months and last follow-up (>12 months) were reviewed for aneurysm occlusion. Complication and retreatment rates were recorded and analyzed statistically. Results The study included 141 aneurysm treatments in 119 patients. A single PED was deployed in 105 cases, two PEDs in 31 cases, and three PEDs in 5 cases (total = 182 devices). Six-month angiographic data were available for 103 patients. Occlusion rates were 67.1% for single-PED cases and 90.0% for cases with > 1 PED (p = 0.028). The 12-month occlusion rate (follow-up available for 132) for single-PED cases was 74.7% compared to 91.7% for multiple-PED cases (p = 0.04). On multivariate analysis, number of PEDs was an independent predictor of aneurysm occlusion at 12 months (odds ratio 6.3, 95% confidence interval 1.8–22.8, p = 0.005). Thromboembolic complication rates were the same in the single- and multiple-PED treatment groups (2.8%). The retreatment rate was higher in patients treated with a single PED (16.2% vs. 0%, p = 0.01). Conclusions Deployment of > 1 Pipeline embolization device was associated with higher intracranial aneurysm occlusion and lower retreatment rates. No significant difference was found in complication rates.

A survey of intracranial aneurysm treatment practices among United States physicians

2017 ◽  
Vol 10 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Kyle M Fargen ◽  
Hector E Soriano-Baron ◽  
Julia T Rushing ◽  
William Mack ◽  
J Mocco ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Online Survey ◽  
Treatment Strategies ◽  
International Study ◽  
Treatment Preferences ◽  
Anterior Circulation ◽  
Treatment Practices ◽  
Aneurysm Treatment ◽  
Unruptured Intracranial Aneurysms

BackgroundRecent surveys have failed to examine cerebrovascular aneurysm treatment practices among US physicians.ObjectiveTo survey physicians who are actively involved in the care of patients with cerebrovascular aneurysms to determine current aneurysm treatment preferences.MethodsA 25-question SurveyMonkey online survey was designed and distributed electronically to members of the Society of NeuroInterventional Surgery, Society of Vascular and Interventional Neurology, and the American Association of Neurological Surgeons/Congress of Neurological Surgeons Combined Cerebrovascular Section.Results211 physicians completed the survey. Most respondents recommend endovascular treatment as the first-line management strategy for most ruptured (78%) and unruptured (71%) aneurysms. Thirty-eight per cent of respondents indicate that they routinely treat all patients with subarachnoid hemorrhage regardless of grade. Most physicians use the International Study of Unruptured Intracranial Aneurysms data for counseling patients on natural history risk (80%); a small minority (11%) always or usually recommend treatment of anterior circulation aneurysms of <5 mm. Two-thirds of respondents continue to recommend clipping for most middle cerebral artery aneurysms, while most (51%) recommend flow diversion for wide-necked internal carotid artery aneurysms. Follow-up imaging schedules are highly variable. Neurosurgeons at academic institutions and those practicing longer were more likely to recommend clipping surgery for aneurysms (p<0.05).ConclusionsThis survey demonstrates considerable variability in patient selection for intracranial aneurysm treatment, preferred treatment strategies, and follow-up imaging schedules among US physicians.

scholarly journals Kinematic measures provide useful information after intracranial aneurysm treatment

2017 ◽  
Vol 4 ◽  
pp. 205566831774499
Author(s):  
Rachael K Raw ◽  
Richard M Wilkie ◽  
Mark Mon-Williams ◽  
Stuart A Ross ◽  
Kenan Deniz ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Subarachnoid Haemorrhage ◽  
Memory Function ◽  
Pilot Trial ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
Operative Outcomes ◽  
Aneurysm Treatment ◽  
Operative Care ◽  
Kinematic Measures

Introduction Current methods of assessing the outcomes of intracranial aneurysm treatment for aneurysmal subarachnoid haemorrhage are relatively insensitive, and thus unlikely to detect subtle deficits. Failures to identify cognitive and motor outcomes of intracranial aneurysm treatment might prevent delivery of optimal post-operative care. There are also concerns over risks associated with using intracranial aneurysm treatment as a preventative measure. Methods We explored whether our kinematic tool would yield useful information regarding motor/cognitive function in patients who underwent intracranial aneurysm treatment for aneurysmal subarachnoid haemorrhage or unruptured aneurysm. Computerised kinematic motor and learning tasks were administered alongside standardised clinical outcome measures of cognition and functional ability, in 10 patients, as a pilot trial. Tests at post-intracranial aneurysm treatment discharge and six-week follow-up were compared to see which measures detected changes. Results Kinematic tests captured significant improvements from discharge to six-week follow-up, indexed by reduced motor errors and improved learning. Increased Addenbrooke’s Cognitive Examination-Revised scores reflected some recovery of memory function for most individuals, but other standardised cognitive measures, functional outcome scores and a psychological questionnaire showed no changes. Conclusions Kinematic measures can identify variation in performance in individuals with only slightly improved abilities post-intracranial aneurysm treatment. These measures may provide a sensitive way to explore post-operative outcomes following intracranial aneurysm treatment, or other similar surgical procedures.

scholarly journals Robotic-assisted intracranial aneurysm treatment: 1 year follow-up imaging and clinical outcomes

2021 ◽  
pp. neurintsurg-2021-017865
Author(s):  
Nicole Mariantonia Cancelliere ◽  
Jeremy Lynch ◽  
Patrick Nicholson ◽  
Tomas Dobrocky ◽  
Saravana Kumar Swaminathan ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Clinical Outcomes ◽  
Intracranial Aneurysms ◽  
Robotic System ◽  
Robotic Assisted ◽  
Technical Success Rate ◽  
Aneurysm Treatment ◽  
Technical Accuracy ◽  
Aneurysm Embolization

BackgroundThe use of robotics in medicine may enable increased technical accuracy, reduced procedural time and radiation exposure, and remote completion of procedures. We have previously described the first-in-human, robotic-assisted cerebral aneurysm treatment using the CorPath GRX Robotic System. In this report we discuss our early experiences and outcomes using this robotic device for endovascular treatment of intracranial aneurysms using stent-assisted coil embolization and flow diversion.MethodsThe patient and disease characteristics, procedural details, and follow-up imaging and clinical outcomes of consecutive patients undergoing robotically-assisted intracranial aneurysm embolization between November 2019 and February 2020 are presented.ResultsSix patients underwent robotically-assisted embolization of intracranial aneurysms. Four of the patients were treated with a neck-bridging stent (with or without coiling) and two patients were treated with a flow-diverting stent. Two patients were treated in the subacute period of subarachnoid hemorrhage and four patients were treated electively. All of the procedures could be completed robotically and there was no need for unplanned manual intervention. The technical success rate of the procedures was 100%. There was no morbidity or mortality associated with the procedures. One year follow-up imaging showed that four aneurysms were completely obliterated (Raymond-Roy Occlusion Classification (RROC) class I) and the remaining two were occluded with a residual neck (RROC class II).ConclusionsThe Corpath GRX Robotic System demonstrated a precise control over the microcatheter, wire and stent during aneurysm treatment. Robotic neuro-procedures seem to be safe and effective and demonstrate stable occlusion results in the midterm follow-up.

Recanalization and rupture after intracranial aneurysm treatment

2019 ◽  
Vol 63 (5) ◽  
Author(s):  
Emmanuel Costa ◽  
Geraldo Vaz ◽  
Patrice Finet ◽  
Pierre Goffette ◽  
Marie-Agnès Docquier ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Aneurysm Treatment

scholarly journals Waning antibody responses in COVID-19: what can we learn from the analysis of other coronaviruses?

Infection ◽  
2021 ◽  
Author(s):  
Ali Hamady ◽  
JinJu Lee ◽  
Zuzanna A. Loboda
Keyword(s):  
Cross Reactivity ◽  
Antibody Responses ◽  
The Novel ◽  
Incidence And Mortality ◽  
Antibody Titres ◽  
Human Coronaviruses ◽  
Public Health Strategies ◽  
Antibody Dynamics

Abstract Objectives The coronavirus disease 2019 (COVID-19), caused by the novel betacoronavirus severe acute respiratory syndrome 2 (SARS-CoV-2), was declared a pandemic in March 2020. Due to the continuing surge in incidence and mortality globally, determining whether protective, long-term immunity develops after initial infection or vaccination has become critical. Methods/Results In this narrative review, we evaluate the latest understanding of antibody-mediated immunity to SARS-CoV-2 and to other coronaviruses (SARS-CoV, Middle East respiratory syndrome coronavirus and the four endemic human coronaviruses) in order to predict the consequences of antibody waning on long-term immunity against SARS-CoV-2. We summarise their antibody dynamics, including the potential effects of cross-reactivity and antibody waning on vaccination and other public health strategies. At present, based on our comparison with other coronaviruses we estimate that natural antibody-mediated protection for SARS-CoV-2 is likely to last for 1–2 years and therefore, if vaccine-induced antibodies follow a similar course, booster doses may be required. However, other factors such as memory B- and T-cells and new viral strains will also affect the duration of both natural and vaccine-mediated immunity. Conclusion Overall, antibody titres required for protection are yet to be established and inaccuracies of serological methods may be affecting this. We expect that with standardisation of serological testing and studies with longer follow-up, the implications of antibody waning will become clearer.

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