Abstract 1122‐000049: Safety and Efficacy of Daily Intra‐Arterial Endovascular Therapy for Refractory Cerebral Vasospasm Following Subarachnoid Hemorrhage

Introduction : Delayed cerebral ischemia (DCI) and cerebral infarction (CI) due to vasospasm is a major cause of death and disability after aneurysmal subarachnoid hemorrhage (aSAH). Transluminal balloon angioplasty (BA) and super‐selective intra‐arterial (IA) infusion of vasodilators are considered for refractory vasospasm. We examined the safety and efficacy of repeated daily IA treatment in vasospasm. Methods : We reviewed records a single center of vasospasm treatment for aSAH from 2016 through 2019. Primary endpoints were rate of cerebral infarctions and safety related to daily treatments. Secondary endpoints were mortality and favorable clinical outcome at hospital discharge defined as modified Rankin scale of scores 0–2. Results : Of 426 patients with SAH, 197 were aneurysmal with 79 with DCI. Forty‐five out of 79 underwent IA treatment, of which 14 underwent 1 or 2 treatments (Group 1) and 31 underwent ≥3 treatments (Group2). Incidence of CI were similar (Group 1: 42.8%; Group 2: 54.8%, p = 0.45) Good clinical outcomes at discharge were seen in 36% in Group 1 and 16% in Group 2 (p = 0.15). Mortality was 7% in group 1 and 26% in group 2 (p = 0.17). Conclusions : Complications including vessel dissection, systemic hypotension and seizures did not increase with repeated treatments. CI was not noted to differ, but the outcomes were worse in group 2 which may relate to severity of SAH rather than DCI.

Download Full-text

Post-streptokinase PCI in STEMI patients exceeding the 24-h guidelines

Beni-Suef University Journal of Basic and Applied Sciences ◽

10.1186/s43088-021-00162-3 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

El-Zahraa M. Esmat Sultan ◽

Khaled R. Abdel Meguid ◽

Hesham B. Mahmoud

Keyword(s):

End Point ◽

Timi Flow ◽

Primary Endpoints ◽

Significant Difference ◽

Close Observation ◽

Secondary Endpoints ◽

Group 2 ◽

Group 1 ◽

The Ideal

Abstract Background Due to delay in obtaining approval from insurance institution, performing PCI after successful reperfusion using streptokinase was postponed for ˃24 h-1 week. The study was conducted to investigate safety and efficacy of such delay in comparison to the ideal guidelines of PCI (≤ 24 h) in 129 STEMI patients received streptokinase followed by PCI. Patients were divided into two groups: (group 1 = 57; early PCI ≤ 24 h.) and (group 2 = 72; late PCI > 24 h.). Results Primary end point was death, congestive heart failure and reinfarction up to 30 days. Secondary end point was TIMI flow < G3, ischemic stroke, intracranial hemorrhage and non-intracranial bleeding. No statistical significant difference was found between both groups regarding LVEF, dimensions and myocardium wall preservation and incidence of complications and TIMI flow. No primary endpoints were detected. Five patients had secondary endpoints in early PCI and four in the late PCI. Suction device and IV Eptifibatide were used more in early PCI (p = 0.003). Conclusions The study suggests that relatively late PCI (> 24 h–1wk) after successful reperfusion using streptokinase in STEMI patients seems to be safe and effective in 30-day follow-up, provided that patients received DAPT and were subjected to close observation. The results seem safely applicable when we are forced to this choice; however lack of more investigations to this hypothesis is considered a limitation.

Download Full-text

UGT1A1*28 polymorphism in advanced colorectal cancer: The story is not yet ended.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.3_suppl.516 ◽

2014 ◽

Vol 32 (3_suppl) ◽

pp. 516-516

Author(s):

Ahmed El Saied El Bastawisy ◽

Amany El-Zeiny ◽

Samar Farid ◽

Abeer Bahnasy

Keyword(s):

Colorectal Cancer ◽

Advanced Colorectal Cancer ◽

Progression Free Survival ◽

Treatment Delay ◽

Free Survival ◽

Primary Endpoints ◽

Secondary Endpoints ◽

Group 2 ◽

Group 1

516 Background: UGT1A1*28 polymorphism is associated with neutropenia and diarrhea in previous reports, this study tried to investigate correlation with other toxicities like vomiting. Methods: This is a prospective case control study including all eligible cases of advanced colorectal cancer. The genotypes of UGT1A1*28 was assessed in the peripheral blood and/or in tissues by PCR. Patients were divided into two groups, group 1—patients with no mutation, group 2—patients with homo or hetero mutation. All patients received standard IFL regimen. Primary endpoints were (1) comparison between the 2 groups as regard vomiting (2) assessement of the incidence of UGT1A1*28 polymorphism. Secondary endpoints were comparison between the 2 groups as regard: neutropenia, diarrhea, treatment delay, progressive diseases (PD), progression free survival (PFS), and overall survival (OS). Results: 46 cases of advanced colorectal cancer presenting to National Cancer Institute, Cairo University, aged between 19 and 71 years with a median age of 45 years were included and followed up during the period from September 2010 to January 2013 with a median follow up of 9 months. UGT1A1*28 polymorphism was present in 20 patients (43%) of them 15% are homozygous. Grade (2-4) vomiting was found in 8.3 % of group 1 versus 52.5 % of group 2. (p = 0.01). Grade (2-4) neutropenia were found in 20.8 % of group 1 versus 64.7 % of group2. (p = 0.03). Grade (2-4) diarrhea was found in 37.5 % of patients of group 1 and 27.5% of patients with group 2. (p = 0.75). Treatment delay occurred in 29.16 % of group 1 versus 72.4 % of group 2. (p = 0.02). 25% of group 1 showed PD versus 25 % of group 2. (p = 0.8). 1 year PFS was 19% in group 1 versus 23 % in group 2. (p = 0.8) while there was a trend towards better OS in group 1 (47 % versus % 35). (p = 0.07). Conclusions: UGT1A1*28 polymorphism is present frequently (43%) in a Caucasian population and is associated with more vomiting, neutropenia and treatment delay.

Download Full-text

Effects of Timing of Coil Embolization after Aneurysmal Subarachnoid Hemorrhage on Procedural Morbidity and Outcomes

Neurosurgery ◽

10.1097/00006123-200012000-00010 ◽

2000 ◽

Vol 47 (6) ◽

pp. 1320-1331 ◽

Cited By ~ 48

Author(s):

Gerasimos S. Baltsavias ◽

James V. Byrne ◽

Jim Halsey ◽

Stuart C. Coley ◽

Min-Joo Sohn ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Coil Embolization ◽

Glasgow Outcome Scale ◽

Aneurysmal Subarachnoid Hemorrhage ◽

World Federation ◽

Treatment Groups ◽

Scale Scores ◽

Group 3 ◽

Group 2 ◽

Group 1

ABSTRACT OBJECTIVE To elucidate the effect of treatment timing on procedural clinical outcomes after aneurysmal subarachnoid hemorrhage (SAH) for patients treated by endosaccular coil embolization. METHODS A group of 327 patients who were consecutively treated, during a 46-month period, for ruptured intracranial aneurysms by coil embolization within 30 days after SAH were evaluated. Outcomes were assessed by comparing immediate pretreatment World Federation of Neurological Surgeons (WFNS) grades, 72-hour posttreatment WFNS grades, and modified Glasgow Outcome Scale scores at 6 months for patients treated within 48 hours (Group 1), 3 to 10 days (Group 2), or 11 to 30 days (Group 3) after SAH. RESULTS The three interval-to-treatment groups included 33, 38, and 29% of the patients, respectively. Before treatment, 70% of the patients in Group 1, 78% of those in Group 2, and 83% of those in Group 3 were in good clinical grades (i.e., WFNS Grade 1 or 2). After coil embolization, the WFNS grades were either unchanged or improved for 93.5% of the patients in Group 1, 89.5% of those in Group 2, and 91.5% of those in Group 3. After 6 months, 81.3% of the patients in Group 1 experienced good outcomes (modified Glasgow Outcome Scale scores of 1 or 2), as did 84% of those in Group 2 and 80% of those in Group 3. No statistical difference was demonstrated between the three groups when they were compared for these two variables. CONCLUSION The interval between endovascular treatment and SAH did not affect periprocedural morbidity rates or 6-month outcomes. Coil embolization should therefore be performed as early as possible after aneurysmal SAH, to prevent aneurysmal rerupture.

Download Full-text

Biomarkers of Neurological Outcome After Aneurysmal Subarachnoid Hemorrhage as Early Predictors at Discharge from an Intensive Care Unit

Neurocritical Care ◽

10.1007/s12028-020-01110-2 ◽

2020 ◽

Author(s):

Jaroslaw Kedziora ◽

Malgorzata Burzynska ◽

Waldemar Gozdzik ◽

Andrzej Kübler ◽

Katarzyna Kobylinska ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Subarachnoid Hemorrhage ◽

Acute Treatment ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Treatment Phase ◽

Icu Outcome ◽

Outcome Group ◽

Group 2 ◽

Group 1

Abstract Background Subarachnoid bleeding is associated with brain injuries and ranges from almost negligible to acute and life threatening. The main objectives were to study changes in brain-specific biomarker levels in patients after an aneurysmal subarachnoid hemorrhage (aSAH) in relation to early clinical findings, severity scores, and intensive care unit (ICU) outcome. Analysis was done to identify specific biomarkers as predictors of a bad outcome in the acute treatment phase. Methods Analysis was performed for the proteins of neurofilament, neuron-specific enolase (NSE), microtubule-associated protein tau (MAPT), and for the proteins of glial cells, S100B, and glial fibrillary acidic protein (GFAP). Outcomes were assessed at discharge from the ICU and analyzed based on the grade in the Glasgow Outcome Scale (GOS). Patients were classified into two groups: with a good outcome (Group 1: GOS IV–V, n = 24) and with a bad outcome (Group 2: GOS I–III, n = 31). Blood samples were taken upon admission to the ICU and afterward daily for up to 6 days. Results In Group 1, the level of S100B (1.0, 0.9, 0.7, 2.0, 1.0, 0.3 ng/mL) and NSE (1.5, 2.0, 1.6, 1.2, 16.6, 2.2 ng/mL) was significantly lower than in Group 2 (S100B: 4.7, 4.8, 4.4, 4.5, 6.6, 6.8 ng/mL; NSE: 4.0, 4.1, 4.3, 3.8, 4.4, 2.5 1.1 ng/mL) on day 1–6, respectively. MAPT was significantly lower only on the first and second day (83.2 ± 25.1, 132.7 ± 88.1 pg/mL in Group 1 vs. 625.0 ± 250.7, 616.4 ± 391.6 pg/mL in Group 2). GFAP was elevated in both groups from day 1 to 6. In the ROC analysis, S100B showed the highest ability to predict bad ICU outcome of the four biomarkers measured on admission [area under the curve (AUC) 0.81; 95% CI 0.67–0.94, p < 0.001]. NSE and MAPT also had significant predictive value (AUC 0.71; 95% CI 0.54–0.87, p = 0.01; AUC 0.74; 95% CI 0.55–0.92, p = 0.01, respectively). A strong negative correlation between the GOS and S100B and the GOS and NSE was recorded on days 1–5, and between the GOS and MAPT on day 1. Conclusion Our findings provide evidence that brain biomarkers such as S100B, NSE, GFAP, and MAPT increase significantly in patients following aSAH. There is a direct relationship between the neurological outcome in the acute treatment phase and the levels of S100B, NSE, and MAPT. The detection of brain-specific biomarkers in conjunction with clinical data may constitute a valuable diagnostic and prognostic tool in the early phase of aSAH treatment.

Download Full-text

Management of elderly patients with aneurysmal subarachnoid hemorrhage

Journal of Neurosurgery ◽

10.3171/jns.1988.69.3.0332 ◽

1988 ◽

Vol 69 (3) ◽

pp. 332-339 ◽

Cited By ~ 81

Author(s):

Tetsuji Inagawa ◽

Mitsuo Yamamoto ◽

Kazuko Kamiya ◽

Hidenori Ogasawara

Keyword(s):

Subarachnoid Hemorrhage ◽

Mortality Rate ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Age Groups ◽

Content Type ◽

Significant Difference ◽

Group 3 ◽

Group 2 ◽

Fine Print ◽

Group 1

✓ A total of 299 patients with aneurysmal subarachnoid hemorrhage (SAH) were classified into three age groups, that is, those aged 59 years or younger (Group 1: 159 patients, 53%), those aged 60 to 69 years (Group 2: 85 patients, 28%), and those aged 70 years or older (Group 3: 55 patients, 18%). A comparison was made of the surgical indications and their overall management outcome in these age groups. The overall outcome at 1 year after SAH of Group 3 was significantly poorer than that of Group 1 (p < 0.01) or Group 2 (p < 0.01), but no significant difference could be demonstrated between Groups 1 and 2. Overall, 104 of the 299 patients died, for a mortality rate of 35%. The mortality rate by age group was 29% for Group 1, 33% for Group 2, and 55% for Group 3. Surgery was performed on 122 patients (77%) in Group 1, 56 (66%) in Group 2, and 25 (45%) in Group 3. The overall operative outcome at 1 year after SAH in Group 3 was significantly poorer than that of Group 1 (p < 0.01), but no significant difference was observed in this regard between Groups 1 and 2. The operative mortality rate of the patients in Groups 1 , 2, and 3 who were preoperatively in Hunt and Hess Grades I and II was 1%, 7%, and 22%, respectively (no significant difference). By life-table analysis the 5-year survival probability was 65% for Group 1, 60% for Group 2, and 37% for Group 3. The rate of patients surviving in good condition or in a disabled but independent condition at 1 year after SAH was 93% and no statistically significant difference in survival probability was observed among the three age groups.

Download Full-text

Abstract P555: Safety and Efficacy of Daily Intra-Arterial Endovascular Therapy for Medically Refractory Cerebral Vasospasm Following Subarachnoid Hemorrhage

Stroke ◽

10.1161/str.52.suppl_1.p555 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Rahul Chandra ◽

Chris Hackett ◽

Andrew Ku ◽

Richard Williamson ◽

Konark MALHOTRA ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Cerebral Infarction ◽

Endovascular Therapy ◽

Delayed Cerebral Ischemia ◽

Retrospective Chart Review ◽

Imaging Data ◽

Entire Cohort ◽

Fisher Grade ◽

Group 2 ◽

Group 1

Introduction: Delayed cerebral ischemia (DCI) and cerebral infarction due to medically refractory vasospasm in aneurysmal SAH (aSAH) is a major cause of death and disability. The guidelines for endovascular therapy (EVT) for medically refractory vasospasm are not well established, especially regarding duration and frequency of therapy. Methods: Single center retrospective chart review was performed. We included patients with aSAH who had medically refractory vasospasm and underwent EVT. Demographics, clinical characteristics, imaging data, procedural details and outcomes were collected. Results: From 2016 to 2019, 303 subarachnoid hemorrhage (SAH) patients were identified. 133 (43.9%) were aSAH, of which 120 (90.2%) had DCI. Forty-one (34.1%) patients met our inclusion criteria. Median age was 56 years [Interquartile range (IQR) 46, 63] and 33 (80.5%) patients were female. We divided the EVT arm into two groups, group 1 underwent < 3 consecutive days of EVT comprising of 11 patients (26.8%) and group 2 underwent ≥3 consecutive days of EVT comprising of 30 patients (73.2%). Median Hunt and Hess score and Fisher grade were 1.5 (IQR 1,3) and 3.5 (IQR 2,4)in group 1 and 3 (IQR 2,4) and 4 (3,4) in group 2, (p =0.08) and (p =0.5) respectively . Median number of days of EVT was 4(IQR 2,6.5) for the entire cohort. Median days of EVT in group 1 was 2 (IQR 1,2) and for group 2 was 5 (IQR 3,7, p=0.24). Cerebral infarction was seen in 5/11 (45.4%) patients in group 1 and 16/30 (53.3%) patients in group 2 (p = 0.73). Median modified Rankin scale (mRS) at discharge in both groups was 4 (p=0.55, r=0.1). Good clinical outcome at discharge (mRS 0-2) was seen in 4/11 (36.3%) patients in group 1 and 5/30 (16.7%) patients in group 2 (p=0.22). Procedure related complications were seen in 3/11 (27.2%) patients in group 1 and 3/30 (10%) patients in group 2 (p=0.32) whereas mortality rate was 1/11(9.1%) and 8/30 (26.6%) (p=0.4)respectively. No mortality was associated with the procedure. Conclusion: Daily endovascular therapy in medically refractory vasospasm is safe but not efficacious in reducing the rates of cerebral infarctions.

Download Full-text

UGT1A1*28 polymorphism and vomiting in advanced colorectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e14678 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e14678-e14678

Author(s):

Ahmed El Saied El Bastawisy ◽

Amany El-Zeiny ◽

Samar Farid ◽

Abeer Bahnasy

Keyword(s):

Colorectal Cancer ◽

Advanced Colorectal Cancer ◽

Progression Free Survival ◽

Free Survival ◽

Primary Endpoints ◽

Secondary Endpoints ◽

Grade Ii ◽

Group 2 ◽

Group 1

e14678 Background: UGT1A1*28 polymorphism is associated with neutropenia and diarrhea in previous reports, this study tried to investigate correlation with other toxicities like vomiting. Methods: This is a prospective case control study including all eligible cases of advanced colorectal cancer. The genotypes of UGT1A1*28 was assessed in the peripheral blood and/or in tissues by PCR. Patients were divided into two groups, group1: patients with no or hetero mutation, group 2: patients with homo mutation. All patients received standard IFL regimen. Primary endpoints were: 1-comparison between the 2 groups as regard vomiting .2-assessement of the incidence of UGT1A1*28 polymorphism. Secondary endpoints were: comparison between the 2 groups as regard: neutropenia, diarrhea, progressive diseases (PD), progression free survival (PFS) and overall survival (OS). Results: 43 cases of advanced colorectal cancer aged between 19 and 68 years with a median age of 45 years were included and followed up during the period from September 2010 to January 2013 with a median follow up of 9 months. UGT1A1*28 polymorphism were present in 21 patients (42%) of them 14% are homozygous. Grade (II-III) vomiting was found in 18.9% of group 1 versus 66.7% of group2. (P=0.03).Grade (II-IV) neutropenia were found in 27% of group 1 versus 83.4% of group2. (P=0.01). Grade (II-III) diarrhea was found in 37.8% of patients of group1 and 16.7% of patients with group 2. (P=0.44).20% of group 1 showed PD versus 40% of group 2. (P=0.5).1year PFS was 19% in group 1 versus 0% in group 2. (P= 0.74) while there was a trend towards better OS in group 1 (47% versus 0%). (P= 0.0892). Conclusions: UGT1A1*28 polymorphism is present frequently (42%) in a Caucasian population and is associated with more vomiting and neutropenia.

Download Full-text