Selection bias in patients proposed for neurosurgical versus endovascular treatment of aneurysms of the posterior communicating artery

Background Microsurgical clipping and endovascular coiling are viable treatment options for posterior communicating artery (PComA) aneurysms, but there are still major limitations to evidence-based decisions regarding standard-of-care treatment. In this study, we aimed at assessing potential selection biases that may influence our ability to extract conclusions about the comparative effectiveness or efficacy of the aneurysm treatment. Objective To study the patient/aneurysm characteristics as possible biases in the option for endovascular or neurosurgical treatment of PComA aneurysms. Methods A single-center, retrospective cohort study was performed, including all patients with treated PComA aneurysms with neurosurgical clipping or endovascular coiling between January 2010 and January 2021. Clinical and morphological data were collected from electronic records, and statistical analysis was performed. Results A total of 64 patients was eligible for inclusion; 24 (37.5%) patients were proposed for neurosurgical treatment, while 40 (62.5%) for endovascular treatment; 10 patients (25%) crossed over to the clipping group whereas none crossed over to the coiling side. Actual treatment analysis showed significantly higher diameters of mother vessel (t-test, p = 0.034) and aneurysm neck (Mann–Whitney, p = 0.029) in the clipping group and higher aspect and dome-to-neck ratios in the endovascular group (Mann–Whitney, p = 0.008). A significantly higher vasospasm frequency was found in the clipping group but only in the intention-to-treat analysis (Chi-square, p = 0.032). Conclusion Significant morphological differences between effective endovascular and surgical groups and differences in intention-to-treat analysis may limit the validity of a direct comparison between treatment options and suggest the presence of a possible selection bias.

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Intention-to-treat analysis of percutaneous endovascular treatment of hepatic artery stenosis after orthotopic liver transplantation

Liver Transplantation ◽

10.1002/lt.24468 ◽

2016 ◽

Vol 22 (7) ◽

pp. 923-933 ◽

Cited By ~ 19

Author(s):

Muthukumarassamy Rajakannu ◽

Sameh Awad ◽

Oriana Ciacio ◽

Gabriella Pittau ◽

René Adam ◽

...

Keyword(s):

Liver Transplantation ◽

Endovascular Treatment ◽

Hepatic Artery ◽

Orthotopic Liver Transplantation ◽

Artery Stenosis ◽

Intention To Treat ◽

Hepatic Artery Stenosis ◽

Treat Analysis

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Microcatheter Neck Bridging and Incorporated Branch Vessel Protection for Coil Embolization of a Wide-Neck Ruptured Aneurysm: Technical Case Report

Operative Neurosurgery ◽

10.1227/neu.0b013e318207819f ◽

2011 ◽

Vol 68 (suppl_1) ◽

pp. ons40-ons44 ◽

Cited By ~ 5

Author(s):

Ajeet Gordhan

Keyword(s):

Artery Aneurysm ◽

Posterior Communicating Artery ◽

Endovascular Coiling ◽

Parent Vessel ◽

Aneurysm Neck ◽

Guglielmi Detachable Coil ◽

Fisher Grade ◽

Branch Vessel ◽

Posterior Communicating Artery Aneurysm ◽

Wide Neck

Abstract BACKGROUND AND IMPORTANCE: A novel technique in which microcatheter neck bridging of a ruptured wide-neck posterior communicating artery aneurysm was performed by intra-aneurysmal catheter navigation into a fetal configuration posterior cerebral artery (PCA) branch vessel arising from the sac. CLINICAL PRESENTATION: An 88-year-old woman with a Hunt and Hess grade 1 and Fisher grade 4 subarachnoid hemorrhage was identified as having a wide-neck posterior communicating artery aneurysm and an isolated fetal configuration PCA with origins from the aneurysm sac. Delivery of a bare platinum Guglielmi detachable coil within the aneurysm lumen resulted in persistent coil prolapse into the parent vessel with occlusion of the incorporated vital PCA origin. A microcatheter was then navigated through the aneurysm lumen and into the fetal configuration PCA. This was retained within the PCA with resultant aneurysm neck narrowing and branch vessel protection. A second microcatheter was placed in the aneurysm lumen for coil delivery. Complete aneurysm occlusion with patency of the PCA without coil loop prolapse into the parent vessel was achieved. CONCLUSION: The presence of normal branch vessels arising from the dome is a limitation for endovascular techniques. To the best of our knowledge, no prior description of a dual-microcatheter technique with selective catheter placement within an important intra-aneurysmal branch vessel has been published. The vital branch vessel was protected and the wide-neck aneurysm completely occluded. Novel placement of microcatheters further expands the range of complex configuration aneurysms amenable to endovascular coiling.

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Randomised controlled trial of a self-guided online fatigue intervention in multiple sclerosis

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2017-317463 ◽

2018 ◽

Vol 89 (9) ◽

pp. 970-976 ◽

Cited By ~ 14

Author(s):

Jana Pöttgen ◽

Rona Moss-Morris ◽

Janina-Maria Wendebourg ◽

Lena Feddersen ◽

Stefanie Lau ◽

...

Keyword(s):

Multiple Sclerosis ◽

Controlled Trial ◽

Treatment Options ◽

Behavioural Therapy ◽

Mean Difference ◽

Control Group ◽

Effective Treatment Option ◽

Intention To Treat ◽

Cost Effective Treatment ◽

Treat Analysis

ObjectiveFatigue is a major disabling symptom in many chronic diseases including multiple sclerosis (MS), but treatment options are limited.Here, we tested the effectiveness of a self-guided , interactive, online fatigue management programme (ELEVIDA) based on principles of cognitive behavioural therapy (CBT) and related psychotherapeutic approaches (eg, mindfulness) for reducing fatigue in MS.MethodsPatients with MS and self-reported fatigue were recruited via the website of the German MS Society and assigned via an automated randomisation generator (1:1, no blocking or stratification) to a 12-week online intervention (ELEVIDA, n=139, 82% female, mean age 40.8, median patient determined disease steps (PDDS) 3.0) or a waitlist control group (n=136, 79% female, mean age 41.9, median PDDS 3.0). The primary outcome was the Chalder Fatigue Scale. Outcomes were assessed at baseline, at week 12 (postintervention) and at follow-up (week 24).ResultsCompared with the control group, significantly greater reductions in Chalder Fatigue Scale scores were seen in the ELEVIDA group at week 12 (primary endpoint, intention-to-treat analysis: between-group mean difference 2.74 points; 95% CI 1.16 to 4.32; p=0.0007; effect size d=0.53), with effects sustained at week 24 (intention-to-treat analysis: between-group mean difference 2.19 points; 95% CI 0.57 to 3.82; p=0.0080).ConclusionsOur trial provides evidence for the effectiveness of a self-guided , internet-based intervention to reduce fatigue in MS. Interventions such as ELEVIDA may be a suitable low barrier, cost-effective treatment option for MS fatigue.Trial registration numberISRCTN registry (number ISRCTN25692173).

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Clinical Case: Complications after Endovascular Treatment of Intracranial Aneurysm in a Patient after Subarachnoid Hemorrhage

International Journal of Anesthesiology Research ◽

10.31907/2310-9394.2020.08.02 ◽

2020 ◽

Vol 8 (1) ◽

pp. 9-15

Author(s):

Petrov Nikolay ◽

◽

Marinova R. ◽

Odiseeva Ev.

Keyword(s):

Intracranial Aneurysm ◽

Endovascular Treatment ◽

Clinical Case ◽

Endovascular Coiling ◽

Published Data ◽

Military Medical Academy ◽

Life Threatening ◽

Arachnoid Hemorrhage ◽

The Right ◽

Brain Artery

Abstract: Intracranial aneurysm is one of the most common neurovascular complications. During the recent years the accepted treatment of enraptured cranial aneurysm is noninvasive endovascular coiling. This technique is modern but it is not without complications which can be serious and life-threatening. A clinical case of a patient admitted to the ICU of Military Medical Academy - Sofia with sub arachnoid hemorrhage is described. After a positive clinical course, the check-up magnetic resonance showed intracranial aneurism of the right carotid artery. The patient underwent angiographic endovascular treatment. Vasospasm of the middle and right brain artery and thrombosis were detected during the procedure. Attempt of thromboaspiration was made without success. This article reviews published data on broad-spectrum researches concerning complications of endovascular coiling of intracranial aneurysms and the ways to prevent and reduce them.

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Manual therapies for pain relief in patients with headache

Revista Neurociências ◽

10.34024/rnc.2015.v23.8053 ◽

2015 ◽

Vol 23 (1) ◽

pp. 89-96

Author(s):

Débora Wanderley ◽

Andrea Lemos ◽

Larissa de Andrade Carvalho ◽

Daniella Araújo de Oliveira

Keyword(s):

Treatment Effect ◽

Cervicogenic Headache ◽

Allocation Concealment ◽

Tension Type Headache ◽

Manual Therapies ◽

Osteopathic Manipulation ◽

Intention To Treat ◽

Headache Relief ◽

Type Headache ◽

Treat Analysis

Objective. This systematic review aimed to assess the efficacy of manual therapies for headache relief. Method. A systematic search in MEDLINE, LILACS, Cochrane, CINAHL, Scopus and Web of Science databases was conducted for randomized and quasi-randomized trials, with no restrictions for language or year of publication. The descriptors were ‘Headache’, ‘Headache disorders’ and ‘Musculoskeletal manipulations’, in addition to the keyword ‘Manual therapy’ and its equivalents in Portuguese. We included studies that compared massage, chiropractic manipulation, osteopathic manipulation and other spinal manipulation to groups with no intervention, other physiotherapeutic modalities or to a sham group. Results. Seven of the 567 articles initially screened were selected, including patients with tension type headache, cervicogenic headache or migraine. It was not possible to assess the magnitude of the treatment effect on the findings of this review. The main limitations were the absence of randomization and adequate allocation concealment, the lack of blinded evaluators and intention-to-treat analysis and inadequate statistical analysis. Conclusions. We were unable to determine the size of the treatment effect due to the selective description of findings. Owing to the high risk of bias in the articles included, the available evidence regarding the efficacy of manual therapies for headache relief is insufficient.

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The Treatment Effect of Liver Transplantation versus Liver Resection for HCC: A Review and Future Perspectives

Cancers ◽

10.3390/cancers13153730 ◽

2021 ◽

Vol 13 (15) ◽

pp. 3730

Author(s):

Berend R. Beumer ◽

Roeland F. de Wilde ◽

Herold J. Metselaar ◽

Robert A. de Man ◽

Wojciech G. Polak ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Liver Resection ◽

Early Stage ◽

Disease Free Survival ◽

Milan Criteria ◽

Term Survival ◽

Equal Distribution ◽

Intention To Treat ◽

Treat Analysis

For patients presenting with hepatocellular carcinoma within the Milan criteria, either liver resection or liver transplantation can be performed. However, to what extent either of these treatment options is superior in terms of long-term survival is unknown. Obviously, the comparison of these treatments is complicated by several selection processes. In this article, we comprehensively review the current literature with a focus on factors accounting for selection bias. Thus far, studies that did not perform an intention-to-treat analysis conclude that liver transplantation is superior to liver resection for early-stage hepatocellular carcinoma. In contrast, studies performing an intention-to-treat analysis state that survival is comparable between both modalities. Furthermore, all studies demonstrate that disease-free survival is longer after liver transplantation compared to liver resection. With respect to the latter, implications of recurrences for survival are rarely discussed. Heterogeneous treatment effects and logical inconsistencies indicate that studies with a higher level of evidence are needed to determine if liver transplantation offers a survival benefit over liver resection. However, randomised controlled trials, as the golden standard, are believed to be infeasible. Therefore, we suggest an alternative research design from the causal inference literature. The rationale for a regression discontinuity design that exploits the natural experiment created by the widely adopted Milan criteria will be discussed. In this type of study, the analysis is focused on liver transplantation patients just within the Milan criteria and liver resection patients just outside, hereby ensuring equal distribution of confounders.

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Krebstherapie – 68Ga-PSMA-PET/CT beim rezidivierten Prostatakarzinom richtungweisend und kosteneffektiv

Gesundheitsökonomie & Qualitätsmanagement ◽

10.1055/a-1244-6542 ◽

2020 ◽

Vol 25 (04) ◽

pp. 184-185

Author(s):

Susanne Krome

Keyword(s):

Prostate Cancer ◽

Cancer Recurrence ◽

Intention To Treat ◽

Biochemisches Rezidiv ◽

Choline Pet ◽

Psma Pet ◽

Pet Ct ◽

Prostate Cancer Recurrence ◽

Treat Analysis

Schwenck J et al. Intention-to-Treat Analysis of 68Ga-PSMA and 11C-Choline PET/CT Versus CT for Prostate Cancer Recurrence After Surgery. J Nucl Med 2019; 60: 1359–1365 15–40 % der Patienten mit einem Prostatakarzinom erleiden postoperativ ein biochemisches Rezidiv. In der retrospektiven Analyse beeinflussten die Bildgebungsverfahren die Häufigkeit einer richtigen Therapiewahl. Die Autoren empfehlen die 68Ga-PSMA-PET/CT, die die höchste Genauigkeit aufwies. Unter Berücksichtigung der Kosten für inadäquate Behandlungen entstünden keine ökonomischen Nachteile.

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