The Effects of Diagnosis-Related Group Payment on Diagnostic Cerebral Angiograms through a Transradial and Transfemoral Approach: A Comparative Observational Study

Background. Cerebral angiography is an X-ray examination technique widely used in hospitals. At present, it is mainly divided into two kinds of angiography examination: transfemoral artery and transradial artery puncture. The diagnosis-related group (DRG) system is a new type of payment standard recognized internationally, but its impact on medical care and health outcomes is currently controversial. Aim. In this study, we conducted a comparative study on two invasive approaches, transradial artery and transfemoral artery puncture and observed whether DRG had an impact on the quality of the medical process. Methods. We compared and analyzed patients undergoing cerebral angiography via the femoral artery and radial artery puncture by recording the relevant parameters and comfort scale scores (GCQ) during the operation, as well as postoperative complications. At the same time, we observed the proportion of different puncture routes and the success rate of cerebral angiography before and after the implementation of a DRG payment simulation. Results. The results of the comparative analysis of patients’ transradial artery and transfemoral artery puncture angiography showed that the puncture success rate (99.1% vs. 97.2%, P > 0.05 ), angiography success rate (97.3% vs. 95.1%, P > 0.05 ), and X-ray radiation time (4.82 vs. 5.15 min, P > 0.05 ) demonstrated no significant difference. The ambulation time (1.52 vs. 12.06 h, P < 0.05 ), puncture time (22.42 vs. 31.02 min, P < 0.05 ), and complications (3.57% vs. 9.03%, P < 0.05 ) of the radial artery group were significantly lower than those of the femoral artery group. In contrast, the GCQ score of the radial artery group at each stage after angiography was significantly higher than that of the femoral artery group ( P < 0.05 ). Compared with before the DRG simulation, the proportion of cerebral angiography with transradial artery puncture increased significantly after its implementation. Conclusion. Compared with transfemoral cerebrovascular angiography, transradial cerebrovascular angiography has many advantages, such as less local damage, less pain, less postoperative bed-rest time, significantly lower incidence of total complications, and a lower cost. Following the implementation of the DRG payment method, the quality of the angiography medical process improved.

Three-Dimensional Model Extraction and Parameter Measurement of Cerebral Hemangioma Based on Mimics

In this paper, Mimics is using to reconstruct the 3D model of hemangioma from 2D cerebral angiography images. The process of 3D model reconstruction is formulated. The hemangioma model is extracted and the parameters of the hemangioma are measured, which provided a model basis for the structural design of the spring coil. The shape and structure of the coil are very important for the therapeutic effect. During the treatment, the coil is implanted into the hemangioma from outside the body through a catheter.

Robotics in neurointerventional surgery: a systematic review of the literature

BackgroundRobotically performed neurointerventional surgery has the potential to reduce occupational hazards to staff, perform intervention with greater precision, and could be a viable solution for teleoperated neurointerventional procedures.ObjectiveTo determine the indication, robotic systems used, efficacy, safety, and the degree of manual assistance required for robotically performed neurointervention.MethodsWe conducted a systematic review of the literature up to, and including, articles published on April 12, 2021. Medline, PubMed, Embase, and Cochrane register databases were searched using medical subject heading terms to identify reports of robotically performed neurointervention, including diagnostic cerebral angiography and carotid artery intervention.ResultsA total of 8 articles treating 81 patients were included. Only one case report used a robotic system for intracranial intervention, the remaining indications being cerebral angiography and carotid artery intervention. Only one study performed a comparison of robotic and manual procedures. Across all studies, the technical success rate was 96% and the clinical success rate was 100%. All cases required a degree of manual assistance. No studies had clearly defined patient selection criteria, reference standards, or index tests, preventing meaningful statistical analysis.ConclusionsGiven the clinical success, it is plausible that robotically performed neurointerventional procedures will eventually benefit patients and reduce occupational hazards for staff; however, there is no high-level efficacy and safety evidence to support this assertion. Limitations of current robotic systems and the challenges that must be overcome to realize the potential for remote teleoperated neurointervention require further investigation.

Early Ambulation After Transfemoral Diagnostic Cerebral Angiography: A Pilot Study

BackgroundA significant proportion of transfemoral cerebral angiography complications are related to the access site, with no clear consensus concerning the optimal closure technique. In this study, we examined the usefulness of a new closure protocol for transfemoral diagnostic cerebral angiography.MethodsWe performed a retrospective review of patients who underwent transfemoral (4Fr sheath) diagnostic cerebral angiography procedures at our institution. We included patients >18 years old who underwent the new closure protocol to achieve hemostasis at the access site. The new protocol entailed the use of nonocclusive manual compression for 15 minutes followed by 2 hours of bed rest, with additional 10-15 minutes of compression for new hematoma. We collected and analyzed the patients’ demographics, use of antiplatelet and anticoagulation medications, sheath size, and others.ResultsThe study cohort comprised 119 patients with a mean age was 54 years with (88%) females. Forty-one patients (34%) were on antiplatelet medications, with 12 (10%) on dual antiplatelet therapy (DAPT). Four patients (3%) (two on DAPT, one on Aspirin alone, and one was not on any antiplatelet medication) had access site hematoma that required additional compression. Subgroup analysis showed that within the DAPT, Aspirin alone, and no antiplatelet medications groups, (17%), (3%), and (1%) of patients developed access site hematoma, respectively.ConclusionThis pilot study demonstrates that our closure protocol for transfemoral angiograms is safe and effective. There was a trend toward higher access-site complications in patients on DAPT. Further studies are required to expand on and validate our results.

Abstract 1122‐000216: Evacuation of Bilateral Intracerebral Hemorrhages Using a Novel Disposable Surgiscopic System: A Case Report

Introduction : Patients presenting with intracerebral hemorrhage (ICH) face higher rates of morbidity and mortality than other stroke patients. Currently, these patients are managed by surgical intervention and decompression or medical management, depending on categorization of the hemorrhage. Simultaneous, multifocal hemorrhages are a rare presentation of ICH that portend a worse prognosis. Here we report the treatment of bilateral simultaneous ICHs in a young patient with diagnostic cerebral angiography, biopsy, and bilateral minimally invasive surgiscopic ICH evacuation in a single procedure. Methods : The patient was a young female who presented to an outside hospital after two days of progressively worsening headaches and vomiting. Her medical history was significant for systemic lupus erythematosus (SLE), hypertension, chronic migraines, and opioid use disorder. In the emergency department, her mental status deteriorated, and she was intubated. Computed tomography (CT) scan was performed and showed a right parietal 43.3 cc ICH and a left parietal 38.7 cc ICH. MR angiogram and venogram showed no evidence of vascular malformations but were suggestive of potential cerebral venous sinus thrombosis. Upon arrival, the patient remained intubated but was able to open her eyes, follow commands, and respond to stimulation. The patient was brought to the angiosuite for diagnostic cerebral angiography which revealed diffuse intermittent arterial narrowing suggestive of vasculitis and patent venous sinuses. The patient was then positioned in the prone position and bilateral parietal 1.5 cm craniectomies were performed. Surgiscopic evacuation was performed sequentially using stereotactic navigation to access and evacuate each clot. A right parietal brain biopsy was performed at the minimally invasive cortical access point. Results : Active bleeding was encountered in both hematoma sites and was treated with a combination of irrigation and monopolar cautery transmitted through the Aurora Evacuator. After complete evacuation of the hematomas on both sides, an intraoperative conebeam CT was performed, demonstrating good right‐sided evacuation and resident left‐sided hematoma. Additional evacuation was performed on the left side and repeat conebeam CT demonstrated good bilateral evacuation. CT head on post operative day 1 showed 97.7% right‐sided evacuation and 81.5% left‐sided evacuation. The patient was treated with steroids for presumed vasculitis given the angiographic findings, which was later supported by the results of the brain biopsy. The patient made a good recovery and was discharged from the hospital alert and oriented, with CN II‐XII grossly intact, no focal deficits, and 5/5 strength in all extremities. Conclusions : Minimally invasive ICH evacuation can be performed in the angiosuite for ICH‐associated with vasculitis and even multifocal ICH when appropriate. Performing the procedure in the angiosuite permits completion of the diagnostic cerebral angiogram, brain biopsy, and hematoma evacuation at the same time, accelerating time to treatment for a patient with severe, symptomatic vasculitis.

A Man With Recurrent Headache and Focal Neurologic Deficits

A 42-year-old healthy man sought care for transient episodes of neurologic deficits followed by severe headache. The first episode began with left hand weakness, numbness, and dysarthria, followed approximately 1 hour later by a right temporal headache. His symptoms spontaneously resolved after 8 hours. He had a second episode 2 days later manifested by confusion and bilateral lower extremity numbness, again followed by severe headache with symptoms resolving within 12 hours. A total of 8 episodes occurred over 3 weeks, each lasting 8 to 24 hours, with spontaneous resolution each time. His most recent episode occurred during cerebral angiography. Cerebrospinal fluid evaluation showed opening pressure, 190 mm H2O; white blood cells, 205/μ‎L, 97% lymphocytes; protein, 95 mg/dL; and glucose, 40 mg/dL. Electroencephalography demonstrated right greater than left generalized slowing, with increased-voltage rhythmic delta wave activity, in the frontal regions predominantly. Conventional cerebral angiography findings were normal, but the test appeared to provoke the patient’s previous episode. Neurologic examination was normal after his most recent episode resolved, and no further episodes were reported. This case highlights a typical presentation of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis. Because the disorder was self-limited, treatment was aimed at symptomatic management of headache. In this case patient with a secure diagnosis of headache and neurologic deficits with cerebrospinal fluid lymphocytosis and stereotypical episodes limited to 3 months after the initial presentation, additional testing was not indicated. Headache and neurologic deficits with cerebrospinal fluid lymphocytosis is a rare, self-limited, benign condition with migrainelike headache episodes accompanied by transient neurologic deficits usually lasting more than 4 hours, with some deficits lasting more than 24 hours.

Safety of pediatric cerebral angiography

OBJECTIVE Catheter-based cerebral angiography is commonly used for neurovascular diagnosis in children. In this work, the authors aimed to quantify the complication rate of cerebral angiography in children, characterize these complications, and identify risk factors for complications. METHODS Relevant clinical data were retrospectively obtained for 587 consecutive cerebral angiography procedures performed in 390 children from March 2002 to March 2020. Complications were categorized as neurological or nonneurological, and severity was graded using a standard schema. Incidences of complications were reported as point estimates. Associations between risk factors and complications were characterized in univariate analysis using the two-tailed Fisher exact test and in multivariate analysis using multiple logistic regression with bidirectional elimination based on the Akaike information criterion. In both univariate and multivariate analyses, statistical significance was corrected for multiple comparisons using the Benjamini-Hochberg method. RESULTS Complications occurred in 6.5% of procedures, including neurological complications in 1.9% and nonneurological complications in 4.8%. Permanent deficits occurred in only 0.2% of cases. Overall, 0.5% of procedures resulted in major complications, while 6.0% resulted in minor complications. Female sex and a history of hypertension or ischemic stroke were associated with an increased risk of complications, while femoral artery access was associated with a decreased risk of complications. CONCLUSIONS Pediatric cerebral angiography was shown to have a low rate of major or permanent complications. Children who were female and those with a history of hypertension or ischemic stroke were shown to be at higher risk of complications, while the use of femoral access carried a lower risk of complications.