5 results on '"Budzik, Ronald"'
Search Results
2. Rapid learning curve for Solitaire FR stent retriever therapy: evidence from roll-in and randomised patients in the SWIFT trial
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Sheth, Sunil A, Jahan, Reza, Levy, Elad I, Jovin, Tudor G, Baxter, Blaise, Nogueira, Raul G, Clark, Wayne, Budzik, Ronald, Zaidat, Osama O, and Saver, Jeffrey L
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Biomedical and Clinical Sciences ,Clinical Sciences ,Bioengineering ,Clinical Trials and Supportive Activities ,Stroke ,Neurosciences ,Brain Disorders ,Clinical Research ,Evaluation of treatments and therapeutic interventions ,6.1 Pharmaceuticals ,Aged ,Aged ,80 and over ,Brain Ischemia ,Female ,Humans ,Learning Curve ,Male ,Middle Aged ,Prospective Studies ,Stents ,Survival Rate ,Thrombectomy ,SWIFT Trialists ,Angiography ,Intervention ,Technique ,Clinical sciences - Abstract
BackgroundIn light of recent positive trial data for endovascular therapy in acute ischemic stroke (AIS), stent retriever use by practitioners without prior experience with these devices may become more common.ObjectiveTo assess the safety and efficacy of thrombectomy for AIS using Solitaire for patients treated in the roll-in period of the Solitaire With the Intention For Thrombectomy (SWIFT) trial, which represented the first clinical use of the device for these interventionalists.MethodsProspectively collected demographic, clinical, and angiographic data on patients treated in the initial roll-in and subsequent randomized phases of the SWIFT study were collected and analyzed. Key statistical analyses were validated by an independent external statistician.ResultsPatients in the roll-in period achieved equivalently high rates of reperfusion (55%) compared with those treated with the device in the randomized phase (61%). Rates of adverse events were comparable (13% vs. 9%). Rates of good neurological outcome were equivalent between the roll-in and randomized patients treated with Solitaire (63% vs. 58%). Including the roll-in patients strengthened the conclusions of the study, that reperfusion rates without symptomatic hemorrhage with Solitaire were greater than with Merci (59% vs. 24%, p
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- 2016
3. Carotid I's, L's and T's: collaterals shape the outcome of intracranial carotid occlusion in acute ischemic stroke
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Liebeskind, David S, Flint, Alexander C, Budzik, Ronald F, Xiang, Bin, Smith, Wade S, Duckwiler, Gary R, and Nogueira, Raul G
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Biomedical and Clinical Sciences ,Clinical Sciences ,Brain Disorders ,Neurosciences ,Stroke ,Adult ,Aged ,Aged ,80 and over ,Brain Ischemia ,Carotid Artery ,Internal ,Cerebral Arterial Diseases ,Cerebrovascular Circulation ,Clinical Trials as Topic ,Collateral Circulation ,Female ,Humans ,Male ,Mechanical Thrombolysis ,Middle Aged ,Outcome Assessment ,Health Care ,Radiography ,Thrombosis ,Angiography ,Blood Flow ,Thrombectomy ,MERCI and Multi-MERCI Investigators ,Clinical sciences - Abstract
BackgroundCollaterals may affect revascularization, ischemic severity, and clinical outcomes in acute stroke owing to internal carotid artery (ICA) occlusion.ObjectiveTo examine the hypothesis that morphology of occlusive thrombus and collateral flow patterns may influence the outcome of ICA occlusions after mechanical thrombectomy.MethodsPooled analyses of ICA occlusions in the MERCI and Multi-MERCI trials employed central angiography review readings to categorize lesions as I, L, or T clots and functional lesions based on collateral flow patterns. Demographic variables, procedural details, and clinical outcomes were compared across ICA lesion types.ResultsA total of 72 subjects (mean age 67 years (SD 16), 51% female, median National Institutes of Health Stroke Scale 20 (range 8-35)) were included, with 90-day modified Rankin score ≤2 in 28% and 51% mortality. Clots were categorized as an I lesion in 9/72 (12.5%), L lesion in 12/72 (16.7%), and T lesion in 51/72 (70.8%). Based on collateral flow patterns, cases were categorized as having a functional I lesion in 7/72 (9.7%), functional L in 38/72 (52.8%), and functional T in only 27/72 (37.5%). Multivariate analyses showed that a functional T lesion, with insufficient collateral flow to ipsilateral anterior cerebral arteries via the contralateral ICA, was a strong predictor of both revascularization success and subsequent clinical outcomes.ConclusionsCollateral flow patterns distinguish the nature and impact of ICA occlusions on expected revascularization and subsequent clinical outcomes in acute ischemic stroke. The nomenclature of terminal ICA occlusions introduced here (carotid I's, L's, and T's) may enhance future endovascular trials targeting such proximal occlusions.Trial registration numberNCT00318071 (http://clinicaltrials.gov). MERCI was not registered because enrollment began before July 1, 2005.
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- 2015
4. Predictors of Functional Dependence Despite Successful Revascularization in Large-Vessel Occlusion Strokes
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Shi, Zhong-Song, Liebeskind, David S, Xiang, Bin, Ge, Sijian Grace, Feng, Lei, Albers, Gregory W, Budzik, Ronald, Devlin, Thomas, Gupta, Rishi, Jansen, Olav, Jovin, Tudor G, Killer-Oberpfalzer, Monika, Lutsep, Helmi L, Macho, Juan, Nogueira, Raul G, Rymer, Marilyn, Smith, Wade S, Wahlgren, Nils, and Duckwiler, Gary R
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Biomedical and Clinical Sciences ,Clinical Sciences ,Neurosciences ,Clinical Trials and Supportive Activities ,Stroke ,Clinical Research ,Brain Disorders ,Aged ,Aged ,80 and over ,Brain Infarction ,Brain Ischemia ,Cerebral Revascularization ,Clinical Trials as Topic ,Female ,Humans ,Male ,Middle Aged ,Multicenter Studies as Topic ,Predictive Value of Tests ,Recovery of Function ,Severity of Illness Index ,Thrombectomy ,Thrombolytic Therapy ,stroke ,Multi MERCI ,TREVO ,and TREVO 2 Investigators ,Cardiorespiratory Medicine and Haematology ,Neurology & Neurosurgery ,Clinical sciences ,Allied health and rehabilitation science - Abstract
Background and purposeHigh revascularization rates in large-vessel occlusion strokes treated by mechanical thrombectomy are not always associated with good clinical outcomes. We evaluated predictors of functional dependence despite successful revascularization among patients with acute ischemic stroke treated with thrombectomy.MethodsWe analyzed the pooled data from the Multi Mechanical Embolus Removal in Cerebral Ischemia (MERCI), Thrombectomy Revascularization of Large Vessel Occlusions in Acute Ischemic Stroke (TREVO), and TREVO 2 trials. Successful revascularization was defined as thrombolysis in cerebral infarction score 2b or 3. Functional dependence was defined as a score of 3 to 6 on the modified Rankin Scale at 3 months. We assessed relationship of demographic, clinical, angiographic characteristics, and hemorrhage with functional dependence despite successful revascularization.ResultsTwo hundred and twenty-eight patients with successful revascularization had clinical outcome follow-up. The rates of functional dependence with endovascular success were 48.6% for Trevo thrombectomy and 58.0% for Merci thrombectomy. Age (odds ratio, 1.04; 95% confidence interval, 1.02-1.06 per 1-year increase), National Institutes of Health Stroke Scale score (odds ratio, 1.08; 95% confidence interval, 1.02-1.15 per 1-point increase), and symptom onset to endovascular treatment time (odds ratio, 1.11; 95% confidence interval, 1.01-1.22 per 30-minute delay) were predictors of functional dependence despite successful revascularization. Symptom onset to reperfusion time beyond 5 hours was associated with functional dependence. All subjects with symptomatic intracranial hemorrhage had functional dependence.ConclusionsOne half of patients with successful mechanical thrombectomy do not have good outcomes. Age, severe neurological deficits, and delayed endovascular treatment were associated with functional dependence despite successful revascularization. Our data support efforts to minimize delays to endovascular therapy in patients with acute ischemic stroke to improve outcomes.Clinical trial registration urlhttp://www.clinicaltrials.gov. Unique identifier: NCT00318071, NCT01088672, and NCT01270867.
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- 2014
5. Rheolytic Thrombectomy of the Occluded Internal Carotid Artery in the Setting of Acute Ischemic Stroke
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Bellon, Richard J., Putman, Christopher M., Budzik, Ronald F., Pergolizzi, Richard S., Reinking, Gregory F., and Norbash, Alexander M.
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Aged, 80 and over ,Carotid Artery Diseases ,Male ,Interventional ,Constriction, Pathologic ,Middle Aged ,Brain Ischemia ,Catheterization ,Cerebral Angiography ,Stroke ,cardiovascular system ,Humans ,Female ,cardiovascular diseases ,Intracranial Thrombosis ,Carotid Artery, Internal ,Aged ,Retrospective Studies ,Thrombectomy - Abstract
BACKGROUND AND PURPOSE: Acute thromboembolic stroke complicated by ipsilateral carotid occlusion may present both mechanical and inflow-related barriers to effective intracranial thrombolysis. We sought to review our experience with a novel method of mechanical thrombectomy, in such cases, using the Possis AngioJet system, a rheolytic thrombectomy device. METHODS: A review of our interventional neuroradiology database revealed three patients in whom an occluded cervical internal carotid artery was encountered during endovascular treatment for acute stroke and in whom thrombectomy was attempted, using the 5F Possis AngioJet thrombectomy catheter. The medical records and radiographic studies of these patients were reviewed. RESULTS: Three patients were identified (ages, 52–84 years). Two patients had isolated occlusion of the internal carotid artery; in one patient, thrombus extended down into the common carotid artery. Treatment was initiated within 190 to 360 minutes of stroke onset. Thrombectomy of the carotid artery was deemed necessary because of poor collateral flow to the affected hemisphere (chronic contralateral internal carotid artery occlusion [one patient] and thrombus extending to the carotid “T” [one patient]) or inability to pass a microcatheter through the occluded vessel (one patient). Adjunctive therapy included pharmacologic thrombolysis with tissue plasminogen activator (all patients), carotid angioplasty and stenting (two patients), and middle cerebral artery angioplasty (one patient). Patency of the carotid artery was reestablished in two patients, with some residual thrombus burden. In the third patient, the device was able to create a channel through the column of thrombus, allowing intracranial access. CONCLUSION: Rheolytic thrombectomy shows potential for rapid, large-burden thrombus removal in cases of internal carotid artery thrombosis, allowing expedient access to the intracranial circulation for additional thrombolytic therapy.
- Published
- 2001
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