41 results on '"Joshua W Osbun"'
Search Results
2. Time Line of Occlusion for Intracranial Aneurysms Treated with the Pipeline Embolization Device
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Samuel J. Cler, David C. Lauzier, Arindam R. Chatterjee, Joshua W. Osbun, Christopher J. Moran, and Akash P. Kansagra
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Treatment Outcome ,Humans ,Intracranial Aneurysm ,Stents ,Surgery ,Neurology (clinical) ,Embolization, Therapeutic ,Blood Vessel Prosthesis ,Follow-Up Studies ,Retrospective Studies - Abstract
Rates of aneurysm occlusion following treatment with flow-diverting stents have been quantified at predefined time points in clinical trials, but data characterizing the continuous temporal progression of aneurysm occlusion are lacking. This study used real-world variability in timing of angiographic follow-up to characterize the time line of aneurysm occlusion following treatment with the Pipeline embolization device (PED).All aneurysms treated with a PED at our institution between 2011 and 2020 were screened. Nonsaccular or ruptured aneurysms were excluded. Aneurysm occlusion status and time since treatment were recorded for each follow-up angiogram. Aneurysm occlusion was characterized using Kaplan-Meier and Cox proportional hazards analysis after censoring at last follow-up or subsequent treatment.There were 290 aneurysms in 222 patients analyzed. The median time of observed aneurysm occlusion was 7.5 months, and overall rate of aneurysm occlusion was 77.9%. Larger aneurysms demonstrated a longer median time to occlusion and lower rate of aneurysm occlusion (P = 0.029). There were no observed differences in the time line of occlusion for aneurysms treated with a single PED or multiple PEDs (P = 0.889) or without or with adjunctive coiling (P = 0.771).Aneurysms treated with a PED had a median time to observed occlusion of 7.5 months. Occlusion of larger aneurysms occurred more slowly than occlusion of smaller aneurysms following flow diversion. The number of PEDs deployed or the use of adjunctive coiling did not affect the time line or likelihood of aneurysm occlusion. These findings may guide optimal timing of follow-up after treatment with a PED.
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- 2022
3. Characterization of the Genomic and Immunologic Diversity of Malignant Brain Tumors through Multisector Analysis
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Anthony Z. Wang, Hsiang Chih Lu, Zachary L. Skidmore, Obi L. Griffith, Gregory J. Zipfel, Katherine E. Miller, Megan Richters, Eric C. Leuthardt, Malachi Griffith, Albert H. Kim, Gavin P. Dunn, Tanner M. Johanns, Tammi L. Vickery, Joshua W. Osbun, Ralph G. Dacey, Bryan Fisk, Elaine R. Mardis, Michael R. Chicoine, Joshua L. Dowling, and Maximilian Schaettler
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Brain Neoplasms ,Immune microenvironment ,T cell ,Receptors, Antigen, T-Cell ,Genomics ,Biology ,medicine.disease ,Article ,Immunological diversity ,Immune system ,medicine.anatomical_structure ,Oncology ,Exome Sequencing ,Tumor Microenvironment ,Cancer research ,medicine ,Humans ,Immunotherapy ,Neoplasm Metastasis ,Treatment resistance ,Glioblastoma ,Multi sectoral ,Exome - Abstract
Despite some success in secondary brain metastases, targeted or immune-based therapies have shown limited efficacy against primary brain malignancies such as glioblastoma (GBM). Although the intratumoral heterogeneity of GBM is implicated in treatment resistance, it remains unclear whether this diversity is observed within brain metastases and to what extent cancer cell–intrinsic heterogeneity sculpts the local immune microenvironment. Here, we profiled the immunogenomic state of 93 spatially distinct regions from 30 malignant brain tumors through whole-exome, RNA, and T-cell receptor sequencing. Our analyses identified differences between primary and secondary malignancies, with gliomas displaying more spatial heterogeneity at the genomic and neoantigen levels. In addition, this spatial diversity was recapitulated in the distribution of T-cell clones in which some gliomas harbored highly expanded but spatially restricted clonotypes. This study defines the immunogenomic landscape across a cohort of malignant brain tumors and contains implications for the design of targeted and immune-based therapies against intracranial malignancies. Significance: This study describes the impact of spatial heterogeneity on genomic and immunologic characteristics of gliomas and brain metastases. The results suggest that gliomas harbor significantly greater intratumoral heterogeneity of genomic alterations, neoantigens, and T-cell clones than brain metastases, indicating the importance of multisector analysis for clinical or translational studies. This article is highlighted in the In This Issue feature, p. 1
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- 2021
4. Effect of Intravenous Thrombolysis on Clot Survival during Mechanical Thrombectomy in Acute Large Vessel Occlusion Strokes
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Joshua W. Osbun, Adam N. Wallace, Akash P. Kansagra, DeWitte T. Cross, Arindam R. Chatterjee, Amber Salter, Brendan Eby, Christopher J. Moran, and Mohamed Shehabeldin
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medicine.medical_specialty ,Mechanical Thrombolysis ,medicine.medical_treatment ,Ischemia ,Brain Ischemia ,Reperfusion therapy ,Fibrinolytic Agents ,Modified Rankin Scale ,Internal medicine ,Humans ,Medicine ,Thrombolytic Therapy ,Stroke ,Retrospective Studies ,Thrombectomy ,Acute stroke ,business.industry ,Thrombolysis ,medicine.disease ,Mechanical thrombectomy ,Treatment Outcome ,Cardiology ,Surgery ,Neurology (clinical) ,business ,Large vessel occlusion - Abstract
Background The benefit of intravenous thrombolysis (IVT) before mechanical thrombectomy (MT) in patients with large vessel occlusion (LVO) stroke is uncertain. Conventional metrics of final modified thrombolysis in cerebral ischemia (mTICI) score and 90-d modified Rankin Scale may be insensitive to IVT effects on procedural complexity and duration. Objective To study the effect of IVT prior to MT on clot survival. Methods We performed a single-center retrospective analysis of 257 acute stroke patients with LVO undergoing MT and analyzed the effect of IVT prior to MT using a novel, pass-by-pass clot survival methodology. Results The use of IVT was associated with a significantly lower number of passes to attain mTICI 2B or greater (P = .002) or mTICI 3 (P = .039) reperfusion. The number of patients who achieved mTICI 2B or greater after the first pass was significantly higher in the IVT group (P = .003). This increased rate of reperfusion persisted into subsequent passes. Conclusion IVT prior to MT reduces the number of thrombectomy passes required to achieve mTICI 2B or mTICI 3 reperfusion. This information should be considered as the merits of IVT prior to MT are debated.
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- 2021
5. Mechanical Thrombectomy for Distal Occlusions: Efficacy, Functional and Safety Outcomes: Insight from the STAR Collaboration
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Nitin Goyal, Mohammad Anadani, Sami Al Kasab, Peter Kan, Richard Williamson, Christopher S. Ogilvy, Reda M. Chalhoub, Maxim Mokin, Ali Alawieh, Robert M. Starke, Brian M. Howard, Justin R Mascitelli, Kyle M Fargen, Sharon Webb, Joshua W. Osbun, Ansaar T Rai, Min S. Park, Albert J Yoo, Reade De Leacy, Alejandro M Spiotta, Shakeel A. Chowdhry, Isabel Fragata, Travis M. Dumont, Roberto Crosa, Jonathan A Grossberg, R. Webster Crowley, Charles C. Matouk, Michael R. Levitt, Ilko Maier, Marios Psychogios, Christopher P. Kellner, Pascal Jabbour, Stacey Q Wolfe, Fábio A. Nascimento, and Adam S Arthur
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Adult ,medicine.medical_specialty ,Posterior cerebral artery ,03 medical and health sciences ,0302 clinical medicine ,Modified Rankin Scale ,medicine.artery ,Occlusion ,Anterior cerebral artery ,Humans ,Medicine ,Stroke ,Aged ,Retrospective Studies ,Thrombectomy ,business.industry ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,030220 oncology & carcinogenesis ,Middle cerebral artery ,Cohort ,Cerebral Arterial Diseases ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
Background Mechanical thrombectomy (MT) is the standard of care for the treatment of proximal anterior circulation large vessel occlusions. However, little is known about its efficacy and safety in the treatment of distal intracranial occlusions. Methods This is a multicenter retrospective study of patients treated with MT at 15 comprehensive centers between January 2015 and December 2018. The study cohort was divided into 2 groups based on the location of occlusion (proximal vs. distal). Distal occlusion was defined as occlusion of M3 segment of the middle cerebral artery, any segment of the anterior cerebral artery, or any segment of the posterior cerebral artery. Only isolated distal occlusion was included. Good outcome was defined as 90-day modified Rankin scale score 0–2. Results A total of 4710 patients were included in this study, of whom 189 (4%) had MT for distal occlusions. Compared with the proximal occlusion group, distal occlusion group had a higher rate of good outcome (45% vs. 36%; P = 0.03) and a lower rate of successful reperfusion (78% vs. 84%; P = 0.04). However, the differences did not retain significance in adjusted models. Otherwise there was no difference in the rate of hemorrhagic complications, mortality, or procedure-related complications between the 2 groups. Successful reperfusion, age, and admission stroke severity emerged as predictors of good functional outcome in the distal occlusion group. Conclusions Thrombectomies of distal vessels achieve high rate of successful reperfusion with similar safety profile to those in more proximal locations.
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- 2021
6. Pipeline embolization of proximal middle cerebral artery aneurysms: A multicenter cohort study
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Akash P. Kansagra, Josser E Delgado Almandoz, Christopher J. Moran, Kayla L Whaley, David C Lauzier, Yasha Kayan, Arindam R. Chatterjee, Joshua W. Osbun, Brandon K Root, and Megan E. Tipps
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medicine.medical_specialty ,Pipeline (computing) ,medicine.medical_treatment ,030218 nuclear medicine & medical imaging ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,medicine.artery ,medicine ,Humans ,cardiovascular diseases ,Embolization ,Retrospective Studies ,business.industry ,Endovascular Procedures ,Intracranial Aneurysm ,Original Articles ,medicine.disease ,Embolization, Therapeutic ,Cerebral Angiography ,Treatment Outcome ,Middle cerebral artery ,cardiovascular system ,Radiology ,business ,030217 neurology & neurosurgery ,Cohort study - Abstract
Background and purpose Flow diversion of aneurysms located in the M1 segment and middle cerebral artery bifurcation with Pipeline embolization device is sometimes performed, but further study is needed to support its regular use in aneurysm treatment. Here, we report measures of safety and efficacy for Pipeline embolization in the proximal middle cerebral artery in a multi-center cohort. Materials and methods Clinical and angiographic data of eligible patients were retrospectively obtained from participating centers and assessed for key clinical and angiographic outcomes. Additional details were extracted for patients with complications. Results In our multi-center cohort, complete aneurysm occlusion was achieved in 71% (17/24) of treated aneurysms. There were no deaths or disabling strokes, but non-disabling ischemic strokes occurred in 8% (2/24) of patients. For aneurysms in the M1 segment, complete aneurysm occlusion was observed in 75% (12/16) of aneurysms, aneurysm volume reduction was observed in 100% (16/16) of aneurysms, and non-disabling ischemic strokes occurred in 13% (2/16) of patients. For aneurysms at the middle cerebral artery bifurcation, complete aneurysm occlusion was observed in 63% (5/8) of aneurysms, aneurysm volume reduction occurred in 88% (7/8) of aneurysms, and ischemic or hemorrhagic complications occurred in 0% (0/8) of patients. Conclusion Pipeline embolization of cerebral aneurysms in the M1 segment and middle cerebral artery bifurcation demonstrated a 71% rate of complete aneurysm occlusion. There were no deaths or disabling strokes, but there was an 8% rate of non-disabling ischemic strokes.
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- 2021
7. Pipeline embolization of distal posterior inferior cerebellar artery aneurysms
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Kayla L Whaley, Christopher J. Moran, David C Lauzier, Akash P. Kansagra, Arindam R. Chatterjee, Yasha Kayan, Megan E. Tipps, Joshua W. Osbun, Brandon K Root, and Josser E Delgado Almandoz
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Pipeline (computing) ,Carotid arteries ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Cerebral circulation ,0302 clinical medicine ,Aneurysm ,medicine.artery ,Humans ,Medicine ,Embolization ,Vertebral Artery ,Retrospective Studies ,business.industry ,Endovascular Procedures ,Intracranial Aneurysm ,Original Articles ,medicine.disease ,Embolization, Therapeutic ,Cerebral Angiography ,Treatment Outcome ,Posterior inferior cerebellar artery ,Female ,Radiology ,business ,030217 neurology & neurosurgery - Abstract
Background and purpose Flow diversion is commonly used to treat intracranial aneurysms in various regions of the cerebral vasculature, but is only approved for use in the internal carotid arteries. Treatment of distal PICA aneurysms with PED is sometimes performed but has not been well studied. Here, we report our experience with flow diversion of distal PICA aneurysms with PED. Materials and methods Clinical and angiographic data of eligible patients was retrospectively obtained and assessed for key demographic characteristics and clinical and angiographic outcomes. Principal outcomes included rates of aneurysm occlusion, ischemic or hemorrhagic complication, technical complication, and in-stent stenosis. Results Three female and 2 male patients underwent placement of PED in the PICA for treatment of 5 distal PICA aneurysms. Clinical and angiographic follow-up was obtained for all patients. Complete aneurysm occlusion was observed in 100% (5/5) of treated aneurysms at 6 month and longest angiographic follow-up. While there were no ischemic or device-related complications, delayed hemorrhagic complications occurred in 20% (1/5) of patients. Conclusion Pipeline embolization of distal PICA aneurysms can be performed in select patients. Further study is necessary in larger cohorts to better define clinical scenarios in which flow diversion in the distal PICA should be considered.
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- 2021
8. Automated Quantification of Reduced Sulcal Volume Identifies Early Brain Injury After Aneurysmal Subarachnoid Hemorrhage
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Atul Kumar, Zach Zlepper, Wint Yan Aung, Joshua W. Osbun, Keshav Jayaraman, Julian V. Clarke, Michelle Allen, Gregory J. Zipfel, Jane Y. Yuan, Yasheng Chen, Rajat Dhar, and Umeshkumar Athiraman
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Advanced and Specialized Nursing ,medicine.medical_specialty ,Subarachnoid hemorrhage ,business.industry ,Brain edema ,Ischemia ,Vasospasm ,Subarachnoid Hemorrhage ,medicine.disease ,Article ,Cerebrospinal fluid ,Brain Injuries ,Internal medicine ,medicine ,Cardiology ,Humans ,Neurology (clinical) ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Algorithms ,Cerebrospinal Fluid - Abstract
Background and Purpose:Early brain injury may be a more significant contributor to poor outcome after aneurysmal subarachnoid hemorrhage (aSAH) than vasospasm and delayed cerebral ischemia. However, studying this process has been hampered by lack of a means of quantifying the spectrum of injury. Global cerebral edema (GCE) is the most widely accepted manifestation of early brain injury but is currently assessed only through subjective, qualitative or semi-quantitative means. Selective sulcal volume (SSV), the CSF volume above the lateral ventricles, has been proposed as a quantitative biomarker of GCE, but is time-consuming to measure manually. Here we implement an automated algorithm to extract SSV and evaluate the age-dependent relationship of reduced SSV on early outcomes after aSAH.Methods:We selected all adults with aSAH admitted to a single institution with imaging within 72 hours of ictus. Scans were assessed for qualitative presence of GCE. SSV was automatically segmented from serial CTs using a deep learning-based approach. Early SSV was the lowest SSV from all early scans. Modified Rankin Scale score of 4 to 6 at hospital discharge was classified as a poor outcome.Results:Two hundred forty-four patients with aSAH were included. Sixty-five (27%) had GCE on admission while 24 developed it subsequently within 72 hours. Median SSV on admission was 10.7 mL but frequently decreased, with minimum early SSV being 3.0 mL (interquartile range, 0.3–11.9). Early SSV below 5 mL was highly predictive of qualitative GCE (area under receiver-operating-characteristic curve, 0.90). Reduced early SSV was an independent predictor of poor outcome, with a stronger effect in younger patients.Conclusions:Automated assessment of SSV provides an objective biomarker of GCE that can be leveraged to quantify early brain injury and dissect its impact on outcomes after aSAH. Such quantitative analysis suggests that GCE may be more impactful to younger patients with SAH.
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- 2021
9. Evolution of Elective Intracranial Aneurysm Treatment
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David C. Lauzier, Samuel J. Cler, Ananth K. Vellimana, Joshua W. Osbun, Arindam R. Chatterjee, Colin P. Derdeyn, Dewitte T. Cross, Christopher J. Moran, and Akash P. Kansagra
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Treatment Outcome ,Elective Surgical Procedures ,Endovascular Procedures ,Humans ,Intracranial Aneurysm ,Surgery ,Neurology (clinical) - Published
- 2022
10. Frequency of Screening-Detected Intracranial Aneurysms in Patients With Loeys-Dietz Syndrome
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Anna L. Huguenard, Gabrielle W. Johnson, Joshua W. Osbun, Ralph G. Dacey, and Alan C. Braverman
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Loeys-Dietz Syndrome ,Physiology (medical) ,Humans ,Intracranial Aneurysm ,Cardiology and Cardiovascular Medicine - Published
- 2022
11. Upper extremity transvenous access for neuroendovascular procedures: an international multicenter case series
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Evan Luther, Joshua W. Osbun, Dileep R. Yavagal, Min S. Park, Michael R. Levitt, Muhammad Waqas, Miguel Schüller Arteaga, Gregory D Selkirk, Jorge Galvan Fernandez, Ahmad Sweid, Marios Psychogios, Alejandro M Spiotta, Vasu Saini, Timothy J Phillips, Ahmed Nada, W. Christopher Fox, Joshua D. Burks, Daniel Giansante Abud, Mario Martínez-Galdámez, Jason M Davies, R. Webster Crowley, Alex Brehm, Pascal Jabbour, Rimal H Dossani, Eric C. Peterson, Stephanie H Chen, Robert M. Starke, Mithun G. Sattur, and Isaac Josh Abecassis
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Adult ,Male ,medicine.medical_specialty ,Internationality ,Femoral vein ,Upper Extremity ,Patient satisfaction ,medicine.artery ,medicine ,Humans ,Radial artery ,Vein ,Retrospective Studies ,Protocol (science) ,medicine.diagnostic_test ,business.industry ,Medical record ,Endovascular Procedures ,General Medicine ,Middle Aged ,Surgery ,medicine.anatomical_structure ,Radial Artery ,Angiography ,Female ,Neurology (clinical) ,Complication ,business - Abstract
BackgroundRadial artery access for transarterial procedures has gained recent traction in neurointerventional due to decreased patient morbidity, technical feasibility, and improved patient satisfaction. Upper extremity transvenous access (UETV) has recently emerged as an alternative strategy for the neurointerventionalist, but data are limited. Our objective was to quantify the use of UETV access in neurointerventions and to measure failure and complication rates.MethodsAn international multicenter retrospective review of medical records for patients undergoing UETV neurointerventions or diagnostic procedures was performed. We also present our institutional protocol for obtaining UETV and review the existing literature.ResultsOne hundred and thirteen patients underwent a total of 147 attempted UETV procedures at 13 centers. The most common site of entry was the right basilic vein. There were 21 repeat puncture events into the same vein following the primary diagnostic procedure for secondary interventional procedures without difficulty. There were two minor complications (1.4%) and five failures (ie, conversion to femoral vein access) (3.4%).ConclusionsUETV is safe and technically feasible for diagnostic and neurointerventional procedures. Further studies are needed to determine the benefit over alternative venous access sites and the effect on patient satisfaction.
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- 2021
12. Axis-specific analysis and predictors of endocrine recovery and deficits for non-functioning pituitary adenomas undergoing endoscopic transsphenoidal surgery
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Joshua W. Osbun, Ralph G. Dacey, Albert H. Kim, Jenie Y. Hwang, Keith M. Rich, Diane J. Aum, Cristine N. Klatt-Cromwell, Michael R. Chicoine, John S. Schneider, Jonathan L. McJunkin, Patrik Pipkorn, Gregory J. Zipfel, and Julie Silverstein
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Male ,Hydrocortisone ,Endoscopic endonasal surgery ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Pituitary-Adrenal System ,Thyrotropin ,Hypopituitarism ,0302 clinical medicine ,Endocrinology ,Testosterone ,Insulin-Like Growth Factor I ,Estradiol ,Human Growth Hormone ,Middle Aged ,Hypothalamic–pituitary–thyroid axis ,Treatment Outcome ,Pituitary hormones ,Female ,Pituitary dysfunction ,Adenoma ,Hypothalamo-Hypophyseal System ,medicine.medical_specialty ,Urology ,030209 endocrinology & metabolism ,03 medical and health sciences ,Adrenocorticotropic Hormone ,Hypothyroidism ,Sphenoid Bone ,medicine ,Humans ,Endocrine system ,Pituitary Neoplasms ,Aged ,Transsphenoidal surgery ,business.industry ,Hypogonadism ,Recovery of Function ,Luteinizing Hormone ,medicine.disease ,Prolactin ,Hyperprolactinemia ,Thyroxine ,Neuroendoscopy ,Pituitary-Adrenal Function Tests ,Follicle Stimulating Hormone ,business ,030217 neurology & neurosurgery ,Adrenal Insufficiency ,Hormone - Abstract
Endoscopic transsphenoidal surgery (ETSS) is a well-established treatment for patients with nonfunctioning pituitary adenomas (NFPAs). Data on the rates of pituitary dysfunction and recovery in a large cohort of NFPA patients undergoing ETSS and the predictors of endocrine function before and after ETSS are scarce. This study is purposed to analyze the comprehensive changes in hormonal function and identify factors that predict recovery or worsening of hormonal axes following ETSS for NFPA. A retrospective review of 601 consecutive patients who underwent ETSS between 2010 and 2018 at one institution was performed. Recovery or development of new hypopituitarism was analyzed in 209 NFPA patients who underwent ETSS. Patients with preoperative endocrine deficits (59.8%) in one or more pituitary axes had larger tumor volumes (P = 0.001) than those without preoperative deficits. Recovery of preoperative pituitary deficit occurred in all four axes, with overall mean recovery of 29.7%. The cortisol axis showed the highest recovery whereas the thyroid axis showed the lowest, with 1-year cumulative recovery rates of 44.3% and 6.1%, respectively. Postoperative hypopituitarism occurred overall in 17.2%, most frequently in the thyroid axis (24.3%, 27/111) and least frequently in the cortisol axis (9.7%, 16/165). Axis-specific predictors of post-operative recovery and deficiency were identified. Dynamic alterations in pituitary hormones were observed in a proportion of patients following ETSS in NFPA patients. Postoperative endocrine vulnerability, recovery, and factors that predicted recovery or loss of endocrine function depended on the hormonal system, necessitating an axis-specific surveillance strategy postoperatively.
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- 2020
13. Incorporation of transradial approach in neuroendovascular procedures: defining benchmarks for rates of complications and conversion to femoral access
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Bradley A. Gross, Eric C. Peterson, Eyad Almallouhi, Stephanie H. Chen, M. Reid Gooch, Do H Lim, Joshua W. Osbun, Ahmad Sweid, Mithun G. Sattur, Jeremy G Stone, Ashutosh P Jadhav, Brian T. Jankowitz, Pascal Jabbour, Alejandro M Spiotta, Nohra Chalouhi, Robert M. Starke, Benjamin M Zussman, Jonathan Lena, Yangchun Li, Dileep R. Yavagal, Christopher C. Young, Sami Al Kasab, Daniel A Tonetti, and Michael R. Levitt
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Adult ,Male ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,Balloon ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,Femoral access ,Humans ,Medicine ,Prospective Studies ,Stage (cooking) ,Intraoperative Complications ,Stroke ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Endovascular Procedures ,Arteriovenous malformation ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Femoral Artery ,Benchmarking ,Radial Artery ,Angiography ,Female ,Stents ,Neurology (clinical) ,business ,Complication ,030217 neurology & neurosurgery - Abstract
BackgroundThe transradial approach (TRA) has gained increasing popularity for neuroendovascular procedures. However, the experience with TRA in neuroangiography is still in early stages in most centers, and the safety and feasibility of this approach have not been well established. The purpose of this study is to report the safety and feasibility of TRA for neuroendovascular procedures.MethodsWe reviewed charts from six institutions in the USA to include consecutive patients who underwent diagnostic or interventional neuroendovascular procedures through TRA from July 2018 to July 2019. Collected data included baseline characteristics, procedural variables, complications, and whether there was a crossover to transfemoral access.ResultsA total of 2203 patients were included in the study (age 56.1±15.2, 60.8% women). Of these, 1697 (77%) patients underwent diagnostic procedures and 506 (23%) underwent interventional procedures. Successfully completed procedures included aneurysm coiling (n=97), flow diversion (n=89), stent-assisted coiling (n=57), balloon-assisted coiling (n=19), and stroke thrombectomy (n=76). Crossover to femoral access was required in 114 (5.2%). There were no major complications related to the radial access site. Minor complications related to access site were seen in 14 (0.6%) patients.ConclusionIn this early stage of transforming to the ‘radial-first’ approach for neuroendovascular procedures, TRA was safe with low complication rates for both diagnostic and interventional procedures. A wide range of procedures were completed successfully using TRA.
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- 2020
14. Phosphoproteomic and Kinomic Signature of Clinically Aggressive Grade I (1.5) Meningiomas Reveals RB1 Signaling as a Novel Mediator and Biomarker
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Joshua W. Osbun, Luis F. Gonzalez-Cuyar, Jason Barber, Carolina Parada, Yigit Karasozen, Patrick J. Cimino, Catherine Pan, Donald E. Born, Min Shi, Robert C. Rostomily, Jing Zhang, Tina Busald, Sumanpreet Kaur, Widya Adidharma, and Manuel Ferreira
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0301 basic medicine ,Oncology ,Cancer Research ,medicine.medical_specialty ,Proteome ,Ubiquitin-Protein Ligases ,AKT1 ,medicine.disease_cause ,Mass Spectrometry ,Meningioma ,Kruppel-Like Factor 4 ,03 medical and health sciences ,0302 clinical medicine ,Western blot ,Risk Factors ,Internal medicine ,Genotype ,Biomarkers, Tumor ,Meningeal Neoplasms ,medicine ,Humans ,Tissue microarray ,medicine.diagnostic_test ,business.industry ,Phosphoproteomics ,Phosphoproteins ,Prognosis ,medicine.disease ,Retinoblastoma Binding Proteins ,030104 developmental biology ,Tissue Array Analysis ,Disease Progression ,Histopathology ,Neoplasm Grading ,Neoplasm Recurrence, Local ,business ,Carcinogenesis ,Protein Kinases ,030217 neurology & neurosurgery ,Follow-Up Studies ,Signal Transduction - Abstract
Purpose: Most World Health Organization (WHO) grade I meningiomas carry a favorable prognosis. Some become clinically aggressive with recurrence, invasion, and resistance to conventional therapies (grade 1.5; recurrent/progressive WHO grade I tumors requiring further treatment within 10 years). We aimed to identify biomarker signatures in grade 1.5 meningiomas where histopathology and genetic evaluation has fallen short. Experimental Design: Mass spectrometry (MS)–based phosphoproteomics and peptide chip array kinomics were used to compare grade I and 1.5 tumors. Ingenuity Pathway Analysis (IPA) identified alterations in signaling pathways with validation by Western blot analysis. The selected biomarker was evaluated in an independent cohort of 140 samples (79/140 genotyped for meningioma mutations) by tissue microarray and correlated with clinical variables. Results: The MS-based phosphoproteomics revealed differential Ser/Thr phosphorylation in 32 phosphopeptides. The kinomic profiling by peptide chip array identified 10 phosphopeptides, including a 360% increase in phosphorylation of RB1, in the 1.5 group. IPA of the combined datasets and Western blot validation revealed regulation of AKT and cell-cycle checkpoint cascades. RB1 hyperphosphorylation at the S780 site distinguished grade 1.5 meningiomas in an independent cohort of 140 samples and was associated with decreased progression/recurrence-free survival. Mutations in NF2, TRAF7, SMO, KLF4, and AKT1 E17K did not predict RB1 S780 staining or progression in grade 1.5 meningiomas. Conclusions: RB1 S780 staining distinguishes grade 1.5 meningiomas, independent of histology, subtype, WHO grade, or genotype. This promising biomarker for risk stratification of histologically bland WHO grade I meningiomas provides insight into the pathways of oncogenesis driving these outlying clinically aggressive tumors.
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- 2020
15. Left transradial access for cerebral angiography
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Joshua W. Osbun, David I. Bass, Eric C. Peterson, Marie Christine Brunet, Michael R. Levitt, Melanie Walker, Guilherme Barros, Cory M. Kelly, and Stephanie H. Chen
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Adult ,Male ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,Occlusion ,medicine ,Humans ,Radial artery ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,Interventional cardiology ,business.industry ,Arteriovenous malformation ,General Medicine ,Middle Aged ,medicine.disease ,Cerebral Angiography ,Cerebrovascular Disorders ,Stenosis ,medicine.anatomical_structure ,Radial Artery ,Angiography ,Female ,Surgery ,Neurology (clinical) ,Radiology ,business ,030217 neurology & neurosurgery ,Artery ,Cerebral angiography - Abstract
IntroductionTransradial access is increasingly used among neurointerventionalists as an alternative to the transfemoral route. Currently available data, building on the interventional cardiology experience, primarily focus on right radial access. However, there are clinical scenarios when left-sided access may be indicated. The purpose of this study was to evaluate the technical feasibility of left transradial access to cerebral angiography across three institutions.MethodsA retrospective chart review was performed for patients who underwent cerebral angiography accessed via the left radial artery at three institutions between January 2018 and July 2019. The outcome variables studied were successful catheterization, vascular complications, and fluoroscopic time.ResultsNineteen patients underwent a total of 25 cerebral angiograms via left transradial access for cerebral aneurysms (n=15), basilar occlusion (n=1), carotid stenosis (n=1), arteriovenous malformation (n=1), and cervical neurofibroma (n=1). There were 12 diagnostic angiograms and 13 interventional angiograms. The left transradial approach was chosen due to left vertebrobasilar pathology (n=22), right subclavian stenosis (n=2), and previous right arm amputation (n=1). There was one instance of radial artery spasm, which resolved after catheter removal, and one conversion to transfemoral access in an interventional case due to lack of distal catheter support. There were no procedural complications.ConclusionsLeft transradial access in diagnostic and interventional cerebral angiography is a technically feasible, safe, and an effective alternative when indicated, and may be preferable for situations in which pathology locations or anatomic limitations preclude right-sided radial access.
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- 2019
16. Single-cell profiling of human dura and meningioma reveals cellular meningeal landscape and insights into meningioma immune response
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Anthony Z. Wang, Jay A. Bowman-Kirigin, Rupen Desai, Liang-I Kang, Pujan R. Patel, Bhuvic Patel, Saad M. Khan, Diane Bender, M. Caleb Marlin, Jingxian Liu, Joshua W. Osbun, Eric C. Leuthardt, Michael R. Chicoine, Ralph G. Dacey, Gregory J. Zipfel, Albert H. Kim, David G. DeNardo, Allegra A. Petti, and Gavin P. Dunn
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Mice ,Meninges ,Genetics ,Immunity ,Meningeal Neoplasms ,Tumor Microenvironment ,Molecular Medicine ,Animals ,Endothelial Cells ,Humans ,Meningioma ,Molecular Biology ,Genetics (clinical) - Abstract
Background Recent investigations of the meninges have highlighted the importance of the dura layer in central nervous system immune surveillance beyond a purely structural role. However, our understanding of the meninges largely stems from the use of pre-clinical models rather than human samples. Methods Single-cell RNA sequencing of seven non-tumor-associated human dura samples and six primary meningioma tumor samples (4 matched and 2 non-matched) was performed. Cell type identities, gene expression profiles, and T cell receptor expression were analyzed. Copy number variant (CNV) analysis was performed to identify putative tumor cells and analyze intratumoral CNV heterogeneity. Immunohistochemistry and imaging mass cytometry was performed on selected samples to validate protein expression and reveal spatial localization of select protein markers. Results In this study, we use single-cell RNA sequencing to perform the first characterization of both non-tumor-associated human dura and primary meningioma samples. First, we reveal a complex immune microenvironment in human dura that is transcriptionally distinct from that of meningioma. In addition, we characterize a functionally diverse and heterogenous landscape of non-immune cells including endothelial cells and fibroblasts. Through imaging mass cytometry, we highlight the spatial relationship among immune cell types and vasculature in non-tumor-associated dura. Utilizing T cell receptor sequencing, we show significant TCR overlap between matched dura and meningioma samples. Finally, we report copy number variant heterogeneity within our meningioma samples. Conclusions Our comprehensive investigation of both the immune and non-immune cellular landscapes of human dura and meningioma at single-cell resolution builds upon previously published data in murine models and provides new insight into previously uncharacterized roles of human dura.
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- 2021
17. Transradial intraoperative cerebral angiography: a multicenter case series and technical report
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Michael R. Levitt, Joshua W. Osbun, Louis J. Kim, Michael R. Chicoine, Alexander T. Yahanda, Kathleen M Dlouhy, Joshua P Thatcher, Amar S Shah, Bhuvic Patel, and Gregory J. Zipfel
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Male ,medicine.medical_specialty ,Intraoperative Neurophysiological Monitoring ,Femoral artery ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,medicine.artery ,Humans ,Medicine ,Radial artery ,Child ,Stroke ,Aged ,medicine.diagnostic_test ,Interventional cardiology ,business.industry ,Intracranial Aneurysm ,Arteriovenous malformation ,General Medicine ,Middle Aged ,medicine.disease ,Cerebral Angiography ,Radial Artery ,Angiography ,Female ,Surgery ,Neurology (clinical) ,Radiology ,business ,030217 neurology & neurosurgery ,Cerebral angiography - Abstract
BackgroundUse of the radial artery as an access site for neurointerventional procedures is gaining popularity after several studies in interventional cardiology have demonstrated superior patient safety, decreased length of stay, and patient preference compared with femoral artery access. The transradial approach has yet to be characterized for intraoperative cerebral angiography.ObjectiveTo report a multicenter experience on the use of radial artery access in intraoperative cerebral angiography, including case series and discussion of technical nuances.Methods27 patients underwent attempted transradial cerebral angiography betweenMay 2017 and May 2019. Data were collected regarding technique, patient positioning, vessels selected, technical success rate, and access site complications.Results24 of the 27 patients (88.8%) underwent successful transradial intraoperative cerebral angiography. 18 patients (66.7%) were positioned supine, 6 patients (22.2%) were positioned prone, 1 patient (3.7%) was positioned lateral, and 2 patients (7.4%) were positioned three-quarters prone. A total of 31 vessels were selected including 13 right carotid arteries (8 common, 1 external, 4 internal), 11 left carotid arteries (9 common and 2 internal), and 6 vertebral arteries (5 right and 1 left). Two patients (7.4%) required conversion to femoral access in order to complete the intraoperative angiogram (1 due to arterial vasospasm and 1 due to inadvertent venous catheterization). One procedure (3.7%) was aborted because of inability to obtain the appropriate fluoroscopic views due to patient positioning. No patient experienced stroke, arterial dissection, or access site complication.ConclusionsTransradial intraoperative cerebral angiography is safe and feasible with potential for improved operating room workflow ergonomics, faster patient mobility in the postoperative period, and reduced costs.
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- 2019
18. Transradial approach for flow diversion treatment of cerebral aneurysms: a multicenter study
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Stephanie H. Chen, Brian Snelling, Eric C. Peterson, Joshua W. Osbun, Sumedh S. Shah, Robert M. Starke, Marie Christine Brunet, Samir Sur, and Dileep R. Yavagal
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Self Expandable Metallic Stents ,030204 cardiovascular system & hematology ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,medicine.artery ,Humans ,Medicine ,Prospective Studies ,Common carotid artery ,Radial artery ,Aged ,Retrospective Studies ,Flow diverter ,Aged, 80 and over ,Flow diversion ,business.industry ,Endovascular Procedures ,Intracranial Aneurysm ,Left internal carotid artery ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,Multicenter study ,Cerebrovascular Circulation ,Radial Artery ,Access site ,Female ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
BackgroundThe transradial approach (TRA) to endovascular procedures decreases access site morbidity and mortality in comparison with the traditional transfemoral technique (TFA). Despite its improved safety profile, there is a concern that TRA is less favorable for neurointerventional procedures that require large coaxial systems to manage the small tortuous cerebral vessels.ObjectiveTo report our experience with TRA for flow diverter placement for treatment of unruptured cerebral aneurysms.MethodsWe performed a retrospective review of prospective institutional databases at two high-volume centers to identify 49 patients who underwent flow diversion for aneurysm treatment via primary TRA between November 2016 and November 2018. Patient demographics, procedural techniques, and clinical data were recorded.ResultsOf the 49 patients, 39 underwent successful flow diversion placement by TRA. Ten patients were converted to TFA after attempted TRA. There were no procedural complications. Reasons for failure included tortuosity in eight patients and severe radial artery spasm in two.ConclusionsIn the largest reported series to date of flow diverter deployment via TRA for aneurysm treatment, we demonstrate the technical feasibility and safety of the method. The most common reason for failure of TRA was an acute angle of left common carotid artery origin or left internal carotid artery tortuosity. Overall, our data suggest that increasing adoption of TRA is merited given its apparent equivalence to the current TFA technique and its documented reduction in access site complications.
- Published
- 2019
19. Impact of Stroke Call on Career Satisfaction and Burnout for Academic Neurointerventionalists: A Grounded Theory Model
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Gregory J. Zipfel, Jin Vivian Lee, Alexander W. Scott, and Joshua W. Osbun
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media_common.quotation_subject ,education ,Psychological intervention ,Workload ,Burnout ,Affect (psychology) ,Grounded theory ,Job Satisfaction ,03 medical and health sciences ,0302 clinical medicine ,Intervention (counseling) ,medicine ,Humans ,Attrition ,Burnout, Professional ,media_common ,Ischemic Stroke ,Thrombectomy ,Medical education ,business.industry ,medicine.disease ,United States ,Neurosurgeons ,Evaluation Studies as Topic ,030220 oncology & carcinogenesis ,Conceptual model ,Surgery ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
Background The demand of thrombectomy treatment for acute ischemic stroke increased dramatically in the United States after the publication of 5 pivotal trials in 2015. The impact of call burden on career satisfaction and burnout in neurointerventionalists has not been explored. Methods A qualitative approach was chosen to obtain rich, detailed accounts of physician experiences. From July 2018 to July 2019, we conducted in-depth, semistructured interviews (mean duration, 43 minutes) with 16 academic neurointerventionalists from various institutions in the United States. Participants were chosen from the Society of Neurointerventional Surgery to include multiple specialties, career stages, and geographic locations. Key themes/subthemes were organized into a conceptual model and shown by exemplary quotes. Results Participants report a diverse range of previously uncharacterized ways in which stroke call responsibilities affect their lives. Unrealistic performance expectations, discipline-based inequalities, poor organizational workflow, limited opportunities for growth and advancement, and lack of control over call conditions are some of the key themes identified. Participants describe a need for interventions that address both the issues of workload stress (i.e., resources for stroke call and administrative work) and their ability to accomplish professional goals (i.e., flexible work arrangements, leadership autonomy support, and organizational value congruence). Conclusions The burden of stroke call has strong implications for career satisfaction and burnout in neurointerventionalists. This model can be used by hospitals, departments, and physician groups to better conceptualize conditions that facilitate burnout and attrition. Changes to hospital management practices and culture may be the most productive focal areas for intervention.
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- 2021
20. Lower complication rates associated with transradial versus transfemoral flow diverting stent placement
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Dileep R. Yavagal, Oded Goren, Christoph J. Griessenauer, Cory M. Kelly, Stephanie H. Chen, Travis M. Dumont, Eyad Almallouhi, Eric C. Peterson, Axel Rosengart, Adam S Arthur, Evan Luther, Christopher C. Young, Peter Kan, Jeremy C. Peterson, Min S. Park, Tyler Scullen, Clemens M. Schirmer, Ching-Jen Chen, Joshua W. Osbun, Aaron S. Dumont, Shamsher S. Dalal, Daniel M.S. Raper, Peter S. Amenta, David Dornbos, Pascal Jabbour, Mohammad El-Ghanem, Suhas Pai, Waleed Brinjikji, Yangchun Li, Giuseppe Lanzino, Samir Sur, Gregory M. Weiner, Michael Nahhas, Marie Christine Brunet, Michael R. Levitt, Nitin Goyal, Ahmad Sweid, Alejandro M Spiotta, Robert M. Starke, Arunprasad Gunasekaran, Stacey Q Wolfe, Mehdi Abbasi, Allison Strickland, Nohra Chalouhi, and Kyle M Fargen
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Self Expandable Metallic Stents ,030204 cardiovascular system & hematology ,Article ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,Postoperative Complications ,Flow diverting stent ,Catheterization, Peripheral ,medicine ,Humans ,Registries ,Aged ,Retrospective Studies ,business.industry ,Endovascular Procedures ,Large series ,Intracranial Aneurysm ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Femoral Artery ,Access site complication ,Pooled analysis ,Treatment Outcome ,Cohort ,Radial Artery ,Access site ,Female ,Neurology (clinical) ,business ,Complication ,030217 neurology & neurosurgery - Abstract
BackgroundCurrently, there are no large-scale studies in the neurointerventional literature comparing safety between transradial (TRA) and transfemoral (TFA) approaches for flow diversion procedures. This study aims to assess complication rates in a large multicenter registry for TRA versus TFA flow diversion.MethodsWe retrospectively analyzed flow diversion cases for cerebral aneurysms from 14 institutions from 2010 to 2019. Pooled analysis of proportions was calculated using weighted analysis with 95% CI to account for results from multiple centers. Access site complication rate and overall complication rate were compared between the two approaches.ResultsA total of 2,285 patients who underwent flow diversion were analyzed, with 134 (5.86%) treated with TRA and 2151 (94.14%) via TFA. The two groups shared similar patient and aneurysm characteristics. Crossover from TRA to TFA was documented in 12 (8.63%) patients. There were no access site complications in the TRA group. There was a significantly higher access site complication rate in the TFA cohort as compared with TRA (2.48%, 95% CI 2.40% to 2.57%, vs 0%; p=0.039). One death resulted from a femoral access site complication. The overall complications rate was also higher in the TFA group (9.02%, 95% CI 8.15% to 9.89%) compared with the TRA group (3.73%, 95% CI 3.13% to 4.28%; p=0.035).ConclusionTRA may be a safer approach for flow diversion to treat cerebral aneurysms at a wide range of locations. Both access site complication rate and overall complication rate were lower for TRA flow diversion compared with TFA in this large series.
- Published
- 2020
21. Feasibility and safety of transradial access for pediatric neurointerventions
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Joshua W. Osbun, Eric C. Peterson, Jeremiah N. Johnson, Visish M. Srinivasan, Peter Kan, Melissa A. LoPresti, Stephanie H Chen, Caroline Hadley, Marc Prablek, Christopher C. Young, Pascal Jabbour, Jan-Karl Burkhardt, Michael R. Levitt, and Ahmad Sweid
- Subjects
Male ,medicine.medical_specialty ,Adolescent ,Wrist ,Asymptomatic ,Neurosurgical Procedures ,Hematoma ,medicine.artery ,Catheterization, Peripheral ,medicine ,Humans ,Prospective Studies ,Radial artery ,Child ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Vasospasm ,Intracranial Aneurysm ,General Medicine ,medicine.disease ,Surgery ,Cerebral Angiography ,Catheter ,medicine.anatomical_structure ,Child, Preschool ,Angiography ,Radial Artery ,Feasibility Studies ,Female ,Neurology (clinical) ,medicine.symptom ,business ,Complication - Abstract
BackgroundDiagnostic cerebral angiograms are increasingly being performed by transradial access (TRA) in adults, following data from the coronary literature supporting fewer access-site complications. Despite this ongoing trend in neuroangiography, there has been no discussion of its use in the pediatric population. Pediatric TRA has scarcely been described even for coronary or other applications. This is the first dedicated large study of transradial access for neuroangiography in pediatric patients.MethodsA multi-institutional series of consecutively performed pediatric transradial angiograms and interventions was collected. This included demographic, procedural, outcomes, and safety data. Data was prospectively recorded and retrospectively analyzed.ResultsThirty-seven diagnostic angiograms and 24 interventions were performed in 47 pediatric patients. Mean age, height, and weight was 14.1 years, 158.6 cm, and 57.1 kg, respectively. The radial artery measured 2.09+/-0.54 mm distally, and 2.09+/-0.44 mm proximally. Proximal and distal angiography were performed for both diagnostic and interventional application (17 distal angiograms, two distal interventions). Clinically significant vasospasm occurred in eight patients (13.1%). Re-access was successfully performed 11 times in seven patients. Conversion to femoral access occurred in five cases (8.2%). The only access-related complication was a small asymptomatic wrist hematoma after TR band removal.ConclusionsTransradial access in pediatric patients is safe and feasible. It can be performed successfully in many cases but carries some unique challenges compared with the adult population. Despite the challenge of higher rates of vasospasm and conversion to femoral access, it is worth exploring further, given the potential benefits.
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- 2020
22. Treatment of pediatric intracranial aneurysms: case series and meta-analysis
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Joshua W. Osbun, Gregory J. Zipfel, Christopher J. Moran, Adam N. Wallace, Akash P. Kansagra, Thomas P Madaelil, David D. Limbrick, Ralph G. Dacey, DeWitte T. Cross, and Junaid T Yasin
- Subjects
Male ,Pediatrics ,medicine.medical_specialty ,Adolescent ,Databases, Factual ,Ruptured aneurysms ,Patient characteristics ,Aneurysm, Ruptured ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,Case log ,medicine ,Humans ,Favorable outcome ,Child ,business.industry ,Endovascular Procedures ,Infant ,Intracranial Aneurysm ,General Medicine ,medicine.disease ,Embolization, Therapeutic ,Exact test ,Treatment Outcome ,Systematic review ,Child, Preschool ,Meta-analysis ,Female ,Surgery ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
BackgroundThere are limited outcome data to guide the choice of treatment in pediatric patients with cerebral aneurysms.ObjectiveTo describe our institutional experience treating pediatric patients with cerebral aneurysms and to conduct a meta-analysis of available studies to provide the best current evidence on treatment related outcomes.MethodsWe identified pediatric patients with cerebral aneurysms evaluated or treated at our institution using a comprehensive case log. We also identified studies to include in a meta-analysis through a systematic search of Pubmed, SCOPUS, EMBASE, and the Cochrane Database of Systematic Reviews. As part of both the local analysis and meta-analysis, we recorded patient characteristics, aneurysm characteristics, management, and outcomes. Statistical analysis was performed using Fisher’s exact test and the two tailed Student’s t test, as appropriate.Results42 pediatric patients with 57 aneurysms were evaluated at our institution, and treatment specific outcome data were available in 560 patients as part of our meta-analysis. Endovascular and surgical treatments yielded comparable rates of favorable outcome in all children (88.3% vs 82.7%, respectively, P=0.097), in children with ruptured aneurysms (75% vs 83%, respectively, P=0.357), and in children with unruptured aneurysms (96% vs 97%, respectively, P=1.000).ConclusionEndovascular and surgical treatment yield comparable long term clinical outcomes in pediatric patients with cerebral aneurysms.
- Published
- 2018
23. Endovascular Treatment of Posterior Inferior Cerebellar Artery Aneurysms with Flow Diversion
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Christopher J. Moran, Thomas P Madaelil, Junaid T Yasin, Jonathan A Grossberg, Anil K. Roy, Yasha Kayan, Adam N. Wallace, Joshua W. Osbun, Josser E Delgado Almandoz, Mudassar Kamran, and Brian M. Howard
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Fusiform Aneurysm ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,medicine.artery ,medicine ,Humans ,cardiovascular diseases ,Pica (disorder) ,Embolization ,Vertebral Artery ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Endovascular Procedures ,Intracranial Aneurysm ,Middle Aged ,medicine.disease ,Neurovascular bundle ,Embolization, Therapeutic ,Cerebral Angiography ,Surgery ,Treatment Outcome ,Posterior inferior cerebellar artery ,Perforating arteries ,Angiography ,cardiovascular system ,Female ,Neurology (clinical) ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Flow diversion is a viable alternative for treatment of wide-neck and fusiform aneurysms originating from the posterior inferior cerebellar artery (PICA), but coverage of the PICA and vertebral perforating arteries may be a concern. The aim of this study was to examine procedural, clinical, and angiographic outcomes of patients with PICA aneurysms treated with the Pipeline Embolization Device.Retrospective review was performed of PICA aneurysms treated with the Pipeline device at 3 neurovascular centers, including periprocedural complications and clinical and angiographic outcomes.In 16 procedures, 14 PICA aneurysms were treated with the Pipeline device. These included 11 saccular aneurysms with a mean size of 7.4 mm (range, 2.0-11.1 mm) and 3 fusiform aneurysms with a mean diameter of 6.1 mm (range, 5.0-8.0 mm) and mean length of 10.3 mm (range, 6.0-15.0 mm). One patient developed a PICA territory infarct with mild leg weakness that resolved in7 days. Overall complication rate was 7% (1/14) per patient and 6% (1/16) per procedure. Mean duration of clinical follow-up was 13.5 months (range, 3 weeks to 61.7 months), with all patients returning to baseline functional status. Complete or near-complete aneurysm occlusion was achieved in 58% (7/12) of cases with angiographic follow-up (mean, 15 months; range, 4-61 months). All covered PICAs remained patent.Flow diversion of PICA aneurysms is a safe and viable treatment option when traditional endovascular options are unlikely to preserve parent vessel patency.
- Published
- 2018
24. Endovascular Treatment of Posterior Cerebral Artery Aneurysms With Flow Diversion: Case Series and Systematic Review
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DeWitte T. Cross, Jonathan A Grossberg, Anil K. Roy, Mudassar Kamran, Brian M. Howard, Joshua W. Osbun, Yasha Kayan, Adam N. Wallace, C. Michael Cawley, Akash P. Kansagra, Christopher J. Moran, Matthew J. Austin, Jacques E. Dion, and Josser E Delgado Almandoz
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Infarction ,Fusiform Aneurysm ,Posterior cerebral artery ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,Blood vessel prosthesis ,medicine.artery ,Occlusion ,medicine ,Humans ,cardiovascular diseases ,Embolization ,Aged ,Retrospective Studies ,business.industry ,Endovascular Procedures ,Angiography ,Intracranial Aneurysm ,Middle Aged ,medicine.disease ,Embolization, Therapeutic ,Thrombosis ,Blood Vessel Prosthesis ,Surgery ,Treatment Outcome ,cardiovascular system ,Female ,Neurology (clinical) ,business ,030217 neurology & neurosurgery ,Follow-Up Studies - Abstract
Background Flow diversion of posterior cerebral artery (PCA) aneurysms has not been widely reported, possibly owing to concerns regarding parent vessel size and branch vessel coverage. Objective To examine the safety and effectiveness of PCA aneurysm flow diverter treatment. Methods Retrospective review of PCA aneurysms treated with the Pipeline Embolization Device (PED; Medtronic Inc, Dublin, Ireland) at 3 neurovascular centers, including periprocedural complications and clinical and angiographic outcomes. Systematic review of the literature identified published reports of PCA aneurysms treated with flow diversion. Rates of aneurysm occlusion and complications were calculated, and outcomes of saccular and fusiform aneurysm treatments were compared. Results Ten PCA aneurysms in 9 patients were treated with the PED. There were 2 intraprocedural thromboembolic events (20%), including 1 symptomatic infarction and 1 delayed PED thrombosis. Eight of 10 patients returned to or improved from their baseline functional status. Complete aneurysm occlusion with parent vessel preservation was achieved in 75% (6/8) of cases at mean follow-up of 16.7 mo. Eleven of 12 (92%) major branch vessels covered by a PED remained patent. Including the present study, systematic review of 15 studies found a complete aneurysm occlusion rate of 88% (30/34) and complication rate of 26% (10/38), including 5 symptomatic ischemic strokes (13%; 5/38). Fusiform aneurysms more frequently completely occluded compared with saccular aneurysms (100% vs 70%; P = .03) but were associated with a higher complication rate (43% vs 9%; P = .06). Conclusion The safety and effectiveness profile of flow diverter treatment of PCA aneurysms may be acceptable in select cases.
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- 2018
25. The value of long-term angiographic follow-up following Pipeline embolization of intracranial aneurysms
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Akash P. Kansagra, Arindam R. Chatterjee, Joshua W. Osbun, Christopher J. Moran, David C Lauzier, and Samuel J. Cler
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medicine.medical_specialty ,medicine.medical_treatment ,Constriction, Pathologic ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,Occlusion ,medicine ,Multiple time ,Humans ,In patient ,Embolization ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Intracranial Aneurysm ,General Medicine ,medicine.disease ,Embolization, Therapeutic ,Cerebral Angiography ,Stenosis ,Treatment Outcome ,Angiography ,Stents ,Surgery ,Neurology (clinical) ,Radiology ,business ,Background flow ,030217 neurology & neurosurgery ,Follow-Up Studies - Abstract
BackgroundFlow diversion of intracranial aneurysms with the Pipeline Embolization Device (PED) is commonly performed, but the value of long-term angiographic follow-up has not been rigorously evaluated. Here we examine the prevalence of actionable findings of aneurysm recurrence and development of in-stent stenosis in a cohort of patients that underwent long-term angiographic follow-up at multiple time points.MethodsAngiographic data from eligible patients were retrospectively assessed for aneurysm occlusion, in-stent stenosis, and aneurysm regrowth or recurrence. Patients were included in this study if they underwent angiographic imaging at 6 months post-treatment and at least one later time point.Results100% (132/132) of aneurysms occluded at 6 months remained occluded at final follow-up. 85.7% (6/7), 56.3% (27/48), and 25% (6/24) of aneurysms with entry remnant, subtotal filling, and total filling, respectively, at 6 months were completely occluded at final follow-up. 98.7% (147/149) of PED constructs that demonstrated no stenosis at 6 months demonstrated no stenosis at final angiography, while 44.4% (8/18) of PED constructs demonstrating in-stent stenosis at 6 months had resolution of stenosis on final angiography.ConclusionsAmong patients who undergo treatment of intracranial aneurysms with PED, the value of long-term angiography in patients demonstrating complete aneurysm occlusion and no in-stent stenosis on 6 month post-treatment angiography is low.
- Published
- 2021
26. Pipeline embolization of posterior communicating artery aneurysms associated with a fetal origin posterior cerebral artery
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Josser E Delgado Almandoz, Mudassar Kamran, Joshua W. Osbun, Adam N. Wallace, Akash P. Kansagra, Yasha Kayan, Christopher J. Moran, DeWitte T. Cross, and Matthew J. Austin
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Infarction ,Posterior cerebral artery ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,medicine.artery ,Outcome Assessment, Health Care ,Occlusion ,medicine ,Humans ,cardiovascular diseases ,Posterior communicating artery ,Embolization ,Aged ,Retrospective Studies ,Posterior Cerebral Artery ,medicine.diagnostic_test ,business.industry ,Angiography, Digital Subtraction ,Intracranial Aneurysm ,General Medicine ,Middle Aged ,medicine.disease ,Embolization, Therapeutic ,Surgery ,Angiography ,cardiovascular system ,Circle of Willis ,Female ,Neurology (clinical) ,Radiology ,business ,030217 neurology & neurosurgery - Abstract
Background and purpose Flow diversion may have advantages in the treatment of posterior communicating artery (PComA) aneurysms associated with a fetal origin posterior cerebral artery (PCA), which can be challenging to treat with conventional techniques. However, a PComA incorporated into the aneurysm may prevent or delay aneurysm occlusion. Also, coverage of a fetal origin PCA risks infarction of a large vascular territory. The purpose of this study was to examine the safety and effectiveness of using the Pipeline Embolization Device (PED) to treat PComA aneurysms associated with a fetal origin PCA. Patients and methods Retrospective review of PComA aneurysms associated with a fetal origin PCA treated with the PED at two neurovascular centers was performed. Periprocedural complications and clinical and angiographic outcomes were reviewed. Results Seven female patients underwent a total of seven PED procedures to treat seven PcomA aneurysms associated with a fetal origin PCA. The symptomatic complication rate was 14% (1/7) per patient and 13% (1/8) per procedure. Angiographic follow up was obtained for 6 of 7 aneurysms. Follow-up DSA at 5–7 months after treatment demonstrated complete occlusion of 17% (1/6) of aneurysms. One aneurysm was retreated with a second PED and occlusion was demonstrated 36 months after the second treatment, yielding an overall complete occlusion rate of 33% (2/6). Conclusions PED treatment was largely ineffective at treating PComA aneurysms associated with a fetal origin PCA, and should only be considered when conventional treatment options, including microsurgical clipping, are not feasible.
- Published
- 2017
27. Reduced Efficacy of the Pipeline Embolization Device in the Treatment of Posterior Communicating Region Aneurysms with Fetal Posterior Cerebral Artery Configuration
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Jonathan A Grossberg, Susana L Skukalek, Joshua W. Osbun, Diogo C Haussen, Sameer H. Halani, Jacques E. Dion, Anil K. Roy, Charles M Cawley, Raul G Nogueira, Frank C. Tong, and Brian M. Howard
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Posterior cerebral artery ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Text mining ,Aneurysm ,medicine.artery ,Occlusion ,Humans ,Medicine ,Embolization ,Posterior communicating artery ,Aged ,Posterior Cerebral Artery ,Fetus ,medicine.diagnostic_test ,business.industry ,Intracranial Aneurysm ,Magnetic resonance imaging ,Middle Aged ,medicine.disease ,Embolization, Therapeutic ,Surgery ,Treatment Outcome ,Female ,Neurology (clinical) ,Radiology ,business ,030217 neurology & neurosurgery - Abstract
Background Aneurysms at the origin of the posterior communicating artery (PcommA) have been demonstrated to be effectively treated with the pipeline embolization device (PED). Much less is known about the efficacy of the PED for aneurysms associated with a fetal posterior cerebral artery (fPCA) variant. Objective To study PED treatment efficacy of PcommA aneurysms, including fPCA aneurysms. Methods A prospectively maintained university database of aneurysm patients treated with the PED was retrospectively reviewed. Demographics, treatment details, and imaging were reviewed for all PcommA and fPCA aneurysms. Results Out of a total of 285 patients treated with PED, 50 patients (mean age 57.5 ± 12.2 yr, 42 females) with unruptured PcommA (9 fPCA) aneurysms were identified. Mean follow-up duration was 14.0 ± 11.6 mo (48 patients). Roy-Raymond class I occlusion on follow-up magnetic resonance or catheter angiography (mean time 11.7 ± 6.8 mo) was achieved in 30 patients (62.5%), class II occlusion in 11 patients (22.9%) and class III occlusion in 7 patients (14.5%). The PcommA was occluded in 56% of patients without any clinical symptoms. No deaths or permanent neurological complications occurred. In fPCA aneurysms, class I occlusion was seen in 1 patient, class 2 occlusion in 2 patients, and class III occlusion in 6 patients. Multivariate analysis revealed an independent association between incomplete occlusion and fPCA configuration (OR 73.65; 95% CI: 5.84-929.13; P = .001). Conclusion The PED is a safe and effective treatment for PcommA aneurysms, although fetal anatomy should increase consideration of traditional endovascular techniques or surgical clipping.
- Published
- 2017
28. Predictors of preoperative endovascular embolization of meningiomas: subanalysis of anatomic location and arterial supply
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Basavaraj Ghodke, Guilherme Barros, Abdullah H. Feroze, Rajeev Sen, Jason Barber, Louis J. Kim, Michael R. Levitt, Joshua W. Osbun, Danial K. Hallam, and Cory M. Kelly
- Subjects
Adult ,Male ,medicine.medical_specialty ,Middle meningeal artery ,medicine.medical_treatment ,030218 nuclear medicine & medical imaging ,Meningioma ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,medicine.artery ,Preoperative Care ,medicine ,Meningeal Neoplasms ,Humans ,Complication rate ,Embolization ,Angiographic embolization ,Anatomic Location ,Aged ,Retrospective Studies ,Retrospective review ,medicine.diagnostic_test ,business.industry ,Endovascular Procedures ,Brain ,General Medicine ,Middle Aged ,medicine.disease ,Embolization, Therapeutic ,Cerebral Angiography ,Angiography ,Surgery ,Female ,Neurology (clinical) ,Radiology ,business ,030217 neurology & neurosurgery - Abstract
IntroductionEndovascular embolization of intracranial meningiomas is commonly used as an adjunct to surgical resection. We sought to describe the anatomic locations and vascular supplies of meningiomas to identify characteristics predictive of successful preoperative endovascular embolization.MethodsWe conducted a retrospective review of 139 meningioma cases receiving cerebral angiograms for possible preoperative endovascular embolization at our institution between December 2000 and March 2017. The extent of embolization, arterial supply, anatomic location, and procedural complications were recorded for each case. Univariate and multivariate analyses were performed to identify tumor characteristics that predicted successful embolization.ResultsOf the total meningioma patients undergoing preoperative angiography, 78% (108/139) were successfully embolized, with a 2.8% periprocedural complication rate (3/108). Within the subset of patients with successful embolization, 31% (33/108) achieved complete angiographic embolization. Significant multivariate predictors of embolization (either partial or complete) were convexity/parasagittal locations (OR 5.15, 95% CI 0.93 to 28.54, p=0.060), meningohypophyseal trunk (MHT, OR 4.65, 95% CI 1.63 to 13.23, p=0.004), middle meningeal artery (MMA, OR 10.89, 95% CI 3.43 to 34.64, pConclusionsTumor characteristics can be used to predict the likelihood of preoperative meningioma embolization. Parasagittal and convexity meningiomas, and those with APA supply, are most likely to achieve complete angiographic embolization.
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- 2019
29. Somatic PDGFRB activating variants in fusiform cerebral aneurysms
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Philip D. Tatman, William B. Dobyns, Luis F. Gonzalez-Cuyar, Michael O. Dorschner, Joshua W. Osbun, Mitzi L. Murray, Yigit Karasozen, Christopher J. Hale, Mark O'Driscoll, Diana Alcantara, Manuel Ferreira, Louis J. Kim, Tina Busald, Carolina Parada, and Peter H. Byers
- Subjects
Adult ,Male ,0301 basic medicine ,Adolescent ,Somatic cell ,Sequence Homology ,PDGFRB ,Fusiform Aneurysm ,RB024 ,Biology ,QH460 ,RB127 ,Cohort Studies ,Receptor, Platelet-Derived Growth Factor beta ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,Growth factor receptor ,Report ,Genetics ,medicine ,Humans ,Amino Acid Sequence ,Child ,Protein kinase B ,Exome ,Genetics (clinical) ,Exome sequencing ,QP0001 ,Intracranial Aneurysm ,QM0531 ,medicine.disease ,030104 developmental biology ,Mutation ,Cancer research ,Female ,QH0447 ,030217 neurology & neurosurgery - Abstract
The role of somatic genetic variants in the pathogenesis of intracranial-aneurysm formation is unknown. We identified a 23-year-old man with progressive, right-sided intracranial aneurysms, ipsilateral to an impressive cutaneous phenotype. The index individual underwent a series of genetic evaluations for known connective-tissue disorders, but the evaluations were unrevealing. Paired-sample exome sequencing between blood and fibroblasts derived from the diseased areas detected a single novel variant predicted to cause a p.Tyr562Cys (g.149505130T>C [GRCh37/hg19]; c.1685A>G) change within the platelet-derived growth factor receptor β gene (PDGFRB), a juxtamembrane-coding region. Variant-allele fractions ranged from 18.75% to 53.33% within histologically abnormal tissue, suggesting post-zygotic or somatic mosaicism. In an independent cohort of aneurysm specimens, we detected somatic-activating PDGFRB variants in the juxtamembrane domain or the kinase activation loop in 4/6 fusiform aneurysms (and 0/38 saccular aneurysms; Fisher’s exact test, p < 0.001). PDGFRB-variant, but not wild-type, patient cells were found to have overactive auto-phosphorylation with downstream activation of ERK, SRC, and AKT. The expression of discovered variants demonstrated non-ligand-dependent auto-phosphorylation, responsive to the kinase inhibitor sunitinib. Somatic gain-of-function variants in PDGFRB are a novel mechanism in the pathophysiology of fusiform cerebral aneurysms and suggest a potential role for targeted therapy with kinase inhibitors.
- Published
- 2019
30. Direct puncture Onyx embolization of a large calvarial metastasis with intracranial extension: Case report
- Author
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Gavin P. Dunn, Akash P. Kansagra, Ralph G. Dacey, Minerva H Zhou, Joshua W. Osbun, Christopher J. Moran, and DeWitte T. Cross
- Subjects
medicine.medical_specialty ,Percutaneous ,medicine.medical_treatment ,Skull Neoplasms ,Contrast Media ,Tantalum ,030218 nuclear medicine & medical imaging ,Metastasis ,03 medical and health sciences ,0302 clinical medicine ,Renal cell carcinoma ,Direct puncture ,Parenchyma ,medicine ,Humans ,Dimethyl Sulfoxide ,Embolization ,Infusions, Intravenous ,Carcinoma, Renal Cell ,Aged, 80 and over ,business.industry ,Onyx embolization ,medicine.disease ,Embolization, Therapeutic ,Magnetic Resonance Imaging ,Kidney Neoplasms ,Surgery ,Cerebral Angiography ,Drug Combinations ,medicine.anatomical_structure ,Scalp ,Fluoroscopy ,Female ,Polyvinyls ,Radiology ,business ,030217 neurology & neurosurgery ,Head and Neck - Abstract
We report a case of renal cell carcinoma (RCC) metastasis to the calvarium and describe a strategy for percutaneous embolization of hypervascular calvarial tumors with intracranial extension. An elderly patient with history of RCC presented with left-sided weakness. Imaging studies showed a large right frontoparietal calvarial mass with intra- and extracranial extension. The tumor was devascularized by direct puncture tumor embolization using Onyx 18, allowing subsequent operative resection without significant blood loss or the need for flap reconstruction of the scalp. Compared to more common endovascular approaches, direct-needle puncture embolization of transcalvarial masses may offer lower risk of injury to scalp vessels and underlying brain parenchyma.
- Published
- 2017
31. Kinase Activity in Recurring Primary Skull Base Chordomas and Chondrosarcomas: Identification of Novel Pathways of Oncogenesis and Potential Drug Targets
- Author
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Sumanpret Kaur, Donald E. Born, Carolina Parada, Philip D. Tatman, Owais Ahmad, Tina Busald, Manuel Ferreira, Youssef Yakkioui, Jing Zhang, Joshua W. Osbun, RS: MHeNs - R3 - Neuroscience, Promovendi MHN, Neurochirurgie, and MUMC+: MA AIOS Neurochirurgie (9)
- Subjects
musculoskeletal diseases ,Pathology ,medicine.medical_specialty ,Kinase ,Proteome ,Carcinogenesis ,p38 mitogen-activated protein kinases ,Chondrosarcoma ,medicine.disease_cause ,Skull Base Neoplasms ,03 medical and health sciences ,0302 clinical medicine ,Recurrence ,Adjuvant therapy ,medicine ,Chordoma ,MANAGEMENT ,Humans ,Phosphorylation ,Kinase activity ,SCALE ,OUTCOMES ,RECEPTOR ,business.industry ,Phosphotransferases ,Computational Biology ,medicine.disease ,Clinical trial ,030220 oncology & carcinogenesis ,Cancer research ,Surgery ,Neurology (clinical) ,business ,Biomarkers ,030217 neurology & neurosurgery - Abstract
BACKGROUND: Chordomas and chondrosarcomas can occur in the skull base. Currently, 45% of chordomas and 56% of chondrosarcomas recur within 5 years of surgery. The role of adjuvant therapy is highly debated. No pharmacotherapies have been approved by the U.S. Food and Drug Administration for chordomas or chondrosarcomas. High propensity for recurrence and lack of definitive adjuvant therapy necessitate additional basic science research to identify molecular anomalies associated with recurrent disease.METHODS: We pooled tumor lysates from patients based on clinical criteria into 4 groups: primary chordomas, primary chordomas that recurred, primary chondrosarcomas, and primary chondrosarcomas that recurred. We used a peptide labeling method, isobaric tags for relative and absolute quantitation, to uniquely identify each tumor group. Phosphorylated peptides were identified and quantified via mass spectroscopy to determine and predict active kinases. -RESULTS: Six groups of phosphorylated peptides were associated with primary tumors that later recurred. Specific kinases associated with primary chordomas that recurred were FES and FER. Specific kinases associated with primary chondrosarcomas that recurred were FES, FER, SRC family kinases, PKC, ROCK, and mitogen-activated protein kinase signaling (JNK, ERK1, p38).CONCLUSIONS: These data provide clinicians with a means to screen skull base chordomas and chondrosarcomas to help identify tumors with a propensity to recur. Many of these kinases can be efficaciously inhibited by Food and Drug Administrationeapproved drugs that have not yet been used in clinical trials for treatment of skull base chordomas or chondrosarcomas. Validation of kinases identified in this study may advance treatment options for patients with these tumors.
- Published
- 2017
32. Kinome and phosphoproteome of high-grade meningiomas reveal AKAP12 as a central regulator of aggressiveness and its possible role in progression
- Author
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Jing Zhang, Joshua W. Osbun, Yigit Karasozen, Luis F. Gonzalez-Cuyar, Youssef Yakkioui, Manuel Ferreira, Sumanpreet Kaur, Tina Busald, Robert C. Rostomily, Catherine Pan, Min Shi, and Carolina Parada
- Subjects
0301 basic medicine ,Male ,Proteome ,Carcinogenesis ,Regulator ,lcsh:Medicine ,A Kinase Anchor Proteins ,Cell Cycle Proteins ,Biology ,medicine.disease_cause ,Article ,Meningioma ,03 medical and health sciences ,Cell Movement ,medicine ,otorhinolaryngologic diseases ,Biomarkers, Tumor ,Meningeal Neoplasms ,Humans ,Kinome ,Neoplasm Invasiveness ,Biomarker discovery ,lcsh:Science ,neoplasms ,Cell Proliferation ,Multidisciplinary ,lcsh:R ,Cell Cycle ,Phosphoproteomics ,Cell cycle ,Middle Aged ,medicine.disease ,Phosphoproteins ,Prognosis ,nervous system diseases ,Gene Expression Regulation, Neoplastic ,Survival Rate ,030104 developmental biology ,Benign Meningioma ,Cancer research ,lcsh:Q ,Female ,Neoplasm Recurrence, Local ,Protein Kinases - Abstract
There is a need to better understand meningioma oncogenesis for biomarker discovery and development of targeted therapies. Histological or genetic criteria do not accurately predict aggressiveness. Post-translational studies in meningioma progression are lacking. In the present work, we introduce a combination of mass spectrometry-based phosphoproteomics and peptide array kinomics to profile atypical and anaplastic (high-grade) meningiomas. In the discovery set of fresh-frozen tissue specimens (14), the A-kinase anchor protein 12 (AKAP12) protein was found downregulated across the grades. AKAP12 knockdown in benign meningioma cells SF4433 increases proliferation, cell cycle, migration, invasion, and confers an anaplastic profile. Differentially regulated pathways were characteristic of high-grade meningiomas. Low AKAP12 expression in a larger cohort of patients (75) characterized tumor invasiveness, recurrence, and progression, indicating its potential as a prognostic biomarker. These results demonstrate AKAP12 as a central regulator of meningioma aggressiveness with a possible role in progression.
- Published
- 2017
33. Isolated Internal Carotid Artery Thrombus and Cerebral Infarction in a Patient with Necrotizing Pancreatitis: Case Report
- Author
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DeWitte T. Cross, Joshua W. Osbun, Christopher J. Moran, Daniel R. Ludwig, Adam N. Wallace, Akash P. Kansagra, Matthew J. Austin, and Mudassar Kamran
- Subjects
Adult ,Carotid Artery Diseases ,Male ,medicine.medical_specialty ,Anemia ,Computed Tomography Angiography ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine.artery ,Pancreatitis, Chronic ,medicine ,Coagulopathy ,Humans ,Thrombus ,Stroke ,Cerebral infarction ,business.industry ,Pancreatitis, Acute Necrotizing ,Rehabilitation ,Anticoagulants ,Infarction, Middle Cerebral Artery ,Thrombosis ,Phlebography ,medicine.disease ,Magnetic Resonance Imaging ,Treatment Outcome ,cardiovascular system ,Cardiology ,Pancreatitis ,Surgery ,Neurology (clinical) ,Internal carotid artery ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery ,Carotid Artery, Internal ,Anemia of chronic disease - Abstract
Isolated internal carotid artery (ICA) thrombus in the absence of underlying atherosclerotic disease is a rare entity. We report a case of a patient presenting with right arm weakness, slurred speech, and altered mental status in the setting of acute on chronic pancreatitis. The patient was found to have scattered left cerebral hemisphere cortical infarctions, and catheter angiography confirmed the presence of intraluminal left ICA thrombus, with no evidence of atherosclerotic disease in the cervical or intracranial vasculature. Further workup also demonstrated the presence of anemia of chronic disease. The patient was initiated on anticoagulation, and follow-up imaging demonstrated a complete resolution of the left ICA thrombus. In the reported case, coagulopathy in the setting of acute on chronic pancreatitis was presumably the primary etiology. Anemia of chronic disease, related to a proinflammatory state, may also play a contributory role.
- Published
- 2017
34. Arteriovenous malformations: epidemiology, clinical presentation, and diagnostic evaluation
- Author
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Joshua W, Osbun, Matthew R, Reynolds, and Daniel L, Barrow
- Subjects
Intracranial Arteriovenous Malformations ,Headache Disorders ,Seizures ,Humans ,Intracranial Hemorrhages - Abstract
Brain arteriovenous malformations (AVMs) represent an uncommon disease of the central nervous system characterized by an arteriovenous shunt in which one or multiple arterial pedicles feed into a vascular nidus, creating early drainage into a venous outflow channel. These lesions are considered to be congenital and can come to clinical attention in a variety of ways such as seizure, intracranial hemorrhage, chronic headache or progressive neurological deficit. We focus on the epidemiology, clinical presentation and diagnostic evaluation in this chapter.
- Published
- 2017
35. Classification and pathophysiology of spinal vascular malformations
- Author
-
Isaac Josh, Abecassis, Joshua W, Osbun, and Louis, Kim
- Subjects
Arteriovenous Malformations ,Central Nervous System Vascular Malformations ,Spinal Cord ,Medical Illustration ,Humans - Abstract
Spinal arteriovenous malformations and fistulas comprise spinal vascular malformations (sVMs), a rare but challenging neurosurgic entity. A number of mechanisms have been proposed as explanations of neurologic decline in the setting of arteriovenous shunting, including venous hypertension, venous congestion, hemorrhage, vascular steal, or mass effect, which can be worsened with venous varices or aneurysmal dilations. Anatomic location and features dictate the categorization of sVMs. Two major systems are in place for classification of sVMs - (1) the American/French/English connection and (2) the Spetzler system - as well as a number of systems that have been described over the past century.
- Published
- 2017
36. Pipeline Embolization Device as primary treatment for blister aneurysms and iatrogenic pseudoaneurysms of the internal carotid artery
- Author
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Basavaraj Ghodke, Joshua W. Osbun, Manuel Ferreira, Michael R. Levitt, John D. Nerva, Louis J. Kim, and Ryan P. Morton
- Subjects
Adult ,Male ,medicine.medical_specialty ,Subarachnoid hemorrhage ,medicine.medical_treatment ,Iatrogenic Disease ,Blister ,Aneurysm ,medicine.artery ,Occlusion ,medicine ,Humans ,cardiovascular diseases ,Embolization ,business.industry ,Intracranial Aneurysm ,General Medicine ,Middle Aged ,Subarachnoid Hemorrhage ,medicine.disease ,Embolization, Therapeutic ,Surgery ,Hydrocephalus ,Radiography ,Treatment Outcome ,Blood blister ,cardiovascular system ,Female ,Stents ,Neurology (clinical) ,Radiology ,Internal carotid artery ,business ,Complication ,Aneurysm, False ,Carotid Artery, Internal - Abstract
Background Blood blister type aneurysms (BBAs) and pseudoaneurysms create a unique treatment challenge. Despite many advances in open surgical and endovascular techniques, this subset of patients retains relatively high rates of morbidity and mortality. Recently, BBAs have been treated with flow-diverting stents such as the Pipeline Embolization Device (PED) with overall positive results. Methods Four patients presented with dissecting internal carotid artery (ICA) aneurysms treated with the PED (two BBAs presenting with subarachnoid hemorrhage (SAH), two pseudoaneurysms after injury during endoscopic trans-sphenoidal tumor surgery). Results Three patients had a successful angiographic and neurological outcome. One patient with a BBA re-ruptured during initial PED placement, again in the postoperative period, and later died. Primary PED treatment involved telescoping stents in two patients and coil embolization supplementation in one patient. Conclusions The PED should be used selectively in the setting of acute SAH. Dual antiplatelet therapy can complicate hydrocephalus management, and the lack of immediate aneurysm occlusion creates the risk of short-term re-rupture. PED treatment for iatrogenic ICA pseudoaneurysms can provide a good angiographic and neurological outcome.
- Published
- 2014
37. A Multicenter, Single-Blind, Prospective Randomized Trial to Evaluate the Safety of a Polyethylene Glycol Hydrogel (Duraseal Dural Sealant System) as a Dural Sealant in Cranial Surgery
- Author
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Mark E. Shaffrey, Joshua W. Osbun, J. Paul Muizelaar, Jeremy D.W. Greenlee, Mitesh V. Shah, Patrick J. Connolly, Martin E. Weinand, John G. Golfinos, James E. Wilberger, Richard G. Ellenbogen, John M. Tew, Stephen J. Haines, Johnny B. Delashaw, Randall M. Chesnut, Anil Nanda, Harry R. van Loveren, Jonathan White, G. Rees Cosgrove, Lawrence S. Chin, Jack Jallo, Toxicogenomics, and RS: GROW - School for Oncology and Reproduction
- Subjects
Male ,Leak ,medicine.medical_specialty ,Cerebrospinal Fluid Rhinorrhea ,PEG hydrogel ,medicine.medical_treatment ,DuraSeal ,Polyethylene Glycol Hydrogel ,Fibrin ,Neurosurgical Procedures ,Polyethylene Glycols ,Cranial surgery ,Cerebrospinal fluid ,Postoperative Complications ,otorhinolaryngologic diseases ,Valsalva maneuver ,medicine ,Humans ,Surgical Wound Infection ,Single-Blind Method ,CSF leak ,Brain Diseases ,biology ,Cerebrospinal Fluid Leak ,business.industry ,Sealant ,Suture Techniques ,technology, industry, and agriculture ,Middle Aged ,medicine.disease ,Surgery ,Pseudomeningocele ,Drug Combinations ,Dural sealant ,Treatment Outcome ,Anesthesia ,biology.protein ,Female ,Neurology (clinical) ,Dura Mater ,business ,Meningitis ,Oligopeptides - Abstract
Incisional cerebrospinal fluid (CSF) leakage after cranial surgery is a significant cause of morbidity due to poor wound healing and infection, meningitis, and pseudomeningocele formation. Many common dural closure techniques, such as sutures, autologous grafts, gelatin or collagen sponges, and fibrin glues, are used to achieve watertight closure, although none are US Food and Drug Administration approved for this use. DuraSeal Dural Sealant System is a polyethylene glycol (PEG) hydrogel approved by the U.S. Food and Drug Administration for obtaining watertight dural closure when applied after standard dural suturing. This multicenter, prospective randomized study further evaluated the safety of a PEG hydrogel compared with common dural sealing techniques.A total of 237 patients undergoing elective cranial surgery at 17 institutions were randomized to dural closure augmented with the PEG hydrogel or a control "standard of care" dural sealing technique after Valsalva maneuver demonstrated an intraoperative nonwatertight dural closure. Data were collected on complications resulting in unplanned postoperative interventions or reoperations, surgical site infections, CSF leaks, and other neurological complications within 30 days. Surgeons also provided data on the ease of use of the dural sealing techniques, as well as preparation and application times.The incidences of neurosurgical complications, surgical site infections, and CSF leaks were similar between treatment and control groups, with no statistically significant difference between the measures. In the PEG hydrogel group (n = 120), the incidence of neurosurgical complications was 5.8% (n = 7), the incidence of surgical site infections was 1.7% (n = 2), and the incidence of CSF leak was 0.8% (n = 1). In the control group (n = 117), the incidence of neurosurgical complications was 7.7% (n = 9), the incidence of surgical site infection was 2.6% (n = 3), and the incidence of CSF leak was 1.7% (n = 2). Sealant preparation time was less than 5 minutes in 96.6% of the PEG hydrogel group compared with 66.4% of controls (P
- Published
- 2012
38. Carotid cavernous fistula after Pipeline placement: a single-center experience and review of the literature
- Author
-
Brian M. Howard, Jacques E. Dion, Joshua W. Osbun, Anil K. Roy, Jonathan A Grossberg, Frank C. Tong, Charles M Cawley, Faiz U. Ahmad, and Susana L Skukalek
- Subjects
Male ,medicine.medical_specialty ,Transvenous embolization ,medicine.medical_treatment ,Single Center ,Neurosurgical Procedures ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Blood Vessel Prosthesis Implantation ,0302 clinical medicine ,Aneurysm ,Carotid-Cavernous Sinus Fistula ,medicine ,Oculomotor Nerve Diseases ,Humans ,Embolization ,Carotid-cavernous fistula ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Angiography, Digital Subtraction ,Intracranial Aneurysm ,General Medicine ,Digital subtraction angiography ,Balloon Occlusion ,Middle Aged ,medicine.disease ,Surgery ,Blood Vessel Prosthesis ,Cerebral Angiography ,Safety profile ,Regimen ,Treatment Outcome ,Fluoroscopy ,Female ,Neurology (clinical) ,business ,030217 neurology & neurosurgery ,Carotid Artery, Internal ,Magnetic Resonance Angiography ,Platelet Aggregation Inhibitors ,Follow-Up Studies - Abstract
ObjectiveCarotid cavernous fistula (CCF) development after Pipeline Embolization Device (PED) treatment of cavernous carotid aneurysms (CCA) can be a challenging pathology to treat for the neurointerventionalist.MethodsA database of all patients whose aneurysms were treated with the PED since its approval by the Food and Drug Administration in 2011 was retrospectively reviewed. Demographic information, aneurysm characteristics, treatment technique, antiplatelet regimen, and follow-up data were collected. A literature review of all papers that describe PED treatment of CCA was then completed.ResultsA total of 44 patients with 45 CCAs were identified (38 women, 6 men). The mean age was 59.9±9.0 years. The mean maximal aneurysm diameter was 15.9±6.9 mm (mean neck 7.1±3.6 mm). A single PED was deployed in 32 patients, with two PEDs deployed in 10 patients and three PEDs in 3 patients. Adjunctive coiling was performed in 3 patients. Mean follow-up duration based on final imaging (MR angiography or digital subtraction angiography) was 14.1±12.2 months. Five patients (11.4%) developed CCFs in the post-procedural period after PED treatment, all within 2 weeks of device placement. These CCFs were treated with a balloon test occlusion followed by parent artery sacrifice. Our literature review yielded only three reports of CCFs after PED placement, with the largest series having a CCF rate of 2.3%.ConclusionsCCF formation is a known risk of PED treatment of CCA. Although transvenous embolization can be used for treating CCFs, parent artery sacrifice remains a viable option on the basis of these data. Studies support the view that adjunctive coiling may have a protective effect against post-PED CCF formation. None of the coiled aneurysms in our database or in the literature have ruptured. Follow-up data will lead to a better understanding of the safety profile of the PED for CCA.
- Published
- 2016
39. Self-injection of household cleaning detergents into a ventriculoperitoneal shunt reservoir during a suicide attempt: a case report and literature review
- Author
-
Jason W. Signorelli, Eric J. Arias, Joshua W. Osbun, Lauren C. Reynolds, Douglas Chyatte, and Matthew R. Reynolds
- Subjects
Ventriculostomy ,Adult ,medicine.medical_specialty ,Pseudotumor cerebri ,medicine.medical_treatment ,Detergents ,Poison control ,Suicide, Attempted ,Ventriculoperitoneal Shunt ,Cerebral Ventricles ,Injections ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Ventriculitis ,Humans ,Past medical history ,business.industry ,030206 dentistry ,medicine.disease ,Hydrocephalus ,Shunt (medical) ,Surgery ,Female ,Neurology (clinical) ,business ,030217 neurology & neurosurgery ,Ventriculomegaly - Abstract
Self-injection of household cleaning detergents (more specifically, commercial toilet bowl cleaner) into the reservoir of a ventriculoperitoneal shunt (VPS) has never been reported in the neurosurgical literature. A right-handed 41-year-old female with a past medical history significant for bipolar depression (with multiple prior hospital admissions for suicide attempts) and pseudotumor cerebri (status-post VPS placement from a right frontal approach) successfully injected ∼5 ml of toilet bowl cleaner into her ventricular shunt reservoir during a suicide attempt. She was found unresponsive by a family member 48 h after this event and presented to our hospital in moribund neurological condition (bilaterally fixed and dilated pupils with decerebrate posturing). Head computed tomography (CT) demonstrated marked ventriculomegaly. She was taken emergently to the operating room for placement of a left frontal ventriculostomy. Cerebrospinal fluid (CSF) sampled intraoperatively showed numerous Gram-positive cocci (later determined to be Staphylococcus epidermidis). For this reason, her right-sided shunt system was also removed in its entirety. She was treated with broad-spectrum intravenous and intraventricular antibiotics for her bacterial ventriculitis and her CSF was aggressively drained to treat her hydrocephalus. Once her infection had resolved, the shunt was replaced (using a right parietal approach) and she went on to make an excellent neurological recovery. Here, the authors present the case of a patient who self-injected household cleaning detergents into her VPS reservoir—and, likely, the ventricular system—during a suicide attempt and subsequently developed hydrocephalus and ventriculitis. Following this infrequent clinical scenario, consideration should be given to temporary ventriculostomy placement and shunt removal. Moreover, in patients with a known history of psychiatric co-morbidities—and particularly those patients with prior suicide attempts—the neurosurgeon should give serious consideration to placing the shunt system in an anatomical region which is difficult for the patient to self-access based upon their handedness.
- Published
- 2016
40. Endovascular treatment of complex dural arteriovenous fistula using the dual-microcatheter technique
- Author
-
Michael R. Levitt, Louis J. Kim, Joshua W. Osbun, and John D. Nerva
- Subjects
medicine.medical_specialty ,Fistula ,medicine.medical_treatment ,Arteriovenous fistula ,medicine ,Humans ,Dimethyl Sulfoxide ,Embolization ,Endovascular treatment ,Hemianopsia ,Sinus (anatomy) ,Aged ,Central Nervous System Vascular Malformations ,medicine.diagnostic_test ,business.industry ,General Medicine ,medicine.disease ,Embolization, Therapeutic ,Surgery ,Cerebral Angiography ,medicine.anatomical_structure ,Angiography ,Female ,Polyvinyls ,Neurology (clinical) ,Radiology ,Pouch ,business - Abstract
A 71-year-old woman presented with headache and dilated vessels on CTA. Angiography demonstrated a complex dural arteriovenous fistula with retrograde cortical venous hypertension, supplied by branches of internal and external carotids bilaterally into a fistulous pouch paralleling the left transverse and sigmoid sinuses, which was occluded at the jugular bulb. The patient refused treatment and was lost to follow-up, returning with sudden confusion and hemianopsia from left temporo-occipital hemorrhage. Transvenous endovascular embolization was performed using the dual-microcatheter technique with a combination of coiling and Onyx copolymer, completely occluding the sinus and fistula while preserving normal venous drainage.The video can be found here: http://youtu.be/u_4Oc7tSmDM.
- Published
- 2014
41. Internal Carotid Artery Stenting for Intracranial Atherosclerosis
- Author
-
Joshua W. Osbun and Louis J. Kim
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Ischemia ,Neurovascular Diseases: Aneurysms and Arteriovenous Malformations ,Neurosurgical Procedures ,medicine.artery ,Internal medicine ,Angioplasty ,medicine ,Humans ,cardiovascular diseases ,Stroke ,Coronary atherosclerosis ,business.industry ,Arterial stenosis ,General Medicine ,Intracranial Arteriosclerosis ,medicine.disease ,Stenosis ,Bypass surgery ,Cardiology ,Stents ,Internal carotid artery ,business ,Vascular Surgical Procedures ,Carotid Artery, Internal - Abstract
Intracranial atherosclerotic disease is a significant cause of stroke in the United States. Much like coronary atherosclerosis, this disease leads to arterial stenosis secondary to the buildup of lipid-based plaques in intracranial vessels. Ischemic stroke may occur following thromboembolic events near the site of stenosis or from watershed ischemia secondary to cerebral hypoperfusion. While this disease has been treated with intracranial angioplasty and stenting and cerebrovascular bypass surgery, the current literature supports aggressive medical management with dual antiplatelet therapy, treatment of comorbidities such as hypertension, diabetes, and hyperlipidemia, and lifestyle modification. Intracranial angioplasty and stenting is reserved for cases of medical failure.
- Published
- 2014
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