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206. Blood pressure reduction and outcome after endovascular therapy with successful reperfusion: a multicenter study

Author

Anadani, Mohammad, primary, Arthur, Adam S, additional, Alawieh, Ali, additional, Orabi, Yser, additional, Alexandrov, Andrei, additional, Goyal, Nitin, additional, Psychogios, Marios-Nikos, additional, Maier, Ilko, additional, Kim, Joon-tae, additional, Keyrouz, Saleh G, additional, de Havenon, Adam, additional, Petersen, Nils H, additional, Pandhi, Abhi, additional, Swisher, Christa B, additional, Inamullah, Ovais, additional, Liman, Jan, additional, Kodali, Sreeja, additional, Giles, James A, additional, Allen, Michelle, additional, Wolfe, Stacey Q, additional, Tsivgoulis, Georgios, additional, Cagle, Bradley A, additional, Oravec, Chesney S, additional, Gory, Benjamin, additional, De Marini, Pierre, additional, Kan, Peter, additional, Rahman, Shareena, additional, Richard, Sébastien, additional, Nascimento, Fábio A, additional, and Spiotta, Alejandro, additional

Published
2019
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207. Real-world effects of late window neurothrombectomy: procedure rates increase without night-time bias

Author

Williams, Michelle Marie, primary, Leslie-Mazwi, Thabele, additional, Hirsch, Joshua A, additional, Kittel, Carol, additional, Spiotta, Alejandro, additional, De Leacy, Reade, additional, Mocco, J, additional, Albuquerque, Felipe C, additional, Ducruet, Andrew F, additional, Goyal, Nitin, additional, Arthur, Adam S, additional, Kan, Peter, additional, Mokin, Maxim, additional, Dumont, Travis M, additional, Reeves, Alan, additional, Wolfe, Stacey Q, additional, and Fargen, Kyle, additional

Published
2019
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208. Intravenous thrombolysis pretreatment and other predictors of infarct in a new previously unaffected territory (INT) in ELVO strokes treated with mechanical thrombectomy

Author

Goyal, Nitin, primary, Tsivgoulis, Georgios, additional, Chang, Jason J, additional, Malhotra, Konark, additional, Goyanes, Juan, additional, Pandhi, Abhi, additional, Krishnan, Rashi, additional, Ishfaq, Muhammad F, additional, Hoit, Daniel, additional, Nickele, Christopher, additional, Inoa-Acosta, Violiza, additional, Katsanos, Aristeidis H, additional, Elijovich, Lucas, additional, Alexandrov, Andrei, additional, and Arthur, Adam S, additional

Published
2019
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209. An international multicenter retrospective study to survey the landscape of thrombectomy in the treatment of anterior circulation acute ischemic stroke: outcomes with respect to age

Author

Martini, Michael, primary, Mocco, J, additional, Turk, Aquilla, additional, Siddiqui, Adnan H, additional, Fiorella, David, additional, Hanel, Ricardo, additional, Woodward, Keith, additional, Rai, Ansaar, additional, Frei, Don, additional, Delgado Almandoz, Josser E, additional, Kelly, Michael E, additional, Peeling, Lissa, additional, Arthur, Adam S, additional, Baxter, Blaise, additional, English, Joey, additional, Linfante, Italo, additional, and De Leacy, Reade, additional

Published
2019
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211. Endosaccular flow disruption: where are we now?

Author

Bhogal, Pervinder, primary, Udani, Sundip, additional, Cognard, Christophe, additional, Piotin, Michel, additional, Brouwer, Patrick, additional, Sourour, Nader-Antoine, additional, Andersson, Tommy, additional, Makalanda, Levansri, additional, Wong, Ken, additional, Fiorella, David, additional, Arthur, Adam S, additional, Yeo, Leonard LL, additional, Soderman, Michael, additional, Henkes, Hans, additional, and Pierot, Laurent, additional

Published
2019
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213. Vascular

Author

Arthur, Adam S, primary, Abecassis, I Josh, additional, Abi-Aad, Karl R, additional, Albuquerque, Felipe C, additional, Almefty, Rami O, additional, Aoun, Rami James N, additional, Barrow, Daniel L, additional, Bederson, Joshua, additional, Bendok, Bernard R, additional, Ducruet, Andrew F, additional, Fanous, Andrew A, additional, Fennell, Vernard S, additional, Flores, Bruno C, additional, Griessenauer, Christoph J, additional, Kim, Louis J, additional, Levitt, Michael R, additional, Mack, William J, additional, Mascitelli, Justin, additional, Min, Elliott, additional, Mocco, J, additional, Morr, Simon, additional, Nerva, John D, additional, Richards, Alexandra E, additional, Schirmer, Clemens M, additional, See, Alfred P, additional, Snyder, Kenneth V, additional, Tian, Fucheng, additional, Walcott, Brian P, additional, and Welz, Matthew E, additional

Published
2019
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214. Impact of pretreatment with intravenous thrombolysis on reperfusion status in acute strokes treated with mechanical thrombectomy

Author

Goyal, Nitin, primary, Tsivgoulis, Georgios, additional, Pandhi, Abhi, additional, Malhotra, Konark, additional, Krishnan, Rashi, additional, Ishfaq, Muhammad F, additional, Krishnaiah, Balaji, additional, Nickele, Christopher, additional, Inoa-Acosta, Violiza, additional, Katsanos, Aristeidis H, additional, Hoit, Daniel, additional, Elijovich, Lucas, additional, Alexandrov, Andrei, additional, and Arthur, Adam S, additional

Published
2019
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215. The safety and effectiveness of the Woven EndoBridge (WEB) system for the treatment of wide-necked bifurcation aneurysms: final 12-month results of the pivotal WEB Intrasaccular Therapy (WEB-IT) Study

Author

Arthur, Adam S, primary, Molyneux, Andy, additional, Coon, Alexander L, additional, Saatci, Isil, additional, Szikora, Istvan, additional, Baltacioglu, Feyyaz, additional, Sultan, Ali, additional, Hoit, Daniel, additional, Delgado Almandoz, Josser E, additional, Elijovich, Lucas, additional, Cekirge, Saru, additional, Byrne, James V, additional, and Fiorella, David, additional

Published
2019
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216. A survey of burnout and professional satisfaction among United States neurointerventionalists

Author

Fargen, Kyle M, primary, Arthur, Adam S, additional, Leslie-Mazwi, Thabele, additional, Garner, Rebecca M, additional, Aschenbrenner, Carol A, additional, Wolfe, Stacey Q, additional, Ansari, Sameer A, additional, Dabus, Guilherme, additional, Spiotta, Alejandro, additional, Mokin, Maxim, additional, Linfante, Italo, additional, Mocco, J, additional, and Hirsch, Joshua A, additional

Published
2019
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217. ‘Real-world’ comparison of first-line direct aspiration and stent retriever mechanical thrombectomy for the treatment of acute ischemic stroke in the anterior circulation: a multicenter international retrospective study

Author

Martini, Michael, primary, Mocco, J, additional, Turk, Aquilla, additional, Siddiqui, Adnan H, additional, Fiorella, David, additional, Hanel, Ricardo A, additional, Woodward, Keith, additional, Rai, Ansaar, additional, Frei, Don, additional, Delgado Almandoz, Josser E, additional, Kelly, Michael E, additional, Peeling, Lissa, additional, Arthur, Adam S, additional, Baxter, Blaise, additional, English, Joey, additional, Linfante, Italo, additional, and De Leacy, Reade, additional

Published
2019
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220. Endovascular thrombectomy in pediatric patients with large vessel occlusion

Author

Shoirah, Hazem, primary, Shallwani, Hussain, additional, Siddiqui, Adnan H, additional, Levy, Elad I, additional, Kenmuir, Cynthia L, additional, Jovin, Tudor G, additional, Levitt, Michael R, additional, Kim, Louis J, additional, Griauzde, Julius, additional, Pandey, Aditya S, additional, Gemmete, Joseph J, additional, Abruzzo, Todd, additional, Arthur, Adam S, additional, Elijovich, Lucas, additional, Hoit, Daniel, additional, Cheema, Ahmed, additional, Aghaebrahim, Amin, additional, Sauvageau, Eric, additional, Hanel, Ricardo, additional, Ringer, Andrew J, additional, Nascimento, Fábio A, additional, Kan, Peter, additional, and Mocco, J, additional

Published
2019
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221. Matricidal cavernous aneurysms: a multicenter case series

Author

Dacus, Mallory R, primary, Nickele, Chris, additional, Welch, Babu G, additional, Ban, Vin Shen, additional, Ringer, Andrew J, additional, Kim, Louis J, additional, Levitt, Michael R, additional, Lanzino, Giuseppe, additional, Kan, Peter, additional, and Arthur, Adam S, additional

Published
2019
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223. Abstract WP15: Safety of Dual Antiplatelet Treatment in Emergent Large Vessel Occlusion (ELVO) Patients Treated With Mechanical Thrombectomy (MT) and Extracranial Internal Carotid Artery Stenting

Author

Ishfaq, Muhammad F, primary, Tsivgoulis, Georgios, additional, Goyal, Nitin, additional, Pandhi, Abhi, additional, Krishnan, Rashi, additional, Malhotra, Konark, additional, Krishnaiah, Balaji, additional, Nickele, Christopher, additional, Inoa, Violiza, additional, Hoit, Daniel, additional, Elijovich, Lucas, additional, Alexandrov, Anne W, additional, Alexandrov, Andrei V, additional, and Arthur, Adam S, additional

Published
2019
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224. Abstract TP436: Minimally Invasive Endoscopic Hematoma Evacuation vs. Best Medical Management for Spontaneous Basal Ganglia Intracerebral Hemorrhage

Author

Goyal, Nitin, primary, Tsivgoulis, Georgios, additional, Malhotra, Konark, additional, Katsanos, Aristeidis, additional, Pandhi, Abhi, additional, Alsherbini, Khalid, additional, Chang, Jason, additional, Hoit, Daniel, additional, Alexandrov, Andrei, additional, Elijovich, Lucas, additional, Fiorella, David, additional, Nickele, Christopher, additional, and Arthur, Adam S, additional

Published
2019
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225. Abstract WP30: Does Pretreatment With Intravenous Thrombolysis Prevent Infarct in a New Previously Unaffected Territory (INT) in Emergent Large Vessel Occlusion (ELVO) Patients Treated With Mechanical Thrombectomy (MT)?

Author

Goyal, Nitin, primary, Tsivgoulis, Georgios, additional, Pandhi, Abhi, additional, Krishnan, Rashi, additional, Malhotra, Konark, additional, Ishfaq, Muhammad F, additional, Krishnaiah, Balaji, additional, Nickele, Christopher, additional, Inoa, Violiza, additional, Hoit, Daniel, additional, Elijovich, Lucas, additional, Atkins, Cole, additional, Alexandrov, Anne, additional, Alexandrov, Andrei V, additional, and Arthur, Adam S, additional

Published
2019
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226. Abstract TP19: Impact of Single-Pass Complete Reperfusion on Clinical Outcomes in Emergent Large Vessel Occlusion (ELVO) Patients Treated With Mechanical Thrombectomy (MT)

Author

Pandhi, Abhi, primary, Tsivgoulis, Georgios, additional, Goyal, Nitin, additional, Krishnan, Rashi, additional, Ishfaq, Muhammad, additional, Swatzell, Victoria, additional, Katsanos, Aristeidis, additional, Krishnaiah, Balaji, additional, Nickele, Christopher, additional, Inoa, Violiza, additional, Elijovich, Lucas, additional, Alexandrov, Anne W, additional, Alexandrov, Andrei V, additional, and Arthur, Adam S, additional

Published
2019
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227. A2, M2, P2 aneurysms and beyond: results of treatment with pipeline embolization device in 65 patients

Author

Primiani, Christopher T, primary, Ren, Zeguang, additional, Kan, Peter, additional, Hanel, Ricardo, additional, Pereira, Vitor Mendes, additional, Lui, Wai Man, additional, Goyal, Nitin, additional, Elijovich, Lucas, additional, Arthur, Adam S, additional, Hasan, David M, additional, Ortega-Gutierrez, Santiago, additional, Samaniego, Edgar A, additional, Puri, Ajit S, additional, Kuhn, Anna L, additional, Orlov, Kirill, additional, Kislitsin, Dmitry, additional, Gorbatykh, Anton, additional, Waqas, Muhammad, additional, Levy, Elad I, additional, Siddiqui, Adnan H, additional, and Mokin, Maxim, additional

Published
2019
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228. Minimally invasive endoscopic hematoma evacuation vs best medical management for spontaneous basal-ganglia intracerebral hemorrhage

Author

Goyal, Nitin, primary, Tsivgoulis, Georgios, additional, Malhotra, Konark, additional, Katsanos, Aristeidis H, additional, Pandhi, Abhi, additional, Alsherbini, Khalid A, additional, Chang, Jason J, additional, Hoit, Daniel, additional, Alexandrov, Andrei V, additional, Elijovich, Lucas, additional, Fiorella, David, additional, Nickele, Christopher, additional, and Arthur, Adam S, additional

Published
2019
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229. Is a picture-perfect thrombectomy necessary in acute ischemic stroke?

Author

Chen, Ching-Jen, Chalhoub, Reda, Ding, Dale, Kumar, Jeyan S, Ironside, Natasha, Kellogg, Ryan T, Worrall, Bradford B, Southerland, Andrew M, Jabbour, Pascal, Wolfe, Stacey Q, Arthur, Adam S, Goyal, Nitin, Fragata, Isabel, Maier, Ilko, Matouk, Charles, Grossberg, Jonathan A, Kan, Peter, Schirmer, Clemens M, Crowley, R Webster, Ares, William J, Ogilvy, Christopher S, Rai, Ansaar T, Levitt, Michael R, Mokin, Maxim, Guerrero, Waldo R, Mascitelli, Justin R, Yoo, Albert J, Williamson, Richard, Grande, Andrew Walker, Crosa, Roberto Javier, Webb, Sharon, Psychogios, Marios N, Starke, Robert M, Spiotta, Alejandro M, and Park, Min S

Abstract

BackgroundThe benefit of complete reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI) 3) over near-complete reperfusion (≥90%, mTICI 2c) remains unclear. The goal of this study is to compare clinical outcomes between mechanical thrombectomy (MT)-treated stroke patients with mTICI 2c versus 3.MethodsThis is a retrospective study from the Stroke Thrombectomy and Aneurysm Registry (STAR) comprising 33 centers. Adults with anterior circulation arterial vessel occlusion who underwent MT yielding mTICI 2c or mTICI 3 reperfusion were included. Patients were categorized based on reperfusion grade achieved. Primary outcome was modified Rankin Scale (mRS) 0–2 at 90 days. Secondary outcomes were mRS scores at discharge and 90 days, National Institutes of Health Stroke Scale score at discharge, procedure-related complications, and symptomatic intracerebral hemorrhage.ResultsThe unmatched mTICI 2c and mTICI 3 cohorts comprised 519 and 1923 patients, respectively. There was no difference in primary (42.4% vs 45.1%; p=0.264) or secondary outcomes between the unmatched cohorts. Reperfusion status (mTICI 2c vs 3) was also not predictive of the primary outcome in non-imputed and imputed multivariable models. The matched cohorts each comprised 191 patients. Primary (39.8% vs 47.6%; p=0.122) and secondary outcomes were also similar between the matched cohorts, except the 90-day mRS which was lower in the matched mTICI 3 cohort (p=0.049). There were increased odds of the primary outcome with mTICI 3 in patients with baseline mRS ≥2 (36% vs 7.7%; p=0.011; pinteraction=0.014) and a history of stroke (42.3% vs 15.4%; p=0.027; pinteraction=0.041).ConclusionsComplete and near-complete reperfusion after MT appear to confer comparable outcomes in patients with acute stroke.

Published
2022
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233. Predicting the degree of difficulty of the trans- radial approach in cerebral angiography.

Author

Khan, Nickalus R., Peterson, Jeremy, Dornbos III, David, Nguyen, Vincent, Goya, Nitin, Torabi, Radmehr, Hoit, Daniel, Elijovich, Lucas, Inoa-Acosta, Violiza, Morris, David, Nickele, Christopher, Jabbour, Pascal, Peterson, Eric C., and Arthur, Adam S.

Subjects
INTRAVENOUS catheterization, CEREBRAL angiography, ACQUISITION of data methodology, MEDICAL care, TERTIARY care, THORACIC aorta, RETROSPECTIVE studies, CARDIOVASCULAR system, FEMORAL artery, FLUOROSCOPY, RADIAL artery, MEDICAL records, DESCRIPTIVE statistics
Abstract

Background To evaluate anatomical and clinical factors that make trans- radial cerebral angiography more difficult. Methods A total of 52 trans- radial diagnostic angiograms were evaluated in a tertiary care stroke center from December 2019 until March 2020. We analyzed a number of anatomical variables to evaluate for correlation to outcome measures of angiography difficulty. Results The presence of a proximal radial loop had a higher conversion to femoral access (p<0.03). The presence of a large diameter aortic arch (p<0.01), double subclavian innominate curve (p<0.01), left proximal common carotid artery (CCA) loop (p<0.001), acute subclavian vertebral angle (p<0.01), and absence of bovine aortic arch anatomy (p=0.03) were associated with more difficult trans- radial cerebral angiography and increased fluoroscopy time-per-vessel. Conclusion The presence of a proximal radial loop, large diameter aortic arch, double subclavian innominate curve, proximal left CCA loop, acute subclavian vertebral angle, and absence of bovine aortic arch anatomy were associated with more difficult trans- radial cerebral angiography. We also introduce a novel grading scale for diagnostic trans- radial angiography. [ABSTRACT FROM AUTHOR]

Published
2021
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234. Clot perviousness is associated with first pass success of aspiration thrombectomy in the COMPASS trial.

Author

Mokin, Maxim, Waqas, Muhammad, Fifi, Johanna, de De Leacy, Rea, Fiorella, David, Levy, Elad I., Snyder, Kenneth, Hanel, Ricardo, Woodward, Keith, Chaudry, Imran, Rai, Ansaar T., Frei, Donald, Delgado Almandoz, Josser E., Kelly, Michael, Arthur, Adam S., Baxter, Blaise W., English, Joey, Linfante, Italo, Fargen, Kyle M., and Turk, Aquilla

Subjects
THROMBOSIS risk factors, STATISTICS, CONFIDENCE intervals, CEREBRAL infarction, MULTIVARIATE analysis, VEIN surgery, TREATMENT effectiveness, THROMBECTOMY, DESCRIPTIVE statistics, ANGIOGRAPHY, DATA analysis, ODDS ratio
Abstract

Background Clot density (Hounsfield units, HU) and perviousness (post- contrast increase in the HU of clot) are thought to be associated with clot composition. We evaluate whether these imaging characteristics were associated with angiographic outcomes of aspiration and stent retriever thrombectomy in COMPASS: a trial of aspiration thrombectomy versus stent retriever thrombectomy as first- line approach for large vessel occlusion. Methods Clot density and perviousness were measured by two independent operators who were blind to all the final angiographic and clinical outcomes. The association of clot density and perviousness with the Thrombolysis In Cerebral Infarction (TICI) scale after first pass was assessed using univariate and multivariate analysis. Results Among all patients enrolled in COMPASS, 165 were eligible for the post- hoc analysis (81 patients in the aspiration first and 84 in the stent retriever first groups). Overall mean perviousness of clot was significantly higher in patient with mTICI 2b-3 after first pass (28.6±22.9 vs 20.3±19.2, p=0.017). Mean perviousness among patients who achieved TICI 2c/3 versus TICI 2b versus TICI 0- 2a in the aspiration first group varied significantly (32.6±26.1, 35.3±24.4, and 17.7±13.1, p=0.013). The association of perviousness with first pass success was not significant in the stent retriever group. Using multivariate analysis, high perviousness (defined as cut- off >27.6) was an independent predictor of TICI 2b-3 (OR 3.82, 95% CI 1.10 to 13.19; p=0.034). Conclusions Clot perviousness is associated with first pass angiographic success in patients treated with the aspiration first approach for thrombectomy. [ABSTRACT FROM AUTHOR]

Published
2021
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235. Woven EndoBridge (WEB) device in the treatment of ruptured aneurysms.

Author

Youssef, Patrick P., Dornbos III, David, Peterson, Jeremy, Sweid, Ahmad, Zakeri, Amanda, Nimjee, Shahid M., Jabbour, Pascal, and Arthur, Adam S.

Subjects
INTRACRANIAL aneurysm surgery, CEREBRAL embolism & thrombosis, CLINICAL trials, RESEARCH methodology, THERAPEUTIC embolization, RETROSPECTIVE studies, MANN Whitney U Test, SUBARACHNOID hemorrhage, CEREBRAL arteries, T-test (Statistics), CHI-squared test, ANGIOGRAPHY
Published
2021
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236. Lower complication rates associated with transradial versus transfemoral flow diverting stent placement.

Author

Yangchun Li, Chen, Stephanie H., Spiotta, Alejandro M., Jabbour, Pascal, Levitt, Michael R., Kan, Peter, Griessenauer, Christoph J., Arthur, Adam S., Osbun, Joshua W., Min S. Park, Chalouhi, Nohra, Sweid, Ahmad, Wolfe, Stacey Q., Fargen, Kyle M., Dumont, Aaron S., Dumont, Travis M., Brunet, Marie-Christine, Sur, Samir, Luther, Evan, and Strickland, Allison

Subjects
INTRACRANIAL aneurysm surgery, ENDOVASCULAR surgery, COMPARATIVE studies, CONFIDENCE intervals, FEMORAL artery, MEDICAL cooperation, MEDICAL records, PATIENT safety, RESEARCH, SURGICAL stents, SURGICAL complications, TREATMENT effectiveness, RETROSPECTIVE studies, RADIAL artery, DESCRIPTIVE statistics, ACQUISITION of data methodology
Abstract

Background Currently, 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. Methods We 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. Results A 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). Conclusion TRA 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. [ABSTRACT FROM AUTHOR]

Published
2021
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237. Blood pressure reduction and outcome after endovascular therapy with successful reperfusion: a multicenter study.

Author

Anadani, Mohammad, Arthur, Adam S., Alawieh, Ali, Orabi, Yser, Alexandrov, Andrei, Goyal, Nitin, Psychogios, Marios- Nikos, Maier, Ilko, Joon- Tae Kim, Keyrouz, Saleh G., De Havenon, Adam, Petersen, Nils H., Pandhi, Abhi, Swisher, Christa B., Inamullah, Ovais, Liman, Jan, Kodali, Sreeja, Giles, James A., Allen, Michelle, and Wolfe, Stacey Q.

Subjects
ENDOVASCULAR surgery, CONFIDENCE intervals, HYPERTENSION, LIFE skills, MEDICAL cooperation, PATIENT safety, REPERFUSION, RESEARCH, THROMBOSIS, VEIN surgery, TREATMENT effectiveness, RETROSPECTIVE studies, DESCRIPTIVE statistics
Abstract

Background elevated systolic blood pressure (sBP) after mechanical thrombectomy (MT) correlates with worse outcome. however, the association between sBP reduction (sBPr) and outcome after successful reperfusion with MT is not well established. Objective To investigate the association between sBPr in the first 24 hours after successful reperfusion and the functional and safety outcomes of MT. Methods a multicenter retrospective study, which included 10 comprehensive stroke centers, was carried out. Patients with acute ischemic stroke and anterior circulation large vessel occlusions who achieved successful reperfusion via MT were included. SBPr was calculated using the formula 100x([admission SBP-mean sBP]/admission SBP). Poor outcome was defined as a modified rankin scale (mrs) score of 3-6 at 90 days. safety endpoints included symptomatic intracerebral hemorrhage, mortality, and requirement for hemicraniectomy during admission. a generalized mixed linear model was used to study the association between sBPr and outcomes. results a total of 1361 patients were included in the final analysis. sBPr as a continuous variable was inversely associated with poor outcome (Or=0.97; 95% ci 0.95 to 0.98; p<0.001) but not with the safety outcomes. subanalysis based on reperfusion status showed that sBPr was associated with lower odds of poor outcome only in patients with complete reperfusion (modified Thrombolysis in cerebral infarction (mTici 3)) but not in patients with incomplete reperfusion (mTici 2b). When sBPr was divided into categories (<1%, 1%-10%, 11%-20%, >20%), the rate of poor outcome was highest in the first group. Conclusion SBPr in the first 24 hours after successful reperfusion was inversely associated with poor outcome. no association between sBPr and safety outcome was found. [ABSTRACT FROM AUTHOR]

Published
2020
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238. Letter: Considerations for Performing Emergent Neurointerventional Procedures in a COVID-19 Environment.

Author

Pandey, Aditya S, Ringer, Andrew J, Rai, Ansaar, Kan, Peter T, Jabbour, Pascal M, Siddiqui, Adnan, Levy, Elad, Snyder, Kenneth V, Riina, Howard A, Tanweer, Omar, Levitt, Michael R, Kim, Louis J, Veznedaroglu, Erol, Binning, Mandy, Arthur, Adam S, Mocco, J, Schirmer, Clemens M, Thompson, B Gregory, Langer, David, and (ENRG), the Endovascular Neurosurgery Research Group

Published
2020
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239. Real- world effects of late window neurothrombectomy: procedure rates increase without night- time bias.

Author

Williams, Michelle Marie, Mazwi, Thabele Leslie, Hirsch, Joshua A., Kittel, Carol, Spiotta, Alejandro, De Leacy, Rea, Mocco, J., Albuquerque, Felipe C., Ducruet, Andrew F., Goyal, Nitin, Arthur, Adam S., Kan, Peter, Mokin, Maxim, Dumont, Travis M., Reeves, Alan, Wolfe, Stacey Q., and Fargen, Kyle

Subjects
DIAGNOSTIC errors, LONGITUDINAL method, MEDICAL cooperation, MEDICAL referrals, NEUROSURGERY, NEUROLOGISTS, PATIENTS, RESEARCH, SURGERY, THROMBOSIS, TIME, VEIN surgery, TREATMENT duration
Abstract

Introduction With the expansion of the interventional time window for stroke from emergent large vessel occlusion (ELVO), the rate of mechanical thrombectomy (MT) is expected to rise, potentially causing higher burnout rates and requiring hospitals to develop strategies for adequate coverage of these procedures. Methods Neurointerventional physicians at 10 participating stroke centers prospectively recorded time requirements for all MT consultations over 30 consecutive 24- hour call periods, including both false positive consultations and MT procedures, during mid to late 2018. Consult start time, procedure start and end time, and data regarding commute to the hospital and delay in scheduled procedures were collected and compared with those from an identical prospective study performed in 2017. Results Data were collected from a total of 300 days of call. a total of 166 procedures were performed (mean 0.55 per day), an increase from 0.32 per day in 2017. Overall mean MT direct time burden during each 24- hour call was 124 min (compared with 85 min in 2017). The percentage of consultations for thrombectomy varied based on time of day, with 87% of consults between the hours of midnight and 04:00 proceeding to thrombectomy compared with 37% between the hours of 16:00 and 20:00. Conclusions MT procedural volumes have increased from one every 5 days in 2016 to one every 2 days in 2018. The highest percentage of consults leading to thrombectomy occur in the early morning hours after midnight. compared with similar data from 2016 and 2017, call demands continue to escalate, representing a significant demand on neurointerventional teams. [ABSTRACT FROM AUTHOR]

Published
2020
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240. Intravenous thrombolysis pretreatment and other predictors of infarct in a new previously unaffected territory (INT) in ELVO strokes treated with mechanical thrombectomy.

Author

Goyal, Nitin, Tsivgoulis, Georgios, Chang, Jason J., Malhotra, Konark, Goyanes, Juan, Pandhi, Abhi, Krishnan, Rashi, Ishfaq, Muhammad F., Hoit, Daniel, Nickele, Christopher, Inoa-Acosta, Violiza, Katsanos, Aristeidis H., Elijovich, Lucas, Alexandrov, Andrei, and Arthur, Adam S.

Subjects
STROKE treatment, CONFIDENCE intervals, INFARCTION, INTRAVENOUS therapy, RISK assessment, THROMBOLYTIC therapy, THROMBOSIS, VEIN surgery, LOGISTIC regression analysis, DISEASE incidence, DESCRIPTIVE statistics, ODDS ratio, DISEASE risk factors
Abstract

Introduction One uncommon complication of mechanical thrombectomy (MT) is an infarct in a new previously unaffected territory (infarct in new territory (INT)). Objective To evaluate the predictors of INT with special focus on intravenous thrombolysis(IVT) pretreatmentbefore MT. Methods Consecutive patients with emergent large vessel occlusion (ELVO) treated with MT during a 5-year period were evaluated. INT was defined using standardized methodology proposed by ESCAPE investigators. The predictors of INT and its impact on outcomes were investigated. results A total of 419 consecutive patients with ELVO received MT (mean age 64±15 years, 50% men, median baseline National Institutes of Health Stroke Scale score 16 points (IQR 11-20), 69% pretreated with IVT). The incidence of INT was lower in patients treated with combination therapy (IVTandMT) than in patients treated with MT alone, respectively (10% vs 20%; p=0.011). The INT group had more patients with posterior circulation occlusions than the group without INT (28% vs 10%, respectively; p<0.001). The rates of 3-month functional independence were lower in patients with INT (30% vs 50%; p=0.007). IVT pretreatment was not independently related to INT (OR=0.75; 95% CI 0.32 to 1.76), and INT did not emerge as an independent predictor of 3-month functional independence (OR=0.69; 95% CI 0.29 to 1.62) on multivariable logistic regression models. Location of posterior circulation occlusion was independently associated with a higher odds of INT (OR=3.33; 95% CI 1.43 to 7.69; p=0.005). Conclusions IVT pretreatment is not independently associated with a lower likelihood of INT in patients with ELVO treated with MT. Patients with ELVO with posterior circulation occlusion are more likely to have INT after MT. [ABSTRACT FROM AUTHOR]

Published
2020
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241. An international multicenter retrospective study to survey the landscape of thrombectomy in the treatment of anterior circulation acute ischemic stroke: outcomes with respect to age.

Author

Martini, Michael, Mocco, J., Turk, Aquilla, Siddiqui, Adnan H., Fiorella, David, Hanel, Ricardo, Woodward, Keith, Rai, Ansaar, Frei, Don, Delgado Almandoz, Josser E., Kelly, Michael E., Peeling, Lissa, Arthur, Adam S., Baxter, Blaise, English, Joey, Linfante, Italo, and De Leacy, Reade

Subjects
AGE distribution, MEDICAL cooperation, RESEARCH, STROKE, THROMBOSIS, VEIN surgery, LOGISTIC regression analysis, TREATMENT effectiveness, RETROSPECTIVE studies, ACUTE diseases, REVASCULARIZATION (Surgery), DESCRIPTIVE statistics
Abstract

Background Thrombectomy is an efficacious treatment for acute ischemic stroke (AIS). However, relatively few studies to date have specifically examined the impact and clinical implications of age on outcomes for thrombectomy in anterior AIS. Objective To provide a snapshot of patient metrics and outcomes with respect to age following thrombectomy for anterior AIS to supplement the current body of data for predictors of clinical outcomes in a real-world setting. Methods Data were collected for 20 consecutive patients with AIS treated with thrombectomy at 15 highvolume stroke centers across North America between 2015 and 2016. Patients with anterior occlusions were dichotomized based on whether they were older or younger than 80 years. Ordinal logistic regression analyzed how clinical variables impacted disability using 90-day modified Rankin Scale (mRS) scores. results Adequate revascularization (TICI ≥2B) was achieved in 92.3% of patients aged <80 years with an average 1.7±0.1 passes taken with the primary technique and in 88.0% of patients aged ≥80 years with an average 1.7±0.2 passes. Despite similar baseline characteristics, mRS scores were significantly higher in older patients postoperatively and at 90 days after intervention. Age was a significant predictor of 90-day mRS across the study population. Conclusion This analysis affirms age is a significant determinant of 90-day mRS scores following thrombectomy for large vessel anterior AIS. Further investigation into risks faced by elderly patients during thrombectomy may provide actionable information to help refine patient selection and improve outcomes. [ABSTRACT FROM AUTHOR]

Published
2020
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243. Stroke patients can’t ask for a second opinion: a multi-specialty response to The Joint Commission’s recent suspension of individual stroke surgeon training and volume standards

Author

Arthur, Adam S, primary, Mocco, J, additional, Linfante, Italo, additional, Fiorella, David, additional, Hussain, M Shazam, additional, Jovin, Tudor G, additional, Nogueira, Raul, additional, Schirmer, Clemens, additional, Barr, John D, additional, Meyers, Phillip M, additional, De Leacy, Reade, additional, and Albuquerque, Felipe C, additional

Published
2018
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246. Multicenter Study of Pipeline Flex for Intracranial Aneurysms

Author

Brasiliense, Leonardo B C, primary, Aguilar-Salinas, Pedro, additional, Lopes, Demetrius K, additional, Nogueira, Danilo, additional, DeSousa, Keith, additional, Nelson, Peter K, additional, Moran, Christopher J, additional, Mazur, Marcus D, additional, Taussky, Philipp, additional, Park, Min S, additional, Dabus, Guilherme, additional, Linfante, Italo, additional, Chaudry, Imran, additional, Turner, Ray D, additional, Spiotta, Alex M, additional, Turk, Aquilla S, additional, Siddiqui, Adnan H, additional, Levy, Elad I, additional, Hopkins, L Nelson, additional, Arthur, Adam S, additional, Nickele, Christopher, additional, Gonsales, Douglas, additional, Sauvageau, Eric, additional, and Hanel, Ricardo A, additional

Published
2018
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247. Hemicraniectomy for Malignant Middle Cerebral Artery Syndrome: A Review of Functional Outcomes in Two High-Volume Stroke Centers

Author

Pandhi, Abhi, primary, Tsivgoulis, Georgios, additional, Goyal, Nitin, additional, Ishfaq, Muhammad F., additional, Male, Shailesh, additional, Boviatsis, Efstathios, additional, Chang, Jason J., additional, Zand, Ramin, additional, Voumvourakis, Konstantinos, additional, Elijovich, Lucas, additional, Alexandrov, Anne W., additional, Malkoff, Marc D., additional, Hoit, Daniel, additional, Arthur, Adam S., additional, and Alexandrov, Andrei V., additional

Published
2018
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248. Comparative Safety and Efficacy of Modified TICI 2b and TICI 3 Reperfusion in Acute Ischemic Strokes Treated With Mechanical Thrombectomy

Author

Goyal, Nitin, primary, Tsivgoulis, Georgios, additional, Frei, Donald, additional, Turk, Aquilla, additional, Baxter, Blaise, additional, Froehler, Michael T, additional, Mocco, J, additional, Ishfaq, Muhammad Fawad, additional, Malhotra, Konark, additional, Chang, Jason J, additional, Hoit, Daniel, additional, Elijovich, Lucas, additional, Loy, David, additional, Turner, Raymond D, additional, Mascitelli, Justin, additional, Espaillat, Kiersten, additional, Alexandrov, Andrei V, additional, and Arthur, Adam S, additional

Published
2018
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