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1. Abstract Number ‐ 35: Maximum Euclidean Deflection‐A Novel Metric For Safety Of Neurovascular Devices

Author

Shashvat M Desai, Joshua Catapano, Neil Majmundar, Andrew Ducruet, and Ashutosh P Jadhav

Subjects
Neurology. Diseases of the nervous system, RC346-429, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Introduction Endovascular thrombectomy (EVT) devices are evolving rapidly to improve safety and efficacy of EVT‐mediated recanalization of large vessel occlusion strokes, and to access medium and distal vessel occlusions. To enable effective comparative analyses, there is a need to develop an objective in‐vitro safety metric for new EVT devices. Methods We utilized three FDA‐approved stent‐retrievers (4 mm diameter; variable lengths) currently available in the United States and deployed them in an in‐vitro ischemic stroke bench model (Sim Agility, Mentice Inc., Sweden). The stent‐retrievers were deployed in the M1 segment of the middle cerebral artery of the model using a system comprised of an 0.014 inch guide wire and 0.021 inch microcatheter. After unsheathing in the M1 segment, in the absence of a blood clot, the microcatheter was withdrawn back into the petrous internal carotid artery, and the whole system was withdrawn as a rate of 5 mm per second. Maximum deflection of the terminal internal carotid was measured in 3 axes using a specialized camera set‐up. Results A total of 3 passes were performed for each stent‐retriever (stent A, stent B, and stent C). Maximum deflection of the terminal internal carotid artery (from resting position to largest displacement during stent‐retrieval withdrawal) was measured in 3 planes and the values were as follows (Table).Maximum Euclidean Deflection (MED) ranged from 6.1 to 9.1 mm. Deflection varied based on 3 stent‐retriever designs and the plane of measurement. Figure demonstrates deflections as seen in Stent A. Conclusions Withdrawing an unsheathed stent‐retriever from the middle cerebral artery leads to significant deflection of the internal carotid artery terminus in an in‐vitro stroke model. The degree of deflection is variable in different planes and varies based on stent‐retriever design. Further studies are required to examine the predictors and impact of the deflection.

Published
2023
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5. Correlation Analysis between NETosis Biomarkers and Peripheral Immune Cells in a Preclinical Model of Ischemic Stroke

Author

Junxiang Yin, Michael Wu, Tasha Mohseni, Adam Kindelin, Saif Ahmad, Andrew Ducruet, Abdullah Ahmad, and Michael Waters

Abstract

Neutrophil extracellular traps formation (NETosis) facilitates thrombosis and contributes to reperfusion resistance - a major challenge encountered during the treatment of acute ischemic stroke. The effect of acute stroke on plasma NETosis biomarkers remains unclear. In this study, young adult C57BL/6 wildtype (WT) mice were subjected to acute brain ischemia-reperfusion (IR) injury. The IR-subjected mice exhibited a drastic increase in plasma citrullinated histone 3 (CitH3) and neutrophil elastase (NE) on day 1 (p

Published
2021
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6. Pivotal Trial of the Neuroform Atlas Stent for Treatment of Anterior Circulation Aneurysms: One-Year Outcomes

Author

Osama O. Zaidat, Ricardo A. Hanel, Eric A. Sauvageau, Amin Aghaebrahim, Eugene Lin, Ashutosh P. Jadhav, Tudor G. Jovin, Ahmad Khaldi, Rishi G. Gupta, Andrew Johnson, Donald Frei, David Loy, Adel Malek, Gabor Toth, Adnan Siddiqui, John Reavey-Cantwell, Ajith Thomas, Steven W. Hetts, Brian T. Jankowitz, Bradley Gross, Andrew Ducruet, David Panczkowski, Hazem Shoirah, Alhamza Al-Bayati, Greg Weiner, Cynthia Kenmuir, Prasanna Tadi, Gregory Walker, K. Johnson, Don Frei, Richard Bellon, Benjamin Atchie, Ian Kaminsky, Dan Huddle, Mark Bain, Peter Rasmussen, M. Shazam Hussain, Nina Moore, Thomas Masaryk, Mohamed Elgabaly, Russell Cerejo, Julian Hardman, Seby John, Andrew Bauer, Jenny Peih-Chir Tsai, Elad Levy, Kenneth Snyder, Jason Davies, Christopher Ogilvy, Dennis Rivet, Michael Alexander, Franklin Moser, Marcel Maya, Michael Schiraldi, Paula Eboli, Justin Caplan, Bowen Jiang, Matthew Bender, Geoffrey Colby, Sudhakar Satti, Thinesh Sivapatham, David Kung, Bryan Pukenas, Robert Hurst, Michelle J. Smith, Ajit Puri, Francesco Massari, David Rex, Justin Fraser, Stephen Grupke, Abdulnasser Alhajeri, Richard Klucznik, Orlando Diaz, Gavin Britz, Yi Zhan, Alejandro Spiotta, Jonathan Lena, Aquilla Turk, Mohamad Chaudry, Kyle Fargen, Raymond Turner, Peter Kan, Edward Duckworth, Muhammad Asif Taqi, Samuel Hou, Adam S. Arthur, Lucas Elijovich, Daniel Hoit, Christopher Nickele, Jay Vachhani, Vinodh Thomas Doss, Richard Crowley, Demetrius Lopes, Michael Chen, Danial Hallam, Basavaraj Ghodke, Louis Kim, Richard Callison, Amer Alshekhlee, Sushant Kale, Michael Froehler, Matt Fusco, and Rohan Chitale

Subjects
Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Original Contributions, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, Clinical and Population Sciences, 0302 clinical medicine, Atlas (anatomy), medicine.artery, medicine, Humans, angiography, Coil embolization, Aged, Advanced and Specialized Nursing, middle cerebral artery, medicine.diagnostic_test, business.industry, Endovascular Procedures, Stent, Intracranial Aneurysm, Middle Aged, Embolization, Therapeutic, medicine.anatomical_structure, Treatment Outcome, Angiography, Middle cerebral artery, ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, Female, Stents, stent, Neurology (clinical), Radiology, Cardiology and Cardiovascular Medicine, business, retreatment, 030217 neurology & neurosurgery
Abstract

Supplemental Digital Content is available in the text., Background and Purpose: Stent-assisted coil embolization using the new generation Neuroform Atlas Stent System has shown promising safety and efficacy. The primary study results of the anterior circulation aneurysm cohort of the treatment of wide-neck, saccular, intracranial, aneurysms with the Neuroform Atlas Stent System (ATLAS trial [Safety and Effectiveness of the Treatment of Wide Neck, Saccular Intracranial Aneurysms With the Neuroform Atlas Stent System]) are presented. Methods: ATLAS IDE trial (Investigational Device Exemption) is a prospective, multicenter, single-arm, open-label study of wide-neck (neck ≥4 mm or dome-to-neck ratio 50%) at the target location. The primary safety end point was any major stroke or ipsilateral stroke or neurological death within 12 months. Adjudication of the primary end points was performed by an independent Imaging Core Laboratory and the Clinical Events Committee. Results: A total of 182 patients with wide-neck anterior circulation aneurysms at 25 US centers were enrolled. The mean age was 60.3±11.4 years, 73.1% (133/182) women, and 80.8% (147/182) white. Mean aneurysm size was 6.1±2.2 mm, mean neck width was 4.1±1.2 mm, and mean dome-to-neck ratio was 1.2±0.3. The most frequent aneurysm locations were the anterior communicating artery (64/182, 35.2%), internal carotid artery ophthalmic artery segment (29/182, 15.9%), and middle cerebral artery bifurcation (27/182, 14.8%). Stents were placed in the anticipated anatomic location in all patients. The study met both primary safety and efficacy end points. The composite primary efficacy end point of complete aneurysm occlusion (Raymond-Roy 1) without parent artery stenosis or aneurysm retreatment was achieved in 84.7% (95% CI, 78.6%–90.9%) of patients. Overall, 4.4% (8/182, 95% CI, 1.9%–8.5%) of patients experienced a primary safety end point of major ipsilateral stroke or neurological death. Conclusions: In the ATLAS IDE anterior circulation aneurysm cohort premarket approval study, the Neuroform Atlas stent with adjunctive coiling met the primary end points and demonstrated high rates of long-term complete aneurysm occlusion at 12 months, with 100% technical success and

Published
2020

7. Abstract WP32: Introducing STAR: A Multicenter International Collaborative Registry of Real-World Outcomes After Mechanical Thrombectomy for Ischemic Stroke

Author

Ali M Alawieh, Shakeel Chowdhry, Italo Linfante, Jonathan Grossberg, Benjamin Gory, Amir Shaban, Roberto Crosa, Shreyansh Shah, Richard Crowley, Jared Knopman, Christopher Fox, Michael Levitt, Andrew Ducruet, Min Park, Christopher S Ogilvy, Pascal Jabbour, Adam Arthur, Joon-Tae Kim, Reade De Leacy, Marios Psychogios, Ilko Maier, Ansaar Rai, Salah Keyrouz, Kyle Fargen, Travis Dumont, Peter Kan, Robert M Starke, and Alejandro Spiotta

Subjects
Advanced and Specialized Nursing, medicine.medical_specialty, Standard of care, business.industry, Real world outcomes, medicine.disease, Endovascular therapy, 030218 nuclear medicine & medical imaging, 3. Good health, Mechanical thrombectomy, 03 medical and health sciences, 0302 clinical medicine, Emergency medicine, Ischemic stroke, Medicine, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, Stroke, 030217 neurology & neurosurgery, Acute stroke
Abstract

Introduction: Mechanical thrombectomy (MT) for acute stroke is the current standard of care treatment. Level 1 evidence for efficacy of thrombectomy has been established in multiple randomized controlled trials on selective patient populations; however, the high effect size of MT had led multiple centers in the US and globally to expand their patient selection to include populations that were not studied in major trials. To provide ongoing data on MT outcomes in different patient populations from the real-world, we have initiated an international multicenter initiative, STAR (Stroke Thrombectomy and Aneurysm Registry). Methods: STAR is a multicenter and international platform to curate patient outcome data after MT for acute ischemic stroke at comprehensive stroke centers. STAR includes all patients who underwent MT for acute ischemic stroke irrespective of age, time from onset, ASPECT score, and NIHSS. Patients were curated from 01/2015 to date and is prospectively maintained. Patient charts are reviewed for demographics, baseline functioning, and admission deficits. Procedure notes are reviewed for technical variables and technical outcomes. Clinical outcomes were collected at 90-day follow-up by stroke neurologist. Results: A total of 24 centers globally have enrolled in STAR. By December 2018, the total number of enrolled and verified patients in STAR was 3,850 (mean age 69±14, 51% females). Anterior circulation strokes were treated in 89% of cases, average NIHSS on admission was 15.5±7, and 73% had pre-stroke mRS below 2. Around 51% of patients received IV-tPA. Mechanical thrombectomy was performed using aspiration (45%), stent retriever (28%), primary combined approach (24%) or intracranial stenting (3%). Successful recanalization was achieved in 84% of cases, the rate of favorable outcome (mRS 0-2) was 41%, and mortality was 25%. Complication rate was 6% and rate of symptomatic post-procedural hemorrhage was 6%. Conclusions: STAR represent a large real-world international registry for outcomes after MT, and constitutes a statistically robust platform to study real-world practice outcome in patient sub-populations that are under-represented in randomized trials. Link: https://medicine.musc.edu/departments/neurosurgery/star

Published
2020
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8. Basilar stroke from a persistent hypoglossal artery

Author

Alfred P See, Jacob F Baranoski, Bruno C Flores, Andrew Ducruet, and Felipe C Albuquerque

Subjects
Computed Tomography Angiography, Endovascular Procedures, General Medicine, 030204 cardiovascular system & hematology, Article, Cerebral Angiography, Stroke, 03 medical and health sciences, 0302 clinical medicine, Carotid Arteries, Imaging, Three-Dimensional, Thalamus, Basilar Artery, Vertebrobasilar Insufficiency, Humans, Female, Tomography, X-Ray Computed, 030217 neurology & neurosurgery, Aged, Thrombectomy
Abstract

Occlusion of the basilar artery can be treated with endovascular thrombectomy, although the results have not been well studied. Persistent fetal cerebrovascular anatomy can lead to unusual presentation of carotid atherosclerotic disease and can be a barrier to successful mechanical thrombectomy if not recognized. This case presents a rare persistent carotico-basilar anastomosis which resulted in basilar occlusion via the persistent hypoglossal artery and coincident absence of contralateral vertebral arterial access due to a left vertebral artery terminating in the left posterior inferior cerebellar artery. Preoperative recognition of this anatomy afforded by review of cross-sectional imaging was critical to success during this emergent procedure.

Published
2017

9. Basilar stroke from a persistent hypoglossal artery

Author

Alfred P, See, Jacob F, Baranoski, Bruno C, Flores, Andrew, Ducruet, and Felipe C, Albuquerque

Subjects
Carotid Artery Diseases, Stroke, Cerebral Revascularization, Basilar Artery, Humans, Female, Vertebral Artery, Aged, Follow-Up Studies, Thrombectomy
Abstract

Occlusion of the basilar artery can be treated with endovascular thrombectomy, although the results have not been well studied. Persistent fetal cerebrovascular anatomy can lead to unusual presentation of carotid atherosclerotic disease and can be a barrier to successful mechanical thrombectomy if not recognized. This case presents a rare persistent carotico-basilar anastomosis which resulted in basilar occlusion via the persistent hypoglossal artery and coincident absence of contralateral vertebral arterial access due to a left vertebral artery terminating in the left posterior inferior cerebellar artery. Preoperative recognition of this anatomy afforded by review of cross-sectional imaging was critical to success during this emergent procedure.

Published
2017

10. Abstract W P223: Systems wide Streamlining of Door to Recanalization Processes in Endovascular Stroke Therapy

Author

Amin Aghaebrahim, Ashutosh Jadhav, Cynthia Kenmuir, Dan-Victor Giurgiutiu, Anat Horev, Yumna Saeed, Clifton Callaway, Frank Guyette, Andrew Ducruet, Brain Jankowitz, Charissa Pacella, and Tudor Jovin

Subjects
Advanced and Specialized Nursing, Neurology (clinical), Cardiology and Cardiovascular Medicine
Abstract

Objective: Faster reperfusion leads to better outcome both in thrombolytic therapy and endovascular therapy in acute stroke. We analyzed the effect of interventions aimed to reduce treatment delays in our single-center prospective series. Methods: All consecutive ischemic stroke patients treated with endovascular therapy were prospectively registered from 4/20/12 to 7/29/14. We divided the patients into pre-intervention (4/20/12-10/8/13) and post-intervention (10/9/13-7/29/14) period. The main interventions included: awareness, continuous feedback and regular education of staff involved, EMS pre notification, protocolized immediate direct ED attending to stroke attending communication, direct IR activation by stroke team including for possible rather than certain intervention, direct patient transportation by EMS to CT scanner, direct transportation of patient from CT scanner to angiosuite, direct transport from outside hospital to angiosuite. Results: See table. There was no significant difference between the demographics, location of the occlusion, rate of IV tpa, or revascularization rate between the groups with the exception of better ASPECT in pre-intervention group (P=0.034). Compared to pre-intervetion, time delays were improved at virtually every step. Median door-to-puncture (D2P) improved from 105 minutes to 67 minutes post-intervention which was significant (p=0.006). Despite time to perfusion improvement, there was no significant difference in rate of 3 month good outcome which is most likely due to small sample size. Conclusions: This pilot study demonstrates that D2P times can be dramatically lowered with a few simple measures. Larger prospective studies will be necessary to determine whether these interventions will translate into improved clinical outcomes.

Published
2015
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11. Abstract W MP4: Stentriever Mediated Manual Aspiration Thrombectomy (SMAT) for Acute Ischemic Stroke in 93 Consecutive Patients

Author

Ashutosh P Jadhav, Nima Aghaebrahim, Anat Horev, Dan Victor Giurgiutiu, Andrew Ducruet, Brian Jankowitz, and Tudor Jovin

Subjects
Advanced and Specialized Nursing, Neurology (clinical), Cardiology and Cardiovascular Medicine
Abstract

Background and Purpose: Both stentriever technology and manual aspiration thrombectomy have been demonstrated to independently lead to high rates of recanalization in acute ischemic strokes presenting with large vessel occlusions. We sought to describe the safety and efficacy of a multimodal approach combining the two techniques. Methods: Retrospective review of a prospectively acquired acute endovascular stroke database. Results: 93 consecutive patients were identified presenting between July 2013 and July 2014. Median age: 67. Median NIHSS: 17. Patients had the following baseline features: 48% female gender, 72% hypertension, 12% diabetes, 39% atrial fibrillation, 29% CAD. Occlusion distribution included 71% M1, 13% M2, 13% ICAT, 16% VB. On presentation, 28% received IV tpa and 34% presented beyond 8 hours. High quality recanalization (TICI2b/3) was achieved in 88% of patients. Recanalization required an average of 2.36 passes. The Solitaire stentriever was used in 81% of cases and the Trevo device was used in the remainder of cases. The aspiration catheter employed was the 072/058 Navien in 74% of cases, 043 DAC in 4% of cases and 5Max ACE in 27% of cases. Median door to groin puncture time was 69 minutes and median groin puncture to recanalization time was 47 minutes. Symptomatic hemorrhage occurred in 5% of patients. Good outcomes were noted in 42% of patients. In anterior circulation stroke patients who received IV tpa prior to IA therapy, good outcomes were noted in 50% of patients. Conclusions: SMAT is a safe and efficacious method of achieving rapid revascularization in acute stroke patients. Future prospective comparisons of MAT, stentreiver alone and SMAT are necessary to establish the most clinical effective therapy for acute thrombectomy.

Published
2015
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12. Contributors

Author

Bizhan Aarabi, Rick Abbott, Saleem I. Abdulrauf, Frank L. Acosta, John R. Adler, Nzhde Agazaryan, Manish Aghi, Edward S. Ahn, Ali Alaraj, Gregory W. Albert, Leland Albright, Felipe C. Albuquerque, Tord D. Alden, Michael J. Alexander, Andrei V. Alexandrov, Ossama Al-Mefty, Ron L. Alterman, Lázaro Álvarez, Nduka M. Amankulor, Peter S. Amenta, Christopher P. Ames, Sepideh Amin-Hanjani, Mario Ammirati, Carryn Anderson, Richard C.E. Anderson, William S. Anderson, Peter D. Angevine, Hiba Arif, Jeffrey E. Arle, Rocco Armonda, Paul M. Arnold, Kaveh Asadi-Moghaddam, Ferhan A. Asghar, William W. Ashley, Sabri Aydin, Nafi Aygun, Joachim M. Baehring, Jacob H. Bagley, Diaa Bahgat, Julian E. Bailes, Jonathon R. Ball, Gordon H. Baltuch, Nicholas C. Bambakidis, Scott C. Baraban, Igor J. Barani, Nicholas M. Barbaro, Frederick G. Barker, Gene H. Barnett, Stanley L. Barnwell, Constance M. Barone, Daniel L. Barrow, Fabrice Bartolomei, Juan Bartolomei, Tracy T. Batchelor, H. Hunt Batjer, Andrew M. Bauer, Joel A. Bauman, Thomas K. Baumann, James E. Baumgartner, John Bayouth, Andrew Beaumont, Joshua B. Bederson, Rudolf Beisse, Randy S. Bell, Allan Belzberg, Alim Louis Benabid, Eduardo E. Benarroch, Abdelhamid Benazzouz, Bernard R. Bendok, Edward C. Benzel, Alejandro Berenstein, Mitchel S. Berger, Marvin Bergsneider, Helmut Bertalanffy, Tarun Bhalla, Dani S. Bidros, José Biller, Mark H. Bilsky, Devin K. Binder, William Bingaman, Rolfe Birch, Allen T. Bishop, Peter M. Black, Jeffrey P. Blount, Peter C. Blumbergs, Leif-Erik Bohman, Zackary E. Boomsaad, Frederick A. Boop, Pascal Bou-Haidar, Daniel R. Boué, Blaise F.D. Bourgeois, Robin M. Bowman, Oliver Bozinov, Helen M. Bramlett, Henry Brem, Steven Brem, Gavin W. Britz, Douglas L. Brockmeyer, David J. Brooks, Samuel R. Browd, Paul D. Brown, Robert D. Brown, Jeffrey N. Bruce, Janice E. Brunstrom-Hernandez, John Buatti, M. Ross Bullock, Kim J. Burchiel, Peter C. Burger, Marc R. Bussière, Mohamad Bydon, Richard W. Byrne, Maria Elisa Calcagnotto, Victoria A. Campbell, William Campbell, George M. Cannon, Louis P. Caragine, Benjamin S. Carson, Gregory D. Cascino, Ethan Cascio, Frédéric Castinetti, C. Michael Cawley, Justin S. Cetas, Stéphan Chabardès, Edward F. Chang, Eric C. Chang, Eric L. Chang, Steven D. Chang, Steven W. Chang, Susan M. Chang, Kevin Chao, Paul H. Chapman, Fady T. Charbel, Patrick Chauvel, Grace Chen, Boyle C. Cheng, Joseph S. Cheng, Joshua J. Chern, E. Antonio Chiocca, Ondrej Choutka, Shakeel A. Chowdhry, Cindy W. Christian, Kathy Chuang, Jan Claassen, Richard E. Clatterbuck, Elizabeth B. Claus, Daniel R. Cleary, Robert J. Coffey, Alan R. Cohen, Andrew J. Cole, E. Sander Connolly, Patrick J. Connolly, Anne G. Copay, Jeroen R. Coppens, James J. Corbett, Daniel M. Corcos, Domagoj Coric, Garth Rees Cosgrove, William T. Couldwell, Stirling Craig, Neil R. Crawford, Peter B. Crino, R. Webster Crowley, Bradford A. Curt, Marek Czosnyka, Zofia Czosnyka, Vladimir Y. Dadashev, Andrew T. Dailey, Deepa Danan, Shabbar F. Danish, Shervin R. Dashti, Carlos A. David, David J. David, Arthur L. Day, Antonio A.F. De Salles, Amir R. Dehdashti, Oscar H. Del Brutto, Johnny B. Delashaw, Bradley Delman, Mahlon R. DeLong, Franco DeMonte, Sanjay S. Dhall, Mark S. Dias, Curtis A. Dickman, W. Dalton Dietrich, Michael L. DiLuna, Francesco Di Meco, Peter Dirks, C. Edward Dixon, Jacob A. Donoghue, Ian G. Dorward, Amish H. Doshi, James Drake, Dan Drzymalski, Rose Du, Andrew Ducruet, Ann-Christine Duhaime, Aaron S. Dumont, Christopher D. Duntsch, Joshua R. Dusick, Suzan Dyve, James Eberwine, Paula Eboli, Robert D. Ecker, Richard J. Edwards, Marc E. Eichler, Doortje C. Engel, Nancy E. Epstein, Matthew G. Ewend, Hamad Farhat, Christopher J. Farrell, Michael G. Fehlings, Iman Feiz-Erfan, Neil A. Feldstein, Richard G. Fessler, Juan J. Figueroa, Aaron G. Filler, J. Max Findlay, Michael A. Finn, David J. Fiorella, James L. Fisher, Robert S. Fisher, Eugene S. Flamm, James D. Fleck, Kelly D. Flemming, John C. Flickinger, Laura Flores-Sarnat, Kenneth A. Follett, Kelly D. Foote, Daryl R. Fourney, Valerie Fraix, James L. Frazier, Itzhak Fried, Allan H. Friedman, William A. Friedman, Gerhard M. Friehs, Donald E. Fry, Gregory N. Fuller, Hector H. Garcia, Paul A. Gardner, Mark Garrett, Hugh Garton, Cormac G. Gavin, Alisa D. Gean, Thomas A. Gennarelli, Venelin Gerganov, Anand V. Germanwala, Massimo Gerosa, Elizabeth R. Gerstner, Peter C. Gerszten, Saadi Ghatan, Samer Ghostine, Steven Giannotta, Paul R. Gigante, Frank Gilliam, Holly Gilmer-Hill, Albert Gjedde, Roberta P. Glick, Ziya L. Gokaslan, Yakov Gologorsky, Kiarash Golshani, Nestor R. Gonzalez, James Tait Goodrich, Tessa Gordon, Alessandra A. Gorgulho, Liliana C. Goumnerova, M. Sean Grady, Jordan Grafman, Sylvie Grand, Gerald A. Grant, Gregory P. Graziano, Benjamin Greenberg, James Guest, Abhijit Guha, Murat Günel, Gaurav Gupta, Nalin Gupta, Jorge Guridi, Barton L. Guthrie, Georges F. Haddad, Michael M. Haglund, Regis W. Haid, Stephen J. Haines, Clement Hamani, Bronwyn E. Hamilton, D. Kojo Hamilton, Todd C. Hankinson, Leo T. Happel, Ihtsham Ul Haq, Raqeeb Haque, Robert E. Harbaugh, Ciara D. Harraher, Leo Harris, James S. Harrop, Wael Hassaneen, Cynthia Hawkins, Gregory W.J. Hawryluk, Neal G. Haynes, Robert F. Heary, Amy B. Heimberger, Mary M. Heinricher, Thomas M. Hemmen, Jaimie M. Henderson, Roberto C. Heros, Karl Herrup, Shawn L. Hervey-Jumper, Gregory G. Heuer, Lawrence J. Hirsch, Robert Hirschl, Brian L. Hoh, Daniel J. Hoh, Eric C. Holland, Paul E. Holtzheimer, L. Nelson Hopkins, Philip J. Horner, David A. Hovda, Matthew A. Howard, Patrick Hsieh, Yin C. Hu, Sherwin E. Hua, Jason H. Huang, Judy Huang, Samuel A. Hughes, Thierry A.G.M. Huisman, Matthew A. Hunt, R. John Hurlbert, Robert W. Hurst, Anita Huttner, Steven W. Hwang, Ioannis U. Isaias, Bermans J. Iskandar, Arun Jacob, Kurt A. Jaeckle, Jay Jagannathan, Regina I. Jakacki, George I. Jallo, John A. Jane, Ryan Janicki, Damir Janigro, N u Owase Jeelani, Kurt A. Jellinger, Arthur L. Jenkins, Sarah Jernigan, David F. Jimenez, Conrad E. Johanson, J. Patrick Johnson, Matthew D. Johnson, G. Alexander Jones, Rajni K. Jutla, Koijan Singh Kainth, Michael G. Kaiser, U. Kumar Kakarla, Iain H. Kalfas, Aleksandrs Uldis Kalnins, Hideyuki Kano, Yucel Kanpolat, Adam S. Kanter, Reza J. Karimi, Amin B. Kassam, Bruce A. Kaufman, Christian B. Kaufman, Hiroto Kawasaki, Brian C. Kelley, Christopher P. Kellner, Nicole C. Keong, John R.W. Kestle, Alexander A. Khalessi, Nadia Khan, Vini G. Khurana, Daniel H. Kim, Dong Gyu Kim, Dong H. Kim, Jong Hyun Kim, Louis J. Kim, Paul K. Kim, Thomas Aquinas Kim, Won Kim, James A.J. King, Ryan S. Kitagawa, Neil D. Kitchen, Paul Klimo, David G. Kline, Kazutaka Kobayashi, Patrick M. Kochanek, Douglas Kondziolka, Paul N. Kongkham, Tyler R. Koski, Thomas Kosztowski, Paul Krack, Joachim K. Krauss, Michael A. Kraut, Niklaus Krayenbühl, Thomas Kretschmer, Ajit Krishnaney, Charles Kuntz, Jeffrey V. Kuo, Brian K. Kwon, Nadia N. Issa Laack, Shivanand P. Lad, Alim M. Ladha, Amos K. Ladouceur, Arthur M. Lam, Frederick F. Lang, Giuseppe Lanzino, Sean D. Lavine, Edward R. Laws, Michael T. Lawton, Adrian W. Laxton, Tuong H. Le, Jean François LeBas, Brett D. Lebed, Richard L. Lebow, Amy Lee, Ian Lee, Seon-Kyu Lee, Emily Lehmann, James W. Leiphart, Gregory P. Lekovic, Frederick A. Lenz, Jeffrey R. Leonard, Peter D. LeRoux, Marc Lévêque, Allan D. Levi, Elad I. Levy, Linda M. Liau, Jason Liauw, Roger Lichtenbaum, Terry Lichtor, David D. Limbrick, Hester Lingsma, Michael J. Link, Mark E. Linskey, Brian Litt, Zachary N. Litvack, James K.C. Liu, Kenneth C. Liu, Jay S. Loeffler, Christopher M. Loftus, Russell R. Lonser, Angeliki Louvi, Andres M. Lozano, Daniel C. Lu, Rimas V. Lukas, L. Dade Lunsford, Neal Luther, Pedro Lylyk, Andrew I.R. Maas, R. Loch Macdonald, Andre Machado, Raul Macias, Robert J. Maciunas, Brian N. Maddux, Pierre Magistretti, Martijn J.A. Malessy, Neil R. Malhotra, Donald A. Malone, Adam N. Mamelak, Christopher E. Mandigo, Francesco T. Mangano, Allen H. Maniker, Geoffrey T. Manley, Daniel Marchac, Anthony Marmarou, Joseph C. Maroon, Lawrence F. Marshall, Neil A. Martin, Timothy J. Martin, Alexander M. Mason, Marlon S. Mathews, Helen S. Mayberg, James P. McAllister, J. Gordon McComb, Paul C. McCormick, Ian E. McCutcheon, Michael W. McDermott, Cameron G. McDougall, Matthew McGehee, Cameron C. McIntyre, Guy M. McKhann, M. Sean McKisic, David F. Meaney, Minesh P. Mehta, Vivek Mehta, William P. Melega, Arnold H. Menezes, Patrick Mertens, Fredric B. Meyer, Scott A. Meyer, Philip M. Meyers, Costas Michaelides, Karine Michaud, Rajiv Midha, Vincent J. Miele, Jonathan Miller, Matthew L. Miller, Neil R. Miller, John Mitrofanis, Kevin Y. Miyashiro, J. Mocco, Michael T. Modic, Parham Moftakhar, Avinash Mohan, Stephen J. Monteith, Jacques J. Morcos, Michael Morgan, David E. Morris, S. David Moss, J. Paul Muizelaar, Karim Mukhida, Praveen V. Mummaneni, Gregory J.A. Murad, Karin Muraszko, Antônio C.M. Mussi, Imad Najm, Peter Nakaji, Sandra Narayanan, David W. Newell, M. Kelly Nicholas, Yasunari Niimi, Shahid M. Nimjee, Ajay Niranjan, Richard B. North, Josef Novotny, Turo Nurmikko, Samuel E. Nutt, W. Jerry Oakes, José A. Obeso, Alfred T. Ogden, Lissa Ogieglo, Christopher S. Ogilvy, David O. Okonkwo, Michael S. Okun, Edward H. Oldfield, Alessandro Olivi, Stephen E. Olvey, David Omahen, Brent O'Neill, Rod J. Oskouian, Robert Owen, Koray Özduman, Ali Kemal Ozturk, M. Necmettin Pamir, Dachling Pang, Jamie Pardini, Andrew D. Parent, T.S. Park, Michael D. Partington, Aman B. Patel, Parag G. Patil, Nicola Pavese, Richard D. Penn, Noel I. Perin, John A. Persing, Erika A. Petersen, Anthony L. Petraglia, Brigitte Piallat, Joseph H. Piatt, John D. Pickard, Joseph M. Piepmeier, Webster H. Pilcher, José Pineda, Joseph D. Pinter, Mary L. Pisculli, Thomas Pittman, Ian F. 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Vaccaro, Koen van Besien, Jerrold L. Vitek, Kenneth P. Vives, Timothy W. Vogel, Michael A. Vogelbaum, Dennis G. Vollmer, Gretchen K. Von Allmen, Kajetan L. von Eckardstein, P. Ashley Wackym, Mark Wainwright, Ben Waldau, Marion L. Walker, M. Christopher Wallace, Brian Walsh, Huan Wang, Michael Y. Wang, Vincent Y. Wang, Ronald E. Warnick, Sharon Webb, Ralf Weigel, Robert J. Weil, Jon D. Weingart, Bryce Weir, Martin Weiss, Nirit Weiss, William C. Welch, John C. Wellons, Hung Tzu Wen, Christian Wess, G. Alexander West, Nicholas M. Wetjen, Robert G. Whitmore, Louis A. Whitworth, Thomas Wichmann, Joseph L. Wiemels, Eelco F.M. Wijdicks, Adam C. Wilberger, Jack Wilberger, David M. Wildrick, Jason Wilson, Christopher J. Winfree, H. Richard Winn, Christopher Wolfla, Eric T. Wong, Peter J. Wormald, Margaret Wrensch, Neill M. Wright, Zachary Wright, David Yam, Shinya Yamada, Yoshiya Yamada, Isaac Yang, Victor X.D. Yang, Tom Yao, Chun-Po Yen, H. Kwang Yeoh, Yasuhiro Yonekawa, Alice Yoo, David M. Yousem, Eric C. Yuen, Joseph M. Zabramski, Andrew C. Zacest, J. Christopher Zacko, Gabriel Zada, Ross Zafonte, Eric L. Zager, Hasan A. Zaidi, Hekmat Zarzour, Vasilios A. Zerris, Justin A. Zivin, John G. Zovickian, Alexander Y. Zubkov, and Marike Zwienenberg-Lee

Published
2011
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13. Pupillary Reactivity Upon Hospital Admission Predicts Long-term Outcome in Poor Grade Aneurysmal Subarachnoid Hemorrhage Patients.

Author

William Mack, Zachary Hickman, Andrew Ducruet, James Kalyvas, Matthew Garrett, Robert Starke, Ricardo Komotar, Sean Lavine, Phil Meyers, Stephan Mayer, and E. Connolly

Subjects
HEMORRHAGE, HOSPITALS, NEUROLOGY, THERAPEUTICS, PROGNOSIS
Abstract

Abstract Background  Historically, the prognosis for poor grade subarachnoid hemorrhage patients has been considered dismal. As a result, many hospitals have chosen conservative management over aggressive therapy. This guarded approach, however, is based on studies that do not take into account newer, more effective, management protocols and more recent long-term evidence that significant neurological recovery occurs in the months to years following discharge. More accurate and predictive methods are needed to decide when aggressive therapy is warranted. Methods  Two hundred and twenty-six grade aneurysmal subarachnoid hemorrhage (aSAH) patients of grades IV and V were admitted to Columbia University Medical Center and enrolled in our study. Demographics, clinical information (e.g. pupillary reactivity on admission), and treatment course (operative versus non-operative) were recorded. Rankin scores at 14 days, 3 months, and 1 year were also recorded. A favorable Rankin score was defined as 0–3. Unfavorable was defined as 4–6. Results  Among all poor grade patients who received operative therapy, pupillary reactivity at admission was not predictive of a favorable Rankin score at day 14 (odds ratio = 3.3, P = 0.129). Pupillary reactivity, however, was predictive of Rankin score at 3 months (odds ratio = 4.57, P = 0.05) and 12 months (odds ratio = 6.44, P = 0.008). After constructing a Kaplan–Meiers survival curve, pupillary reactivity was a better predictor of survival at 12 months than H&H grade [Hazard ratio 3.342 (1.596–7.000) P = 0.001 versus 1.964 (1.016–3.798) P = 0.045]. Conclusions  This study demonstrates that significant recovery occurs in the weeks to months after poor grade aSAH. Pupillary reactivity on admission can be used as a predictor of survival and recovery at intermediate and long-term time points, more so than Hunt and Hess grade. [ABSTRACT FROM AUTHOR]

Published
2008
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