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5. Mid-term safety and efficacy in small intracranial aneurysm coiling: results from TARGET® nano prospective independent core lab adjudicated multicenter registry

Author

Ashouri, Yazan, primary, Paul, Alexandra R., additional, Puri, Ajit, additional, Liaw, Nicholas, additional, Majjhoo, Aniel, additional, Taqi, Asif, additional, Rai, Ansaar, additional, Badruddin, Aamir, additional, Alshekhlee, Amer, additional, Naravetla, Bharath, additional, Rayes, Mahmoud, additional, Lawson, Matthew, additional, Al Masaid, Batool, additional, Langerford, Claire, additional, Shah, Qaisar, additional, Beaty, Karen, additional, Lin, Eugene, additional, Gray-Duvall, Tanner, additional, Olvany, Jasmine, additional, Slight, Hannah, additional, Chaubal, Varun, additional, Bushnaq, Saif, additional, Tan, Benedict, additional, Al Majali, Mohammad, additional, Elijovich, Lucas, additional, Sunenshine, Peter, additional, and Zaidat, Osama O., additional

Published
2024
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6. Sequence-defined phosphoestamers for selective inhibition of the KRAS G12D /RAF1 interaction

Author

Claringbold, Bini, Vance, Steven, Paul, Alexandra R., Williamson, James, Garrett, Michelle D., Serpell, Christopher J., Claringbold, Bini, Vance, Steven, Paul, Alexandra R., Williamson, James, Garrett, Michelle D., and Serpell, Christopher J.

Abstract

RAS proteins are the most frequently mutated in cancer, yet they have proved extremely difficult to target in drug discovery, largely because interfering with the interaction of RAS with its downstream effectors comes up against the challenge of protein–protein interactions (PPIs). Sequence-defined synthetic oligomers could combine the precision and customisability of synthetic molecules with the size required to address entire PPI surfaces. We have adapted the phosphoramidite chemistry of oligonucleotide synthesis to produce a library of nearly one million non-nucleosidic oligophosphoester sequences (phosphoestamers) composed of units taken from synthetic supramolecular chemistry, and used a fluorescent-activated bead sorting (FABS) process to select those that inhibit the interaction between KRASG12D (the most prevalent, and undrugged, RAS mutant) and RAF, a downstream effector of RAS that drives cell proliferation. Hits were identified using tandem mass spectrometry, and orthogonal validation showed effective inhibition of KRASG12D with IC50 values as low as 25 nM, and excellent selectivity over the wild type form. These findings have the potential to lead to new drugs that target mutant RAS-driven cancers, and provide proof-of-principle for the phosphoestamer chemical platform against PPIs in general – opening up new possibilities in neurodegenerative disease, viral infection, and many more conditions.

Published
2024

11. Developing a fast-track discharge protocol for patients with cerebral aneurysms treated via neuroendovascular techniques.

Author

Entezami, Pouya, Rock, Andrew K., Topp, Gregory P., Heydari, Ehsaun S., Field, Nicholas C., Boulos, Alan S., Dalfino, John C., Yamamoto, Junichi, Pilitsis, Julie G., Cherukupalli, Divya, McCallum, Sarah E., and Paul, Alexandra R.

Subjects
INTRACRANIAL aneurysms, HOSPITAL admission & discharge, HOSPITAL utilization, LOGISTIC regression analysis, PATIENT readmissions, THERAPEUTIC embolization
Abstract

Introduction: As we emerge from the current pandemic, hospitals, staff, and resources will need to continue to adjust to meet ongoing healthcare demands. Lessons learned during past shortages can be used to optimize peri-procedural protocols to safely improve the utilization of hospital resources. Methods: Retrospective review of patients who underwent elective endovascular intracranial aneurysm treatment was performed. Multivariable logistic regression was used to identify factors associated with patients who were able to be discharged within 24 h of elective procedures. Rates of complications (particularly readmission) were determined. Results: 330 patients underwent elective endovascular aneurysm treatment with 86 (26.1%) discharged within 24 h. Factors associated with earlier discharge included procedure years (2019–2021) and male sex. Patients were more likely to be discharged later (after 24 h) if they underwent stent-coil embolization or flow-diversion. There was no association between discharge timing and likelihood of readmission. Discussion: Our review highlights the safety of earlier discharge and allowed us to prepare a fast-track protocol for same-day discharge in these patients. This protocol will be studied prospectively in the next phase of this study. As we gain more comfort with emerging, minimally invasive endovascular therapies, we hope to safely achieve same-day discharge on a protocolized and routine basis, reducing the demand of elective aneurysm treatments on our healthcare system. Conclusion: We retrospectively demonstrate that early discharge following elective aneurysm treatment is safe in our cohort and provide a fast-track pathway based on these findings for other centers developing similar protocols. [ABSTRACT FROM AUTHOR]

Published
2024
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12. Drainage, Irrigation, and Fibrinolytic Therapy (DRIFT) for Adult Intraventricular Hemorrhage Associated with Primary Hypertensive Hemorrhages Using IRRAflow Self-Irrigating Catheter: A Report of Three Cases and Prior Historical Controls

Author

Field, Nicholas C., primary, Custozzo, Amanda J., additional, Harland, Tessa A., additional, Sweeney, Jared F., additional, Adamo, Matthew A., additional, Dalfino, John C., additional, and Paul, Alexandra R., additional

Published
2023
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18. Use of intravenous cangrelor in the treatment of ruptured and unruptured cerebral aneurysms: an updated single-center analysis and pooled analysis of current studies.

Author

Entezami, Pouya, Dalfino, John C., Boulos, Alan S., Junichi Yamamoto, Holden, Devin N., Field, Nicholas C., Rock, Andrew K., Najera, Edinson, and Paul, Alexandra R.

Subjects
DRUG efficacy, CEREBRAL embolism & thrombosis, INTRAVENOUS therapy, HEMATOMA, PERITONEUM diseases, INTRACRANIAL hemorrhage, GASTROINTESTINAL hemorrhage, ISCHEMIC stroke, THERAPEUTIC embolization, SURGICAL stents, PLATELET aggregation inhibitors, THROMBOEMBOLISM, DESCRIPTIVE statistics, INTRACRANIAL aneurysms, PATIENT safety, LONGITUDINAL method, EVALUATION, SYMPTOMS
Abstract

Background Intracranial stent placement for the treatment of cerebral aneurysms is increasingly utilized in both ruptured and unruptured scenarios. Intravenous (IV) cangrelor is a relatively new antiplatelet agent that was initially approved for coronary interventions. In addition to our institution, five other centers have published their results using IV cangrelor in neurointerventional procedures. This article combines the aneurysm treatment data from all prior studies to provide insight into the safety and efficacy of cangrelor for intracranial aneurysm treatment. Methods A prospectively maintained database was reviewed to identify all cases of IV cangrelor administration during aneurysm embolization. 20 additional patients were identified who had not been previously published. In addition, a literature search was performed to identify prior publications regarding cangrelor in neurointervention. The data from these were combined with our institutional results in a pooled-analysis. Results Overall, 85 patients who received IV cangrelor during aneurysm embolization were identified, including 46 ruptured and 39 unruptured cases. The asymptomatic and symptomatic intracranial hemorrhage rates were 4% (2/46) for ruptured cases and 2.6% (1/39) for unruptured cases. The rate of retroperitoneal hematoma and gastrointestinal bleeding was 0%. There were no incidents of intraprocedural thromboembolic complication or intraprocedural in-stent thrombosis in either cohort. One subject suffered an ischemic stroke at 24 hours secondary to in-stent thrombosis in a ruptured case. Conclusions IV cangrelor during aneurysm embolization appears to be safe, with a symptomatic intracranial hemorrhage rate of 4% in ruptured cases and 2.6% in unruptured cases. More research is needed to determine the ideal dosing regimen. [ABSTRACT FROM AUTHOR]

Published
2023
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21. Developing a fast-track discharge protocol for patients with cerebral aneurysms treated via neuroendovascular techniques

Author

Entezami, Pouya, primary, Rock, Andrew K., additional, Topp, Gregory P., additional, Heydari, Ehsaun S., additional, Field, Nicholas C., additional, Boulos, Alan S., additional, Dalfino, John C., additional, Yamamoto, Junichi, additional, Pilitsis, Julie G., additional, Cherukupalli, Divya, additional, McCallum, Sarah E., additional, and Paul, Alexandra R., additional

Published
2022
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23. sj-pdf-1-ine-10.1177_15910199211014417 - Supplemental material for Use of intravenous cangrelor and stenting in acute ischemic stroke interventions: a new single center analysis and pooled-analysis of current studies

Author

Paul, Alexandra R, Pouya Entezami, Holden, Devin, Field, Nicholas, Dalfino, John, and Boulos, Alan

Subjects
FOS: Clinical medicine, 110904 Neurology and Neuromuscular Diseases, Neuroscience
Abstract

Supplemental material, sj-pdf-1-ine-10.1177_15910199211014417 for Use of intravenous cangrelor and stenting in acute ischemic stroke interventions: a new single center analysis and pooled-analysis of current studies by Alexandra R Paul, Pouya Entezami, Devin Holden, Nicholas Field, John Dalfino and Alan Boulos in Interventional Neuroradiology

Published
2021
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25. Multicenter analysis of the incidence of in-stent stenosis following the deployment of flow-redirection endoluminal device in the treatment of intracranial aneurysms

Author

Gajjar, Avi A., Sioutas, Georgios S., Custozzo, Amanda, Salem, Mohamed M., Field, Nicholas C., Shekhtman, Oleg, Davis, Pierce, Prabhala, Tarun, Jankowitz, Brian T., Dalfino, John C., Boulos, Alan S., Burkhardt, Jan-Karl, Paul, Alexandra R., and Srinivasan, Visish M.

Abstract

Introduction The Flow Re-direction Endoluminal Device (FRED) is a novel flow diverter with a unique double stent design, with an inner stent composed of 48 nitinol wires, and an outer stent with 16 nitinol wires. It is designed for endovascular cerebral aneurysm treatment, although, limited data exist regarding in-stent stenosis (ISS) rates associated with FRED devices.Methods A registry encompassing two North American comprehensive stroke centers was the base of this study. We longitudinally assessed patients implanted with FRED devices, emphasizing baseline demographics, aneurysmal characteristics, procedural data, aneurysmal occlusion, and the incidence of ISS.Results In our cohort of 87 patients receiving 88 FRED devices, ISS occurred in 10.4% (9) of cases. Mild ISS (<50%) was noted in 8.0% (7) of patients, moderate ISS (50–75%) in 1.1% (1), and severe ISS (>75%) in 1.1% (1). Analysis indicated ISS in 17.0% (8) of patients with the FRED device and 5.7% (2) with the FRED-X device; all ISS cases in the FRED-X group were mild. Differences in ISS rates between device types were not significant (p= 0.122). Delayed thrombotic events were documented in 6.9% (6) of patients. Aneurysm occlusion rates, measured via the Raymond–Roy Scale (RRS), showed adequate occlusion (RRS 1 or 2) in 68.8% at 3 months, 74.6% at 6 months, and 89.3% at 12 months.Conclusions The study elucidates the efficacy and safety profile of FRED devices, presenting favorable aneurysm occlusion rates and low retreatment needs while underscoring the manageability of ISS.

Published
2025
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28. Contributors

Author

Acosta, Frank L., primary, Adelson, P. David, additional, Adler, ., John R., additional, Aghayev, Kamran V., additional, Aghi, Manish K., additional, Agrawal, Basheal M., additional, Ahluwalia, Manmeet S., additional, Ahmad, Faiz, additional, Air, Ellen, additional, Ajler, Pablo, additional, Albuquerque, Felipe C., additional, Amar, Arun P., additional, Amendola, Luca, additional, Ames, Christopher, additional, Amin, Beejal Y., additional, Amin-Hanjani, Sepideh, additional, Ammerman, Joshua M., additional, Anderson, William S., additional, Apfelbaum, Ronald I., additional, Apuzzo, Michael L.J., additional, Armonda, Rocco, additional, Arnold, Paul M., additional, Arzi, Harel, additional, Asthagiri, Ashok R., additional, Auguste, Kurtis, additional, Awad, Tariq E., additional, Aziz, Khaled M., additional, Aziz, Tipu, additional, Baehring, Joachim M., additional, Baig, Mirza N., additional, Bakay, Roy, additional, Ball, Perry A., additional, Bandiera, Stefano, additional, Barbaro, Nicholas M., additional, Barker, Frederick G., additional, Barrow, Daniel L., additional, Batra, Sachin, additional, Bederson, Joshua, additional, Bekelis, Kimon, additional, Bellabarba, Carlo, additional, Bello, Lorenzo, additional, Belzberg, Allan J., additional, Bendok, Bernard R., additional, Benes, Ludwig, additional, Benzel, Edward C., additional, Bertalanffy, Helmut, additional, Bettegowda, Chetan, additional, Bhatia, Ravi, additional, Bhatia, Sanjay, additional, Bishop, Allen T., additional, Black, Keith L., additional, Blevins, Lewis S., additional, Blike, George T., additional, Blitz, Ari, additional, Blomstedt, Göran C., additional, Blondel, Benjamin, additional, Boahene, Kofi, additional, Boleaga, Bernardo, additional, Bookland, Markus, additional, Boriani, Stefano, additional, Boxell, Christopher M., additional, Brem, Henry, additional, Bricolo, Albino, additional, Brodkey, Jason A., additional, Brotchi, Jacques, additional, Bruce, Jeffrey N., additional, Bruneau, Michael, additional, Buchbinder, Bradley R., additional, Burchiel, Kim J., additional, Burke, Timothy G., additional, Bydon, Ali, additional, Cacciola, Francesco, additional, Cahill, Kevin, additional, Cappabianca, Paolo, additional, Caputy, Anthony J., additional, Cardinale, Francesco, additional, Carrau, Ricardo L., additional, Carson, Benjamin S., additional, Carter, Bob S., additional, Casaceli, Giuseppe, additional, Castana, Laura, additional, Castillo, Gabriel, additional, Cavallo, Luigi M., additional, Cawley, C. Michael, additional, Chakraborty, Aabir, additional, Chang, Edward F., additional, Chang, Eric C., additional, Chang, Steven D., additional, Chapman, Jens R., additional, Chappell, E. Thomas, additional, Chaudhary, Neeraj, additional, Chen, Douglas, additional, Chen, James, additional, Chen, Linda C., additional, Cheng, Boyle C., additional, Chern, Joshua J., additional, Chi, John H., additional, Chien, Wade W., additional, Chiocca, E. Antonio, additional, Chitale, Rohan, additional, Chitnavis, Bhupal, additional, Christiano, Lana D., additional, Chu, Ray M., additional, Ciceri, Elisa F., additional, Clarke, Michelle J., additional, Cohen, Alan, additional, Colao, Annamaria, additional, Colby, Geoffrey P., additional, Collice, Massimo, additional, Condit, Daniel, additional, Coon, Alexander L., additional, Corrêa Dos Reis, Cassius Vinícius, additional, Cosgrove, G. Rees, additional, Cossu, Massimo, additional, Couldwell, William T., additional, Curry, William T., additional, Dabus, Guilherme, additional, Dagi, Teodoro Forcht, additional, D'Aliberti, Giuseppe, additional, Danielpour, Moise, additional, Dannenbaum, Mark J., additional, Dardis, Ronan M., additional, Dasenbrock, Hormuzdiyar H., additional, Dashti, Reza, additional, Day, Arthur L., additional, Day, John Diaz, additional, Deletis, Vedran, additional, Del-Valle, Ramiro, additional, DeMonte, Franco, additional, Dimeco, Francesco, additional, Dodd, Robert, additional, Doglietto, Francesco, additional, Dörner, Lutz, additional, Dorsi, Michael J., additional, Doumit, Gaby D., additional, Drake, James M., additional, Drazin, Doniel, additional, Du, Rose, additional, Ducker, Thomas B., additional, Duffau, Hugues, additional, Duhon, Bradley S., additional, Eboli, Paula, additional, Elhammady, Mohamed Samy, additional, Ely, Pamela, additional, Epstein, Nancy E., additional, Erkmen, Kadir, additional, Errico, Thomas, additional, Eskandar, Emad N., additional, Eskey, Clifford J., additional, Esposito, Felice, additional, Fadul, Camilo E., additional, Fanciullo, Gilbert J., additional, Fargen, Kyle M., additional, Felsen, Gidon, additional, Feng, Dong Xia, additional, Fessler, Richard G., additional, Filler, Aaron G., additional, Flickinger, John C., additional, Floyd, John R., additional, Foley, Kevin T., additional, Fountas, Kostas N., additional, Francis, Howard, additional, Frazier, James L., additional, Frerichs, Kai, additional, Frim, David M., additional, Froelich, Sebastien, additional, Fukushima, Takanori, additional, Gailloud, Philippe, additional, Gaini, Sergio Maria, additional, Gandhi, Chirag D., additional, Gandhi, Dheeraj, additional, Gardner, Gale, additional, Gardner, Paul, additional, Garrett, Mark, additional, Garzón-Muvdi, Tomás, additional, Gasbarrini, Alessandro, additional, Geisler, Fred H., additional, Gemmete, Joseph J., additional, Gerosa, Massimo, additional, Goel, Atul, additional, Gokaslan, Ziya L., additional, Gonzalez, L. Fernando, additional, Goodwin, C. Rory, additional, Goto, Takeo, additional, Gould, Grahame C., additional, Grady, M. Sean, additional, Grande, Andrew W., additional, Grandhi, Ramesh, additional, Green, Alexander L., additional, Greenfield, Jeffrey P., additional, Gross, Bradley A., additional, Grossman, Rachel, additional, Groves, Mari, additional, Guinto, Gerardo, additional, Gullan, Richard, additional, Gupta, Gaurav, additional, Gupta, Nalin, additional, Hankinson, Todd C., additional, Hansasuta, Ake, additional, Harrop, James S., additional, Harsh, Griffith R., additional, Hdeib, Alia, additional, Heinze, Stefan, additional, Heiss, John, additional, Hellwig, Dieter, additional, Hernesniemi, Juha, additional, Heros, Roberto C., additional, Hillman, Todd, additional, Hinojosa, Jose, additional, Hiremath, Girish K., additional, Hoh, Brian L., additional, Hopkins, L. Nelson, additional, Hsu, Wesley, additional, Hu, Yin C., additional, Huang, Jason H., additional, Huang, Judy, additional, Hutchinson, Peter J., additional, Hyam, Jonathan A., additional, Ioachimescu, Adriana G., additional, Jabbour, Pascal M., additional, Jackson, Juan, additional, Jallo, George I., additional, Janecka, Ivo P., additional, Javadpour, Mohsen, additional, Jea, Andrew, additional, Jeswani, Sunil, additional, Jho, David H., additional, Jho, Diana H., additional, Jho, Hae-Dong, additional, Jiang, Bowen, additional, Jung, Tae-Young, additional, Kalani, M. Yashar S., additional, Kano, Hideyuki, additional, Kapadia, Silloo B., additional, Kaplitt, Michael G., additional, Kappus, Christoph, additional, Kapsalaki, Eftychia Z., additional, Karmon, Yuval, additional, Kassam, Amin B., additional, Kathuria, Sudhir, additional, Kawase, Takeshi, additional, Khalessi, Alexander A., additional, Khu, Kathleen, additional, Kim, Daniel H., additional, Kirsch ., Matthias, additional, Kivisaari, Riku, additional, Kolias, Angelos G., additional, Kondziolka, Douglas, additional, Korinth, Marcus C, additional, Krex, Dietmar, additional, Krieger, Mark D., additional, Krishnan, Kartik G., additional, Krishnaney, Ajit A., additional, Lacy, Maureen, additional, Lad, Santosh D., additional, Landeiro, Jose Alberto, additional, Lang, Frederick F., additional, Lang, Shih-Shan, additional, LaPierre, Françoise, additional, Larson, Paul S., additional, Lawton, Michael T., additional, Lee, Marco, additional, Lehecka, Martin, additional, Levi, Allan, additional, Levy, Elad I., additional, Lieberson, Robert E., additional, Lim, Michael, additional, Lin, Ning, additional, Lind, Göran, additional, Linderoth, Bengt, additional, Lindley, Timothy, additional, Listrat, Antoine, additional, Liu, Charles Y., additional, Liu, James K., additional, Liu, John C., additional, Lo Russo, Giorgio, additional, Loftus, Christopher M., additional, Lonser, Russell R., additional, Lu, Daniel C., additional, Lu, Yi, additional, Lunsford, L. Dade, additional, Macenski, M. Mason, additional, Maciaczyk, Jaroslaw, additional, Madsen, Joseph R., additional, Magge, Subu N., additional, Maira, Giulio, additional, Malessy, Martijn J.A., additional, Malone, David G., additional, Maniker, Allen, additional, Manley, Geoffrey T., additional, Manwaring, Jotham, additional, Martineau, Mitchell, additional, Martuza, Robert L., additional, Mathews, Marlon S., additional, Mathioudakis, Nestoras, additional, McCormick, Paul, additional, McDermott, Michael W., additional, McDougall, Cameron G., additional, Mehdorn, H. Maximilian, additional, Mehta, Vivek A., additional, Menezes, Arnold, additional, Mertens, Patrick, additional, Meyer, Frederic B., additional, Mian, Matthew K., additional, Midha, Rajiv, additional, San Millán Ruíz, Diego, additional, Miller, Jonathan, additional, Miller, Neil R., additional, Mirzadeh, Zaman, additional, Mishra, Ganpati Prasad, additional, Missios, Symeon, additional, Mitchell, James B., additional, Mitha, Alim, additional, Mocco, J., additional, Moghekar, Abhay, additional, Morcos, Jacques J., additional, Morgan, Chad J., additional, Morrison, John F., additional, Moyle, Henry, additional, Muh, Carrie R., additional, Mukherjee, Debraj, additional, Nabavi, Arya, additional, Nanaszko, Michael J., additional, Nandi, Dipankar, additional, Narayan, Raj, additional, Natarajan, Sabareesh K., additional, Nathal, Edgar, additional, Nayar, Vikram V., additional, Netalkar, Audumbar Shantaram, additional, Newman, C. Benjamin, additional, Nguyen, Trang, additional, Ngwenya, Laura B., additional, Nicolato, Antonio, additional, Niemelä, Mika, additional, Nikkhah, Guido, additional, Nimmagadda, Anitha, additional, Niparko, John K., additional, Niranjan, Ajay, additional, North, Richard B., additional, Núñez, José María, additional, Oakes, W. Jerry, additional, Ogilvy, Christopher S., additional, Ohata, Kenji, additional, Ojemann, Jeffrey G., additional, Ojemann, Steven, additional, Okonkwo, David O., additional, Oldfield, Edward H., additional, O'Neill, Brent, additional, Oyesiku, Nelson M., additional, Pallini, Roberto, additional, Pandey, Aditya S., additional, Pang, Dachling, additional, Papadimitriou, Kyriakos, additional, Pascual, José María, additional, Patel, Aman, additional, Patel, Anoop P., additional, Patel, Toral R., additional, Paterno, Vincenzo, additional, Patir, Rana, additional, Paul, Alexandra R., additional, Pawar, Sanjay J., additional, Penn, Richard, additional, Pereira, Erlick A.C., additional, Perez-Cruet, Mick J., additional, Peterson, Eric C., additional, Pichelmann, Mark A., additional, Piepmeier, Joseph M., additional, Pinsker, Marcus O., additional, Pitts, Lawrence H., additional, Placide, Rick J., additional, Pondaag, Willem, additional, Post, Kalmon, additional, Potts, Matthew B., additional, Poulsgaard, Lars, additional, Pradilla, Gustavo, additional, Prestigiacomo, Charles J., additional, Prevedello, Daniel M., additional, Prieto, Ruth, additional, Quiñones-Hinojosa, Alfredo, additional, Quintana, Leonidas M., additional, Rahimi, Scott Y., additional, Rahme, Rudy J., additional, Ramos-Zúñiga, Rodrigo, additional, Ranalli, Nathan J., additional, Raza, Shaan M., additional, Recinos, Pablo F., additional, Recinos, Violette Renard, additional, Rege, Shrikant, additional, Reithmeier, Thomas, additional, Relyea, Katherine, additional, Resnick, Daniel, additional, Rigamonti, Daniele, additional, Rigoard, Philippe, additional, Rinne, Jaakko, additional, Robertson, Jon H., additional, Rochkind, Shimon, additional, Rock, Jack P., additional, Romani, Rossana, additional, Rosenthal, Guy, additional, Rosenwasser, Robert H., additional, Rowland, Nathan C., additional, Rutka, James T., additional, Ryu, Samuel, additional, Sala, Francesco, additional, Salvatori, Roberto, additional, Sammalkorpi, Kari, additional, Sanai, Nader, additional, Santarius, Thomas, additional, Saxena, Amar, additional, Schackert, Gabriele, additional, Schick, Uta, additional, Schildhauer, Thomas A., additional, Schmidek, Alexandra, additional, Schmidek, Henry H., additional, Schmidt, Meic H., additional, Schmitt, Paul, additional, Schramm, Johannes, additional, Schwab, Joseph, additional, Schwartz, Theodore H., additional, Schweder, Patrick, additional, Sciubba, Daniel M., additional, Scott, R. Michael, additional, Sekula, Raymond F., additional, Senatus, Patrick, additional, Shad, Amjad, additional, Shaibani, Ali, additional, Sharma, Manish S., additional, Sharma, Rewati Raman, additional, Sheth, Sameer A., additional, Shin, Alexander Y., additional, Shirzadi, Ali, additional, Siddiqui, Adnan H., additional, Silveira, Roberto Leal, additional, Simmons, Nathan E., additional, Sindou, Marc, additional, Sinisi, Marco, additional, Siu, Timothy, additional, Smith, Edward, additional, Smith, Joseph R., additional, Smith, Patricia, additional, Smyth, Matthew, additional, Solari, Domenico, additional, Solomon, David, additional, Sonabend, Adam M., additional, Souweidane, Mark M., additional, Spagnuolo, Edgardo, additional, Spetzler, Robert F., additional, Spinner, Robert J., additional, Stark, Andreas M., additional, Starr, Philip A., additional, Steiner, Ladislau, additional, Steinmetz, Michael P., additional, Stiver, Shirley I., additional, Subramanian, Prem, additional, Sughrue, Michael E., additional, Suk, Ian, additional, Sun, Daniel Q., additional, Sure, Ulrich, additional, Szentirmai, Oszkar, additional, Taghva, Alexander, additional, Talamonti, Giuseppe, additional, Tamargo, Rafael J., additional, Teff, Richard J., additional, Tew, John M., additional, Theodore, Nicholas, additional, Theodosopoulos, Philip V., additional, Thompson, B. Gregory, additional, Tirakotai, Wuttipong, additional, Tjoumakaris, Stavropoula I., additional, Tonsgard, James H., additional, Trejo, David, additional, Trippel, Michael, additional, Tubbs, R. Shane, additional, Tumialan, Luis M., additional, Unterberg, Andreas, additional, Vaphiades, Michael S., additional, Vaughan, T. Brooks, additional, Veeravagu, Anand, additional, Velasco, Ana Luisa, additional, Velasco, Francisco, additional, Velat, Gregory J., additional, Verlicchi, Angela, additional, Vrionis, Frank D., additional, Wager, Michel, additional, Wallace, M. Christopher, additional, Wand, Gary S., additional, Warf, Benjamin C., additional, Waters, Michael F., additional, Watson, Joseph, additional, Weiss, Martin H., additional, Weiss, Nirit, additional, Welch, William, additional, Werner, J. Kent, additional, Whitworth, Louis A., additional, Winfree, Christopher, additional, Witham, Timothy F., additional, Wolinsky, Jean-Paul, additional, Wong, Judith M., additional, Xavier, Shaun, additional, Yamini, Bakhtiar, additional, Yampolsky, Claudio, additional, Yaremchuk, Michael J., additional, Yassari, Reza, additional, Yen, Chun-Po, additional, Yianni, John, additional, Yu, Alexander K., additional, Zager, Eric L., additional, Zanotti, Bruno, additional, Zenteno, Marco, additional, Zileli, Mehmet, additional, and Zouzias, Alexandros D., additional

Published
2012
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38. Comparison of hydrogel coils versus bare platinum coils for the treatment of anterior communicating artery aneurysms.

Author

MacDonell, Jacquelyn, Field, Nicholas C., Entezami, Pouya, Yamamoto, Junichi, Boulos, Alan S., Dalfino, John C., and Paul, Alexandra R.

Subjects
INTRACRANIAL aneurysms, HYDROGELS, THERAPEUTIC embolization, ANEURYSMS, DISEASE relapse
Abstract

INTRODUCTION: While endovascular coiling has been shown to be a safe treatment option for intracranial aneurysms, there remains concern regarding increased recurrence and retreatment rates. Preliminary studies evaluating hydrogel coated coils have demonstrated decreased recurrence rates compared to bare metal coils. METHODS: A retrospective chart review was done on all patients with anterior communicating artery aneurysms (ACoAAs) treated with endovascular coiling between 2014 and 2018. Treatment groups were divided into hydrogel coated coils or bare metal coils. Patients were categorized into the hydrogel group when = 70% of the coil length was hydrogel coated. RESULTS: Eighty-four ACoAAs were treated with coil embolization between 2014 and 2018. Postoperative imaging was available for 68 patients. Twenty-six patients were categorized into the hydrogel treatment group. Aneurysm recurrence was seen in 7.7% (2/26) of patients treated with hydrogel coated coils compared to 33.3% (14/42) of those treated with bare metal coils (P = 0.03). Subanalysis of patients with ruptured aneurysms revealed decreased recurrence rates in patients treated with hydrogel coated coils at 5.9% (1/17) compared to patients treated with bare metal coils at 39.4% (13/33) (P = 0.01). CONCLUSIONS: Hydrogel-coated coils may reduce recurrence rates in the treatment of both ruptured and unruptured ACoAAs. [ABSTRACT FROM AUTHOR]

Published
2022
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39. INE885253 Supplemetal Material - Supplemental material for Simultaneous revascularization of the occluded internal carotid artery using the Solitaire as a workhorse wire during acute ischemic stroke intervention

Author

Paul, Alexandra R, Pouya Entezami, Nourollahzadeh, Emad, Dalfino, John, and Boulos, Alan S

Subjects
FOS: Clinical medicine, 110904 Neurology and Neuromuscular Diseases, Neuroscience
Abstract

Supplemental material, INE885253 Supplemetal Material for Simultaneous revascularization of the occluded internal carotid artery using the Solitaire as a workhorse wire during acute ischemic stroke intervention by Alexandra R Paul, Pouya Entezami, Emad Nourollahzadeh, John Dalfino and Alan S Boulos in Interventional Neuroradiology

Published
2019
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42. Femoral access in 100 consecutive subarachnoid hemorrhage patients: the 'craniotomy' of endovascular neurosurgery

Author

Huang Judy, Radvany Martin G, Colby Geoffrey P, Paul Alexandra R, Tamargo Rafael J, and Coon Alexander L

Subjects
Medicine, Biology (General), QH301-705.5, Science (General), Q1-390
Abstract

Abstract Background Femoral access is a fundamental element of catheter-based cerebral angiography. Knowledge of location of the common femoral artery (CFA) bifurcation is important as the risk of retroperitoneal bleeding is increased if the puncture is superior to the inguinal ligament and there is an increased risk of thrombosis and arteriovenous fistula formation if the puncture is distal into branch vessels. We sought to characterize the location of the CFA bifurcation along with the presence of significant atherosclerosis or iliac tortuosity in a contemporary series of subarachnoid hemorrhage (SAH) patients. Findings The records of a prospective single-center aneurysm database were reviewed to identify 100 consecutive SAH patients. Using an oblique femoral arteriogram, the presence of significant atherosclerosis, iliac tortuosity, and the CFA bifurcation were assessed. The CFA bifurcation was graded according to its position with respect to the femoral head: below (grade 1), lower half (grade 2), and above the upper half (grade 3). We found a CFA bifurcation grade 1 in 50 patients (50%, mean age 51.2 years), grade 2 in 40 patients (40%, mean age 55.5 years), and grade 3 in 10 patients (10%, mean age 58.2 years). Whereas 30 of 90 patients with CFA grades I or II were male (33%), only 10% with grade 3 were male (1 of 10, p = 0.12). Mean age for significant atherosclerosis was 65.5 +/- 2.6 years versus 50.9 +/- 1.6 years (p < 0.001) without, and iliac tortuosity was 64.9 +/- 2.4 years versus 50.3 +/- 1.6 years (p < 0.001) without. Conclusions Although a requisite element of endovascular treatment in SAH patients, femoral access can be complicated by a high common femoral artery bifurcation and the presence of atherosclerotic disease and/or iliac artery tortuosity. In this study, we found a grade 3 (above the femoral head) CFA bifurcation in 10% patients, with 90% of these patients being female. We also found the presence of atherosclerotic disease and iliac tortuosity to be significantly more likely in patients older than 65 years of age.

Published
2010
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43. Cangrelor dose titration using platelet function testing during cerebrovascular stent placement.

Author

Entezami, Pouya, Holden, Devin N, Boulos, Alan S, Paul, Alexandra R, Field, Nicholas C, Nourollahzadeh, Emad, Yamamoto, Junichi, and Dalfino, John C

Subjects
PLATELET function tests, PATIENTS' attitudes, VOLUMETRIC analysis, PLATELET aggregation inhibitors
Abstract

Background: Optimal antiplatelet inhibition is vital during cerebrovascular stenting procedures, yet no standardized recommendation exists for antithrombotic therapy in these scenarios. Cangrelor is an intravenous P2Y12 inhibitor with a favorable pharmacokinetic profile for use during neuroendovascular stenting. Methods: A retrospective review of all neuroendovascular patients who underwent stenting between 1 January 2019 and 22 March 2020 and were treated with cangrelor was conducted. Thirty-seven patients met inclusion criteria. Results: All patients were administered a bolus of 5 mcg/kg of cangrelor followed by a maintenance infusion. Antiplatelet effects of cangrelor were monitored using platelet reactivity units (PRU). Based on the initial PRU, seven patients' doses were adjusted with subsequent PRUs in or near the goal range of 50–150. One patient experienced an acute intraprocedural occlusion likely related to a subtherapeutic PRU which subsequently resolved with cangrelor dose adjustment and intra-arterial tirofiban administration, and one patient experienced a post-procedure stent occlusion which required a thrombectomy and intra-arterial tirofiban administration. No hemorrhagic complications occurred. Discussion: Cangrelor utilization during neuroendovascular stenting with maintenance doses of <2 mcg/kg/min with dose adjustments based on platelet function testing has not been previously described. Cangrelor presents many advantages compared to standard therapy in patients undergoing stent placement related to its pharmacokinetic profile, rapid onset of action, ease of transition to oral P2Y12 antiplatelet agents, and measurability. Conclusion: Cangrelor is a promising alternative to currently available therapies, especially in patients with a high hemorrhagic risk. [ABSTRACT FROM AUTHOR]

Published
2021
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44. Simultaneous revascularization of the occluded internal carotid artery using the Solitaire as a workhorse wire during acute ischemic stroke intervention.

Author

Paul, Alexandra R, Entezami, Pouya, Nourollahzadeh, Emad, Dalfino, John, and Boulos, Alan S

Subjects
*INTERNAL carotid artery, *WIRE, *CAROTID artery, *STROKE, CAROTID artery stenosis
Abstract

Introduction: Tandem lesions involving a large vessel occlusion intracranially with concomitant cervical carotid critical stenosis or occlusion are a common presentation of acute ischemic stroke. These lesions are both challenging and time-consuming but can be extremely beneficial for patients when successful. We present a technique utilizing the pusher wire of the stent retriever used for intracranial thrombectomy as the workhorse wire for carotid intervention using a monorail system to perform cervical carotid angioplasty. Methods: We reviewed four successive patients who presented with a tandem occlusion and underwent thrombectomy and simultaneous carotid artery intervention using this technique. Results: All four patients had radiographically successful intracranial thrombectomy and cervical carotid revascularization. Time from groin puncture to intracranial stent retriever deployment was 63 min on average. Then, using the pusher wire as a monorail workhorse, time from stent retriever deployment to carotid angioplasty was on average 6 min. Discussion: This technique allows for cervical carotid revascularization to begin during the recommended 5-min wait time after stent retriever deployment, allowing for rapid near-simultaneous revascularization across both lesions. This technique has been reported briefly in the past for management of a cervical dissection. There is continued debate regarding the management of tandem occlusions, as to which lesion should be managed first. Conclusion: As the management paradigms of tandem occlusions continue to evolve, this technique may improve outcomes by expediting endovascular intervention. Using the stent retriever wire provides a method of expediting the management of the proximal lesion after addressing the more distal intracranial occlusion first. [ABSTRACT FROM AUTHOR]

Published
2020
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45. Non-accidental trauma in pediatric patients: a review of epidemiology, pathophysiology, diagnosis and treatment

Author

Paul, Alexandra R. and Adamo, Matthew A.

Subjects
Review Article
Abstract

Non-accidental trauma (NAT) is a leading cause of childhood traumatic injury and death in the United States. It is estimated that 1,400 children died from maltreatment in the United States in 2002 and abusive head trauma (AHT) accounted for 80% of these deaths. This review examines the epidemiology and risk factors for NAT as well as the general presentation and required medical work up of abused children. In addition, potential algorithms for recognizing cases of abuse are reviewed as well as outcomes in children with NAT and potential neurosurgical interventions which may be required. Finally, the evidence for seizure prophylaxis in this population is addressed.

Published
2014

46. Colaboradores

Author

Adepoju, Adedamola, Argoff, Charles E., Babu, Maya A., Backonja, Miroslav “Misha”, Basbaum, Allan I., Bemis, Abigail, Bhangav, Anisha, Boulos, Alan S., Brenner, Darren, Bushey, Michael A., Chen, Kevin S., Chen, Nita, Clark, Michael R., Cleary, Jacqueline H., Collison, Claire, Duarte, Robert A., Dubin, Andrew, Forde, Grace, Fudin, Jeffrey, Galluzzi, Katherine, Gannon, Sara, Girgis, Fady, Gruenthal, Eric, Hayek, Salim, Jacobs, Marilyn S., Jones, R. Carter W., III, Kenning, Tyler J., Kumar, Vignessh, Lange, Steven, Laufer, Andras, Lofland, Kenneth R., Manworren, Renee C.B., McLain, David, Miller, Jonathan, Mogilner, Alon Y., Muraszko, Karin M., Narayan, Sarah, Pastena, Gaetano, Patil, Parag G., Paul, Alexandra R., Peperzak, Katherin, Pilitsis, Julie G., Prusik, Julia, Raviv, Nataly, Reddy, Gaddum Duemani, Reppel, Alycia, Rosenow, Joshua M., Rosen, Noah, Sondhi, Nidhi, Sparkes, Steven, Stacey, Brett R., Stern, Emily K., Sumner, Lekeisha A., Viswanathan, Ashwin, Walk, David, Wallace, Mark S., Walling, Ian, Wilock, Meghan, Yim, Benjamin, and Youn, Youngwon

Published
2019
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48. Post-operative weight loss in venous sinus stenting patients: A multi-center review, systematic review, and meta-analysis

Author

Gajjar, Avi A, Rogers, Aubrey, Ghosh, Ritam, Abbas, Rawad, Naamani, Kareem El, Gooch, M Reid, Field, Nicholas, Dalfino, John C, and Paul, Alexandra R

Abstract

Introduction Idiopathic intracranial hypertension (IIH) can result in headaches, pulsatile tinnitus, papilledema, and other neurological symptoms. Weight loss can alleviate some symptoms of IIH. This study aims to investigate the effect of venous sinus stenting on post-operative weight and body mass index (BMI) changes among IIH patients. The secondary objective is to investigate the relationship between post-operative weight changes and papilledema resolution.Methods Patients with papilledema undergoing venous sinus stenting for IIH were retrospectively reviewed from two comprehensive North American cerebrovascular centers. Patient demographics, surgical course, post-operative outcomes, and weight were analyzed. A systematic review and meta-analysis of post-operative weight in stented IIH patients was conducted.Results Twenty-eight patients with a diagnosis of IIH and papilledema who underwent venous sinus stenting were identified across two institutions. Patients had a mean pre-operative weight of 103.2 kg, which decreased to 101.5 kg at 3-month follow up (p= 0.0757). Patients at 6-month follow-up saw a weight decrease to 97.4 kg (p= 0.0066). Patients who saw papilledema resolution saw a mean greater decrease in weight (−4.5%) at 6-month follow up than those whose papilledema did not resolve (−1.7%), although this was insignificant (p= 0.1091). A total of 41 patients were included in the meta-analysis. Patients had an average of 1.1 increase in BMI at 3-month follow up.Conclusions This study shows that venous sinus stenting leads to modest weight reduction in IIH patients, and those with resolved papilledema experience slightly greater weight loss. Further research is necessary to determine the clinical significance of these findings.

Published
2024
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49. Incidence of mechanical thrombectomy among stroke patients brought directly to a comprehensive stroke center versus transfer from a primary stroke center in upstate New York

Author

Khazen, Olga, Bao, Jonathan, Gajjar, Avi A, Entezami, Pouya, Dalfino, John C, Feustel, Paul J, and Paul, Alexandra R

Abstract

Background Faster time to treatment for stroke is associated with improved outcomes. In cases of large vessel occlusion (LVO), standard of care treatment with thrombectomy can only be provided at a comprehensive stroke center (CSC). We examine the outcomes of patients who are directly brought to our center, a CSC, compared to those seen at a primary stroke center (PSC) and then transferred.Methods Patients with LVO presenting to our center from 1/1/2019 to 12/31/2019 were included. Cohorts of patients presenting first to a PSC and presenting first to a CSC were compared. Demographics and outcome metrics (Discharge Modified Rankin Scale (mRS) and National Institute of Health Stroke Severity Scale (NIHSS) scores) were obtained for all LVO patients. Imaging was also assessed.Results Of 864 stroke admissions, 346 had LVO (40%) with 183 (53%) transferring from a PSC and 163 (47%) presenting directly. Similar percentages of each cohort were taken for thrombectomy (25.1% transfer and 31.3% direct). However, as distance between PSC and CSC increased, likelihood of thrombectomy decreased. Transfer patients were more likely to be excluded from thrombectomy secondary to a large volume of complete stroke (p  =  0.0001). Direct presenters had lower discharge mRS scores than transfer patients (p < 0.01), however, severity of stroke upon admission was similar in the two groups.Conclusion Patients transferred from a PSC were more likely to have a worse outcome at time of discharge than those presenting directly to our center. Large volume of completed stroke was a frequent reason for exclusion from thrombectomy. Optimizing stroke protocols to CSC in cases of LVOs may result in better outcomes.

Published
2024
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50. Comparison of pipeline embolization device, flow re-direction endoluminal device and surpass flow diverters in the treatment of intracerebral aneurysms

Author

Field, Nicholas C., Custozzo, Amanda, Gajjar, Avi A, Dalfino, John C., Boulos, Alan S., and Paul, Alexandra R.

Abstract

Objectives The use of flow diversion for the treatment of intracranial aneurysms has gained broad acceptance. Three flow-diverting stents are approved by the Food and Drug Administration for use in the United States. We sought to compare the outcomes and safety profiles between the three devices at our institution.Methods A retrospective review of aneurysms treated with pipeline embolization device (PED), flow re-direction endoluminal device (FRED), and SURPASS was performed for aneurysms treated between 2018 and 2022 at our institution.Results The study cohort consisted of 142 patients. Precisely, 86 aneurysms were treated with a pipeline, 33 aneurysms were treated with FRED, and 23 aneurysms were treated with SURPASS. The 1-year complete occlusion rates were 59.4%, 60%, and 65%, respectively (0.91). Linear regression models found that only adjunctive coiling predicted aneurysm occlusion at 6 months (p= 0.02), but this effect was lost at 1 year and beyond. There was no significant difference in acute thrombotic or acute hemorrhagic complications between the three cohorts. There was a higher rate of delayed hemorrhagic complications in the SURPASS cohort (10%) compared to the PED (1.3%) and FRED (0%) cohorts (p= 0.04). There was also a higher rate of in-stent stenosis in the SURPASS cohort (20%) compared to the PED (5%) and FRED (3.1%) cohorts (p< 0.01).Conclusions Treatment with PED, FRED, and SURPASS all resulted in similar complete occlusion rates at 6 months and 1 year. SURPASS was associated with higher in-stent stenosis as well as delayed hemorrhagic complications. Additional future studies evaluating the newest generation of flow-diverting stents with long-term follow-up will be necessary to make any definitive conclusions.

Published
2024
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