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Papers by guilherme dabus
Frontiers in Neurology, 2021
Background and Purpose: End-of-procedure substantial reperfusion [modified Treatment in Cerebral ... more Background and Purpose: End-of-procedure substantial reperfusion [modified Treatment in Cerebral Ischemia (mTICI) 2b-3], the leading endpoint for thrombectomy studies, has several limitations including a ceiling effect, with recent achieved rates of ~90%. We aimed to identify a more optimal definition of angiographic success along two dimensions: (1) the extent of tissue reperfusion, and (2) the speed of revascularization. Methods: Core-lab adjudicated TICI scores for the first three passes of EmboTrap and the final all-procedures result were analyzed in the ARISE II multicenter study. The clinical impact of extent of reperfusion and speed of reperfusion (first-pass vs. later-pass) were evaluated. Clinical outcomes included 90-day functional independence [modified Rankin Scale (mRS) 0–2], 90-day freedom-from-disability (mRS 0–1), and dramatic early improvement [24-h National Institutes of Health Stroke Scale (NIHSS) improvement ≥ 8 points]. Results: Among 161 ARISE II subjects with ...
Stroke
Background and Purpose: The Tigertriever is a novel, radially adjustable, fully visible, stentrie... more Background and Purpose: The Tigertriever is a novel, radially adjustable, fully visible, stentriever that permits the operator to align radial expansion with target vessel diameters. This multicenter trial compared the Tigertriever’s effectiveness and safety compared with established stent retrievers. Methods: Single arm, prospective, multicenter trial comparing the Tigertriever to efficacy and safety performance goals derived from outcomes in 6 recent pivotal studies evaluating the Solitaire and Trevo stent-retriever devices with a lead-in and a main-study phase. Patients were enrolled if they had acute ischemic stroke with National Institutes of Health Stroke Scale score ≥8 due to large vessel occlusion within 8 hours of onset. The primary efficacy end point was successful reperfusion, defined as core laboratory-adjudicated modified Thrombolysis in Cerebral Ischemia score 2b-3 within 3 passes of the Tigertriever. The primary safety end point was a composite of 90-day all-cause mor...
Oral Poster Abstracts
Background and purpose Endovascular treatment of intracranial aneurysms has become a routine firs... more Background and purpose Endovascular treatment of intracranial aneurysms has become a routine first-line option for treatment of an increasing population of intracranial aneurysms at many neurovascular centers. Since appearance of the balloon-remodeling technique and stent-assisted coiling, wide-neck and complex aneurysms have been treated successfully endovascularly worldwide. Although these 2 techniques have been widely proven, the combination of both traditionally required “extra” maneuvers which made the procedures more complicated technically The aim of our study was to evaluate the technical success, safety and efficacy of the low-profile stents delivered through double lumen balloons. Material and methods Clinical, procedural, and angiographic data, including aneurysm size and location, device or devices used, angiographic and clinical data were analyzed. Results Forty nine patients (33 females, 16 males; range 38–79) harboring 49 aneurysms were analyzed. Aneurysms maximal diameter ranged from 2.5 to 26 mm, with 8 mm average. There were 36 unruptured, 8 recanalized (previously ruptured), 1 wrapped (previously ruptured) and 3 ruptured aneurysms. Locations were ACom (17/49 cases), MCA (17/49 cases), M3 (1/49 case), ICA (3/49 cases), Basilar (7/49 cases), PCA-PSA (1/49 case), PICA (1/49 case) and VA (1/49 case). Scepter (C and XC) and Eclipse 2L double lumen balloons were used. All the low-profile stents available in the market were evaluated, both braided and laser-cut (LVIS junior, LEO Baby, ACCLINO Flex and Neuroform Atlas). In 32 wide-neck of 49 cases, the operator decided the combined technique as first option; While in 17 of 49 cases, combined techniques were used as a bailout because of branch occlusion, coil protrusion or instability during balloon remodeling. 53 devices were placed properly (23 LVIS jr, 15 LEO Baby, 14 ACCLINO Flex and 1 Neuroform Atlas). Navigation and compatibility were effective in 100% of the cases. All devices were deployed satisfactorily through the double lumen balloons and no device had to be removed. Initial wall apposition was excellent in 27 devices, 22 devices fully-opened after jailed microcatheter removal and posterior angioplasty was done in 4. We found 2 minor clinical events (4%) and 1 major event (2%) (Secondary to stents thrombosis in a case where stents were used as bailout because of branches occlusion after intrasaccular device deployment). We had 3 intraprocedural complications, resolved without clinical consequences (2 in-stent thrombus solved with medication and 1 focal SAH controlled with balloon inflation). Three months imaging follow-up were obtained in 3 patients, six-month (±1 month) follow-up were obtained in 18 aneurysms, 12–14 months follow-up in 21 aneurysms. Raymond-1 occlusion rate (complete occlusion) was achieved in 66,6%, Raymond-2 obliteration rate (neck remnant) in 31% and Raymond-3 (residual aneurysm) in 2%. Conclusion The “Combined Remodeling Technique” with low-profile stents delivered through double-lumen balloons is technically easy, feasible, safe and effective for the treatment of intracranial aneurysms. This technique allows the operator to avoid extra maneuvers. Disclosures M. Martínez-galdámez: None. G. Dabus: None. K. Kadziolka: None. M. Puthuran: None. V. Kalousek: None. A. Chandran: None. P. Vega: None. B. Zheng: None. A. Hermosín: None. C. Rodríguez: None.
Journal of NeuroInterventional Surgery, 2013
Introduction/Purpose IMS3 demonstrated no significant difference between treatment with IV-rtPA a... more Introduction/Purpose IMS3 demonstrated no significant difference between treatment with IV-rtPA alone or IV-rtPA plus IA therapy. However, the trial included only earlier generations of thrombectomy devices and did not evaluate the efficacy of newer devices. Here, we present data on an “IMS-III-Like group” from The North American SOLITAIRE Acute Stroke (NASA) Registry, a repository database of the newer generation Solitaire Stent-retriever. An exploratory analysis was performed to compare these results to the IMS3 IV and IV/IA groups. Materials and Methods The investigator-initiated NASA Registry recruited sites to submit data on consecutive patients treated with Solitaire-FR. A cohort similar to the IMS-III IV-rtPA+Solitaire-FR population (NASA-IMS3 Matched Group (NIMG)) was identified and compared to the recently published results of the IMS3 IV and IV/IA groups. Good clinical outcome was defined as a 90-day mRS ≤2. Successful recanalisation was defined as TIMI ≥2. SICH was defined as any parenchymal haematoma, SAH, or IVH associated with a worsening of the NIHSS score by 4 or more within 24 hours. Results 354 acute ischaemic stroke patients were enrolled in the NASA Registry from 24 centres. The cohorts were comprised of: 156 NIMG versus 434 and 222 in the IMS3 IV/IA and IV only groups, respectively. Baseline demographics were similar between cohorts: Median age 70 (NIMG); 69 (IMS3 IV/IA); 70 (IMS3 IV). Initial median NIHSS was higher in NIMG (19) compared to the IMS3 IV/IA (17) and IMS3 IV groups (18). mTICI > 2b rate was 69.9% in NIMG versus 39.6% in the IMS III IV/IA. Interestingly, mTICI 3 rate was 41% in NIMG vs 2.2% in the IMS III IV/IA group. The 90-day mRS outcome was available in 88.5% (138/156) of NIMG patients. A good outcome of mRS?2 was demonstrated in 51.5% (71/138), compared to 40.8% (169/415) in IMS3 IV/IA and 38.7% (83/215) in IM3 IV alone groups. 90-day mortality was 24.6% in NIMG versus 19.1% and 21.6% in IMS3 IV/IA and IV alone groups, respectively. Abstract O-003 Table 1 NASA IMS III IMS III Characteristic IV-tPA+Solitaire IV-tPA+IA IV-tPA Only (N=156) (N=434) (N=222) Age-yrs.(median, range) 70 (28-100) 69 (23-89) 68 (23-84) Male sex - no. (%) 80 (51.3) 218 (50.2) 122 (55.0) Black race - no. (%) 27 (17.6) 51 (11.8) 19 (8.6) A Fib - no. (%) 66 (42.6) 153 (35.3) 70 (31.5) HTN 114 (73.5) 319 (73.5) 171 (77.0) DM 35 (22.6) 94 (21.7) 54 (24.3) CAD 40 (25.8) 102 (23.5) 72 (32.4) NIHSSi - (median, range) 19 (9-40) 17 (7-40) 16 (8-30) SBPi - (mean±SD) 143.3±26.9 148±21.3 147.3±24.0 mRS ≤2 (N 138 vs 415) 71/138 (51.5) 169/415 (40.8) 83/215 (38.7) mTICI ≥ 2b-3 109/156 (69.9) 126/318 (39.6) NA mTICI 3 64/156 (41.03) 7/318 (2.2) NA sICH 18 (11.6) 27 (6.2) 13 (5.9) Death within 90 days - no. (%) 34/138 (24.6) 83 (19.1) 48 (21.6) Conclusion In the NASA registry, the NASA-IMS3 Matched Group (NIMG) demonstrated a higher rate of good clinical outcome (51.5%) compared to the IMS3 IV/IA (40.8%) and IV alone (34.6%) groups. Disclosures R. Nogueira: None. A. Castonguay: None. R. Gupta: None. C. Sun: None. C. Martin: None. W. Holloway: None. N. Mueller-Kronast: None. J. English: None. I. Linfante: None. G. Dabus: None. T. Malisch: None. H. Bozorgchami: None. A. Xavier: None. A. Rai: None. M. Froehler: None. A. Badruddin: None. T. Nguyen: None. M. Taqi: None. M. Abraham: None. V. Janardhan: None. H. Shaltoni: None. A. Yoo: None. A. Abou-Chebl: None. P. Chen: None. O. Zaidat: None.
Journal of NeuroInterventional Surgery
Ethmoidal dural arteriovenous fistulas (dAVFs) are rare, accounting for 1–1.5% of all intracrania... more Ethmoidal dural arteriovenous fistulas (dAVFs) are rare, accounting for 1–1.5% of all intracranial malformations.1 However, they may have angiographic features that increase the risk of rupture: cortical venous drainage, venous ectasia, venous stenosis and high arterial flow. If the dAVF has these angiographic features, treatment may be indicated regardless of the clinical presentation.2–4 In this neurosurgical …
Journal of NeuroInterventional Surgery
BackgroundDual antiplatelet therapy (DAP) is necessary to prevent thromboembolic events during ca... more BackgroundDual antiplatelet therapy (DAP) is necessary to prevent thromboembolic events during carotid stenting, stent-assisted coil embolization, and implant of flow diverters (FD). However, DAP in the acute phase may be challenging. An intravenous alternative, cangrelor, has rapid onset, short plasma half-life, and more reliable antiplatelet action for acute interventions. The study objective was to evaluate feasibility and safety of IV cangrelor during acute neuroendovascular surgery procedures.MethodsWe performed a retrospective analysis of our database of patients treated with stent-assisted coil embolization, FD placement for aneurysmal subarachnoid hemorrhage (aSAH), or stenting for acute internal carotid artery (ICA) occlusion where IV cangrelor was used. Morbidity, mortality, incidence of thromboembolic events, hemorrhages, and 90-day outcomes were reported.ResultsTen patients were found in our database from June 2018 through January 2019. Four patients had aSAH, four had m...
Journal of the American Heart Association
Background Acute ischemic stroke (AIS) in the context of COVID‐19 has received considerable atten... more Background Acute ischemic stroke (AIS) in the context of COVID‐19 has received considerable attention for its propensity to affect patients of all ages. We aimed to evaluate the effect of age on functional outcome and mortality following an acute ischemic event. Methods and Results A prospectively maintained database from comprehensive stroke centers in Canada and the United States was analyzed for patients with AIS from March 14 to September 30, 2020 who tested positive for SARS‐CoV‐2. The primary outcome was Modified Rankin Scale score at discharge, and the secondary outcome was mortality. Baseline characteristics, laboratory values, imaging, and thrombectomy workflow process times were assessed. Among all 126 patients with COVID‐19 who were diagnosed with AIS, the median age was 63 years (range, 27–94). There were 35 (27.8%) patients with AIS in the aged ≤55 years group, 47 (37.3%) in the aged 56 to 70 group, and 44 (34.9%) in the aged >70 group. Intravenous tissue plasminogen...
Interventional Neurology
Cone beam computed tomography (CBCT), initially used for evaluation of intraprocedural complicati... more Cone beam computed tomography (CBCT), initially used for evaluation of intraprocedural complications such as hemorrhage, has evolved to provide details of implanted devices such as flow diverters. The study aim is to present our experience in using CBCT with intra-arterial injection and provide a step-by-step approach for postprocessing in a practical protocol for daily use. IRB approval was obtained, and the neurointerventional database was retrospectively reviewed from July 2012 to June 2017. Patients who underwent cone beam intra-arterial CT angiography for evaluation of implanted flow diverter devices were reviewed. Patient demographics, aneurysm location (internal carotid artery [ICA]-cavernous, ICA-paraclinoid, and ICA-distal; middle cerebral artery [MCA], anterior cerebral artery [ACA]-acom, ACA-pericallosal, vertebral artery [VA]), type (saccular, dissecting fusiform, or blister) and size, device, injection technique (contrast dilution, rate, and volume), and reconstruction ...
Journal of NeuroInterventional Surgery
ObjectiveIsolated dissecting spinal aneurysms are rare lesions that pose a therapeutic challenge.... more ObjectiveIsolated dissecting spinal aneurysms are rare lesions that pose a therapeutic challenge. We report our experience in the management of four patients with dissecting spinal aneurysms.MethodsAfter institutional review board approval was obtained, the neurointerventional databases of the two participating institutions were retrospectively reviewed. Aneurysms in the anterior spinal artery, posterior spinal artery, or in a radiculomedullary artery were included in the analysis. Flow-related aneurysms were excluded. Data on clinical presentation, hemorrhage location, aneurysm size, location, angiographic follow-up, re-hemorrhage, and clinical outcome were obtained and analyzed.ResultsFour patients with five spinal dissecting aneurysms met the inclusion criteria. There were two women and the mean age was 63 years (range 36–64). All patients presented with hemorrhage. Three radiculomedullary arteries in two different patients had one lesion each; the other two involved the anterior...
Neurosurgery, Jan 17, 2018
The Pipeline Flex (PED Flex; Medtronic, Dublin, Ireland) was designed to facilitate deployment an... more The Pipeline Flex (PED Flex; Medtronic, Dublin, Ireland) was designed to facilitate deployment and navigation compared to its previous iteration to reduce the rate of technical events and complications. To assess the neurological morbidity and mortality rates of the PED Flex at 30 d. Information from 9 neurovascular centers was retrospectively obtained between July 2014 and March 2016. Data included patient/aneurysm characteristics, periprocedural events, clinical, and angiographic outcomes. Multivariate logistic regression was performed to determine predictors of unfavorable clinical outcome (modified Rankin Scale [mRS] > 2). A total of 205 patients harboring 223 aneurysms were analyzed. The 30-d neurological morbidity and mortality rates were 1.9% (4/205) and 0.5% (1/205), respectively. The rate of intraprocedural events without neurological morbidity was 6.8% (14/205), consisting of intraprocedural ischemic events in 9 patients (4.5%) and hemorrhage in 5 (2.4%). Other technica...
Journal of neurointerventional surgery, 2018
Interventional neurology, 2018
Complex wide-neck intracranial aneurysms are challenging to treat. We report a multicenter experi... more Complex wide-neck intracranial aneurysms are challenging to treat. We report a multicenter experience using the LVIS Jr stent for "Y-stent"-assisted coiling embolization of wide-neck bifurcation aneurysms. Seven centers provided retrospective data on patients who underwent Y-stenting. Technical complications, immediate posttreatment angiographic results, clinical outcomes, and imaging follow-up were assessed. Thirty patients/aneurysms were treated: 15 basilar tip, 8 middle cerebral artery, 4 anterior communicating artery, 1 pericallosal, and 2 posterior inferior cerebellar artery aneurysms. The mean aneurysm size was 11 mm and the mean dome-to-neck ratio was 1.3 mm. Twenty-four aneurysms were unruptured and treated electively, and 6 were acutely ruptured. Fifty-eight LVIS Jr stents were successfully deployed without any technical issue. One pro-cedural and transient in-stent thrombosis resolved with the intravenous infusion of a glycoprotein IIb/IIIa inhibitor. Five peripr...
Interventional neurology, 2018
Various techniques are used to enhance the results of mechanical thrombectomy with stent-retrieve... more Various techniques are used to enhance the results of mechanical thrombectomy with stent-retrievers, including proximal arrest with balloon guide catheter (BGC), conventional large bore proximal catheter (CGC), or in combination with local aspiration through a large-bore catheter positioned at the clot interface (Aspiration-Retriever Technique for Stroke [ARTS]). We evaluated the impact of ARTS in the North American Solitaire Acute Stroke (NASA) registry. Data on the use of the aspiration technique were available for 285 anterior circulation patients, of which 29 underwent ARTS technique, 131 CGC, and 125 BGC. Baseline demographics were comparable, except that ARTS patients are less likely to have hypertension or atrial fibrillation. The ARTS group had more ICA occlusions (41.4 vs. 22% in the BGC,= 0.04 and 26% in CGC,= 0.1) and less MCA/M1 occlusions (44.8 vs. 68% in BGC and 62% in CGC). Time from arterial puncture to reperfusion or end of procedure with ARTS was shorter than with ...
Journal of neurointerventional surgery, Jan 24, 2018
Blood blister aneurysms (BBA) are a rare subset of intracranial aneurysms that represent a therap... more Blood blister aneurysms (BBA) are a rare subset of intracranial aneurysms that represent a therapeutic challenge from both a surgical and endovascular perspective. To report multicenter experience with flow diversion exclusively for BBA, located at non-branching segments along the anteromedial wall of the supraclinoidal internal carotid artery (ICA). Consecutive cases of BBA located at non-branching segments along the anteromedial wall of the supraclinoidal ICA treated with flow diversion were included in the final analysis. 49 patients with 51 BBA of the ICA treated with devices to achieve the flow diversion effect were identified. 43 patients with 45 BBA of the ICA were treated with the pipeline embolization device and were included in the final analysis. Angiographic follow-up data were available for 30 patients (32 aneurysms in total); 87.5% of aneurysms (28/32) showed complete obliteration, 9.4% (3/32) showed reduced filling, and 3.1% (1/32) persistent filling. There was no dif...
Journal of neurointerventional surgery, 2018
Frontiers in Neurology, 2021
Background and Purpose: End-of-procedure substantial reperfusion [modified Treatment in Cerebral ... more Background and Purpose: End-of-procedure substantial reperfusion [modified Treatment in Cerebral Ischemia (mTICI) 2b-3], the leading endpoint for thrombectomy studies, has several limitations including a ceiling effect, with recent achieved rates of ~90%. We aimed to identify a more optimal definition of angiographic success along two dimensions: (1) the extent of tissue reperfusion, and (2) the speed of revascularization. Methods: Core-lab adjudicated TICI scores for the first three passes of EmboTrap and the final all-procedures result were analyzed in the ARISE II multicenter study. The clinical impact of extent of reperfusion and speed of reperfusion (first-pass vs. later-pass) were evaluated. Clinical outcomes included 90-day functional independence [modified Rankin Scale (mRS) 0–2], 90-day freedom-from-disability (mRS 0–1), and dramatic early improvement [24-h National Institutes of Health Stroke Scale (NIHSS) improvement ≥ 8 points]. Results: Among 161 ARISE II subjects with ...
Stroke
Background and Purpose: The Tigertriever is a novel, radially adjustable, fully visible, stentrie... more Background and Purpose: The Tigertriever is a novel, radially adjustable, fully visible, stentriever that permits the operator to align radial expansion with target vessel diameters. This multicenter trial compared the Tigertriever’s effectiveness and safety compared with established stent retrievers. Methods: Single arm, prospective, multicenter trial comparing the Tigertriever to efficacy and safety performance goals derived from outcomes in 6 recent pivotal studies evaluating the Solitaire and Trevo stent-retriever devices with a lead-in and a main-study phase. Patients were enrolled if they had acute ischemic stroke with National Institutes of Health Stroke Scale score ≥8 due to large vessel occlusion within 8 hours of onset. The primary efficacy end point was successful reperfusion, defined as core laboratory-adjudicated modified Thrombolysis in Cerebral Ischemia score 2b-3 within 3 passes of the Tigertriever. The primary safety end point was a composite of 90-day all-cause mor...
Oral Poster Abstracts
Background and purpose Endovascular treatment of intracranial aneurysms has become a routine firs... more Background and purpose Endovascular treatment of intracranial aneurysms has become a routine first-line option for treatment of an increasing population of intracranial aneurysms at many neurovascular centers. Since appearance of the balloon-remodeling technique and stent-assisted coiling, wide-neck and complex aneurysms have been treated successfully endovascularly worldwide. Although these 2 techniques have been widely proven, the combination of both traditionally required “extra” maneuvers which made the procedures more complicated technically The aim of our study was to evaluate the technical success, safety and efficacy of the low-profile stents delivered through double lumen balloons. Material and methods Clinical, procedural, and angiographic data, including aneurysm size and location, device or devices used, angiographic and clinical data were analyzed. Results Forty nine patients (33 females, 16 males; range 38–79) harboring 49 aneurysms were analyzed. Aneurysms maximal diameter ranged from 2.5 to 26 mm, with 8 mm average. There were 36 unruptured, 8 recanalized (previously ruptured), 1 wrapped (previously ruptured) and 3 ruptured aneurysms. Locations were ACom (17/49 cases), MCA (17/49 cases), M3 (1/49 case), ICA (3/49 cases), Basilar (7/49 cases), PCA-PSA (1/49 case), PICA (1/49 case) and VA (1/49 case). Scepter (C and XC) and Eclipse 2L double lumen balloons were used. All the low-profile stents available in the market were evaluated, both braided and laser-cut (LVIS junior, LEO Baby, ACCLINO Flex and Neuroform Atlas). In 32 wide-neck of 49 cases, the operator decided the combined technique as first option; While in 17 of 49 cases, combined techniques were used as a bailout because of branch occlusion, coil protrusion or instability during balloon remodeling. 53 devices were placed properly (23 LVIS jr, 15 LEO Baby, 14 ACCLINO Flex and 1 Neuroform Atlas). Navigation and compatibility were effective in 100% of the cases. All devices were deployed satisfactorily through the double lumen balloons and no device had to be removed. Initial wall apposition was excellent in 27 devices, 22 devices fully-opened after jailed microcatheter removal and posterior angioplasty was done in 4. We found 2 minor clinical events (4%) and 1 major event (2%) (Secondary to stents thrombosis in a case where stents were used as bailout because of branches occlusion after intrasaccular device deployment). We had 3 intraprocedural complications, resolved without clinical consequences (2 in-stent thrombus solved with medication and 1 focal SAH controlled with balloon inflation). Three months imaging follow-up were obtained in 3 patients, six-month (±1 month) follow-up were obtained in 18 aneurysms, 12–14 months follow-up in 21 aneurysms. Raymond-1 occlusion rate (complete occlusion) was achieved in 66,6%, Raymond-2 obliteration rate (neck remnant) in 31% and Raymond-3 (residual aneurysm) in 2%. Conclusion The “Combined Remodeling Technique” with low-profile stents delivered through double-lumen balloons is technically easy, feasible, safe and effective for the treatment of intracranial aneurysms. This technique allows the operator to avoid extra maneuvers. Disclosures M. Martínez-galdámez: None. G. Dabus: None. K. Kadziolka: None. M. Puthuran: None. V. Kalousek: None. A. Chandran: None. P. Vega: None. B. Zheng: None. A. Hermosín: None. C. Rodríguez: None.
Journal of NeuroInterventional Surgery, 2013
Introduction/Purpose IMS3 demonstrated no significant difference between treatment with IV-rtPA a... more Introduction/Purpose IMS3 demonstrated no significant difference between treatment with IV-rtPA alone or IV-rtPA plus IA therapy. However, the trial included only earlier generations of thrombectomy devices and did not evaluate the efficacy of newer devices. Here, we present data on an “IMS-III-Like group” from The North American SOLITAIRE Acute Stroke (NASA) Registry, a repository database of the newer generation Solitaire Stent-retriever. An exploratory analysis was performed to compare these results to the IMS3 IV and IV/IA groups. Materials and Methods The investigator-initiated NASA Registry recruited sites to submit data on consecutive patients treated with Solitaire-FR. A cohort similar to the IMS-III IV-rtPA+Solitaire-FR population (NASA-IMS3 Matched Group (NIMG)) was identified and compared to the recently published results of the IMS3 IV and IV/IA groups. Good clinical outcome was defined as a 90-day mRS ≤2. Successful recanalisation was defined as TIMI ≥2. SICH was defined as any parenchymal haematoma, SAH, or IVH associated with a worsening of the NIHSS score by 4 or more within 24 hours. Results 354 acute ischaemic stroke patients were enrolled in the NASA Registry from 24 centres. The cohorts were comprised of: 156 NIMG versus 434 and 222 in the IMS3 IV/IA and IV only groups, respectively. Baseline demographics were similar between cohorts: Median age 70 (NIMG); 69 (IMS3 IV/IA); 70 (IMS3 IV). Initial median NIHSS was higher in NIMG (19) compared to the IMS3 IV/IA (17) and IMS3 IV groups (18). mTICI > 2b rate was 69.9% in NIMG versus 39.6% in the IMS III IV/IA. Interestingly, mTICI 3 rate was 41% in NIMG vs 2.2% in the IMS III IV/IA group. The 90-day mRS outcome was available in 88.5% (138/156) of NIMG patients. A good outcome of mRS?2 was demonstrated in 51.5% (71/138), compared to 40.8% (169/415) in IMS3 IV/IA and 38.7% (83/215) in IM3 IV alone groups. 90-day mortality was 24.6% in NIMG versus 19.1% and 21.6% in IMS3 IV/IA and IV alone groups, respectively. Abstract O-003 Table 1 NASA IMS III IMS III Characteristic IV-tPA+Solitaire IV-tPA+IA IV-tPA Only (N=156) (N=434) (N=222) Age-yrs.(median, range) 70 (28-100) 69 (23-89) 68 (23-84) Male sex - no. (%) 80 (51.3) 218 (50.2) 122 (55.0) Black race - no. (%) 27 (17.6) 51 (11.8) 19 (8.6) A Fib - no. (%) 66 (42.6) 153 (35.3) 70 (31.5) HTN 114 (73.5) 319 (73.5) 171 (77.0) DM 35 (22.6) 94 (21.7) 54 (24.3) CAD 40 (25.8) 102 (23.5) 72 (32.4) NIHSSi - (median, range) 19 (9-40) 17 (7-40) 16 (8-30) SBPi - (mean±SD) 143.3±26.9 148±21.3 147.3±24.0 mRS ≤2 (N 138 vs 415) 71/138 (51.5) 169/415 (40.8) 83/215 (38.7) mTICI ≥ 2b-3 109/156 (69.9) 126/318 (39.6) NA mTICI 3 64/156 (41.03) 7/318 (2.2) NA sICH 18 (11.6) 27 (6.2) 13 (5.9) Death within 90 days - no. (%) 34/138 (24.6) 83 (19.1) 48 (21.6) Conclusion In the NASA registry, the NASA-IMS3 Matched Group (NIMG) demonstrated a higher rate of good clinical outcome (51.5%) compared to the IMS3 IV/IA (40.8%) and IV alone (34.6%) groups. Disclosures R. Nogueira: None. A. Castonguay: None. R. Gupta: None. C. Sun: None. C. Martin: None. W. Holloway: None. N. Mueller-Kronast: None. J. English: None. I. Linfante: None. G. Dabus: None. T. Malisch: None. H. Bozorgchami: None. A. Xavier: None. A. Rai: None. M. Froehler: None. A. Badruddin: None. T. Nguyen: None. M. Taqi: None. M. Abraham: None. V. Janardhan: None. H. Shaltoni: None. A. Yoo: None. A. Abou-Chebl: None. P. Chen: None. O. Zaidat: None.
Journal of NeuroInterventional Surgery
Ethmoidal dural arteriovenous fistulas (dAVFs) are rare, accounting for 1–1.5% of all intracrania... more Ethmoidal dural arteriovenous fistulas (dAVFs) are rare, accounting for 1–1.5% of all intracranial malformations.1 However, they may have angiographic features that increase the risk of rupture: cortical venous drainage, venous ectasia, venous stenosis and high arterial flow. If the dAVF has these angiographic features, treatment may be indicated regardless of the clinical presentation.2–4 In this neurosurgical …
Journal of NeuroInterventional Surgery
BackgroundDual antiplatelet therapy (DAP) is necessary to prevent thromboembolic events during ca... more BackgroundDual antiplatelet therapy (DAP) is necessary to prevent thromboembolic events during carotid stenting, stent-assisted coil embolization, and implant of flow diverters (FD). However, DAP in the acute phase may be challenging. An intravenous alternative, cangrelor, has rapid onset, short plasma half-life, and more reliable antiplatelet action for acute interventions. The study objective was to evaluate feasibility and safety of IV cangrelor during acute neuroendovascular surgery procedures.MethodsWe performed a retrospective analysis of our database of patients treated with stent-assisted coil embolization, FD placement for aneurysmal subarachnoid hemorrhage (aSAH), or stenting for acute internal carotid artery (ICA) occlusion where IV cangrelor was used. Morbidity, mortality, incidence of thromboembolic events, hemorrhages, and 90-day outcomes were reported.ResultsTen patients were found in our database from June 2018 through January 2019. Four patients had aSAH, four had m...
Journal of the American Heart Association
Background Acute ischemic stroke (AIS) in the context of COVID‐19 has received considerable atten... more Background Acute ischemic stroke (AIS) in the context of COVID‐19 has received considerable attention for its propensity to affect patients of all ages. We aimed to evaluate the effect of age on functional outcome and mortality following an acute ischemic event. Methods and Results A prospectively maintained database from comprehensive stroke centers in Canada and the United States was analyzed for patients with AIS from March 14 to September 30, 2020 who tested positive for SARS‐CoV‐2. The primary outcome was Modified Rankin Scale score at discharge, and the secondary outcome was mortality. Baseline characteristics, laboratory values, imaging, and thrombectomy workflow process times were assessed. Among all 126 patients with COVID‐19 who were diagnosed with AIS, the median age was 63 years (range, 27–94). There were 35 (27.8%) patients with AIS in the aged ≤55 years group, 47 (37.3%) in the aged 56 to 70 group, and 44 (34.9%) in the aged >70 group. Intravenous tissue plasminogen...
Interventional Neurology
Cone beam computed tomography (CBCT), initially used for evaluation of intraprocedural complicati... more Cone beam computed tomography (CBCT), initially used for evaluation of intraprocedural complications such as hemorrhage, has evolved to provide details of implanted devices such as flow diverters. The study aim is to present our experience in using CBCT with intra-arterial injection and provide a step-by-step approach for postprocessing in a practical protocol for daily use. IRB approval was obtained, and the neurointerventional database was retrospectively reviewed from July 2012 to June 2017. Patients who underwent cone beam intra-arterial CT angiography for evaluation of implanted flow diverter devices were reviewed. Patient demographics, aneurysm location (internal carotid artery [ICA]-cavernous, ICA-paraclinoid, and ICA-distal; middle cerebral artery [MCA], anterior cerebral artery [ACA]-acom, ACA-pericallosal, vertebral artery [VA]), type (saccular, dissecting fusiform, or blister) and size, device, injection technique (contrast dilution, rate, and volume), and reconstruction ...
Journal of NeuroInterventional Surgery
ObjectiveIsolated dissecting spinal aneurysms are rare lesions that pose a therapeutic challenge.... more ObjectiveIsolated dissecting spinal aneurysms are rare lesions that pose a therapeutic challenge. We report our experience in the management of four patients with dissecting spinal aneurysms.MethodsAfter institutional review board approval was obtained, the neurointerventional databases of the two participating institutions were retrospectively reviewed. Aneurysms in the anterior spinal artery, posterior spinal artery, or in a radiculomedullary artery were included in the analysis. Flow-related aneurysms were excluded. Data on clinical presentation, hemorrhage location, aneurysm size, location, angiographic follow-up, re-hemorrhage, and clinical outcome were obtained and analyzed.ResultsFour patients with five spinal dissecting aneurysms met the inclusion criteria. There were two women and the mean age was 63 years (range 36–64). All patients presented with hemorrhage. Three radiculomedullary arteries in two different patients had one lesion each; the other two involved the anterior...
Neurosurgery, Jan 17, 2018
The Pipeline Flex (PED Flex; Medtronic, Dublin, Ireland) was designed to facilitate deployment an... more The Pipeline Flex (PED Flex; Medtronic, Dublin, Ireland) was designed to facilitate deployment and navigation compared to its previous iteration to reduce the rate of technical events and complications. To assess the neurological morbidity and mortality rates of the PED Flex at 30 d. Information from 9 neurovascular centers was retrospectively obtained between July 2014 and March 2016. Data included patient/aneurysm characteristics, periprocedural events, clinical, and angiographic outcomes. Multivariate logistic regression was performed to determine predictors of unfavorable clinical outcome (modified Rankin Scale [mRS] > 2). A total of 205 patients harboring 223 aneurysms were analyzed. The 30-d neurological morbidity and mortality rates were 1.9% (4/205) and 0.5% (1/205), respectively. The rate of intraprocedural events without neurological morbidity was 6.8% (14/205), consisting of intraprocedural ischemic events in 9 patients (4.5%) and hemorrhage in 5 (2.4%). Other technica...
Journal of neurointerventional surgery, 2018
Interventional neurology, 2018
Complex wide-neck intracranial aneurysms are challenging to treat. We report a multicenter experi... more Complex wide-neck intracranial aneurysms are challenging to treat. We report a multicenter experience using the LVIS Jr stent for "Y-stent"-assisted coiling embolization of wide-neck bifurcation aneurysms. Seven centers provided retrospective data on patients who underwent Y-stenting. Technical complications, immediate posttreatment angiographic results, clinical outcomes, and imaging follow-up were assessed. Thirty patients/aneurysms were treated: 15 basilar tip, 8 middle cerebral artery, 4 anterior communicating artery, 1 pericallosal, and 2 posterior inferior cerebellar artery aneurysms. The mean aneurysm size was 11 mm and the mean dome-to-neck ratio was 1.3 mm. Twenty-four aneurysms were unruptured and treated electively, and 6 were acutely ruptured. Fifty-eight LVIS Jr stents were successfully deployed without any technical issue. One pro-cedural and transient in-stent thrombosis resolved with the intravenous infusion of a glycoprotein IIb/IIIa inhibitor. Five peripr...
Interventional neurology, 2018
Various techniques are used to enhance the results of mechanical thrombectomy with stent-retrieve... more Various techniques are used to enhance the results of mechanical thrombectomy with stent-retrievers, including proximal arrest with balloon guide catheter (BGC), conventional large bore proximal catheter (CGC), or in combination with local aspiration through a large-bore catheter positioned at the clot interface (Aspiration-Retriever Technique for Stroke [ARTS]). We evaluated the impact of ARTS in the North American Solitaire Acute Stroke (NASA) registry. Data on the use of the aspiration technique were available for 285 anterior circulation patients, of which 29 underwent ARTS technique, 131 CGC, and 125 BGC. Baseline demographics were comparable, except that ARTS patients are less likely to have hypertension or atrial fibrillation. The ARTS group had more ICA occlusions (41.4 vs. 22% in the BGC,= 0.04 and 26% in CGC,= 0.1) and less MCA/M1 occlusions (44.8 vs. 68% in BGC and 62% in CGC). Time from arterial puncture to reperfusion or end of procedure with ARTS was shorter than with ...
Journal of neurointerventional surgery, Jan 24, 2018
Blood blister aneurysms (BBA) are a rare subset of intracranial aneurysms that represent a therap... more Blood blister aneurysms (BBA) are a rare subset of intracranial aneurysms that represent a therapeutic challenge from both a surgical and endovascular perspective. To report multicenter experience with flow diversion exclusively for BBA, located at non-branching segments along the anteromedial wall of the supraclinoidal internal carotid artery (ICA). Consecutive cases of BBA located at non-branching segments along the anteromedial wall of the supraclinoidal ICA treated with flow diversion were included in the final analysis. 49 patients with 51 BBA of the ICA treated with devices to achieve the flow diversion effect were identified. 43 patients with 45 BBA of the ICA were treated with the pipeline embolization device and were included in the final analysis. Angiographic follow-up data were available for 30 patients (32 aneurysms in total); 87.5% of aneurysms (28/32) showed complete obliteration, 9.4% (3/32) showed reduced filling, and 3.1% (1/32) persistent filling. There was no dif...
Journal of neurointerventional surgery, 2018