134 results on '"Daniel Giansante Abud"'
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2. Acknowledgement to Editors and Scientific Referees 2022
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Matheus Fernando Manzolli Ballestero, Alexandre Canheu, Aline Saré de Melo, Amanda Lopez, Artur Henrique Galvão Bruno da Cunha, Bruno Fernandes, Carlos Eduardo Barros Jucá, Carlos Umberto Pereira, Cassio Raposo-Amaral, Clarissa Turrer, Daniel Giansante Abud, Emmanuel de Oliveira Sampaio Vasconcelos e Sá, Guilherme Podolsky-Gondim, Gustavo Sampaio, José Aloysio da Costa Val Filho, José Roberto Tude, Leopoldo Mandic Furtado, Leyzeane Marques do Nascimento, Linoel Valsechi, Luciano Furlanetti, Marcelo Volpon Santos, Marco Tulio Rezende, Marcius Benigno Marques dos Santos, Marcos Devanir Silva da Costa, Nelci Zanon, Patricia Dastoli, Paulo Ronaldo Jubé Ribeiro, Ricardo Santos de Oliveira, Ricardo de Amoreira Gepp, Sergio Cavalheiro, Simone Mendes Rogerio, Tatiana Protzenko Protzenko, Tiago Paiva Cavalcante, Vinícius Marques Carneiro, and Alexandre Varella Giannetti
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acknowledgement ,Pediatrics ,RJ1-570 ,Surgery ,RD1-811 - Abstract
A scientific journal’s greatest responsibility is to ensure that all contributions accepted for publications are rigorously but fairly reviewed. The Editor-in-Chief and Archives of Pediatric Neurosurgery gratefully acknowledge the qualified and regular collaboration of renowned medical doctors and scientists who kindly devoted their time to constructively review the submitted articles. Their expertise and invaluable assistance contributed to maintain a high scientific standard for APN. We are thus indebted to the Editorial Board members and the following experts who reviewed papers and completed the peer-reviewing process within 2022.
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- 2023
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3. Transarterial embolization with n-butyl cyanoacrylate for the treatment of active abdominopelvic bleeding in the polytraumatized patient
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Rafael Kiyuze de Freitas, Lucas Moretti Monsignore, Luis Henrique de Castro-Afonso, Guilherme Seizem Nakiri, Jorge Elias-Junior, Valdair Francisco Muglia, Sandro Scarpelini, and Daniel Giansante Abud
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Hemorrhage ,Trans-arterial embolization ,Interventional radiology ,Wounds and injuries ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Purpose An increasing number of polytraumatized patient presenting with active abdominal pelvic bleeding (APB) have been treated by endovascular selective embolization. However, reports on evaluate the efficacy, safety and complications caused by this technique have been limited. The aim of this study was to assess the safety and efficacy of embolization of APB using N-butyl cyanoacrylate glue (NBCA). Materials and methods Single center retrospective study, that included consecutive 47 patients presenting with traumatic APB treated by embolization with NBCA between January 2013 and June 2019. The efficacy endpoint was defined as the absence of contrast extravasation immediately after procedure and clinical stabilization in the following 24 h after procedure. Clinical stabilization was defined as no rebleeding after embolization or the need for a surgical approach until the patient is discharged. Safety endpoint were any technical or clinical complications related to the embolization procedure. Results The mean age of patients was 38.6 years (3–81), with a predominance of males (87.2%). The major causal factor of APB being involvement in a car accident, accounting for 68% of cases. Of the 47 cases, 29.8% presented pelvic trauma and the remaining (70.2%) presented abdominal trauma. The efficacy rate was 100%, while no complications related to the procedure were observed. The mortality rate was 14.8% (7/47) due to neurologic decompensation and other clinical causes. Conclusion Endovascular embolization of traumatic abdominopelvic bleedings appear to be a highly safe and effective treatment, while avoiding emergent exploratory open surgeries.
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- 2021
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4. Casper stent in the treatment of pulsatile tinnitus in fibromuscular dysplasia: Therapeutic review and case report
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José Ricardo Vanzin, Artur Eduardo Martio, Luciano Bambini Manzato, and Daniel Giansante Abud
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carotid artery angioplasty stenting ,casper stent ,dual-layer stent ,fibromuscular dysplasia ,tinnitus ,Medical technology ,R855-855.5 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Fibromuscular dysplasia (FMD) is a known cause of pulsatile tinnitus that can, on rare occasion, evolve into an incapacitating condition. It is a noninflammatory and nonatherosclerotic arteriopathy of unknown cause that affects medium-sized vessels, such as the carotid and renal arteries, occurring mainly in women. We describe a 72-year-old woman suffering from pulsatile tinnitus refractory to medical treatment who was successfully treated with Casper stent in the carotid artery. The different treatment strategies published in the literature were reviewed.
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- 2021
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5. Safety of ultrasound-guided distal radial artery access for abdominopelvic transarterial interventions: a prospective study
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Adib Koury Jr., Lucas Moretti Monsignore, Luis Henrique de Castro-Afonso, and Daniel Giansante Abud
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Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
PURPOSEWe aimed to evaluate ultrasound-guided distal radial artery (DRA) access to perform abdominopelvic endovascular procedures.METHODSA prospective, observational study was carried out in a single center between December 2017 and February 2019. Forty-two abdominopelvic endovascular procedures were performed by the same operator in 37 patients with DRA access using a 5 F sheath. Most patients were male (67.6%) with a mean age of 62.0±11.4 years (age range, 27.6–82.8 years). Patient characteristics, including Barbeau’s test classification, radial and ulnar sizes and technical success, were evaluated. Patients with a DRA smaller than 1.7 mm could not be safely punctured and were not included.RESULTSProcedures included chemoembolization of hepatocellular carcinoma in 35 cases (83.3%), embolization of hepatic metastasis in neuroendocrine tumors in 4 cases (9.5%) and other embolization procedures in 3 cases (7.1%). The mean diameters of the DRA, proximal radial artery and proximal ulnar artery were 2.31, 2.63, and 2.09 mm, respectively. Out of 42 DRA puncture attempts, 97.6% (41/42) were successfully performed. There were no postoperative complications related to the access site, such as pain, palsy, paresthesia, occlusion, finger ischemia, bleeding, hematoma, and pseudoaneurysm. Transient forearm discomfort was reported in 7.1% of patients (3/42); one occurrence was associated with kinking rectification, and two occurrences were attributed to small arteries and/or vasospasm.CONCLUSIONUltrasound-guided DRA access seems to be feasible and safe to perform in abdominopelvic endovascular procedures in patients with a DRA considered amenable to be safely punctured, with high technical success rates.
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- 2020
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6. Management of acute stroke and urgent neurointerventional procedures during COVID-19 pandemic: recommendations on the Scientific Department on Cerebrovascular Diseases of the Brazilian Academy of Neurology, Brazilian Society of Cerebrovascular Diseases and Brazilian Society of Neuroradiology
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Francisco José Arruda MONT’ALVERNE, Fabrício Oliveira LIMA, Raul Gomes NOGUEIRA, Carlos Clayton Macedo de FREITAS, Octávio Marques Pontes NETO, Gisele Sampaio SILVA, Maura Salaroli de OLIVEIRA, Michel FRUDIT, Jose Guilherme Mendes Pereira CALDAS, Daniel Giansante ABUD, Adriana Bastos CONFORTO, Fernanda Martins Maia CARVALHO, Francisco Antunes DIAS, Rodrigo BAZAN, Wagner Mauad AVELAR, Carla Heloísa Cabral MORO, Pedro Silva Correa de MAGALHÃES, Maramelia MIRANDA, Leandro de Assis BARBOSA, José Antonio FIOROT JUNIOR, Fabrício Buchdid CARDOSO, Leticia Costa REBELLO, Bruno de Sousa Mendes PARENTE, Mário de Barros FARIA, Gabriel Rodriguez de FREITAS, Viviane de Hiroki Flumignan ZÉTOLA, Jamary OLIVEIRA-FILHO, Daniel da Cruz BEZERRA, Jorge Luis Nobre RODRIGUES, Gustavo KUSTER, Sheila MARTINS, and João José Freitas de CARVALHO
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neurointerventional treatment ,coronavirus infections ,stroke ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
ABSTRACT Introduction: Although the 2019 severe acute respiratory syndrome coronavirus 2 infection (SARS-CoV-2, COVID-19) pandemic poses new challenges to the healthcare system to provide support for thousands of patients, there is special concern about common medical emergencies, such as stroke, that will continue to occur and will require adequate treatment. The allocation of both material and human resources to fight the pandemic cannot overshadow the care for acute stroke, a time-sensitive emergency that with an inefficient treatment will further increase mortality and long-term disability. Objective: This paper summarizes the recommendations from the Scientific Department on Cerebrovascular Diseases of the Brazilian Academy of Neurology, the Brazilian Society of Cerebrovascular Diseases and the Brazilian Society of Neuroradiology for management of acute stroke and urgent neuro-interventional procedures during the COVID-19 pandemic, including proper use of screening tools, personal protective equipment (for patients and health professionals), and patient allocation.
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- 2020
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7. Transarterial embolization with n-butyl cyanoacrylate for the treatment of abdominal wall hemorrhage
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Tales Vieira Cavalcanti Albuquerque, Lucas Moretti Monsignore, Luis Henrique de Castro-Afonso, Jorge Elias-Junior, Valdair Francisco Muglia, and Daniel Giansante Abud
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Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
PURPOSEWe aimed to evaluate the effectiveness and safety of n-butyl cyanoacrylate (n-BCA) in the context of the transarterial embolization (TAE) of abdominal wall hemorrhage in an urgent scenario.METHODSA retrospective study of cases admitted from January 2008 to December 2017 in the emergency unit of our institution revealed 11 patients with abdominal wall hemorrhage who underwent digital subtraction angiography and TAE with n-BCA. We analyzed the sex, age, hemorrhagic risk factors, etiology, embolized vessel, technical success (no rebleeding in the embolized area), clinical success (hemoglobin level control and hemodynamic stability after the procedure), complications inherent to the procedure, and clinical outcome (mortality in 30 days).RESULTSThe mean age was 63.4 years (52–83 years), with a predominance of the female sex (64%). The majority (91%) of patients presented hemorrhagic risk factors (chronic hepatopathy and anticoagulation drug usage). Spontaneous hemorrhage was present in 18% of patients, and the other 82% had an iatrogenic etiology. Technical success was achieved in 100% of the patients, which required the embolization of inferior epigastric artery in 10 patients (91%), circumflex iliac artery in 2 (18%), and superior epigastric artery in 1 (9%). Five patients were hemodynamically unstable, and despite achieving technical success, 4 (36%) died in less than 30 days due to decompensation of their clinical comorbidities caused by the acute phase. There were no complications inherent to the procedures.CONCLUSIONThe present study concludes that TAE with n-BCA is a safe and effective treatment for abdominal wall hemorrhage in an urgent scenario, with high rates of technical and clinical success.
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- 2020
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8. Curative embolization of a vein of Galen malformation with a dual-lumen balloon and ethylene vinyl alcohol copolymer
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Luís Henrique de Castro-Afonso and Daniel Giansante Abud
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vein of galen malformation ,embolization ,dual-lumen balloons ,Pediatrics ,RJ1-570 ,Surgery ,RD1-811 - Abstract
The endovascular approach is the standard treatment of vein of Galen malformations (VOGMs,) however the morbidity and mortality rates of VOGMs treated by embolization are still significant. Embolization with ethylene vinyl alcohol copolymer (EVOH) by a dual-lumen balloon (DLB) is a promising. In the present case we demonstrated two strategies of transarterial (TA) embolization of a mural type VOGM presenting with two direct shunts. The first shunt was embolized using coils to reduce the flow through the shunt, following by an EVOH injection which resulted in the complete occlusion of that shunt. The second shunt was embolized also with EVOH but through a DLB. In the second embolization a very precise cast of EVOH could be created resulting in a complete occlusion of the VOGM. This case demonstrated the advantages of DLB compared to other embolization techniques
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- 2021
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9. Value of 3D-TOF MR angiography and 4D-dynamic contrast-enhanced MRI in the assessment of spontaneous posterior cavernous sinus dural arteriovenous fistula
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Francisco Bermal CAPARROZ NETO, Lucas Giansante ABUD, Rafael Gouveia Gomes de OLIVEIRA, Daniel Giansante ABUD, and Soraia Ramos Cabete FABIO
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Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Published
- 2021
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10. Intracranial aneurysm diameter and risk of rupture
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Felipe Padovani Trivelato, Alexandre Cordeiro Ulhôa, Daniel Giansante Abud, and Marco Túlio Salles Rezende
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Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Published
- 2019
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11. Carotid artery stenting in the context of endovascular treatment of acute ischemic stroke
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Adson F. de Lucena, Luís Henrique de Castro-Afonso, Lucas M. Monsignore, Guilherme S. Nakiri, Soraia R. C. Fábio, Octávio Pontes Neto, and Daniel Giansante Abud
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acidente vascular cerebral isquêmico agudo ,estenose carotídea sintomática ,angiolastia com stent de carótida ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
ABSTRACT Mechanical thrombectomy as an adjunctive to intravenous thrombolysis is now the standard treatment for acute ischemic stroke (AIS) due to large vessel occlusions. However, the best management of acute carotid tandem occlusions (CTO) remains controversial. Method Twenty patients underwent endovascular treatment of acute CTO. The primary endpoint was the composite rate of complete or partial recanalization without a symptomatic intracranial hemorrhage (sICH). Secondary endpoints were recanalization times, procedure times, and clinical outcomes at three months. Results The primary endpoint was reached in 17 (85%) patients. Recanalization rate was reached in 90% of patients (19/20) and sICH rate was 5% (1/20). At the 3-month follow-up we obtained a mRS ≤ 2 rate of 35% (7/20) and a mortality rate of 20% (4/20). Conclusion Carotid angioplasty stenting and endovascular treatment of AIS due to CTO appears effective with an acceptable rate of sICH.
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- 2016
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12. International Survey on the Management of Wake-Up Stroke
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Luís Henrique de Castro-Afonso, Guilherme Seizem Nakiri, Octávio Marques Pontes-Neto, Antônio Carlos dos Santos, and Daniel Giansante Abud
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Brain imaging ,Intravenous thrombolysis ,Endovascular treatment ,Wake-up stroke ,Mechanical thrombectomy ,Intra-arterial thrombolysis ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: Patients who wake up having experienced a stroke while asleep represent around 20% of acute stroke admissions. According to international guidelines for the management of acute stroke, patients presenting with wake-up stroke are not currently eligible to receive revascularization treatments. In this study, we aimed to assess the opinions of stroke experts about the management of patients with wake-up stroke by using an international multicenter electronic survey. Method: This study consisted of 8 questions on wake-up stroke treatment. Results: Two hundred invitations to participate in the survey were sent by e-mail. Fifty-nine participants started the survey, 4 dropped out before completing it, and 55 completed the full questionnaire. We had 55 participants from 22 countries. Conclusions: In this study, most stroke experts recommended a recanalization treatment for wake-up stroke. However, there was considerable disagreement among experts regarding the best brain imaging method and the best recanalization treatment. The results of ongoing randomized trials on wake-up stroke are urgently needed.
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- 2016
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13. Addition of n-butyl cyanoacrylate to classic transarterial chemoembolization may improve the radiological response in patients with hepatocellular carcinoma
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Lucas Moretti Monsignore, Jorge Elias-Junior, Valdair Francisco Muglia, Andreza Correa Teixeira, Enio David Mente, Ana de Lourdes Candolo Martinelli, and Daniel Giansante Abud
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Liver ,Hepatocellular carcinoma ,Therapeutic chemoembolization ,Enbucrilate ,Medicine (General) ,R5-920 - Abstract
OBJECTIVE: Transarterial chemoembolization is the treatment of choice for intermediate-stage hepatocellular carcinoma. However, there are no clear data supporting transarterial chemoembolization vs . transarterial embolization or regarding the best chemotherapeutic agent, which may suggest a preponderant role of ischemia over chemotherapeutic action. This study sought to evaluate the radiological response and outcome of transarterial chemoembolization modified by n-butyl cyanoacrylate addition compared to conventional transarterial chemoembolization in hepatocellular carcinoma patients. MATERIALS AND METHODS: A retrospective review identified forty-seven patients who underwent modified chemoembolization and thirty-three who underwent conventional chemoembolization between June 2006 and December 2011. The radiological response was reassessed using the modified Response Evaluation Criteria in Solid Tumors. The sustained complete response, time to progression and overall survival rates were also analyzed. RESULTS: Complete response rates were significantly higher in patients who had undergone modified chemoembolization compared to those who had undergone conventional treatment (61.7% and 24.3%, respectively; p
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- 2015
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14. Shared decision-making in the context of unruptured intracranial aneurysms management
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Luís Henrique de Castro-Afonso and Daniel Giansante Abud
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aneurismas cerebrais não rotos ,decisão médica compartilhada ,aneurismas cerebrais ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
Shared decision-making practice has been encouraged in several clinical settings. In this model, clinical decisions are defined by doctors and patients based on the principle of patient autonomy. Shared decisions have been argued as an ethical clinical practice during complex and uncertain clinical situations. The best management of unruptured intracranial aneurysms (UIA) remains controversial. Despite the fact that shared decisions has probably been practiced, as far as we are aware it has not yet been evaluated, nor has it been standardized for patients presenting UIA. We aim to discuss possible roles, pros and cons of shared decision-making on the management of UIA.
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- 2015
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15. Outcomes of carotid artery stenting at a high-volume Brazilian interventional neuroradiology center
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Luis Henrique de Castro-Afonso, Guilherme Seizem Nakiri, Lucas Moretti Monsignore, Daniela dos Santos, Millene Rodrigues Camilo, Francisco Antunes Dias, Pedro Telles Cougo-Pinto, Clara Monteiro Antunes Barreira, Frederico Fernandes Alessio-Alves, Soraia Ramos Cabette Fábio, Octávio Marques Pontes-Neto, and Daniel Giansante Abud
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Carotids angioplasty stenting ,Symptomatic carotid artery stenosis ,Asymptomatic carotid artery stenosis ,Carotid endarterectomy ,Medicine (General) ,R5-920 - Abstract
OBJECTIVES: Carotid artery stenting is an emerging revascularization alternative to carotid endarterectomy. However, guidelines have recommended carotid artery stenting only if the rate of periprocedural stroke or death is < 6% among symptomatic patients and < 3% among asymptomatic patients. The aim of this study is to evaluate and compare clinical outcomes of symptomatic and asymptomatic patients who had undergone carotid artery stenting as a first-intention treatment. METHOD: A retrospective analysis of patients who underwent carotid artery stenting by our interventional neuroradiology team was conducted. Patients were divided into two groups: symptomatic and asymptomatic patients. The primary endpoints were ipsilateral ischemic stroke, ipsilateral parenchymal hemorrhage and major adverse cardiac and cerebrovascular events at 30 days. The secondary endpoints included ipsilateral ischemic stroke, ipsilateral parenchymal hemorrhage, ipsilateral transient ischemic attack and major adverse cardiac and cerebrovascular events between the 1- and 12-month follow-ups. RESULTS: A total of 200 consecutive patients were evaluated. The primary endpoints obtained in the symptomatic vs. asymptomatic groups were ipsilateral stroke (2.4% vs. 2.7%, p = 1.00), ipsilateral parenchymal hemorrhage (0.8% vs. 0.0%, p = 1.00) and major adverse cardiac and cerebrovascular events (4.7% vs. 2.7%, p = 0.71). The secondary endpoints obtained in the symptomatic vs. asymptomatic groups were ipsilateral ischemic stroke (0.0% vs. 0.0%), ipsilateral parenchymal hemorrhage (0.0% vs. 0.0%), ipsilateral TIA (0.0% vs. 0.0%, p = 1.00) and major adverse cardiac and cerebrovascular events (11.2% vs. 4.1%, p = 0.11). CONCLUSIONS: In this retrospective study, carotid artery stenting was similarly safe and effective when performed as a first-intention treatment in both symptomatic and asymptomatic patients. The study results comply with the safety requirements from current recommendations to perform carotid artery stenting as an alternative treatment to carotid endarterectomy.
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- 2015
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16. Mechanical thrombectomy with solitaire stent retrieval for acute ischemic stroke in a Brazilian population
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Luis Henrique de Castro-Afonso, Thiago Giansante Abud, Octávio Marques Pontes-Neto, Lucas Moretti Monsignore, Guilherme Seizem Nakiri, Pedro Telles Cougo-Pinto, Lívia de Oliveira, Daniela dos Santos, Francisco A Dias, Soraia Cabette Ramos Fábio, Francisco Antônio Coletto, and Daniel Giansante Abud
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Acute Ischemic Stroke ,Mechanical Thrombectomy ,Stent Retrieval ,Thrombolysis ,Medicine (General) ,R5-920 - Abstract
OBJECTIVE: Large vessel occlusion in acute ischemic stroke is associated with low recanalization rates under intravenous thrombolysis. We evaluated the safety and efficacy of the Solitaire AB stent in treating acute ischemic stroke. METHODS: Patients presenting with acute ischemic stroke were prospectively evaluated. The neurological outcomes were assessed using the National Institutes of Health Stroke Scale and the modified Rankin Scale. Time was recorded from the symptom onset to the recanalization and procedure time. Recanalization was assessed using the thrombolysis in cerebral infarction score. RESULTS: Twenty-one patients were evaluated. The mean patient age was 65, and the National Institutes of Health Stroke Scale scores ranged from 7 to 28 (average 17±6.36) at presentation. The vessel occlusions occurred in the middle cerebral artery (61.9%), distal internal carotid artery (14.3%), tandem carotid occlusion (14.3%), and basilarartery (9.5%). Primary thrombectomy, rescue treatment and a bridging approach represented 66.6%, 28.6%, and 4.8% of the performed procedures, respectively. The mean time from symptom onset to recanalization was 356.5±107.8 minutes (range, 80-586 minutes). The mean procedure time was 60.4±58.8 minutes (range, 14-240 minutes). The overall recanalization rate (thrombolysis in cerebral infarction scores of 3 or 2b) was 90.4%, and the symptomatic intracranial hemorrhage rate was 14.2%. The National Institutes of Health Stroke Scale scores at discharge ranged from 0 to 25 (average 6.9±7). At three months, 61.9% of the patients had a modified Rankin Scale score of 0 to 2, with an overall mortality rate of 9.5%. CONCLUSIONS: Intra-arterial thrombectomy with the Solitaire AB device appears to be safe and effective. Large randomized trials are necessary to confirm the benefits of this approach in acute ischemic stroke.
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- 2012
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17. Number of coils necessary to treat cerebral aneurysms according to each size group: a study based on a series of 952 embolized aneurysms
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José Ricardo Vanzin, Daniel Giansante Abud, Marco Tulio Salles Rezende, and Jacques Moret
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aneurisma intracraniano ,tratamento endovascular ,molas ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
OBJECTIVE: The Brazilian public health system determines a quantity of coils allowed to treat a cerebral aneurysm. The goal of this paper was to determine the number of coils necessary to treat an aneurysm based on size. METHODS: All patients harboring an aneurysm treated by endovascular approach between 1999 and 2003 were reviewed. RESULTS: There were 952 aneurysms included. Mean diameter sac was 8.2 mm with 7.9 coils per aneurysm. Out of 462 small aneurysms, mean size was 4.8 mm, with 4.6 coils/aneurysm used. A total of 315 medium aneurysms were treated, mean size was 8.6 mm, with 8.2 coils. Out of 135 large, mean size was 17 mm, with 16.1 coils. Forty giant aneurysms were treated with a mean size of 32 mm and 28.7 coils. CONCLUSIONS: We propose size as a reference to predict the number of coils necessary to treat each aneurysm: one coil for each millimeter of diameter.
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- 2012
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18. Frequency and predictors of symptomatic intracranial hemorrhage after intravenous thrombolysis for acute ischemic stroke in a Brazilian public hospital
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Pedro Telles Cougo-Pinto, Bruno Lopes dos Santos, Francisco Antunes Dias, Soraia Ramos Cabette Fabio, Ilana Vaula Werneck, Millene Rodrigues Camilo, Daniel Giansante Abud, João Pereira Leite, and Octavio Marques Pontes-Neto
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Acute Stroke ,Thrombolytic Therapy ,Brain Hemorrhage ,Statins ,Tissue Plasminogen Activator ,Medicine (General) ,R5-920 - Abstract
OBJECTIVE: Scarce data are available on the occurrence of symptomatic intracranial hemorrhage related to intravenous thrombolysis for acute stroke in South America. We aimed to address the frequency and clinical predictors of symptomatic intracranial hemorrhage after stroke thrombolysis at our tertiary emergency unit in Brazil. METHOD: We reviewed the clinical and radiological data of 117 consecutive acute ischemic stroke patients treated with intravenous thrombolysis in our hospital between May 2001 and April 2010. We compared our results with those of the Safe Implementation of Thrombolysis in Stroke registry. Univariate and multiple regression analyses were performed to identify factors associated with symptomatic intracranial transformation. RESULTS: In total, 113 cases from the initial sample were analyzed. The median National Institutes of Health Stroke Scale score was 16 (interquartile range: 10-20). The median onset-to-treatment time was 188 minutes (interquartile range: 155-227). There were seven symptomatic intracranial hemorrhages (6.2%; Safe Implementation of Thrombolysis in Stroke registry: 4.9%; p = 0.505). In the univariate analysis, current statin treatment and elevated National Institute of Health Stroke Scale scores were related to symptomatic intracranial hemorrhage. After the multivariate analysis, current statin treatment was the only factor independently associated with symptomatic intracranial hemorrhage. CONCLUSIONS: In this series of Brazilian patients with severe strokes treated with intravenous thrombolysis in a public university hospital at a late treatment window, we found no increase in the rate of symptomatic intracranial hemorrhage. Additional studies are necessary to clarify the possible association between statins and the risk of symptomatic intracranial hemorrhage after stroke thrombolysis.
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- 2012
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19. Dural arteriovenous fistulas with direct cortical venous drainage treated with Onyx®: a case series Fístulas arteriovenosas durais com drenagem cortical direta tratadas com Onyx®: casuística
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Felipe Padovani Trivelato, Daniel Giansante Abud, Alexandre Cordeiro Ulhôa, Tiago de Jesus Menezes, Thiago Giansante Abud, Guilherme Seikem Nakiri, Benedicto Oscar Colli, Sebastião Nataniel Silva Gusmão, and Marco Túlio Salles Rezende
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fistula arteriovenosa dural ,malformação ,arteriovenosa dural ,embolização ,endovascular ,Onyx® ,transarterial ,dural arteriovenous fistula ,dural arteriovenous malformation ,embolization ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
Dural arteriovenous fistulas (DAVFs) may have aggressive symptoms, especially if there is direct cortical venous drainage. We report our preliminary experience in transarterial embolization of DAVFs with direct cortical venous drainage (CVR) using Onyx®. METHOD: Nine patients with DAVFs with direct cortical venous drainage were treated: eight type IV and one type III (Cognard). Treatment consisted of transarterial embolization using Onyx-18®. Immediate post treatment angiographies, clinical outcome and late follow-up angiographies were studied. RESULTS: Complete occlusion of the fistula was achieved in all patients with only one procedure and injection in only one arterial pedicle. On follow-up, eight patients became free from symptoms, one improved and no one deteriorated. Late angiographies showed no evidence of recurrent DAVF. CONCLUSION: We recommend that transarterial Onyx® embolization of DAVFs with direct cortical venous drainage be considered as a treatment option, while it showed to be feasible, safe and effective.As fistulas arteriovenosas durais (FAVDs) podem se manifestar com sintomas agressivos, especialmente se existe drenagem cortical direta. Relatamos nossa experiência preliminar na embolização transarterial de FAVDs com drenagem cortical direta usando Onyx®. MÉTODO: Nove pacientes com FAVDs com drenagem cortical direta foram tratados: oito do tipo IV e uma do tipo III (Cognard). O tratamento consistiu na embolização transarterial usando Onyx-18®. Angiografias imediatas pós-tratamento, evolução clínica e angiografias de controle tardias foram estudadas. RESULTADOS: A oclusão completa da fístula foi alcançada em todos pacientes através de um só procedimento e injeção em apenas um pedículo arterial. No seguimento, oito pacientes ficaram livres de sintomas, um melhorou e nenhum deteriorou. Angiografias tardias de controle não mostraram evidência de FAVD recorrente. CONCLUSÃO: Nós recomendamos que a embolização transarterial com Onyx® das FAVDs com drenagem cortical direta, seja considerada como uma opção terapêutica, uma vez que mostrou ser factível, segura e efetiva.
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- 2010
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20. Diabetic hemichorea-hemiballismus with nonketotic hyperglicemia: a rare cause of hyperkinetic movement disorders
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Lucas Giansante Abud, Thiago Giansante Abud, Rodolfo Mendes Queiroz, Giovanni Salton Pietroni, and Daniel Giansante Abud
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Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Published
- 2016
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21. Intracranial dural arteriovenous fistula with perimedullary drainage treated by endovascular embolization
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Lucas Giansante Abud, Thiago Giansante Abud, Guilherme Seizem Nakiri, Rodolfo Mendes Queiroz, and Daniel Giansante Abud
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Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Published
- 2015
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22. Evaluation of embolization for periuterine varices involving chronic pelvic pain secondary to pelvic congestion syndrome
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Flavio Meirelles Siqueira, Lucas Moretti Monsignore, Julio Cesar Rosa-e-Silva, Omero Benedicto Poli-Neto, Luis Henrique de Castro-Afonso, Guilherme Seizem Nakiri, Valdair Francisco Muglia, and Daniel Giansante Abud
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chronic pelvic pain ,pelvic congestion syndrome ,embolization ,endovascular procedures ,Medicine (General) ,R5-920 - Abstract
OBJECTIVES: To evaluate the clinical response and success rate after periuterine varices embolization in patients with chronic pelvic pain secondary to pelvic congestion syndrome and to report the safety of endovascular treatment and its rate of complications. METHODS: Retrospective cohort of patients undergoing endovascular treatment of pelvic congestion syndrome in our department from January 2012 to November 2015. Data were analyzed based on patient background, imaging findings, embolized veins, rate of complications, and clinical response as indicated by the visual analog pain scale. RESULTS: We performed periuterine varices embolization in 22 patients during the study, four of which required a second embolization. Seventeen patients reported a reduction in pelvic pain after the first embolization and three patients reported a reduction in pelvic pain after the second embolization. Minor complications were observed in our patients, such as postural hypotension, postoperative pain, and venous perforation during the procedure, without clinical repercussion. CONCLUSION: Periuterine varices embolization in patients with chronic pelvic pain secondary to pelvic congestion syndrome appears to be an effective and safe technique.
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23. The direct first pass aspiration technique in the treatment of acute ischemic stroke resulting from large vessel occlusions
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Luís Henrique de Castro-Afonso, Guilherme Seizem Nakiri, Lucas Moretti Monsignore, Pedro Telles Cougo-Pinto, Francisco Antunes Dias, Frederico Aléssio-Alves, Octávio Marques Pontes-Neto, and Daniel Giansante Abud
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stroke ,stents ,catheters ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
ABSTRACT Mechanical thrombectomy using stent retrievers is the standard treatment for acute ischemic stroke that results from large vessel occlusions. The direct aspiration first pass technique (ADAPT) has been proposed as an efficient, fast, and cost-effective thrombectomy strategy. The aim of this study was to assess the safety and efficacy of ADAPT. Methods Recanalization was assessed using the modified thrombolysis in cerebral infarction (mTICI) score. Neurological outcomes were assessed using the National Institutes of Health Stroke Scale and modified Rankin Scale. Results Fifteen patients were evaluated. The mTICI score was 2b-3 in 80%, and it was 3 in 60% of patients. No intracranial hemorrhage was seen. At three months, modified Rankin Scale scores ≤ 2 were observed in 60% of patients and the mortality rate was 13.3%. Conclusions The ADAPT appears to be a safe, effective, and fast recanalization strategy for treatment of acute ischemic stroke resulting from large vessel occlusions.
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24. The history of basilar artery occlusion: when art aids science
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Francisco Antunes Dias, Daniel Giansante Abud, and Octavio Marques Pontes-Neto
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acidente vascular cerebral ,artéria basilar ,história ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
ABSTRACT Basilar artery occlusion (BAO) ischemic stroke is a relatively rare condition with high morbidity and mortality rates. To date, the best acute reperfusion therapy for BAO has still not been established, mainly due to the lack of randomized controlled trials in this field. In this article, we review the history of BAO diagnosis and treatment, and the impact of modern technological resources on the clinical evolution and prognosis of BAO over time. Furthermore, we describe historical events and nonmedical literature descriptions related to BAO. We conclude that BAO is a singular example of how art may help medical sciences with accurate descriptions of medical conditions.
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25. Multimodal quantitative magnetic resonance imaging analysis with individualized postprocessing in patients with drug-resistant focal epilepsy and conventional visual inspection negative for epileptogenic lesions
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Lucas Giansante Abud, Tonicarlo Rodrigues Velasco, Carlos Ernesto Garrido Salmon, Americo Ceiki Sakamoto, Thiago Giansante Abud, Rodrigo Antonio Pessini, Daniel Giansante Abud, João Pereira Leite, and Antonio Carlos dos Santos
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Drug-Resistant Epilepsy ,Magnetic Resonance Imaging ,Multimodal Imaging ,Computer-Assisted Image Processing ,Medicine (General) ,R5-920 - Abstract
OBJECTIVES: Approximately one-third of candidates for epilepsy surgery have no visible abnormalities on conventional magnetic resonance imaging. This is extremely discouraging, as these patients have a less favorable prognosis. We aimed to evaluate the utility of quantitative magnetic resonance imaging in patients with drug-resistant neocortical focal epilepsy and negative imaging. METHODS: A prospective study including 46 patients evaluated through individualized postprocessing of five quantitative measures: cortical thickness, white and gray matter junction signal, relaxation rate, magnetization transfer ratio, and mean diffusivity. Scalp video-electroencephalography was used to suggest the epileptogenic zone. A volumetric fluid-attenuated inversion recovery sequence was performed to aid visual inspection. A critical assessment of follow-up was also conducted throughout the study. RESULTS: In the subgroup classified as having an epileptogenic zone, individualized postprocessing detected abnormalities within the region of electroclinical origin in 9.7% to 31.0% of patients. Abnormalities outside the epileptogenic zone were more frequent, up to 51.7%. In five patients initially included with negative imaging, an epileptogenic structural abnormality was identified when a new visual magnetic resonance imaging inspection was guided by information gleaned from postprocessing. In three patients, epileptogenic lesions were detected after visual evaluation with volumetric fluid-attenuated sequence guided by video electroencephalography. CONCLUSION: Although quantitative magnetic resonance imaging analyses may suggest hidden structural lesions, caution is warranted because of the apparent low specificity of these findings for the epileptogenic zone. Conversely, these methods can be used to prevent visible lesions from being ignored, even in referral centers. In parallel, we need to highlight the positive contribution of the volumetric fluid-attenuated sequence.
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26. Can the combination of internal iliac temporary occlusion and uterine artery embolization reduce bleeding and the need for intraoperative blood transfusion in cases of invasive placentation?
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Salomão Faroj Chodraui-Filho, Lucas Moretti Monsignore, Rafael Kiyuze Freitas, Guilherme Seizem Nakiri, Ricardo de Carvalho Cavalli, Geraldo Duarte, and Daniel Giansante Abud
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Abnormally Invasive Placenta ,High-Risk Pregnancy ,Postpartum Hemorrhage ,Embolization ,Placenta Accreta ,Medicine (General) ,R5-920 - Abstract
OBJECTIVES: Women with invasive placentation (IP) are at high risk of life-threatening hemorrhage. In the last two decades, less invasive surgical approaches combined with endovascular procedures have proven to be safe. Most case series describe the use of temporary balloon occlusion and embolization, either combined or not. Concerning hemorrhage rates, each separate interventional approach performs better than surgery alone does, yet it is not clear whether the combination of multiple interventional techniques can be beneficial and promote a lower incidence of intrapartum bleeding. We aim to evaluate whether combining temporary balloon occlusion of the internal iliac artery and uterine artery embolization promotes better hemorrhage control than do other individual interventional approaches reported in the scientific literature in the context of cesarean birth followed by hysterectomy in patients with IP. METHODS: This is a retrospective analysis of patients with confirmed IP who underwent temporary balloon occlusion and embolization of the internal iliac arteries followed by puerperal hysterectomy. We compared patient results to data extracted from a recent systematic review and meta-analysis of the current literature that focused on interventional procedures in patients with IP. RESULTS: A total of 35 patients underwent the procedure during the study period in our institution. The mean volume of packed red blood cells and the estimated blood loss were 487.9 mL and 1193 mL, respectively. Four patients experienced complications that were attributed to the endovascular procedure. CONCLUSION: The combination of temporary balloon occlusion and uterine artery embolization does not seem to promote better hemorrhage control than each procedure performed individually does.
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27. Analysis of 565 thrombectomies for anterior circulation stroke: A Brazilian registry
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Luis Henrique de Castro-Afonso, Thiago Giansante Abud, Lucas Moretti Monsignore, Guilherme Seizem Nakiri, Francisco Antunes Dias, Octavio M. Pontes-Neto, Vitor Rodrigues Fornazari, and Daniel Giansante Abud
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medicine.medical_specialty ,Large vessel ,law.invention ,Brain Ischemia ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Registries ,Stroke ,Acute ischemic stroke ,Stent retriever ,Acute stroke ,Retrospective Studies ,Thrombectomy ,business.industry ,Original Articles ,medicine.disease ,Mechanical thrombectomy ,Treatment Outcome ,Cardiology ,Stents ,business ,030217 neurology & neurosurgery ,Brazil ,Large vessel occlusion - Abstract
Introduction The benefits of mechanical thrombectomy in the treatment of patients with acute stroke due to large vessel occlusions (LVOs) have been extensively demonstrated by randomized trials and registries in developed countries. However, data on thrombectomy outside controlled trials are scarce in developing countries. The aim of this study was to assess the safety and efficacy, and to investigate the predictors for good and poor outcomes of thrombectomy for treatment of AIS due to anterior circulation LVOs in Brazil. Materials and Methods This was a single center registry of thrombectomy in the treatment of stroke caused by anterior circulation LVOs. Between 2011 and 2019, a total of 565 patients were included. Results the mean baseline NIHSS score on admission was 17.2. The average baseline ASPECTS was 8, and 91.0% of patients scored ≥6. Half of the patients received intravenous thrombolysis. The mean time from symptom onset to arterial puncture was 296.4 minutes. The mean procedure time was 61.4 minutes. The rates of the main outcomes were recanalization (TICI 2b-3) 85.6%, symptomatic intracranial hemorrhage (sICH) 8,1%, good clinical outcome (mRS=0-2) 43,5%, and mortality 22.1% at three months. Conclusions This study demonstrates the efficacy and safety of mechanical thrombectomy for treatment of patients with AIS of the anterior circulation in real-life conditions under limited facilities and resources. The results of the present study were relatively similar to those of large trials and population registers of developed countries.
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- 2023
28. What the radiologist should know about the role of percutaneous gastrostomy: a pictorial essay
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Tiago Kojun Tibana, Leonardo Verza, Bernardo Caetano da Silva Rodrigues, Lucas Moretti Monsignore, Daniel Giansante Abud, and Thiago Franchi Nunes
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Radiology, Nuclear Medicine and imaging - Abstract
The image-guided gastrostomy techniques, as transoral and transabdominal, can be performed when there is a failure of the endoscopic procedure or in some specific clinical scenarios. This pictorial essay intends to show the percutaneous gastrostomy techniques, indications, technical approaches, post-procedure care, and complications.As técnicas de gastrostomia guiadas por imagem, por via transoral e transabdominal podem ser realizadas quando há falha na técnica endoscópica ou em cenários clínicos em que a endoscopia não pode ser realizada. Este ensaio iconográfico pretende mostrar as técnicas de gastrostomia percutânea, suas indicações, aspectos técnicos, cuidados pós-procedimento e complicações.
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- 2022
29. Endovascular treatment of residual or recurrent intracranial aneurysms after surgical clipping
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Nilton Rocha da Silva Júnior, Felipe Padovani Trivelato, Thiago Giansante Abud, José Ricardo Vanzin, Alexandre Varella Giannetti, Guilherme Seizem Nakiri, Luis Henrique de Castro-Afonso, Alexandre Cordeiro Ulhôa, Marco Túlio Salles Rezende, Daniel Giansante Abud, and Luciano Bambini Manzato
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medicine.medical_specialty ,Endovascular ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Clipping ,Retrospective cohort study ,Clipping (medicine) ,medicine.disease ,Balloon ,Aneurysm ,Surgery ,Embolization ,Occlusion ,Angiography ,cardiovascular system ,Medicine ,Original Article ,cardiovascular diseases ,Endovascular treatment ,business - Abstract
Objective: Total aneurysm occlusion is crucial for the prevention of rebleeding of a ruptured aneurysm or to avoid rupture of an unruptured lesion. Both surgical and endovascular embolization fail to achieve complete aneurysm occlusion in all the cases. The objective of the study was to establish the safety and efficacy of endovascular treatment for previously clipped residual or recurrent aneurysms.Methods: This was an observational, retrospective study of patients harboring incompletely occluded intracranial aneurysms after clipping who underwent endovascular treatment. Patients were treated using 4 different techniques: (1) simple coiling, (2) balloon remodeling, (3) stent-assisted coiling, and (4) flow diversion. Analyses were performed to identify predictors of total aneurysm occlusion, recanalization and complications.Results: Between May 2010 and September 2018, 70 patients harboring incompletely occluded intracranial aneurysms after clipping met the inclusion criteria in 5 centers. The mean residual aneurysm size was 7.5 mm. Fifty-nine aneurysms were unruptured. Total aneurysm occlusion was achieved in 75.3% of the aneurysms after 1 year. All aneurysms treated with flow diversion revealed complete occlusion according to control angiography. Recanalization was observed in 14.5%. Permanent morbidity and mortality occurred in 2.9% and 1.4% of the patients, respectively.Conclusions: Endovascular treatment of recurrent or residual aneurysms after surgical clipping was safe and efficacious. Flow diversion seems to be associated with better anatomical results. A more rigid study, a larger group of patients, and longterm follow-up are required to provide stronger conclusions about the best approach for residual clipped aneurysms.
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- 2021
30. Preoperative rectal tumor embolization as an adjunctive tool for bloodless abdominoperineal excision: A case report
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Omar Féres, José Joaquim Ribeiro da Rocha, Ligia Magnani Landell, Rogério Serafim Parra, Marley Ribeiro Feitosa, Daniel Giansante Abud, Lucas Fernandes de Freitas, Mariângela Ottoboni Brunaldi, Guilherme Seizem Nakiri, and Antonio Balestrim Filho
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0301 basic medicine ,medicine.medical_specialty ,Rectum ,Rectal neoplasms ,Femoral artery ,03 medical and health sciences ,0302 clinical medicine ,Colorectal surgery ,medicine.artery ,Case report ,medicine ,Bloodless medical and surgical procedures ,Embolization, therapeutic ,Proctectomy ,NEOPLASIAS RETAIS ,business.industry ,Abdominoperineal resection ,medicine.disease ,Rectal tenesmus ,Surgery ,030104 developmental biology ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Tumor embolization ,Adenocarcinoma ,medicine.symptom ,business ,Major bleeding - Abstract
Background Abdominoperineal excision (APE)-related hemorrhage can be challenging due to difficult access to pelvic organs and the risk of massive blood loss. The objective of the present study was to demonstrate the use of preoperative embolization (PE) as a strategy for blood preservation in a patient with a large low rectal tumor with a high risk of bleeding, scheduled for APE. Case summary A 56-year-old man presented to our institution with a one-year history of anal bleeding and rectal tenesmus. The patient was diagnosed with bulky adenocarcinoma limited to the rectum. As the patient refused any clinical treatment, surgery without previous neoadjuvant chemoradiation was indicated. The patient underwent a tumor embolization procedure, two days before surgery performed via the right common femoral artery. The tumor was successfully devascularized and no major bleeding was noted during APE. Postoperative recovery was uneventful and a one-year follow-up showed no signs of recurrence. Conclusion Therapeutic tumor embolization may play a role in bloodless surgeries and increase surgical and oncologic prognoses. We describe a patient with a bulky low rectal tumor who successfully underwent preoperative embolization and bloodless abdominoperineal resection.
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- 2020
31. Transarterial Treatment of Cranial Dural Arteriovenous Fistulas: The Role of Transarterial and Transvenous Balloon-Assisted Embolization
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Daniel Giansante Abud, L. H. de Castro-Afonso, Alexandre Cordeiro Ulhôa, Guilherme Seizem Nakiri, Rafael Kiyuze de Freitas, Thiago Giansante Abud, M.T.S. Rezende, J.O. Zamponi, and Felipe Padovani Trivelato
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Adult ,Male ,congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,Fistula ,medicine.medical_treatment ,Balloon ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Dural arteriovenous fistulas ,Occlusion ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Embolization ,Vein ,Sinus (anatomy) ,Aged ,Retrospective Studies ,Central Nervous System Vascular Malformations ,Interventional ,business.industry ,Endovascular Procedures ,Balloon catheter ,Balloon Occlusion ,Middle Aged ,medicine.disease ,Embolization, Therapeutic ,Surgery ,medicine.anatomical_structure ,Female ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
BACKGROUND AND PURPOSE: Treatment of dural arteriovenous fistulas can be performed by transarterial or transvenous accesses. For those fistulas located at a dural sinus wall, obliteration of the sinus might lead to a substantial risk of complications if the occluded sinus impairs normal venous drainage. For those fistulas with direct leptomeningeal venous drainage, navigation to reach the arteriovenous shunting point of a leptomeningeal vein is usually technically demanding. We report the outcomes of patients with dural AVFs treated by transarterial injection of liquid embolic agents assisted by transarterial double-lumen balloon catheters and/or transvenous balloon catheters. MATERIALS AND METHODS: This was a retrospective, 3-center study including patients with dural AVFs treated with a balloon-assisted technique in at least 1 treatment session. Angiographic follow-up was performed at 6 months. Clinical assessment was performed at admission and discharge and was reassessed at 30-day and 6-month follow-ups. RESULTS: Forty-one patients with 43 dural AVFs were treated. Thirty-four fistulas were located at a dural sinus wall. Treatment was performed using only a transarterial approach in 42 fistulas. Only 1 session was needed for complete obliteration of the fistula in 86% of the patients. Immediate complete angiographic occlusion was achieved in 39 fistulas. Of the 41 controlled fistulas, 40 (97.6%) were completely occluded at 6 months. Thirty-nine fistulas (95.1%) were cured without any report of major neurologic events or death during follow-up. CONCLUSIONS: Transarterial balloon-assisted treatment of dural AVFs with or without transvenous balloon protection was shown to be safe and effective.
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- 2020
32. Transarterial embolization with n-butyl cyanoacrylate for the treatment of abdominal wall hemorrhage
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Valdair Francisco Muglia, Luis Henrique de Castro-Afonso, Jorge Elias-Junior, Tales Vieira Cavalcanti Albuquerque, Daniel Giansante Abud, and Lucas Moretti Monsignore
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Male ,medicine.medical_specialty ,Superior epigastric artery ,medicine.medical_treatment ,Hemorrhage ,Context (language use) ,030218 nuclear medicine & medical imaging ,Abdominal wall ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,medicine.artery ,Interventional Radiology ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Decompensation ,Embolization ,Inferior epigastric artery ,Aged ,Retrospective Studies ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Liver Diseases ,Abdominal Wall ,Endovascular Procedures ,Angiography, Digital Subtraction ,Anticoagulants ,Digital subtraction angiography ,Enbucrilate ,Middle Aged ,Embolization, Therapeutic ,Surgery ,RESULTADO DE TRATAMENTO ,Treatment Outcome ,medicine.anatomical_structure ,Chronic Disease ,Angiography ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Purpose We aimed to evaluate the effectiveness and safety of n-butyl cyanoacrylate (n-BCA) in the context of the transarterial embolization (TAE) of abdominal wall hemorrhage in an urgent scenario. Methods A retrospective study of cases admitted from January 2008 to December 2017 in the emergency unit of our institution revealed 11 patients with abdominal wall hemorrhage who underwent digital subtraction angiography and TAE with n-BCA. We analyzed the sex, age, hemorrhagic risk factors, etiology, embolized vessel, technical success (no rebleeding in the embolized area), clinical success (hemoglobin level control and hemodynamic stability after the procedure), complications inherent to the procedure, and clinical outcome (mortality in 30 days). Results The mean age was 63.4 years (52-83 years), with a predominance of the female sex (64%). The majority (91%) of patients presented hemorrhagic risk factors (chronic hepatopathy and anticoagulation drug usage). Spontaneous hemorrhage was present in 18% of patients, and the other 82% had an iatrogenic etiology. Technical success was achieved in 100% of the patients, which required the embolization of inferior epigastric artery in 10 patients (91%), circumflex iliac artery in 2 (18%), and superior epigastric artery in 1 (9%). Five patients were hemodynamically unstable, and despite achieving technical success, 4 (36%) died in less than 30 days due to decompensation of their clinical comorbidities caused by the acute phase. There were no complications inherent to the procedures. Conclusion The present study concludes that TAE with n-BCA is a safe and effective treatment for abdominal wall hemorrhage in an urgent scenario, with high rates of technical and clinical success.
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- 2020
33. Transarterial embolization with n-butyl cyanoacrylate for the treatment of active abdominopelvic bleeding in the polytraumatized patient
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Daniel Giansante Abud, Rafael Kiyuze de Freitas, Lucas Moretti Monsignore, Luis Henrique de Castro-Afonso, Valdair Francisco Muglia, Guilherme Seizem Nakiri, Sandro Scarpelini, and Jorge Elias-Junior
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medicine.medical_specialty ,medicine.medical_treatment ,Embolization procedure ,Hemorrhage ,030230 surgery ,Single Center ,030218 nuclear medicine & medical imaging ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,medicine ,Diseases of the circulatory (Cardiovascular) system ,Trans-arterial embolization ,Radiology, Nuclear Medicine and imaging ,Embolization ,Interventional radiology ,medicine.diagnostic_test ,business.industry ,Mortality rate ,Wounds and injuries ,Retrospective cohort study ,medicine.disease ,Surgery ,Abdominal trauma ,Cyanoacrylate ,RC666-701 ,FERIDA CIRÚRGICA ,Original Article ,Cardiology and Cardiovascular Medicine ,business - Abstract
Purpose An increasing number of polytraumatized patient presenting with active abdominal pelvic bleeding (APB) have been treated by endovascular selective embolization. However, reports on evaluate the efficacy, safety and complications caused by this technique have been limited. The aim of this study was to assess the safety and efficacy of embolization of APB using N-butyl cyanoacrylate glue (NBCA). Materials and methods Single center retrospective study, that included consecutive 47 patients presenting with traumatic APB treated by embolization with NBCA between January 2013 and June 2019. The efficacy endpoint was defined as the absence of contrast extravasation immediately after procedure and clinical stabilization in the following 24 h after procedure. Clinical stabilization was defined as no rebleeding after embolization or the need for a surgical approach until the patient is discharged. Safety endpoint were any technical or clinical complications related to the embolization procedure. Results The mean age of patients was 38.6 years (3–81), with a predominance of males (87.2%). The major causal factor of APB being involvement in a car accident, accounting for 68% of cases. Of the 47 cases, 29.8% presented pelvic trauma and the remaining (70.2%) presented abdominal trauma. The efficacy rate was 100%, while no complications related to the procedure were observed. The mortality rate was 14.8% (7/47) due to neurologic decompensation and other clinical causes. Conclusion Endovascular embolization of traumatic abdominopelvic bleedings appear to be a highly safe and effective treatment, while avoiding emergent exploratory open surgeries.
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- 2021
34. Thrombectomy for M2 occlusions and the role of the dominant branch
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Octavio M. Pontes-Neto, Guilherme Borghini Pazuello, Daniel Giansante Abud, Lucas Moretti Monsignore, Guilherme Seizem Nakiri, Luís Henrique de Castro Afonso, and Francisco Antunes Dias
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Male ,medicine.medical_specialty ,business.industry ,Infarction, Middle Cerebral Artery ,Cerebral Angiography ,Surgery ,ESTUDOS PROSPECTIVOS ,Stroke ,Occlusion ,medicine ,Humans ,Female ,In patient ,Prospective Studies ,Tomography, X-Ray Computed ,business ,Aged ,Thrombectomy ,Acute stroke - Abstract
Introduction The benefits of thrombectomy for occlusion of M2 segments remain controversial. The aim of this study is to assess thrombectomy’s efficacy and safety in patients with M2 segment occlusion and associations between occlusion sites and anatomic variations of M1 division. Materials and methods A prospective series of 30 patients with acute ischemic stroke (AIS) resulting from M2 segment occlusion of the middle cerebral artery (MCA) who underwent thrombectomy was analyzed. The primary endpoint was assessed by the Extended Treatment in Cerebral Infarction scale (eTICI). The secondary endpoints were the incidence of symptomatic hemorrhagic transformation (sICH), mortality and good functional outcome at three months. Results The mean patient age was 69.2 years. The mean National Institutes Health Stroke Scale score (NIHSS) upon hospital admission was 16. The recanalization rates were eTICI 2b/3 in 90% and 2c/3 in 60% of the patients. Total recanalization of the M2 branch was achieved in 53% of patients. sICH incidence was 6.6%, the mortality rate was 30%, and a good functional outcome (mRS ≤2) was observed in 50% of the patients. Twenty-seven patients (90%) had a dominant M2 branch and all were occluded. Regarding the site of M2 occlusions, 74% of patients had proximal M2 occlusions. Conclusions Thrombectomy appears to be a safe and effective method for the treatment of acute M2 segment occlusions of the MCA. Most of the cases had a dominant M2 branch, and all of them were occluded. Larger studies are needed to verify the benefits of thrombectomy for different settings of M2 occlusions.
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- 2019
35. The use of dual-lumen balloon for embolization of peripheral arteriovenous malformations
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Daniel Giansante Abud, Dimitrius Nikolaos Jaconi Stamoulis, José Ricardo Vanzin, Felipe Padovani Trivelato, Alexandre Cordeiro Ulhôa, Lucas Moretti Monsignore, Guilherme Seizem Nakiri, Marco Túlio Salles Rezende, Tales Vieira Cavalcanti Albuquerque, and Luis Henrique de Castro-Afonso
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Adult ,Intracranial Arteriovenous Malformations ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Lumen (anatomy) ,Stage ii ,Balloon ,Young Adult ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Embolization ,Stage (cooking) ,Child ,Aged ,Retrospective Studies ,High rate ,Aged, 80 and over ,business.industry ,Interventional Radiology: Original Article ,Retrospective cohort study ,Middle Aged ,Embolization, Therapeutic ,Surgery ,Peripheral ,Treatment Outcome ,Polyvinyls ,Cardiology and Cardiovascular Medicine ,business - Abstract
Purpose We aimed to evaluate the safety and feasibility of the embolization of peripheral arteriovenous malformation (AVM) with non-adhesive liquid agents (NALA) injected by dual-lumen balloons (DLB). Methods We conducted a multicenter retrospective study between January 2017 and June 2019, including patients with peripheral AVM embolized with NALA by DLB. Fourteen patients were included. The AVM classification, technical and clinical success were evaluated, as were nidus size, liquid agent used, volume and time of injection in DLB, complications, follow-up and need of surgical intervention. Results The mean age of the patients was 37±22.5 years (range, 6-82 years). The mean nidus size was 5.2±2.4 cm (range, 3.0-12.0 cm). By Schobinger classification, 11 AVMs were classified in stage 3 and 3 AVMs were classified in stage 2. By Cho's classification, 2 AVMs were in stage II, 4 AVMs were in stage I, 4 AVMs were in stage IIIa and 4 AVMs were in stage IIIb. Onyx was used in 11 patients (78.6%), while Squid, PHIL, and both Onyx and Squid were used in one patient each (7.1%). Seven patients (50%) required one session of embolization, 4 patients (28.6%) required two, 2 patients (14.3%) required three and 1 patient (7.1%) required four sessions. Complete nidus exclusion was achieved in 11 patients (78.6%), optimal clinical response in 12 patients (85.7%). Four patients (28.6%) exhibited minor complications, all controlled. No major complications were seen. Four patients underwent surgical intervention (28.6%). Conclusion The embolization of peripheral AVM with NALA in DLB appears to be safe and feasible, achieving high rates of technical and clinical success.
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- 2021
36. Randomization of endovascular treatment with stent-retriever and/or thromboaspiration versus best medical therapy in acute ischemic stroke due to large vessel occlusion trial: rationale and design
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Gabriel R. de Freitas, Daniel C Bezerra, Michel Frudit, Sheila Cristina Ouriques Martins, Carlos A. Molina, David S Liebeskind, Raul G Nogueira, Octavio M. Pontes-Neto, José E. Fogolin Passos, Gisele Sampaio Silva, Diogo C Haussen, Fabricio O. Lima, Francisco Mont’Alverne, Jamary Oliveira-Filho, Joseph P. Broderick, Jeffrey L. Saver, Daniel Giansante Abud, Paulo Passos, Mario Bernardes Wagner, and Guilherme Dabus
- Subjects
medicine.medical_specialty ,Randomization ,Adolescent ,Brain Ischemia ,Random Allocation ,medicine ,Humans ,Prospective Studies ,Endovascular treatment ,Acute ischemic stroke ,Stroke ,Ischemic Stroke ,Thrombectomy ,Stent retriever ,Medical treatment ,business.industry ,CONTENEDORES ,Endovascular Procedures ,medicine.disease ,Surgery ,Treatment Outcome ,Neurology ,Stents ,business ,Medical therapy ,Large vessel occlusion - Abstract
Background RESILIENT is a prospective, multicenter, randomized phase III trial to test the safety, efficacy, and cost-effectiveness of mechanical thrombectomy as compared to medical treatment alone in patients treated under the less than ideal conditions typically found in the public healthcare system of a developing country. Methods Subjects must fulfill the following main inclusion criteria: symptom onset ≤8 h, age ≥18 years, baseline NIHSS ≥8, evidence of intracranial ICA or proximal MCA (M1 segment) occlusion, ASPECTS ≥6 on CT or >5 on DWI-MRI and be either ineligible for or unresponsive to intravenous alteplase. The primary end-point is the distribution of disability levels (on the modified Rankin Scale, mRS) at 90 days under the intention-to-treat principle. Randomization Randomization is performed under a minimization process using age, baseline NIHSS, intravenous alteplase use, occlusion site and center. Design The trial is designed with an expectation of a 10% difference in the proportion of favorable outcome (mRS 0–2 at 90 days) common odds ratio of 1.615. Primary outcome Projected sample size is 690 subjects with pre-planned interim analyses at 174, 346, and 518 subjects. Secondary outcomes Secondary end-points include: 90-day functional independence (mRS ≤2), mRS shift stratified for treatment with IV rt-PA at 90 days, infarct volume on 24 h CT or MRI, early dramatic response (NIHSS 0–2 or improvement ≥8 points) at 24 h, vessel recanalization evaluated by CTA or MRA at 24 h, and the post-procedure rate of successful reperfusion (defined as a modified Treatment in Cerebral Infarction 2b or greater). Safety variables are mortality at 90 days, symptomatic intracranial hemorrhage at 24 h and procedure-related complications.
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- 2021
37. Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic
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Ajit S. Puri, Allan Taylor, Huynh Le Vu, Tatemi Todaka, Teddy Y. Wu, Octavio M. Pontes-Neto, Eytan Raz, Pedro Lylyk, Jasmine Johann, Roberta Novakovic, Hormuzdiyar H. Dasenbrock, Francisco Mont’Alverne, Nobuyuki Sakai, Melanie Walker, Hugh Stephen Winters, Ossama Mansour, Yohei Takenobu, Gregory Walker, Miki Fujimura, Saif Bushnaq, Odysseas Kargiotis, Nabeel Herial, Markus A Möhlenbruch, Malveeka Sharma, Hiroshi Tokimura, Maxim Mokin, Jean Raymond, Michael D. Hill, Amal Abou-Hamden, Leonardo Renieri, Serdar Geyik, Yuri Sugiura, Luisa Fonseca, Roberto Crosa, Fabricio O Lima, Ameer E Hassan, Viet Quy Nguyen, Jane G. Morris, Steven W. Hetts, Jawad F. Kirmani, Matthew S. Tenser, Muhammad M. Qureshi, Gianmarco Bernava, Mahmoud H Mohammaden, Verónica V. Olavarría, Jun Deguchi, André Beer-Furlan, Steve M. Cordina, Hiroshi Yamagami, Mohamad Abdalkader, Toshiyuki Fujinaka, Clifford J. Eskey, Rotem Sivan-Hoffmann, Hao Zhang, Anirudh Kulkarni, Brendan Steinfort, Özlem Aykaç, Barbara Voetsch, Alex Brehm, Italo Linfante, Wenguo Huang, Omer Eker, M. Luis Silva, Pascal Jabbour, Lissa Peeling, Mollie McDermott, Pascale Lavoie, Kazutaka Sonoda, Thomas Devlin, Alicia C. Castonguay, Jin Soo Lee, Diogo C Haussen, Dileep R. Yavagal, Thanh N. Nguyen, Umair Rashid, Vasu Saini, Raghid Kikano, Hiroyuki Hashimoto, Masaaki Uno, Saima Ahmad, Artem Kaliaev, Eiji Hagashi, Ajay K. Wakhloo, Romain Bourcier, Ryoo Yamamoto, Jesse M. Thon, Georgios Tsivgoulis, Dorothea Altschul, Achmad Fidaus Sani, Satoshi Yamada, Varsha Singh, David S Liebeskind, Tatsuo Amano, Anchalee Churojana, Juan F. Arenillas, Junichi Iida, Charles C. Matouk, Nobuyuki Ohara, Osama O. Zaidat, Mario Martínez-Galdámez, Chandril Chugh, Don Frei, Vanessa Chalumeau, Brijesh P Mehta, Marios Psychogios, Anna Luisa Kühn, Leticia C Rebello, Xianjin Shang, Hosam Al-Jehani, Hiroki Fukuda, Hong Gee Roh, Gisele Sampaio Silva, Rakesh Khatri, Kenichi Todo, Amal Al Hashmi, Alex Bou Chebl, Sunil A Sheth, Zhongming Qiu, Oriana Cornett, Zhengzhou Yuan, Wazim Izzath, Hesham Masoud, Rodrigo Rivera, Michel Piotin, Vikram Huded, Mamoru Murakami, Mohamed Teleb, Viktor Szeder, Ruchir Shah, Dheeraj Gandhi, John Thornton, Michael Chen, Vitor Mendes Pereira, Nadia Hammami, Alice Ma, Anna M. Cervantes-Arslanian, James E. Siegler, Seby John, Carlos Ynigo Lopez, Mudassir Farooqui, David Ozretić, Takuya Kanamaru, Romain Guile, Daisuke Watanabe, Kosuke Miyake, Alejandro Rodriguez Vasquez, Patrick Nicholson, Yuki Yamamoto, William J. Mack, Naoto Kimura, Simon Mathew John, Robert Fahed, Yuji Matsumaru, David Y. Chung, Rishi Gupta, Ryuhei Kono, Michael Frankel, Victor S. Lopez Rivera, Johanna T. Fifi, Raul G Nogueira, Paolo Machi, Tudor G. Jovin, Jordi Blasco, Emma Griffin, Salvatore Mangiafico, Masafumi Morimoto, Jun Luo, Santiago Ortega-Gutierrez, Monika Killer-Oberpfalzer, Daniel Giansante Abud, Syed I. Hussain, Fawaz Al-Mufti, Yusuke Sugimura, Atilla Özcan Özdemir, Stephan A. Mayer, Sumeet Multani, Adel Alhazzani, Alhamza R Al-Bayati, Michael Kelly, Lee A Birnbaum, Shadi Yaghi, Jeyaraj D Pandian, Ji Man Hong, Junsuke Shimbo, Johnny Ho-Yin Wong, Elena A. Cora, Laura Mechtouff, Pedro S.C. Magalhães, Pablo M. Lavados, Yuichi Murayama, Dong Hun Shin, Simon Nagel, Ken Wong, Jose Antonio Fiorot, Jeremy Payne, Randall C. Edgell, Adrienne Weeks, CarMeN, laboratoire, Department of Neurology [Boston], Harvard Medical School [Boston] (HMS)-Massachusetts General Hospital [Boston], Emory University School of Medicine, Emory University [Atlanta, GA], Boston University School of Medicine (BUSM), Boston University [Boston] (BU), National Hospital Organization Osaka National Hospital [Japon] (NHO Osaka National Hospital), Alexandria University [Alexandrie], Boston Medical Center [Boston, MA, USA] (BMC), Xinqiao Hospital [Chongqing, China] (XH), University of Cape Town, La Sagrada Familia Clinic/Clínica La Sagrada Familia [Buenos Aires, Argentina] (LSFC), Hospices Civils de Lyon (HCL), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Fondation Ophtalmologique Adolphe de Rothschild [Paris], Hospital General de Fortaleza [Fortaleza, Brazil] (HGF), Nottingham University Hospitals NHS Trust [UK], Kobe City Medical Center General Hospital [Kobe, Hyogo, Japan] (KCMCGH), Azienda Ospedaliero-Universitaria Careggi [Firenze, Toscana, Italy] (AOUC), University Hospital Centre Zagreb, Partenaires INRAE, AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Service de Neuroradiologie [CHU de Bicêtre], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Cleveland Clinic Abu Dhabi [Abou Dabi, Émirats arabes unis], Hôpital de Beaumont [Dublin, Ireland] (HB), Hospital-Estadual Central [Vitoria, Brazil] (HEC), Instituto de NeuroCirugía Asenjo, Institut national de neurologie Mongi-Ben Hamida [Tunis], Hue Central Hospital [Thua Thien Hue, Vietnam] (HCH), University of California [San Francisco] (UC San Francisco), University of California (UC), Centre hospitalier universitaire de Nantes (CHU Nantes), Washington University School of Medicine (WUSM), University of Washington [Seattle], Englewood Hospital and Medical Center [Englewood], Jefferson (Philadelphia University + Thomas Jefferson University), Westchester Medical Center [Valhalla, New York, USA] (WMC), Eskisehir Osmangazi University, University of Maryland School of Medicine, University of Maryland System, MAX Superspecialty Hospital [Saket, New Delhi, India] (MSH), Yale School of Medicine [New Haven, Connecticut] (YSM), Université Laval [Québec] (ULaval), Washington University School of Medicine in St. Louis, Washington University in Saint Louis (WUSTL), Rush University Medical Center [Chicago], Paracelsus Medizinische Privatuniversität = Paracelsus Medical University (PMU), University of Toronto, NH Mazumdar Shah Medical Center [Bangalore, India] (NHMSMC), IMS Tokyo-Katsushika General Hospital [Tokyo, Japan], Gachon University [Seongnam, Korea] (GU), Hospital Municipal Sao Jose [Joinville, Santa Catarina, Brazil] (HMSJ), Lau Medical Center [Beirut, Lebanon] (LMC), University of Iowa [Iowa City], Royal Adelaide Hospital [Adelaide Australia], Kyorin University [Tokyo, Japan], Yokohama Brain and Spine Center [Yokohama, Japan] (YBSC), Dalhousie University [Halifax], Rambam Health Care Campus [Haifa, Israel], Centro Endovascular Neurologico Medica Uruguaya [Montevideo, Uruguay] (CENMU), Heidelberg University Hospital [Heidelberg], Imam Abdulrahman bin Faisal University [Alkhobar, Saudi Arabia] (IAFU), McGovern Medical School [Houston, TX, USA] (McGMS), The University of Texas Health Science Center at Houston (UTHealth), Cooper Medical School of Rowan University [Camden] (CMSRU), Airlangga University [Jawa Timur, Indonesia] (AU), University of Massachusetts Medical School [Worcester] (UMASS), University of Massachusetts System (UMASS), Geneva University Hospitals and Geneva University, Universidade de São Paulo = University of São Paulo (USP), Beth Israel Lahey Health [Burlington, MA, USA] (BILH), New York University School of Medicine (NYU Grossman School of Medicine), Memorial Neuroscience Institute [Pembroke Pines, FL, USA] (MNI), Iwate Prefectural Central Hospital [Morioka, Iwate, Japan] (IPCH), Japanese Red Cross Musashino Hospital [Tokyo], Ajou University, University of Ottawa [Ottawa], Saga-ken Medical Centre Koseikan [Saga, Japan] (SMCK), University of South Alabama, Konkuk University [Seoul], Royal Free Hospital [London, UK], Hospital Clinico Universitario de Valladolid [Castilla y León, Spain] (HCUV), Universidad de Valladolid [Valladolid] (UVa), Instituto de Ciencia de Materiales de Aragón [Saragoza, España] (ICMA-CSIC), University of Zaragoza - Universidad de Zaragoza [Zaragoza], Hospital Clínic de Barcelona [Catalonia, Spain], Centro Hospitalar Universitário de São João [Porto], Christchurch Hospital [Christchurch, New Zealand] (CH), University Hospital Basel [Basel], University of Southern California (USC), Kohnan Hospital - Sendai [Miyagi, Japan], University of Texas Southwestern Medical Center [Dallas], Nara City Hospital [Nara, Japan] (NCH), Toyonaka Municipal Hospital [Osaka, Japan] (TMH), Kagoshima City Hospita [Kagoshima, Japan] (KCH), Texas Tech University System [Lubbock, TX, USA] (TTUS), University of Saskatchewan [Saskatoon] (U of S), National Institute of Information and Communications Technology [Tokyo, Japan] (NICT), Royal Prince Alfred Hospital [Camperdown, Australia] (RPAH), Banner Desert Medical Center [Mesa, AZ, USA] (BDMC), Japanese Red Cross Matsue Hospital [Shimane, Japan] (JRCMH), Shiroyama Hospital [Osaka, Japan] (SH), Niigata City General Hospital [Niigata, Japan] (NCGH), Sugimura Hospital [Kumamoto, Japan] (SH), Kawasaki Medical School [Kurashiki, Japan] (KMS), Osaka Red Cross Hospital [Osaka, Japan] (ORCH), Université de Tsukuba = University of Tsukuba, Saiseikai Central Hospital [Tokyo, Japan] (SCH), Kinikyo Chuo Hospital - Sapporo [Hokkaido, Japan] (KCHS), NTT Medical Center Tokyo [Tokyo, Japan] (NTTMCT), Yokohama Shintoshi Neurosurgical Hospital [Yokohama, Japan]. (YSNH), Osaka General Medical Center [Osaka, Japan] (OGMC), University of Miami Leonard M. Miller School of Medicine (UMMSM), Bon Secours Mercy Health System [Toledo, OH, USA] (BSMHS), Maoming City Hospital [Guandong, China] (MCH), Miami Cardiac & Vascular Institute [Miami, FL, USA] (MC&VI), Hackensack University Medical Center [Hackensack], David Geffen School of Medicine [Los Angeles], University of California [Los Angeles] (UCLA), University of California (UC)-University of California (UC), University of Tennessee [Chattanooga] (UTC), The University of Texas at San Antonio (UTSA), Mianyang 404 Hospital [Sichuan, China] (M404H), Siriraj Hosital - Mahidol University [Bangkok, Thailand] (SHMU), SUNY Upstate Medical University, State University of New York (SUNY), Royal North Shore Hospital (RNSH), The University of Texas Rio Grande Valley [Harlingen, TX, USA] (UTRGV), Khoula Hospital [Muscat, Oman] (Ministry of Health - KH), University of Michigan [Ann Arbor], University of Michigan System, University of South Florida [Tampa] (USF), Henry Ford Health System [Detroit, MI, USA] (HFHS), Metropolitan Hospital [Piraeus, Greece] (MH), National and Kapodistrian University of Athens (NKUA), Maine Medical Center, Dartmouth Hitchcock Medical Center [Lebanon, NH, USA] (DHMC), Centro Universitário Feevale (BRAZIL), The Valley Hospital [Ridgewood, NJ, USA] (TVH), St Joseph's University Medical Center [Paterson, NJ, USA] (StJUMC), Christian Medical College and Hospital Ludhiana [Punjab, India] (CMCHL), Universidad del Desarrollo, University Graduate School of Medicine [Osaka, Japan], Tokushima University, Universidade Federal de São Paulo, Istanbul Aydin University [İstanbul, Turkey] (IAU), Swedish Medical Center [Englewood, CO, USA] (SMC), Bayhealth Medical Center [Dover, DE, USA] (BMC), Saiseikai Fukuoka General Hospital [Fukuoka, Japan] (SFGH), Osaka Rosai Hospital - Sakai [Osaka, Japan] (ORHS), King Saud University [Riyadh] (KSU), Mount Sinai Health System, University of Calgary, Huzhou University [Zhejiang], The Affiliated Hospital of Southwest Medical University - Luzhou [Sichuan, China] (TAHSMUL), Yijishan Hospital of Wannan Medical College [Wuhu, Anhui, China] (YHWMC), University of Toledo, WellStar Health System [Marietta, GA, USA] (WHS), Institut National de la Recherche Scientifique [Québec] (INRS), Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CR CHUM), Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal (UdeM)-Université de Montréal (UdeM), SVIN COVID-19 Registry, the Middle East North Africa Stroke and Interventional Neurotherapies Organization (MENA-SINO), Japanese Society of Vascular and Interventional Neurology Society (JVIN), University of California [San Francisco] (UCSF), University of California, Yale University School of Medicine, University of São Paulo (USP), and University of California-University of California
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[SDV]Life Sciences [q-bio] ,COVID-19 ,Subarachnoid Hemorrhage* / diagnostic imaging ,030204 cardiovascular system & hematology ,Intracranial Aneurysm* / therapy ,lcsh:RC346-429 ,0302 clinical medicine ,Pandemic ,Myocardial infarction ,Prospective Studies ,Stroke ,Original Research ,3. Good health ,[SDV] Life Sciences [q-bio] ,Treatment Outcome ,Intracranial Aneurysm* / diagnostic imaging ,Cardiology ,Subarachnoid haemorrhage ,haemorrhage ,Cardiology and Cardiovascular Medicine ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Subgroup analysis ,subarachnoid ,Intracranial Aneurysm* / epidemiology ,03 medical and health sciences ,Aneurysm ,Internal medicine ,medicine ,Humans ,coil ,cardiovascular diseases ,Pandemics ,lcsh:Neurology. Diseases of the nervous system ,Retrospective Studies ,business.industry ,SARS-CoV-2 ,Intracranial Aneurysm ,Subarachnoid Hemorrhage ,medicine.disease ,infection ,nervous system diseases ,Mechanical thrombectomy ,Cross-Sectional Studies ,aneurysm ,Neurology (clinical) ,Subarachnoid Hemorrhage* / epidemiology ,business ,030217 neurology & neurosurgery - Abstract
BackgroundDuring the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The study’s objective was to examine whether subarachnoid haemorrhage (SAH) hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines.MethodsWe conducted a cross-sectional, retrospective, observational study across 6 continents, 37 countries and 140 comprehensive stroke centres. Patients with the diagnosis of SAH, aneurysmal SAH, ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases, 10th Revision, codes. The 3-month cumulative volume, monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before (1 year and immediately before) and during the pandemic, defined as 1 March–31 May 2020. The prior 1-year control period (1 March–31 May 2019) was obtained to account for seasonal variation.FindingsThere was a significant decline in SAH hospitalisations, with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic, representing a relative decline of 22.5% (95% CI −24.3% to −20.7%, pInterpretationThere was a relative decrease in the volume of SAH hospitalisations, aneurysmal SAH hospitalisations and ruptured aneurysm embolisations during the COVID-19 pandemic. These findings in SAH are consistent with a decrease in other emergencies, such as stroke and myocardial infarction.
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- 2021
38. Performance evolution over 645 acute stroke thrombectomies in a public Brazilian healthcare institution
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Lucas Moretti Monsignore, Vitor Rodrigues Fornazari, Antonio Pazin-Filho, Octavio M. Pontes-Neto, Rui Kleber Martins-Filho, Millene Rodrigues Camilo, Luis Henrique de Castro-Afonso, Francisco Antunes Dias, Guilherme Borghini Pazuello, Soraia Cr Fábio, Daniel Giansante Abud, Guilherme Seizem Nakiri, Frederico F Alessio-Alves, and Thiago Giansante Abud
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medicine.medical_specialty ,business.industry ,Endovascular Procedures ,030204 cardiovascular system & hematology ,Brain Ischemia ,Stroke ,03 medical and health sciences ,0302 clinical medicine ,Treatment Outcome ,Neurology ,Health care ,Emergency medicine ,SISTEMA DE SAÚDE ,Medicine ,Humans ,business ,Acute ischemic stroke ,Delivery of Health Care ,030217 neurology & neurosurgery ,Large vessel occlusion ,Healthcare system ,Acute stroke ,Retrospective Studies ,Thrombectomy - Abstract
Background Assessment of the impact of the thrombectomy learning curve on clinical outcomes is essential for developing healthcare system protocols. Aims The aim of this study was to assess the effect of thrombectomy case volume on procedural and clinical outcomes in a Brazilian registry. Methods A total of 645 patients with acute ischemic stroke treated by thrombectomy were included in the analysis. Patients were divided into two groups regarding the period of treatment: the early period group and the late period group. Results In the adjusted analysis, treatment in the late period was an independent predictor of recanalization (odds ratio 1.91, 95% CI 1.28–2.86) and excellent neurologic outcomes at three months (odds ratio 1.77, 95% CI 1.04–3.01). Treatment in the late period had no significant association with mortality (odds ratio 0.88, 95% CI 0.55–1.41). Conclusions An increase in thrombectomy case volume for the treatment of AIS over time was an independent predictor of recanalization and excellent neurologic outcome.
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- 2020
39. Thrombectomy for Posterior Circulation Stroke: Predictors of Outcomes in a Brazilian Registry
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Daniel Giansante Abud, Guilherme Borghini Pazuello, Octavio M. Pontes-Neto, Lucas Moretti Monsignore, Guilherme Seizem Nakiri, Rui Kleber Martins-Filho, Thiago Giansante Abud, Luis Henrique de Castro-Afonso, Francisco Antunes Dias, Frederico F Alessio-Alves, Milene Rodrigues Camilo, and Vitor Rodrigues Fornazari
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Adult ,Male ,medicine.medical_specialty ,FATORES DE RISCO ,Arterial Occlusive Diseases ,Brain Ischemia ,03 medical and health sciences ,0302 clinical medicine ,Modified Rankin Scale ,Risk Factors ,Internal medicine ,Diabetes mellitus ,Occlusion ,medicine ,Clinical endpoint ,Vertebrobasilar Insufficiency ,Humans ,Registries ,Stroke ,Aged ,Thrombectomy ,Aged, 80 and over ,business.industry ,Basilar artery occlusion ,Endovascular Procedures ,Atrial fibrillation ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Treatment Outcome ,030220 oncology & carcinogenesis ,Cardiology ,Surgery ,Female ,Neurology (clinical) ,business ,Intracranial Hemorrhages ,030217 neurology & neurosurgery ,Brazil - Abstract
Background Acute basilar artery occlusion is a devastating life-threatening condition. Early recanalization is the therapeutic goal in patients with acute ischemic stroke. Despite the high rates of recanalization achieved with modern devices for basilar occlusions, many patients have had poor clinical outcomes. This study aimed to assess the predictors of good and poor outcomes among patients with basilar artery occlusion treated with thrombectomy. Methods A consecutive registry of 80 patients was included in this retrospective study. The primary end point was to access variables associated with neurologic outcomes defined by a modified Rankin Scale (mRS) score of 0–2, symptomatic intracranial hemorrhage (sICH), and mortality at 3 months follow-up. Results Recanalization was achieved in 86.2%, and the sICH rate was 8.7%. A good neurologic outcome (mRS score 0–2) was observed in 26.2% and a moderate outcome (mRS score 0–3) in 32.5% of patients. The mortality was 38.7% at 3 months follow-up. Conclusions After thrombectomy for posterior circulation strokes, young patients, V4–proximal basilar occlusion, (high) baseline posterior circulation Alberta Stroke Program Early CT Score, and complete recanalization were independent predictors of good neurologic outcomes. Failure to recanalize was strongly related to sICH and mortality. In addition, diabetes, atrial fibrillation, and baseline National Institutes of Health Stroke Scale scores ≥10 had an independent association with mortality. This study contributes to the knowledge required to optimize recanalization treatments for posterior circulation strokes and may help to improve future clinical studies.
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- 2020
40. Valor da angiografia por ressonância magnética 3D-TOF e RM 4D-dinâmica pós-contraste na avaliação de fístula arteriovenosa espontânea do seio cavernoso
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Francisco Bermal CAPARROZ NETO, Lucas Giansante ABUD, Rafael Gouveia Gomes de OLIVEIRA, Daniel Giansante ABUD, and Soraia Ramos Cabete FABIO
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Palsy ,medicine.diagnostic_test ,business.industry ,Mr angiography ,Arteriovenous fistula ,Neurosciences. Biological psychiatry. Neuropsychiatry ,Magnetic resonance imaging ,medicine.disease ,Right cavernous sinus ,medicine.anatomical_structure ,Neurology ,Cavernous sinus ,Dynamic contrast-enhanced MRI ,medicine ,Neurology (clinical) ,Nuclear medicine ,business ,Sinus (anatomy) ,RC321-571 - Abstract
A 46-year-old female patient presented symptoms of complete right oculomotor nerve palsy without proptosis. Orbital magnetic resonance (MR) imaging showed no abnormalities (). 3D time-of-flight MR angiography revealed high signal intensity in the right cavernous sinus (). This isolated finding has a 10-15% rate of false-positive in the diagnosis of dural arteriovenous fistula (DAVF). Additional 4D-dynamic contrast-enhanced MR angiography evidenced an early asymmetric enhancement of bilateral cavernous sinus, mainly on the right, draining downward through the inferior petrous sinus (),,,. [...]
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- 2020
41. Safety of ultrasound-guided distal radial artery access for abdominopelvic transarterial interventions: a prospective study
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Luis Henrique de Castro-Afonso, Adib Koury, Lucas Moretti Monsignore, and Daniel Giansante Abud
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Pseudoaneurysm ,0302 clinical medicine ,Hematoma ,Forearm ,medicine.artery ,Occlusion ,Interventional Radiology ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Embolization ,Prospective Studies ,Radial artery ,Prospective cohort study ,Ulnar artery ,Ultrasonography, Interventional ,Aged ,Ultrasonography ,Aged, 80 and over ,business.industry ,Endovascular Procedures ,Middle Aged ,medicine.disease ,medicine.anatomical_structure ,Treatment Outcome ,Radial Artery ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Purpose We aimed to evaluate ultrasound-guided distal radial artery (DRA) access to perform abdominopelvic endovascular procedures. Methods A prospective, observational study was carried out in a single center between December 2017 and February 2019. Forty-two abdominopelvic endovascular procedures were performed by the same operator in 37 patients with DRA access using a 5 F sheath. Most patients were male (67.6%) with a mean age of 62.0±11.4 years (age range, 27.6-82.8 years). Patient characteristics, including Barbeau's test classification, radial and ulnar sizes and technical success, were evaluated. Patients with a DRA smaller than 1.7 mm could not be safely punctured and were not included. Results Procedures included chemoembolization of hepatocellular carcinoma in 35 cases (83.3%), embolization of hepatic metastasis in neuroendocrine tumors in 4 cases (9.5%) and other embolization procedures in 3 cases (7.1%). The mean diameters of the DRA, proximal radial artery and proximal ulnar artery were 2.31, 2.63, and 2.09 mm, respectively. Out of 42 DRA puncture attempts, 97.6% (41/42) were successfully performed. There were no postoperative complications related to the access site, such as pain, palsy, paresthesia, occlusion, finger ischemia, bleeding, hematoma, and pseudoaneurysm. Transient forearm discomfort was reported in 7.1% of patients (3/42); one occurrence was associated with kinking rectification, and two occurrences were attributed to small arteries and/or vasospasm. Conclusion Ultrasound-guided DRA access seems to be feasible and safe to perform in abdominopelvic endovascular procedures in patients with a DRA considered amenable to be safely punctured, with high technical success rates.
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- 2020
42. Management of acute stroke and urgent neurointerventional procedures during COVID-19 pandemic: recommendations on the Scientific Department on Cerebrovascular Diseases of the Brazilian Academy of Neurology, Brazilian Society of Cerebrovascular Diseases and Brazilian Society of Neuroradiology
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Fabrício Buchdid Cardoso, Gabriel R. de Freitas, João José Freitas de Carvalho, Carla H.C. Moro, Bruno de Sousa Mendes Parente, Octávio Marques Pontes Neto, Raul G Nogueira, Maura Salaroli de Oliveira, Gisele Sampaio Silva, Carlos Clayton Macedo de Freitas, Francisco Mont’Alverne, Leticia C Rebello, Rodrigo Bazan, Jamary Oliveira-Filho, Daniel C Bezerra, Viviane Flumignan Zétola, Michel Frudit, Sheila Cristina Ouriques Martins, Daniel Giansante Abud, Wagner M Avelar, Adriana Bastos Conforto, Francisco Antunes Dias, Gustavo W. Kuster, Mário de Barros Faria, Fabricio O Lima, Maramelia Miranda, José Antonio Fiorot Junior, Pedro S.C. Magalhães, Leandro A. Barbosa, Fernanda Martins Maia Carvalho, José Guilherme Mendes Pereira Caldas, and Jorge Luis Nobre Rodrigues
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medicine.medical_specialty ,Neurology ,Infectious Disease Transmission, Patient-to-Professional ,Pneumonia, Viral ,MEDLINE ,Neurosciences. Biological psychiatry. Neuropsychiatry ,neurointerventional treatment ,Infectious Disease Transmission, Professional-to-Patient ,Betacoronavirus ,coronavirus infections ,Pandemic ,medicine ,Humans ,Disease management (health) ,Human resources ,Personal protective equipment ,Stroke ,Pandemics ,Societies, Medical ,Neuroradiology ,business.industry ,SARS-CoV-2 ,COVID-19 ,Disease Management ,medicine.disease ,stroke ,Coronavirus ,Neurology (clinical) ,Medical emergency ,business ,Coronavirus Infections ,Brazil ,RC321-571 - Abstract
Introduction: Although the 2019 severe acute respiratory syndrome coronavirus 2 infection (SARS-CoV-2, COVID-19) pandemic poses new challenges to the healthcare system to provide support for thousands of patients, there is special concern about common medical emergencies, such as stroke, that will continue to occur and will require adequate treatment. The allocation of both material and human resources to fight the pandemic cannot overshadow the care for acute stroke, a time-sensitive emergency that with an inefficient treatment will further increase mortality and long-term disability. Objective: This paper summarizes the recommendations from the Scientific Department on Cerebrovascular Diseases of the Brazilian Academy of Neurology, the Brazilian Society of Cerebrovascular Diseases and the Brazilian Society of Neuroradiology for management of acute stroke and urgent neuro-interventional procedures during the COVID-19 pandemic, including proper use of screening tools, personal protective equipment (for patients and health professionals), and patient allocation.
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- 2020
43. Association between draining vein diameters and intracranial arteriovenous malformation hemorrhage: a multicentric retrospective study
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Alexandre Cordeiro Ulhôa, Luiz Gustavo de Abreu Mattos, José Ricardo Vanzim, Marco Túlio Salles Rezende, Daniel Giansante Abud, IntraCranial Arteriovenous RUpture riSk Study (Icaruss) investigators, Benedicto Oscar Colli, Guilherme Seizem Nakiri, Salomão Faroj Chodraui-Filho, Felipe Padovani Trivelato, Charbel Mounayer, and Luis Henrique de Castro-Afonso
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Adult ,Intracranial Arteriovenous Malformations ,Male ,medicine.medical_specialty ,Adolescent ,HEMORRAGIA ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Risk factor ,Prospective cohort study ,Vein ,Child ,Neuroradiology ,Aged ,Retrospective Studies ,business.industry ,Angiography, Digital Subtraction ,Infant ,Retrospective cohort study ,Arteriovenous malformation ,Middle Aged ,medicine.disease ,Cerebral Veins ,Cerebral Angiography ,medicine.anatomical_structure ,Child, Preschool ,Female ,Neurology (clinical) ,Radiology ,Neurosurgery ,France ,Cardiology and Cardiovascular Medicine ,business ,Intracranial Hemorrhages ,030217 neurology & neurosurgery ,Brazil - Abstract
Intracranial arteriovenous malformations (AVMs) cause hemorrhage, and the role of draining vein diameters in rupture risk is controversial. The aims of the present study were to investigate the variables related with intracranial AVM rupture and to examine the association of draining vein diameters and AVM hemorrhage. Two hundred three patients were included in this study, of which 117 (57%) had unruptured AVMs, and 86 (43%) had ruptured AVMs. In an adjusted (multivariate) analysis, the variables significantly associated with AVM hemorrhagic presentation were age (OR per year increase 0.97, 95%CI 0.95–0.99, p = 0.007), a deep nidus compared with superficial nidus (OR 3.21, 95%CI 1.13–9.06, p = 0.028), the nidus diameter (OR per each mm increase 0.95, 95%CI 0.92–0.97, p
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- 2020
44. Abstract WP50: Cost-Effectiveness of Mechanical Thrombectomy for Acute Ischemic Stroke: An Analysis From RESILIENT Trial
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Francisco Mont’Alverne, Gabriel R. de Freitas, Jeruza Lavanholi Neyeloff, Carisi Anne Polanczyk, Viviane Flumignan Zétola, Sheila Cristina Ouriques Martins, Ana Cláudia de Souza, Leonardo A Carbonera, Leticia C Rebello, Denizar Vianna, Octavio M. Pontes-Neto, Maramelia Miranda, João José Freitas de Carvalho, Marcia Lorena Fagundes Chaves, Raul G Nogueira, Fabricio O Lima, Jamary Oliveira-Filho, Daniel Giansante Abud, Gisele Sampaio Silva, David S Liebeskind, and Jeffrey L. Saver
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Advanced and Specialized Nursing ,medicine.medical_specialty ,business.industry ,Cost effectiveness ,medicine.disease ,Endovascular therapy ,Mechanical thrombectomy ,Economic evaluation ,Emergency medicine ,medicine ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,Acute ischemic stroke ,Stroke ,Acute stroke - Abstract
Background and purpose: RESILIENT Trial was the first study in a developing country to demonstrate the benefit of mechanical thrombectomy (MT) in acute stroke patients. This economic evaluation aimed to access the cost-utility of MT under the perspective of the Brazilian Public Healthcare System. Methods: Analysis was based on a subset sample of the original study (151 of 221 patients) from 4 hospitals. We compared costs and utilities between MT plus standard care (n=78) vs. standard care alone (n=73). Direct medical costs were considered, and utilities were inputted according to each patient’s Utility-Weighted modified Rankin Score (UW-mRS). First-year survival was obtained from trial follow-up and modelled for a life-time horizon adjusted by National Mortality Data. Direct medical costs were converted to I$ using Purchasing Power Parity (PPP). A discount rate of 5% was used. Incremental cost-effectiveness ratio (ICER) is expressed in cost (I$) per Quality-Adjusted Life Year (QALY). Results: RESILIENT trial was stopped on its first interim analysis because of early efficacy. The incremental costs and QALYs gained with MT were estimated at I$ 8,369 and 0.75, respectively, compared with standard medical care, yielding an incremental cost-effectiveness ratio (ICER) of I$ 7,256 per QALY. Conclusion: The initially higher costs of MT were offset by the clear benefit of the intervention. RESILIENT trial demonstrated that such therapy is likely to be cost-effective despite the economical constraints in the Brazilian healthcare system.
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- 2020
45. Abstract WMP10: The Role of Intravenous Thrombolysis Before Mechanical Thrombectomy: A Subgroup Analysis of the RESILIENT Trial
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Daniel Giansante Abud, Gabriel Mosmann, David S Liebeskind, Sheila Cristina Ouriques Martins, Leonardo A Carbonera, Raul G Nogueira, Maramelia Miranda, Jeffrey L. Saver, Daniel C Bezerra, Michel Frudit, Gisele Sampaio Silva, Felipe Barros, Octavio M. Pontes-Neto, Fabricio O Lima, Ana Cláudia de Souza, Francisco Mont’Alverne, Fabrício Buchidid Cardoso, and Leticia C Rebello
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Advanced and Specialized Nursing ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Subgroup analysis ,Thrombolysis ,medicine.disease ,Endovascular therapy ,Mechanical thrombectomy ,Internal medicine ,medicine ,Cardiology ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,Stroke ,Acute ischemic stroke ,Large vessel occlusion - Abstract
Background: Mechanical thrombectomy (MT) in addition to intravenous thrombolysis (IVT) is now the recommended treatment for acute ischemic stroke (AIS) patients with large vessel occlusion (LVO). The positive trials also demonstrated that MT alone among patients ineligible for IVT is an effective therapy for AIS. Whether MT alone is as effective, worse, or better than pretreatment with IVT before MT among IVT-eligible AIS patients with LVO is debatable. We aimed to assess the effect of IVT on the clinical outcome of MT in the RESILIENT trial. Methods: RESILIENT was a randomized, prospective, multicenter, controlled trial evaluating the safety, efficacy, and cost-effectiveness of thrombectomy versus medical treatment alone. A total of 221 patient were enrolled. The trial showed a strong benefit to thrombectomy (90-day mRS ordinal shift, OR 95%CI). All eligible patients received intravenous tPA within the 4.5-hour-window. The primary end-point was the common odds ratio (cOR) of mRs at 90 days (shift analysis) and the main secondary endpoint was the rate of functional independence (mRS 0-2) at 90 days. Ordinal logistic and binary regression analyses with the use of intravenous tPA as an interaction term were performed with adjustments for potential confounders including age, baseline NIHSS score, occlusion site, IV tPA use and ASPECTS. A p value < 0.05 was considered statistically significant. Results: Among 221 randomized patients (median NIHSS, 18 IQR [14-21]), 155 (70%) were treated with IV tPA. The frequency of good recanalization (TICI 2b> ) and of hemorrhagic transformation was not affected by IVT. There was no significant difference in the treatment effect size across patients who received intravenous tPA versus those who did not in terms of overall functional disability (ordinal mRS shift: aOR: 2.63, 95%CI [1.48-4.69] vs. 1.54, 95%CI [0.63-3.74]; p=0.42) or functional independence (mRS 0-2: aOR: 3.06, 95%CI [1.37-6.48] vs. 1.71 95%CI [0.55-5.33], p=0.40) at 90 days. Conclusions: The large effect size of MT on LVO outcomes was not significantly affected by IVT. Further studies directly evaluating the role of IVT before MT are of utmost importance.
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- 2020
46. Abstract 131: Feasibility and Efficacy of Central Blinded Video Rankin Scale Outcome Assessments in a Randomized Clinical Trial
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David S Liebeskind, Leticia C Rebello, Francisco Mont’Alverne, Gabriel R. de Freitas, Sheila Cristina Ouriques Martins, Octavio Mattasoglio Neto, Mario B Farias, Mario Bernardes Wagner, Viviane Flumignan Zétola, Daniel C Bezerra, Michel Frudit, Carlos A. Molina, Daniel Giansante Abud, Lucas Scotta Cabral, Gisele Sampaio Silva, Raul G Nogueira, Jamary Oliveira-Filho, and Fabricio O Lima
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Advanced and Specialized Nursing ,medicine.medical_specialty ,business.industry ,medicine.disease ,Outcome (game theory) ,Endovascular therapy ,law.invention ,Clinical trial ,Randomized controlled trial ,law ,Scale (social sciences) ,Physical therapy ,Medicine ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,Stroke - Abstract
Introduction: In randomized clinical trials, central adjudication is frequently used for study outcomes. However, stroke trials have historically used site-derived Rankin scale assessments as primary outcome. Hypothesis: A central adjudication of Rankin scale assessment is at least as accurate as site-derived assessment. Methods: We studied acute stroke survivors from the RESILIENT study, where primary outcome was the consensus Rankin scale rating of two blinded central adjudicators who independently watched video recordings of a 90-day post-stroke structured patient and/or family interview. We compared agreement rates (weighted kappa statistics) between both central adjudicators with that between the blinded site investigator and the consensus reading between central adjudicators. Results: Trial randomized 221 patients to thrombectomy or medical treatment alone. At 90 days, 161 (73%) survived and 142/161 (88%) had quality video recordings for central adjudicators. Median (interquartile range) Rankin scores were similarly 3 (2-4) for each central rater and for the site investigators. Agreement rates between central adjudicators was 79.6% (kappa=0.94, p Conclusions: Central blinded Rankin scale outcome assessment is feasible and is at least as good as site investigator assessments. For open-label trials with blinded clinical outcome assessment, central adjudication of video-recorded interviews provides safer blinding and accountability.
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- 2020
47. Abstract WP9: Impact of Sex Differences on the Treatment Effect of Mechanical Thrombectomy: A Subgroup Analysis of the RESILIENT Trial
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Rui Kleber Martins-Filho, Daniel C Bezerra, Michel Frudit, Sheila Cristina Ouriques Martins, Guilherme Dabus, David S Liebeskind, Raul G Nogueira, Gisele Sampaio Silva, Leticia C Rebello, Francisco Mont’Alverne, Luis Henrique de Castro-Afonso, Carlos A. Molina, Jamary Oliveira-Filho, Daniel Giansante Abud, Gabriel R. de Freitas, Joseph P. Broderick, Octavio M. Pontes-Neto, Mário Henrique Girão Faria, Jose Antonio Fiorot, Fabricio O Lima, Ana Cláudia de Souza, Guilherme Seizem Nakiri, and Mario Bernardes Wagner
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Advanced and Specialized Nursing ,medicine.medical_specialty ,business.industry ,Subgroup analysis ,medicine.disease ,Endovascular therapy ,Mechanical thrombectomy ,Internal medicine ,Cardiology ,medicine ,Treatment effect ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,Stroke ,Acute ischemic stroke ,Large vessel occlusion - Abstract
Background: Despite evidence supporting the overall efficacy of mechanical thrombectomy (MT) in acute ischemic stroke (AIS) due to large vessel occlusion (LVO) of the anterior circulation, it is unclear whether the treatment effect of MT differs by sex in different populations. We assessed the impact of sex differences in the treatment effect of MT in the RESILIENT trial. Methods: RESILIENT was a prospective, multicenter, randomized phase III trial that was designed to assess the safety, efficacy, and cost-effectiveness of mechanical thrombectomy as compared to medical treatment alone in patients treated under the less than ideal conditions typically found in the public healthcare system of a developing country. Results: Among 221 patients enrolled in the trial, 104 (47,1%) were female. Baseline characteristics were well balanced between sexes, except for a higher prevalence of hypertension (76% vs. 57.4%; p=0.004) and diabetes (34.3% vs. 21.7%; p=0.039) and a lower frequency of alcohol abuse (4% vs. 28.9%; p=0.001) in females. After adjustment for baseline characteristics, we found a significant interaction (p=0.026) between sex and the effect of MT with a lower efficacy of MT for functional independency at 90 days among women (aOR=1.13;95%CI:0.42-3.02) compared to men (aOR=4.78; 95%CI:1.88-12.15). Conclusions: In our study population of patients with AIS caused by LVO of the anterior circulation, women were less likely to benefit from MT than men. Further studies are necessary to investigate these findings.
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- 2020
48. Abstract 4: RESILIENT Collaterals and 24-Hour Infarct Growth: Revascularization is Essential
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Leticia C Rebello, Leonardo A Carbonera, Gisele Sampaio Silva, Michel Frudit, Octavio M. Pontes-Neto, David S Liebeskind, Mário de Barros Faria, Jeffrey L. Saver, Fabrício Buchidid Cardoso, Raul G Nogueira, Daniel Giansante Abud, Fabricio O Lima, Sheila Cristina Ouriques Martins, Mario Bernardes Wagner, Francisco Mont’Alverne, Jamary Oliveira-Filho, and Diogo C Haussen
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Advanced and Specialized Nursing ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Collateral circulation ,Revascularization ,medicine.disease ,Endovascular therapy ,law.invention ,Randomized controlled trial ,law ,Internal medicine ,Angiography ,Cardiology ,Medicine ,cardiovascular diseases ,Neurology (clinical) ,Symptom onset ,Cardiology and Cardiovascular Medicine ,business ,Stroke - Abstract
Background: The RESILIENT randomized trial of endovascular therapy for anterior circulation stroke within 8 hours of symptom onset excluded subjects with poor collaterals. We analyzed the relationship of CTA collateral grade with respect to subsequent infarct growth over 24 hours, with and without revascularization. Methods: The independent RESILIENT imaging and angiography core lab scored baseline CTA Tan collateral grade (0-3) and CT ASPECTS scores at baseline and 24 hours in both arms. ASITN collateral grade (0-4) was adjudicated prior to revascularization in the interventional arm. Descriptive statistics, univariate, multivariate and ANOVA related CTA collateral grade with 24-hour infarct growth. Results: 210/221 (95%) subjects (median age 67 (53-76) years; 48% women) in RESILIENT had baseline single-phase CTA available to the core lab evaluation. CTA collateral grade was complete (grade 3) in 106 (50.5%), grade 2 (50-99%) in 68 (32.4%), grade 1 (1-49%) in 36 (17.1%), with no collaterals in 0. The extent of collaterals was more robust in the medical arm (55.0% grade 3, 31.4% grade 2, 13.3% grade 1) compared to the interventional arm (45.7% grade 3, 33.3% grade 2, 21.0% grade 1), although this finding was not statistically significant (p=0.11). In the interventional arm, the extent of CTA collaterals had a strong correlation with ASITN grade (ρ=0.59, p Conclusions: In RESILIENT, CTA collateral grade was linked with higher ASPECTS and less infarct growth over 24 hours. Despite more robust collaterals in the medical arm, greater infarct growth occurred without revascularization or endovascular therapy.
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- 2020
49. Abstract TP4: Age is an Important Effect Modifier of Mechanical Thrombectomy: A Subgroup Analysis of the Resilient Trial
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Sheila Cristina Ouriques Martins, Joseph P. Broderick, Raul G Nogueira, Diogo C Haussen, Gisele Sampaio Silva, David S Liebeskind, Norberto Anízio Ferreira Frota, Jamary Oliveira-Filho, Ana Cláudia de Souza, Fabricio O. Lima, Mario Bernardes Wagner, João José Freitas de Carvalho, Daniel Giansante Abud, Michel Frudit, Diego Bandeira, Leticia C Rebello, Francisco Mont’Alverne, and Octavio M. Pontes-Neto
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Advanced and Specialized Nursing ,Mechanical thrombectomy ,medicine.medical_specialty ,business.industry ,medicine ,Subgroup analysis ,Neurology (clinical) ,Effect modifier ,Cardiology and Cardiovascular Medicine ,business ,Surgery - Abstract
Background: Randomized trials performed in high income countries have shown similar effects of mechanical thrombectomy (MT) in elderly and non-elderly patients with large vessel ischemic strokes (LVO). We aimed to assess the effect of age on the clinical outcome of MT in RESILIENT (a randomized, prospective, multicenter, controlled, phase III, clinical trial with blinded outcome assessment performed in Brazil designed to assess the safety, efficacy, and cost-effectiveness of mechanical thrombectomy as compared to medical treatment alone). Methods: Patients were classified as elderly and non-elderly (≤ 70 vs. > 70 years). The end-points were the common odds ratio (cOR) of mRs (shift analysis) and the frequency of functional independence (mRS 0-2) at 90 days. Ordinal logistic regression analysis (unadjusted and adjusted for important potential confounders) with age group as an interaction term were performed. A p value < 0.05 was considered statistically significant. Results: Among 221 randomized patients (117- 52.9% males), 89 (40.2%) were classified as elderly. Age had an important effect modification of MT on the mRS shift analysis (elderly - cOR 1.20 95% CI [0.57-2.51] vs. non-elderly cOR 3.9, 95% CI [1.65-5.80], p-interaction = 0.003) and on the frequency of functional independence at 90 days (elderly - OR 0.92 95% CI [0.33 - 2.59] vs. non-elderly OR 3.56, 95% CI [1.64 - 7.75], p-interaction = 0.04). A similar effect modification was observed after adjusting for IV rt-PA, occlusion site, baseline NIHSS and ASPECTS on the mRS shift analysis (elderly - cOR 1.34, 95% CI [0.63 - 2.86] vs. non-elderly cOR 3.26, 95% CI [1.73 - 6.13], p-interaction = 0.06) and on the frequency of functional independence at 90 days (elderly - OR 1.08 95% CI [0.36 - 3.21] vs. non-elderly OR 4.26, 95% CI [1.85 - 9.82], p-interaction = 0.04) . Conclusion: The large effect size of MT on LVO outcomes is significantly diminished in the elderly population of patients treated under the less than ideal conditions typically found in the public healthcare system of a developing country.
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- 2020
50. Abstract 5: CT Perfusion is Not a Treatment Effect Modifier for Mechanical Thrombectomy in the 0-8-Hour-Window: A Pre-Planned Analysis of the RESILIENT Trial
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Leticia C Rebello, Carlos A. Molina, Daniel Giansante Abud, Raul G Nogueira, Eduardo Siqueira Waihrich, Mario Bernardes Wagner, Sheila C Martins, Gisele Sampaio Silva, Fabricio O Lima, Bruno de Sousa Mendes Parente, Gabriel R. de Freitas, Leandro A. Barbosa, Francisco Mont’Alverne, David S Liebeskind, Octavio M. Pontes-Neto, and Michel Frudit
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Advanced and Specialized Nursing ,medicine.medical_specialty ,business.industry ,Perfusion scanning ,medicine.disease ,Endovascular therapy ,Mechanical thrombectomy ,medicine ,Treatment effect ,Neurology (clinical) ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Stroke ,Selection (genetic algorithm) - Abstract
Background: CT perfusion has been increasingly used as a selection tool in acute reperfusion therapies. However, it remains unknown whether its use is associated with a higher treatment benefit in patients undergoing thrombectomy. We sought to evaluate the interaction between imaging selection modalities and treatment effect in the RESILIENT Trial. Methods: RESILIENT was a randomized, prospective, multicenter, controlled trial evaluating the safety, efficacy, and cost-effectiveness of thrombectomy versus medical treatment alone in Brazil. A total of 221 patient were enrolled. The trial showed a strong benefit of thrombectomy (90-day mRS ordinal shift, OR 2.28 95%CI [1.41-3.70]; p=0.001). Key imaging selection criteria included ASPECTS ≥6 on non-contrast CT (NCCT) and the exclusion of malignant collateral profile on CT angiography. The use of automated CT perfusion software (RAPID, IschemaView) was optional but was made available in some centers with the pre-specified plan to compare imaging selection modalities. The primary end-point was the common odds ratio (cOR) of mRs at 90 days (shift analysis) and the main secondary endpoint was the rate of functional independence (mRS 0-2) at 90 days. Ordinal logistic and binary regression analyses with imaging selection modality (NCCT versus CTP) as an interaction term were performed with adjustments for potential confounders including age, baseline NIHSS score, occlusion site, IV tPA use and ASPECTS. A p value < 0.05 was considered statistically significant. Results: CTP was performed in 41% of the thrombectomy group and 45% in the control group. There was no significant difference in the treatment effect size for patients selected on the basis of NCCT and CTA only versus those submitted to CTP in terms of overall functional disability (ordinal mRS shift: aOR: 2.87, 95%CI [1.47-5.61] vs. 2.10, 95%CI [1.01-4.36]; p=0.390) or functional independence (mRS 0-2: aOR: 3.16, 95%CI [1.32-7.57] vs. 2.54 95%CI [0.86-7.49], p=0.40) at 90 days. Conclusion: In a randomized clinical trial of thrombectomy within 8 hours of stroke onset, there was no evidence of difference in the treatment effect size across patients selected with NCCT and CTA alone versus automated CT perfusion software.
- Published
- 2020
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