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1. Endovascular Treatment and Peri-interventional Management of Ruptured Cerebrovascular Lesions During Pregnancy: Case Series and Case-based Systematic Review

Author

Etter, Manina M., Nguyen, Anh, Brehm, Alex, Aberle, Christoph, Tsogkas, Ioannis, Guzman, Raphael, Dmytriw, Adam A., Parra-Farinas, Carmen, Mascitelli, Justin R., Pereira, Vitor Mendes, Starke, Robert M., Fragata, Isabel, Reis, João, Wolfe, Stacey Quintero, Porto, Guilherme B., Spiotta, Alejandro M., and Psychogios, Marios-Nikos

Published
2023
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5. The Impact of Dual Antiplatelet Therapy Duration on Unruptured Aneurysm Occlusion After Flow Diversion: A Multicenter Study

Author

Vranic, Justin E., Harker, Pablo, Stapleton, Christopher J., Regenhardt, Robert W., Dmytriw, Adam A., Doron, Omer M., Alotaibi, Naif M., Leslie-Mazwi, Thabele M., Gupta, Rajiv, Berglar, Inka K., Tan, Can Ozan, Koch, Matthew J., Raymond, Scott B., Mascitelli, Justin R., Patterson, T. Tyler, Seinfeld, Joshua, White, Andrew, Case, David, Roark, Christopher, Gandhi, Chirag D., Al-Mufti, Fawaz, Cooper, Jared, Matouk, Charles, Sujijantarat, Nanthiya, Devia, Diego A., Ocampo-Navia, Maria I., Villamizar-Torres, Daniel E., Puentes, Juan C., and Patel, Aman B.

Published
2023
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6. Comprehensive analysis of the impact of procedure time and the 'golden hour' in subpopulations of stroke thrombectomy patients.

Author

Ash, Makenna, Dimisko, Laurie, Chalhoub, Reda M., Howard, Brian M., Cawley, C. Michael, Matouk, Charles, Pabaney, Aqueel, Spiotta, Alejandro M., Jabbour, Pascal, Maier, Ilko, Wolfe, Stacey Q., Rai, Ansaar T., Joon-tae Kim, Psychogios, Marios-Nikos, Mascitelli, Justin R., Starke, Robert M., Shaban, Amir, Shinichi Yoshimura, De Leacy, Reade, and Kan, Peter

Abstract

Objective To evaluate the effect of procedure time on thrombectomy outcomes in different subpopulations of patients undergoing endovascular thrombectomy (EVT), given the recently expanded indications for EVT. Methods This multicenter study included patients undergoing EVT for acute ischemic stroke at 35 centers globally. Procedure time was defined as time from groin puncture to successful recanalization (Thrombolysis in Cerebral Infarction score ≥2b) or abortion of procedure. Patients were stratified based on stroke location, use of IV tissue plasminogen activator (tPA), Alberta Stroke Program Early CT score, age group, and onset-to-groin time. Primary outcome was the 90-day modified Rankin Scale (mRS) score, with scores 0-2 designating good outcome. Secondary outcome was postprocedural symptomatic intracranial hemorrhage (sICH). Multivariate analyses were performed using generalized linear models to study the impact of procedure time on outcomes in each subpopulation. results Among 8961 patients included in the study, a longer procedure time was associated with higher odds of poor outcome (mRS score 3-6), with 10% increase in odds for each 10 min increment. When procedure time exceeded the 'golden hour', poor outcome was twice as likely. The golden hour effect was consistent in patients with anterior and posterior circulation strokes, proximal or distal occlusions, in patients with large core infarcts, with or without IV tPA treatment, and across age groups. Procedures exceeding 1 hour were associated with a 40% higher sICH rate. Posterior circulation strokes, delayed presentation, and old age were the variables most sensitive to procedure time. Conclusions In this work we demonstrate the universality of the golden hour effect, in which procedures lasting more than 1 hour are associated with worse clinical outcomes and higher rates of sICH across different subpopulations of patients undergoing EVT. [ABSTRACT FROM AUTHOR]

Published
2024
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8. Does eloquence subtype influence outcome following arteriovenous malformation surgery?

Author

Mascitelli, Justin R, Yoon, Seungwon, Cole, Tyler S, Kim, Helen, and Lawton, Michael T

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Patient Safety, Clinical Research, Neurosciences, Adolescent, Adult, Brain Mapping, Female, Humans, Intracranial Arteriovenous Malformations, Language, Logistic Models, Male, Microsurgery, Middle Aged, Motor Activity, Radiography, Retrospective Studies, Risk Assessment, Severity of Illness Index, Treatment Outcome, Visual Perception, Young Adult, arteriovenous malformation, brain eloquence, modified Rankin Scale, Spetzler-Martin grading system, Lawton-Young grading system, patient selection, risk prediction, vascular disorders, AVM = arteriovenous malformation, LED = lesion-to-eloquence distance, MSI = magnetic source imaging, SM = Spetzler-Martin, fMRI = functional MRI, mRS = modified Rankin Scale, Neurology & Neurosurgery, Clinical sciences
Abstract

ObjectiveAlthough numerous arteriovenous malformation (AVM) grading scales consider eloquence in risk assessment, none differentiate the types of eloquence. The purpose of this study was to determine if eloquence subtype affects clinical outcome.MethodsThis is a retrospective review of a prospectively collected clinical database of brain AVMs treated with microsurgery in the period from 1997 to 2017. The only inclusion criterion for this study was the presence of eloquence as defined by the Spetzler-Martin grading scale. Eloquence was preoperatively categorized by radiologists. Poor outcome was defined as a modified Rankin Scale (mRS) score 3-6, and worsening clinical status was defined as an increase in the mRS score at follow-up. Logistic regression analyses were performed.ResultsTwo hundred forty-one patients (49.4% female; average age 33.9 years) with eloquent brain AVMs were included in this review. Of the AVMs (average size 2.7 cm), 54.4% presented with hemorrhage, 46.2% had deep venous drainage, and 17.0% were diffuse. The most common eloquence type was sensorimotor (46.1%), followed by visual (27.0%) and language (22.0%). Treatments included microsurgery alone (32.8%), microsurgery plus embolization (51.9%), microsurgery plus radiosurgery (7.9%), and all three modalities (7.5%). Motor mapping was used in 9% of sensorimotor AVM cases, and awake speech mapping was used in 13.2% of AVMs with language eloquence. Complications occurred in 24 patients (10%). At the last follow-up (average 24 months), 71.4% of the patients were unchanged or improved and 16.6% had a poor outcome. There was no statistically significant difference in the baseline patient and AVM characteristics among the different subtypes of eloquence. In a multivariate analysis, in comparison to visual eloquence, both sensorimotor (OR 7.4, p = 0.004) and language (OR 6.5, p = 0.015) eloquence were associated with poor outcomes. Additionally, older age (OR 1.31, p = 0.016) and larger AVM size (OR 1.37, p = 0.034) were associated with poor outcomes.ConclusionsUnlike visual eloquence, sensorimotor and language eloquence were associated with worse clinical outcomes after the resection of eloquent AVMs. This nuance in AVM eloquence demands consideration before deciding on microsurgical intervention, especially when numerical grading systems produce a score near the borderline between operative and nonoperative management.

Published
2018

12. Focused update to guidelines for endovascular therapy for emergent large vessel occlusion: basilar artery occlusion patients.

Author

Heit, Jeremy Josef, Chaudhary, Neeraj, Mascitelli, Justin R., Al-Kawaz, Mais, Baker, Amanda, Bulsara, Ketan R., Burkhardt, Jan Karl, Marden, Franklin A., Raper, Daniel, Tjoumakaris, Stavropoula I., Schirmer, Clemens M., and Hetts, Steven W.

Subjects
MEDICAL protocols, CONSENSUS (Social sciences), BASILAR artery, NEUROSURGERY, PATIENTS, MEDICAL personnel, BLOOD vessels, COMPUTED tomography, ENDOVASCULAR surgery, EMERGENCY medical services, TREATMENT effectiveness, ISCHEMIC stroke, MEDICAL research, ARTERIAL occlusions, STROKE, EVIDENCE-based medicine, EXPERTISE, THROMBECTOMY
Abstract

Background Endovascular therapy (EVT) dramatically improves clinical outcomes for patients with anterior circulation emergent large vessel occlusion (ELVO) strokes. With recent publication of two randomized controlled trials in favor of EVT for basilar artery occlusions, the Society of NeuroInterventional Surgery (SNIS) Standards and Guidelines Committee provides this focused update for the existing SNIS guideline, 'Current endovascular strategies for posterior circulation large vessel occlusion stroke.' Methods A structured literature review and analysis of studies related to posterior circulation large vessel occlusion (basilar or vertebral artery) strokes treated by EVT was performed. Based on the strength and quality of the evidence, recommendations were made by consensus of the writing committee, with additional input from the full SNIS Standards and Guidelines Committee and the SNIS Board of Directors. Results Based on the results of the most recent randomized, controlled trials on EVT for basilar or vertebral artery occlusion, the expert panel agreed on the following recommendations. For patients presenting with an acute ischemic stroke due to an acute basilar or vertebral artery occlusion confirmed on CT angiography, National Institutes of Health Stroke Scale (NIHSS) score of ≥6, posterior circulation Alberta Stroke Program Early CT Score (PC-ASPECTS) ≥6, and age 18--89 years: (1) thrombectomy is indicated within 12 hours since last known well (class I, level B-R); (2) thrombectomy is reasonable within 12--24 hours from the last known well (class IIa, level B-R); (3) thrombectomy may be considered on a case by case basis for patients presenting beyond 24 hours since last known well (class IIb, level C-EO). In addition, thrombectomy may be considered on a case by case basis for patients aged <18 years or >89 years on a case by case basis (class IIb, level C-EO). Conclusions The indications for EVT of ELVO strokes continue to expand and now include patients with basilar artery occlusion. Further prospective, randomized controlled trials are warranted to elucidate the efficacy and safety of EVT in populations not included in this set of recommendations, and to confirm long term outcomes. [ABSTRACT FROM AUTHOR]

Published
2024
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13. Flow Diversion for Endovascular Treatment of Intracranial Aneurysms: Past, Present, and Future Directions.

Author

Gaub, Michael, Murtha, Greg, Lafuente, Molly, Webb, Matthew, Luo, Anqi, Birnbaum, Lee A., Mascitelli, Justin R., and Al Saiegh, Fadi

Subjects
INTRACRANIAL aneurysms, RUPTURED aneurysms, INTRACRANIAL aneurysm ruptures, ENDOVASCULAR surgery, ARTIFICIAL intelligence
Abstract

Flow diversion for intracranial aneurysms emerged as an efficacious and durable treatment option over the last two decades. In a paradigm shift from intrasaccular aneurysm embolization to parent vessel remodeling as the mechanism of action, the proliferation of flow-diverting devices has enabled the treatment of many aneurysms previously considered untreatable. In this review, we review the history and development of flow diverters, highlight the pivotal clinical trials leading to their regulatory approval, review current devices including endoluminal and intrasaccular flow diverters, and discuss current and expanding indications for their use. Areas of clinical equipoise, including ruptured aneurysms and wide-neck bifurcation aneurysms, are summarized with a focus on flow diverters for these pathologies. Finally, we discuss future directions in flow diversion technology including bioresorbable flow diverters, transcriptomics and radiogenomics, and machine learning and artificial intelligence. [ABSTRACT FROM AUTHOR]

Published
2024
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14. The Impact of Preprocedural Platelet Function Testing on Periprocedural Complication Rates Associated With Pipeline Flow Diversion: An International Multicenter Study.

Author

Vranic, Justin E., Dmytriw, Adam A., Berglar, Inka K., Alotaibi, Naif M., Cancelliere, Nicole M., Stapleton, Christopher J., Rabinov, James D., Harker, Pablo, Gupta, Rajiv, Bernstock, Joshua D., Koch, Matthew J., Raymond, Scott B., Mascitelli, Justin R., Patterson, T. Tyler, Seinfeld, Joshua, White, Andrew, Case, David, Roark, Christopher, Gandhi, Chirag D., and Al-Mufti, Fawaz

Published
2024
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16. Microsurgical Clipping of Unruptured Anterior Circulation Aneurysms—A Global Multicenter Investigation of Perioperative Outcomes

Author

Sauvigny, Jennifer, primary, Drexler, Richard, additional, Pantel, Tobias F., additional, Ricklefs, Franz L., additional, Catapano, Joshua S., additional, Wanebo, John E., additional, Lawton, Michael T., additional, Sanchin, Aminaa, additional, Hecht, Nils, additional, Vajkoczy, Peter, additional, Raygor, Kunal, additional, Tonetti, Daniel, additional, Abla, Adib, additional, El Naamani, Kareem, additional, Tjoumakaris, Stavropoula I., additional, Jabbour, Pascal, additional, Jankowitz, Brian T., additional, Salem, Mohamed M., additional, Burkhardt, Jan-Karl, additional, Wagner, Arthur, additional, Wostrack, Maria, additional, Gempt, Jens, additional, Meyer, Bernhard, additional, Gaub, Michael, additional, Mascitelli, Justin R., additional, Dodier, Philippe, additional, Bavinzski, Gerhard, additional, Roessler, Karl, additional, Stroh, Nico, additional, Gmeiner, Matthias, additional, Gruber, Andreas, additional, Figueiredo, Eberval G., additional, Coelho, Antonio Carlos Samaia da Silva, additional, Bervitskiy, Anatoliy V., additional, Anisimov, Egor D., additional, Rzaev, Jamil A., additional, Krenzlin, Harald, additional, Keric, Naureen, additional, Ringel, Florian, additional, Park, Dougho, additional, Kim, Mun-Chul, additional, Marcati, Eleonora, additional, Cenzato, Marco, additional, Krause, Linda, additional, Westphal, Manfred, additional, Dührsen, Lasse, additional, and Sauvigny, Thomas, additional

Published
2024
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19. Abstract 168: Platelet function testing and risk of periprocedural complications with flow diversion: An international multicenter study

Author

Vranic, Justin E., primary, Dmytriw, Adam A., additional, Dipl‐Math, Inka K. Bergler, additional, Alotaibi, Naif M., additional, Cancelliere, Nicole M., additional, Stapleton, Christopher J., additional, Rabinov, James D., additional, Harker, Pablo, additional, Gupta, Rajiv, additional, Koch, Matthew J., additional, Raymond, Scott B., additional, Mascitelli, Justin R., additional, Patterson, T. Masoud, additional, Namaani, Kareem El, additional, Kühn, Anna L., additional, Pukenas, Bryan, additional, Jankowitz, Brian, additional, Burkhardt, Jan M., additional, Siddiqui, Adnan H., additional, Jabbour, Pascal, additional, Singh, Jasmeet, additional, Puri, Ajit S., additional, Regenhardt, Robert, additional, Pereira, Vitor M., additional, and Patel, Aman, additional

Published
2023
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20. Comprehensive analysis of the impact of procedure time and the ‘golden hour’ in subpopulations of stroke thrombectomy patients

Author

Ash, Makenna, primary, Dimisko, Laurie, additional, Chalhoub, Reda M, additional, Howard, Brian M, additional, Cawley, C Michael, additional, Matouk, Charles, additional, Pabaney, Aqueel, additional, Spiotta, Alejandro M, additional, Jabbour, Pascal, additional, Maier, Ilko, additional, Wolfe, Stacey Q, additional, Rai, Ansaar T, additional, Kim, Joon-tae, additional, Psychogios, Marios-Nikos, additional, Mascitelli, Justin R, additional, Starke, Robert M, additional, Shaban, Amir, additional, Yoshimura, Shinichi, additional, De Leacy, Reade, additional, Kan, Peter, additional, Fragata, Isabel, additional, Polifka, Adam J, additional, Arthur, Adam S, additional, Park, Min S, additional, Crosa, Roberto Javier, additional, Williamson, Richard, additional, Dumont, Travis M, additional, Levitt, Michael R, additional, Al Kasab, Sami, additional, Tjoumakaris, Stavropoula I, additional, Liman, Jan, additional, Saad, Hassan, additional, Samaniego, Edgar A, additional, Fargen, Kyle M, additional, Grossberg, Jonathan A, additional, and Alawieh, Ali, additional

Published
2023
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22. Safety and efficacy of the Pipeline Flex embolization device with Shield Technology for the acute treatment of ruptured internal carotid artery pseudoaneurysms: a multi-institution case series

Author

Bounajem, Michael T., primary, Joyce, Evan, additional, Scoville, Jonathan P., additional, Seinfeld, Joshua, additional, Hoffman, Jessa, additional, Grossberg, Jonathan A., additional, Waiters, Vanesha, additional, White, Andrew C., additional, Nerva, John, additional, Burkhardt, Jan-Karl, additional, Tonetti, Daniel A., additional, El Naamani, Kareem, additional, Gooch, M. Reid, additional, Jabbour, Pascal, additional, Tjoumakaris, Stavropoula, additional, Ortega Gutierrez, Santiago, additional, Levitt, Michael R., additional, Lang, Michael, additional, Ares, William J., additional, Desai, Sohum, additional, Mascitelli, Justin R., additional, Kilburg, Craig J., additional, Budohoski, Karol P., additional, Couldwell, William T., additional, Gross, Bradley A., additional, and Grandhi, Ramesh, additional

Published
2023
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23. Commentary: Twenty Years, 10 Fellows, 1 Article: Reflections on Cerebrovascular Training and the Evolution of Basilar Apex Aneurysm Treatments

Author

Graffeo, Christopher S., primary, Srinivasan, Visish M., additional, Frisoli, Fabio, additional, Lang, Michael J., additional, Mascitelli, Justin R., additional, Burkhardt, Jan-Karl, additional, Walcott, Brian P., additional, Owen, Christopher M., additional, Rodriguez-Hernandez, Ana, additional, and Abla, Adib A., additional

Published
2023
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24. Global Outcomes for Microsurgical Clipping of Unruptured Intracranial Aneurysms: A Benchmark Analysis of 2245 Cases

Author

Drexler, Richard, Sauvigny, Thomas, Pantel, Tobias F., Ricklefs, Franz L., Catapano, Joshua S., Wanebo, John E., Lawton, Michael T., Sanchin, Aminaa, Hecht, Nils, Vajkoczy, Peter, Raygor, Kunal, Tonetti, Daniel, Abla, Adib, El Naamani, Kareem, Tjoumakaris, Stavropoula I., Jabbour, Pascal, Jankowitz, Brian T., Salem, Mohamed M., Burkhardt, Jan-Karl, Wagner, Arthur, Wostrack, Maria, Gempt, Jens, Meyer, Bernhard, Gaub, Michael, Mascitelli, Justin R., Dodier, Philippe, Bavinzski, Gerhard, Roessler, Karl, Stroh, Nico, Gmeiner, Matthias, Gruber, Andreas, Figueiredo, Eberval G., da Silva Coelho, Antonio Carlos Samaia, Bervitskiy, Anatoliy V., Anisimov, Egor D., Rzaev, Jamil A., Krenzlin, Harald, Keric, Naureen, Ringel, Florian, Park, Dougho, Kim, Mun-Chul, Marcati, Eleonora, Cenzato, Marco, Westphal, Manfred, Dührsen, Lasse, Drexler, Richard, Sauvigny, Thomas, Pantel, Tobias F., Ricklefs, Franz L., Catapano, Joshua S., Wanebo, John E., Lawton, Michael T., Sanchin, Aminaa, Hecht, Nils, Vajkoczy, Peter, Raygor, Kunal, Tonetti, Daniel, Abla, Adib, El Naamani, Kareem, Tjoumakaris, Stavropoula I., Jabbour, Pascal, Jankowitz, Brian T., Salem, Mohamed M., Burkhardt, Jan-Karl, Wagner, Arthur, Wostrack, Maria, Gempt, Jens, Meyer, Bernhard, Gaub, Michael, Mascitelli, Justin R., Dodier, Philippe, Bavinzski, Gerhard, Roessler, Karl, Stroh, Nico, Gmeiner, Matthias, Gruber, Andreas, Figueiredo, Eberval G., da Silva Coelho, Antonio Carlos Samaia, Bervitskiy, Anatoliy V., Anisimov, Egor D., Rzaev, Jamil A., Krenzlin, Harald, Keric, Naureen, Ringel, Florian, Park, Dougho, Kim, Mun-Chul, Marcati, Eleonora, Cenzato, Marco, Westphal, Manfred, and Dührsen, Lasse

Abstract

BACKGROUND AND OBJECTIVES: Benchmarks represent the best possible outcome and help to improve outcomes for surgical procedures. However, global thresholds mirroring an optimal and reachable outcome for microsurgical clipping of unruptured intracranial aneurysms (UIA) are not available. This study aimed to define standardized outcome benchmarks in patients who underwent clipping of UIA. METHODS: A total of 2245 microsurgically treated UIA from 15 centers were analyzed. Patients were categorized into low- ("benchmark") and high-risk ("nonbenchmark") patients based on known factors affecting outcome. The benchmark was defined as the 75th percentile of all centers' median scores for a given outcome. Benchmark outcomes included intraoperative (eg, duration of surgery, blood transfusion), postoperative (eg, reoperation, neurological status), and aneurysm-related factors (eg, aneurysm occlusion). Benchmark cutoffs for aneurysms of the anterior communicating/anterior cerebral artery, middle cerebral artery, and posterior communicating artery were determined separately. RESULTS: Of the 2245 cases, 852 (37.9%) patients formed the benchmark cohort. Most operations were performed for middle cerebral artery aneurysms (53.6%), followed by anterior communicating and anterior cerebral artery aneurysms (25.2%). Based on the results of the benchmark cohort, the following benchmark cutoffs were established: favorable neurological outcome (modified Rankin scale ≤2) ≥95.9%, postoperative complication rate ≤20.7%, length of postoperative stay ≤7.7 days, asymptomatic stroke ≤3.6%, surgical site infection ≤2.7%, cerebral vasospasm ≤2.5%, new motor deficit ≤5.9%, aneurysm closure rate ≥97.1%, and at 1-year follow-up: aneurysm closure rate ≥98.0%. At 24 months, benchmark patients had a better score on the modified Rankin scale than nonbenchmark patients. CONCLUSION: This study presents internationally applicable benchmarks for clinically relevant outcomes after microsurgical clipping of UIA.

Published
2023

26. Effect of intravenous thrombolysis before endovascular therapy on outcomes in patients with large core infarct.

Author

Anadani, Mohammad, Almallouhi, Eyad, Maier, Ilko, Al Kasab, Sami, Jabbour, Pascal, Joon-tae Kim, Wolfe, Stacey Q., Rai, Ansaar, Starke, Robert M., Psychogios, Marios-Nikos, Samaniego, Edgar A., Arthur, Adam S., Shinichi Yoshimura, Cuellar, Hugo, Howard, Brian M., Alawieh, Ali, Fragata, Isabel, Polifka, Adam J., Mascitelli, Justin R., and Osbun, Joshua W.

Subjects
DRUG efficacy, STROKE, HEMORRHAGIC stroke, THROMBOLYTIC therapy, RETROSPECTIVE studies, MANN Whitney U Test, COMPARATIVE studies, THROMBECTOMY, DESCRIPTIVE statistics, CHI-squared test, ENDOVASCULAR surgery, LOGISTIC regression analysis, DATA analysis software, PATIENT safety, LONGITUDINAL method
Abstract

Background The safety and efficacy of bridging therapy with intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) in patients with large core infarct has not been sufficiently studied. In this study, we compared the efficacy and safety outcomes between patients who received IVT+MT and those treated with MT alone. Methods This is a retrospective analysis of the Stroke Thrombectomy Aneurysm Registry (STAR). Patients with Alberta Stroke Program Early CT Score (ASPECTS) ≤5 treated with MT were included in this study. Patients were divided into two groups based on pre-treatment IVT (IVT, no IVT). Propensity score matched analysis were used to compare outcomes between groups. results A total of 398 patients were included; 113 pairs were generated using propensity score matching analyses. Baseline characteristics were well balanced in the matched cohort. The rate of any intracerebral hemorrhage (ICH) was similar between groups in both the full cohort (41.4% vs 42.3%, P=0.85) and matched cohort (38.55% vs 42.1%, P=0.593). Similarly, the rate of significant ICH was similar between the groups (full cohort: 13.1% vs 16.9%, P=0.306; matched cohort: 15.6% vs 18.95, P=0.52). There was no difference in favorable outcome (90-day modified Rankin Scale 0-2) or successful reperfusion between groups. In an adjusted analysis, IVT was not associated with any of the outcomes. Conclusion Pretreatment IVT was not associated with an increased risk of hemorrhage in patients with large core infarct treated with MT. Future studies are needed to assess the safety and efficacy of bridging therapy in patients with large core infarct. [ABSTRACT FROM AUTHOR]

Published
2023
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27. Mechanical thrombectomy for large vessel occlusion strokes beyond 24 hours.

Author

Shaban, Amir, Al Kasab, Sami, Chalhoub, Reda M., Bass, Eric, Maier, Ilko, Psychogios, Marios-Nikos, Alawieh, Ali, Wolfe, Stacey Q., Arthur, Adam S., Dumont, Travis M., Kan, Peter, Joon-tae Kim, de De Leacy, Rea, Osbun, Joshua W., Rai, Ansaar T., Jabbour, Pascal, Min S. Park, Crosa, Roberto Javier, Mascitelli, Justin R., and Levitt, Michael R.

Subjects
REPORTING of diseases, STROKE, TIME, MULTIVARIATE analysis, RETROSPECTIVE studies, CEREBRAL arteries, TREATMENT effectiveness, FUNCTIONAL assessment, THROMBECTOMY, RESEARCH funding, DESCRIPTIVE statistics, ODDS ratio
Abstract

Background Recent clinical trials have shown that mechanical thrombectomy is superior to medical management for large vessel occlusion for up to 24 hours from onset. Our objective is to examine the safety and efficacy of thrombectomy beyond the standard of care window. Methods A retrospective review was undertaken of the multicenter Stroke Thrombectomy and Aneurysm Registry (STAR). We identified patients who underwent mechanical thrombectomy for large vessel occlusion beyond 24 hours. We selected a matched control group from patients who underwent thrombectomy in the 6-24-hour window. We used functional independence at 3 months as our primary outcome measure. results We identified 121 patients who underwent thrombectomy beyond 24 hours and 1824 in the 6-24-hour window. We selected a 2:1 matched group of patients with thrombectomy 6-24 hours as a comparison group. Patients undergoing thrombectomy beyond 24 hours were less likely to be independent at 90 days (18 (18.8%) vs 73 (34.9%), P=0.005). They had higher odds of mortality at 90 days in the adjusted analysis (OR 2.34, P=0.023). Symptomatic intracerebral hemorrhage and other complications were similar in the two groups. In a multivariate analysis only lower number of attempts was associated with good outcomes (OR 0.27, P=0.022). Conclusions Mechanical thrombectomy beyond 24 hours appears to be safe and tolerable with no more hemorrhages or complications compared with standard of care thrombectomy. Outcomes and mortality in this time window are worse compared with an earlier time window, but the rates of good outcomes may justify this therapy in selected patients. [ABSTRACT FROM AUTHOR]

Published
2023
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28. Risk factors and predictors of intracranial hemorrhage after mechanical thrombectomy in acute ischemic stroke: insights from the Stroke Thrombectomy and Aneurysm Registry (STAR)

Author

Ironside, Natasha, primary, Chen, Ching-Jen, additional, Chalhoub, Reda M, additional, Kellogg, Ryan T, additional, Ding, Dale, additional, Maier, Ilko, additional, Al Kasab, Sami, additional, Jabbour, Pascal, additional, Kim, Joon-tae, additional, Wolfe, Stacey Q, additional, Rai, Ansaar, additional, Starke, Robert M, additional, Psychogios, Marios-Nikos, additional, Shaban, Amir, additional, Arthur, Adam S, additional, Yoshimura, Shinichi, additional, Grossberg, Jonathan A, additional, Alawieh, Ali, additional, Fragata, Isabel, additional, Polifka, Adam J, additional, Mascitelli, Justin R, additional, Osbun, Joshua W, additional, Matouk, Charles, additional, Levitt, Michael R, additional, Dumont, Travis M, additional, Cuellar-Saenz, Hugo H, additional, Williamson, Richard, additional, Romano, Daniele G, additional, Crosa, Roberto Javier, additional, Gory, Benjamin, additional, Mokin, Maxim, additional, Moss, Mark, additional, Limaye, Kaustubh, additional, Kan, Peter, additional, Spiotta, Alejandro M, additional, and Park, Min S, additional

Published
2023
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31. Microsurgical Obliteration of Craniocervical Junction Dural Arteriovenous Fistulas: Multicenter Experience

Author

Salem, Mohamed M., primary, Srinivasan, Visish M., additional, Tonetti, Daniel A., additional, Ravindran, Krishnan, additional, Taussky, Philipp, additional, Yang, Kaiyun, additional, Karahalios, Katherine, additional, Raygor, Kunal P., additional, Naylor, Ryan M., additional, Catapano, Joshua S., additional, Tavakoli-Sabour, Samon, additional, Abdelsalam, Ahmed, additional, Chen, Stephanie H., additional, Grandhi, Ramesh, additional, Jankowitz, Brian T., additional, Baskaya, Mustafa K., additional, Mascitelli, Justin R., additional, Van Gompel, Jamie J., additional, Cherian, Jacob, additional, Couldwell, William T., additional, Kim, Louis J., additional, Cohen-Gadol, Aaron A., additional, Starke, Robert M., additional, Kan, Peter, additional, Dehdashti, Amir R., additional, Abla, Adib A., additional, Lawton, Michael T., additional, and Burkhardt, Jan-Karl, additional

Published
2022
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33. Multicenter investigation of technical and clinical outcomes after thrombectomy for distal vessel occlusion by frontline technique

Author

Alawieh, Ali M, primary, Chalhoub, Reda M, additional, Al Kasab, Sami, additional, Jabbour, Pascal, additional, Psychogios, Marios-Nikos, additional, Starke, Robert M, additional, Arthur, Adam S, additional, Fargen, Kyle M, additional, De Leacy, Reade, additional, Kan, Peter, additional, Dumont, Travis M, additional, Rai, Ansaar, additional, Crosa, Roberto Javier, additional, Maier, Ilko, additional, Goyal, Nitin, additional, Wolfe, Stacey Q, additional, Cawley, C Michael, additional, Mocco, J, additional, Tjoumakaris, Stavropoula I, additional, Howard, Brian M, additional, Dimisko, Laurie, additional, Saad, Hassan, additional, Ogilvy, Christopher S, additional, Crowley, R Webster, additional, Mascitelli, Justin R, additional, Fragata, Isabel, additional, Levitt, Michael R, additional, Kim, Joon-tae, additional, Park, Min S, additional, Gory, Benjamin, additional, Polifka, Adam J, additional, Matouk, Charles, additional, Grossberg, Jonathan A, additional, and Spiotta, Alejandro M, additional

Published
2022
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34. Endovascular therapy versus microsurgical clipping of unruptured wide-neck aneurysms: a prospective multicenter study with propensity score analysis

Author

Mascitelli, Justin R., primary, Mocco, J, additional, Hardigan, Trevor, additional, Hendricks, Benjamin K., additional, Yoon, James S., additional, Yaeger, Kurt A., additional, Kellner, Christopher P., additional, De Leacy, Reade A., additional, Fifi, Johanna T., additional, Bederson, Joshua B., additional, Albuquerque, Felipe C., additional, Ducruet, Andrew F., additional, Birnbaum, Lee A., additional, Caron, Jean Louis R., additional, Rodriguez, Pavel, additional, and Lawton, Michael T., additional

Published
2022
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35. Endovascular Therapy Versus Microsurgical Clipping of Ruptured Wide Neck Aneurysms (EVERRUN Registry): a multicenter, prospective propensity score analysis

Author

Mascitelli, Justin R., primary, Lawton, Michael T., additional, Hendricks, Benjamin K., additional, Hardigan, Trevor A., additional, Yoon, James S., additional, Yaeger, Kurt A., additional, Kellner, Christopher P., additional, De Leacy, Reade A., additional, Fifi, Johanna T., additional, Bederson, Joshua B., additional, Albuquerque, Felipe C., additional, Ducruet, Andrew F., additional, Birnbaum, Lee A., additional, Caron, Jean Louis R., additional, Rodriguez, Pavel, additional, and Mocco, J, additional

Published
2022
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36. Mobile Interventional Stroke Teams Lead to Faster Treatment Times for Thrombectomy in Large Vessel Occlusion

Author

Wei, Daniel, Oxley, Thomas J., Nistal, Dominic A., Mascitelli, Justin R., Wilson, Natalie, Stein, Laura, Liang, John, Turkheimer, Lena M., Morey, Jacob R., Schwegel, Claire, Awad, Ahmed J., Shoirah, Hazem, Kellner, Christopher P., De Leacy, Reade A., Mayer, Stephan A., Tuhrim, Stanley, Paramasivam, Srinivasan, Mocco, J, and Fifi, Johanna T.

Published
2017
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40. Impact of Endoluminal Flow Diverter Number on Aneurysm Treatment Outcomes: A Multicenter Study

Author

Vranic, Justin E., primary, Harker, Pablo, additional, Stapleton, Christopher J., additional, Regenhardt, Robert W., additional, Alotaibi, Naif M., additional, Leslie‐Mazwi, Thabele M., additional, Gupta, Rajiv, additional, Tan, Can Ozan, additional, Koch, Matthew J., additional, Dmytriw, Adam A., additional, Raymond, Scott B., additional, Mascitelli, Justin R., additional, Patterson, T. Tyler, additional, Seinfeld, Joshua, additional, White, Andrew, additional, Case, David, additional, Roark, Christopher, additional, Gandhi, Chirag D., additional, Al‐Mufti, Fawaz, additional, Cooper, Jared, additional, Matouk, Charles, additional, Sujijantarat, Nanthiya, additional, Devia, Diego A., additional, Ocampo‐Navia, Maria I., additional, Villamizar‐Torres, Daniel E., additional, Puentes, Juan C., additional, and Patel, Aman B., additional

Published
2022
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43. Microsurgical Obliteration of Craniocervical Junction Dural Arteriovenous Fistulas: Multicenter Experience.

Author

Salem, Mohamed M., Srinivasan, Visish M., Tonetti, Daniel A., Ravindran, Krishnan, Taussky, Philipp, Yang, Kaiyun, Karahalios, Katherine, Raygor, Kunal P., Naylor, Ryan M., Catapano, Joshua S., Tavakoli-Sabour, Samon, Abdelsalam, Ahmed, Chen, Stephanie H., Grandhi, Ramesh, Jankowitz, Brian T., Baskaya, Mustafa K., Mascitelli, Justin R., Van Gompel, Jamie J., Cherian, Jacob, and Couldwell, William T.

Published
2023
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47. Determinants of intracranial aneurysm retreatment following embolization with a single flow-diverting stent

Author

Vranic, Justin E, primary, Harker, Pablo, additional, Stapleton, Christopher J, additional, Regenhardt, Robert W, additional, Dmytriw, Adam A, additional, Alotaibi, Naif M, additional, Gupta, Rajiv, additional, Leslie-Mazwi, Thabele M, additional, Koch, Matthew J, additional, Raymond, Scott B, additional, Mascitelli, Justin R, additional, Patterson, T Tyler, additional, Seinfeld, Joshua, additional, White, Andrew, additional, Case, David, additional, Roark, Christopher, additional, Gandhi, Chirag D, additional, Al-Mufti, Fawaz, additional, Cooper, Jared, additional, and Patel, Aman B, additional

Published
2021
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