8 results on '"R.A. Ashforth"'
Search Results
2. Reliability of the Diagnosis of Cerebral Vasospasm Using Catheter Cerebral Angiography: A Systematic Review and Inter- and Intraobserver Study
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J. Zehr, Carol Derksen, Alain Weill, William Boisseau, Miguel Chagnon, Jean-Christophe Gentric, R.A. Ashforth, J.M. Findlay, Anne Christine Januel, Laurent Létourneau-Guillon, M.M. Chow, David Volders, Jean Raymond, Denis-Claude Roy, Behzad Farzin, Michael B. Keough, Guylaine Gevry, Stephanos Finitsis, Tim E. Darsaut, Andrew P. Carlson, Thanh N. Nguyen, Robert Fahed, Jeremy L. Rempel, and Cian O'Kelly
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Adult ,Male ,medicine.medical_specialty ,Catheters ,Subarachnoid hemorrhage ,Neurology ,Adolescent ,MEDLINE ,030218 nuclear medicine & medical imaging ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Cerebral vasospasm ,Humans ,Vasospasm, Intracranial ,Medicine ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Reliability (statistics) ,Aged ,Observer Variation ,Interventional ,medicine.diagnostic_test ,business.industry ,Reproducibility of Results ,Vasospasm ,Middle Aged ,Subarachnoid Hemorrhage ,medicine.disease ,Cerebral Angiography ,cardiovascular system ,Female ,Neurology (clinical) ,Radiology ,Neurosurgery ,business ,030217 neurology & neurosurgery ,Cerebral angiography - Abstract
BACKGROUND AND PURPOSE: Conventional angiography is the benchmark examination to diagnose cerebral vasospasm, but there is limited evidence regarding its reliability. Our goals were the following: 1) to systematically review the literature on the reliability of the diagnosis of cerebral vasospasm using conventional angiography, and 2) to perform an agreement study among clinicians who perform endovascular treatment. MATERIALS AND METHODS: Articles reporting a classification system on the degree of cerebral vasospasm on conventional angiography were systematically searched, and agreement studies were identified. We assembled a portfolio of 221 cases of patients with subarachnoid hemorrhage and asked 17 raters with different backgrounds (radiology, neurosurgery, or neurology) and experience (junior ≤10 and senior >10 years) to independently evaluate cerebral vasospasm in 7 vessel segments using a 3-point scale and to evaluate, for each case, whether findings would justify endovascular treatment. Nine raters took part in the intraobserver reliability study. RESULTS: The systematic review showed a very heterogeneous literature, with 140 studies using 60 different nomenclatures and 21 different thresholds to define cerebral vasospasm, and 5 interobserver studies reporting a wide range of reliability (κ = 0.14–0.87). In our study, only senior raters reached substantial agreement (κ ≥ 0.6) on vasospasm of the supraclinoid ICA, M1, and basilar segments and only when assessments were dichotomized (presence or absence of ≥50% narrowing). Agreement on whether to proceed with endovascular management of vasospasm was only fair (κ ≤ 0.4). CONCLUSIONS: Research on cerebral vasospasm would benefit from standardization of definitions and thresholds. Dichotomized decisions by experienced readers are required for the reliable angiographic diagnosis of cerebral vasospasm.
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- 2021
3. A randomized trial of endovascular versus surgical management of ruptured intracranial aneurysms: Interim results from ISAT2
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Chiraz Chaalala, Jean Raymond, Jai Jai Shiva Shankar, Ignacio Arrese, Suzanne Nolet, M.M. Chow, A. Bilocq, Marc Kotowski, Elsa Magro, M. Lemus, François Guilbert, Jeremy L. Rempel, Fuat Arikan, Robert Fahed, R.A. Ashforth, Tim E. Darsaut, Cian O'Kelly, Michel W. Bojanowski, Alain Weill, Miguel Chagnon, David J. Altschul, J.M. Findlay, F. Proust, R. Sarabia, Denis-Claude Roy, and Guylaine Gevry
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Male ,medicine.medical_specialty ,Endpoint Determination ,medicine.medical_treatment ,Aneurysm, Ruptured ,Neurosurgical Procedures ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,Randomized controlled trial ,law ,Interim ,Occlusion ,medicine ,Clinical endpoint ,Humans ,cardiovascular diseases ,Endovascular coiling ,Cross-Over Studies ,business.industry ,Endovascular Procedures ,Intracranial Aneurysm ,Clipping (medicine) ,Length of Stay ,Middle Aged ,medicine.disease ,Interim analysis ,Cerebral Angiography ,Surgery ,Treatment Outcome ,030220 oncology & carcinogenesis ,Female ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
Background and purpose Appropriate management of ruptured intracranial aneurysm (RIA) in patients eligible for surgical clipping but under-represented in or excluded from previous randomized trials remains undetermined. Methods The International Subarachnoid Aneurysm Trial-2 (ISAT-2) is a randomized care trial comparing surgical versus endovascular treatment (EVT) of RIA. All patients considered for surgical clipping but eligible for endovascular treatment can be included. The primary endpoint is death or dependency on modified Rankin score (mRS > 2) at 1 year. Secondary endpoints are 1 year angiographic results and length of hospital stay. Results An interim analysis was performed after 103 patients were treated from November 2012 to July 2017 in 4 active centers. Fifty-two of the 55 patients allocated to surgery were treated by clipping, and 45 of the 48 allocated to EVT were treated by coiling, with 3 crossovers in each arm. The main endpoint (1 year mRS > 2), available for 76 patients, was reached in 16/42 patients allocated to clipping (38%; 95%CI: 25%–53%), and 10/34 patients allocated to coiling (29%; 17%–46%). One year imaging results were available in 54 patients: complete aneurysm occlusion was found in 23/27 patients allocated to clipping (85%; 67%–94%), and 18/27 patients allocated to coiling (67%; 47%–81%). Hospital stay exceeding 20 days was more frequent in surgery (26/55 [47%; 34%–60%]) than EVT (9/48 [19%; 10%–31%]). Conclusion Ruptured aneurysm patients for whom surgical clipping may still be best can be managed in a randomized care trial, which is feasible in some centers. More participating centers are needed.
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- 2019
4. Surgical or Endovascular Management of Middle Cerebral Artery Aneurysms: A Randomized Comparison
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David J. Altschul, Chiraz Chaalala, Fuat Arikan, Behzad Farzin, Guylaine Gevry, M.M. Chow, Alain Weill, Cian O'Kelly, R.A. Ashforth, Abdelaziz Sagga, Elsa Magro, Jean Paul Lejeune, Daniela Iancu, Miguel Chagnon, Laurent Estrade, Bernard Otto, Didier Martin, Howard Lesiuk, J. Max Findlay, Marc Kotowski, Alain Bilocq, Nicolas Bricout, François Guilbert, John Sinclair, Vivien Chan, Jeremy L. Rempel, Ange Diouf, Daniel Roy, William Boisseau, Michel W. Bojanowski, Jean Raymond, Tim E. Darsaut, Michael B. Keough, and Félix Scholtes
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Adult ,Male ,medicine.medical_specialty ,International Subarachnoid Aneurysm Trial ,medicine.medical_treatment ,Aneurysm, Ruptured ,Neurosurgical Procedures ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,Randomized controlled trial ,Modified Rankin Scale ,law ,Recurrence ,medicine.artery ,Occlusion ,medicine ,Humans ,cardiovascular diseases ,Endovascular coiling ,business.industry ,Endovascular Procedures ,Intracranial Aneurysm ,Clipping (medicine) ,Middle Aged ,Subarachnoid Hemorrhage ,medicine.disease ,Embolization, Therapeutic ,Surgery ,Stroke ,030220 oncology & carcinogenesis ,Middle cerebral artery ,cardiovascular system ,Neurology (clinical) ,business ,Intracranial Hemorrhages ,030217 neurology & neurosurgery - Abstract
Objective There are few randomized data comparing clipping and coiling for middle cerebral artery (MCA) aneurysms. We analyzed results from patients with MCA aneurysms enrolled in the CURES (Collaborative UnRuptured Endovascular vs. Surgery) and ISAT-2 (International Subarachnoid Aneurysm Trial II) randomized trials. Methods Both trials are investigator-led parallel-group 1:1 randomized studies. CURES includes patients with 3-mm to 25-mm unruptured intracranial aneurysms (UIAs), and ISAT-2 includes patients with ruptured aneurysms (RA) for whom uncertainty remains after ISAT. The primary outcome measure of CURES is treatment failure: 1) failure to treat the aneurysm, 2) intracranial hemorrhage during follow-up, or 3) residual aneurysm at 1 year. The primary outcome of ISAT-2 is death or dependency (modified Rankin Scale score >2) at 1 year. One-year angiographic outcomes are systematically recorded. Results There were 100 unruptured and 71 ruptured MCA aneurysms. In CURES, 90 patients with UIA have been treated and 10 await treatment. Surgical and endovascular management of unruptured MCA aneurysms led to treatment failure in 3/42 (7%; 95% confidence interval [CI], 0.02–0.19) for clipping and 13/48 (27%; 95% CI, 0.17–0.41) for coiling (P = 0.025). All 71 patients with RA have been treated. In ISAT-2, patients with ruptured MCA aneurysms managed surgically had died or were dependent (modified Rankin Scale score >2) in 7/38 (18%; 95% CI, 0.09–0.33) cases, and 8/33 (24%; 95% CI, 0.13–0.41) for endovascular. One-year imaging results were available in 80 patients with UIA and 62 with RA. Complete aneurysm occlusion was found in 30/40 (75%; 95% CI, 0.60–0.86) patients with UIA allocated clipping, and 14/40 (35%; 95% CI, 0.22–0.50) patients with UIA allocated coiling. Complete aneurysm occlusion was found in 24/34 (71%; 95% CI, 0.54–0.83) patients with RA allocated clipping, and 15/28 (54%; 95% CI, 0.36–0.70) patients with RA allocated coiling. Conclusions Randomized data from 2 trials show that better efficacy may be obtained with surgical management of patients with MCA aneurysms.
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- 2020
5. Pre-operative Embolization of an Intraventricular Meningioma Using Onyx
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Tim E. Darsaut, Jian-Qiang Lu, R.A. Ashforth, Andrew S. Jack, and Robert Broad
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Adult ,medicine.medical_specialty ,medicine.medical_treatment ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Text mining ,Preoperative Care ,Meningeal Neoplasms ,medicine ,Humans ,Dimethyl Sulfoxide ,Embolization ,business.industry ,General Medicine ,Embolization, Therapeutic ,Pre operative ,Surgery ,Intraventricular Meningioma ,Neurology ,030220 oncology & carcinogenesis ,Female ,Polyvinyls ,Neurology (clinical) ,Meningioma ,business ,030217 neurology & neurosurgery - Published
- 2015
6. Surgical or endovascular management of ruptured intracranial aneurysms: an agreement study
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Alain Bilocq, M. Yashar S. Kalani, Luis Henrique de Castro-Afonso, R.A. Ashforth, M.M. Chow, Fuat Arikan, J. Max Findlay, Adam S Arthur, Alain Weill, Miguel Chagnon, Daniel Roy, Guylaine Gevry, Jeremy L. Rempel, Tim E. Darsaut, R. Loch Macdonald, Robert Fahed, and Jean Raymond
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medicine.medical_specialty ,International Subarachnoid Aneurysm Trial ,business.industry ,Ruptured aneurysms ,Surgical clipping ,General surgery ,General Medicine ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,cardiovascular diseases ,030212 general & internal medicine ,Endovascular treatment ,business ,030217 neurology & neurosurgery ,Clinical vignette - Abstract
OBJECTIVERuptured intracranial aneurysms (RIAs) can be managed surgically or endovascularly. In this study, the authors aimed to measure the interobserver agreement in selecting the best management option for various patients with an RIA.METHODSThe authors constructed an electronic portfolio of 42 cases of RIA in which an angiographic image along with a brief clinical vignette for each patient were displayed. Undisclosed to the responders was that the RIAs had been categorized as International Subarachnoid Aneurysm Trial (ISAT) (small, anterior-circulation, non–middle cerebral artery location, n = 18) and non-ISAT (n = 22) aneurysms; the non-ISAT group also included 2 basilar apex aneurysms for which a high number of endovascular choices was expected. The portfolio was sent to 132 clinicians who manage patients with RIAs and circulated to members of an American surgical association. Judges were asked to choose between surgical and endovascular management, to indicate their level of confidence in the choice of treatment on a quantitative 0–10 scale, and to determine whether they would include the patient in a randomized trial in which both treatments are compared. Eleven clinicians were asked to respond twice at least 1 month apart. Responses were analyzed using kappa statistics.RESULTSEighty-five clinicians (58 cerebrovascular surgeons, 21 interventional neuroradiologists, and 6 interventional neurologists) answered the questionnaire. Overall, endovascular management was chosen more frequently (n = 2136 [59.8%] of 3570 answers). The proportions of decisions to clip were significantly higher for non-ISAT (50.8%) than for ISAT (26.2%) aneurysms (p = 0.0003). Interjudge agreement was only fair (kappa 0.210, 95% CI 0.158–0.276) for all cases and judges, despite high confidence levels (mean score > 8 for all cases). Agreement was no better within subgroups of clinicians with the same specialty, years of experience, or location of practice or across capability groups (ability to clip or coil, or both). When agreement was defined as > 80% of responders choosing the same option, agreement occurred for only 7 of 40 cases, all of which were ISAT aneurysms, for which coiling was preferred.CONCLUSIONSAgreement between clinicians regarding the best management option was infrequent but centered around coiling for some ISAT aneurysms. Surgical clipping was chosen more frequently for non-ISAT aneurysms than for ISAT aneurysms. Patients with such an aneurysm might be candidates for inclusion in randomized trials.
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- 2017
7. Endovascular Management of an Embedded Intracranial Knife
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M.M. Chow, J.M. Findlay, R.A. Ashforth, and Tim E. Darsaut
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Adult ,Male ,medicine.medical_specialty ,Anterior Cerebral Artery ,medicine.medical_treatment ,Endovascular therapy ,Neurosurgical Procedures ,Eye injuries ,medicine.artery ,medicine ,Anterior cerebral artery ,Humans ,Contrast extravasation ,Elevated Intracranial Pressure ,Embolization ,medicine.diagnostic_test ,business.industry ,General Medicine ,medicine.disease ,Embolization, Therapeutic ,Eye Injuries, Penetrating ,Cerebral Angiography ,Surgery ,Neurology ,Angiography ,Neurology (clinical) ,business ,Vascular Surgical Procedures ,Cerebral angiography - Abstract
Background:Endovascular therapy (ET) is infrequently used in the setting of acute penetrating intracranial trauma.Methods:We report a case where ET was used immediately prior to and following removal of an embedded intracranial knife, which was found to be disrupting the anterior cerebral artery.Results:The proximal vessel was coiled and angiographically occluded and then the knife was removed with the microcatheter in place. Immediate angiography allowed us to see and quickly treat the contrast extravasation with further coiling. Despite full medical management, the patient died of elevated intracranial pressure.Conclusion:In this severely injured patient, endovascular therapy represented the most suitable means to attempt safe removal of the knife.
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- 2007
8. MR of deep cerebral venous thrombosis
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R.A. Ashforth, D. Melanson, and R. Ethier
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Adult ,medicine.medical_specialty ,business.industry ,General Medicine ,Intracranial Embolism and Thrombosis ,medicine.disease ,Thrombosis ,Magnetic Resonance Imaging ,Venous thrombosis ,Text mining ,Neurology ,Deep cerebral vein ,Occlusion ,medicine ,Humans ,Female ,Neurology (clinical) ,Radiology ,business ,Tomography, X-Ray Computed - Abstract
Two cases of deep cerebral venous thrombosis are presented with specific reference to the CT and MR findings. The MR findings are discussed, with comparison to the findings of superficial cerebral sino-venous occlusion.
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- 1989
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