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Article ; Online: Diagnostic accuracy of intraoperative neuromonitoring in transcarotid artery revascularization.

Diogo, Cinira / Na, Doohwan / Sujijantarat, Nanthiya / Matouk, Charles / Callahan, Brooke

2024

Abstract: Background: In recent years, transcarotid artery revascularization (TCAR) has emerged as a safe and effective alternative to carotid artery stenting. While intraoperative neuromonitoring (IONM) techniques such as electroencephalogram (EEG) and ... ...

Abstract	Background: In recent years, transcarotid artery revascularization (TCAR) has emerged as a safe and effective alternative to carotid artery stenting. While intraoperative neuromonitoring (IONM) techniques such as electroencephalogram (EEG) and somatosensory evoked potentials (SSEPs) are often employed during TCAR, there is limited research on their diagnostic accuracy. Methods: The authors retrospectively reviewed a multi-institutional IONM database of TCAR procedures performed with EEG and SSEP monitoring. A total of 516 TCAR procedures were included in this study. Significant changes in EEG and/or SSEPs, surgeon's interventions, resolution of significant changes, and immediate postoperative neurological outcome were documented. Sensitivity, specificity, positive and negative predictive values were calculated. Results: The incidence of intraoperative onset new neurologic deficit was 0.4%. Significant changes in EEG and/or SSEPs occurred in 5.4% of the cases. Of the cases with IONM alerts, 78.5% returned to baseline with a surgical or hemodynamic intervention. From the cases with unresolved IONM alerts, 33.3% woke up with a new neurological deficit. The overall sensitivity and specificity for IONM was 100% and 99.2%, respectively. The positive predictive value was 33.3% and the negative predictive value was 100%. Conclusions: IONM during TCAR offers high sensitivity and specificity in predicting postoperative outcome. Patients with resolved IONM alerts had immediate neurological outcomes that were comparable to those who had no IONM alerts.
Language	English
Publishing date	2024-02-20
Publishing country	England
Document type	Journal Article
ZDB-ID	2514982-9
ISSN	1759-8486 ; 1759-8478
ISSN (online)	1759-8486
ISSN	1759-8478
DOI	10.1136/jnis-2023-021282
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Article ; Online: Staged endovascular treatment of a coexisting parasellar aneurysm and endoscopic resection of a pituitary macroadenoma: illustrative case.

Nene, Aishwarya / Hong, Christopher S / McGuone, Declan / Matouk, Charles C / Omay, S Bulent

Journal of neurosurgery. Case lessons

2022 Volume 3, Issue 10

Abstract: Background: Intracranial aneurysms and pituitary adenomas are relatively common pathologies that, in rare instances, may concurrently present. Their management poses considerable clinical and technical challenges.: Observations: The authors present a ...

Abstract	Background: Intracranial aneurysms and pituitary adenomas are relatively common pathologies that, in rare instances, may concurrently present. Their management poses considerable clinical and technical challenges. Observations: The authors present a case of a 66-year-old female patient with a fusiform aneurysm of the left internal carotid artery associated with a symptomatic pituitary macroadenoma that had been causing visual deficits for the past several years. She underwent successful placement of flow diverter stents across her aneurysm, followed by routine dual antiplatelet therapy to maintain stent patency. She underwent frequent serial radiographic, endocrine, and ophthalmological evaluations during this time to ensure stability of her pituitary adenoma. Following confirmation of aneurysm obliteration and subsequent de-escalation of antiplatelet medications to aspirin monotherapy, her tumor was subsequently resected via an endoscopic endonasal approach in a delayed fashion. Lessons: The authors review the literature regarding management of these concurrent pathologies and describe the aspects of the case that led them to their chosen treatment strategy. An algorithm is proposed regarding the management of parasellar aneurysms with a concurrent diagnosis of pituitary tumor pathology.
Language	English
Publishing date	2022-03-07
Publishing country	United States
Document type	Journal Article
ISSN	2694-1902
ISSN (online)	2694-1902
DOI	10.3171/CASE21699
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Article ; Online: APOE ε4 and Intracerebral Hemorrhage in Patients With Brain Arteriovenous Malformation.

Renedo, Daniela / Rivier, Cyprien A / Koo, Andrew B / Sujijantarat, Nanthiya / Clocchiatti-Tuozzo, Santiago / Wu, Kane / Torres-Lopez, Victor M / Huo, Shufan / Gunel, Murat / de Havenon, Adam / Sheth, Kevin N / Matouk, Charles C / Falcone, Guido J

JAMA network open

2024 Volume 7, Issue 2, Page(s) e2355368

Abstract: Importance: Intracerebral hemorrhage (ICH) is a serious complication of brain arteriovenous malformation (AVM). Apolipoprotein E (APOE) ε4 is a well-known genetic risk factor for ICH among persons without AVM, and cerebral amyloid angiopathy is a ... ...

Abstract	Importance: Intracerebral hemorrhage (ICH) is a serious complication of brain arteriovenous malformation (AVM). Apolipoprotein E (APOE) ε4 is a well-known genetic risk factor for ICH among persons without AVM, and cerebral amyloid angiopathy is a vasculopathy frequently observed in APOE ε4 carriers that may increase the risk of ICH. Objective: To assess whether APOE ε4 is associated with a higher risk of ICH in patients with a known AVM. Design, setting, and participants: This cross-sectional study including 412 participants was conducted in 2 stages (discovery and replication) using individual-level data from the UK Biobank (released March 2012 and last updated October 2023) and the All of Us Research Program (commenced on May 6, 2018, with its latest update provided in October 2023). The occurrence of AVM and ICH was ascertained at the time of enrollment using validated International Classification of Diseases, Ninth Revision and Tenth Revision, codes. Genotypic data on the APOE variants rs429358 and rs7412 were used to ascertain the ε status. Main outcomes and measures: For each study, the association between APOE ε4 variants and ICH risk was assessed among patients with a known AVM by using multivariable logistic regression. Results: The discovery phase included 253 UK Biobank participants with known AVM (mean [SD] age, 56.6 [8.0] years, 119 [47.0%] female), of whom 63 (24.9%) sustained an ICH. In the multivariable analysis of 240 participants of European ancestry, APOE ε4 was associated with a higher risk of ICH (odds ratio, 4.58; 95% CI, 2.13-10.34; P < .001). The replication phase included 159 participants with known AVM enrolled in All of Us (mean [SD] age, 57.1 [15.9] years; 106 [66.7%] female), of whom 29 (18.2%) sustained an ICH. In multivariable analysis of 101 participants of European ancestry, APOE ε4 was associated with higher risk of ICH (odds ratio, 4.52; 95% CI, 1.18-19.38; P = .03). Conclusions and relevance: The results of this cross-sectional study of patients from the UK Biobank and All of Us suggest that information on APOE ε4 status may help identify patients with brain AVM who are at particularly high risk of ICH and that cerebral amyloid angiopathy should be evaluated as a possible mediating mechanism of the observed association.
MeSH term(s)	Female ; Humans ; Male ; Middle Aged ; Apolipoprotein E4/genetics ; Brain/blood supply ; Cerebral Amyloid Angiopathy/complications ; Cerebral Hemorrhage/etiology ; Cerebral Hemorrhage/genetics ; Cross-Sectional Studies ; Intracranial Arteriovenous Malformations/complications
Chemical Substances	Apolipoprotein E4
Language	English
Publishing date	2024-02-05
Publishing country	United States
Document type	Journal Article
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2023.55368
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Article ; Online: Carotid Artery Disease Among Broadly Defined Underrepresented Groups: The All of Us Research Program.

Renedo, Daniela / Acosta, Julián N / Sujijantarat, Nanthiya / Antonios, Joseph P / Koo, Andrew B / Sheth, Kevin N / Matouk, Charles C / Falcone, Guido J

Stroke

2022 Volume 53, Issue 3, Page(s) e88–e89

MeSH term(s)	Adult ; Aged ; Carotid Artery Diseases/epidemiology ; Carotid Artery Diseases/surgery ; Cerebral Revascularization ; Cross-Sectional Studies ; Female ; Humans ; Male ; Middle Aged ; Population Health ; Prevalence
Language	English
Publishing date	2022-02-03
Publishing country	United States
Document type	Letter ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	80381-9
ISSN	1524-4628 ; 0039-2499 ; 0749-7954
ISSN (online)	1524-4628
ISSN	0039-2499 ; 0749-7954
DOI	10.1161/STROKEAHA.121.037554
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Article ; Online: Response to letter to the Editor on 'Utility of the Hospital Frailty Risk Score in patients undergoing endovascular treatment for ruptured aneurysms'.

Koo, Andrew B / Elsamadicy, Aladine A / Renedo, Daniela / Matouk, Charles

Journal of neurointerventional surgery

2022 Volume 15, Issue 3, Page(s) 307–308

MeSH term(s)	Humans ; Frailty/diagnosis ; Aneurysm, Ruptured/surgery ; Intracranial Aneurysm/surgery ; Risk Factors ; Hospitals
Language	English
Publishing date	2022-11-01
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	2514982-9
ISSN	1759-8486 ; 1759-8478
ISSN (online)	1759-8486
ISSN	1759-8478
DOI	10.1136/jnis-2022-019708
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Article: Radiomics-Based Prediction of Collateral Status from CT Angiography of Patients Following a Large Vessel Occlusion Stroke.

Avery, Emily W / Abou-Karam, Anthony / Abi-Fadel, Sandra / Behland, Jonas / Mak, Adrian / Haider, Stefan P / Zeevi, Tal / Sanelli, Pina C / Filippi, Christopher G / Malhotra, Ajay / Matouk, Charles C / Falcone, Guido J / Petersen, Nils / Sansing, Lauren H / Sheth, Kevin N / Payabvash, Seyedmehdi

Diagnostics (Basel, Switzerland)

2024 Volume 14, Issue 5

Abstract: Background: A major driver of individual variation in long-term outcomes following a large vessel occlusion (LVO) stroke is the degree of collateral arterial circulation. We aimed to develop and evaluate machine-learning models that quantify LVO ... ...

Abstract	Background: A major driver of individual variation in long-term outcomes following a large vessel occlusion (LVO) stroke is the degree of collateral arterial circulation. We aimed to develop and evaluate machine-learning models that quantify LVO collateral status using admission computed tomography angiography (CTA) radiomics. Methods: We extracted 1116 radiomic features from the anterior circulation territories from admission CTAs of 600 patients experiencing an acute LVO stroke. We trained and validated multiple machine-learning models for the prediction of collateral status based on consensus from two neuroradiologists as ground truth. Models were first trained to predict (1) good vs. intermediate or poor, or (2) good vs. intermediate or poor collateral status. Then, model predictions were combined to determine a three-tier collateral score (good, intermediate, or poor). We used the receiver operating characteristics area under the curve (AUC) to evaluate prediction accuracy. Results: We included 499 patients in training and 101 in an independent test cohort. The best-performing models achieved an averaged cross-validation AUC of 0.80 ± 0.05 for poor vs. intermediate/good collateral and 0.69 ± 0.05 for good vs. intermediate/poor, and AUC = 0.77 (0.67-0.87) and AUC = 0.78 (0.70-0.90) in the independent test cohort, respectively. The collateral scores predicted by the radiomics model were correlated with (rho = 0.45, Conclusions: Automated tools for the assessment of collateral status from admission CTA-such as the radiomics models described here-can generate clinically relevant and reproducible collateral scores to facilitate a timely treatment triage in patients experiencing an acute LVO stroke.
Language	English
Publishing date	2024-02-23
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662336-5
ISSN	2075-4418
ISSN	2075-4418
DOI	10.3390/diagnostics14050485
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Article ; Online: COVID-19 Infection Is Associated With Poor Outcomes in Patients With Intracerebral Hemorrhage.

Renedo, Daniela / Leasure, Audrey C / Young, Rebecca / Rivier, Cyprien A / Alhanti, Brooke / Mac Grory, Brian / Messe, Steven R / Reeves, Mathew J / Hassan, Ameer E / Schwamm, Lee / de Havenon, Adam / Matouk, Charles C / Sheth, Kevin N / Falcone, Guido J

Journal of the American Heart Association

2024 Volume 13, Issue 3, Page(s) e030999

Abstract: Background: Patients with ischemic stroke and concomitant COVID-19 infection have worse outcomes than those without this infection, but the impact of COVID-19 on hemorrhagic stroke remains unclear. We aimed to assess if COVID-19 worsens outcomes in ... ...

Abstract	Background: Patients with ischemic stroke and concomitant COVID-19 infection have worse outcomes than those without this infection, but the impact of COVID-19 on hemorrhagic stroke remains unclear. We aimed to assess if COVID-19 worsens outcomes in intracerebral hemorrhage (ICH). Methods and results: We conducted an observational study of ICH outcomes using Get With The Guidelines Stroke data. We compared patients with ICH who were COVID-19 positive and negative during the pandemic (March 2020-February 2021) and prepandemic (March 2019-February 2020). Main outcomes were poor functional outcome (defined as a modified Rankin scale score of 4 to 6 at discharge), mortality, and discharge to a skilled nursing facility or hospice. The first stage included 60 091 patients with ICH who were COVID-19 negative and 1326 COVID-19 positive. In multivariable analyses, patients with ICH with versus without COVID-19 infection had 68% higher odds of poor outcome (odds ratio [OR], 1.68 [95% CI, 1.41-2.01]), 51% higher odds of mortality (OR, 1.51 [95% CI, 1.33-1.71]), and 66% higher odds of being discharged to a skilled nursing facility/hospice (OR, 1.66 [95% CI, 1.43-1.93]). The second stage included 62 743 prepandemic and 64 681 intrapandemic cases with ICH. In multivariable analyses, patients with ICH admitted during versus before the COVID-19 pandemic had 10% higher odds of poor outcomes (OR, 1.10 [95% CI, 1.07-1.14]), 5% higher mortality (OR, 1.05 [95% CI, 1.02-1.08]), and no significant difference in the risk of being discharged to a skilled nursing facility/hospice (OR, 0.93 [95% CI, 0.90-0.95]). Conclusions: The pathophysiology of the COVID-19 infection and changes in health care delivery during the pandemic played a role in worsening outcomes in the patient population with ICH.
MeSH term(s)	Humans ; Pandemics ; COVID-19/epidemiology ; Cerebral Hemorrhage ; Stroke ; Patients
Language	English
Publishing date	2024-01-31
Publishing country	England
Document type	Observational Study ; Journal Article
ZDB-ID	2653953-6
ISSN	2047-9980 ; 2047-9980
ISSN (online)	2047-9980
ISSN	2047-9980
DOI	10.1161/JAHA.123.030999
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Article ; Online: The Utility of Imaging Parameters in Predicting Long-Term Clinical Improvement After Shunt Surgery in Patients with Idiopathic Normal Pressure Hydrocephalus.

Subramanian, Harry E / Fadel, Sandra A / Matouk, Charles C / Zohrabian, Vahe M / Mahajan, Amit

World neurosurgery

2021 Volume 149, Page(s) e1–e10

Abstract: Objective: It is difficult to predict which patients with idiopathic normal pressure hydrocephalus (iNPH) will improve after shunt surgery. This study investigated the association between preoperative imaging parameters in patients with iNPH and long- ... ...

Abstract	Objective: It is difficult to predict which patients with idiopathic normal pressure hydrocephalus (iNPH) will improve after shunt surgery. This study investigated the association between preoperative imaging parameters in patients with iNPH and long-term outcome after shunt placement. Methods: Patients with iNPH who showed a response to large-volume cerebrospinal fluid drainage and subsequently underwent ventriculoperitoneal shunt surgery were reviewed. Long-term patient-reported outcomes were obtained by telephone interview. Preoperative computed tomography and/or magnetic resonance imaging were retrospectively reviewed to determine associations between imaging parameters and clinical outcome. Results: The final analysis included 37 patients. The median duration between shunt surgery and telephone interview was 30 months (range, 12-56 months). Gait improvement after shunting was present more often in patients without focally dilated sulci (95% vs. 71%, P = 0.04), but a statistically significant relationship was not established after logistic regression. Patients with cognitive improvement after shunting had a higher preoperative Evans index (mean 0.41 vs. 0.36, P < 0.01), and Evans index was a predictor of cognitive improvement (odds ratio = 1.40, scale of 0.01, P = 0.01). Conclusions: Higher Evans index is a predictor of long-term cognitive improvement after shunt placement; however, no cutoff value demonstrates sufficient accuracy for the selection of shunt candidates. None of the evaluated imaging features was predictive of long-term gait or urinary improvement. The utility of imaging to predict a response to shunting is limited, and no imaging feature alone can be used to exclude patients from shunt surgery.
MeSH term(s)	Aged ; Aged, 80 and over ; Female ; Humans ; Hydrocephalus, Normal Pressure/diagnostic imaging ; Hydrocephalus, Normal Pressure/surgery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Retrospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome ; Ventriculoperitoneal Shunt
Language	English
Publishing date	2021-03-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2021.02.108
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Article ; Online: Management of Small, Unruptured Intracranial Aneurysms.

Malhotra, Ajay / Wu, Xiao / Gandhi, Dheeraj / Sanelli, Pina / Matouk, Charles C

World neurosurgery

2020 Volume 135, Page(s) 379–380

MeSH term(s)	Conservative Treatment ; Disease Management ; Embolization, Therapeutic ; Humans ; Incidental Findings ; Intracranial Aneurysm/diagnostic imaging ; Intracranial Aneurysm/therapy ; Practice Guidelines as Topic ; Risk Assessment ; Watchful Waiting
Language	English
Publishing date	2020-03-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2019.12.139
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Article ; Online: Initial experience of using a large-bore (0.096″ inner diameter) access catheter in neurovascular interventions.

Starke, Robert M / Abecassis, Isaac Josh / Saini, Vasu / Matouk, Charles C / Hassan, Ameer E / Siddiqui, Adnan H / Frei, Donald F

Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences

2022 , Page(s) 15910199221127074

Abstract: Introduction: The purpose of this study was to report our initial experience of using a large-bore (0.096″ inner diameter) access catheter in neurovascular interventions.: Methods: Data were retrospectively collected from 5 sites in the US for ... ...

Abstract	Introduction: The purpose of this study was to report our initial experience of using a large-bore (0.096″ inner diameter) access catheter in neurovascular interventions. Methods: Data were retrospectively collected from 5 sites in the US for neurovascular procedures performed using a large-bore access catheter. The effectiveness outcome was technical success, defined as the access catheter's successfully reaching its target vessel without conversion to direct carotid puncture or to a smaller-bore access catheter and successfully completing the intended neurointervention. Results: One hundred and thirteen procedures performed in 112 patients were included in this study. The mean age of the patients was 67.5 years (SD 16.2), and about half (49.1%) were female. The most common primary access sites were the femoral (64.6%) or radial (32.7%) artery. Challenging anatomic variations included severe vessel tortuosity (26/81, 32.1%), type II aortic arch (17/88, 19.3%), type III aortic arch (14/88, 15.9%), bovine arch (16/104, 15.4%), severe angle (<30°) between the subclavian and target vessel (11/74, 14.9%), and subclavian loop (7/79, 8.9%). The median access time to branch view was 18 min (IQR 11-28, N = 75). The technical success rate was 94.7%. Two dissections (1.8%) were related to the large-bore access catheter. Access site complications occurred in 2 patients (1.8%). Four additional symptomatic periprocedural complications not related to the large-bore access catheter occurred (7.1%). Conclusion: For neurovascular interventions, a 0.096″ inner diameter access catheter could be used with both femoral and radial arterial approaches, had a high technical success rate, and had a low rate of periprocedural complications.
Language	English
Publishing date	2022-09-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	1354913-3
ISSN	2385-2011 ; 1591-0199 ; 1123-9344
ISSN (online)	2385-2011
ISSN	1591-0199 ; 1123-9344
DOI	10.1177/15910199221127074
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