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Article ; Online: Pipeline embolization of ruptured, previously coiled cerebral aneurysms: Case series and considerations for management.

Cooper, Jared B / Li, Boyi / Kaur, Gurmeen / Gandhi, Chirag D / Santarelli, Justin G

2021 Volume 7, Issue 2, Page(s) 111–117

Abstract: Purpose: Aneurysmal recurrence represents a significant drawback of endovascular coiling, particularly in aneurysms that have previously ruptured. Given the high recurrence rate of coiled aneurysms and particularly the risk of posttreatment rupture in ... ...

Abstract	Purpose: Aneurysmal recurrence represents a significant drawback of endovascular coiling, particularly in aneurysms that have previously ruptured. Given the high recurrence rate of coiled aneurysms and particularly the risk of posttreatment rupture in previously ruptured aneurysms that have been treated by coiling, the question of how best to treat ruptured aneurysms that recur postcoiling remains. Materials and methods: We conducted a retrospective analysis of twenty patients who underwent pipeline embolization of previously ruptured, coiled cerebral aneurysms. Results: Pipeline embolization device (PED) treatment resulted in complete aneurysmal occlusion in 10 patients (62.5%) at first angiographic follow-up, and 11 patients (68.75%) at last follow-up. No PED-related complications were encountered and there were no peri-procedural or postprocedural hemorrhages, or symptomatic ischemic events following flow diversion. Conclusions: PED as a second-line treatment is a safe and effective modality for achieving aneurysmal occlusion in recurrent, previously ruptured, primarily coiled aneurysms. Additionally, a staged coil-to-PED approach may be considered for the management of acutely ruptured aneurysms to achieve aneurysmal obliteration in an effort to mitigate recurrence, and reduce the amount of postprocedural studies.
Language	English
Publishing date	2021-05-29
Publishing country	India
Document type	Journal Article
ZDB-ID	2950273-1
ISSN	2455-4626 ; 2394-8108
ISSN (online)	2455-4626
ISSN	2394-8108
DOI	10.4103/bc.bc_59_20
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Article ; Online: Flow diversion in anterior cerebral artery aneurysms.

Dakay, Katarina / Cooper, Jared Blaine / Greisman, Jacob D / Kaur, Gurmeen / Al-Mufti, Fawaz / Gandhi, Chirag D / Santarelli, Justin G

Brain circulation

2021 Volume 7, Issue 4, Page(s) 247–252

Abstract: Introduction: Anterior cerebral artery (ACA) aneurysms are commonly encountered in clinical practice but can be challenging to treat. Flow diversion is a viable treatment in this population.: Methods: We retrospectively evaluated patients treated at ... ...

Abstract	Introduction: Anterior cerebral artery (ACA) aneurysms are commonly encountered in clinical practice but can be challenging to treat. Flow diversion is a viable treatment in this population. Methods: We retrospectively evaluated patients treated at our center from May 2017 to December 2020 who underwent flow diversion for an ACA aneurysm at or distal to the anterior communicating artery (ACOM). We defined ACA aneurysms as any aneurysm involving the ACOM itself, at the junction of the ACA with the ACOM (A1/A2), or in distal A2/A3 branches; both ruptured and unruptured aneurysms were included. Baseline and follow-up clinical and angiographic data were collected; the primary measure was elimination of the aneurysm on follow-up angiogram. Patients underwent flow diversion with a Pipeline stent. A single flow diverting stent was placed in the dominant ACA spanning from the A2 segment extending into the A1 segment; two patients required H-pipe technique. Distal aneurysms were treated with a single Pipeline device deployed across the parent vessel, covering the aneurysm. Results: Two-seven patients underwent a total of 28 flow diversion procedures; median age was 57 and 16 (59.3%) were male. Thirteen (48.2%) patients presented with subarachnoid hemorrhage; of these, four were treated within 6 weeks of the index hemorrhage. Most patients (22; 81.5%) had significant ACA asymmetry. There was one postoperative intracerebral hemorrhage and one groin complication. Follow-up data were available for 19 patients, 15 (78.9%) of which showed no residual aneurysm and 17 (89.5%) had protection of the dome. Conclusion: Flow diversion of ACA aneurysms can be a primary treatment modality in an unruptured aneurysm or a complement to initial coil protection of a ruptured aneurysm. Further studies are needed to confirm these results.
Language	English
Publishing date	2021-12-21
Publishing country	India
Document type	Journal Article
ZDB-ID	2950273-1
ISSN	2455-4626 ; 2394-8108
ISSN (online)	2455-4626
ISSN	2394-8108
DOI	10.4103/bc.bc_49_21
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Article ; Online: Incidence of Neo-Intimal Hyperplasia in Anterior Circulation Aneurysms Following Pipeline Flow Diversion.

Cooper, Jared B / Greisman, Jacob D / Dakay, Katarina / Kaur, Gurmeen / Al-Mufti, Fawaz / Gandhi, Chirag D / Santarelli, Justin G

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

2021 Volume 30, Issue 7, Page(s) 105794

Abstract: Introduction: Flow diversion of the distal anterior circulation cerebral vasculature may be used for management of wide necked aneurysms not amenable to other endovascular approaches. Follow-up angiography sometimes demonstrates neo-intimal hyperplasia ... ...

Abstract	Introduction: Flow diversion of the distal anterior circulation cerebral vasculature may be used for management of wide necked aneurysms not amenable to other endovascular approaches. Follow-up angiography sometimes demonstrates neo-intimal hyperplasia within or adjacent to the stent, however there is limited evidence in the literature examining the incidence in MCA and ACA aneurysms. We present our experience with flow diversion of the distal vasculature and evaluate the incidence of neo-intimal hyperplasia. Materials and methods: Retrospective review of patients who underwent Pipeline embolization device (PED) treatment for ruptured and unruptured anterior circulation aneurysms. Results: A total of 251 anterior circulation aneurysms were treated by pipeline flow diversion, of which 175 were ICA aneurysms, 14 were ACA aneurysms and 18 were MCA aneurysms. 6-month follow-up angiography was available in 207 patients. The incidence of neo-intimal hyperplasia was 15.9%, 21.4%, and 61.1% in ICA, ACA, and MCA aneurysms, respectively. MCA-territory aneurysms developed neo-intimal hyperplasia at a significantly higher rate than aneurysms in other vessel territories. Rates of aneurysmal occlusion did not significantly differ from those patients who did not exhibit intimal hyperplasia on follow-up angiography. Conclusion: In our experience, flow diversion of distal wide-necked MCA and ACA aneurysms is a safe and effective treatment strategy. The presence of neo-intimal hyperplasia at 6-month angiography is typically clinically asymptomatic. Given the statistically higher rate of neo-intimal hyperplasia in MCA aneurysms at 6-month angiography, we propose delaying initial follow-up angiography to 12-months and maintaining dual antiplatelet therapy during that time.
MeSH term(s)	Anterior Cerebral Artery/diagnostic imaging ; Anterior Cerebral Artery/pathology ; Blood Flow Velocity ; Carotid Artery, Internal/diagnostic imaging ; Carotid Artery, Internal/pathology ; Cerebral Angiography ; Cerebrovascular Circulation ; Embolization, Therapeutic/adverse effects ; Embolization, Therapeutic/instrumentation ; Endovascular Procedures/adverse effects ; Endovascular Procedures/instrumentation ; Female ; Humans ; Hyperplasia ; Intracranial Aneurysm/diagnostic imaging ; Intracranial Aneurysm/physiopathology ; Intracranial Aneurysm/therapy ; Male ; Middle Aged ; Middle Cerebral Artery/diagnostic imaging ; Middle Cerebral Artery/pathology ; Neointima ; Retrospective Studies ; Stents ; Time Factors ; Treatment Outcome
Language	English
Publishing date	2021-04-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	1131675-5
ISSN	1532-8511 ; 1052-3057
ISSN (online)	1532-8511
ISSN	1052-3057
DOI	10.1016/j.jstrokecerebrovasdis.2021.105794
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Article: Acute communicating hydrocephalus after intracranial arachnoid cyst decompression: A report of two cases.

Benton, Joshua A / Dominguez, Jose / Ng, Christina / Li, Boyi / Gandhi, Chirag D / Santarelli, Justin G / Houten, John K / Kinon, Merritt D

Surgical neurology international

2021 Volume 12, Page(s) 533

Abstract: Background: Arachnoid cysts (AC) may cause hydrocephalus and neurological symptoms, necessitating surgical intervention. Cyst drainage may result in postoperative complications, however, these interventions are not normally associated with the ... ...

Abstract	Background: Arachnoid cysts (AC) may cause hydrocephalus and neurological symptoms, necessitating surgical intervention. Cyst drainage may result in postoperative complications, however, these interventions are not normally associated with the subsequent development of acute hydrocephalus. Herein, we present two unique cases of AC drainage with postoperative development of acute communicating hydrocephalus. Case description: Case 1. A 75-year-old female presented with progressive headaches, cognitive decline, and questionable seizures. Her neurological examination was non-focal, but a head computed tomography scan (CT) identified a large right frontal AC with mass effect. She subsequently underwent craniotomy and decompression of the cyst. Postoperatively, her neurological examination deteriorated, and a head CT demonstrated new communicating hydrocephalus. The opening pressure was elevated upon placement of an external ventricular drain. Her hydrocephalus improved on follow-up imaging, but her neurological examination failed to improve, and she ultimately expired. Case 2. A 61-year-old female presented with headache and seizures attributed to a left parietal AC. She underwent open craniotomy for fenestration of the cyst into the Sylvian fissure. Postoperatively, her neurologic examination deteriorated, and she developed acute communicating hydrocephalus. She was initially managed with external ventricular drainage (EVD). The hydrocephalus resolved after several days, and the EVD was subsequently removed. Late follow-up imaging at 2 years showed that the regression of the AC was maintained. Conclusion: Acute development of hydrocephalus is a potential complication of intracranial AC fenestration. A better understanding of intracranial cerebrospinal fluid flow dynamics may better inform as to the underlying cause of this complication.
Language	English
Publishing date	2021-10-25
Publishing country	United States
Document type	Case Reports
ISSN	2229-5097
ISSN	2229-5097
DOI	10.25259/SNI_712_2021
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Article ; Online: Traumatic cervical internal carotid artery pseudoaneurysm in a child refractory to initial endovascular treatment: case report and technical considerations.

Wang, Arthur / Santarelli, Justin G / Stiefel, Michael F

Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery

2016 Volume 32, Issue 12, Page(s) 2459–2464

Abstract: Purpose: Optimal management of extracranial carotid artery dissections (eCAD) in pediatric patients is not well documented, and endovascular interventions are rarely reported.: Methods: A 10-year-old girl sustained multiple systemic injuries in a ... ...

Abstract	Purpose: Optimal management of extracranial carotid artery dissections (eCAD) in pediatric patients is not well documented, and endovascular interventions are rarely reported. Methods: A 10-year-old girl sustained multiple systemic injuries in a motor vehicle accident, including an eCAD with pseudoaneurysm. She initially failed both aspirin and endovascular stenting with progressive enlargement of a traumatic cervical carotid pseudoaneurysm and stenosis. Results: Second-stage endovascular stent placement with coiling resulted in successful occlusion of the pseudoaneurysm. At 30-month imaging follow-up, the parent vessel remained patent with no evidence of the pseudoaneurysm. Conclusion: In the setting of poly-trauma, management of eCAD can be complex especially in the pediatric population. There is little data on the endovascular treatment of eCAD in children. Failed endovascular therapies are extremely rare. Our report supports surveillance imaging as repeat endovascular treatment may be necessary.
MeSH term(s)	Accidents, Traffic ; Carotid Artery Injuries/surgery ; Carotid Artery, Internal, Dissection/surgery ; Child ; Embolization, Therapeutic/methods ; Endovascular Procedures/methods ; Female ; Humans
Keywords	covid19
Language	English
Publishing date	2016-12
Publishing country	Germany
Document type	Case Reports ; Journal Article
ZDB-ID	605988-0
ISSN	1433-0350 ; 0302-2803 ; 0256-7040
ISSN (online)	1433-0350
ISSN	0302-2803 ; 0256-7040
DOI	10.1007/s00381-016-3171-6
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Zs.A 2036: Show issues

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Article ; Online: A novel variant of the aortic arch great vessels.

Feldstein, Eric / Zeller, Sabrina / Mureb, Monica / Kamal, Haris / Shapiro, Steven D / Kaur, Gurmeen / Al-Mufti, Fawaz / Gandhi, Chirag D / Santarelli, Justin

Clinical neurology and neurosurgery

2022 Volume 214, Page(s) 107172

Abstract: Congenital variants of the aortic arch are important to recognize not only for their association with congenital heart disease, vascular rings, and chromosomal abnormalities but also for the purposes of neurointerventional angiography. While many ... ...

Abstract	Congenital variants of the aortic arch are important to recognize not only for their association with congenital heart disease, vascular rings, and chromosomal abnormalities but also for the purposes of neurointerventional angiography. While many different variants have been reported in the literature, we present two rare cases of an aortic arch variant that, to the best of our knowledge, has not yet been described in the literature- an anteriorly-directed, independent common origin of both carotid arteries from the ascending aorta, with separate subclavian artery trunks originating from the arch.
MeSH term(s)	Aorta, Thoracic/diagnostic imaging ; Humans ; Subclavian Artery/abnormalities ; Subclavian Artery/diagnostic imaging
Language	English
Publishing date	2022-02-11
Publishing country	Netherlands
Document type	Case Reports ; Journal Article
ZDB-ID	193107-6
ISSN	1872-6968 ; 0303-8467
ISSN (online)	1872-6968
ISSN	0303-8467
DOI	10.1016/j.clineuro.2022.107172
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Article ; Online: Cerebral Herniation Secondary to Stroke-Associated Hemorrhagic Transformation, Fulminant Cerebral Edema in Setting of COVID-19 Associated ARDS and Active Malignancy.

Dakay, Katarina / Kaur, Gurmeen / Mayer, Stephan A / Santarelli, Justin / Gandhi, Chirag / Al-Mufti, Fawaz

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

2020 Volume 29, Issue 12, Page(s) 105397

Abstract: SARS-CoV-2 infection has been associated with ischemic stroke as well as systemic complications such as acute respiratory failure; cytotoxic edema is a well-known sequelae of acute ischemic stroke and can be worsened by the presence of hypercarbia ... ...

Abstract	SARS-CoV-2 infection has been associated with ischemic stroke as well as systemic complications such as acute respiratory failure; cytotoxic edema is a well-known sequelae of acute ischemic stroke and can be worsened by the presence of hypercarbia induced by respiratory failure. We present the case of a very rapid neurologic and radiographic decline of a patient with an acute ischemic stroke who developed rapid fulminant cerebral edema leading to herniation in the setting of hypercarbic respiratory failure attributed to SARS-CoV-2 infection. Given the elevated incidence of cerebrovascular complications in patients with COVID-19, it is imperative for clinicians to be aware of the risk of rapidly progressive cerebral edema in patients who develop COVID-19 associated acute respiratory distress syndrome.
MeSH term(s)	Aged ; Brain Edema/diagnostic imaging ; Brain Edema/etiology ; Breast Neoplasms/complications ; Breast Neoplasms/diagnosis ; Breast Neoplasms/drug therapy ; COVID-19/complications ; COVID-19/diagnosis ; Disease Progression ; Encephalocele/diagnostic imaging ; Encephalocele/etiology ; Female ; Humans ; Intracranial Hemorrhages/diagnostic imaging ; Intracranial Hemorrhages/etiology ; Risk Factors ; Stroke/diagnostic imaging ; Stroke/etiology
Keywords	covid19
Language	English
Publishing date	2020-10-10
Publishing country	United States
Document type	Case Reports
ZDB-ID	1131675-5
ISSN	1532-8511 ; 1052-3057
ISSN (online)	1532-8511
ISSN	1052-3057
DOI	10.1016/j.jstrokecerebrovasdis.2020.105397
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Article ; Online: Reversible cerebral vasoconstriction syndrome and bilateral vertebral artery dissection presenting in a patient after cesarean section.

Mitchell, Lex A / Santarelli, Justin G / Singh, Inder Paul / Do, Huy M

Journal of neurointerventional surgery

2014 Volume 6, Issue 1, Page(s) e5

Abstract: Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by sudden-onset thunderclap headache and focal neurologic deficits. Once thought to be a rare syndrome, more advanced non-invasive imaging has led to an increase in RCVS diagnosis. ... ...

Abstract	Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by sudden-onset thunderclap headache and focal neurologic deficits. Once thought to be a rare syndrome, more advanced non-invasive imaging has led to an increase in RCVS diagnosis. Unilateral vertebral artery dissection has been described in fewer than 40% of cases of RCVS. Bilateral vertebral artery dissection has rarely been reported. We describe the case of a patient with RCVS and bilateral vertebral artery dissection presenting with an intramedullary infarct treated successfully with medical management and careful close follow-up. This rare coexistence should be recognized as the treatment differs.
MeSH term(s)	Cesarean Section/adverse effects ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Middle Aged ; Pregnancy ; Vasospasm, Intracranial/diagnosis ; Vasospasm, Intracranial/etiology ; Vasospasm, Intracranial/therapy ; Vertebral Artery Dissection/diagnosis ; Vertebral Artery Dissection/etiology ; Vertebral Artery Dissection/therapy
Language	English
Publishing date	2014-01
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	2514982-9
ISSN	1759-8486 ; 1759-8478
ISSN (online)	1759-8486
ISSN	1759-8478
DOI	10.1136/neurintsurg-2012-010521.rep
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Article ; Online: Frailty and spontaneous intracerebral hemorrhage: Does the modified frailty index predict mortality?

Kim, Michael G / Gandhi, Chirag / Azizkhanian, Ida / Epstein, Benjamin / Mittal, Abhiniti / Lee, Nam / Santarelli, Justin / Schmidt, Meic / Al-Mufti, Fawaz / Bowers, Christian A

Clinical neurology and neurosurgery

2020 Volume 194, Page(s) 105816

Abstract: Objective: This study aims to elucidate the impact of frailty on spontaneous intracranial hemorrhage (SICH) patient outcomes in the United States.: Patients and methods: This is a single center retrospective chart review of all adult patients (≥18 ... ...

Abstract	Objective: This study aims to elucidate the impact of frailty on spontaneous intracranial hemorrhage (SICH) patient outcomes in the United States. Patients and methods: This is a single center retrospective chart review of all adult patients (≥18 years old) admitted with a primary diagnosis of SICH due to hypertension, amyloid angiopathy, and coagulopathy from 2014-2017. The studied variables included length of stay, age, sex, ICH score variables, medications, and frailty as measured by the modified Frailty Index (mFI). Results: A total of 240 patients with 248 SICH were included in the analysis. In this study, mFI was not predictive of overall mortality (p = 0.12). To further investigate this issue, patients with ICH scores of 2 or 3 were separately analyzed to assess the impact of mFI on moderate ICH cases. However, mFI was also not associated with increased hospital mortality in moderate ICH cases (p = 0.812). In bivariate Spearman analysis, mFI significantly correlated with several outcome measures including modified Rankin Scale (MRS) at discharge (p = 0.01), but ICH score also correlated with these outcomes (p < 0.001). Although ICH & mFI scores were both predictive of MRS with linear regression, multivariate demonstrated that the ICH score was the only independent risk factor for MRS (p = 0.698, p < 0.001 respectively). Conclusion: Frailty, as measured by the mFI, was not an independent risk factor for increased mortality or worse outcomes in SICH patients. This study does not support incorporating the mFI score for SICH patients for prognostication.
MeSH term(s)	Aged ; Aged, 80 and over ; Blood Coagulation Disorders/complications ; Cerebral Amyloid Angiopathy/complications ; Female ; Frailty/diagnosis ; Frailty/mortality ; Hospital Mortality ; Humans ; Hypertension/complications ; Intracranial Hypotension/mortality ; Middle Aged ; Negative Results ; Predictive Value of Tests ; Prognosis ; Retrospective Studies ; Risk Factors ; Treatment Outcome
Language	English
Publishing date	2020-03-24
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	193107-6
ISSN	1872-6968 ; 0303-8467
ISSN (online)	1872-6968
ISSN	0303-8467
DOI	10.1016/j.clineuro.2020.105816
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Article ; Online: Reversible cerebral vasoconstriction syndrome and bilateral vertebral artery dissection presenting in a patient after cesarean section.

Mitchell, Lex A / Santarelli, Justin G / Singh, Inder Paul / Do, Huy M

BMJ case reports

2013 Volume 2013

Abstract	Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by sudden-onset thunderclap headache and focal neurologic deficits. Once thought to be a rare syndrome, more advanced non-invasive imaging has led to an increase in RCVS diagnosis. Unilateral vertebral artery dissection has been described in fewer than 40% of cases of RCVS. Bilateral vertebral artery dissection has rarely been reported. We describe the case of a patient with RCVS and bilateral vertebral artery dissection presenting with an intramedullary infarct treated successfully with medical management and careful close follow-up. This rare coexistence should be recognized as the treatment differs.
MeSH term(s)	Aspirin ; Cerebral Angiography ; Cesarean Section ; Clopidogrel ; Female ; Headache/etiology ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Platelet Aggregation Inhibitors/therapeutic use ; Postoperative Complications/diagnosis ; Syndrome ; Ticlopidine/analogs & derivatives ; Tomography, X-Ray Computed ; Vasoconstriction ; Vasospasm, Intracranial/cerebrospinal fluid ; Vasospasm, Intracranial/complications ; Vasospasm, Intracranial/diagnosis ; Vertebral Artery Dissection/complications ; Vertebral Artery Dissection/diagnosis
Chemical Substances	Platelet Aggregation Inhibitors ; Clopidogrel (A74586SNO7) ; Ticlopidine (OM90ZUW7M1) ; Aspirin (R16CO5Y76E)
Language	English
Publishing date	2013-01-24
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2012-010521
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