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  1. Article ; Online: Laterality of previous stoke affects endovascular thrombectomy outcomes.

    Bageac, Devin V / Gershon, Blake S / Chada, Deeksha / Siddiqui, Neha / Majidi, Shahram / Fifi, Johanna T / De Leacy, Reade

    Journal of neurointerventional surgery

    2022  Volume 15, Issue 3, Page(s) 238–241

    Abstract: Background: Investigations into the effect of previous stroke on thrombectomy outcomes have yielded conflicting results, and are limited by small sample sizes. We present the results of a large single center retrospective study aimed at investigating ... ...

    Abstract Background: Investigations into the effect of previous stroke on thrombectomy outcomes have yielded conflicting results, and are limited by small sample sizes. We present the results of a large single center retrospective study aimed at investigating the effect of chronic stroke laterality on thrombectomy outcomes.
    Methods: A prospectively maintained database was queried for all thrombectomy cases conducted between December 2014 and January 2020, and patient imaging was prospectively reviewed for evidence of prior supratentorial infarction. Procedural, clinical, and demographic characteristics were recorded, and good clinical outcome was defined as a 90 day modified Rankin Scale (mRS) score of <2 or mRS score unchanged if baseline was >2.
    Results: The final analysis cohort included 555 patients, 79 of whom were found to have radiographic evidence of prior chronic infarcts. On univariate analysis, patients with any chronic supratentorial infarct achieved a lower rate of good clinical outcome than patients with no chronic infarct (22.8% vs 41.0%, p=0.0021). With regard to subgroups, this difference remained only in patients with ipsilateral (14.3%, p=0.0018) and bilateral (11.8%, p=0.015) lesions. Patients with chronic contralateral supratentorial infarcts were no less likely to achieve good outcomes (40.7%, p=0.98). After multivariate regression controlling for age, sex, and baseline mRS, chronic ipsilateral infarcts (OR 0.22, CI 0.07 to 0.67) and chronic bilateral infarcts (OR 0.19, CI 0.04 to 0.85) were the only independent predictors of poor outcome in endovascular thrombectomy patients.
    Conclusions: In this single center retrospective study of thrombectomy patients with chronic supratentorial infarcts, the laterality of the previous stroke significantly affected the likelihood of good clinical outcomes.
    MeSH term(s) Humans ; Retrospective Studies ; Treatment Outcome ; Stroke/diagnostic imaging ; Stroke/surgery ; Stroke/pathology ; Thrombectomy/methods ; Infarction ; Endovascular Procedures/methods ; Brain Ischemia
    Language English
    Publishing date 2022-01-31
    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/neurintsurg-2021-018011
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 6845: Show issues Location:
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  2. Article ; Online: AI software detection of large vessel occlusion stroke on CT angiography: a real-world prospective diagnostic test accuracy study.

    Matsoukas, Stavros / Morey, Jacob / Lock, Gregory / Chada, Deeksha / Shigematsu, Tomoyoshi / Marayati, Naoum Fares / Delman, Bradley N / Doshi, Amish / Majidi, Shahram / De Leacy, Reade / Kellner, Christopher Paul / Fifi, Johanna T

    Journal of neurointerventional surgery

    2022  Volume 15, Issue 1, Page(s) 52–56

    Abstract: Background: Artificial intelligence (AI) software is increasingly applied in stroke diagnostics. However, the actual performance of AI tools for identifying large vessel occlusion (LVO) stroke in real time in a real-world setting has not been fully ... ...

    Abstract Background: Artificial intelligence (AI) software is increasingly applied in stroke diagnostics. However, the actual performance of AI tools for identifying large vessel occlusion (LVO) stroke in real time in a real-world setting has not been fully studied.
    Objective: To determine the accuracy of AI software in a real-world, three-tiered multihospital stroke network.
    Methods: All consecutive head and neck CT angiography (CTA) scans performed during stroke codes and run through an AI software engine (Viz LVO) between May 2019 and October 2020 were prospectively collected. CTA readings by radiologists served as the clinical reference standard test and Viz LVO output served as the index test. Accuracy metrics were calculated.
    Results: Of a total of 1822 CTAs performed, 190 occlusions were identified; 142 of which were internal carotid artery terminus (ICA-T), middle cerebral artery M1, or M2 locations. Accuracy metrics were analyzed for two different groups: ICA-T and M1 ±M2. For the ICA-T/M1 versus the ICA-T/M1/M2 group, sensitivity was 93.8% vs 74.6%, specificity was 91.1% vs 91.1%, negative predictive value was 99.7% vs 97.6%, accuracy was 91.2% vs 89.8%, and area under the curve was 0.95 vs 0.86, respectively. Detection rates for ICA-T, M1, and M2 occlusions were 100%, 93%, and 49%, respectively. As expected, the algorithm offered better detection rates for proximal occlusions than for mid/distal M2 occlusions (58% vs 28%, p=0.03).
    Conclusions: These accuracy metrics support Viz LVO as a useful adjunct tool in stroke diagnostics. Fast and accurate diagnosis with high negative predictive value mitigates missing potentially salvageable patients.
    MeSH term(s) Humans ; Computed Tomography Angiography ; Artificial Intelligence ; Prospective Studies ; Stroke/diagnostic imaging ; Arterial Occlusive Diseases ; Ischemic Stroke ; Software ; Diagnostic Tests, Routine ; Cerebral Angiography ; Retrospective Studies
    Language English
    Publishing date 2022-01-27
    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/neurintsurg-2021-018391
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Size Matters: Rethinking of the Sizing Classification of Pituitary Adenomas Based on the Rates of Surgery: A Multi-institutional Retrospective Study of 29,651 Patients.

    Bhimani, Abhiraj D / Schupper, Alexander J / Arnone, Gregory D / Chada, Deeksha / Chaker, Anisse N / Mohammadi, Nicki / Hadjipanayis, Costas G / Mehta, Ankit I

    Journal of neurological surgery. Part B, Skull base

    2020  Volume 83, Issue 1, Page(s) 66–75

    Abstract: ... ...

    Abstract Objective
    Language English
    Publishing date 2020-09-10
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 2654269-9
    ISSN 2193-634X ; 2193-6331
    ISSN (online) 2193-634X
    ISSN 2193-6331
    DOI 10.1055/s-0040-1716673
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 3425: Show issues Location:
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  4. Article ; Online: Comparative study of intracranial access in thrombectomy using next generation 0.088 inch guide catheter technology.

    Bageac, Devin V / Gershon, Blake S / Vargas, Jan / Mokin, Maxim / Ren, Zeguang / Chada, Deeksha / Turk, Aquilla S / Chaudry, M Imran / Turner, Raymond D / Fifi, Johanna T / Shigematsu, Tomoyoshi / De Leacy, Reade

    Journal of neurointerventional surgery

    2021  Volume 14, Issue 4, Page(s) 390–396

    Abstract: Background: Most conventional 0.088 inch guide catheters cannot safely navigate intracranial vasculature. The objective of this study is to evaluate the safety of stroke thrombectomy using a novel 0.088 inch guide catheter designed for intracranial ... ...

    Abstract Background: Most conventional 0.088 inch guide catheters cannot safely navigate intracranial vasculature. The objective of this study is to evaluate the safety of stroke thrombectomy using a novel 0.088 inch guide catheter designed for intracranial navigation.
    Methods: This is a multicenter retrospective study, which included patients over 18 years old who underwent thrombectomy for anterior circulation large vessel occlusions. Technical outcomes for patients treated using the TracStar Large Distal Platform (TracStar LDP) or earlier generation TRX LDP were compared with a matched cohort of patients treated with other commonly used guide catheters. The primary outcome measure was device-related complications. Secondary outcome measures included guide catheter failure and time between groin puncture and clot engagement.
    Results: Each study arm included 45 patients. The TracStar group was non-inferior to the control group with regard to device-related complications (6.8% vs 8.9%), and the average time to clot engagement was 8.89 min shorter (14.29 vs 23.18 min; p=0.0017). There were no statistically significant differences with regard to other technical outcomes, including time to recanalization (modified Thrombolysis In Cerebral Infarction (mTICI) ≥2B). The TracStar was successfully advanced into the intracranial internal carotid artery in 33 cases (73.33%); in three cases (6.67%), it was swapped for an alternate catheter. Successful reperfusion (mTICI 2B-3) was achieved in 95.56% of cases. Ninety-day follow-up data were available for 86.67% of patients, among whom 46.15% had an modified Rankin Score of 0-2%, and 10.26% were deceased.
    Conclusions: Tracstar LDP is safe for use during stroke thrombectomy and was associated with decreased time to clot engagement. Intracranial access was regularly achieved.
    MeSH term(s) Adult ; Brain Ischemia/complications ; Catheters/adverse effects ; Humans ; Retrospective Studies ; Stroke/diagnostic imaging ; Stroke/etiology ; Stroke/surgery ; Technology ; Thrombectomy/adverse effects ; Treatment Outcome
    Language English
    Publishing date 2021-05-26
    Publishing country England
    Document type Journal Article ; Multicenter Study
    ZDB-ID 2514982-9
    ISSN 1759-8486 ; 1759-8478
    ISSN (online) 1759-8486
    ISSN 1759-8478
    DOI 10.1136/neurintsurg-2021-017341
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 6845: Show issues Location:
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  5. Article ; Online: Interhospital Transfer of Intracerebral Hemorrhage Patients Undergoing Minimally Invasive Surgery: The Experience of a New York City Hospital System.

    Kleitsch, Julianne / Nistal, Dominic A / Romano Spica, Natalia / Alkayyali, Miryam / Song, Rui / Chada, Deeksha / Reilly, Kaitlin / Lay, Cappi / Reynolds, Alexandra S / Fifi, Johanna T / Bederson, Joshua B / Mocco, J / Liang, John W / Kellner, Christopher P / Dangayach, Neha S

    World neurosurgery

    2021  Volume 148, Page(s) e390–e395

    Abstract: Objective: The impact of interhospital transfer (IHT) on outcomes of patients with intracerebral hemorrhage (ICH) has not been well studied. We seek to describe the protocolized IHT and systems of care approach of a New York City hospital system, where ... ...

    Abstract Objective: The impact of interhospital transfer (IHT) on outcomes of patients with intracerebral hemorrhage (ICH) has not been well studied. We seek to describe the protocolized IHT and systems of care approach of a New York City hospital system, where ICH patients undergoing minimally invasive surgery (MIS) are transferred to a dedicated ICH center.
    Methods: We retrospectively reviewed 100 consecutively admitted patients with spontaneous ICH. We gathered information on demographics, variables related to IHT, clinical and radiographic characteristics, and details about the clinical course and outpatient follow-up. We grouped patients into 2 cohorts: those admitted through IHT and those directly admitted through the emergency department. Primary outcome was good functional outcome at 6 months, defined as modified Rankin Scale score 0-3.
    Results: Of 100 patients, 89 underwent IHT and 11 were directly admitted. On multivariable analysis, there were no significant differences in 6-month functional outcome between the 2 cohorts. All transfers were managed by a system-wide transfer center and 24/7 hotline for neuroemergencies. An ICH-specific IHT protocol was followed, in which a neurointensivist provided recommendations for stabilizing patients for transfer. Average transfer time was 199.7 minutes and average distance travelled was 13.6 kilometers.
    Conclusions: In our hospital system, a centralized approach to ICH management and a dedicated ICH center increased access to specialist services, including MIS. Most patients undergoing MIS were transferred from outside hospitals, which highlights the need for additional studies and descriptions of experiences to further elucidate the impact of and best protocols for the IHT of ICH patients.
    Language English
    Publishing date 2021-01-08
    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.2020.12.163
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 1159: Show issues Location:
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  6. Article: Size Matters: Rethinking of the Sizing Classification of Pituitary Adenomas Based on the Rates of Surgery: A Multi-institutional Retrospective Study of 29,651 Patients

    Bhimani, Abhiraj D. / Schupper, Alexander J. / Arnone, Gregory D. / Chada, Deeksha / Chaker, Anisse N. / Mohammadi, Nicki / Hadjipanayis, Costas G. / Mehta, Ankit I.

    Journal of Neurological Surgery Part B: Skull Base

    2020  Volume 83, Issue 01, Page(s) 66–75

    Abstract: Objective: Pituitary adenomas are historically classified into microadenoma or macroadenomas based on size less than or greater than/equal to 1c m. “Giant” adenomas describe tumors ≥4 cm. The aim of this study is to present an evidence-based approach to ...

    Abstract Objective: Pituitary adenomas are historically classified into microadenoma or macroadenomas based on size less than or greater than/equal to 1c m. “Giant” adenomas describe tumors ≥4 cm. The aim of this study is to present an evidence-based approach to size classification based on national trends.
    Design: The design involved is multi-institutional retrospective study.
    Participants: A total of 29,651 patients were studied from National Cancer Institute's SEER program from 2004 to 2016 across the United States.
    Main Outcome Measures: The main outcome measures include demographics, treatment characteristics, and overall survival in the population.
    Results: At the 20-mm threshold, the likelihood of operation exceeds the likelihood of nonoperative management. Patients with adenoma size 1 to 19 mm had significantly longer overall survival compared with 20 to 50 mm (Log rank: p  < 0.0001). No survival difference was found between size 20 to 29 mm and larger. There was no significant difference in the rate of surgery between 30 to 39 mm and 40 to 50 mm tumors( p  = 0.5035). Surgery group had a higher overall survival compared with nonsurgically managed patients (Log rank: p  < 0.0001).
    Conclusion: Microadenoma has classically been used to describe pituitary tumors less than 1 cm, though no clinical significance of this threshold has been demonstrated. The current study suggests a size cut-off of 20 or 30 mm as more clinically relevant. Still, future studies are warranted to examine the significance of this classification by specific tumor type, and subclassified as appropriate. There is no difference in the rate of surgery or survival for adenomas between 30 and 50 mm, challenging the 4-mm cutoff threshold for “giant” adenoma.
    Keywords pituitary adenoma ; giant adenoma ; macroadenoma ; microadenoma ; surgery ; SEER
    Language English
    Publishing date 2020-09-10
    Publisher Georg Thieme Verlag KG
    Publishing place Stuttgart ; New York
    Document type Article
    ZDB-ID 2654269-9
    ISSN 2193-634X ; 2193-6331
    ISSN (online) 2193-634X
    ISSN 2193-6331
    DOI 10.1055/s-0040-1716673
    Database Thieme publisher's database

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