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  1. Article ; Online: A Review of Robotic Interventional Neuroradiology.

    Beaman, C B / Kaneko, N / Meyers, P M / Tateshima, S

    AJNR. American journal of neuroradiology

    2021  Volume 42, Issue 5, Page(s) 808–814

    Abstract: Robotic interventional neuroradiology is an emerging field with the potential to enhance patient safety, reduce occupational hazards, and expand systems of care. Endovascular robots allow the operator to precisely control guidewires and catheters from a ... ...

    Abstract Robotic interventional neuroradiology is an emerging field with the potential to enhance patient safety, reduce occupational hazards, and expand systems of care. Endovascular robots allow the operator to precisely control guidewires and catheters from a lead-shielded cockpit located several feet (or potentially hundreds of miles) from the patient. This has opened up the possibility of expanding telestroke networks to patients without access to life-saving procedures such as stroke thrombectomy and cerebral aneurysm occlusion by highly-experienced physicians. The prototype machines, first developed in the early 2000s, have evolved into machines capable of a broad range of techniques, while incorporating newly automated maneuvers and safety algorithms. In recent years, preliminary clinical research has been published demonstrating the safety and feasibility of the technology in cerebral angiography and intracranial intervention. The next step is to conduct larger, multisite, prospective studies to assess generalizability and, ultimately, improve patient outcomes in neurovascular disease.
    MeSH term(s) Humans ; Nervous System Diseases/diagnostic imaging ; Nervous System Diseases/surgery ; Radiography, Interventional/methods ; Robotics/methods ; Stroke/diagnostic imaging ; Stroke/surgery ; Telemedicine ; Thrombectomy
    Language English
    Publishing date 2021-02-04
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 603808-6
    ISSN 1936-959X ; 0195-6108
    ISSN (online) 1936-959X
    ISSN 0195-6108
    DOI 10.3174/ajnr.A6976
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Lesion stability characteristics outperform degree of stenosis in predicting outcomes following stenting for symptomatic intracranial atherosclerosis.

    Alexander, M D / Cooke, D L / Meyers, P M / Amans, M R / Dowd, C F / Halbach, V V / Higashida, R T / Hetts, S W

    Journal of neurointerventional surgery

    2016  Volume 8, Issue 1, Page(s) 19–23

    Abstract: Background: Intracranial atherosclerotic disease (ICAD) causes substantial morbidity and mortality. Treatment decisions have most commonly been driven by the degree of luminal stenosis. This study compares ICAD lesion stability features with percentage ... ...

    Abstract Background: Intracranial atherosclerotic disease (ICAD) causes substantial morbidity and mortality. Treatment decisions have most commonly been driven by the degree of luminal stenosis. This study compares ICAD lesion stability features with percentage stenosis for associations with adverse outcomes following treatment with stents.
    Materials and methods: Retrospective analysis was performed of prospectively maintained procedure logs. Lesions were classified by symptom type as hypoperfusion, non-hypoperfusion, or indeterminate, and pretreatment asymptomatic intervals were noted. Hypoperfusion lesions and indeterminate or non-hypoperfusion lesions with ≥14 days of asymptomatic interval were classified as stable. Percentage stenosis was calculated and compared against these other symptom features for value in predicting technical complication, ischemic stroke, disability, or death at 90 days and 2 years using univariate and multivariate analysis.
    Results: 130 lesions were treated in 124 patients. The only statistically significant percent stenosis finding was lesions with 60-99% stenosis were less likely to have technical complications. In univariate analysis, stroke at 2 years was less common with hypoperfusion and stable lesions. In multivariate analysis, only hypoperfusion status was associated with lower stroke rates at 2 years.
    Conclusions: Lesion stability features, particularly non-hypoperfusion symptomatology, outperform percentage stenosis in predicting outcomes following treatment of ICAD with stents. Further examination is needed to better classify the natural history of ICAD and more precisely classify lesion stability.
    MeSH term(s) Aged ; Aged, 80 and over ; Cerebrovascular Circulation/physiology ; Constriction, Pathologic/diagnosis ; Constriction, Pathologic/therapy ; Female ; Humans ; Intracranial Arteriosclerosis/diagnosis ; Intracranial Arteriosclerosis/therapy ; Male ; Middle Aged ; Outcome Assessment (Health Care) ; Prognosis ; Retrospective Studies ; Stents
    Language English
    Publishing date 2016-01
    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-2014-011482
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Interventional therapy for carotid artery disease using angioplasty and stenting with embolic protection.

    Loftus, M L / Schumacher, H C / Meyers, P M

    Minerva cardioangiologica

    2006  Volume 54, Issue 5, Page(s) 679–685

    Abstract: Carotid artery angioplasty with stenting (CAS) has emerged as a viable alternative to endarterectomy for the treatment of occlusive vascular disease. Advances in endovascular techniques and the improvement of specialized stents have served to rapidly ... ...

    Abstract Carotid artery angioplasty with stenting (CAS) has emerged as a viable alternative to endarterectomy for the treatment of occlusive vascular disease. Advances in endovascular techniques and the improvement of specialized stents have served to rapidly close the gap with the traditional gold standard surgery. Furthermore, the development of cerebral embolic protection devices has reduced the occurrence of distal embolization of atheromatous material during such interventions and has reduced periprocedural stroke rates considerably. Continued improvements in distal embolic protection have further improved the risk profile of CAS, and increased operator experience with these interventional procedures has also been shown to reduce periprocedural complication rates. Outcomes may continue to improve as more providers gain experience with the evolving endovascular device technology, and several prospective clinical trials are currently investigating the efficacy of CAS with embolization protection versus endarterectomy in different cohorts. This review will survey the background and current literature covering angioplasty and stenting for occlusive disease in the carotid arteries and discuss the current methods employed to prevent distal emboli during intervention.
    MeSH term(s) Angioplasty, Balloon/adverse effects ; Carotid Artery Diseases/therapy ; Embolism/etiology ; Embolism/prevention & control ; Humans ; Stents/adverse effects
    Language English
    Publishing date 2006-10
    Publishing country Italy
    Document type Journal Article ; Review
    ZDB-ID 123583-7
    ISSN 1827-1618 ; 0026-4725
    ISSN (online) 1827-1618
    ISSN 0026-4725
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Observer agreement regarding the necessity of retreatment of previously coiled recurrent cerebral aneurysms.

    Daugherty, W P / Rad, A Ehteshami / White, J B / Meyers, P M / Lanzino, G L / Cloft, H J / Gordon, J / Kallmes, D F

    AJNR. American journal of neuroradiology

    2011  Volume 32, Issue 3, Page(s) 566–569

    Abstract: Background and purpose: The decision regarding whether or not to retreat a previously treated aneurysm not only directly impacts patient care but also serves as a primary outcome measure in numerous, leading randomized controlled trials of modified ... ...

    Abstract Background and purpose: The decision regarding whether or not to retreat a previously treated aneurysm not only directly impacts patient care but also serves as a primary outcome measure in numerous, leading randomized controlled trials of modified coils. Our aim was to determine the degree of interobserver variability regarding the need and type of treatment for recurrent aneurysms following coil embolization.
    Materials and methods: Twenty-seven previously treated recurrent aneurysms were identified. Five independent readers rated each aneurysm on a 5-point scale: 1, definitely do not retreat; 2, probably do not retreat; 3, unsure; 4, probably retreat; and 5, definitely retreat. The readers noted, in grades 2-5, the type of retreatment preferred, including simple coiling, balloon- or stent-assist coiling, or surgical clipping. Intraobserver agreement κ was calculated. Retreatment recommendations were evaluated between observers by using a Wilcoxon signed rank comparison. Descriptive statistics were performed for categoric treatment-type comparisons.
    Results: At least 2- or 3-point differences between 2 readers were present in 17 (63%) and 11 (41%) of 27 cases, respectively. The median κ was 0.27 (range, 0.04-0.43), which indicates fair agreement. Differences between readers varied, with readers 4 and 5 more often recommending retreatment compared with reviewers 1-3 (P < .05). Wide variation was noted in treatment approach, with recommendations for surgical clipping ranging from 2 (7%) to 18 (67%) of 27 cases between readers 1 and 5.
    Conclusions: The current study demonstrates substantial variability among observers not only in whether to retreat a recurrent aneurysm but also how to treat it. These findings suggest that patient management varies widely across treating physicians and also calls into question the use of "retreatment" as an objective end point in clinical trials.
    MeSH term(s) Adult ; Embolization, Therapeutic ; Female ; Humans ; Intracranial Aneurysm/diagnostic imaging ; Intracranial Aneurysm/surgery ; Observer Variation ; Radiography ; Reoperation ; Reproducibility of Results ; Sensitivity and Specificity ; Young Adult
    Language English
    Publishing date 2011-01-20
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 603808-6
    ISSN 1936-959X ; 0195-6108
    ISSN (online) 1936-959X
    ISSN 0195-6108
    DOI 10.3174/ajnr.A2336
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Multisociety Consensus Quality Improvement Revised Consensus Statement for Endovascular Therapy of Acute Ischemic Stroke.

    Sacks, D / Baxter, B / Campbell, B C V / Carpenter, J S / Cognard, C / Dippel, D / Eesa, M / Fischer, U / Hausegger, K / Hirsch, J A / Hussain, M S / Jansen, O / Jayaraman, M V / Khalessi, A A / Kluck, B W / Lavine, S / Meyers, P M / Ramee, S / Rüfenacht, D A /
    Schirmer, C M / Vorwerk, D

    AJNR. American journal of neuroradiology

    2018  Volume 39, Issue 6, Page(s) E61–E76

    MeSH term(s) Cerebral Revascularization/methods ; Cerebral Revascularization/standards ; Consensus ; Endovascular Procedures/methods ; Endovascular Procedures/standards ; Humans ; Quality Improvement ; Stroke/surgery
    Keywords covid19
    Language English
    Publishing date 2018-05-17
    Publishing country United States
    Document type Journal Article ; Practice Guideline ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 603808-6
    ISSN 1936-959X ; 0195-6108
    ISSN (online) 1936-959X
    ISSN 0195-6108
    DOI 10.3174/ajnr.A5638
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article: Temporary endovascular balloon occlusion of the internal carotid artery with a nondetachable silicone balloon catheter: analysis of technique and cost.

    Meyers, P M / Thakur, G A / Tomsick, T A

    AJNR. American journal of neuroradiology

    1999  Volume 20, Issue 4, Page(s) 559–564

    Abstract: Background and purpose: Temporary balloon occlusion has become a routine and medically accepted technique for the management of patients with aneurysms or intracranial or head/neck tumors. We describe our experience using a nondetachable silicone ... ...

    Abstract Background and purpose: Temporary balloon occlusion has become a routine and medically accepted technique for the management of patients with aneurysms or intracranial or head/neck tumors. We describe our experience using a nondetachable silicone balloon (NDSB) catheter in 103 endovascular temporary balloon occlusions of the internal carotid artery, with attention focused on technique, complications, and cost.
    Methods: Between 1993 and 1998, 103 patients underwent preoperative temporary balloon occlusion testing with a 1.5-mm NDSB catheter. Clinical testing during endovascular blockade was combined with qualitative cerebral blood flow analysis using technetium-99m HMPAO SPECT. Cost-effective analysis was performed, emphasizing cost and complication rates in comparison with those in previously reported series in which multiple types of temporary balloon occlusion catheters were used, predominantly not of the NDSB type.
    Results: No carotid artery injury or complication, including cerebral infarction due to NDSB use, was encountered. Despite the increased cost of the NDSB catheter system, cost-effective analysis showed up to 40% reduction in cost per quality adjusted life years.
    Conclusion: Temporary balloon occlusion using the NDSB catheter is safe and cost-effective, owing to the low rate of complications.
    MeSH term(s) Aged ; Carotid Artery, Internal/physiopathology ; Catheterization/economics ; Catheterization/instrumentation ; Catheterization/methods ; Cerebrovascular Circulation/physiology ; Cost-Benefit Analysis ; Embolization, Therapeutic/economics ; Embolization, Therapeutic/instrumentation ; Embolization, Therapeutic/methods ; Health Care Costs ; Humans ; Intraoperative Care ; Middle Aged ; Neurologic Examination ; Preoperative Care ; Quality-Adjusted Life Years ; Radiopharmaceuticals ; Regional Blood Flow/physiology ; Risk Factors ; Safety ; Silicones ; Technetium Tc 99m Exametazime ; Tomography, Emission-Computed, Single-Photon
    Chemical Substances Radiopharmaceuticals ; Silicones ; Technetium Tc 99m Exametazime (3B744AG22N)
    Language English
    Publishing date 1999-04
    Publishing country United States
    Document type Comparative Study ; Journal Article
    ZDB-ID 603808-6
    ISSN 1936-959X ; 0195-6108
    ISSN (online) 1936-959X
    ISSN 0195-6108
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  7. Article ; Online: Symptom differences and pretreatment asymptomatic interval affect outcomes of stenting for intracranial atherosclerotic disease.

    Alexander, M D / Meyers, P M / English, J D / Stradford, T R / Sung, S / Smith, W S / Halbach, V V / Higashida, R T / Dowd, C F / Cooke, D L / Hetts, S W

    AJNR. American journal of neuroradiology

    2014  Volume 35, Issue 6, Page(s) 1157–1162

    Abstract: Background and purpose: Different types of symptomatic intracranial stenosis may respond differently to interventional therapy. We investigated symptomatic and pathophysiologic factors that may influence clinical outcomes of patients with intracranial ... ...

    Abstract Background and purpose: Different types of symptomatic intracranial stenosis may respond differently to interventional therapy. We investigated symptomatic and pathophysiologic factors that may influence clinical outcomes of patients with intracranial atherosclerotic disease who were treated with stents.
    Materials and methods: A retrospective analysis was performed of patients treated with stents for intracranial atherosclerosis at 4 centers. Patient demographics and comorbidities, lesion features, treatment features, and preprocedural and postprocedural functional status were noted. χ(2) univariate and multivariate logistic regression analysis was performed to assess technical results and clinical outcomes.
    Results: One hundred forty-two lesions in 131 patients were analyzed. Lesions causing hypoperfusion ischemic symptoms were associated with fewer strokes by last contact [χ(2) (1, n = 63) = 5.41, P = .019]. Nonhypoperfusion lesions causing symptoms during the 14 days before treatment had more strokes by last contact [χ(2) (1, n = 136), 4.21, P = .047]. Patients treated with stents designed for intracranial deployment were more likely to have had a stroke by last contact (OR, 4.63; P = .032), and patients treated with percutaneous balloon angioplasty in addition to deployment of a self-expanding stent were less likely to be stroke free at point of last contact (OR, 0.60; P = .034).
    Conclusions: More favorable outcomes may occur after stent placement for lesions causing hypoperfusion symptoms and when delaying stent placement 7-14 days after most recent symptoms for lesions suspected to cause embolic disease or perforator ischemia. Angioplasty performed in addition to self-expanding stent deployment may lead to worse outcomes, as may use of self-expanding stents rather than balloon-mounted stents.
    MeSH term(s) Adult ; Aged ; Angioplasty/instrumentation ; Angioplasty/methods ; Blood Vessel Prosthesis ; Female ; Humans ; Intracranial Arteriosclerosis/therapy ; Male ; Middle Aged ; Preoperative Care/methods ; Retrospective Studies ; Stents ; Treatment Outcome ; United States
    Language English
    Publishing date 2014-03-27
    Publishing country United States
    Document type Journal Article ; Multicenter Study ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 603808-6
    ISSN 1936-959X ; 0195-6108
    ISSN (online) 1936-959X
    ISSN 0195-6108
    DOI 10.3174/ajnr.A3836
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Patient radiation exposure during diagnostic and therapeutic interventional neuroradiology procedures.

    Alexander, M D / Oliff, M C / Olorunsola, O G / Brus-Ramer, M / Nickoloff, E L / Meyers, P M

    Journal of neurointerventional surgery

    2010  Volume 2, Issue 1, Page(s) 6–10

    Abstract: Purpose: Increasing in number and complexity, interventional neuroradiology (INR) procedures are becoming an important source of radiation exposure for patients. In accordance with the ALARA principle, radiation exposure during INR procedures should be ... ...

    Abstract Purpose: Increasing in number and complexity, interventional neuroradiology (INR) procedures are becoming an important source of radiation exposure for patients. In accordance with the ALARA principle, radiation exposure during INR procedures should be curtailed as much as possible while reaching successful treatment outcomes. Moreover, the extent of radiation exposure should be one outcome measure used to assess new technologies and procedural efficacy, and training programs should include techniques for exposure limitation. This study provides a methodology and preliminary data to assess radiation exposure during different INR procedure types.
    Materials and methods: All patients undergoing endovascular procedures in two biplanar dedicated neuroangiography suites at a major academic medical center were monitored according to procedure type, pathological indication, fluoroscopy time and machine-generated patient dose estimates between April 2006 and July 2008.
    Results: 1678 patients underwent cerebral arteriography during the study period. Women (62.1%) accounted for the majority of patients, but men (38.9%) were more likely to undergo an interventional procedure than women (32.8%). Diagnostic studies accounted for 64.9% of procedures. Variable exposures were found between diagnostic and interventional procedures. Exposure differed depending on indications for the procedure and procedure type.
    Conclusion: Radiation exposure is an increasingly important consideration in the development of minimally invasive neurological procedures including cerebral angiography and INR. The type of procedure and lesion type allow the practitioner to estimate radiation exposure. Such information informs the clinical decision making process. Normative data should be collected and used for comparison purposes as one measure of technical and procedural success.
    MeSH term(s) Adult ; Aged ; Cerebral Angiography/adverse effects ; Cerebral Angiography/methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Neuroradiography/adverse effects ; Neuroradiography/methods ; Radiation Dosage ; Radiography, Interventional/adverse effects ; Radiography, Interventional/methods ; Radiology, Interventional/methods ; Retrospective Studies
    Language English
    Publishing date 2010-03
    Publishing country England
    Document type Comparative Study ; Journal Article
    ZDB-ID 2514982-9
    ISSN 1759-8486 ; 1759-8478
    ISSN (online) 1759-8486
    ISSN 1759-8478
    DOI 10.1136/jnis.2009.000802
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Reporting standards for balloon test occlusion.

    Narayanan, S / Singer, R / Abruzzo, T A / Hussain, M S / Powers, C J / Prestigiacomo, C J / Heck, D V / Sunshine, J L / Kelly, M / Jayaraman, M V / Meyers, P M

    Journal of neurointerventional surgery

    2013  Volume 5, Issue 6, Page(s) 503–505

    MeSH term(s) Balloon Occlusion/adverse effects ; Balloon Occlusion/methods ; Cerebral Angiography ; Cerebrovascular Disorders/diagnosis ; Cerebrovascular Disorders/surgery ; Documentation/standards ; Humans ; Nervous System Diseases/epidemiology ; Nervous System Diseases/etiology ; Neurosurgery/standards ; Reference Standards ; Reproducibility of Results ; Skull Base/surgery
    Language English
    Publishing date 2013-11
    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-2013-010848
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Society of NeuroInterventional Surgery Standards of Practice: general considerations.

    Meyers, P M / Blackham, K A / Abruzzo, T A / Gandhi, C D / Higashida, R T / Hirsch, J A / Hsu, D / Moran, C J / Narayanan, S / Prestigiacomo, C J / Tarr, R / Hussein, Muhammad Shazam

    Journal of neurointerventional surgery

    2012  Volume 4, Issue 1, Page(s) 11–15

    Abstract: This is the first in a set of documents intended to standardize techniques, procedures, and practices in the field of endovascular surgical neuroradiology. Standards are meant to define core practices for peer review, comparison, and improvement. ... ...

    Abstract This is the first in a set of documents intended to standardize techniques, procedures, and practices in the field of endovascular surgical neuroradiology. Standards are meant to define core practices for peer review, comparison, and improvement. Standards and guidelines also form the basic dialogue, reporting, and recommendations for ongoing practices and future development.
    MeSH term(s) Endovascular Procedures/standards ; Endovascular Procedures/trends ; Humans ; Neurosurgical Procedures/standards ; Neurosurgical Procedures/trends ; Practice Guidelines as Topic/standards ; Societies, Medical/standards ; Societies, Medical/trends ; Standard of Care/standards ; Standard of Care/trends
    Language English
    Publishing date 2012-01-01
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2514982-9
    ISSN 1759-8486 ; 1759-8478
    ISSN (online) 1759-8486
    ISSN 1759-8478
    DOI 10.1136/neurintsurg-2011-010180
    Database MEDical Literature Analysis and Retrieval System OnLINE

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