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Safety of tirofiban and dual antiplatelet therapy in treating intracranial aneurysms

Stroke & Vascular Neurology 2019年第1期4卷 36-42页

作者： Edgar A Samaniego Emilee Gibson Daichi Nakagawa Santiago Ortega-Gutierrez Mario Zanaty Jorge A Roa pascal jabbour David M Hasan Department of Neurology Neurosurgery and RadiologyUniversity of Iowa Hospitals and ClinicsIowa CityIowaUSA Department of Neurology University of Iowa Hospitals and ClinicsIowa CityIowaUSA Department of Neurosurgery University of Iowa Hospitals and ClinicsIowa CityIowaUSA Department of Neurosurgery Thomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA

Background Endovascular treatment of intracranial aneurysms usually involves stent-assisted coiling(SAC)and flow *** IIb/IIIa inhibitors such as tirofiban and dual antiplatelet therapy(DAPT)are required to prevent thromboembolic complications *** sought to determine the safety of tirofiban and DAPT in these *** We conducted a retrospective analysis of our database for patients with intracranial aneurysms who underwent SAC or flow *** tirofiban-DAPT protocol used is *** regarding duration of infusion,placement of external ventricular devices(EVDs),complications,haemoglobin levels and platelet count before and 24 hours after antiplatelet therapy were collected and *** One-hundred and forty-one patients with 148 aneurysms/procedures were included.110 aneurysms were treated acutely and 38 *** and major haemorrhagic events were recognised in 20%(30/148)*** 5(3.4%)intracerebral haemorrhages were symptomatic:3 cortical/SAH and 2 *** average blood volume in symptomatic haemorrhages was 24.8 cc versus 5.42 cc in asymptomatic haemorrhages(p=0.002).The rate of EVD-related haemorrhages was 15.7%(19/121)and only 2(1.7%)were *** haemorrhagic events occurred in ruptured aneurysms(90.1%,p=0.01).No significant change in platelet count or haemoglobin levels before and 24 hours after administration of tirofiban and DAPT was *** administration of heparin did not increase haemorrhagic *** The use of the GP IIb/IIIa inhibitors tirofiban and DAPT in this series was *** and DAPT did not affect platelet count or haemoglobin levels and did not increase rate of symptomatic haemorrhages or thromboembolic complications.

关键词： aneurysm intracranial infusion

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Transradial approach for acute stroke intervention: technical procedure and clinical outcomes

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Stroke & Vascular Neurology 2020年第1期5卷 103-106页

作者： Omaditya Khanna Nikolaos Mouchtouris Ahmad Sweid Nohra Chalouhi Ritam Ghosh Fadi Al Saiegh Michael R Gooch Stavropoula Tjoumakaris Robert H Rosenwasser Victor Romo pascal jabbour Neurosurgery Thomas Jefferson University HospitalPhiladelphiaPennsylvaniaUSA Anesthesia Thomas Jefferson University-Center City CampusPhiladelphiaPennsylvaniaUSA

background and purpose Radial artery catheterisation is an alternate route of access that has recently started to gain more widespread use for neuroendovascular procedures,including acute stroke *** this small case series,we present our institution’s outcomes in patients undergoing acute stroke interventions via transradial *** and methods We present a retrospective study of 15 patients who underwent acute stroke intervention via radial artery *** analyse these patients’periprocedural and clinical outcomes after undergoing mechanical *** A total of 15 consecutive patients were included in the study(9 males and 6 females),and all patients were able to successfully undergo mechanical thrombectomy via radial artery *** mean time of arterial puncture to reperfusion was 50±28 min(range:15-104).A TICI 2b/3 revascularisation was achieved in 13/15 patients(87%);a TICI 1 and TICI 2a outcome was achieved on the other two *** patient incurred an iatrogenic vessel dissection during the *** of out 15 patients(53%)had favourable mRS(0-3)at the time of discharge from the *** Radial artery catheterisation is technically feasible for performing acute stroke interventions with favourable time to revascularisation and good overall clinical outcomes.

关键词： acute clinical radial

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Acute ischaemic stroke interventions: large vessel occlusion and beyond

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Stroke & Vascular Neurology 2020年第1期5卷 80-85页

作者： Ahmad Sweid Batoul Hammoud Sunidhi Ramesh Daniella Wong Tyler D Alexander Joshua Harrison Weinberg Maureen Deprince Jaime Dougherty Dimitri Jean-Mickael Maamari Stavropoula Tjoumakaris Hekmat Zarzour Michael R Gooch Nabeel Herial Victor Romo David M Hasan Robert H Rosenwasser pascal jabbour Neurosurgery Thomas Jefferson University HospitalPhiladelphiaPennsylvaniaUSA Endocrinology Children’s Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA Sydney Kimmel Medical College Thomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA School of Medicine American University of BeirutBeirutLebanon Anesthesia Thomas Jefferson University-Center City CampusPhiladelphiaPennsylvaniaUSA Neurosurgery University of Iowa Hospitals and ClinicsIowa CityIowaUSA

Care for acute ischaemic stroke is one of the most rapidly evolving fields due to the robust outcomes achieved by mechanical *** vessel occlusion(LVO)accounts for up to 38%of acute ischaemic stroke and comes with devastating outcomes for patients,families and society in the pre-intervention era.A paradigm shift and a breakthrough brought mechanical thrombectomy back into the spotlight for acute ischaemic stroke;this was because five randomised controlled trials from several countries concluded that mechanical thrombectomy for acute stroke offered overwhelming *** review article will present a comprehensive overview of LVO management,techniques and devices used,and the future of stroke *** addition,we review our institution experience of mechanical thrombectomy for posterior and distal circulation occlusion.

关键词： acute occlusion breakthrough

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Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID- 19 pandemic

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Stroke & Vascular Neurology 2021年第4期6卷 542-552,I0026-I0032页

作者： Thanh N Nguyen Diogo C Haussen Muhammad M Qureshi Hiroshi Yamagami Toshiyuki Fujinaka Ossama Y Mansour Mohamad Abdalkader Michael Frankel Zhongming Qiu Allan Taylor Pedro Lylyk Omer F Eker Laura Mechtouff Michel Piotin Fabricio Oliveira Lima Francisco Mont'Alverne Wazim Izzath Nobuyuki Sakai Mahmoud Mohammaden Alhamza R Al-Bayati Leonardo Renieri Salvatore Mangiafico David Ozretic Vanessa Chalumeau Saima Ahmad Umair Rashid Syed Irteza Hussain Seby John Emma Griffin John Thornton Jose Antonio Fiorot Rodrigo Rivera Nadia Hammami Anna M Cervantes-Arslanian Hormuzdiyar H Dasenbrock Huynh Le Vu Viet Quy Nguyen Steven Hetts Romain Bourcier Romain Guile Melanie Walker Malveeka Sharma Don Frei pascal jabbour Nabeel Herial Fawaz Al-Mufti Atilla Ozcan Ozdemir Ozlem Aykac Dheeraj Gandhi Chandril Chugh Charles Matouk pascale Lavoie Randall Edgell Andre Beer-Furlan Michael Chen Monika Killer-Oberpfalzer Vitor Mendes Pereira Patrick Nicholson Vikram Huded Nobuyuki Ohara Daisuke Watanabe Dong Hun Shin Pedro SC Magalhaes Raghid Kikano Santiago Ortega-Gutierrez Mudassir Farooqui Amal Abou-Hamden Tatsuo Amano Ryoo Yamamoto Adrienne Weeks Elena A Cora Rotem Sivan-Hoffmann Roberto Crosa Markus Möhlenbruch Simon Nagel Hosam Al-Jehani Sunil A Sheth Victor S Lopez Rivera James E Siegler Achmad Fidaus Sani Ajit S Puri Anna Luisa Kuhn Gianmarco Bernava Paolo Machi Daniel G Abud Octavio M Pontes-Neto Ajay K Wakhloo Barbara Voetsch Eytan Raz Shadi Yaghi Brijesh P Mehta Naoto Kimura Mamoru Murakami Jin Soo Lee Ji Man Hong Robert Fahed Gregory Walker Eiji Hagashi Steve M Cordina Hong Gee Roh Ken Wong Juan F Arenillas Mario Martinez-Galdamez Jordi Blasco Alejandro Rodriguez Vasquez Luisa Fonseca M Luis Silva Teddy Y Wu Simon John Alex Brehm Marios Psychogios William J Mack Matthew Tenser Tatemi Todaka Miki Fujimura Roberta Novakovic Jun Deguchi Yuri Sugiura Hiroshi Tokimura Rakesh Khatri Michael Kelly Lissa Peeling Yuichi Murayama Hugh Stephen Winters Johnny Wong Mohamed Teleb Jeremy Payne Hiroki Fukuda Kosuke Miyake Junsuke Shimbo Yusuke Sug Neurology RadiologyBoston Medical CenterBostonMassachusettsUSA Neurology Marcus Stroke&Neuroscience CenterGrady Memorial HospitalEmory University School of MedicineAtlantaGAUSA Radiology Radiation OncologyBoston University School of MedicineBostonMassachusettsUSA Neurology National Hospital Organization Osaka National HospitalOsakaJapan Neurosurgery National Hospital Organization Osaka National HospitalOsakaJapan Neurology Alexandria UniversityAlexandriaEgypt Radiology Boston Medical CenterBostonMassachusettsUSA Department of Neurology Xinqiao HospitalChongqingChina Neurosurgery University of Cape TownRondeboschWestern CapeSouth Africa Neurosurgery Interventional NeuroradiologyClinica La Sagrada FamiliaBuenos AiresArgentina Neuroradiologie Neurologie VasculaireHospices Civils de LyonLyonAuvergne-Rhône AlpesFrance Neurologie Vasculaire Hospices Civils de LyonLyonAuvergne-Rhône AlpesFrance Interventional Neuroradiology Fondation Ophtalmologique Adolphe de RothschildParisÎle-de FranceFrance Neurology Hospital Geral de FortalezaFortalezaBrazil Interventional Neuroradiology Hospital Geral de FortalezaFortalezaBrazil Neuroradiology Nottingham University Hospitals NHS TrustNottinghamUK Department of Neurosurgery Kobe City Medical Center General HospitalKobeHyogoJapan Interventional Neurovascular Unit University Hospital CareggiFirenzeToscanaItaly Neuroradiology University Hospital Centre ZagrebZagrebCroatia Interventional Neuroradiology Hopital BicetreLe Kremlin-BicetreFrance Stroke and Interventional Neuroradiology Lahore General HospitalLahorePakistan Neurological Institute Cleveland Clinic Abu DhabiAbu DhabiUAE Department of Radiology Beaumont HospitalDublinIreland Neurology Stroke UnitHospital-Estadual CentralVitoriaBrazil Neuroradiology Instituto de Neurocirugia Dr AsengoSantiagoChile Interventional Neuroradiology Institut National de NeurologieTunisTunisia Neurology Boston Medical CenterBostonMassachusettsUSA Neurosurgery Boston Medical Center

Background During the COVID-19 pandemic,decreased volumes of stroke admissions and mechanical thrombectomy were *** study’s objective was to examine whether subarachnoid haemorrhage(SAH)hospitalisations and ruptured aneurysm coiling interventions demonstrated similar *** We conducted a cross-sectional,retrospective,observational study across 6 continents,37 countries and 140 comprehensive stroke *** with the diagnosis of SAH,aneurysmal SAH,ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases,10th Revision,*** 3-month cumulative volume,monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before(1 year and immediately before)and during the pandemic,defined as 1 March-31 May *** prior 1-year control period(1 March-31 May 2019)was obtained to account for seasonal *** There was a significant decline in SAH hospitalisations,with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic,representing a relative decline of 22.5%(95%CI−24.3%to−20.7%,p<0.0001).Embolisation of ruptured aneurysms declined with 1170-1035 procedures,respectively,representing an 11.5%(95%CI−13.5%to−9.8%,p=0.002)relative *** analysis was noted for aneurysmal SAH hospitalisation decline from 834 to 626 hospitalisations,a 24.9%relative decline(95%CI−28.0%to−22.1%,p<0.0001).A relative increase in ruptured aneurysm coiling was noted in low coiling volume hospitals of 41.1%(95%CI 32.3%to 50.6%,p=0.008)despite a decrease in SAH admissions in this *** There was a relative decrease in the volume of SAH hospitalisations,aneurysmal SAH hospitalisations and ruptured aneurysm embolisations during the COVID-19 *** findings in SAH are consistent with a decrease in other emergencies,such as stroke and myocardial infarction.

关键词： diagnosis representing subarachnoid

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