90 research outputs found
sj-docx-1-ine-10.1177_15910199211060979 - Supplemental material for Fluoroscopy, CT, and MR imaging characteristics of a novel primarily bioresorbable flow-diverting stent for aneurysms
No full textSupplemental material, sj-docx-1-ine-10.1177_15910199211060979 for Fluoroscopy, CT, and MR imaging
characteristics of a novel primarily bioresorbable flow-diverting stent
for aneurysms by Rosalie Morrish, Ronan Corcoran, Jillian Cooke, Muneer Eesa and
John H Wong, Alim P Mitha in Interventional Neuroradiology</p
sj-docx-4-ine-10.1177_15910199211060979 - Supplemental material for Fluoroscopy, CT, and MR imaging characteristics of a novel primarily bioresorbable flow-diverting stent for aneurysms
No full textSupplemental material, sj-docx-4-ine-10.1177_15910199211060979 for Fluoroscopy, CT, and MR imaging
characteristics of a novel primarily bioresorbable flow-diverting stent
for aneurysms by Rosalie Morrish, Ronan Corcoran, Jillian Cooke, Muneer Eesa and
John H Wong, Alim P Mitha in Interventional Neuroradiology</p
sj-docx-2-ine-10.1177_15910199211060979 - Supplemental material for Fluoroscopy, CT, and MR imaging characteristics of a novel primarily bioresorbable flow-diverting stent for aneurysms
No full textSupplemental material, sj-docx-2-ine-10.1177_15910199211060979 for Fluoroscopy, CT, and MR imaging
characteristics of a novel primarily bioresorbable flow-diverting stent
for aneurysms by Rosalie Morrish, Ronan Corcoran, Jillian Cooke, Muneer Eesa and
John H Wong, Alim P Mitha in Interventional Neuroradiology</p
sj-docx-3-ine-10.1177_15910199211060979 - Supplemental material for Fluoroscopy, CT, and MR imaging characteristics of a novel primarily bioresorbable flow-diverting stent for aneurysms
No full textSupplemental material, sj-docx-3-ine-10.1177_15910199211060979 for Fluoroscopy, CT, and MR imaging
characteristics of a novel primarily bioresorbable flow-diverting stent
for aneurysms by Rosalie Morrish, Ronan Corcoran, Jillian Cooke, Muneer Eesa and
John H Wong, Alim P Mitha in Interventional Neuroradiology</p
A modified footplate for the Kerrison rongeur
No full textUse of the Kerrison rongeur for bone removal in spinal surgery is associated with dural tears and cerebrospinal fluid (CSF) leaks. We report a modification of the Kerrison rongeur footplate designed to reduce the risk of dural tears. A novel footplate was designed by incorporating the following parameters: (1) tapering the footplate to deflect soft tissue downward during positioning of the rongeur underneath the bone, and (2) making the footplate longer and wider than the cutting element to prevent soft tissue from entering into the cutting surface. Stereolithography models of the modified footplate were made and tested in a cadaver. A stainless steel modified footplate was then incorporated into an existing Kerrison rongeur as a working prototype, and tested in 20 laminectomy cases to clinically validate its design. The modified footplate prevented soft tissue from entering the cutting surface of the Kerrison rongeur in the manner intended by its design. No dural tears or CSF leaks were encountered in any instance. Potential soft tissue compression caused by an increase in footplate dimensions was not a significant issue in the rongeur size tested. This modification, however, might not be practical in rongeurs larger than 3 mm. The risk of dural tears and cerebrospinal fluid leaks in spinal surgery may be reduced by this footplate modification of the Kerrison rongeur. Soft tissue compression may limit the incorporation of this modification to rongeurs of 3 mm or smaller. The promising results warrant further tests with a wider range of sizes.Center for Integration of Medicine and Innovative Technology (U.S. Army Medical Research Acquisition Activity Cooperative Agreement No. DAMD17-02-2-0006
Can Mesenchymal Stem Cells Inhibit the Formation of Saccular Aneurysms?
No full textIntracranial saccular aneurysms are pathological dilations of cerebral blood vessels that can spontaneously rupture leading to significant morbidity and mortality. Our current understanding of saccular aneurysm pathogenesis involves a complex interplay of predisposing factors and inflammatory cascades, leading to an outpouching at the site of a vessel bifurcation. While several treatments exist today, none are aimed at preventing aneurysm formation. Mesenchymal stem cells are pluripotent cells that have interesting immunomodulatory properties and have been studied in the context of many inflammatory diseases. Few studies have addressed aneurysms and suggest that these cells have the potential to be adjuvants to current treatment modalities in treating fully formed aneurysms. This thesis details the first studies investigating the use of mesenchymal stem cells in preventing the formation of saccular aneurysms. A pre- clinical trial was conducted, as well as an in vivo localization experiment to determine the potential mechanism of action
Platelet Function and the Development of Thromboembolic Events After Cerebrovascular Stenting Procedures
No full textIntroduction: One of the biggest concerns associated with endovascular procedures is the development of thromboembolic events. To mitigate this risk, patients are placed on dual antiplatelet therapy. Interestingly, there is a known variation in one’s ability to appropriately respond to antiplatelet medications and patients with decreased responsiveness may be at an increased risk of developing ischemic complications. Routine testing of antiplatelet responsiveness is not performed at most endovascular centres and is still a topic of controversy within the neurosurgical community. The objective of our study was to determine if non-responsiveness to aspirin and clopidogrel was associated with the development of symptomatic thromboembolic events in patients undergoing cerebrovascular stenting procedures. Methods: A prospective study was conducted at the Foothills Medical Centre in Calgary, Alberta, Canada from August 2019 to February 2021. Patients undergoing cerebrovascular stenting procedures and who were on dual antiplatelet therapy consisting of aspirin and clopidogrel were enrolled in the study. Responsiveness to the antiplatelet medications was determined through whole blood impedance aggregometry and the treating neurointerventionalists were blinded to these results. The primary outcome was the development of a symptomatic thromboembolic event at 90 days after the procedure. Demographic, clinical, radiological, and procedural variables were analyzed to determine which factors were associated with the development of thromboembolic events. Results: One hundred and eighteen procedures were performed in 115 patients. The non-response rate of clopidogrel and aspirin was 21% and 14%, respectively. There were 12 (10%) thromboembolic events that occurred during the study period. On the univariable analysis age (p=0.03) and non-responsiveness to clopidogrel (p=0.01) were associated with the development of thromboembolic events, while aspirin non-responsiveness was not (p=0.13). On the multivariable logistic regression only clopidogrel non-responsiveness (OR 3.91, 95%CI 1.05, 14.50, p=0.04) was associated with the development of thromboembolic events. Conclusion: Our study has demonstrated that patients who were identified as clopidogrel non-responders, using whole blood impedance aggregometry, were at an increased risk of developing thromboembolic events. Furthermore, the results of our study validate the need for larger observational studies or randomized controlled trials to assess the utility of platelet function testing prior to cerebrovascular stenting procedures
Physician factors influencing endovascular treatment decisions in the management of unruptured intracranial aneurysms.
No full textPURPOSE
Deciding about whether an unruptured intracranial aneurysm (UIA) should be treated or not is challenging because robust data on rupture risks, endovascular treatment complication rates, and treatment success rates are limited. We aimed to investigate how neurointerventionalists conceptually approach endovascular treatment decision-making in UIAs.
METHODS
In a web-based international multidisciplinary case-based survey among neurointerventionalists, participants provided their demographics and UIA treatment-volumes, estimated 5-year rupture rates, endovascular treatment complication and success rates and gave their endovascular treatment decision for 15 pre-specified UIA case-scenarios. Differences in estimated 5-year rupture rates, endovascular treatment complication and success rates based on physician and hospital characteristics were evaluated with the Kruskal-Wallis test. Multivariable logistic regression analysis was used to derive adjusted effect size estimates for predictors of endovascular treatment decision.
RESULTS
Two hundred-thirty-three neurointerventionalists from 38 countries participated in the survey (median age 47 years [IQR: 41-55], 25/233 [10.7%] females). The ranges of estimates for 5-year rupture risks, endovascular treatment complication rates, and particularly endovascular treatment success rates were wide, especially for UIAs in the posterior circulation. Estimated 5-year rupture risks, endovascular treatment complication and success rates differed significantly based on personal and institutional endovascular UIA treatment volume, and all three estimates were significantly associated with physicians' endovascular treatment decision.
CONCLUSION
Although several predictors of endovascular treatment decision were identified, there seems to be a high degree of uncertainty when estimating rupture risks, treatment complications, and treatment success for endovascular UIA treatment. More data on the clinical course of UIAs with and without endovascular treatment is needed
Surgical Approaches to Intramedullary Cavernous Malformations of the Spinal Cord
No full textBackground: Resection of intramedullary spinal cord cavernous malformations is associated with a significant risk of morbidity because of the high density of eloquent tissue within the spinal cord. Despite this risk, surgery remains the definitive treatment for symptomatic lesions. Objective: To review the clinical aspects of surgical approaches for spinal cord cavernous malformations. Methods: This article reviews the epidemiology, pathophysiology, clinical and imaging characteristics, and indications for surgical resection. Surgical issues and operative approaches by anatomical location are also detailed, drawing from evidence in the literature and from the senior author\u27s clinical experience. Results: The 3 primary approaches to spinal cord cavernous malformations-the posterior, posterolateral, and lateral approaches-are described and illustrated. Magnetic resonance imaging and intraoperative photographs of representative cases are included. Conclusion: Intramedullary spinal cord cavernous malformations are complex entities, and it is our hope that this article will improve readers\u27 understanding of their clinical characteristics, their indications for treatment, and the surgical pathways through which these lesions can be safely resected. Copyright © 2011 by the Congress of Neurological Surgeons
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