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International Controlled Study of Revascularization and Outcomes Following COVID-Positive Mechanical Thrombectomy

Dmytriw, Adam A; Ghozy, Sherief; Sweid, Ahmad; Piotin, Michel; Bekelis, Kimon; Sourour, Nader; Raz, Eytan; Vela-Duarte, Daniel; Linfante, Italo; Dabus, Guilherme; Kole, Max; Martínez-Galdámez, Mario; Nimjee, Shahid M; Lopes, Demetrius K; Hassan, Ameer E; Kan, Peter; Ghorbani, Mohammad; Levitt, Michael R; Escalard, Simon; Missios, Symeon; Shapiro, Maksim; Clarençon, Fréderic; Elhorany, Mahmoud; Tahir, Rizwan A; Youssef, Patrick P; Pandey, Aditya S; Starke, Robert M; El Naamani, Kareem; Abbas, Rawad; Mansour, Ossama Y; Galvan, Jorge; Billingsley, Joshua T; Mortazavi, Abolghasem; Walker, Melanie; Dibas, Mahmoud; Settecase, Fabio; Heran, Manraj K S; Kuhn, Anna L; Puri, Ajit S; Menon, Bijoy K; Sivakumar, Sanjeev; Mowla, Ashkan; D'Amato, Salvatore; Zha, Alicia M; Cooke, Daniel; Vranic, Justin E; Regenhardt, Robert W; Rabinov, James D; Stapleton, Christopher J; Goyal, Mayank; Wu, Hannah; Cohen, Jake; Turkel-Parella, David; Xavier, Andrew; Waqas, Muhammad; Tutino, Vincent; Siddiqui, Adnan; Gupta, Gaurav; Nanda, Anil; Khandelwal, Priyank; Tiu, Cristina; Portela, Pere C; Perez de la Ossa, Natalia; Urra, Xabier; de Lera, Mercedes; Arenillas, Juan F; Ribo, Marc; Requena, Manuel; Piano, Mariangela; Pero, Guglielmo; De Sousa, Keith; Al-Mufti, Fawaz; Hashim, Zafar; Nayak, Sanjeev; Renieri, Leonardo; Du, Rose; Aziz-Sultan, Mohamed A; Liebeskind, David; Nogueira, Raul G; Abdalkader, Mohamad; Nguyen, Thanh N; Vigilante, Nicholas; Siegler, James E; Grossberg, Jonathan A; Saad, Hassan; Gooch, Michael R; Herial, Nabeel A; Rosenwasser, Robert H; Tjoumakaris, Stavropoula; Patel, Aman B; Tiwari, Ambooj; Jabbour, Pascal
BACKGROUND:Previous studies suggest that the mechanisms and outcomes in COVID-19-associated stroke differ from those with non-COVID-19 strokes, but there is limited comparative evidence focusing on these populations. Therefore, we aimed to determine if a significant association exists between COVID-19 status with revascularization and functional outcomes following thrombectomy for large vessel occlusion (LVO), after adjustment for potential confounding factors. METHODS:A cross-sectional, international multicenter retrospective study of consecutively admitted COVID-19 patients with concomitant acute LVO, compared to a control group without COVID-19. Data collected included age, gender, comorbidities, clinical characteristics, details of the involved vessels, procedural technique, and various outcomes. A multivariable adjusted analysis was conducted. RESULTS:In this cohort of 697 patients with acute LVO, 302 had COVID-19 while 395 patients did not. There was a significant difference (p<0.001) in the mean age (in years) and gender of patients, with younger patients and more males in the COVID-19 group. In terms of favorable revascularization (mTICI 3), COVID-19 was associated with lower odds of complete revascularization [OR=0.33; 95% CI=0.23-0.48; p<0.001], which persisted on multivariable modelling with adjustment for other predictors [aOR=0.30; 95% CI=0.12-0.77; p=0.012]. Moreover, endovascular complications, in-hospital mortality, and length of hospital stay were significantly higher among COVID-19 patients (p<0.001). CONCLUSION/CONCLUSIONS:COVID-19 was an independent predictor of incomplete revascularization and poor functional outcome in patients with stroke due to LVO. Furthermore, COVID-19 patients with LVO were more often younger and suffered higher morbidity/mortality rates.
PMID: 35818781
ISSN: 1468-1331
CID: 5269062

Endovascular Revascularization of Multi Segment Chronically Occluded ICA [Case Report]

Mulchan, Nicholas; Yeun, Phillip; Frontera, Jennifer; Farkas, Jeffrey; Berekashvili, Ketevan; Sanger, Matthew; Torres, Jose; Tiwari, Ambooj
This case report describes a novel endovascular method for treating chronically occluded internal carotid artery (COICA). The patient is a 55-year-old male with vascular risk factors who presented to an outside institution with right-sided weakness and dysarthria, was diagnosed as having a stroke, and discharged with medical management. The patient's symptoms failed to improve throughout the week prompting him to visit another outside institution, where computed tomography (CT) angiography showed bilateral occlusion of the ICAs at their origins extending intracranially. The patient was then transferred to our hospital, where head CT revealed bilateral acute infarcts predominantly in the left centrum ovale/corona radiata and left temporoparietal region. CT perfusion showed a large area of hypoperfusion in the entire left hemisphere as well as part of the right hemisphere (mismatch volume of 438-526 mL). The patient had significant neurological deficits despite sustained high perfusion pressure, so the following morning, the patient was taken for angiography showing complete occlusion of the left ICA with support mostly from the left external carotid artery (ECA)/ophthalmic collateralization. The microcatheter was able to be advanced to the level of the ophthalmic segment of the left ICA, so the decision was made to proceed with stenting from the left ophthalmic ICA to the cervical ICA. Seven consecutive coronary-carotid stents were placed to essentially reconstruct the left ICA. Post-stenting, the patient was treated with an Integrilin drip and transitioned to Aspirin and Brilinta the following morning. The patient's symptoms markedly improved after the procedure. CT perfusion, as well as diffusion magnetic resonance imaging (MRI), revealed recovery of the patient's penumbra and stability of the existing infarcts despite the delayed nature of revascularization respectively. This is a rarely reported study in literature describing the successful deployment of multiple stents in recreating the ICA from its extracranial to intracranial portion.
PMID: 35576859
ISSN: 1532-8511
CID: 5275882

Characteristics of a COVID-19 Cohort With Large Vessel Occlusion: A Multicenter International Study

Jabbour, Pascal; Dmytriw, Adam A; Sweid, Ahmad; Piotin, Michel; Bekelis, Kimon; Sourour, Nader; Raz, Eytan; Linfante, Italo; Dabus, Guilherme; Kole, Max; Martínez-Galdámez, Mario; Nimjee, Shahid M; Lopes, Demetrius K; Hassan, Ameer E; Kan, Peter; Ghorbani, Mohammad; Levitt, Michael R; Escalard, Simon; Missios, Symeon; Shapiro, Maksim; Clarençon, Frédéric; Elhorany, Mahmoud; Vela-Duarte, Daniel; Tahir, Rizwan A; Youssef, Patrick P; Pandey, Aditya S; Starke, Robert M; El Naamani, Kareem; Abbas, Rawad; Hammoud, Bassel; Mansour, Ossama Y; Galvan, Jorge; Billingsley, Joshua T; Mortazavi, Abolghasem; Walker, Melanie; Dibas, Mahmoud; Settecase, Fabio; Heran, Manraj K S; Kuhn, Anna L; Puri, Ajit S; Menon, Bijoy K; Sivakumar, Sanjeev; Mowla, Ashkan; D'Amato, Salvatore; Zha, Alicia M; Cooke, Daniel; Goyal, Mayank; Wu, Hannah; Cohen, Jake; Turkel-Parrella, David; Xavier, Andrew; Waqas, Muhammad; Tutino, Vincent M; Siddiqui, Adnan; Gupta, Gaurav; Nanda, Anil; Khandelwal, Priyank; Tiu, Cristina; Portela, Pere C; Perez de la Ossa, Natalia; Urra, Xabier; de Lera, Mercedes; Arenillas, Juan F; Ribo, Marc; Requena, Manuel; Piano, Mariangela; Pero, Guglielmo; De Sousa, Keith; Al-Mufti, Fawaz; Hashim, Zafar; Nayak, Sanjeev; Renieri, Leonardo; Aziz-Sultan, Mohamed A; Nguyen, Thanh N; Feineigle, Patricia; Patel, Aman B; Siegler, James E; Badih, Khodr; Grossberg, Jonathan A; Saad, Hassan; Gooch, M Reid; Herial, Nabeel A; Rosenwasser, Robert H; Tjoumakaris, Stavropoula; Tiwari, Ambooj
BACKGROUND:The mechanisms and outcomes in coronavirus disease (COVID-19)-associated stroke are unique from those of non-COVID-19 stroke. OBJECTIVE:To describe the efficacy and outcomes of acute revascularization of large vessel occlusion (LVO) in the setting of COVID-19 in an international cohort. METHODS:We conducted an international multicenter retrospective study of consecutively admitted patients with COVID-19 with concomitant acute LVO across 50 comprehensive stroke centers. Our control group constituted historical controls of patients presenting with LVO and receiving a mechanical thrombectomy between January 2018 and December 2020. RESULTS:The total cohort was 575 patients with acute LVO; 194 patients had COVID-19 while 381 patients did not. Patients in the COVID-19 group were younger (62.5 vs 71.2; P < .001) and lacked vascular risk factors (49, 25.3% vs 54, 14.2%; P = .001). Modified thrombolysis in cerebral infarction 3 revascularization was less common in the COVID-19 group (74, 39.2% vs 252, 67.2%; P < .001). Poor functional outcome at discharge (defined as modified Ranklin Scale 3-6) was more common in the COVID-19 group (150, 79.8% vs 132, 66.7%; P = .004). COVID-19 was independently associated with a lower likelihood of achieving modified thrombolysis in cerebral infarction 3 (odds ratio [OR]: 0.4, 95% CI: 0.2-0.7; P < .001) and unfavorable outcomes (OR: 2.5, 95% CI: 1.4-4.5; P = .002). CONCLUSION/CONCLUSIONS:COVID-19 was an independent predictor of incomplete revascularization and poor outcomes in patients with stroke due to LVO. Patients with COVID-19 with LVO were younger, had fewer cerebrovascular risk factors, and suffered from higher morbidity/mortality rates.
PMID: 35238817
ISSN: 1524-4040
CID: 5174582

Neutrophil-Lymphocyte ratio is associated with poor clinical outcome after mechanical thrombectomy in stroke in patients with COVID-19

Al-Mufti, Fawaz; Khandelwal, Priyank; Sursal, Tolga; Cooper, Jared B; Feldstein, Eric; Amuluru, Krishna; Moré, Jayaji M; Tiwari, Ambooj; Singla, Amit; Dmytriw, Adam A; Piano, Mariangela; Quilici, Luca; Pero, Guglielmo; Renieri, Leonardo; Limbucci, Nicola; Martínez-Galdámez, Mario; Schüller-Arteaga, Miguel; Galván, Jorge; Arenillas-Lara, Juan Francisco; Hashim, Zafar; Nayak, Sanjeev; Desousa, Keith; Sun, Hai; Agarwalla, Pankaj K; Sudipta Roychowdhury, J; Nourollahzadeh, Emad; Prakash, Tannavi; Xavier, Andrew R; Diego Lozano, J; Gupta, Gaurav; Yavagal, Dileep R; Elghanem, Mohammad; Gandhi, Chirag D; Mayer, Stephan A
BACKGROUND:The neutrophil-lymphocyte ratio (NLR) is emerging as an important biomarker of acute physiologic stress in a myriad of medical conditions, and is a confirmed poor prognostic indicator in COVID-19. OBJECTIVE:We sought to describe the role of NLR in predicting poor outcome in COVID-19 patients undergoing mechanical thrombectomy for acute ischemic stroke. METHODS:We analyzed NLR in COVID-19 patients with large vessel occlusion (LVO) strokes enrolled into an international 12-center retrospective study of laboratory-confirmed COVID-19, consecutively admitted between March 1, 2020 and May 1, 2020. Increased NLR was defined as ≥7.2. Logistic regression models were generated. RESULTS:Incidence of LVO stroke was 38/6698 (.57%). Mean age of patients was 62 years (range 27-87), and mortality rate was 30%. Age, sex, and ethnicity were not predictive of mortality. Elevated NLR and poor vessel recanalization (Thrombolysis in Cerebral Infarction (TICI) score of 1 or 2a) synergistically predicted poor outcome (likelihood ratio 11.65, p  =  .003). Patients with NLR > 7.2 were 6.8 times more likely to die (OR 6.8, CI95% 1.2-38.6, p  =  .03) and almost 8 times more likely to require prolonged invasive mechanical ventilation (OR 7.8, CI95% 1.2-52.4, p  =  .03). In a multivariate analysis, NLR > 7.2 predicted poor outcome even when controlling for the effect of low TICI score on poor outcome (NLR p  =  .043, TICI p  =  .070). CONCLUSIONS:We show elevated NLR in LVO patients with COVID-19 portends significantly worse outcomes and increased mortality regardless of recanalization status. Severe neuro-inflammatory stress response related to COVID-19 may negate the potential benefits of successful thrombectomy.
PMCID:9006085
PMID: 35404161
ISSN: 2385-2011
CID: 5205282

Acute ischaemic stroke associated with SARS-CoV-2 infection in North America

Dmytriw, Adam A; Dibas, Mahmoud; Phan, Kevin; Efendizade, Aslan; Ospel, Johanna; Schirmer, Clemens; Settecase, Fabio; Heran, Manraj K S; Kühn, Anna Luisa; Puri, Ajit S; Menon, Bijoy K; Sivakumar, Sanjeev; Mowla, Askan; Vela-Duarte, Daniel; Linfante, Italo; Dabus, Guilherme C; Regenhardt, Robert W; D'Amato, Salvatore; Rosenthal, Joseph A; Zha, Alicia; Talukder, Nafee; Sheth, Sunil A; Hassan, Ameer E; Cooke, Daniel L; Leung, Lester Y; Malek, Adel M; Voetsch, Barbara; Sehgal, Siddharth; Wakhloo, Ajay K; Goyal, Mayank; Wu, Hannah; Cohen, Jake; Ghozy, Sherief; Turkel-Parella, David; Farooq, Zerwa; Vranic, Justin E; Rabinov, James D; Stapleton, Christopher J; Minhas, Ramandeep; Velayudhan, Vinodkumar; Chaudhry, Zeshan Ahmed; Xavier, Andrew; Bullrich, Maria Bres; Pandey, Sachin; Sposato, Luciano A; Johnson, Stephen A; Gupta, Gaurav; Khandelwal, Priyank; Ali, Latisha; Liebeskind, David S; Farooqui, Mudassir; Ortega-Gutierrez, Santiago; Nahab, Fadi; Jillella, Dinesh V; Chen, Karen; Aziz-Sultan, Mohammad Ali; Abdalkader, Mohamad; Kaliaev, Artem; Nguyen, Thanh N; Haussen, Diogo C; Nogueira, Raul G; Haq, Israr Ul; Zaidat, Osama O; Sanborn, Emma; Leslie-Mazwi, Thabele M; Patel, Aman B; Siegler, James E; Tiwari, Ambooj
BACKGROUND:To analyse the clinical characteristics of COVID-19 with acute ischaemic stroke (AIS) and identify factors predicting functional outcome. METHODS:Multicentre retrospective cohort study of COVID-19 patients with AIS who presented to 30 stroke centres in the USA and Canada between 14 March and 30 August 2020. The primary endpoint was poor functional outcome, defined as a modified Rankin Scale (mRS) of 5 or 6 at discharge. Secondary endpoints include favourable outcome (mRS ≤2) and mortality at discharge, ordinal mRS (shift analysis), symptomatic intracranial haemorrhage (sICH) and occurrence of in-hospital complications. RESULTS:A total of 230 COVID-19 patients with AIS were included. 67.0% (154/230) were older than 60 years, while 33.0% (76/230) were younger. Median (IQR) National Institutes of Health Stroke Scale (NIHSS) at presentation was 12.0 (17.0) and 42.8% (89/208) presented with large vessel occlusion (LVO). Approximately 50.2% (102/203) of the patients had poor outcomes with an observed mortality rate of 38.8% (35/219). Age >60 years (aOR: 4.60, 95% CI 1.89 to 12.15, p=0.001), diabetes mellitus (aOR: 2.53, 95% CI 1.14 to 5.79, p=0.025), increased NIHSS at admission (aOR: 1.10, 95% CI 1.05 to 1.16, p<0.001), LVO (aOR: 3.02, 95% CI 1.27 to 7.44, p=0.014) and no IV tPA (aOR: 2.76, 95% CI 1.06 to 7.64, p=0.043) were significantly associated with poor functional outcome. CONCLUSION/CONCLUSIONS:There may be a relationship between COVID-19 associated AIS and severe disability or death. We identified several factors that predict worse outcomes, and these outcomes were more frequent compared with global averages. We found that elevated neutrophil-to-lymphocyte ratio, rather than D-dimer, predicted both morbidity and mortality.
PMCID:8804309
PMID: 35078916
ISSN: 1468-330x
CID: 5154472

A Proposed Brain-, Spine-, and Mental- Health Screening Methodology (NEUROSCREEN) for Healthcare Systems: Position of the Society for Brain Mapping and Therapeutics

Nami, Mohammad; Thatcher, Robert; Kashou, Nasser; Lopes, Dahabada; Lobo, Maria; Bolanos, Joe F; Morris, Kevin; Sadri, Melody; Bustos, Teshia; Sanchez, Gilberto E; Mohd-Yusof, Alena; Fiallos, John; Dye, Justin; Guo, Xiaofan; Peatfield, Nicholas; Asiryan, Milena; Mayuku-Dore, Alero; Krakauskaite, Solventa; Soler, Ernesto Palmero; Cramer, Steven C; Besio, Walter G; Berenyi, Antal; Tripathi, Manjari; Hagedorn, David; Ingemanson, Morgan; Gombosev, Marinela; Liker, Mark; Salimpour, Yousef; Mortazavi, Martin; Braverman, Eric; Prichep, Leslie S; Chopra, Deepak; Eliashiv, Dawn S; Hariri, Robert; Tiwari, Ambooj; Green, Ken; Cormier, Jason; Hussain, Namath; Tarhan, Nevzat; Sipple, Daniel; Roy, Michael; Yu, John S; Filler, Aaron; Chen, Mike; Wheeler, Chris; Ashford, J Wesson; Blum, Kenneth; Zelinsky, Deborah; Yamamoto, Vicky; Kateb, Babak
The COVID-19 pandemic has accelerated neurological, mental health disorders, and neurocognitive issues. However, there is a lack of inexpensive and efficient brain evaluation and screening systems. As a result, a considerable fraction of patients with neurocognitive or psychobehavioral predicaments either do not get timely diagnosed or fail to receive personalized treatment plans. This is especially true in the elderly populations, wherein only 16% of seniors say they receive regular cognitive evaluations. Therefore, there is a great need for development of an optimized clinical brain screening workflow methodology like what is already in existence for prostate and breast exams. Such a methodology should be designed to facilitate objective early detection and cost-effective treatment of such disorders. In this paper we have reviewed the existing clinical protocols, recent technological advances and suggested reliable clinical workflows for brain screening. Such protocols range from questionnaires and smartphone apps to multi-modality brain mapping and advanced imaging where applicable. To that end, the Society for Brain Mapping and Therapeutics (SBMT) proposes the Brain, Spine and Mental Health Screening (NEUROSCREEN) as a multi-faceted approach. Beside other assessment tools, NEUROSCREEN employs smartphone guided cognitive assessments and quantitative electroencephalography (qEEG) as well as potential genetic testing for cognitive decline risk as inexpensive and effective screening tools to facilitate objective diagnosis, monitor disease progression, and guide personalized treatment interventions. Operationalizing NEUROSCREEN is expected to result in reduced healthcare costs and improving quality of life at national and later, global scales.
PMID: 35034899
ISSN: 1875-8908
CID: 5131282

Cerebral Venous Thrombosis in COVID-19: A New York Metropolitan Cohort Study

Al-Mufti, F; Amuluru, K; Sahni, R; Bekelis, K; Karimi, R; Ogulnick, J; Cooper, J; Overby, P; Nuoman, R; Tiwari, A; Berekashvili, K; Dangayach, N; Liang, J; Gupta, G; Khandelwal, P; Dominguez, J F; Sursal, T; Kamal, H; Dakay, K; Taylor, B; Gulko, E; El-Ghanem, M; Mayer, S A; Gandhi, C
BACKGROUND AND PURPOSE/OBJECTIVE:Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infection is associated with hypercoagulability. We sought to evaluate the demographic and clinical characteristics of cerebral venous thrombosis among patients hospitalized for coronavirus disease 2019 (COVID-19) at 6 tertiary care centers in the New York City metropolitan area. MATERIALS AND METHODS/METHODS:We conducted a retrospective multicenter cohort study of 13,500 consecutive patients with COVID-19 who were hospitalized between March 1 and May 30, 2020. RESULTS:Of 13,500 patients with COVID-19, twelve had imaging-proved cerebral venous thrombosis with an incidence of 8.8 per 10,000 during 3 months, which is considerably higher than the reported incidence of cerebral venous thrombosis in the general population of 5 per million annually. There was a male preponderance (8 men, 4 women) and an average age of 49 years (95% CI, 36-62 years; range, 17-95 years). Only 1 patient (8%) had a history of thromboembolic disease. Neurologic symptoms secondary to cerebral venous thrombosis occurred within 24 hours of the onset of the respiratory and constitutional symptoms in 58% of cases, and 75% had venous infarction, hemorrhage, or both on brain imaging. Management consisted of anticoagulation, endovascular thrombectomy, and surgical hematoma evacuation. The mortality rate was 25%. CONCLUSIONS:Early evidence suggests a higher-than-expected frequency of cerebral venous thrombosis among patients hospitalized for COVID-19. Cerebral venous thrombosis should be included in the differential diagnosis of neurologic syndromes associated with SARS-CoV-2 infection.
PMID: 33888450
ISSN: 1936-959x
CID: 4847942

Incidence, Characteristics and Outcomes of Large Vessel Stroke in COVID-19 Cohort: An International Multicenter Study

Khandelwal, Priyank; Al-Mufti, Fawaz; Tiwari, Ambooj; Singla, Amit; Dmytriw, Adam A; Piano, Mariangela; Quilici, Luca; Pero, Guglielmo; Renieri, Leonardo; Limbucci, Nicola; Martínez-Galdámez, Mario; Schüller-Arteaga, Miguel; Galván, Jorge; Arenillas-Lara, Juan Francisco; Hashim, Zafar; Nayak, Sanjeev; Desousa, Keith; Sun, Hai; Agarwalla, Pankaj K; Nanda, Anil; Roychowdhury, J Sudipta; Nourollahzadeh, Emad; Prakash, Tannavi; Gandhi, Chirag D; Xavier, Andrew R; Lozano, J Diego; Gupta, Gaurav; Yavagal, Dileep R
BACKGROUND:While there are reports of acute ischemic stroke (AIS) in coronavirus disease 2019 (COVID-19) patients, the overall incidence of AIS and clinical characteristics of large vessel occlusion (LVO) remain unclear. OBJECTIVE:To attempt to establish incidence of AIS in COVID-19 patients in an international cohort. METHODS:A cross-sectional retrospective, multicenter study of consecutive patients admitted with AIS and COVID-19 was undertaken from March 1 to May 1, 2020 at 12 stroke centers from 4 countries. Out of those 12 centers, 9 centers admitted all types of strokes and data from those were used to calculate the incidence rate of AIS. Three centers exclusively transferred LVO stroke (LVOs) patients and were excluded only for the purposes of calculating the incidence of AIS. Detailed data were collected on consecutive LVOs in hospitalized patients who underwent mechanical thrombectomy (MT) across all 12 centers. RESULTS:Out of 6698 COVID-19 patients admitted to 9 stroke centers, the incidence of stroke was found to be 1.3% (interquartile range [IQR] 0.75%-1.7%). The median age of LVOs patients was 51 yr (IQR 50-75 yr), and in the US centers, African Americans comprised 28% of patients. Out of 66 LVOs, 10 patients (16%) were less than 50 yr of age. Among the LVOs eligible for MT, the average time from symptom onset to presentation was 558 min (IQR 82-695 min). A total of 21 (50%) patients were either discharged to home or discharged to acute rehabilitation facilities. CONCLUSION:LVO was predominant in patients with AIS and COVID-19 across 2 continents, occurring at a significantly younger age and affecting African Americans disproportionately in the USA.
PMCID:8108633
PMID: 33734404
ISSN: 1524-4040
CID: 4914422

Recurrence and Coniglobus Volumetric Resolution of Subacute and Chronic Subdural Hematoma Post-Middle Meningeal Artery Embolization

Tiwari, Ambooj; Dmytriw, Adam A; Bo, Ryan; Farkas, Nathan; Ye, Phillip; Gordon, David S; Arcot, Karthikeyan M; Turkel-Parrella, David; Farkas, Jeffrey
OBJECTIVE:To study the efficacy of middle meningeal artery (MMA) embolization for the treatment of chronic subdural hematoma (SDH) and characterize its post-embolization volumetric resolution. METHODS:Ten patients diagnosed with 13 cSDH underwent MMA embolization. SDH volumes were measured from time of initial discovery on imaging to pre-operative, post-operative, short-term and long-term follow-up. Time between procedure to obliteration was also measured. Volumetric analysis was done using the coniglobus formula, and recurrence rate as well as resolution timeline was defined using best-fit models. RESULTS:Out of 10 patients, five were recurrent lesions, three were bilateral and seven unilateral cSDH. Average and median pre-operative volumes were 105.3 cc and 97.4 cc, respectively. Embolization on average was performed 21 days after discovery. Sixty percent of patients had concurrent antiplatelets or anticoagulation use. Forty percent underwent embolization treatment as the primary therapy. Recurrence was not seen in any patients treated with embolization. There were no peri- or post-operative complications. Five patients experienced complete or near-complete obliteration, while those with partial resolution showed a composite average of 75% volumetric reduction in 45 days. Post-embolization, the volumetric resolution followed an exponential decay curve over time and was independent of initial volume. CONCLUSION/CONCLUSIONS:MMA embolization contributed to a marked reduction in SDH volume post-operatively and can be used as a curative therapy for primary or recurrent chronic SDH.
PMID: 33562252
ISSN: 2075-4418
CID: 4779642

Ischaemic stroke associated with COVID-19 and racial outcome disparity in North America [Letter]

Dmytriw, Adam A; Phan, Kevin; Schirmer, Clemens; Settecase, Fabio; Heran, Manraj K S; Efendizade, Aslan; Kühn, Anna Luisa; Puri, Ajit S; Menon, Bijoy K; Dibas, Mahmoud; Sivakumar, Sanjeev; Mowla, Askan; Leung, Lester Y; Malek, Adel M; Voetsch, Barbara; Sehgal, Siddharth; Wakhloo, Ajay K; Wu, Hannah; Xavier, Andrew; Tiwari, Ambooj
PMID: 32801118
ISSN: 1468-330x
CID: 4583742