Adnan H. Siddiqui

Intravenous Thrombolysis and Endovascular Therapy for Acute Ischemic Stroke With Internal Carotid Artery Occlusion: A Systematic Review of Clinical Outcomes

Background and Purpose— Strokes secondary to acute internal carotid artery (ICA) occlusion are associated with extremely poor prognosis. The best treatment approach to acute stroke in this setting is unknown. We sought to determine clinical outcomes in patients with acute ischemic stroke attributable to ICA occlusion treated with intravenous (IV) systemic thrombolysis or intra-arterial endovascular therapy. Methods— Using the PubMed database, we searched for studies that included patients with acute ischemic stroke attributable to ICA occlusion who received treatment with IV thrombolysis or intra-arterial endovascular interventions. Studies providing data on functional outcomes beyond 30 days and mortality and symptomatic intracerebral hemorrhage (sICH) rates were included in our analysis. We compared the proportions of patients with favorable functional outcomes, sICH, and mortality rates in the 2 treatment groups by calculating &khgr;2 and confidence intervals for odds ratios. Results— We identified 28 studies with 385 patients in the IV thrombolysis group and 584 in the endovascular group. Rates of favorable outcomes and sICH were significantly higher in the endovascular group than the IV thrombolysis-only group (33.6% vs 24.9%, P=0.004 and 11.1% vs 4.9%, P=0.001, respectively). No significant difference in mortality rate was found between the groups (27.3% in the IV thrombolysis group vs 32.0% in the endovascular group; P=0.12). Conclusions— According to our systematic review, endovascular treatment of acute ICA occlusion results in improved clinical outcomes. A higher rate of sICH after endovascular treatment does not result in increased overall mortality rate.

Double-barrel stent-assisted coiling of a basilar artery fenestration aneurysm.

Basilar artery fenestration aneurysms are rare aneurysms, posing unique challenges for endovascular treatment. We report a case of successful treatment of a wide‐necked basilar artery fenestration aneurysm with a novel double‐barrel stent‐assisted coiling technique.

Transverse venous stenting for the treatment of idiopathic intracranial hypertension, or pseudotumor cerebri

OBJECTIVE Idiopathic intracranial hypertension (IIH) is a commonly occurring disease, particularly among young women of child-bearing age. The underlying pathophysiology for this disease has remained largely unclear; however, the recent literature suggests that focal outflow obstruction of the transverse sinus may be the cause. The purpose of this study was to report one groups early experience with transverse venous sinus stenting in the treatment of IIH and assess its effectiveness. METHODS The authors performed a retrospective chart review to identify patients who had undergone stenting of an outflow-obstructed transverse venous sinus for the treatment of IIH at Gates Vascular Institute between January 2015 and November 2017. Patient demographic data of interest included age, sex, BMI, and history of smoking, hypertension, obstructive sleep apnea, hormonal contraceptive use, and acetazolamide therapy. Each patients presenting signs and symptoms and whether those symptoms improved with treatment were reviewed. The average opening lumbar puncture (LP) pressure preprocedure, average pressure gradient across the obstructed segment prior to stenting, treatment failure rate (need for shunt placement), and mean follow-up period were calculated. RESULTS Of the 18 patients who had undergone transverse venous stenting for IIH, 16 (88.9%) were women. The mean age of all the patients was 38.3 years (median 38 years). Mean BMI was 34.2 kg/m2 (median 33.9 kg/m2). Presenting symptoms were headache (16 patients [88.9%]), visual disturbances (13 patients [72.2%]), papilledema (8 patients [44.4%]), tinnitus (3 patients [16.7%]), and auditory bruit (3 patients [16.7%]). The mean opening LP pressure pre-procedure was 35.6 cm H2O (median 32 cm H2O). The mean pressure gradient measured proximally and distally to the area of focal obstruction within the transverse sinus was 16.5 cm H2O (median 15 cm H2O). Postprocedurally, 14 patients (77.8%) continued to have headaches; 6 (33.3%) continued to have visual disturbances. No patients continued to have auditory bruit (0%) or papilledema (0%). One patient (5.6%) had new-onset tinnitus postprocedure. Overall improvement of symptoms was noted in 16 patients (88.9%) postprocedure, with 1 patient (5.6%) requiring shunt placement and 2 other patients (11.1%) requiring postprocedural LP to monitor intracranial pressure to determine candidacy for further surgical interventions to treat residual symptoms. The mean duration of follow-up was 194.2 days. CONCLUSIONS Transverse sinus stenting is a rapidly developing technique that has shown good effectiveness and safety in the literature. Authors of the present study found that stenting a flow-obstructed transverse sinus in patients with IIH was a safe and effective way to treat the condition.

X-ray image guidance workflow development for in-vivo aneurysm treatment using a new retrievable asymmetric flow diverter (RAFD).

The vascular procedures during in–vivo aneurysms treatment with the Retrievable Asymmetric Flow Diverter (RAFD) prototype, require accurate x-ray image guidance and flow diversion assessment using angiography. The new device is made of a high porosity scaffold which supports a low-porosity patch used to divert the blood flow from the aneurysm. Two platinum markers have been added to allow stent placement in the longitudinal and azimuthal direction with regard to the aneurysm ostium. The retrievability of the device allows for multiple re-deployments until the placement is optimal. Eleven elastase aneurysms were created and treated with the new device. Placement was done using high definition x-ray fluoroscopy and optimal blood flow diversion was verified using angiography. Once the flow diversion was confirmed, the devices were deployed using electrolytic detachment. Angiograms pre- and post-stent placement were analyzed using parametric imaging based on dye dilution curves of injected contrast. Average values of the area under the curve (AUC), Meant Transit Time (MTT) and Peak Value (PV) for the aneurysms were measured and normalized to the values recorded in the main vessel. Fluoroscopy time for the device deployment was 15.30±5.30 minutes. Angiographic analysis indicated that average normalized values for: MTT increased 227%, AUC decreased 51% times while PV decreased 30%. In conclusion, the device was successfully deployed in eleven rabbits. Based on angiogram analysis, significant flow diversion has been observed. Overall this report demonstrates that the imaging workflow we developed for the new device placement was implemented successfully.