Arra S. Reddy

Stratification of recanalization for patients with endovascular treatment of intracranial aneurysms.

BACKGROUND With the increasing use of endovascular techniques in the treatment of both ruptured and unruptured intracranial aneurysms, the issue of obliteration efficacy has become increasingly important. OBJECTIVE To systematically develop a comprehensive model for predicting retreatment with various types of endovascular treatment. METHODS We retrospectively reviewed medical records that were prospectively collected for 305 patients who received endovascular treatment for intracranial aneurysms from 2007 to 2013. Multivariable logistic regression was performed on candidate predictors identified by univariable screening analysis to detect independent predictors of retreatment. A composite risk score was constructed based on the proportional contribution of independent predictors in the multivariable model. RESULTS Size (>10 mm), aneurysm rupture, stent assistance, and posttreatment degree of aneurysm occlusion were independently associated with retreatment, whereas intraluminal thrombosis and flow diversion demonstrated a trend toward retreatment. The Aneurysm Recanalization Stratification Scale was constructed by assigning the following weights to statistically and clinically significant predictors: aneurysm-specific factors: size (>10 mm), 2 points; rupture, 2 points; presence of thrombus, 2 points. Treatment-related factors were stent assistance, -1 point; flow diversion, -2 points; Raymond Roy occlusion class 2, 1 point; Raymond Roy occlusion class 3, 2 points. This scale demonstrated good discrimination with a C-statistic of 0.799. CONCLUSION Surgical decision making and patient-centered informed consent require comprehensive and accessible information on treatment efficacy. We constructed the Aneurysm Recanalization Stratification Scale to enhance this decision-making process. This is the first comprehensive model that has been developed to quantitatively predict the risk of retreatment after endovascular therapy.

Intra-arterial thrombolysis in patients treated with warfarin.

Intra-Arterial Thrombolysis in Patients Treated with Warfarin Italo Linfante a, Arra S. Reddy c, Vincenzo Andreone e, Louis R. Caplanb, Magdy Selimb, Joshua A. Hirschd aDepartment of Radiology, Neuroendovascular Surgery and Interventional Neuroradiology, University of Miami, Miami, Fla., and Departments of bNeurology, and c Radiology, Beth Israel Deaconess Medical Center, and d Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass., USA; e Department of Neurology, Ospedale Cardarelli, Napoli, Italy

Flow Diverters for Treatment of 160 Ophthalmic Segment Aneurysms: Evaluation of Safety and Efficacy in a Multicenter Cohort

BACKGROUND: Treatment of ophthalmic segment aneurysms (OSA) remains challenging. Flow diverter stents (FDS) have evolved as a promising endovascular treatment option for aneurysms of the internal carotid artery and are associated with high occlusion rates and a favorable morbidity and mortality profile. OBJECTIVE: To determine safety and efficacy of FDS for OSA in a large, multicenter cohort. METHODS: A retrospective analysis of prospectively maintained databases of 127 consecutive patients harboring 160 OSA treated with FDS was performed. Aneurysms were classified based on location and morphology. Follow‐up with digital subtraction angiography (DSA) was performed 6 to 18 months after treatment. RESULTS: Follow‐up DSA was available for 101 (63.1%) aneurysms with a mean follow‐up of 18 months. Complete occlusion was observed in 90 aneurysms (89.1%), near‐complete occlusion (>95%) in 3 (3%), and incomplete occlusion (<95%) in 8 aneurysms (7.9%). One aneurysm was retreated with another FDS (0.9%). No risk factors for incomplete occlusion were identified. The OA was occluded at the latest follow‐up in 6 cases (7.1%). Permanent morbidity occurred in 4 patients (3.1%), and there was no mortality related to the FDS procedure. CONCLUSION: Treatment of OSA with FDS was found to be safe and effective. The retreatment rate was extremely low and aneurysms that occluded did not reanalyze.

Budget Variance Analysis of a Departmentwide Implementation of a PACS at a Major Academic Medical Center

In this study, the costs and cost savings associated with departmentwide implementation of a picture archiving and communication system (PACS) as compared to the projected budget at the time of inception were evaluated. An average of

Lumbar artery pseudoaneurysm after percutaneous vertebroplasty: A unique vascular complication: Report of 2 cases

214,460 was saved each year with a total savings of

Intra-arterial Onyx Embolization of Vertebral Body Lesions

1,072,300 from 1999 to 2003, which is significantly less than the

The glomic artery supply of carotid body tumors and implications for embolization.

2,943,750 projected savings. This discrepancy can be attributed to four different factors: (1) overexpenditures, (2) insufficient cost savings, (3) unanticipated costs, and (4) project management issues. Although the implementation of PACS leads to cost savings, actual savings will be much lower than expected unless extraordinary care is taken when devising the budget.

Dual diagnostic catheter technique in the endovascular management of anterior communicating artery complex aneurysms

Complications from percutaneous vertebroplasty (PV) and kyphoplasty are rare and are most commonly related to cement leakage. Pseudoaneurysm of the segmental arteries has not been reported as a complication of PV in the literature. In this article, the authors describe 2 patients who presented with a lumbar pseudoaneurysm after undergoing PV at other institutions. The authors also review the optimal technique to avoid such vascular complications.

Preoperative Embolization of Extra-axial Hypervascular Tumors with Onyx

While Onyx embolization of cerebrospinal arteriovenous shunts is well-established, clinical researchers continue to broaden applications to other vascular lesions of the neuraxis. This report illustrates the application of Onyx (eV3, Plymouth, MN) embolization to vertebral body lesions, specifically, a vertebral hemangioma and renal cell carcinoma vertebral body metastatic lesion.

Middle Meningeal Artery Arising from the Basilar Artery

Carotid body tumors (CBT) are rare neuroendocrine neoplasms that usually present in the third or fourth decades of life and are benign in more than 95% of cases. In the angiographic literature, the arterial supply to carotid body tumors is well documented but is often incomplete, with infrequent mention of the glomic artery, a common arterial feeder described in the anatomic and pathologic literature. Through a review of our neuroendovascular patient database, we identified eight patients with CBT undergoing transarterial embolization followed by resection. Mean patient age was 51.5 years (range 29-82), and all patients were female. Mean tumor size was 91.2 cc (standard deviation [SD] 61.1, median 67.7 cc). After embolization, greater than 90% flow reduction was achieved in 5/8 patients (63%); 60-80% flow reduction was achieved in the remaining patients. Mean operative blood loss was 166 cc (SD 100, median 122 cc) and mean operative time was 252 minutes (SD 134.5, median 155 minutes). Pre-embolization angiography was reviewed to identify a glomic artery, defined as a dominant artery supplying the CBT arising from the region of the carotid bifurcation. In six of eight patients (75%) a glomic artery could be identified, arising from the common carotid artery in 4/6 patients and the external carotid artery in 2/6 patients. Thus, glomic artery to supply to CBT was identified in the majority of patients in this series. Knowledge of its presence and identification as a direct supplier, frequently from the common carotid artery itself, provides an avenue for more thorough preoperative embolization of CBT.