Farhan Siddiq

University of Minnesota Duluth, Duluth, Minnesota, United States

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Publications (26)66.2 Total impact

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    ABSTRACT: Object The effects of sleep deprivation on performance have been well documented and have led to changes in duty hour regulation. New York State implemented stricter duty hours in 1989 after sleep deprivation among residents was thought to have contributed to a patient's death. The goal of this study was to determine if increased regulation of resident duty hours results in measurable changes in patient outcomes. Methods Using the Nationwide Inpatient Sample (NIS), patients undergoing neurosurgical procedures at hospitals with neurosurgery training programs were identified and screened for in-hospital complications, in-hospital procedures, discharge disposition, and in-hospital mortality. Comparisons in the above outcomes were made between New York hospitals and non-New York hospitals before and after the Accreditation Council for Graduate Medical Education (ACGME) regulations were put into effect in 2003. Results Analysis of discharge disposition demonstrated that 81.9% of patients in the New York group 2000-2002 were discharged to home compared with 84.1% in the non-New York group 2000-2002 (p = 0.6, adjusted multivariate analysis). In-hospital mortality did not significantly differ (p = 0.7). After the regulations were implemented, there was a nonsignificant decrease in patients discharged to home in the non-New York group: 84.1% of patients in the 2000-2002 group compared with 81.5% in the 2004-2006 group (p = 0.6). In-hospital mortality did not significantly change (p = 0.9). In New York there was no significant change in patient outcomes with the implementation of the regulations; 81.9% of patients in the 2000-2002 group were discharged to home compared with 78.0% in the 2004-2006 group (p = 0.3). In-hospital mortality did not significantly change (p = 0.4). After the regulations were in place, analysis of discharge disposition demonstrated that 81.5% of patients in the non-New York group 2004-2006 were discharged to home compared with 78.0% in the New York group 2004-2006 (p = 0.01). In-hospital mortality was not significantly different (p = 0.3). Conclusions Regulation of resident duty hours has not resulted in significant changes in outcomes among neurosurgical patients.
    Journal of neurosurgery. 06/2014;
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    ABSTRACT: Cerebral vasospasm is a major cause of delayed ischemic cerebral injury, typically occurring 3-14 days after subarachnoid hemorrhage (SAH). Ultra-early vasospasm is defined as angiographic vasospasm observed within 48 h of SAH onset. Immediate vasospasm at the time of aneurysmal rupture has been suspected, but has not been previously reported. We describe a case of immediate, transient vasospasm following intra-procedural aneurysmal rupture.
    Journal of vascular and interventional neurology 06/2014; 7(2):7-12.
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    ABSTRACT: To determine the effect of supratentorial intraparenchymal mass lesions of various volumes on dural venous sinuses structure and transluminal pressures.
    Journal of vascular and interventional neurology 05/2014; 7(1):35-42.
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    ABSTRACT: Both primary angioplasty alone and angioplasty with a self-expanding stent have been compared in non-randomized concurrent clinical studies that suggest equivalent results. However, there is no randomized trial that has compared the two procedures in patients with symptomatic high grade intracranial stenosis. The primary aim of the randomized trial was to compare the clinical and angiographic efficacy of primary angioplasty and angioplasty followed by stent placement in preventing restenosis, stroke, requirement for second treatment, and death in patients with symptomatic intracranial stenosis. The study prospectively evaluated efficacy and safety of the two existing neurointerventional techniques for treatment of moderate intracranial stenosis (stenosis ≥ 50%) with documented failure of medical treatment or severe stenosis (≥70%) with or without failure of medical treatment. A total of 18 patients were recruited in the study (mean age [±SD] was 64.7 ± 15.1 years); out of these, 12 were men. Of these 18, 10 were treated with primary angioplasty and 8 were treated with angioplasty followed by self-expanding stent. The technical success rates of intracranial angioplasty and stent placements defined as ability to achieve <30% residual stenosis when assessed by immediate post-procedure angiography was 5 of 10 and 5 of 8 patients, respectively. The total fluoroscopic time (mean [±SD]) was lower in patients undergoing primary angioplasty 37 [±11] min versus those undergoing angioplasty followed by self-expanding stent 42 [±15] min, P = 0.4321. The stroke and death rate within 1 month was very low in both patient groups (1 of 10 versus 0 of 8 patients). One patient randomized to stent placement continued to have recurrent ischemic symptoms requiring another angioplasty in the vertebral artery on post-procedure Day 2. The trial suggests that a randomized trial comparing primary angioplasty to angioplasty followed by stent placement is feasible. The immediate procedural outcomes with primary angioplasty are comparable to stent placement and warrant further studies.
    Journal of vascular and interventional neurology 12/2013; 6(2):34-41.
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    ABSTRACT: Traditional balloon assisted coil embolization techniques for intracranial aneurysms require a single lumen balloon to remodel the aneurysm neck and a separate microcatheter to place coils. Here we report utilization of a single coaxial dual balloon microcatheter to achieve both coil placement and neck remodeling in a series of intracranial and cervical arterial aneurysms. A series of five patients, including two with subarachnoid hemorrhage, presented to our institution with wide necked oblong aneurysms (8-30 mm maximum diameter). Coil embolization in four of these aneurysms was performed by advancing the tip of either a 4×10 mm Scepter C or a 4×11 mm Scepter XC balloon microcatheter (Microvention, Tustin, USA) into the aneurysm, inflating the balloon at the aneurysm neck, and placing the coils through the same microcatheter. In the fifth patient, who had a giant aneurysm at the top of the basilar artery, two Scepter XC balloon microcatheters were placed side by side and inflated simultaneously at the neck of the aneurysm; coil embolization was then successfully performed through both Scepter XC microcatheters. Coil embolization was successfully performed with this technique in all five aneurysms. There was no instance of aneurysm rupture, thromboembolic complications, occlusion of branch vessels near the aneurysm neck, or prolapse of coil loops into the parent vessel. Aneurysmal neck remodeling and coil embolization can both be achieved using a single coaxial dual lumen balloon microcatheter in selected oblong intracranial and cervical arterial aneurysms.
    Journal of neurointerventional surgery 10/2013; · 1.38 Impact Factor
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    ABSTRACT: A high rate of postprocedure complications in the Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis (SAMMPRIS) trial has raised concerns whether such results are representative of intracranial stent placement in actual routine practice. Using the Nationwide Inpatient Sample from 2008 to 2010, patients with cerebral ischemic events treated with intracranial stent as part of a clinical trial or outside the trial were identified. The composite end point (postoperative stroke, cardiac complications, and mortality) was reported. Of the 3447 patients who underwent intracranial stent placement, 223 patients (6.5%) were enrolled in a clinical trial. The rate of composite end point was higher in patients treated outside clinical trials compared with those treated within clinical trials (14.2% versus 4.5%; P=0.1). The proportion of patients discharged to home was higher in those treated in clinical trials (76.8% versus 49.6%; P=0.001). Intracranial stent placement procedures outside a clinical trial have higher rates of postoperative stroke, cardiac complication, and mortality.
    Stroke 10/2013; · 6.16 Impact Factor
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    ABSTRACT: Post-thrombolytic intracerebral hemorrhage (ICH) is an infrequent occurrence in patients with acute ischemic stroke. There is controversy surrounding the value of neurosurgical treatment of symptomatic hematomas in these patients and whether such availability is a necessary pre-requisite for administration of thrombolytics. Our objective to report the frequency and outcomes of patients who undergo craniotomy for post-thrombolytic ICH. Using the Nationwide Inpatient Sample (NIS) from 2002 to 2010, acute ischemic stroke patients who suffered from post-thrombolytic ICH were identified using ICD-9 codes. Patients were divided into those who received craniotomy and those who received medical management alone. Discharge destination and mortality were primary endpoints. An estimated 7607 patients suffered PT-ICH; 125 (1.6%) of those patients underwent craniotomy and 7482 patients (98.4%) received medical treatment alone. Patients in craniotomy group were younger (53.7±36 versus 72.4±29 years, p=0.09) and were frequently in the extreme severity APR-DRG category compared with medical management group (92.2% versus 55.5%, p=0.001). The mean length of stay was also longer in the craniotomy group (21.5 versus 10 days, p<0.0001). In-hospital mortality was higher in medical management group (30.5% versus 24.2%, p=0.5).After adjusting for age, gender and APR-DRG severity index, the odds ratios (OR) of in-hospital mortality, discharge to extended care facility and discharge to home/self-care were 0.8 (95%CI 0.3-2.0, p=0.5), 5.4 (95%CI 0.6-52.0, p=0.1) and 0.2 (95%CI 0.02-1.8, p=0.1), respectively for craniotomy group compared with medical management group. Emergent craniotomy for post-thrombolytic related ICH in acute stroke is a salvage treatment offered to a small proportion of patients. While the biases introduced by patient selection cannot be excluded in our analysis, the excessively high rates of death or disability associated with surgical evacuation limit the value of such a procedure in current practice.
    World Neurosurgery 08/2013; · 1.77 Impact Factor
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    ABSTRACT: Because of the availability of new technology, the spectrum of endovascular treatment for intracranial aneurysms has expanded widely. Some centers have started offering only endovascular treatment to patients with intracranial aneurysms (endovascular treatment-only centers [ETOCs]). Our objective was to identify the proportion and outcome of patients treated at ETOCs in the United States. We determined the proportion of ETOCs in the United States using Nationwide Inpatient Survey data files from 2010. We compared short-term outcomes between ETOCs and endovascular and surgical treatment centers (ESTCs). The outcomes studied were none to minimal disability, moderate to severe disability, in-hospital mortality, postprocedure complications, length of stay, and hospital charges. Out of 85 hospitals performing endovascular treatment of unruptured aneurysms, 13 (15%) were categorized as ETOCs. Out of the 10,447 patients with unruptured aneurysms, 1245 (12%) were treated at ETOCs. ETOCs were more likely to be nonteaching hospitals (55% versus 45%, P = .02). The rates of in-hospital mortality (1.2% versus 1.8%) and none to minimal disability (88% versus 84%) were similar in patients treated at ETOCs and ESTC hospitals. The mean hospitalization charges were similar, but length of stay (4 ± 7 days versus 6 ± 10 days, P < .0001) was significantly shorter among patients treated at ETOCs. Only 2.7% patients required secondary neurosurgical procedures at the ETOCs compared with 5.8% in ESTCs (P = .09). The recent emergence of ETOCs and provision of treatment with comparable outcomes and shorter length of stay at these hospitals may change the pattern of intracranial aneurysm treatment in the United States.
    Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 06/2013;
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    ABSTRACT: The prevalence and impact of prehospital neurologic deterioration (PhND) in patients with traumatic brain injury (TBI) have not been investigated. We aimed to determine the prevalence of PhND during emergency medical service (EMS) transportation among patients with TBI and its impact on patient's outcome. We used the National Trauma Data Bank, using data files from 2009 to 2010 to identify patients with TBI through International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. The initial Glasgow Coma Scale (GCS) score ascertained at the scene by EMS was compared with the subsequent GCS score evaluation in the emergency department (ED) to identify neurologic deterioration (defined as a decrease in GCS of ≥2 points). Patients' demographics, initial injury severity score (ISS), admission GCS score, and hospital outcome were compared between patients with PhND and patients without neurologic deterioration. A total of 257 127 patients with TBI were identified. Among patients with TBI, 22 254 patients had PhND, which comprised 9% of all patients with TBI. The mean of GCS score decrease during EMS transport was 5 points (±3). Patients without PhND tended to have higher GCS recorded by EMS (median, 15 vs 12; P < .0001). Patients with TBI who had PhND had significantly higher hospital length of stay and intensive care unit days after adjusting for baseline characteristics and EMS GCS score, EMS transport time, type of injury, presence of intracranial hemorrhages, and ED ISS (P < .0001). These patients had higher rate of in-hospital mortality after adjusting for the same variables (odds ratio, 2.30; 95% confidence interval, 2.18-2.41). Prehospital neurologic deterioration occurs in 9% of patients with TBI. It is more prevalent in men and associated with lower EMS GCS level and higher ED ISS. Prehospital neurologic deterioration is an independent predictor of worse hospital outcome and higher resource use in patients with TBI.
    The American journal of emergency medicine 06/2013; · 1.54 Impact Factor
  • Farhan Siddiq, Malik M Adil, Adnan I Qureshi
    Neurosurgery 05/2013; 72(5):868-869. · 2.53 Impact Factor
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    ABSTRACT: BACKGROUND: Acute stroke from intracranial internal carotid artery (ICA) occlusion can occasionally resemble angiographic cervical ICA dissection which may cause delays in endovascular acute ischemic stroke treatment. OBJECTIVE: To determine the angiographic characteristics of the phenomenon of "pseudodissection" and its clinical implications in acute ischemic stroke endovascular treatment. MATERIAL AND METHODS: Retrospective analysis of angiographic and clinical data from 31 patients with ischemic acute stroke secondary to intracranial ICA occlusion, treated with endovascular therapy at two University-affiliated institutions, was performed. Pseudodissection was defined as angiographic appearance of typical cervical ICA dissection with evidence of normal inner vascular wall upon further catheter exploration. RESULTS: Angiographic appearance pseudodissection was identified in 7 out of 31 patients (22.6%). Six patients had guide catheters placed proximal to pseudodissection in anticipation of stent placement for treatment of ICA dissection. All 7 patients had further exploration of the presumed dissected segment (6 microcatheter, 1 diagnostic catheter) which demonstrated normal vascular inner wall. The clot was located more commonly in the petro-cavernous segment in the pseudodissection patients (5/7, 71%). Carotid terminus clot was more common in ICA occlusion patients than pseudodissection patients (18/24, 75% vs. 2/7, 29% respectively, P < .0001). Recanalization was less common in pseudodissection patients compared to ICA occlusion patients (3/7 and 21/24 respectively, P = .029). CONCLUSION: Early recognition of pseudodissection in the ICA is important in the setting of acute ischemic stroke to avoid delay in treatment of intracranial ICA occlusion.
    Journal of neuroimaging: official journal of the American Society of Neuroimaging 12/2012; · 3.36 Impact Factor
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    ABSTRACT: BACKGROUND: Intracerebral hemorrhage (ICH) is an infrequent complication of intravenous recombinant tissue plasminogen activator (rt-PA) for the treatment of acute stroke. However, such ICH is an important reason for withdrawal of care because of lack of adequate data regarding long-term patient outcomes. OBJECTIVE: To report the long-term outcomes in patients with post-thrombolytic ICH. METHODS: We analyzed patient data from a randomized, placebo-controlled trial in patients with ischemic stroke presenting within 3 h of symptom onset. Baseline clinical characteristics and outcomes defined by modified Rankin scale (mRS) were ascertained at 3, 6, and 12 months after treatment in patients who suffered from post-thrombolytic ICH. Favorable outcome was defined by mRS of 0-3 and unfavorable outcome by mRS of 4-6 at 1 year. RESULTS: A total of 48 patients suffered post-thrombolytic ICH in the trial. Fourteen patients had favorable outcomes and 34 patients had unfavorable outcomes. Clinical characteristics did not have an impact on patient outcomes at 12 months. Patients with unfavorable outcomes were more likely to have an National Institutes of Health Stroke Scale (NIHSS) score ≥20 at 7-10 days after treatment (64 vs. 7 %, p < 0.0009). Patients with unfavorable outcomes were more likely to have a worsening of NIHSS score of >4 points at 7-10 days from their baseline NIHSS (44 vs. 0 %, p = 0.0006). CONCLUSION: Approximately 30 % of patients with post-thrombolytic ICH have favorable outcomes at 1 year which does not support early withdrawal of care. Ascertainment of NIHSS score and worsening of NIHSS score at 7-10 days may be necessary for accurate prognostic stratification.
    Neurocritical Care 12/2012; · 3.04 Impact Factor
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    ABSTRACT: Recent studies from selected centers have shown that early surgical treatment of aneurysms in subarachnoid hemorrhage (SAH) patients can improve outcomes. These results have not been validated in clinical practice at large. To identify factors and outcomes associated with timing of ruptured intracranial aneurysm obliteration treatment in patients with SAH after hospitalization in the United States. We analyzed the data from the Nationwide Inpatient Sample (2005-2008) for all patients presenting with primary diagnosis of SAH, receiving aneurysm treatment (endovascular coil embolization or surgical clip placement). Early treatment was defined as aneurysm treatment performed within 48 hours and delayed treatment if treatment was performed after 48 hours of admission. Of 32 048 patients with SAH who underwent aneurysm treatment, 24 085 (75.2%) underwent early treatment and 7963 (24.8%) underwent delayed treatment. Female sex (P = .002), endovascular embolization (P < .001), and weekday admission (P < .001) were independent predictors of early treatment. In the early treatment group, patients were more likely discharged with none to minimal disability (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.14-1.47) and less likely to be discharged with moderate to severe disability (OR 0.77, 95%CI 0.67-0.87) compared with those in the delayed treatment group. The in-hospital mortality was higher in the early treatment group compared with the delayed treatment group (OR 1.36 95%CI 1.12-1.66). Patients with SAH who undergo aneurysm treatment within 48 hours of hospital admission are more likely to be discharged with none to minimal disability. Early treatment is more likely to occur in those undergoing endovascular treatment and in patients admitted on weekdays.
    Neurosurgery 05/2012; 71(3):670-7; discussion 677-8. · 2.53 Impact Factor
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    ABSTRACT: Intracranial stenosis in young patients appears to have different characteristics from that observed in the older population. Objective: To study the differences in the pathogenesis of intracranial stenosis in younger patients as compared to the older population. The clinical characteristics of patients with angiographically confirmed intracranial stenosis were matched to a healthy population using the National Health and Nutrition Examination Study (NHANES). The study population was stratified into two age groups (≤45 and >45 years). The relative risk (odds ratios) and attributable risk of known cardiovascular risk factors were estimated. A total of 17 (11%) patients from 153 patients with intracranial stenosis were aged ≤45 years. These patients were more likely to be women (53 vs. 28%, p < 0.05). The location of the lesion in the young patients was more likely to be in the internal carotid artery (65 vs. 29%, p < 0.05). When compared with the stroke risk factors from the NHANES control population, the attributable risk of hypertension, diabetes mellitus, and coronary artery disease for intracranial stenosis was lower among patients aged ≤45 years than that for patients aged >45 years (6.4 vs. 13.1%, 19.9 vs. 33.0% and 1.0 vs. 10.8%, respectively). Hyperlipidemia had a greater attributable risk of intracranial stenosis in patients ≤45 than in those >45 years of age (23.3 vs. 9.3%). Intracranial stenosis in young patients is predominantly located in the anterior circulation and more frequently occurs in young women. Even though the stroke risk factors appear to be strongly associated with intracranial stenosis in this age group, the impact of these risk factors is low due to the low prevalence.
    Neuroepidemiology 03/2012; 38(3):148-53. · 2.37 Impact Factor
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    ABSTRACT: The SAMMPRIS (Stenting vs Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis) trial, comparing aggressive medical vs stent treatment in patients with symptomatic intracranial stenosis, was halted after a 14% stroke and death rate was observed in the stent-treated group. To study the 30-day stroke and death rate in intracranial angioplasty- and stent-treated patients meeting SAMMPRIS trial eligibility criteria. A retrospective analysis of 96 patients treated with intracranial angioplasty and stent placement at 3 university-affiliated institutions was performed. Patients were divided into SAMMPRIS trial eligible and ineligible groups based on inclusion and exclusion criteria for the SAMMPRIS trial. Sixty-nine patients were determined to be SAMMPRIS eligible and 27 patients were ineligible. The SAMMPRIS-eligible group was divided into angioplasty- and stent-treated subgroups (30 and 39 patients, respectively). The overall 30-day postprocedure stroke and death rate was 7.2% in the SAMMPRIS-eligible group and 7.4% in the SAMMPRIS-ineligible group (P = .97). The 30-day postprocedure stroke and death rate was 3.3% in the SAMMPRIS-eligible, angioplasty-treated subgroup and 10.2% in the SAMMPRIS-eligible, stent-treated subgroup (P = .27). The overall 30-day postprocedure stroke and death rate in our study was lower in both SAMMPRIS-eligible and -ineligible groups than the reported 14% stroke and death rate in the SAMMPRIS trial. We hypothesize that a more judicious use of primary angioplasty may be responsible for better postprocedure outcomes and should be considered an acceptable treatment in future trials.
    Neurosurgery 02/2012; 71(1):68-73. · 2.53 Impact Factor
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    ABSTRACT: Intravascular ultrasonography (IVUS) has been used for guiding intravascular stent placement in interventional cardiology. To evaluate the feasibility of aneurysm embolization by using detachable coils under IVUS guidance. IVUS-guided embolization in conjunction with fluoroscopic imaging and subsequently alone were performed in a silicone model with a side wall aneurysm. IVUS-guided embolization in conjunction with fluoroscopic imaging was also used in an in vitro model of a side wall aneurysm created using sheep vessels. The visibility of the aneurysm, microcatheter, and coils ascertained by the IVUS was graded as excellent, good, or poor based on visualization of these items as distinct structures. The agreement between simultaneously acquired angiographic and IVUS images for detecting increasing intra-aneurysmal coil mass and coil prolapse was assessed in 10 and 6 simultaneously acquired angiographic and IVUS images, respectively. IVUS measurements of the aneurysm dimensions strongly correlated with standardized dimensions and measurements acquired by contrast angiography (Pearson coefficient of 0.96 and 0.99 for silicone model and arterial segment model, respectively). IVUS visualization of the aneurysm, microcatheter tip, and coil loops were graded as excellent in the silicone aneurysm model and good in the carotid artery model. The agreement between simultaneously acquired angiographic and IVUS images was very high for detecting increasing intra-aneurysmal coil mass (Spearman rank correlation coefficient of 0.98) and coil prolapse (83% agreement). IVUS guidance during aneurysm embolization may improve the procedure by providing intravascular aneurysmal measurements and visualization of devices used in the procedure.
    Neurosurgery 12/2011; 70(6):1557-64. · 2.53 Impact Factor
  • Neurosurgery 08/2011; 69(2):E513-5; author reply E515-7. · 2.53 Impact Factor
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    ABSTRACT: To compare the clinical and angiographic outcomes of endovascular treatment of symptomatic intracranial stenosis between octogenarian and younger patients. Data for 244 consecutive patients (173 men; mean age 61.6 years) who underwent angioplasty and/or stenting for intracranial atherosclerotic disease at 5 specialized centers were pooled. Baseline, 30-day, and follow-up clinical and angiographic information were collected. Rates of clinical and angiographic endpoints were compared between patients >or=80 years old versus those <80 years. Patients >or=80 years (n = 15) were more likely to be hypertensive (87% versus 69%) and have underlying coronary artery disease (73% versus 36%, p<0.05) compared to younger patients (n = 229). The rate of periprocedural stroke and/or death was 3-fold higher among patients aged >or=80 years compared with those <80 years (20% versus 7%, p = 0.11). No recurrent stroke or death (excluding periprocedural events) was observed during follow-up in the octogenarian group. In patients who had follow-up angiography, a similar rate of >or=50% restenosis was observed among patients aged >or=80 years and those aged <80 years (25% versus 29%, p>0.1). The 3-fold higher periprocedural death and/or stroke rate suggests cautious use of intracranial angioplasty and/or stent placement in octogenarians.
    Journal of Endovascular Therapy 06/2010; 17(3):314-9. · 2.70 Impact Factor
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    ABSTRACT: To compare the short- and long-term rates of stroke-and/or-death associated with primary angioplasty alone and angioplasty with stent placement using a meta-analysis of published studies. Both primary angioplasty alone and angioplasty with stent placement have been proposed as treatment strategies for symptomatic intracranial atherosclerotic disease to reduce the risk of stroke-and/or-death with best medical treatment alone. However, it remains unclear which of these endovascular techniques offers the best risk reduction. We identified pertinent studies published between January 1980 and May 2008 using a search on PubMed and Cochrane libraries, supplemented by a review of bibliographies of selected publications. The incidences of stroke-and/or-death were estimated for each report and pooled for both angioplasty alone and angioplasty with stent placement at 1 month and 1 year postintervention and then compared using a random-effects model. The association of year of publication and 1-year incidence of stroke-and/or-death was analyzed with meta-regression. After applying our selection criteria, we included 69 studies (33 primary angioplasty-alone studies [1027 patients] and 36 studies of angioplasty with stent placement [1291 patients]) in the analysis. There were a total of 91 stroke-and/or-deaths reported in the angioplasty-alone-treated group (8.9%; 95% confidence interval [CI], 7.1%-10.6%), compared with 104 stroke-and/or-deaths in the angioplasty-with-stent-treated group (8.1%; 95% CI, 6.6%-9.5%) during a 1-month period (relative risk [RR], 1.1; P = 0.48). The pooled incidence of 1-year stroke-and/or-death in patients treated with angioplasty alone was 19.7% (95% CI, 16.6%-23.5%), compared with 14.2% (95% CI, 11.9%-16.9%) in the angioplasty-with-stent-treated patients (RR, 1.39; P = 0.009). The incidence of technical success was 79.8% (95% CI, 74.7%-84.8%) in the angioplasty-alone group and 95% (95% CI, 93.4%-96.6%) in the angioplasty-with-stent-treated group (RR, 0.84; P < 0.0001). The pooled restenosis rate was 14.2% (95% CI, 11.8-16.6%) in the angioplasty-alone group, as compared with 11.1% (95% CI, 9.2%-13.0%) in the angioplasty-with-stent-treated group (RR, 1.28; P = 0.04). There was no effect of the publication year of the studies on the risk of stroke-and/or-death. Risk of 1-year stroke-and/or-death and rate of angiographic restenosis may be lower in symptomatic intracranial atherosclerosis patients treated by angioplasty with stent placement compared with patients treated by angioplasty alone.
    Neurosurgery 12/2009; 65(6):1024-33; discussion 1033-4. · 2.53 Impact Factor
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    ABSTRACT: The study's purpose is to report the technical and clinical outcomes of a patient cohort that underwent vertebral artery ostium stent placement for atherosclerotic stenosis. We retrospectively analyzed a prospectively collected database of neurointerventional procedures performed at a single center from 1999 to 2005. Outcome measures included recurrent transient neurological deficits (TNDs), stroke, and death. Kaplan-Meier analysis was used to estimate stroke- and/or death-free survival at 12 months. Cox proportional hazard was used to identify risk factors for recurrent vertebrobasilar ischemic events. Seventy-two patients with 77 treated vertebral ostial lesions were included. The 30-day stroke and/or death rate was 5.2% (n = 4), although no event was directly related to the vertebral ostium stent placement. Three procedure-related strokes were secondary to attempted stent placement at other sites (one carotid artery and two basilar arteries), and the one death was secondary to the presenting stroke severity. The mean clinical follow-up time available for 66 patients was 9 months. There were 14 TNDs (21%), two strokes (3%), and two deaths (3%) recorded in the follow-up. Recurrent vertebrobasilar ischemic events occurred in nine patients (seven TNDs and two strokes). No recurrent stroke and/or deaths were related to the treated vertebral ostium. Stroke- and/or death-free survival rate (including periprocedural stroke and/or death) was 89 +/- 5% at 12 months. No vascular risk factor was significantly associated with recurrent vertebrobasilar ischemic events. Vertebral artery ostium stent placement can be safely and effectively performed with a low rate of recurrent stroke in the territory of the treated vessel. Patients who also underwent attempted treatment of a tandem intracranial stenosis appeared to be at highest risk for periprocedure stroke.
    Neuroradiology 06/2009; 51(8):531-9. · 2.70 Impact Factor

Publication Stats

179 Citations
66.20 Total Impact Points


  • 2011–2013
    • University of Minnesota Duluth
      Duluth, Minnesota, United States
  • 2010–2012
    • University of Minnesota Twin Cities
      • Department of Neurology
      Minneapolis, MN, United States
  • 2008
    • Thomas Jefferson University
      • Department of Neurology
      Philadelphia, PA, United States