Alex M Barrocas

Publications (5)8.29 Total impact

• Chapter: 27 Imaging of the Cervical Carotid Artery for Atherosclerotic Stenosis

  Alex M. Barrocas, Colin P. Derdeyn
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  ABSTRACT: At present, carotid imaging is performed to identify the presence and measure the degree of atherosclerotic stenosis, in order to select appropriate candidates for surgical endarterectomy (strong evidence). Several different imaging strategies may be employed in symptomatic patients: Catheter angiography (CA) may be used for this purpose (strong evidence). Doppler ultrasound (DUS), magnetic resonance angiography (MRA), and computed tomography angiography(CTA), or some combination, if adequately validated, may be used to screen patients (those with less than 50% stenosis) prior to CA (moderate evidence). Doppler ultrasound, MRA, and CTA, or some combination, if adequately validated, may be used to identify patients with severe stenosis (greater than 80%) for surgical endarterectomy (moderate evidence). Screening of asymptomatic patients with noninvasive methods and highly specific thresholds may be cost-effective in certain high-risk populations, such as patients with known atherosclerotic disease in other circulations or the presence of bruit over the carotid artery on physical examination (moderate evidence). More information regarding the safety and efficacy of angioplasty and stenting relative to surgical endarterectomy is expected in the near future. As treatment may be incorporated into the diagnostic catheter angiographic procedure, these recommendations may be revised. Physiologic imaging tools identify higher-risk subgroups in patients with atherosclerotic carotid stenosis and occlusion (strong evidence). The use of these physiologic imaging tools to improve guide therapy and improve outcome is unproven (insufficient evidence). A randomized clinical trial is underway for surgical revascularization of carotid occlusion in patients selected by positron emission tomography (PET).
  12/2010: pages 451-464;
• Article: Management of thrombolysis-associated symptomatic intracerebral hemorrhage.

  Joshua N Goldstein, Marisela Marrero, Shihab Masrur, Muhammad Pervez, Alex M Barrocas, Abdul Abdullah, Alexandra Oleinik, Jonathan Rosand, Eric E Smith, Walter H Dzik, Lee H Schwamm
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  ABSTRACT: Symptomatic intracerebral hemorrhage (sICH) is the most devastating complication of thrombolytic therapy for acute stroke. It is not clear whether patients with sICH continue to bleed after diagnosis, nor has the most appropriate treatment been determined. We performed a retrospective analysis of our prospectively collected Get With the Guidelines-Stroke database between April 1, 2003, and December 31, 2007. Radiologic images and all procoagulant agents used were reviewed. Multivariable logistic regression was performed to identify factors associated with in-hospital mortality. Of 2362 patients with acute ischemic stroke during the study period, sICH occurred in 19 of the 311 patients (6.1%) who received intravenous tissue plasminogen activator and 2 of the 72 (2.8%) who received intra-arterial thrombolysis. In-hospital mortality was significantly higher in patients with sICH than in those without (15 of 20 [75.0]% vs 56 of 332 [16.9%], P < .001). Eleven of 20 patients (55.0%) received therapy for coagulopathy: 7 received fresh frozen plasma; 5, cryoprecipitate; 4, phytonadione (vitamin K(1)); 3, platelets; and 1, aminocaproic acid. Independent predictors of in-hospital mortality included sICH (odds ratio, 32.6; 95% confidence interval, 8.8-120.2), increasing National Institutes of Health Stroke Scale score (1.2; 1.1-1.2), older age (1.3; 1.0-1.7), and intra-arterial thrombolysis (2.9; 1.4-6.0). Treatment for coagulopathy was not associated with outcome. Continued bleeding (>33% increase in intracerebral hemorrhage volume) occurred in 4 of 10 patients with follow-up scans available (40.0%). In many patients with sICH after thrombolysis, coagulopathy goes untreated. Our finding of continued bleeding after diagnosis in 40.0% of patients suggests a powerful opportunity for intervention. A multicenter registry to analyze management of thrombolysis-associated intracerebral hemorrhage and outcomes is warranted.
  Archives of neurology 08/2010; 67(8):965-9. · 6.31 Impact Factor
• Article: Vertebral augmentation in osteoporotic fractures.

  Alex M Barrocas, Clifford J Eskey, Joshua A Hirsch
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  ABSTRACT: Osteoporotic vertebral compression fractures result in an enormous medical, social and economic burden to society. Here, we review osteoporotic vertebral compression fractures, focusing on both their diagnosis and the treatment options, particularly vertebral augmentation.
  Injury 10/2007; 38 Suppl 3:S88-96. · 1.98 Impact Factor
• Article: Cinchonism in a patient taking Quinine for leg cramps.

  Alex M Barrocas, Tyler Cymet
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  ABSTRACT: Quinine is often used as a treatment for benign nocturnal cramps. The use of Quinine remains controversial with conflicting studies regarding its efficacy. Quinine has a side effect profile that cannot be ignored. Cinchonism, or quinine toxicity, includes nausea, vomiting, and tinnitus. Many other side effects have been reported in the literature. A case report demonstrating the side effects of quinine is presented. We briefly review the literature on quinine and alternative medications.
  Comprehensive Therapy 02/2007; 33(3):162-3.
• Article: Histologic and hemodynamic effects of endosaccular platinum coils for intracranial aneurysms.

  Alex M Barrocas, Colin P Derdeyn, DeWitte T Cross, Christopher J Moran, Ralph G Dacey
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  ABSTRACT: Over the past 15 years, endosaccular platinum coil therapy for intracranial aneurysms has evolved from clinical pilot studies of investigational devices to common clinical practice. The mechanism by which these coils reduce the risk of aneurysm rupture-the primary goal of intracranial aneurysm treatment-is the focus of this review. Both histological mechanisms of scar formation and hemodynamic mechanisms of flow diversion may be involved. We will first review aneurysm epidemiology to provide the context and rationale for therapy for patients harboring intracranial aneurysms. Next, we will review the data for and theories of the pathophysiology of aneurysm formation, growth, and rupture, particularly as they relate to endovascular coil therapy. Histological and hemodynamic studies of coiled aneurysms in animals and humans will be reviewed. Finally, we will discuss emerging coil-based therapies, such as bioactive polymer coatings for platinum coils and the adjunctive use of stents.
  Journal of Long-Term Effects of Medical Implants 02/2004; 14(3):225-42.