Farhan Siddiq

University of Minnesota Duluth, Duluth, Minnesota, United States

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Publications (37)131.74 Total impact

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    ABSTRACT: CREST (Carotid Revascularization Endarterectomy Versus Stenting Trial) results, published in 2010, showed no difference in the rates of composite outcome (stroke, myocardial infarction, or death) between carotid artery stent placement (CAS) and carotid endarterectomy (CEA). To identify any changes in use and outcomes of CAS and CEA subsequent to the CREST results. We estimated the frequency of CAS and CEA procedures in the years 2009 (pre-CREST period) and 2011 (post-CREST period), using data from the National Inpatient Sample (NIS). Demographic and clinical characteristics and in-hospital outcomes of pre- and post-CREST CAS-treated and post-CREST CEA-treated patients were compared with pre-CREST CEA-treated patients. A total of 225 191 patients underwent CEA or CAS in the pre- and post-CREST periods. The frequency of CAS among carotid revascularization procedures did not change after publication of the CREST results (12.3% vs 12.7%, P = .9). In the pre-CREST period, the CAS group (compared with the CEA group) had higher rates of congestive heart failure (P < .001), coronary artery disease (P < .001), and renal failure (P < .001). The post-CREST CAS group had a higher frequency of atrial fibrillation (P = .003), congestive heart failure (P < .0001), coronary artery disease (P < .0001), and renal failure (P = .0001). Discharge with moderate to severe disability (P < .0001) and postprocedure neurological complications (P = .005) were more frequently reported in the post-CREST CAS group. After adjusting for age, sex, and risk factors, the odds ratio (OR) for moderate to severe disability was 1.0 (95% confidence interval [CI]: 0.8-1.2) in the pre-CREST CAS group and 1.4 (95% CI: 1.1-1.7) in the post-CREST CAS group compared with the reference group. The adjusted OR for neurological complications in the pre-CREST CAS group was 1.6 (95% CI: 1.2-2.1, P = .002), and 1.5 (95% CI: 1.1-2.0, P = .01) in the post-CREST CAS group. The frequency of CAS and CEA for carotid artery stenosis has not changed after publication of the CREST. The demographics, pretreatment comorbidity profile, and in-hospital complication rates remained unchanged during the 2 time periods. CAS, carotid artery stent placementCEA, carotid endarterectomyCI, confidence intervalICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical ModificationNIS, National Inpatient Sample.
    No preview · Article · Jul 2015 · Neurosurgery
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    ABSTRACT: The American Heart Association/American Stroke Association guidelines strongly recommend a noninvasive intracranial vascular study such as computed tomographic (CT) angiogram in acute stroke patient if endovascular treatment is contemplated. The objective was to determine the frequency of change in occlusion site between CT angiogram and cerebral angiogram in acute ischemic stroke patients undergoing endovascular treatment. All acute ischemic stroke patients who underwent a CT angiogram and subsequently underwent endovascular treatment were included. The CT and cerebral angiographic images were reviewed independently to determine presence and location of arterial occlusion. Severity of occlusion was classified by a previously described grading scheme. Clinical outcome at discharge was determined using modified Rankin scale. Computed tomographic angiogram was performed in 150 patients (mean age ± SD, 64.7 ± 16 years) before endovascular treatment. The mean interval (±SD) between CT angiogram and cerebral angiogram was 193 ± 164 minutes, and 65 (43.3%) of 150 patients received intravenous recombinant tissue plasminogen activator before cerebral angiography. Recanalization between CT angiogram and cerebral angiography was seen in 28 (18.7%) patients, whereas worsening of occlusion was seen in 31 (20.7%) patients. We noticed a trend towards higher rates of improvement (60.7% vs 42.0%, P = .07) and favorable outcome at discharge (42.9% vs 28.7%, P = .1) among patients who experienced preprocedure recanalization. After adjusting for age and initial National Institutes of Health Stroke Scale score strata, preprocedure recanalization was not associated with significantly higher rate of favorable outcome (modified Rankin scale, 0-2) at discharge (odds ratio, 2.1; 95% confidence interval, 0.8-5.5). After adjusting for age and National Institutes of Health Stroke Scale score strata, preprocedure worsening was not associated with significantly lower rates of favorable outcomes at discharge (odds ratio,0.4; 95% confidence interval, 0.1-1.4) CONCLUSIONS: A relatively high proportion of patients have preprocedure recanalization or worsening between CT angiogram and cerebral angiogram in acute ischemic stroke patients selected for endovascular treatment. Copyright © 2015 Elsevier Inc. All rights reserved.
    No preview · Article · Feb 2015 · American Journal of Emergency Medicine
  • Farhan Siddiq · Adil Malik · Adnan I Qureshi

    No preview · Article · Sep 2014 · Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association
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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.
    No preview · Article · Jun 2014 · Journal of Neurosurgery
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    ABSTRACT: Introduction: 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. Methods: A 55-year-old woman presented with SAH from a ruptured anterior communicating artery aneurysm. Subsequent coil embolization was complicated by an intra-procedural rupture following placement of the initial coil. A follow-up angiogram obtained after 9 min demonstrated moderate-to-severe vasospasm in the A2 segments of both anterior cerebral arteries. Results: A repeat angiogram 20 min later demonstrated complete resolution of the vasospasm. The aneurysm was successfully obliterated with coil embolization. Post-procedure, the patient manifested no clinical vasospasm and made a good neurological recovery. Conclusion: We document a case of ultra-early cerebral vasospasm that occurred immediately after an intra-procedural aneurysmal rupture. Catheter-induced vasospasm from mechanical manipulation of extracranial vasculature is well described. However, immediate vasospasm related to extravascular blood has never before been reported. This finding suggests that extravascular blood can have a local direct effect (presumably mechanical) on cerebral blood vessels, and may be an important mechanism for vasospasm.
    No preview · Article · Jun 2014 · Journal of vascular and interventional neurology
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    ABSTRACT: Objective: To determine the effect of supratentorial intraparenchymal mass lesions of various volumes on dural venous sinuses structure and transluminal pressures. Methods: Three set of preparations were made using adult isolated head derived from fresh human cadaver. A supratentorial intraparenchymal balloon was introduced and inflated at various volumes and effect on dural venous sinuses was assessed by serial intravascular ultrasound, computed tomographic (CT), and magnetic resonance (MR) venograms. Contrast was injected through a catheter placed in sigmoid sinus for both CT and MR venograms. Serial trasluminal pressures were measured from middle part of superior sagittal sinus in another set of experiments. Results: At intraparenchymal balloon inflation of 90 cm(3), there was attenuation of contrast enhancement of superior sagittal sinus with compression visualized in posterior part of the sinus without any evidence of compression in the remaining sinus. At intraparenchymal balloon inflation of 180 and 210 cm(3), there was compression and obliteration of superior sagittal sinus throughout the length of the sinus. In the coronal sections, at intraparenchymal balloon inflations of 90 and 120 cm(3), compression and obliteration of the posterior part of superior sagittal sinus were visualized. In the axial images, basal veins were not visualized with intraparenchymal balloon inflation of 90 cm(3) or greater although straight sinus was visualized at all levels of inflation. Trasluminal pressure in the middle part of superior sagittal sinus demonstrated a mild increase from 0 cm H(2)O to 0.4 cm H(2)O and 0.5 cm H(2)O with inflation of balloon to volume of 150 and 180 cm(3), respectively. There was a rapid increase in transluminal pressure from 6.8 cm H(2)O to 25.6 cm H(2)O as the supratentorial mass lesion increased from 180 to 200 cm(3). Conclusions: Our experiments identified distortion and segmental and global obliteration of dural venous sinuses secondary to supratentorial mass lesion and increase in transluminal pressure with large volume lesions. The secondary involvement of dural venous sinuses may represent a mechanism for refractory intracranial hypertension.
    No preview · Article · May 2014 · Journal of vascular and interventional neurology
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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.
    No preview · Article · Dec 2013 · Journal of vascular and interventional neurology
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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.
    No preview · Article · Oct 2013 · Journal of Neurointerventional Surgery
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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.
    No preview · Article · Oct 2013 · Stroke
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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.
    No preview · Article · Aug 2013 · World Neurosurgery
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    ABSTRACT: Introduction Successful endovascular embolisation of intracranial arteriovenous malformations (AVMs) or arteriovenous fistulae (AVFs) requires distal navigation of very small microcatheters to the nidus or fistulous point of the malformation. Such small microcatheters can only be navigated by flow direction or over 0.008 or 0.010 microwires, and the lack of support from these microwires often makes distal navigation challenging. Further, these small microcatheters are sometimes prone to rupture from the high injection pressures used during embolisation or retention within the feeding artery after embolisation. Additionally, not all of them are compatible with Ethylene Vinyl Alcohol Co-polymer (Onyx), which is currently the most widely used liquid embolic agent. Herein we report our initial experience with successful distal navigation of a small but robust microcatheter over a 0.014 wire system and subsequent successful embolisation using either Onyx or n-Butyl Cyano-acrylate (n-BCA). Materials and Methods A series of 6 patients (4 men, age 38–80 years) presented to our hospital with intracranial AVMs and dural AVFs. Of these 3 were ruptured Borden Type III dural AVFs and 3 were pial AVMs (2 ruptured, 1 with hemiplegia, proptosis). In each of these malformations, we navigated a “Headway Duo” microcatheter [156 cm long, 0.34 ml dead space, 2.6 French (proximally) and 1.6 French (distally), Microvention, Tustin, Ca, USA], which is Onyx and n-BCA compatible, in combination with a Synchro 2 microwire (Stryker, Fremont, Ca, USA) to the nidus/fistulous point of these malformations. We performed embolisation using a mixture of Onyx 18 and Onyx 34 with or without coils or using nBCA in each instance. Results We achieved successful navigation of the headway DUO microcatheter over a 0.014 microwire system and accessed the nidus/fistulous point in each of these malformations. Subsequently, we were able to successfully embolise the malformation using Onyx in 10 vessels, n-BCA in 2 vessels, in a total of 6 malformations in 6 patients. In one patient, we were also able to place coils in 3 feeder branches by using this microcatheter system in order to reduce the flow rate as a prelude to liquid embolisation. There was no instance of vascular injury, catheter rupture, or catheter retention. No patient had clinical deficits related to embolisations. Two of the three AVMs underwent surgery after pre-surgical embolisations, one is awaiting surgery. Angiographic cure was achieved with endovascular embolisation in 2 out of the 3 AVFs, and by surgical disconnection of the fistula in one. Conclusion We were able to safely and successfully perform endovascular embolisation of a series of intra-cranial arterial malformations using a new robust but small diameter microcatheter in combination with Onyx or n-BCA after successful navigation of this microcatheter to the nidal or fistulous point over a 0.014 wire system. Disclosures W. Tekle: None. B. Jagadeesan: None. F. Siddiq: None. A. Khan: None. A. Grande: None. R. Tummala: None.
    No preview · Article · Jul 2013 · Journal of Neurointerventional Surgery
  • B. Jagadeesan · F. Siddiq · A. Grande · R. Tummala

    No preview · Article · Jul 2013 · Journal of Neurointerventional Surgery
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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.
    No preview · Article · Jun 2013 · Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association
  • Shahram Majidi · Farhan Siddiq · Adnan I Qureshi
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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.
    No preview · Article · Jun 2013 · The American journal of emergency medicine
  • Farhan Siddiq · Malik M Adil · Adnan I Qureshi

    No preview · Article · May 2013 · Neurosurgery
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    ABSTRACT: 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. To determine the angiographic characteristics of the phenomenon of “pseudodissection” and its clinical implications in acute ischemic stroke endovascular treatment. 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. 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). 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.
    No preview · Article · Dec 2012 · Journal of neuroimaging: official journal of the American Society of Neuroimaging
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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.
    No preview · Article · Dec 2012 · Neurocritical Care
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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.
    No preview · Article · May 2012 · Neurosurgery

  • No preview · Article · Apr 2012 · Neurology
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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.
    No preview · Article · Mar 2012 · Neuroepidemiology