Daniel Huddle's research while affiliated with Swedish Medical Center and other places

Publications (20)

Article
Background Catheter retention and difficulty in retrieval have been observed during embolization of brain arteriovenous malformations (bAVMs) with the Onyx liquid embolic system (Onyx). The Apollo Onyx delivery microcatheter (Apollo) is a single lumen catheter designed for controlled delivery of Onyx into the neurovasculature, with a detachable dis...
Article
Background: CT perfusion (CTP) and diffusion or perfusion MRI might assist patient selection for endovascular thrombectomy. We aimed to establish whether imaging assessments of irreversibly injured ischaemic core and potentially salvageable penumbra volumes were associated with functional outcome and whether they interacted with the treatment effe...
Article
Background: Evidence regarding whether imaging can be used effectively to select patients for endovascular thrombectomy (EVT) is scarce. We aimed to investigate the association between baseline imaging features and safety and efficacy of EVT in acute ischaemic stroke caused by anterior large-vessel occlusion. Methods: In this meta-analysis of in...
Conference Paper
Introduction Endovascular therapy for cerebral aneurysms has increasingly been adopted as a viable treatment strategy for its minimally invasive but effective approach. This rising adoption has been correlated with an evolution in coil technology, including the recently FDA-cleared SMART Coil. In contrast to traditional bare metal coils, which have...
Article
Introduction: Traditional platinum coils used for cerebral aneurysm embolization have a uniform degree of softness throughout an individual coil's length. Recently, SMART Coils (Penumbra Inc., Alameda, CA) have been developed, which transition in softness along the length of their coils. We report the initial clinical results with this technology....
Article
Full-text available
Background Acute stroke treatment has been proven to be most effective when performed immediately. The objective of our study was to describe the steps taken to improve time metrics for patients receiving intra-arterial therapy (IAT), and compare metrics before and after implementation of interventions. Hypothesis Through streamlining the evaluati...
Article
Full-text available
Background and objective: Few prospective studies exist evaluating the safety and efficacy of the Pipeline Embolization Device (PED) in the treatment of intracranial aneurysms. The Aneurysm Study of Pipeline In an observational Registry (ASPIRe) study prospectively analyzed rates of complete aneurysm occlusion and neurologic adverse events followi...
Article
Purpose Newer generations of devices in endovascular therapies are progressively used in the revascularization of large vessel occlusions in acute ischemic stroke. The aim of this case review study was to evaluate if there was a corresponding improvement in procedural times over the course of the evolution of these devices. Methods Procedural times...
Article
Purpose: Endovascular therapies are increasingly used in the revascularization of acute ischemic stroke from large vessel occlusions. There have been many design improvement of these devices from their initial implementation to the recent newer generations of devices. The goal of this case review study was to assess if there was corresponding impro...
Article
Background Aneurysm coil technology has changed considerably since the introduction of the GDC coil. We evaluated our initial clinical experience with a novel 0.020 Penumbra PC 400 coil to determine device safety and acute performance. Materials and Methods Between 2/2011 and 9/2012, 143 aneurysms were coiled with Penumbra PC 400 coils at four high...
Article
Introduction/Purpose We report clinical experience and long-term follow-up results in treating 24 small aneurysms in 22 patients, ranging from 2mm to 4.4mm, using the Penumbra PC400 Large Volume Coil at 4 high volume centres. Follow-ups are available for 12 aneurysms at the current time. Materials and Methods Our treatment population consisted of 2...
Article
Introduction/Purpose Aneurysm coil technology has changed considerably since the introduction of the GDC coil. We evaluated our initial clinical experience with a novel 0.020 Penumbra PC 400 coil to determine device safety and acute performance. Materials and Methods Between 2/2011 and 9/2012, 133 aneurysms were coiled with Penumbra PC 400 coils; 8...
Article
Full-text available
Background The treatment of acute ischemic stroke is traditionally centered on time criteria, although recent evidence suggests that physiologic neuroimaging may be useful. In a multicenter study we evaluated the use of CT perfusion, regardless of time from symptom onset, in patients selected for intra-arterial treatment of ischemic stroke. Method...
Article
Background Traditional treatment in acute ischemic stroke is based on time criteria when administering intravenous and intra-arterial therapies. However recent evidence suggests that image based criteria may be useful for selecting patients for intra-arterial interventions. We investigated CT perfusion (CTP) based criteria, regardless of time from...
Article
Objective Conventional treatment of cerebral venous sinus thrombosis (CVT) has been systemic heparinization. A variety of endovascular treatment paradigms have been described for the treatment of symptomatic CVST that has failed conventional therapy. We retrospectively evaluated the efficacy and safety of thromboembolectomy using the Fogarty balloo...
Article
Introduction Recanalization of tandem vascular occlusions involving the cervical carotid artery and an ipsilateral intracranial large vessel is a difficult treatment challenge. These lesions have been historically observed to be refractory to most conservative medical therapies. New endovascular options have been rapidly emerging over the last few...
Article
PurposeThe 054 reperfusion catheter is a newly introduced component of the Penumbra System specifically designed to enhance aspiration efficiency by increasing the catheter diameter. The goal of this study was to compare its safety and effectiveness in reducing clot burden in the internal carotid artery (ICA) and the middle cerebral artery (MCA).Me...
Article
Full-text available
Abstract BACKGROUND AND PURPOSE: The purpose of this clinical evaluation was to assess the safety and effectiveness of the Penumbra System in the revascularization of patients presenting with acute ischemic stroke secondary to intracranial large vessel occlusive disease. METHODS: In this prospective, multicenter, single-arm study, 125 patients with...

Citations

... Most of the pertinent clinical trials published in the last decade excluded patients with ASPECTS of ≤ 5, which lead treating neurointerventionalists to confront the dilemma of whether to proceed with EVT or have recourse to medical treatment in these circumstances. Patients with AS-PECTS lower than 6 were excluded from most clinical trials that validated mechanical thrombectomy indications in the last decade [8], therefore, data about their outcomes and whether they could benefit from MT remain scarce and largely undetermined [5]. Hence, patients with low AS-PECTS have been generally thought to be ineligible for EVT given the lower chance of salvaging neuronal tissue to improve functional outcome and to mitigate the risk of revascularization bleeding of infarcted tissue [9]. ...
... How much safety is actually 'safe'? Commentary on 'Safety of the Apollo Onyx delivery microcatheter for embolization of brain arteriovenous malformations: results from a prospective post-market study' by Meyers et al Alexander Sirakov,1 Krasimir Minkin, 2 Stanimir Sirakov 1 We read with great interest the recently published article in the journal entitled 'Safety of the Apollo Onyx delivery microcatheter for the embolization of brain arteriovenous malformations: results from a prospective post-market study'. This study yielded overall fantastic technical, angiographic results with low morbidity and mortality rates. 1 The primary endpoints for which the trial was powered were clearly defined as follows: unintentional catheter tip detachment with clinical sequelae, catheter rupture/break/ fracture with clinical sequelae, or retained catheter body in the vasculature. ...
... However, EVT may offer the potential to reduce the burden caused by disability, for example, by avoiding the need for longterm institutional care in patients who survive with a large ischaemic core stroke. The INternational Stroke Perfusion Imaging REgistry (INSPIRE) includes over 200 patients with core ≥70 mL determined by computed tomography perfusion (CTP), representing the largest cohort in this sub-population at the current time [8][9][10]. The next important question to address is whether the benefits from EVT obtained in clinical trials are sustained in real-world practice for large infarct core at the time of the presentation. ...
... After initial screening, we retrieved the full text of 68 records that were considered potentially eligible for inclusion, and after reading the full-text articles, 14 were further excluded (Supplemental eTable 2). Finally, we identified 24 eligible studies for inclusion, of which 1 was an individual patient data (IPD) meta-analysis of RCT-derived data conducted by the Highly Effective Reperfusion Using Multiple Endovascular Devices (HERMES) collaborators, 31 2 were RCTs not included in the previous meta-analysis, 32,33 16 were observational studies based on prospectively collected data (prospective registries), 34-49 and 5 were retrospective cohort studies (Table 1), 50-54 comprising a total of 2539 AIS patients with low ASPECTS score treated with EVT. ...
... Other SMART Coil study results reported adequate aneurysm occlusion between 71.2 and 100% of treated aneurysms, low rebleeds, and low retreatment rates (5)(6)(7)(8). Those studies had either small sample sizes, few study sites, or lacked long-term follow-up. ...
... Before this, the evaluation of the SMART system was limited to small retrospective case series. [5][6][7][8] A multicenter retrospective review of 59 aneurysm patients (44% ruptured) treated with at least one SMART coil between July 2015 to January 2016 by Spiotta et al 7 achieved Raymond I or II occlusion in 71.2% of patients with no device malfunctions or rebleeds observed. Sokolowski et al 5 investigated the follow-up angiographic outcomes of aneurysm embolization with SMART coils in a retrospective cohort. ...
... 24 A similar trend of complication timing was shown in the Aneurysm Study of Pipeline in an observational Registry (ASPIRe) study, with a 6-month major neurologic event of 6.8% but no cases of neurological morbidity and mortality after 6 months. 25 Additionally, in an analysis of the International Retrospective Study of Pipeline Embolization Device (IntrePED) study involving 793 patients treated with the Pipeline embolization device, of 36 patients who had a postoperative acute ischemic stroke, 86.1% (31/36) occurred within the first 6 months of the procedure, with a smaller fraction (13.9%, 5/36) of ischemic events occurring after 6 months. 26 Moreover, of the 20 cases of intraparenchymal hemorrhage reported in the study, 75% occurred within the first month of the procedure. ...
... Frei et al in their retrospective analysis series described the use of FBT for 65 patients and achieved complete recanalization in 80% (52/65) with good outcomes. 11 Our center has a high burden of CVT and strokes in South India. 12,13 In the year 2014, we transitioned from catheter directed local thrombolysis via a transfemoral venous access approach to MT using a Penumbra device with good outcomes. ...
... In 2009, the Penumbra system became available, combining aspiration-debulking with mechanical retrieval, which resulted in higher recanalisation rates (82% TIMI 2-3), but only a modest effect on clinical outcome (mRS 0-2 28% at 90 days) in another single arm study [33]. ...