Ghaith, Hazem S.

Background Cerebral sinus venous thrombosis (CSVT) has traditionally been treated medically with systemic anticoagulation. Recent advances in endovascular therapy (EVT) may represent an alternative treatment to medical therapy for CSVT. We conducted a systematic review and meta-analysis to evaluate the use of EVT for CSVT. Methods We conducted a systematic literature review using PubMed, Embase, Scopus, and Web of Science. We included studies that reported outcomes following EVT for CSVT. The primary outcome of interest was rate of modified Rankin Scale (mRS) 0–2. Secondary outcomes of interest were rates of complete, partial, and failed recanalization, mortality, and new or expansion of hematoma. We calculated pooled rates (%) and their corresponding 95% confidence intervals (CIs). Results Thirty-eight studies with 682 patients were included. Rate of mRS 0–2 was 82.6% (95% CI, 75.3%–88.0%). Rate of complete recanalization was 60.9% (95% CI, 49.1%–71.5%), rate of partial recanalization was 34.2% (95% CI, 24.1%–45.9%), and rate of failed recanalization was 5.4% (95% CI, 3.1%–9.2%). Rate of mortality was 6.7% (95% CI, 4.1%–10.8%), and rate of new hematoma or expansion of hematoma was 5.1% (2.9%–8.8%). Conclusions In this systematic review and meta-analysis, EVT for CSVT was associated with favorable rates of mRS 0–2 and recanalization. Furthermore, EVT was associated with a promising safety profile. Future prospective, comparative studies are warranted to assess EVT for CSVT.

Introduction Neurointervention has become one of the most competitive specialties in the United States due to the limited number of training spots, and a larger pool of applicants from different backgrounds: neurosurgery, neurology, and radiology. The training standards are continuously updated to ensure solid learning experiences, which ultimately factors in better outcomes and fewer complications. There is a move towards a structured competency assessment of training requirements via collaboration among several professional societies. However, the substantial drivers of candidate selection by program directors (PDs) have not been fully established yet. The goal of our study is to investigate the factors influencing the selection of fellowship candidates. Methods We distributed a 52‐question electronic survey via REDCap to 93 PDs. The questionnaire was divided into 5 categories: program characteristics; candidate demographics; educational credentials; personal traits; and research and extracurricular activities. The PDs were then asked to rank 5 pre‐selected factors from across all 5 categories. Each category included a subset of multiple‐choice questions to be graded as indicated for each category. Characteristics for these categories were scored from a range of 1 through 10 and means with standard deviations (SD) were calculated for each characteristic. Results Of the 93 PDs surveyed, 55 PDs filled the survey with a response rate of 59.1%. As per the programs’ characteristics, Neurosurgery was the most involved specialty in running the training programs (69.1%), followed by neurology (38.2%), and radiology (30.9%). Most programs were based in academic hospitals (87.3%, n=48/55). The most important criterion for candidate’s demographic characteristics was the need for visa sponsorship, followed by career gap and number of years from graduation from residency program, as summarized in Figure 1A. The most important criteria for educational credentials were being a graduate from a neurosurgical residency program (5.4 ± 2.9), and the institution where the candidate’s residency training is/was based (5.4 ± 2.5). Regarding the candidate’s personal traits, assessment by faculty members at the interview had the highest score (8.9 ± 1). In terms of research and extracurricular activities, fluency in English had the highest score (7.2 ± 1.9), followed by the number of peer‐reviewed/PubMed‐indexed publications (6.4 ± 2.2). Ranking of a final set of 5 characteristics from across all categories is summarized in Figure 1B, with knowledge of the candidate being the single most important contributing factor. Conclusion Neurointerventional training is open to candidates in neurosurgery, neurology, and radiology. To our knowledge, our survey is the first to investigate the factors that might be implicated in the final decision made by PDs when choosing the future neurointerventional trainee, including demographic, educational, research and extracurricular activities.

Introduction Cerebral sinus venous thrombosis (CSVT) has traditionally been treated medically with systemic anticoagulation. Recent advances in endovascular therapy (EVT) may represent an alternative treatment to medical therapy for CSVT. We conducted a systematic review and meta‐analysis to evaluate the use of EVT for CSVT. Methods We conducted a systematic literature review using PubMed, Embase, Scopus, and Web of Science. We included studies that reported outcomes following EVT for CSVT. The primary outcome of interest was rate of modified Rankin Scale (mRS) 0‐2. Secondary outcomes of interest were rates of complete, partial, and failed recanalization, mortality, and new or expansion of hematoma. We calculated pooled rates (%) and their corresponding 95% confidence intervals (CI). Results Thirty‐eight studies with 682 patients were included. Rate of mRS 0‐2 was 82.6% (95% CI, 75.3%‐88.0%). Rate of complete recanalization was 60.9% (95% CI, 49.1%‐71.5%), rate of partial recanalization was 34.2% (95% CI, 24.1%‐45.9%), and rate of failed recanalization was 5.4% (95% CI, 3.1%‐9.2%). Rate of mortality was 6.7% (95% CI, 4.1%‐10.8%) and rate of new or expansion of hematoma was 5.1% (2.9%‐8.8%). Conclusion In this systematic review and meta‐analysis, EVT for CSVT was associated with favorable rates of mRS 0‐2 and recanalization. Furthermore, EVT was associated with a promising safety profile. Future prospective, comparative studies are warranted to assess EVT for CSVT.

Introduction Mechanical thrombectomy (MT) is the gold standard for acute ischemic stroke (AIS) due to large vessel occlusion (LVO). Although >70% of patients in the randomized clinical trials (RCTs) assessing the efficacy of MT for AIS‐LVO had successful recanalization, only up to 27% were free of disability according to the 90‐day modified Rankin scale (mRS) score. It is suggested that microcirculation disruption distal to the LVO might contribute to futile recanalization. Hence, combining intra‐arterial (IA) tissue plasminogen activator (tPA) with MT was investigated in a few studies in an attempt to reduce the burden of distal microthrombi and microcirculation disruption. We conducted this meta‐analysis to provide collective evidence in this regard. Methods We performed this meta‐analysis following the Preferred Reporting Items for Systematic Review and Meta‐Analyses statement recommendations. We aimed to include all original studies investigating the benefits of IA tPA in AIS patients undergoing MT.All screening and extraction stages were conducted by two authors, with a third author resolving any conflicts. Using R software, we calculated pooled odds ratios (ORs) and their corresponding 95% confidence intervals (CI). A fixed‐effect model was adopted to pool all data due to the absence of significant heterogeneity among the included studies. Heterogeneity was assessed using Q statistics and the I2test, where I2> 50% or P‐value < 0.05 were considered significant. Results Following the database search, a manual search of references, and different screening phases, we included 5 studies (2,686 patients) satisfying the predefined inclusion criteria. Successful recanalization rates were comparable between both groups. The 90‐day functional independence was reported in 4 studies (2,474 patients), with comparable rates between both groups (OR = 1.25; 95%CI = 0.92‐1.70; P‐value = 0.154). Mortality was reported in 3 studies (368 patients), with comparable rates between both groups (OR = 0.73; 95%CI = 0.44‐1.23; P‐value = 0.240). Symptomatic intracranial hemorrhage (sICH) was reported in 5 studies (2,678 patients) with no significant difference between the two groups (OR = 0.66; 95%CI = 0.34‐1.26; P‐value = 0.304). Conclusions The current evidence does not show any significant differences between MT alone versus MT plus IA tPA in terms of 90‐day functional independence, mortality, and sICH. With the limited number of studies and included patients, more studies are needed to investigate the benefits and safety of the combined MT and IA tPA.