Citations 3
Petechial hemorrhage in mechanical thrombectomy for distal and medium-vessel occlusions: technical considerations and outcomes
Baker, Amanda , Adeeb, Nimer , Henninger, Nils , Sundararajan, Sri Hari , Khalife, Jane, Tan, Benjamin Yong‐Qiang , Regenhardt, Robert W. , Heit, Jeremy J. , Cancelliere, Nicole M., Fiehler, Jens, Puri, Ajit S., Dyzmann, Christian , Colasurdo, Marco, Filipe, João Pedro , Harker, Pablo, Abdalkader, Mohamad , Marotta, Thomas R. , Spears, Julian , Jabbour, Pascal , Biswas, Arundhati , Clarençon, Frédéric , Varela, Ricardo , Gonzalez, Nestor R. , Möhlenbruch, Markus , Costalat, Vincent , Gory, Benjamin , Yedavalli, Vivek , Stracke, Christian Paul , Shaikh, Hamza, Liebeskind, David S., Alexandre, Andrea , Faizy, Tobias D., Tancredi, Illario , Kalsoum, Erwah , Lubicz, Boris , Patel, Aman B. , Guenego, Adrien , Altschul, David , _, _, Amllay, Abdelaziz, Gopinathan, Anil, Dusart, Anne , Capirossi, Carolina , Mounayer, Charbel, Hsieh, Cheng-Yang, Stapleton, Christopher J. , Bellante, Flavio, Shaikh, Hamza , Cuellar-Saenz, Hugo H., Rabinov, James D. , Berge, Jérôme , Martinez-Gutierrez, Juan Carlos, Premat, Kévin , Chervak, Lina , Elhorany, Mahmoud, Quintero‐Consuegra, Miguel , Kan, Peter , Khandelwal, Priyank , Kadirvel, Ramanathan , Dofuku, Shogo , Nedelcu, Simona, Tjoumakaris, Stavropoula I, Barreau, Xavier, Liebeskind, David S. , Liebeskind, David S. , Heit, Jeremy J , Altschul, David J , Gonzalez, Nestor R , Regenhardt, Robert W , Yedavalli, Vivek S , Henninger, Nils , Tan, Benjamin Yq , Alexandre, Andrea M , Varela, Ricardo , Essibayi, Muhammed Amir , Salim, Hamza , Fazzari, Melissa J. , Khatri, Deepak , Baker, Amanda, Musmar, Basel , Kühn, Anna Luisa , Khalife, Jane , Ghozy, Sherief , Scarcia, Luca , Yeo, Leonard Ll , Cancelliere, Nicole M , Rouchaud, Aymeric , Sheth, Sunil A , Puri, Ajit S , Colasurdo, Marco , Renieri, Leonardo , Harker, Pablo , Aziz, Yasmin , Radu, Răzvan Alexandru , Klein, Piers , Ota, Takahiro , Mowla, Ashkan , Naamani, Kareem El , Jabbour, Pascal , Siegler, James E. , Nguyen, Thanh N. , Gory, Benjamin , Hecker, Constantin , Marnat, Gaultier , Griessenauer, Christoph J. , Pedicelli, Alessandro , Faizy, Tobias D. , Mendes Pereira, Vitor , Dmytriw, Adam A. , _, _, Amllay, Abdelaziz , Vagal, Achala , Schiphorst, Adrien ter , Thomas, Ajith J , Mounayer, Charbel , Weyland, Charlotte S. , Hsieh, Cheng‐Yang , Forestier, Géraud , Cuellar, Hugo , Valente, Iacopo , Sibon, Igor , Jesser, Jessica , Martinez-Gutierrez, Juan Carlos , Meyer, Lukas , Elhorany, Mahmoud , Aziz‐Sultan, Mohammad Ali , Killer-Oberpfalzer, Monika , Khandelwal, Priyank , Fahed, Robert , Salazar‐Marioni, Sergio , Nedelcu, Simona , Tjoumakaris, Stavropoula , Saleme, Suzana , Barreau, Xavier
Journal of Neurosurgery | July 4, 2025 | Volume: 143 | Issue: 6 | Pages: 1501-1513
OBJECTIVE Mechanical thrombectomy (MT) is well established for large-vessel occlusion (LVO) strokes, but its safety in distal and medium-vessel occlusions (DMVOs) requires further investigation. This study analyzed the relationship between procedural approaches, petechial hemorrhage (PetH), and clinical outcomes in DMVO thrombectomy, with particular attention to technical considerations and the complex interplay between tissue injury and hemorrhagic complications. METHODS A retrospective cohort study was conducted on DMVO stroke patients treated with MT at 37 stroke centers worldwide from 2016 to 2024. Patients were categorized based on follow-up imaging into those with or without PetH. Four logistic regression models analyzed the association of PetH with favorable functional outcomes (modified Rankin Scale score ≤ 2) at 90 days, early neurological improvement (≥ 4-point National Institutes of Health Stroke Scale score decrease at 24 hours), all-cause mortality, and independent determinants of PetH. Adjusted odds ratios (aORs), 95% confidence intervals, and p values were reported. RESULTS Of 1428 patients, 439 (30.7%) developed PetH. Factors independently associated with PetH were multiple thrombectomy passes (aOR 1.58, 95% CI 1.21–2.06; p = 0.001), IV thrombolysis (aOR 1.31, 95% CI 1.01–1.69; p = 0.04), and the combined use of a stent retriever with aspiration as the first-line method compared with aspiration alone (aOR 1.66, 95% CI 1.15–2.38; p = 0.007). Conversely, general anesthesia (aOR 0.55, 95% CI 0.40–0.77; p < 0.001), higher Alberta Stroke Program Early CT Scores (aOR 0.76, 95% CI 0.69–0.83; p < 0.001), and successful recanalization (aOR 0.56, 95% CI 0.39–0.80; p = 0.002) were significantly associated with a lower odds of PetH. PetH was associated with a decreased odds of favorable functional outcomes (aOR 0.51, 95% CI 0.36–0.73; p < 0.001), reduced early neurological improvement (aOR 0.59, 95% CI 0.44–0.79; p < 0.001), and increased all-cause mortality (aOR 1.84, 95% CI 1.23–2.76; p < 0.001). CONCLUSIONS PetH is a frequent sequela following MT in DMVO strokes and is associated with poorer outcomes, likely reflecting underlying ischemic injury rather than direct causation. Procedural factors influence PetH risk, suggesting medical treatment as first-line therapy for DMVOs, with MT reserved for refractory cases using less aggressive approaches.
Impact of smoking on recurrence rates among wide-neck intracranial aneurysms treated with Woven EndoBridge: a multicenter retrospective study
Vaishnav, Dhrumil , Adeeb, Nimer , Aslan, Assala , Cancelliere, Nicole M., McLellan, Rachel , Ghozy, Sherief, Lay, Sovann V. , Guenego, Adrien , Premat, Kévin , Möhlenbruch, Markus, Kral, Michael , Doron, Omer , Salem, Mohamed M. , Foreman, Paul M. , Vachhani, Jay A. , Shaikh, Hamza, Župančić, Vedran , Ayberk, Gıyas , Güneş, Yasin Celal , Rabinov, James D. , Ren, Yifan , Michelozzi, Caterina , Elens, Stéphanie , Starke, Robert M., Hassan, A. , Ogilvie, Mark , Nguyên, Anh , Jones, Jesse , Brinjikji, Waleed , Nawka, Marie Teresa , Psychogios, Marios, Ulfert, Christian , Diestro, Jose Danilo Bengzon , Pukenas, Bryan , Burkhardt, Jan‐Karl , Martinez-Gutierrez, Juan Carlos, Sheth, Sunil G. , Spiegel, Gary, Lubicz, Boris , Puri, Ajit S., Pero, Guglielmo , Nossek, Erez , Raz, Eytan, Griessenauer, Christoph J., Asadi, Hamed , Siddiqui, Adnan, Brook, Allan , Haranhalli, Neil , Ducruet, Andrew F. , Albuquerque, Felipe C. , Regenhardt, Robert W. , Stapleton, Christopher J. , Kan, Peter, Kalousek, Vladimir , Lylyk, Pedro , Boddu, Srikanth , Knopman, Jared , Tjoumakaris, Stavropoula I., Clarençon, Frédéric, Cuellar-Saenz, Hugo H., Patel, Aman B. , Altschul, David , _, _, Spears, Julian , Sundararajan, Sri Hari , Balush, Ali Al, Inoue, Yasuaki , Mirshahi, Shervin , Harker, Pablo, Tutino, Vincent M., Brehm, Alex , Diestro, Jose Danilo B , Shotar, Eimad , Nguyen, Anh , Pero, Guglielmo , Kalousek, Vladimir , Altschul, David J , Regenhardt, Robert W , Ulfert, Christian , Lay, Sovann V , Essibayi, Muhammed Amir , Musmar, Basel , Salim, Hamza , Cancelliere, Nicole M , Algin, Oktay , Ghozy, Sherief , Renieri, Leonardo , Carnevale, Joseph Anthony , Saliou, Guillaume , Mastorakos, Panagiotis , Naamani, Kareem El , Shotar, Eimad , Möhlenbruch, Markus , Chung, Charlotte , Lylyk, Iván , Hafeez, Muhammad Ubaid , Catapano, Joshua S , Waqas, Muhammad , Schirmer, Clemens M. , Piano, Mariangela , Kühn, Anna Luisa , Hassan, Ameer E , Psychogios, Marios‐Nikos , Huynh, Thien , Martinez-Gutierrez, Juan Carlos , Sheth, Sunil A., Tawk, Rabih G. , Panni, Pietro , Puri, Ajit S , Raz, Eytan , Killer-Oberpfalzer, Monika , Griessenauer, Christoph J. , Aziz‐Sultan, Mohammad Ali , Tjoumakaris, Stavropoula , Clarençon, Frédéric , Limbucci, Nicola , Cuellar, Hugo , Jabbour, Pascal , Mendes Pereira, Vitor , Dmytriw, Adam A. , _, _, Dibas, Mahmoud , Vranic, Justin E. , Alotaibi, Naif M. , Harker, Pablo , Sporns, Peter Bernhard
Journal of Neurosurgery | January 31, 2025 | Volume: 142 | Issue: 6 | Pages: 1732-1740
OBJECTIVE Tobacco smoking is among the factors known to significantly augment the risk of untreated intracranial aneurysm (IA) growth and rupture. Smoking appears to have a variable effect on different endovascular treatment modalities. The impact of smoking on the safety, efficacy, and outcomes of Woven EndoBridge (WEB) device use for wide-neck IAs has not been evaluated. This study aimed to investigate the outcomes of WEB devices by smoking status. METHODS A retrospective multicenter analysis was conducted on the data of patients from 36 sites worldwide treated with the WEB device for intracranial saccular aneurysms. Patients were stratified based on smoking status (current, former, and never smokers). The Student t-test and chi-square test were performed for continuous and categorical variables, respectively. Multivariable logistic regression was used to adjust for confounders. RESULTS Of 1376 patients with available smoking status, 504 were current smokers, 358 were former smokers, and 514 were never smokers. Upon adjusting for significant confounders, no association was found between smoking and recurrence outcomes (OR 1.39, 95% CI 0.69–2.80; p = 0.36), thromboembolic and hemorrhagic complications, and mortality among IAs treated with the WEB device. There was no statistically significant difference in outcomes between former and never smokers (OR 1.23, 95% CI 0.70–2.18; p = 0.46). The location of aneurysms differed between smoking groups, with former smokers having more anterior circulation aneurysms compared with current and never smokers (99.0% vs 96.9% vs 95.3%; p = 0.01). In terms of clinical symptoms, headache and dizziness were more common in the never smokers compared with current and former smokers (13.9% vs 8.9% vs 7.7%, p = 0.01). CONCLUSIONS This large-scale study suggests no significant correlation between smoking and the recurrence of IAs treated with the WEB device. Biological studies are warranted to better understand the biological impact of smoking on the growth and rupture of treated IAs.
Creation of a predictive calculator to determine adequacy of occlusion of the woven endobridge (WEB) device in intracranial aneurysms—A retrospective analysis of the WorldWide WEB Consortium database
Musmar, Basel , Adeeb, Nimer , Gendreau, Julian , Horowitz, Melanie Alfonzo , Salim, Hamza , Sanmugananthan, Praveen , Aslan, Assala , Cancelliere, Nicole M , McLellan, Rachel , Şenol, Yiğit Can , Lay, Sovann V. , Guenego, Adrien , Renieri, Leonardo, Naamani, Kareem El, Premat, Kévin , Möhlenbruch, Markus, Kral, Michael , Doron, Omer , Salem, Mohamed M , Foreman, Paul M. , Vachhani, Jay A. , Shaikh, Hamza , Župančić, Vedran , Tutino, Vincent M. , Gokhan, Yuce, İmamoğlu, Çetin , Rabinov, James D. , Ren, Yifan , Michelozzi, Caterina , Elens, Stéphanie , Starke, Robert M, Ogilvie, Mark , Nguyên, Anh , Jones, Jesse , Brinjikji, Waleed , Nawka, Marie Teresa , Psychogios, Marios, Ulfert, Christian , Diestro, Jose Danilo Bengzon , Pukenas, Bryan , Burkhardt, Jan‐Karl , Martinez-Gutierrez, Juan Carlos, Essibayi, Muhammed Amir , Spiegel, Gary, Lubicz, Boris , Puri, Ajit S., Pero, Guglielmo , Nossek, Erez , Raz, Eytan , Killer-Oberfalzer, Monika, Asadi, Hamed , Brook, Allan , Altschul, David , Ducruet, Andrew F. , Albuquerque, Felipe C. , Regenhardt, Robert W. , Stapleton, Christopher J. , Kan, Peter, Kalousek, Vladimir , Lylyk, Pedro , Boddu, Srikanth , Knopman, Jared , Tjoumakaris, Stavropoula , Clarençon, Frédéric , Bydon, Mohamad , Patel, Aman B. , Salim, Hamza , Algin, Oktay , Ghozy, Sherief , Dibas, Mahmoud , Senol, Yigit Can , Guenego, Adrien , Tjoumakaris, Stavropoula , Shotar, Eimad , Lylyk, Ivan , Foreman, Paul M , Shaikh, Hamza A , Župančić, Vedran , Hafeez, Muhammad U , Ren, Yifan , Schirmer, Clemens M , Hassan, Ameer E , Nguyen, Anh , Jones, Jesse , Ulfert, Christian , Essibayi, Muhammed Amir , Tawk, Rabih, Pero, Guglielmo , Raz, Eytan , Griessenauer, Christoph J , Siddiqui, Adnan H , Altschul, David J , Regenhardt, Robert W , Limbucci, Nicola , Cuellar-Saenz, Hugo H , Dmytriw, Adam A , Diestro, Jose Danilo B , Tutino, Vincent M , Kalousek, Vladimir , Musmar, Basel , Cancelliere, Nicole M , Lay, Sovann V , Burkhardt, Jan‐Karl , Brown, Nolan J. , Ghozy, Sherief , Dibas, Mahmoud , Orscelik, Atakan , Renieri, Leonardo , Carnevale, Joseph Anthony , Saliou, Guillaume , Mastorakos, Panagiotis , Naamani, Kareem El , Shotar, Eimad , Möhlenbruch, Markus , Chung, Charlotte , Lylyk, Iván , Hafeez, Muhammad Ubaid , Catapano, Joshua S , Waqas, Muhammad , Bayrak, Ahmet , Schirmer, Clemens M. , Piano, Mariangela , Kühn, Anna Luisa , Hassan, Ameer E , Psychogios, Marios‐Nikos , Huynh, Thien , Martinez-Gutierrez, Juan Carlos , Sheth, Sunil A , Tawk, Rabih G. , Panni, Pietro , Puri, Ajit S , Griessenauer, Christoph J. , Siddiqui, Adnan H. , Aziz‐Sultan, Mohammad Ali , Limbucci, Nicola , Hasan, David , Cuellar, Hugo , Jabbour, Pascal , Mendes Pereira, Vitor , Dmytriw, Adam A.
Interventional Neuroradiology | August 10, 2024 | Volume: No volume available | Issue: No issue available | Pages: No page available
Background Endovascular treatment with the woven endobridge (WEB) device has been widely utilized for managing intracranial aneurysms. However, predicting the probability of achieving adequate occlusion (Raymond–Roy classification 1 or 2) remains challenging. Objective Our study sought to develop and validate a predictive calculator for adequate occlusion using the WEB device via data from a large multi-institutional retrospective cohort. Methods We used data from the WorldWide WEB Consortium, encompassing 356 patients from 30 centers across North America, South America, and Europe. Bivariate and multivariate regression analyses were performed on a variety of demographic and clinical factors, from which predictive factors were selected. Calibration and validation were conducted, with variance inflation factor (VIF) parameters checked for collinearity. Results A total of 356 patients were included: 124 (34.8%) were male, 108 (30.3%) were elderly (≥65 years), and 118 (33.1%) were current smokers. Mean maximum aneurysm diameter was 7.09 mm (SD 2.71), with 112 (31.5%) having a daughter sac. In the multivariate regression, increasing aneurysm neck size (OR 0.706 [95% CI: 0.535–0.929], p = 0.13) and partial aneurysm thrombosis (OR 0.135 [95% CI: 0.024–0.681], p = 0.016) were found to be the only statistically significant variables associated with poorer likelihood of achieving occlusion. The predictive calculator shows a c-statistic of 0.744. Hosmer–Lemeshow goodness-of-fit test indicated a satisfactory model fit with a p-value of 0.431. The calculator is available at: https://neurodx.shinyapps.io/WEBDEVICE/ . Conclusion The predictive calculator offers a substantial contribution to the clinical toolkit for estimating the likelihood of adequate intracranial aneurysm occlusion by WEB device embolization.