Citations 3
Hurting More Than Helping? Decompressive Craniectomy in Patients With Symptomatic Intracerebral Hemorrhage After Mechanical Thrombectomy in Acute Ischemic Stroke: Insights From Stroke Thrombectomy and Aneurysm Registry
Pressman, Elliot , Vakharia, Kunal , Guerrero, Waldo R. , Maier, Ilko , Raai, Ansaar, Jabbour, Pascal , Kim, Joon-Tae , Grossberg, Jonathan A , Wolfe, Stacey Q , Stark, Robert M., Psychogios, Marios‐Nikos , Dye, Justin , Alaraj, Ali , Yoshimura, Shinichi , Ezzeldin, Mohamad , Tanweer, Omar , Polifka, Adam , Siddiqui, Fazeel , Moss, Mark, Brinjikji, Waleed , Dağlıoğlu, Ergün , Williamson, Richard , Altschul, David , Ogilvy, Christopher S. , Crosa, Roberto , Gory, Benjamin , Kan, Peter , Casagrande, Walter, Chowdhry, Shakeel , Stiefel, Michael , Spiotta, Alejandro M , Mokin, Maxim, STAR, on behalf of, Crosa, Roberto , Alaraj, Ali , Altschul, David J , Wolfe, Stacey Quintero , Ogilvy, Christopher S , Sowlat, Mohammad‐Mahdi , Schimmel, Samantha J. , Jabbour, Pascal , Alawieh, Ali , Stark, Robert M., Samaniego, Edgar A , Goyal, Nitin , Fiorella, David , Romano, Daniele G., Navía, Pedro , Cuellar, Hugo, Fragata, Isabel , Mascitelli, Justin R , Osbun, Joshua W , Limaye, Kaustubh , Matouk, Charles , Park, Min S. , Levitt, Michael R. , Gory, Benjamin , Grandhi, Ramesh , Paul, Alexandra R , Mokin, Maxim , STAR, on behalf of
Neurosurgery | June 9, 2025 | Volume: 98 | Issue: 2 | Pages: 345-357
BACKGROUND AND OBJECTIVES: It remains unclear whether decompressive craniectomy (DC) is beneficial in patients who suffer symptomatic intracerebral hemorrhage (sICH) after acute ischemic stroke (AIS). We sought to study the effect of DC on functional outcomes in patients with sICH after AIS who underwent mechanical thrombectomy (MT). METHODS: Patients with AIS from anterior circulation large vessel occlusion who underwent MT and subsequently developed sICH were identified from the Stroke Thrombectomy and Aneurysm Registry database. The primary outcome was acceptable 90-day functional neurological outcome, defined as modified Rankin scale (mRS) 0-3. Multivariable logistic regression and propensity-score matching were used to identify and quantify risk factors. RESULTS: Of 464 patients identified with sICH after AIS after MT, 97 patients (20.9%) underwent DC. Patients who underwent DC were more likely to be female ( P < .001), younger ( P < .001), have a measured medical comorbidity, have higher baseline mRS ( P = .02), and have higher-grade hemorrhages ( P = .01). At 90 days, 14% of patients had the primary outcome of mRS 0-3 and 56% had died. The primary outcome was observed in 11 patients who underwent DC (11%) and 55 (15%) of those without DC (odds ratio [OR] 0.7, 95% CI 0.4-1.4, P = .40). DC did not affect mRS shift at 90 days ( P = .10) but was associated with lower mortality (OR 0.5, 95% CI 0.3-0.8, P = .01). Multivariable analysis demonstrated that DC decreased the odds of primary outcome (adjusted OR 0.2, 95% CI 0.02-0.9, P = .045), but did not affect mortality ( P = .94), mRS shift ( P = .50), or length of stay ( P = .90). Propensity-matched analysis similarly demonstrated that non-DC patients were more likely to achieve the primary outcome (24% vs 8%, P = .045). CONCLUSION: In patients with sICH after AIS after MT, those selected for DC had less favorable outcomes and similar rates of mortality at 90 days.
The Hydrogel Endovascular Aneurysm Treatment Trial (HEAT): A Randomized Controlled Trial of the Second-Generation Hydrogel Coil
Bendok, Bernard R. , Abi-Aad, Karl R., Ward, Jennifer , Kniss, Jason F , Kwasny, Mary , Rahme, Rudy J. , Aoun, Salah G. , Tecle, Najib E. El , Zammar, Samer G. , Aoun, Rami James N. , Patra, Devi Prasad, Raymond, Jean , Woo, Henry H. , Dabus, Guilherme , Milot, Geneviève , Scott, John A. , DeNardo, Andrew , Investigators, HEAT Study, Lavine, Sean D., Bozorgchami, Hormozd, Veznedaroglu, Erol, Albuquerque, Felipe C. , Fiorella, David, Boulos, Alan S. , Cortes, Maria, Kanaan, Hilal, Jindal, Gaurav , Klucznik, Richard , Kalmes, David, Xavier, Andrew, Hussain, Muhammad , Moran, Christopher J. , Adel, Brian van , Milot, Genevieve, Hirsch, Joshua A , Carpenter, Jeffrey , Powers, Ciarán J. , Luh, George, Tummala, Ramanchandra, Evans, Avery J. , Garg, Ankur, James, Roberts, Sauvageau, Eric , Fields, Jeremy D. , Grobelny, Thomas, Hartman, J., Patra, Devi P. , Bendok, Bernard R , Ward, Jennifer D, Ahmadieh, Tarek Y. El , Ansari, Sameer A. , Fiorella, David , Dabus, Guilherme C. , Almandoz, Josser E Delgado , Dashti, Shervin R , Investigators, HEAT Study, Deshaies, Eric Michael , Fiorella, David, Tawk, Rabih G. , Romero, Charles, Kelly, Michael , Chaudry, Imran , Pandey, Aditya S , Wang, Dennis Y.Q. , Milot, Genevieve, Jabbour, Pascal , Shankar, Jai , Patsalides, Athos T , Lee, Sung , James, Robert F. , Jayaraman, Mahesh V. , Satti, Sudhakar R
Neurosurgery | February 10, 2020 | Volume: 86 | Issue: 5 | Pages: 615-624
Abstract BACKGROUND Aneurysm recurrence after coiling has been associated with aneurysm growth, (re)hemorrhage, and a greater need for follow-up. The second-generation HydroCoil Embolic System (HES; MicroVention, Inc) consists of a platinum core with integrated hydrogel and was developed to reduce recurrence through enhancing packing density and healing within the aneurysm. OBJECTIVE To compare recurrence between the second-generation HES and bare platinum coil (BPC) in the new-generation Hydrogel Endovascular Aneurysm Treatment Trial (HEAT). METHODS HEAT is a randomized, controlled trial that enrolled subjects with ruptured or unruptured 3- to 14-mm intracranial aneurysms amenable to coiling. The primary endpoint was aneurysm recurrence using the Raymond-Roy scale. Secondary endpoints included minor and major recurrence, packing density, adverse events related to the procedure and/or device, mortality, initial complete occlusion, aneurysm retreatment, hemorrhage from target aneurysm during follow-up, aneurysm occlusion stability, and clinical outcome at final follow-up. RESULTS A total of 600 patients were randomized (HES, n = 297 and BPC, n = 303), including 28% with ruptured aneurysms. Recurrence occurred in 11 (4.4%) subjects in the HES arm and 44 (15.4%) subjects in the BPC arm ( P = .002). While the initial occlusion rate was higher with BPC, the packing density and both major and minor recurrence rates were in favor of HES. Secondary endpoints including adverse events, retreatment, hemorrhage, mortality, and clinical outcome did not differ between arms. CONCLUSION Coiling of small-to-medium aneurysms with second-generation HES resulted in less recurrence when compared to BPC, without increased harm. These data further support the use of the second-generation HES for the embolization of intracranial aneurysms. Video Abstract
A Randomized Trial Comparing Platinum and Hydrogel-Coated Coils in Patients Prone to Recurrence after Endovascular Treatment (The PRET Trial)
Raymond, Jean , Kallmes, D, GROUP, THE ICONE COLLABORATIVE, Roy, Daniel C. , White, Phil , Fiorella, David , Chapot, René , Bracard, Serge , GROUP, THE ICONE COLLABORATIVE
Interventional Neuroradiology | January 13, 2017 | Volume: 14 | Issue: 1 | Pages: 73-83
New coils have been designed to preserve the safety of coil embolization while improving on long-term efficacy. There is currently no scientific evidence that one type of coil material is better than another. The recurrence problem may be more pressing in certain types of patients, such as patients with large aneurysms or those already presenting with angiographic recurrences.