Journal of NeuroInterventional Surgery最新文献

{"title":"Medical malpractice claims and state medical board complaints among United States neurointerventionalists.","authors":"Kyle M Fargen, Ankitha M Iyer, J Mocco, Johanna T Fifi, Guilherme Dabus, Justin F Fraser, Joshua A Hirsch, Mahesh V Jayaraman","doi":"10.1136/jnis-2024-021959","DOIUrl":"10.1136/jnis-2024-021959","url":null,"abstract":"<p><strong>Background: </strong>Surgeons are at high risk for malpractice claims, which can significantly impact physician quality of life and risk of burnout. There are few published data reporting the incidence, outcomes, and repercussions of malpractice lawsuits on neurointerventionalists.</p><p><strong>Methods: </strong>A survey of senior members of the United States Society of Neurointerventional Surgery (SNIS) was performed to study malpractice litigation and medical board complaints.</p><p><strong>Results: </strong>In total, 173 responses were obtained. Of the total sample, 66 respondents (38.2%) reported being subject to a total of 84 malpractice claims during independent practice over the last 10 years, amounting to a malpractice claim annual incidence of 5.9% (84 cases per 1423 years of practice). The majority of claims involved either brain aneurysms (34.5%) or arteriovenous malformations (23.8%), with most alleging either intra-procedural (38.1%) or post-procedural (27.3%) complications. Only three of the 58 claims that had concluded ended in court settlements (5.2%). The majority (78.3%) of claims resulted in no consequences to physician practice. Fourteen respondents (8.1%) reported being subject to a total of 16 state medical board complaints over the previous decade, with most resulting in no significant repercussions.</p><p><strong>Conclusion: </strong>Malpractice claims are common among neurointerventionalists and often cause significant physician distress, yet most result in claims being dropped or no paid damages, and the majority conclude without practice repercussions for the named physicians.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The correlation between intracranial pressure and venous sinus pressures changes after venous sinus stenting.","authors":"Ankitha M Iyer, Jackson P Midtlien, Carol Kittel, Lucas A Klever, Angelina Wiater, Emily Chang, Connor Margraf, Kyle M Fargen","doi":"10.1136/jnis-2024-022250","DOIUrl":"https://doi.org/10.1136/jnis-2024-022250","url":null,"abstract":"<p><strong>Background: </strong>The pathophysiology of idiopathic intracranial hypertension (IIH) and other cerebral venous outflow disorders (CVD) has largely been unexplored. While a correlation between venous sinus pressure and opening pressure (OP) has been previously noted, there are limited data on this relationship in patients with prior venous sinus stenting (VSS).</p><p><strong>Methods: </strong>A single center retrospective chart review was conducted on CVD patients who underwent diagnostic cerebral venography with manometry followed immediately by lateral decubitus lumbar puncture, from 2016 to 2024.</p><p><strong>Results: </strong>206 patients underwent 216 total procedures and were included. Among all patients, there was a moderate nearly one-to-one correlation between OP and torcular or superior sagittal sinus (SSS) pressures. Thirty-two patients underwent testing after having undergone VSS. Patients with previous VSS showed a significantly altered relationship between venous pressures and OP, whereby as venous sinus pressures increased, OP increased more gradually in previously stented patients compared with non-stented patients. For example, when OP was fixed at 21 mm Hg and body mass index at 30 kg/m², predicted mean SSS pressure was 19.47 mm Hg in non-stented patients versus 16.91 mm Hg in stented patients.</p><p><strong>Conclusion: </strong>This study confirmed a strong relationship between OP and venous sinus pressure in CVD patients. However, patients with previous VSS demonstrated an altered relationship with higher CSF pressures relative to venous pressures compared with naïve patients. This finding may have important clinical implications in the management of IIH patients.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic disease might well impact a patient 'systemically'.","authors":"James M Milburn, Kelsey Rose Casano, Joshua A Hirsch","doi":"10.1136/jnis-2024-022473","DOIUrl":"https://doi.org/10.1136/jnis-2024-022473","url":null,"abstract":"","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial, but is it intelligent?","authors":"Michael R Levitt, Jan Vargas","doi":"10.1136/jnis-2024-022412","DOIUrl":"https://doi.org/10.1136/jnis-2024-022412","url":null,"abstract":"This editorial was not written by a chatbot, but it could have been.1 The expansion of abilities in artificial intelligence and machine learning (AI/ML) has led to a dramatic uptake in a variety of disciplines, with particular excitement in medical diagnosis and prognosis. Aside from its increasingly common use in the detection of large vessel occlusion for rapid stroke triage,2 recent applications of AI/ML in neurointervention have included patient selection3 and prediction of functional outcomes in mechanical thrombectomy,4–6 detection of catheter complications or undesirable embolization during endovascular intervention,7–9 and identification of patients with procedurally challenging arterial anatomy,10 among many others, employing AI/ML applications across large language models and computer vision. The state of the science of AI/ML in clinical outcome prediction in particular was recently summarized in the pages of this journal.11 A meta-analysis of 60 studies that used AI/ML to predict postoperative outcomes or complication after cerebrovascular or neuroendovascular surgery for stroke, aneurysm, or cerebral vascular malformation found relatively favorable performance compared with standard clinical prediction scales (area under the receiver operator characteristics curve (AUROC) >0.85 in most cases). Typically, such performance would be considered acceptable for clinical use. However, only 16.7% of such studies included external validation, and many had a high risk of bias. Given the rapid evolution of AI/ML in neurointervention, it is tempting for the clinician to lean more and more on this technology for diagnosis, prognosis, and clinical decision-making. However, we identify areas of concern that must be addressed in …","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142254070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Braids and beyond: a comprehensive study on pipeline device braid stability from PREMIER data.","authors":"Fernanda Rodriguez-Erazú, Gustavo M Cortez, Demetrius K Lopes, Salvador F Gutierrez-Aguirre, Otavio Frederico De Toledo, Amin Aghaebrahim, Eric Sauvageau, David F Kallmes, Jens Fiehler, Ricardo A Hanel","doi":"10.1136/jnis-2024-022350","DOIUrl":"https://doi.org/10.1136/jnis-2024-022350","url":null,"abstract":"<p><strong>Background: </strong>The pipeline embolization device (PED) has been increasingly used to treat brain aneurysms; however, concerns have been raised about braid stability with newer drawn filled tubing technology devices.</p><p><strong>Objective: </strong>To evaluate braid stability of PED early generations using data from the PREMIER trial.</p><p><strong>Methods: </strong>All consecutive intracranial aneurysms treated with PED (Classic and Flex) within the PREMIER trial were reviewed for braid stability (fish mouthing, foreshortening, braid bump, braid collapsing). Immediate postprocedure cone-beam CT and angiography were compared with 1- and 2- years' follow-up. Analyses included safety, measured with the modified Rankin Scale (mRS) score, including +1 mRS point and a good clinical outcome (mRS score 0-2), vessel stenosis ≥50%, effectiveness measured with Raymond-Roy Scale, and re-treatment rates.</p><p><strong>Results: </strong>133/141 aneurysms had a complete dataset. 8/133 (6%) aneurysms showed braid deformations. Inter-reader agreement was excellent (κ=0.83). Braid deformations were statistically significantly associated with in-stent vessel stenosis >50% (P=0.029), without impact on effectiveness or safety. Fish mouthing was found in 1/133 (0.75%) at 1 year, causing >50% vessel stenosis. Foreshortening occurred in 6/133 (4.5%), and braid bump in 1/133 (0.75%) associated with severe in-stent stenosis. Four other cases (3.0%) of asymptomatic in-stent stenosis due to neointimal hyperplasia were seen without braid changes. No new braid stability deformations were found at the 2-year follow-up.</p><p><strong>Conclusion: </strong>Our study demonstrates excellent braid stability among patients treated with the PED Classic and Flex in the PREMIER trial. Within the uncommon braid changes observed, none affected the PED safety or efficacy.</p><p><strong>Trial registration number: </strong>NCT02186561.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gene therapy for intracranial aneurysms: systemic review.","authors":"Malia McAvoy, Buddy Ratner, Manuel J Ferreira, Michael R Levitt","doi":"10.1136/jnis-2024-021843","DOIUrl":"10.1136/jnis-2024-021843","url":null,"abstract":"<p><p>Treatment of intracranial aneurysms is currently limited to invasive surgical and endovascular modalities, and some aneurysms are not treatable with these methods. Identification and targeting of specific molecular pathways involved in the pathogenesis of aneurysms may improve outcomes. Low frequency somatic variants found in cancer related genes have been linked to intracranial aneurysm development. In particular, mutations in the <i>PDGFRB</i> gene lead to constitutively activated ERK and nuclear factor κB signaling pathways, which can be targeted with tyrosine kinase inhibitors. In this review, we describe how low frequency somatic variants in oncogenic and other genes affect the pathogenesis of aneurysm development, with a focus on gene therapy applications, such as endovascular in situ delivery of chemotherapeutics.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurointerventional payment for out-of-network mechanical thrombectomy in the era of the No Surprises Act.","authors":"Jonathan A Grossberg, Eric W Christensen, James M Milburn, Guilherme Dabus, Richard E Heller, Joshua A Hirsch","doi":"10.1136/jnis-2024-022202","DOIUrl":"https://doi.org/10.1136/jnis-2024-022202","url":null,"abstract":"<p><strong>Background: </strong>Congress enacted the No Surprises Act (NSA) in 2021. The NSA relies on the ability for providers to appeal their out-of-network (OON) payment through an arbitration process known as Independent Dispute Resolution (IDR). This study was designed to evaluate the effective access to IDR for mechanical thrombectomy (MT).</p><p><strong>Methods: </strong>This study uses a simulation to model the likelihood that neurointerventionalists have financially viable access to the NSA IDR process to seek adequate payment for MT OON claims.</p><p><strong>Results: </strong>When evaluating professional claims, for only batches of four or more claims, would the expected payment recovery exceed the expected IDR costs. For global claims (both professional and technical components), a batch size of two claims would be required for the expected payment recovery to exceed expected IDR costs.For the 1000 simulations at large MT centers (300 MT annually), there were no instances where it would have been financially viable to submit professional-only OON claims to the IDR process. For global claims, it would have been financially viable to submit to IDR for only 13.2% of these claims. For smaller stroke centers, there were also no instances where it would have been financially viable to submit professional-only claims. For global claims, it would have been financially viable for only 3.3-6.1% of claims.</p><p><strong>Conclusions: </strong>The NSA process was designed to protect patients from unexpected bills following non-elective medical services. Given the emergent nature of many neuroendovascular cases and the lack of access to the IDR process as this model illustrates, the field is at risk for under-reimbursement due to NSA legislation.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trans-umbilical access in the neonate with sheath preservation for intervention.","authors":"Maximilian Jeremy Bazil, Tomoyoshi Shigematsu, Johanna T Fifi, Alejandro Berenstein","doi":"10.1136/jnis-2024-021561","DOIUrl":"https://doi.org/10.1136/jnis-2024-021561","url":null,"abstract":"<p><p>High-flow vascular malformations in neonates may require emergent embolization to prevent or treat congestive heart failure when intervention is indicated.1 While transfemoral access is the traditional approach, this route may be complicated by the sheath size (typically 4F in our experience, as a smaller sheath system may prove suboptimal) needed for embolization. This is especially true when (1) multiple acute interventions are anticipated during the neonatal period and/or (2) when it is preferred to spare femoral access for future treatments in infancy or childhood.1-3 The safety and feasibility of using transumbilical (TU) access via the umbilical artery and maintaining an indwelling sheath post-procedurally has been previously described and indeed does spare the femoral arteries for later treatments; however, this technique has not yet been sufficiently demonstrated or reported to the extent that it could be easily reproduced.1-10 In this technical video, we detail the required materials and demonstrate a step-by-step guide to obtaining TU access in the context of neonatal vascular malformation embolization. Our practice has utilized this technique for decades and we hope that by sharing our methods with the neurointerventional community we may make this rarely performed procedure a feasible option for proceduralists (see video 1) .neurintsurg;jnis-2024-021561v1/V1F1V1Video 1Technical instructional video for trans-umbilical access in the neonate with sheath preservation for intervention.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early stopping versus continued retrievals after failed recanalization: associated factors and implications for outcome.","authors":"Helge C Kniep, Lukas Meyer, Gabriel Broocks, Matthias Bechstein, Christian Heitkamp, Laurens Winkelmeier, Vincent Geest, Tobias D Faizy, Ludger Feyen, Caspar Brekenfeld, Fabian Flottmann, Rosalie V McDonough, Mate Maros, Maximilian Schell, Uta Hanning, Goetz Thomalla, Jens Fiehler, Susanne Gellissen","doi":"10.1136/jnis-2024-022157","DOIUrl":"https://doi.org/10.1136/jnis-2024-022157","url":null,"abstract":"<p><strong>Background: </strong>Successful recanalization defined as modified Thrombolysis in Cerebral Infarction Score (mTICI) ≥2b is not achieved in 15%-20% of patients with acute ischemic stroke. This study aims to identify patient-specific factors associated with early stopping without successful recanalization. We hypothesized that the probability of the decision for early stopping during mechanical thrombectomy (MT) is higher in patients with an unfavorable prognosis.</p><p><strong>Methods: </strong>All patients enrolled in the German Stroke Registry (GSR) between June 2015 and December 2021 were screened. Inclusion criteria were stroke in the anterior circulation and availability of relevant clinical data. For each retrieval attempt 1-3, patients with stopping and failed reperfusion (mTICI <2b) were compared with all patients with continued retrieval attempts using descriptive statistics and multivariable logistic regression.</p><p><strong>Results: </strong>Our study included 2977 patients, 350 (12%) of which had early stopping. Higher pre-stroke Modified Rankin Scale (mRS) score (adjusted odds ratio (aOR) =1.20 (95% confidence interval (CI): 1.09; 1.32), P<0.001), higher age (aOR=1.01 (1.00; 1.02), P=0.017) and distal occlusions (aOR=1.93 (1.50; 2.47), P<0.001) as well as intraprocedural dissections/perforations (aOR=4.61 (2.95; 7.20), P<0.001) and extravasation (aOR=2.43 (1.55;3.82), P<0.001) were associated with early stopping. In patients with unsuccessful recanalization (n=622), the number of retrieval attempts (aOR=1.05 (0.94; 1.18), p=0.405) was not associated with unfavorable outcomes (90d-mRS>3).</p><p><strong>Conclusion: </strong>The probability of early stopping was higher in patients with clinical conditions associated with: a) Favorable prognosis and assumed lower impact of recanalization success on functional status, such as distal occlusions; and b) Unfavorable prognosis, such as higher age and reduced pre-stroke functional status. Adverse events during the procedure increased the probability of early stopping. The number of recanalization attempts did not increase the risk of unfavorable outcome for patients with persistent occlusion, supporting the decision for continuation of retrieval attempts.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous recanalization in acute large core ischemic stroke due to large vessel occlusion: a post-hoc analysis of the ANGEL-ASPECT trial.","authors":"Longhui Zhang, Fangguang Chen, Thanh N Nguyen, Yuesong Pan, Yufan Liu, Mengxing Wang, Shuo Li, Dapeng Sun, Xiaochuan Huo, BaiXue Jia, Zhongrong Miao","doi":"10.1136/jnis-2024-022357","DOIUrl":"https://doi.org/10.1136/jnis-2024-022357","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have indicated that a subset of patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) experience spontaneous recanalization (SR), but the prognosis and factors associated with SR in these individuals are not well characterized.</p><p><strong>Methods: </strong>We conducted a post hoc secondary analysis of the Study of Endovascular Therapy in Acute Anterior Circulation Large Vessel Occlusive Patients with a Large Infarct Core (ANGEL-ASPECT) trial. SR in the medical management group was defined as a modified arterial occlusive lesion (AOL) grade of 2 or 3 on computed tomography angiography (CTA) or magnetic resonance angiography (MRA) at 36 hours (±12 hours).</p><p><strong>Results: </strong>SR was detected in 67 out of 184 patients (36.4%) in the medical management (MM) group. The median age of patients was 67 years (interquartile range (IQR) 58-72), and 48 (71.6%) were male. The adjusted odds ratio (aOR) for 90-day modified Rankin Scale (mRS) score shift toward better outcomes of the MM with SR group vs the MM without SR group was 1.83, with marginally significant difference (95% confidence interval (CI) 0.992 to 3.36; P=0.053). No significant difference was found between the MM with SR group and EVT recanalization group (aOR 1.45; 95% CI 0.86 to 2.43; P=0.16) with similar findings in the inverse probability treatment weighting analysis (OR 0.85; 95% CI 0.49 to 1.48; P=0.57). Multivariable regression analysis showed that hypertension, atherothrombotic stroke and higher clot burden score were factors associated with SR.</p><p><strong>Conclusions: </strong>SR in medically managed patients with acute large ischemic stroke caused by LVO was associated with good functional outcome. An improved understanding of SR patients may be helpful to develop therapeutic strategy in patients with large infarct due to LVO in anterior circulation.</p><p><strong>Trial registration number: </strong>NCT04551664.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}