The Use of the Scepter Dual-Lumen Balloon Catheter for Trans-Arterial Onyx Embolization of Cranial Dural Arteriovenous Fistulas.

BACKGROUND: Dual lumen balloon microcatheters allow for controlled anterograde flow of Onyx while providing proximal flow arrest, thereby obviating the need for a second microcatheter or Onyx plug formation. OBJECTIVE: To assess the safety and efficiency of the Scepter dual-lumen balloon microcatheter in trans arterial Onyx embolization of intracranial DAVFs. METHODS: This is a retrospective study of 36 patients with cranial DAVFs in which a Scepter balloon microcatheter was used between 2016 and 2023. RESULTS: Our study comprised 36 patients, mostly male (n=23, 63.8%) with a mean age of 60.8 years. Most DAVFs were located in the occipital lobe (n=24, 66.7%) and 50% had external carotid artery supply from the occipital artery. 18 (50%) of DAVFs were Cognard type III and IV, respectively. 33.3% (n= 12) of DAVFs drained into the transverse sigmoid junction, and 27.7% (n= 10) had direct cortical venous drainage into supratentorial or posterior fossa veins. Complete occlusion was obtained in 22 (61.1%) patients while partial occlusion was observed in 14 (38.9%) patients. 1 (2.8%) patient developed a retroperitoneal hematoma. At final follow-up complete occlusion was observed in 21 (77.8%) and partial occlusion was observed in 8 (22.2%). Recurrence was observed in 4/30 (13.3%) patients and retreatment was required in 6 (18.75%) cases. CONCLUSION: At mid-term follow-up, our study showed low morbidity and modest complete occlusion rates using the Scepter for trans arterial Onyx embolization of high grade DAVFs.

Transradial versus transfemoral access routes for diagnostic cerebral angiography: a large single-center comparative cost-analysis study.

OBJECTIVE: Recently, the transradial (TR) approach has become a common alternative because of its safety profile and increased patient satisfaction compared with the transfemoral (TF) route. Both routes are associated with their respective associated costs, and differences typically emerge on the basis of patient anatomy, operator expertise, and occurrence of complications. The authors' objective was to compare the overall costs of diagnostic cerebral angiography via both routes and to shed light on the individual equipment costs of each route. METHODS: This retrospective single-center study of 926 elective diagnostic angiograms was performed between December 2019 and March 2022. RESULTS: The study comprised of 314 and 612 angiograms performed through the TF and TR routes, respectively. A significantly greater proportion of female patients were included in the TF cohort (79.3% vs 67.8%, p < 0.001), and most other demographic characteristics and baseline modified Rankin Scale scores were comparable between cohorts. The overall cost of patients utilizing the TR route was comparable to that of the TF route (mean ± SD $12,591.80 ± $19,128.00 vs $12,789.50 ± 18,424.00, p = 0.88). However, the median cost of catheters was significantly higher in TR group ($55.20 vs $12.40, p = 0.03), while the median costs of closure devices ($87.00 vs $20.20 p < 0.001) and sheaths ($44.60 ± 11.3 vs $41.10 ± 3.10, p < 0.001) were significantly higher in the TF group. CONCLUSIONS: Overall, the authors' study showed that the TR approach can be a less expensive option for patients undergoing diagnostic cerebral angiography, especially if complications occur. Future studies may corroborate these findings and potentially lead to the adoption of TR as a low-cost, efficient, gold-standard technique for cerebral angiography.

Social Media and Neurosurgery: Insights from the Top 100 Neurosurgery Influencers on Twitter.

BACKGROUND: The rise in popularity of social media (SoMe) in medicine has created a powerful tool for the professional development and continued education of clinicians. Numerous benefits of SoMe exist; however, significant challenges concerning professionalism, confidentiality, and spread of misinformation may limit its usefulness. To understand the ways the top 100 Twitter influencers interact with SoMe, their views on SoMe, and its future in the medical field. METHODS: Literature was reviewed to obtain common concerns about SoMe in the medical field. A survey with 30 questions was sent to the top 100 Twitter influencers in the Neurosurgical field identified by Riccio et al. The survey assessed participant demographics, SoMe activity, stance toward SoMe, and views on the future of SoMe. RESULTS: Most participants were in the age group of 35-44 years (n = 23, 44.2%), resided in the United States (n = 39, 73.6%), have been in practice for 6-10 years (n = 14, 26.4%), and ranked Twitter as the mostly used platform (n = 37,72.6%). Per participant Reponses, 35 (66%) participants have taken a political stance on SoMe, 0 (0%) have gotten into any legal issues regarding a post shared on SoMe, 45 (84.9%) agreed/strongly agreed that SoMe is essential for networking and mentorship, and 49 (92.3%) agreed/strongly agreed that that SoMe will continue to play a major role in the medical field. CONCLUSIONS: Although SoMe has its advantages, several disadvantages render it a double-edged sword. Maximizing SoMe's benefits and minimizing its misuse will further strengthen its role in the medical field.

The Effect of COVID-19 Vaccines on Stroke Outcomes: A Single-Center Study.

BACKGROUND: One of the defining narratives of the COVID-19 pandemic has been the acceptance and distribution of vaccine. To compare the outcomes of COVID-19 positive vaccinated and unvaccinated stroke patients. METHODS: This is a single-center retrospective study of COVID-19-vaccinated and unvaccinated stroke patients between April 2020 and March 2022. All patients presenting with stroke regardless of treatment modalities were included. National Institutes of Health Stroke Scale was used to assess stroke severity. The primary outcome was functional capacity of the patients at discharge. RESULTS: The study cohort comprised 203 COVID-19 positive stroke patients divided into 139 unvaccinated and 64 fully vaccinated patients. At discharge, the modified Rankin scale score was significantly lower in the vaccinated cohort (3[1-4] vs. 4[2-5], odds ratio = 0.508, P = 0.011). At 3 months of follow-up, the median modified Rankin scale score was comparable between both cohorts. CONCLUSIONS: Although vaccination did not show any significant difference in stroke patient outcomes on follow-up, vaccines were associated with lower rates of morbidity and mortality at discharge among stroke patients during the pandemic.

Comparison of Flow-Redirection Endoluminal Device and Pipeline Embolization Device in the Treatment of Intracerebral Aneurysms.

BACKGROUND: The use of flow diverters for treating intracranial aneurysms has been widely used in the past decade; however, data comparing pipeline embolization device (PED; Medtronic Inc) and flow-redirection endoluminal device (FRED; MicroVention) in the treatment of intracranial aneurysms remain scarce. OBJECTIVE: To compare the outcomes of PED and FRED in the treatment of intracranial aneurysms. METHODS: This is a single-center retrospective review of aneurysms treated with PED and FRED devices. Patients treated with PED or FRED were included. Cases requiring multiple or adjunctive devices were excluded. Primary outcome was complete aneurysm occlusion at 6 months. Secondary outcomes included good functional outcome, need for retreatment, and any complication. RESULTS: The study cohort comprised 150 patients, including 35 aneurysms treated with FRED and 115 treated with PED. Aneurysm characteristics including location and size were comparable between the 2 cohorts. 6-month complete occlusion rate was significantly higher in the PED cohort (74.7% vs 51.5%; P = .017) but lost significance after inverse probability weights. Patients in the PED cohort were associated with higher rates of periprocedural complications (3.5% vs 0%; P = .573), and the rate of in-stent stenosis was approximately double in the FRED cohort (15.2% vs 6.9%; P = .172). CONCLUSION: Compared with PED, FRED offers modest 6-month occlusion rates, which may be due to aneurysmal and baseline patient characteristics differences between both cohorts. Although not significant, FRED was associated with a higher complication rate mostly because of in-stent stenosis. Additional studies with longer follow-up durations should be conducted to further evaluate FRED thrombogenicity.