Diversity among endovascular neurointerventionalists in Canada results of a national survey 2022.

AIM: Neurointervention (NIR) is a relatively new developing filed of medicine. Diversity and inclusion in various medical fields has made a significant progress. However, many surgical and interventional fields are still lagging in this respect. The aim of this study was to evaluate the degree of diversity and inclusion amongst neurointerventionalists in Canada. MATERIALS AND METHODS: A survey was completed in June 2022 by each neurointerventional division in Canada. The survey included questions regarding demographics, inclusivity, diversity, social and personal parameters. The collected data was analysed using semi-quantitative analysis. RESULTS: As of 2022, 85 physicians were actively practicing NIR in Canada. 52% were neuroradiologists, 38% neurosurgeons and 9% neurologists. 41% were immigrants to Canada (from 19 countries), for 35% English or French were not first language, 35% were visible minority. Women comprised only 21% of the practitioners, with comparable proportion of women in leadership positions. Most practitioners were in the 30-49 age group. 2.4% practitioners identified as LGBTQ. There was no gender difference in terms of life to work balance, with majority of practitioners being engaged in long term relationships and having children. CONCLUSIONS: Our study shows encouraging results in terms of diversity and inclusion amongst Canadian neurointerventionalists regarding the representation of various specialty backgrounds, immigrants, and visible minorities. NIR centers are distributed according to population density and better coverage is needed in smaller communities and remote/isolated areas. Both women and men Canadian neurointerventionalists seem to have a favourable life-work balance. Gaps still exist regarding inclusion of first nations and women which are under-represented among Canadian Neurointerventionalists. Women however are proportionally serving in leadership positions.

Use of the neuroform atlas for stenting of intracranial atherosclerotic disease: Clinical and angiographic outcomes.

BACKGROUND: Intracranial atherosclerotic disease (ICAD) is a potential cause of ischemic stroke. Treatment of ICAD can include intracranial stenting. There are specifically designed stents for this use-case; however, less is known about the off-label use of the Neuroform Atlas stent. In this study, we describe the outcomes of the Neuroform Atlas stent for treatment of ICAD. METHODS: Adult patients with symptomatic ICAD failing best medical treatment undergoing elective intracranial stenting using the Neuroform Atlas stent between November 2018 and March 2021 were included. Patient demographics, procedure-related details and clinical and imaging outcomes were analyzed. RESULTS: Eighteen patients met the inclusion criteria, with a mean follow-up duration of 9.6 ± 6.8 (standard deviation) months. There were two procedure-related mortalities (one massive intracranial hemorrhage and one groin site complication with sepsis). Fifteen patients were alive at the 6-month follow-up, all with satisfactory stent patency on follow-up imaging without any new ischemic events. Modified Rankin Scale at latest follow-up was 1.9 (interquartile range 5). CONCLUSION: In this single-center consecutive series, intracranial stenting with the Neuroform Atlas stent was a safe and effective treatment for symptomatic ICAD patients failing best medical management.

Thoracolumbar spinal dural arteriovenous fistulae present with longer arteriovenous transit compared to cranial and cervical dural fistulae.

BACKGROUND: Thoraco-lumbar spinal dural arteriovenous fistulae represent a rare subset of central nervous system vascular malformations. One of the unique features of spinal dural arteriovenous fistulae is their extremely low propensity to cause hemorrhage (either parenchymal or subarachnoid), with a distinct clinical presentation of myelopathy secondary to spinal venous congestion. The exact mechanism for this unique presentation is still unclear. METHODS: Following institutional review board approval, we retrospectively analyzed our prospectively maintained database of spinal dural arteriovenous fistulae and cranial (cr) DAVF cases presenting between 2008 and 2021. For all cases, angiograms were reviewed and arteriovenous transit times were calculated. Patient demographics, angiographic features, and clinical and radiological outcomes were assessed. RESULTS: In total, 66 patients presenting with confirmed thoracolumbar spinal dural arteriovenous fistulaes were identified and compared to patients presenting with cervical spinal dural arteriovenous fistulaes (n = 10), ruptured crDAVFs (n = 32) and unruptured crDAVFs (n = 20). Mean age in the target group was 66 ± 13 versus 57-62 in the other groups, p < 0.05 on one-way analysis of variance; with 80% males versus 50%-65% in other groups. Mean arteriovenous transit time in the thoracolumbar group measured 1.98 s ± 0.96 versus 0.25-0.5 s range in other groups (p < 0.0001 on one-way analysis of variance). CONCLUSION: Prolonged arteriovenous transit times may represent a distinct feature of thoracolumbar spinal dural arteriovenous fistulaes. This may, amongst other factors, play a role in the observed lesser likelihood of hemorrhagic complications compared to other dural arteriovenous shunts.