Publications by authors named "Ajit Puri"
Background: Mechanical thrombectomy (MT) is established as an effective treatment for large vessel occlusion strokes, but its efficacy and safety for medium vessel occlusions (MeVOs) remain less clear. This study examines the impact of periprocedural embolization to a new vascular territory (ENT) on clinical outcomes in patients with MeVO stroke treated with MT.
Methods: A multicenter, retrospective analysis was conducted using the MAD-MT (Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy) registry, including 2122 patients with MeVO stroke w-ho underwent MT between September 2017 and July 2023.
Objective: The Flow-Redirection Endoluminal Device X (FRED X) is a newer generation flow diverter with surface modifications aimed at minimizing thrombogenicity. At present, data on its long-term efficacy are limited. This multicenter study presents the largest series within the United States describing the device's efficacy, safety, and long-term outcomes in treating cerebral aneurysms of varying morphology.
View Article and Find Full Text PDFThe Woven EndoBridge (WEB) device is FDA-approved for the treatment of bifurcation aneurysms. Despite its wide popularity, it has been under scrutiny for its association with potential aneurysm recanalization and retreatment due to device shape modification. This study aims to analyze the shape modification rate of WEB devices and identify factors associated with this phenomenon, as well as its correlation with aneurysm retreatment.
View Article and Find Full Text PDFBackground: In the ESCAPE-NA1 trial, treatment with nerinetide, an eicosapeptide that interferes with post-synaptic density protein 95, was associated with improved functional outcome among patients with acute ischaemic stroke due to large vessel occlusion undergoing endovascular thrombectomy without co-treatment with an intravenous thrombolytic agent. There was no benefit when intravenous thrombolytic agent co-treatment was used. We sought to confirm the clinical benefit of nerinetide in the absence of previous intravenous thrombolytic drug treatment.
View Article and Find Full Text PDFObjective: 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.
View Article and Find Full Text PDFArticle Synopsis
- This study investigates the effects of pre-stroke low-dose aspirin on patients with acute ischemic stroke due to distal medium vessel occlusion undergoing mechanical thrombectomy.
- Findings show that aspirin users had significantly better functional outcomes and lower mortality rates after treatment, with no increase in bleeding risks.
- The results suggest that pre-stroke low-dose aspirin could be beneficial and safe for these patients, highlighting the need for more research on this topic.
Background: Medium vessel occlusions (MeVOs) account for 25-40% of acute ischemic stroke. The Tenzing 5 (Route 92 Medical, San Mateo, California, USA) and FreeClimb 54 (Route 92 Medical, San Mateo, California, USA) catheter is a novel delivery-aspiration catheter combination designed to facilitate aspiration thrombectomy (AT) of MeVOs. We report our clinical experience using the Tenzing assisted delivery of aspiration (TADA) technique with FreeClimb 54 for first-line AT of MeVO.
View Article and Find Full Text PDFBackground: Current randomized controlled trials are investigating the efficacy and safety of mechanical thrombectomy (MT) in patients with medium vessel occlusion (MeVO) stroke. Whether best medical management (MM) is more efficient than unsuccessful vessel recanalization during MT remains unknown.
Methods: This was a retrospective cohort study using data from 37 academic centers across North America, Asia, and Europe between September 2017 and July 2021.
Introduction: Mechanical thrombectomy (MT) efficacy in medium vessel occlusion (MeVO) stroke, particularly in patients with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS), remains less explored.
Methods: This retrospective study analyzed data from 443 AIS patients treated with MT for MeVO and low ASPECTS (4-7) at 37 centers across North America, Asia, and Europe, from September 2017 to July 2021. Patients were categorized into ASPECTS of 4-5 and 6-7.
Background: Data about the safety and the efficacy of flow diversion for distal anterior cerebral artery (DACA) aneurysms are limited. We present the largest multicenter analysis evaluating the outcomes of flow diversion in unruptured DACA aneurysm treatment.
Methods: Databases from 39 centers were retrospectively reviewed for unruptured DACA aneurysms treated with flow-diverting stents.
Article Synopsis
- The study examined the effectiveness of endovascular therapy (EVT) versus best medical therapy (BMT) for isolated anterior cerebral artery occlusions (ACAo) in acute stroke patients.
- The analysis involved 108 patients from various countries, comparing outcomes like functional independence at 90 days, with results showing no significant difference in success rates between EVT and BMT.
- Conclusions indicate that while EVT had a high success rate in procedures, it did not lead to better functional outcomes or lower mortality compared to BMT, suggesting a need for more randomized trials.
Background: The EXCELLENT registry aimed to evaluate the effectiveness of the EMBOTRAP Revascularization Device in an all-comer population in a real-world setting, with a focus on the composition of retrieved clots.
Methods: EXCELLENT is a prospective, global registry of patients with acute ischemic stroke treated with EMBOTRAP as the first-line mechanical thrombectomy device conducted at 34 sites (25 sites contributing clot) from September 2018 to March 2021, utilizing core imaging and central histology laboratories blinded to clinical data, independent 90-day modified Rankin Scale assessment and Clinical Events Committee.
Results: After screening 3799 patients, a total of 997 subjects (mean age, 70.
Background: Flow diversion has revolutionized the management of wide-necked intracranial aneurysms (IAs). We aimed to assess the effectiveness and safety of the new generation 64-wire Surpass Evolve for the treatment of unruptured small/medium-sized IAs.
Methods And Results: This is a subanalysis from the SEASE (Safety and Effectiveness Assessment of the Surpass Evolve) registry, an observational cohort study including 15 academic institutions in North America and Europe between July 2020 and October 2022.
Background: Despite the proven effectiveness of endovascular therapy (EVT) in acute ischemic strokes (AIS) involving anterior circulation large vessel occlusions, isolated posterior cerebral artery (PCA) occlusions (iPCAo) remain underexplored in clinical trials. This study investigates the comparative effectiveness and safety of EVT against medical management (MM) in patients with iPCAo.
Methods: This multinational, multicenter propensity score-weighted study analyzed data from the Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy (MAD-MT) registry, involving 37 centers across North America, Asia, and Europe.
Article Synopsis
- The study aimed to identify the optimal sizes for middle cerebral artery (MCA) bifurcation aneurysms that are most suitable for treatment with the Woven EndoBridge (WEB) device, focusing on aneurysm width and neck dimensions.
- Using a large retrospective database, the researchers analyzed unruptured MCA bifurcation aneurysms and established ideal cutoff values of 6.1 mm for width and 4.6 mm for neck size regarding treatment effectiveness.
- Findings indicated that aneurysms smaller than these cutoff values had significantly higher rates of occlusion (93% for width and 90% for neck) and lower retreatment rates compared to larger aneurysms, highlighting the importance of
Article Synopsis
- The study looked at whether a medical procedure called thrombectomy helps patients who have a large stroke as seen on a specific type of scan called a noncontrast CT within 24 hours of having the stroke.
- It involved 300 patients from different hospitals who were split into two groups; one group received the thrombectomy treatment, while the other only received regular care.
- The main goal was to see if those who had thrombectomy had better recovery after 90 days compared to those who didn’t, along with checking if there were any serious side effects.
An intuitive guidewire control mechanism for robotic intervention.
Int J Comput Assist Radiol Surg
February 2025
Article Synopsis
- Teleoperated Interventional Robotic systems (TIRs) aim to reduce radiation exposure for physicians and improve accuracy, but their adoption is hindered by control interfaces that are not intuitive compared to traditional methods.
- The research introduces a new control mechanism using an enhanced torque device paired with real-time motion mapping, designed to preserve the tactile feedback and muscle memory that interventionalists rely on.
- Testing showed a low tracking error with the new interface, and though slightly larger and heavier than traditional devices, it offers a more intuitive solution that could lead to broader acceptance of robotic assistance in medical procedures.
Article Synopsis
- Medium vessel occlusion (MeVO) strokes, especially in the M2 segment of the middle cerebral artery, are a significant challenge in stroke management, necessitating effective prediction of patient outcomes after mechanical thrombectomy (MT).
- This study analyzed data from the MAD-MT registry to evaluate the relationship between follow-up infarct volume (FIV) and 90-day functional outcomes, using the modified Rankin Scale (mRS) as a measurement.
- Results showed that FIV is a strong predictor of outcomes, with specific volume thresholds indicating favorable prognosis; notably, an FIV of ≤15 ml had the best predictive capability, outperforming traditional recanalization scores.
Article Synopsis
- The study investigates the effectiveness and safety of two treatment methods for acute ischemic stroke (AIS) caused by distal medium vessel occlusion (DMVO): intravenous thrombolysis (IVT) with mechanical thrombectomy (MT) versus IVT alone.
- Data was collected from 37 centers worldwide, involving over 1,000 patients, with the primary focus on functional independence at 90 days and secondary outcomes including mortality and intracerebral hemorrhage.
- Findings suggest that both treatment options yield similar functional and mortality outcomes for DMVO patients, but the MT-IVT approach carries a higher risk of hemorrhagic complications, indicating that it may not provide significant advantages over IVT alone for every patient.
Background: Treatment of large vessel occlusion (LVO) using mechanical thrombectomy with or without intravenous thrombolysis has demonstrated better outcomes compared to medical treatment alone. Large-bore aspiration catheters have been recently introduced. Their effectiveness and safety have not been demonstrated in a randomized trial.
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- - The study aimed to create a predictive calculator to determine the chances of achieving adequate occlusion (Raymond-Roy classification 1 or 2) when using the woven endobridge (WEB) device for intracranial aneurysms, drawing from a large dataset.
- - Analyzed data from 356 patients across 30 centers worldwide revealed that larger aneurysm neck size and partial thrombosis were linked to lower chances of successful occlusion, while the calculator showed good predictive accuracy.
- - The newly developed tool offers a valuable resource for clinicians to better estimate the success of using the WEB device in treating intracranial aneurysms, helping to enhance patient care.
Article Synopsis
- * Data from 670 patients revealed that while IVT may improve some outcomes, such as higher chances of achieving a modified Rankin Scale score of 0-2 in univariable analysis, this benefit was not consistently observed in more rigorous multivariable analyses.
- * Overall, the findings suggest that adjunctive IVT may not significantly enhance clinical outcomes or safety compared to MT alone for this patient population.
Article Synopsis
- - The Woven EndoBridge (WEB) device is used for treating wide-neck intracranial bifurcation aneurysms smaller than 10 mm, but there's limited data on its effectiveness for larger aneurysms.
- - A study reviewed data from the WorldWide WEB Consortium involving 898 patients to compare outcomes between small and large aneurysms, using propensity score matching (PSM) for accuracy.
- - Results showed that large aneurysms had significantly lower rates of adequate occlusion and higher rates of retreatment compared to small aneurysms, suggesting that these findings could influence treatment choices and patient discussions in the future.
Background: Acute ischemic stroke (AIS) from primary medium vessel occlusions (MeVO) is a prevalent condition associated with substantial morbidity and mortality. Despite the common use of mechanical thrombectomy (MT) in AIS, predictors of poor outcomes in MeVO remain poorly characterized.
Methods: In this prospectively collected, retrospectively reviewed, multicenter, multinational study, data from the MAD-MT (Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy) registry were analyzed.
Article Synopsis
- The Woven EndoBridge (WEB) device is being studied as a new treatment for intracranial aneurysms, particularly its effectiveness for off-label uses which require further investigation.
- A study of 162 patients utilizing machine learning developed predictive models for successful occlusion after off-label WEB treatment, analyzing various factors linked to outcomes.
- Findings indicated that larger neck diameter and the presence of daughter sacs significantly predicted poorer occlusion results, emphasizing the need for further validation to refine patient selection and treatment strategies.