Publications by authors named "Chirag D Gandhi"

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.

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  • This study analyzed decisions regarding decompressive hemicraniectomy (DHC) and early withdrawal of life-sustaining therapy (WLST) in patients with large vessel occlusion (LVO) and large ischemic strokes from the SELECT2 trial.* -
  • Among 352 patients, DHC was utilized in 55 patients, and WLST was chosen for 81, showing no significant differences in usage between those receiving endovascular thrombectomy (EVT) and those treated medically.* -
  • About 21% of DHC patients were able to walk independently after one year, indicating that DHC did not negatively impact the benefits of thrombectomy, while WLST generally resulted in poor outcomes.*
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  • Endovascular thrombectomy (EVT) has proven safe and effective for patients suffering from large core strokes, but the effects of reperfusion quality and procedure details on outcomes are still unclear.
  • In the SELECT2 trial, findings indicated that 80% of patients experienced successful reperfusion, which correlates with better clinical outcomes, particularly in those who achieved near-complete reperfusion.
  • Longer procedure times negatively impacted patient outcomes, while the method of thrombectomy (aspiration vs stent-retriever) showed no significant differences in reperfusion success or functional recovery.
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Glioblastoma (GBM) is categorized by the World Health Organization (WHO) as a grade 4 glioma and is a uniformly fatal tumor of the central nervous system. With the discovery of specific gene anomalies, GBM classification has been modified several times to provide better diagnostic and prognostic accuracy. Survival outcomes remain dismal despite the current therapeutic modalities, which include a combination of surgical resection, adjuvant chemotherapy, and radiotherapies, providing brief control of tumor progression.

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  • Migraine prevalence during reproductive years can be as high as 25%, yet the connection between migraines and stroke is not well understood, particularly in pregnant women.
  • This study analyzed data from over 19 million pregnant patients, finding that those with migraines were more likely to experience ischemic and hemorrhagic strokes compared to those without migraines.
  • Pregnant women with migraines, especially those experiencing aura, have a significantly higher risk of stroke and should consult their healthcare providers to monitor for potential neurological issues.
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Background: Glioblastoma multiforme (GBM), a high-grade primary brain tumor, presents a formidable challenge in neuro-oncology because of its aggressive nature, infiltrative growth, and limited response to treatment. The septum pellucidum represents an uncommon and unexpected location for GBM, adding complexity to the diagnosis and management of this rare intracranial malignancy.

Observations: A 69-year-old male with a previous history of prostate carcinoma presented to an outside hospital with a 2-week history of a "trance-like state" and cognitive decline.

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The proportion of women surgeons is increasing, but studies show that women in surgical residency are granted less autonomy than men. We utilized the Surgical Autonomy Program (SAP), an educational framework, to evaluate gender differences in self-reported autonomy, attending-reported autonomy, and operative feedback among US neurosurgical residents. The SAP tracks resident progression and guides teaching in neurosurgery.

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Background And Purpose: Cerebral venous thrombosis (CVT) is associated with a high degree of morbidity and mortality. Our objective is to elucidate characteristics, treatments, and outcomes of patients with cancer and CVT (CA-CVT).

Methods: The 2016-2019 National Inpatient Sample (NIS) database was queried for patients with a primary diagnosis of CVT.

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  • Dural venous sinus stenting is a growing procedure in otolaryngology that works in tandem with neurosurgeons and neuroradiologists, having been introduced around 20 years ago.
  • * It is now a standard treatment for patients experiencing increased intracranial pressure due to transverse sinus stenosis, with ENT doctors often being the first to diagnose these issues.
  • * Traditional treatments like high-dose diuretics were largely ineffective, and other methods have posed serious risks, making endovascular sinus stenting a promising option for patients with specific clinical and imaging characteristics.
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Endovascular thrombectomy (EVT) safety and efficacy in patients with large core infarcts receiving oral anticoagulants (OAC) are unknown. In the SELECT2 trial (NCT03876457), 29 of 180 (16%; vitamin K antagonists 15, direct OACs 14) EVT, and 18 of 172 (10%; vitamin K antagonists 3, direct OACs 15) medical management (MM) patients reported OAC use at baseline. EVT was not associated with better clinical outcomes in the OAC group (EVT 6 [4-6] vs MM 5 [4-6], adjusted generalized odds ratio 0.

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  • The study investigates the link between acute kidney injury (AKI) and outcomes in patients with spontaneous subarachnoid hemorrhage (SAH), a serious condition with a high risk of complications.
  • An analysis of over 76,000 SAH patients from 2010 to 2019 shows that about 14% developed AKI, with these patients being older and more likely to be obese compared to those without AKI.
  • Findings indicate that AKI is significantly associated with poorer functional outcomes, longer hospital stays, and higher in-hospital mortality, highlighting the need for early detection to improve recovery chances.
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Background: Owing to the relative rarity of unruptured intracranial aneurysms (UIAs) in the pediatric population, evidence regarding treatment modalities and clinical outcomes remains limited.

Objective: To characterize the use and clinical outcomes of endovascular therapy (EVT) and microsurgical clipping (MSC) for pediatric UIAs over a two-decade interval using a large national registry.

Methods: Pediatric (<18 years of age) UIA hospitalizations were identified in the National Inpatient Sample from 2002 to 2019.

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Background: Despite renewed interest and recently demonstrated efficacy for endovascular thrombectomy (EVT) for treatment of acute ischemic stroke (AIS) of the posterior circulation, to date, no randomized clinical trials have been conducted to evaluate EVT for isolated occlusions of the posterior cerebral artery (IPCA).

Methods: Hospitalizations for adult patients with primary admission diagnoses of IPCA occlusion were identified in the National Inpatient Sample registry during the period of 2016-2020. The study exposure was treatment with EVT, and primary clinical endpoints included favorable functional outcome (defined as discharge disposition to home without services, previously shown to have high concordance with modified Rankin scale scores 0-2), in-hospital mortality, and any intracranial hemorrhage (ICH).

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Background: Recent studies indicate endovascular thrombectomy (EVT) as a safe, effective treatment for acute ischemic stroke (AIS) with large ischemic regions. Our study updates an ongoing living systematic review and meta-analysis of randomized controlled trials (RCTs) comparing outcomes of EVT to medical management only.

Methods: We searched MEDLINE, EMBASE, and the Cochrane Library for RCTs comparing EVT to medical management in AIS patients with large ischemic areas.

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Background And Objectives: Dual antiplatelet therapy (DAPT) is necessary to minimize the risk of periprocedural thromboembolic complications associated with aneurysm embolization using pipeline embolization device (PED). We aimed to assess the impact of platelet function testing (PFT) on reducing periprocedural thromboembolic complications associated with PED flow diversion in patients receiving aspirin and clopidogrel.

Methods: Patients with unruptured intracranial aneurysms requiring PED flow diversion were identified from 13 centers for retrospective evaluation.

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  • - The study investigates the occurrence and effects of heparin-induced thrombocytopenia (HIT) in patients with aneurysmal subarachnoid hemorrhage (SAH), finding that 0.22% of 76,387 SAH patients developed HIT between 2010 and 2019.
  • - HIT was linked to significantly longer hospital stays and worse functional outcomes, particularly in younger patients, those with higher SAH severity scores, and individuals on long-term anticoagulants.
  • - The findings highlight that SAH patients with HIT face a range of complications and comorbidities, emphasizing the need for increased clinical awareness regarding HIT in this patient group.
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Introduction: Renal cell carcinoma (RCC) has been associated with an increased risk for acute ischemic stroke (AIS). As individuals with cancer who experience AIS tend to face higher mortality rates compared to AIS patients without cancer, recognizing the implications of RCC in AIS is crucial for identifying high-risk patients for major complications and directing management strategies.

Objective: To examine risk factors, interventions, and outcomes for patients with AIS stratified by their RCC diagnosis.

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Intracerebral hemorrhage (ICH) is the second most common type of stroke, accounting for approximately 10-20% of all strokes, and is linked to severe neurological disability and death. Since the most accurate predictor of outcome in patients with ICH is hematoma volume, there is a great need for pharmacologic therapy that can reduce hematoma expansion and resultant mass effect and edema. This is especially critical within the ultra-early window of 3-4 hours after the presentation.

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The mechanistic target of rapamycin (mTOR) is a serine/threonine kinase that functions via its discrete binding partners to form two multiprotein complexes, mTOR complex 1 and 2 (mTORC1 and mTORC2). Rapamycin-sensitive mTORC1, which regulates protein synthesis and cell growth, is tightly controlled by PI3K/Akt and is nutrient-/growth factor-sensitive. In the brain, mTORC1 is also sensitive to neurotransmitter signaling.

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  • Researchers looked at how bleeding in the brain (intracerebral hemorrhage or ICH) affects people who had a specific treatment for severe strokes called endovascular thrombectomy (EVT).
  • Out of the 351 patients studied, many experienced bleeding, especially those who had EVT, but serious types of bleeding were rare.
  • In the end, having some bleeding didn’t make the patients’ health outcomes worse, and there may be new treatments that could help those with bleeding issues in similar cases.
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  • Patients with large ischemic core strokes often have poor outcomes and are rarely transferred for endovascular thrombectomy (EVT), leading to a need for better understanding of treatment effects in different patient groups.
  • The study analyzed data from the SELECT2 trial, focusing on adults with acute ischemic strokes due to specific artery occlusions, comparing those who were directly treated at EVT centers with those who were transferred.
  • Results indicated that EVT improved functional outcomes in both transfer and non-transfer patients, suggesting that EVT can benefit patients regardless of transfer delays, although the median ASPECTS score showed a decline during transfers.
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Background: Multiple randomised trials have shown efficacy and safety of endovascular thrombectomy in patients with large ischaemic stroke. The aim of this study was to evaluate long-term (ie, at 1 year) evidence of benefit of thrombectomy for these patients.

Methods: SELECT2 was a phase 3, open-label, international, randomised controlled trial with blinded endpoint assessment, conducted at 31 hospitals in the USA, Canada, Spain, Switzerland, Australia, and New Zealand.

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Importance: Whether endovascular thrombectomy (EVT) efficacy for patients with acute ischemic stroke and large cores varies depending on the extent of ischemic injury is uncertain.

Objective: To describe the relationship between imaging estimates of irreversibly injured brain (core) and at-risk regions (mismatch) and clinical outcomes and EVT treatment effect.

Design, Setting, And Participants: An exploratory analysis of the SELECT2 trial, which randomized 352 adults (18-85 years) with acute ischemic stroke due to occlusion of the internal carotid or middle cerebral artery (M1 segment) and large ischemic core to EVT vs medical management (MM), across 31 global centers between October 2019 and September 2022.

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