Publications by authors named "Eytan Raz"
The 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: Intravenous thrombolysis (IVT), utilizing the clot-dissolving medications alteplase (rt-PA) or tenecteplase (TNK), is the cornerstone in acute ischemic stroke (AIS) emergency intervention. However, the impact of prior antiplatelet therapy (APT) on post-IVT outcomes when utilizing alteplase remains controversial. We conducted a systematic review and meta-analysis to evaluate the effect of prior APT on the outcomes after using alteplase in AIS patients.
View Article and Find Full Text PDFObjective: Typical carotid webs are nonatherosclerotic shelf-like projections of fibromyxoid tissue extending from the posterior wall of the proximal internal carotid artery. Carotid webs may precipitate acute embolic stroke, especially in younger patients. We describe our experience with pathology-proven carotid webs of atypical appearance, or atypical carotid webs (ACWs), a subset of carotid webs exhibiting abnormal location, morphology, or association with atherosclerotic changes.
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 PDFBackground: 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.
Interrupted Versus Running Sutures for Superficial Temporal Artery to Middle Cerebral Artery Cranial Bypass.
Oper Neurosurg (Hagerstown)
December 2024
Background And Objectives: Superficial temporal artery to middle cerebral artery (STA-MCA) bypass is the workhorse for flow augmentation surgery. Although either interrupted or running sutures can be used to complete the anastomosis with high intraoperative patency rates, no previous study in the cranial bypass literature has compared long-term patency and maturity of end-to-side STA-MCA anastomoses. We compared STA-MCA anastomoses performed with running vs interrupted sutures by evaluating bypass flow and anastomotic maturation on follow-up vascular imaging.
View Article and Find Full Text PDFBackground: Underlying intracranial stenosis is the most common cause of failed mechanical thrombectomy in patients with acute ischemic stroke with large vessel occlusion. Adjunct emergent stenting is sometimes performed to improve or maintain reperfusion, despite limited data regarding its safety or efficacy.
Methods: We conducted a prospective multicenter observational international cohort study.
Background: Hypoglossal canal dural arteriovenous fistulas (HCDAVFs) are a relatively rare subtype of dural arteriovenous fistula (dAVF), representing 3%-5% of all dAVFs. The complex angio- and venous architecture predisposed to numerous anastomoses and nearby anatomical structures, including the posterior fossa sinuses and cranial nerves, can complicate both the diagnosis and treatment of these lesions.
Observations: The authors describe the case of HCDAVF in a 74-year-old male who presented with pulsatile tinnitus (PT) lasting 3 months and significant fatigue, headaches, and dizziness.
Background: Aspiration thrombectomy is one of the mainstays for stroke interventions. The Zoom 71 (Z71) aspiration catheter is unique with its angled tip. This study describes the orientation of the angled tip as it is navigated around the carotid siphon in relation to trackability.
View Article and Find Full Text PDFArticle Synopsis
- Subdural hematoma is an uncommon occurrence linked to hereditary hemorrhagic telangiectasia (HHT), illustrated by a case study of a 49-year-old man with HHT experiencing symptoms like confusion and weakness.
- Imaging revealed a large chronic subdural hematoma that was impacting brain function, but instead of surgery, doctors opted for conservative treatment strategies to reduce further risks.
- The case emphasizes the need for cautious management of subdural hematomas in patients with HHT and showcases the effectiveness of nonsurgical options like embolization in achieving recovery.
The anatomy of vertebrobasilar perforators has been widely studied in human cadavers, with most reports found in the neurosurgical literature. These arterial perforators are extremely hard to visualize consistently with traditional two-dimensional digital subtraction angiography, but are reliably visible with cross sectional cone beam CT techniques. A clear understanding of this specific neurovascular anatomy and pathology is essential for informed treatment decisions.
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- 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
Treatment of Acute Iatrogenic Cerebrovascular Injury Using Flow Diverter Stents.
Oper Neurosurg (Hagerstown)
September 2024
Background And Objectives: Iatrogenic cerebrovascular injury can cause intracranial hemorrhage and pseudoaneurysm formation, putting patients at high risk for postoperative bleeding. No consensus for management exists. This study describes endovascular treatment of these acute injuries with flow diverter stents.
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- * Initial treatments such as transvenous embolization were ineffective, and traditional methods weren't viable due to the importance of the patient's right sigmoid sinus for brain drainage.
- * A successful alternative treatment used a pipeline embolization device (PED) to block the dAVF while keeping the sigmoid sinus functional, leading to improved blood flow and drainage confirmed in follow-up imaging.
Article Synopsis
- Diagnosing spinal vascular conditions is tough due to small structures, long imaging tests, and overlapping features.
- The authors provide strategies to help radiologists identify these conditions by focusing on vascular anatomy and imaging results.
- Three main types of abnormalities are discussed: infarcts, anomalies, and tumors, to assist in accurate diagnosis.
Article Synopsis
- Understanding neurovascular variants is essential for ensuring safe procedures in endovascular and neurosurgery, as these variations can impact treatment outcomes.
- The study reviewed uncommon neurovascular variants by analyzing a maintained neurovascular database and provided pictorial evidence along with insights on their embryology, clinical significance, and potential complications.
- The findings include a variety of anatomical anomalies both in the brain and outside of it, which can influence diagnosis and interventions; thus, raising awareness among healthcare professionals is critical for patient safety.
Objective: The objective of this study was to investigate the use of indocyanine green videoangiography with FLOW 800 hemodynamic parameters intraoperatively during superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery to predict patency prior to anastomosis performance.
Methods: A retrospective and exploratory data analysis was conducted using FLOW 800 software prior to anastomosis to assess four regions of interest (ROIs; proximal and distal recipients and adjacent and remote gyri) for four hemodynamic parameters (speed, delay, rise time, and time to peak). Medical records were used to classify patients into flow and no-flow groups based on immediate or perioperative anastomosis patency.
Article Synopsis
- - 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
- - 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.
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.
Purpose: Intracranial aneurysms present significant health risks, as their rupture leads to subarachnoid haemorrhage, which in turn has high morbidity and mortality rates. There are several elements affecting the complexity of an intracranial aneurysm. However, criteria for defining a complex intracranial aneurysm (CIA) in open surgery and endovascular treatment could differ, and actually there is no consensus on the definition of a "complex" aneurysm.
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- Researchers aimed to identify factors predicting aneurysm occlusion and retreatment following WEB embolization due to limited existing studies.
- The study reviewed data from 763 patients across 30 institutions, finding a 65.1% complete occlusion rate at follow-up and a 7.3% retreatment rate.
- Key negative predictors for complete occlusion included smoking history, larger aneurysm size, and wall branch presence, while intraprocedural occlusion significantly improved long-term outcomes.
Article Synopsis
- * Neuroradiologists should consistently check T2-weighted images for incidental cerebrovascular lesions, regardless of the primary reason for the MRI.
- * The article outlines the distinct imaging characteristics of various cerebrovascular lesions, including aneurysms, arteriovenous malformations, and other conditions observed in typical T2-weighted MRI scans.
Article Synopsis
- A solid grasp of venous anatomy is crucial for diagnosing and treating various medical conditions, particularly those affecting the brain.
- The venous system is gaining recognition for its potential in treating conditions like idiopathic intracranial hypertension, arteriovenous malformations, and pulsatile tinnitus.
- The article breaks down the anatomy of the central nervous system's venous system into five sections: embryology, dural sinuses, cortical veins, deep veins, and spinal veins.