Publications by authors named "Gustavo M Cortez"
Background And Objectives: The Woven EndoBridge (WEB) device is a breakthrough in brain aneurysm treatment, widely used for intracranial wide neck and complex aneurysms, especially at bifurcations. Although effective, aneurysm recurrence can occur post-treatment and the impact of clipping angle on the WEB mesh remains unclear. In this study, using a human placenta-based ex-vivo aneurysm model, we simulated the application of aneurysm clipping on WEB-treated aneurysms to elucidate the technical aspects and nuances, particularly the influence of the angle of clip application on WEB collapse.
View Article and Find Full Text PDFObjectives: Moyamoya disease (MMD) is a cerebrovascular disorder marked by the progressive steno-occlusion of the bilateral internal carotid arteries and the formation of abnormal collateral vessel networks at the base of the brain. Previous studies have attempted to identify risk factors predictive of postoperative complications to improve patient management. This study aims to identify pretreatment factors associated with post-bypass symptomatic strokes in MMD patients.
View Article and Find Full Text PDFBackground And Objectives: Moyamoya disease (MMD) is characterized by progressive steno-occlusion of the internal carotid arteries, leading to compensatory collateral vessel formation. The optimal surgical approach for MMD remains debated, with bilateral revascularization potentially offering more comprehensive protection but involving more extensive surgery compared to unilateral revascularization. This study aims to compare bilateral revascularization and unilateral revascularization short-term safety profile in the treatment of MMD.
View Article and Find Full Text PDFBackground: 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.
Article Synopsis
- The study examines the stability of the Pipeline Embolization Device (PED) in treating brain aneurysms, focusing on early generations and potential braid deformations.
- Data was gathered from the PREMIER trial, reviewing 133 out of 141 aneurysms for issues like braid bumping and foreshortening, assessing both safety and effectiveness.
- The results show that while a small percentage experienced braid deformations, they didn't significantly impact the device's safety or effectiveness over the follow-up period.
Article Synopsis
- - Moyamoya disease (MMD) is a rare brain disorder that causes narrowing of blood vessels, often accompanied by high blood pressure, which complicates the condition's outcomes; this study compares MMD patients with and without hypertension.
- - A total of 598 MMD patients were analyzed from multiple institutions, with hypertensive (292) and non-hypertensive (306) groups evaluated for clinical characteristics and outcomes using statistical adjustments to account for differences in their backgrounds.
- - Results indicated that although hypertensive patients showed higher rates of certain risk factors (like diabetes and smoking) and higher stroke rates before adjustments, post-matching analysis revealed no significant differences in stroke rates or recovery outcomes between the two groups, suggesting effective
Article Synopsis
- The study investigates the impact of decompressive craniectomy (DC) on patients with symptomatic intracerebral hemorrhage (sICH) following acute ischemic stroke, comparing outcomes between those who had surgery and those treated medically.
- It analyzed data from 85 patients across 8 stroke centers, revealing that DC patients were younger, had longer ICU stays, and showed better functional outcomes at 90 days compared to non-DC patients, especially if they were younger and did not have a history of cancer.
- The results indicate that the DC group had lower in-hospital mortality rates and came out with improved scores on the modified Rankin Scale, suggesting a potential benefit of surgery for select patients with severe sICH.
Background: With transradial access (TRA) being more progressively used in neuroendovascular procedures, we compared TRA with transfemoral access (TFA) in middle meningeal artery embolization (MMAE) for chronic subdural hematoma (cSDH).
Methods: Consecutive patients undergoing MMAE for cSDH at 14 North American centers (2018-23) were included. TRA and TFA groups were compared using propensity score matching (PSM) controlling for: age, sex, concurrent surgery, previous surgery, hematoma thickness and side, midline shift, and pretreatment antithrombotics.
Article Synopsis
- A study was conducted to investigate the effects of different anesthesia types (general vs. non-general) during endovascular treatment for strokes caused by distal medium vessel occlusions (DMVO).
- Researchers analyzed data from multiple centers and focused on outcomes like disability after 90 days, successful blood vessel reperfusion, and rates of complications.
- Results showed no significant differences between the two anesthesia groups regarding disability, successful treatment, or safety measures, suggesting that anesthesia type may not impact clinical outcomes in DMVO strokes.
Article Synopsis
- - The Surpass Evolve (SE) is a new type of flow diverter used as the primary treatment for certain intracranial aneurysms, and its safety and effectiveness were evaluated in a large, multicenter study called SEASE, involving data from 305 patients treated between 2020 and 2022.
- - Most patients in the study were female, had unruptured saccular aneurysms, and showed an average significant follow-up period during which 73% of aneurysms achieved complete occlusion.
- - The findings indicate that SE demonstrates a high rate of effectiveness in closing aneurysms and exhibits a favorable safety profile, with low rates of major strokes and procedure-related mortality.
Introduction: Aspiration mechanical thrombectomy traditionally includes use of an inner microcatheter and leading microwire to navigate an aspiration catheter (AC) to the site of occlusion. Early clinical experience suggests that a leading microwire is often not needed with the Tenzing 7 (T7, Route 92 Medical, San Mateo, CA), a soft tapered tip ledge-reducing delivery catheter. This multicenter experience aims to describe AC delivery success in single-pass thrombectomy using T7 with and without a leading microwire.
View Article and Find Full Text PDFBackground: The Neuroform Atlas Stent System is an established treatment modality for unruptured anterior and posterior circulation intracranial aneurysms. Location-specific results are needed to guide treatment decision-making. However, it is unclear whether there are differences in safety and efficacy outcomes between carotid and more distal anterior circulation aneurysms.
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- Middle meningeal artery embolization (MMAE) is a new treatment for a condition called chronic subdural hematomas (cSDHs), which are injuries inside the brain that can cause problems.
- This study looked at two groups of patients: one that got only MMAE and another that had MMAE plus surgery to see which treatment worked better.
- The results showed that both treatments were pretty much equally effective, meaning MMAE alone is a good option for some patients with cSDHs.
Background: The anterior communicating artery (AComm) region is the most common site of intracranial aneurysms, with increased rupture risk compared with other locations. Overall, flow diverters present as a safe and efficacious treatment for intracranial aneurysms, but there is paucity of data for their use in the treatment of unruptured AComm aneurysms. We present the largest multicentric analysis evaluating the outcomes of flow diverters in AComm aneurysm treatment.
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- * Results indicated that patients who underwent RS after failed MT had significantly lower disability levels and better functional outcomes at 90 days compared to those who didn't receive RS, as well as a lower mortality rate.
- * Safety metrics, including rates of symptomatic intracranial hemorrhage and procedural complications, were similar between both groups, suggesting that RS is a viable option for improving patient outcomes after failed MT.
Direct Versus Indirect Revascularization for Moyamoya: a Large Multicenter Study.
J Neurol Neurosurg Psychiatry
February 2024
Background: Moyamoya is a chronic occlusive cerebrovascular disease of unknown etiology causing neovascularization of the lenticulostriate collaterals at the base of the brain. Although revascularization surgery is the most effective treatment for moyamoya, there is still no consensus on the best surgical treatment modality as different studies provide different outcomes.
Objective: In this large case series, we compare the outcomes of direct (DR) and indirect revascularisation (IR) and compare our results to the literature in order to reflect on the best revascularization modality for moyamoya.
Background: Pipeline Flex Embolization Device with Shield Technology (PED-Shield) is a third-generation flow diverter with reduced thromboembolic potential. However, safety profile and dual antiplatelet therapy (DAPT) recommendations with PED-Shield is not well -established. We aim to assess the safety and complication profile with early termination of DAPT with use of PED-Shield.
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- - The study evaluates the effectiveness of the Pipeline Flex embolization device with Shield technology (PED Shield) compared to the traditional Pipeline Flex device in treating brain aneurysms, focusing on the occurrence of diffusion-weighted imaging positive (DWI+) lesions as a measure of thrombogenicity.
- - Researchers analyzed the outcomes of 89 patients, finding no significant difference in the incidence of DWI+ lesions between the two devices, with both groups exhibiting similar rates of 61% for PED Flex and 62% for PED Shield.
- - Although results showed no major differences, the study suggests the need for larger sample sizes to further investigate potential variances in treatment effects between the two devices.
Article Synopsis
- - A study investigated the occurrence of subarachnoid hemorrhage (SAH) in patients who had mechanical thrombectomy for acute stroke, finding it in 5.63% of cases within 24 hours post-surgery.
- - Factors linked to SAH included tandem occlusion, use of a reperfusion pump, intraoperative complications, longer recanalization times, and needing more passes to achieve recanalization.
- - Despite the presence of SAH, the study concluded that it did not negatively impact long-term functional outcomes for these patients.
Background: There is little data available to guide optimal anesthesia management during rescue intracranial angioplasty and stenting (ICAS) for failed mechanical thrombectomy (MT). We sought to compare the procedural safety and functional outcomes of patients undergoing rescue ICAS for failed MT under general anesthesia (GA) vs non-general anesthesia (non-GA).
Methods: We searched the data from the Stenting and Angioplasty In Neuro Thrombectomy (SAINT) study.
Article Synopsis
- Endovascular therapy is now the primary treatment for acute strokes caused by large vessel occlusions (LVO), and incidental vascular issues, such as brain aneurysms, are often found during these procedures.
- Intracranial aneurysms are found in about 4% of the general population, but stroke patients may have a higher prevalence due to shared risk factors.
- A report details three cases of stroke patients with brain aneurysms found during mechanical thrombectomy, highlighting the risks of aneurysm rupture during the procedure and emphasizing the need for interventionalists to manage these complications carefully.