Publications by authors named "James Siegler"
Introduction: Cervical artery dissection (CAD) involves the carotid or vertebral artery. However, limited studies have compared their clinical features and outcomes.
Methods: We examined non-traumatic CAD patients from the National Inpatient Sample (2005-2019).
Article Synopsis
- The Pipeline Vantage embolization device is a new fourth-generation tool designed to treat intracranial aneurysms, and this study evaluates its safety and effectiveness.
- The research involved 12 patients, primarily women, with a variety of aneurysm types, and demonstrated a 100% success rate in device deployment without intraoperative complications.
- One postprocedural complication occurred, and the findings represent the first US analysis of this device's use in patients with intracranial aneurysms, highlighting its potential for treating both ruptured and unruptured cases.
Background: Isolated anterior cerebral artery occlusions (ACAo) in patients with acute ischemic stroke present significant challenges due to their rarity. The efficacy and safety of endovascular therapy (EVT) in comparison with best medical therapy (BMT) for ACAo remains unclear. This study aimed to assess the outcomes of these treatments.
View Article and Find Full Text PDFBackground: Cerebral venous thrombosis (CVT) accounts for 0.5-1% of all strokes. The role of endovascular therapy (EVT) in the management of CVT remains controversial and variations in practice patterns are not well known.
View Article and Find Full Text PDFEndovascular thrombectomy for distal medium vessel occlusions: A literature review.
J Stroke Cerebrovasc Dis
November 2024
Background: There is a lack of substantial evidence supporting the safety and effectiveness of endovascular thrombectomy in treating distal medium vessel occlusions (DMVOs).
Objective: To summarize the current evidence regarding endovascular thrombectomy for DMVOs.
Methods: We conducted a narrative review of key articles related to the diagnosis and management of DMVOs.
Background: Growing evidence suggests that direct oral anticoagulants (DOACs) may be suitable for cerebral venous thrombosis (CVT). The optimal strategy regarding lead-in parenteral anticoagulation (PA) prior to DOAC is unknown.
Methods: In this post hoc analysis of the retrospective ACTION-CVT study, we compared patients treated with DOACs as part of routine care: those given "very early" DOAC (no PA), "early" (<5 days PA) and "delayed" (5-21 days PA).
Article Synopsis
- A study evaluated the safety and efficacy of endovascular thrombectomy in patients with acute large-vessel occlusion and tandem lesions, focusing on those with low (0-5) and high (6-10) Alberta Stroke Program Early Computed Tomography Scores (ASPECTS).
- The analysis included 691 patients, revealing that those with low ASPECTS had significantly lower odds of achieving a favorable functional outcome (mRS 0-2) and higher odds of suffering symptomatic intracranial hemorrhage compared to those with high ASPECTS.
- The researchers concluded that endovascular thrombectomy may lead to poorer functional recovery in patients with tandem lesions and low ASPECTS, particularly in the
Background: Rapid prehospital identification of acute ischemic stroke secondary to large vessel occlusions (AIS-LVO) has been successful in triaging patients, but the use of stroke screening scales often varies. This study aims to compare different stroke screening scales for the detection of anterior and posterior circulation AIS-LVO and AIS secondary to medium vessel occlusions (AIS-MeVO).
Methods: We prospectively analyzed stroke alert activations at a comprehensive stroke center between August 1, 2022 and December 31, 2023.
Background: In large vessel occlusion (LVO) stroke patients transferred to a comprehensive stroke center for thrombectomy, spontaneous reperfusion may occur during transport, and anecdotally more frequently in patients transferred via helicopter than by ground. This pattern has been more often observed in conjunction with tenecteplase (TNK) treatment prior to helicopter transport. We aim to explore the "chopperlysis" effect-how helicopter transport, particularly with thrombolytics, may affect reperfusion and clinical outcomes.
View Article and Find Full Text PDFArticle Synopsis
- A significant portion of patients (1 in 10) experience epilepsy after having cerebral venous thrombosis (CVT), but it's challenging to predict who will be affected.* -
- Researchers created the DIAS3 prognostic score using clinical data from over 1,100 patients to assess the likelihood of developing post-CVT epilepsy based on six clinical variables.* -
- The study found a range of predicted risks for post-CVT epilepsy within one and three years, with successful validation of the score confirming its effectiveness in estimating individual risk.*
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.
Background: Acute ischemic stroke (AIS) due to intracranial atherosclerotic disease (ICAD) carries a high risk of recurrence despite aggressive medical management. The aim of our study is to present our initial experience with the Onyx Frontier™ balloon-mounted drug-eluting stent (Medtronic, Santa Rosa, CA) for AIS due to ICAD.
Methods: We conducted a multicenter retrospective cohort study describing the technical feasibility, safety, and performance of using the Onyx Frontier™ balloon-mounted drug-eluting stent in patients with acute intracranial vessel occlusion due to ICAD across three comprehensive stroke centers in the United States.
Article Synopsis
- Cervical artery dissection (CeAD) is a leading cause of ischemic strokes in young adults, and this study explored the effects of intravenous thrombolysis (IVT) on patients with CeAD and stroke symptoms.
- Analyzed data from the STOP-CAD study, it found that IVT significantly improved functional independence after 90 days in patients without increasing the risk of symptomatic intracranial hemorrhage.
- The results suggest that IVT is a beneficial treatment for eligible patients with CeAD, aligning with current medical guidelines on its use.
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.