Publications by authors named "Jankowitz B"
Introduction: The Flow Re-direction Endoluminal Device (FRED) is a novel flow diverter with a unique double stent design, with an inner stent composed of 48 nitinol wires, and an outer stent with 16 nitinol wires. It is designed for endovascular cerebral aneurysm treatment, although, limited data exist regarding in-stent stenosis (ISS) rates associated with FRED devices.
Methods: A registry encompassing two North American comprehensive stroke centers was the base of this study.
Background: Underlying intracranial stenosis is the most common cause of failed mechanical thrombectomy in acute ischemic stroke patients 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: 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 PDFBackground And Objectives: Multiple preferences exist for embolic materials selection in middle meningeal artery embolization (MMAE) for chronic subdural hematoma with limited comparative literature data. Herein, we compare different embolic materials.
Methods: Consecutive patients undergoing MMAE for chronic subdural hematoma at 14 North-American centers (2018-2023) were classified into 3 groups: (a) particles, (b) Onyx, (c) n-butyl cyanoacrylate (n-BCA).
Peer review stands as a cornerstone of academic publishing, especially in the era of evidence-based neurosurgery - the scientific literature relies on proficient peer reviewers. Providing a constructive peer review is an art and learned skill that requires knowledge of study design and expertise in the neurosurgical subspeciality. Peer reviewers guard against arbitrary decision-making and are essential in ensuring that published manuscripts are of the highest quality.
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- Social media helps patients with rare diseases, like arteriovenous malformations (AVM), connect and share experiences, as shown in an analysis of posts from platforms like Twitter, Instagram, and TikTok.
- The study found that common themes in posts included raising awareness (87%), recounting symptoms (50.2%), and sharing positivity (17.5%), with most engagement coming from female users.
- Social media serves as a crucial platform for AVM patients to connect with others and discuss their experiences, increasing public awareness about the condition.
Article Synopsis
- The Tigertriever is an innovative stentriever designed to improve mechanical thrombectomy by allowing better user control for tackling different clot types and vessel sizes.
- This paper combines insights from experienced professionals to evaluate the Tigertriever's capabilities and shares updated techniques for its use in clinical settings.
- It highlights the "FLEX" approach, which promotes efficient clot integration while minimizing disruption, especially important for working in challenging distal locations.
As the incidence of subdural hematoma is increasing, it is important to understand symptomatology and clinical variables associated with treatment outcomes and mortality in this population; patients with subdural hematoma were selected from the National Inpatient Sample (NIS) Database between 2016 and 2020 using International Classification of Disease 10th Edition (ICD10) codes. Moderate-to-severe subdural hematoma patients were identified using the Glasgow Coma Scale (GCS). Multivariate regression was first used to identify predictors of in-hospital mortality and then beta coefficients were used to create a weighted mortality score.
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- Robotic neurointervention, specifically using the CorPath GRX platform, improves precision, reduces radiation risk, and enhances access to care, particularly in spinal angiography where data is limited.
- A study of 11 patients from February 2022 to March 2023 showed that although 36.36% of procedures required a switch to manual techniques, there were no robot-related complications and few procedure-related issues.
- The findings suggest that the CorPath GRX system is a safe and reliable option for spinal angiographic procedures, contributing to better accuracy and lower radiation exposure for healthcare providers.
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: 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
- 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
- The study investigates the outcomes of two different radial catheters (Armadillo and RIST) used in neurointervention procedures, focusing on their effectiveness and safety.
- Conducted as a retrospective multicenter study involving 206 patients, the findings show no significant differences in successful catheterization rates, complications, or conversion to femoral access between the two catheters.
- Ultimately, both catheters demonstrated similar performance, indicating that either option could be a viable choice for transradial neuroendovascular interventions.
Objective: We aimed to assess the impact of time to endovascular thrombectomy (EVT) on clinical outcomes in the DAWN trial, while also exploring the potential effect modification of mode of stroke onset on this relationship.
Methods: The association between every 1-h treatment delay with 90-day functional independence (modified Rankin Scale [mRS] score 0-2), symptomatic intracranial hemorrhage, and 90-day mortality was explored in the overall population and in three modes of onset subgroups (wake-up vs. witnessed vs.
Objective: The placement of flow-diverting devices has become a common method of treating unruptured intracranial aneurysms of the internal carotid artery. The progressive improvement of aneurysm occlusion after treatment-with low complication and rupture rates-has led to a dilemma regarding the management of aneurysms in which occlusion has not occurred within 6-24 months. The authors aimed to identify clinical consensus regarding management of intracranial aneurysms displaying persistent filling 6-24 months after flow diversion and to ascertain questions that may drive future investigation.
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- This study looked at how men and women are affected differently after surgery for unruptured brain aneurysms.
- They found that more women were part of the study and that women were usually older but had fewer other health issues.
- Although women had fewer lung problems after surgery, both men and women had similar overall health issues, survival rates, and brain function immediately after the operation.
Article Synopsis
- The study investigates neurosurgeons' awareness of intraoperative radiation exposure and its health impacts, noting that high radiation can increase cancer risk.* -
- Out of 3344 surveyed neurosurgeons, only 6.8% responded, revealing that many do not use dosimeters, but most wear protective gear; however, knowledge of radiation safety limits was low.* -
- Findings indicate heightened concern about radiation exposure among neurosurgeons and highlight a significant correlation between increased radiation exposure and the risk of developing leukemia and thyroid nodular diseases.*
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.
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.
Introduction: Distal navigability and imprecise delivery of embolic agents are two limitations encountered during liquid embolization of cerebrospinal lesions. The dual-lumen Scepter Mini balloon (SMB) microcatheter was introduced to overcome these conventional microcatheters' limitations with few small single-center reports suggesting favorable results.
Methods: A series of consecutive patients undergoing SMB-assisted endovascular embolization were extracted from prospectively maintained registries in seven North-American centers (November 2019 to September 2022).
Background: Trials of surgical evacuation of supratentorial intracerebral hemorrhages have generally shown no functional benefit. Whether early minimally invasive surgical removal would result in better outcomes than medical management is not known.
Methods: In this multicenter, randomized trial involving patients with an acute intracerebral hemorrhage, we assessed surgical removal of the hematoma as compared with medical management.
Background: Chronic subdural hematoma (CSDH) often requires surgical evacuation, but recurrence rates remain high. Middle meningeal artery (MMA) embolization (MMAE) has been proposed as an alternative or adjunct treatment. There is concern that prior surgery might limit patency, access, penetration, and efficacy of MMAE, such that some recent trials excluded patients with prior craniotomy.
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- Middle meningeal artery embolization (MMAE) is being recognized as an effective treatment for non-acute subdural hematomas (NASHs), but its impact on coagulopathic patients needs further investigation.
- In a study analyzing 537 patients undergoing MMAE from 2019 to 2023, researchers found that coagulopathy significantly increases the likelihood of needing additional surgical intervention post-treatment.
- Specifically, patients with coagulopathy required rescue surgery at rates almost three times higher than those without coagulopathy, suggesting that anticoagulant and antiplatelet use may worsen outcomes.
Objective: Treatment of intracranial aneurysms by flow diversion is safe and effective and is increasingly popular. However, the correct treatment paradigm for aneurysms incompletely treated by initial placement of a flow diverter has not been established, nor have the subsequent natural history and occlusion rates of such aneurysms. The authors sought to outline the natural history of such aneurysms, which to date have been considered partially treated.
View Article and Find Full Text PDFBackground And Objectives: The choice of anesthesia type (general anesthesia [GA] vs nongeneral anesthesia [non-GA]) in middle meningeal artery embolization (MMAE) procedures for chronic subdural hematomas (cSDH) differs between institutions and left to care team discretion given lack of standard guidelines. We compare the outcomes of GA vs non-GA in MMAE.
Methods: Consecutive patients receiving MMAE for cSDH at 14 North American centers (2018-2023) were included.