Publications by authors named "Jonathan Grossberg"
Background: Aneurysmal subarachnoid hemorrhage (aSAH) is frequently complicated by permanent shunt-dependent hydrocephalus, but it is difficult to predict which patients are at highest risk.
Objective: This study seeks to identify novel variables associated with shunt dependency after aSAH and to create a predictive algorithm that improves upon existing models.
Methods: Retrospective case control design was used.
Following recent advances in post-thrombectomy stroke care, the role of neuroinflammation and neuroprotective strategies in mitigating secondary injury has gained prominence. Yet, while neuroprotection and anti-inflammatory agents have re-emerged in clinical trials, their success has been limited. The neuroinflammatory response in cerebral ischemia is robust and multifactorial, complicating therapeutic approaches targeting single pathways.
View Article and Find Full Text PDFObjective: The objective was to evaluate the etiology, natural history, and impact of surgical intervention on outcomes of left ventricular assist device (LVAD) patients presenting with intracranial hemorrhage (ICH).
Methods: The authors completed a retrospective review of LVAD patients who presented with ICH at 2 centers between 2013 and 2022. Patients were reviewed for demographic, clinical, and radiographic variables.
The Woven EndoBridge (WEB) device has become a prominent treatment for wide-neck bifurcation intracranial aneurysms since its FDA approval in 2018. However, the impact of anticoagulant therapy on its efficacy and patient outcomes remains underexplored. This study aims to evaluate the effects of postoperative anticoagulant use on aneurysm occlusion, retreatment rates, and functional outcomes following WEB device implantation.
View Article and Find Full Text PDFBackground: Classic teaching in neurocritical care is to avoid jugular access for central venous catheterization (CVC) because of a presumed risk of increasing intracranial pressure (ICP). Limited data exist to test this hypothesis. Aneurysmal subarachnoid hemorrhage (aSAH) leads to diffuse cerebral edema and often requires external ventricular drains (EVDs), which provide direct ICP measurements.
View Article and Find Full Text PDFBackground: 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.
Objectives: 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: Subacute and chronic subdural hematomas are common and frequently recur after surgical evacuation. The effect of adjunctive middle meningeal artery embolization on the risk of reoperation remains unclear.
Methods: In a prospective, multicenter, interventional, adaptive-design trial, we randomly assigned patients with symptomatic subacute or chronic subdural hematoma with an indication for surgical evacuation to undergo middle meningeal artery embolization plus surgery (treatment group) or surgery alone (control group).
Background: The duration of mechanical thrombectomy (MT) is a negative predictor of outcomes in acute ischemic stroke (AIS), yet the precise mechanisms are unclear. We investigated whether the placement of large-bore catheters intracranially reduces blood flow to the ischemic penumbra and diminishes the efficacy of MT.
Methods: We investigated the impact of different catheter sizes on flow through the intracranial circulation using an in vitro model.
ACR Appropriateness Criteria® Imaging of Suspected Intracranial Hypotension.
J Am Coll Radiol
November 2024
The clinical syndrome of intracranial hypotension refers to the symptoms caused by cerebrospinal fluid hypovolemia and is primarily characterized by postural headaches, but can be associated with a multitude of other neurological symptoms. Imaging plays a critical role in helping to establish a diagnosis of intracranial hypotension, localize the source of cerebrospinal fluid leak, and assist in directing targeted treatments. Using the best available evidence, this document provides diagnostic imaging recommendations for the workup of intracranial hypotension across various clinical presentations.
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- This study aims to enhance prediction of patient outcomes after severe traumatic brain injury (sTBI) by integrating clinical data with serum inflammatory and neuronal protein levels.
- Researchers enrolled 53 adult patients and used machine learning techniques to develop models predicting post-traumatic vasospasm (PTV) and mortality, identifying specific biomarkers and clinical signs as key predictors.
- Findings reveal that certain inflammatory markers and demographic factors can better predict PTV development and mortality than standard clinical tools, indicating the importance of biochemical data in assessing sTBI outcomes.
Article Synopsis
- Researchers aimed to create and validate a prediction score for futile recanalization (FR) in patients with low Alberta Stroke Program Early Computed Tomography Scores (ASPECTS) who underwent endovascular thrombectomy (EVT) for large vessel occlusions (LVO).
- The study analyzed data from 219 patients with anterior circulation LVO and identified key predictors of FR, resulting in the development of the SNAP score, which considers factors like the site of occlusion and patient age.
- The SNAP score successfully predicted FR with an area under the curve of 0.79 in both training and validation cohorts, indicating its potential usefulness for guiding expectations in patients undergoing EVT for severe strokes.
Background 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 PDFIncidence, Management, and Outcomes of Pediatric Infectious Aneurysms.
Oper Neurosurg (Hagerstown)
October 2024
Background And Objectives: Infectious intracranial aneurysms (IIAs) are rare cerebrovascular complications of infective endocarditis (IE) accounting approximatively for 0.5% to 6.5% of all aneurysms.
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- The No Surprises Act (NSA), enacted by Congress in 2021, allows out-of-network providers to appeal payment disputes through an arbitration process called Independent Dispute Resolution (IDR), specifically evaluated for mechanical thrombectomy (MT).
- A simulation study found that neurointerventionalists generally need to submit multiple claims to make the IDR process financially viable; for professional claims, at least four are needed, while global claims require at least two.
- The results indicate that large MT centers rarely benefit from IDR for professional-only claims (0% viability), and only 13.2% of global claims are financially viable through IDR; smaller stroke centers show even less viability, raising concerns about inadequate reimbursement under NSA.
Article Synopsis
- The study evaluates the effectiveness of a new thrombus removal method called Contact Aspiration Mechanical Thrombectomy (CAMT) using specialized catheters (FreeClimb 88 and Tenzing 8) in treating large vessel occlusions in the brain.
- A retrospective analysis of 53 patients showed a high success rate for delivering the FreeClimb 88 catheter to the occlusion site, with 94.3% successful deliveries and a first-pass success rate of 67.9% for restoring blood flow.
- The procedure was found to be safe, with no complications or symptomatic hemorrhages, indicating that this technique could be a reliable option for treating these severe blockages.
Background And Objectives: This study aimed to compare outcomes of low Alberta Stroke Program Early Computed Tomography Score (ASPECTS) patients with stroke who underwent mechanical thrombectomy (MT) within 6 hours or 6 to 24 hours after stroke onset.
Methods: A retrospective cohort study was conducted using data from a large multicenter international registry from 2013 to 2023. Patients with low ASPECTS (2-5) who underwent MT for anterior circulation intracranial large vessel occlusion were included.
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 looked at strokes caused by a neck problem called carotid artery web (CaW) in young patients, who often don't have typical stroke risk factors.
- Researchers used a score called RoPE to see how many patients had high-risk profiles related to CaW, and found that many had high scores.
- The results suggest that doctors need to look for CaW in stroke patients, even if they have a condition called patent foramen ovale (PFO), to figure out the real cause of their strokes.
Introduction: The recently developed MR-PREDICTS@24 h model showed excellent performance in the MR-CLEAN Registry cohort in patients presenting within 12 h from onset. However, its applicability to an U.S.
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- The eTICI score, previously validated for large proximal artery occlusions (pLAOs), has not been fully tested for distal medium vessel occlusions (DMVOs), prompting this study to assess its reliability in DMVO cases.
- Researchers conducted a retrospective analysis of data from a stroke center, where two specialists independently evaluated angiograms, comparing their eTICI score assessments.
- Results showed that eTICI scores for DMVO demonstrated almost-perfect agreement among raters, comparable to pLAO cases, indicating that eTICI can be reliably used for DMVOs, but more studies are needed to explore its connection to clinical outcomes.
Introduction: Carotid Web (CaW) represents an overlooked stroke etiology and has been associated with high recurrence rates and to be amenable to stenting. We evaluated the diagnostic performance of different computed tomography angiography (CTA) projections in CaW.
Methods: Consecutive patients <65 years-old with symptomatic CaW (n=31), carotid atherosclerosis (n=27), or normal carotids (n=49) diagnosed with a thin-cut CTA were included.