Publications by authors named "Miguel Quintero-Consuegra"

Article Synopsis
  • * Data from 670 patients revealed that while IVT may improve some outcomes, such as higher chances of achieving a modified Rankin Scale score of 0-2 in univariable analysis, this benefit was not consistently observed in more rigorous multivariable analyses.
  • * Overall, the findings suggest that adjunctive IVT may not significantly enhance clinical outcomes or safety compared to MT alone for this patient population.
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Article Synopsis
  • Mechanical thrombectomy is the standard treatment for large vessel occlusions, but there's limited evidence for its effectiveness in treating distal and medium vessel occlusions, particularly for patients with low stroke scale scores (≤6).
  • A study analyzed data from 41 academic centers, comparing outcomes of low versus higher stroke scale score patients who underwent thrombectomy, revealing high successful reperfusion rates in both groups.
  • Results showed that patients with lower stroke scale scores experienced better functional outcomes and lower mortality rates, but the treatment's effectiveness compared to intravenous thrombolysis (IVT) is still uncertain.
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Background: Optimal anesthetic strategy for the endovascular treatment of stroke is still under debate. Despite scarce data concerning anesthetic management for medium and distal vessel occlusions (MeVOs) some centers empirically support a general anesthesia (GA) strategy in these patients.

Methods: We conducted an international retrospective study of MeVO cases.

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Objective: Intracranial dural arteriovenous fistulas (dAVFs) are rare vascular lesions that can be asymptomatic or can lead to devastating hemorrhage based on the dAVF's aggressiveness. Several approaches can be taken to treat dAVFs, such as endovascular embolization and surgical ligation. However, very few studies have evaluated the influence of surgery compared to endovascular approaches on patient outcomes.

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Background: Mechanical thrombectomy (MT) has revolutionized the treatment of acute ischemic stroke (AIS) due to large vessel occlusion (LVO), but its efficacy and safety in medium vessel occlusion (MeVO) remain less explored. This multicenter, retrospective study aims to investigate the incidence and clinical outcomes of vessel perforations (confirmed by extravasation during an angiographic series) during MT for AIS caused by MeVO.

Methods: Data were collected from 37 academic centers across North America, Asia, and Europe between September 2017 and July 2021.

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Article Synopsis
  • The study aimed to evaluate the effectiveness and safety of the pRESET LITE stent retriever for treating medium vessel occlusions in acute ischemic stroke patients.
  • A retrospective analysis included 227 patients from 37 institutions, distinguishing between proximal and distal occlusions, revealing successful reperfusion rates of 85% and 97%, respectively.
  • Despite a 7% complication rate and a significant percentage of patients experiencing hemorrhagic transformations, the procedure showed a favorable outcome in 58% of cases after three months.
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Purpose: The blood-brain barrier can prevent circulating tumor DNA (ctDNA) derived from the central nervous system from entering the blood making it challenging to evaluate molecular features of leptomeningeal metastasis (LM). Accordingly, we sought to systematically compare the diagnostic power or significance of ctDNA derived from cerebrospinal fluid (CSF) compared to plasma ctDNA in patients with LM.

Methods: A systematic review and meta-analysis was performed under the PRISMA guideline.

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Article Synopsis
  • The study investigates the first pass effect (FPE) in endovascular treatment (EVT) for medium vessel occlusion strokes, focusing on its predictors and impact on patient outcomes.
  • The analysis included 836 patients, revealing that FPE occurred in 36.1% and was linked to better functional outcomes as well as lower rates of mortality and intracranial hemorrhage.
  • FPE was significantly associated with favorable outcomes at 90 days, suggesting its importance in improving recovery and reducing complications in stroke patients.
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Study Design: Retrospective cohort study.

Objectives: To describe the common types of complications and their risk factors during spine surgery in patients with achondroplasia.

Methods: A retrospective review was performed of medical records of adult achondroplasia patients who underwent spine surgery at our institution between 2007 and 2021.

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Purpose: During intracranial meningioma surgery, surgeons experience considerable blood loss. Tranexamic acid (TXA) is used to minimize blood loss in several neurosurgical settings. However, evidence and trials are lacking.

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Three-dimensional printing (3DP) has recently gained importance in the medical industry, especially in surgical specialties. It uses different techniques and materials based on patients' needs, which allows bioprofessionals to design and develop unique pieces using medical imaging provided by computed tomography (CT) and magnetic resonance imaging (MRI). Therefore, the Department of Biology and Medicine and the Department of Physics and Engineering, at the Bioastronautics and Space Mechatronics Research Group, have managed and supervised an international cooperation study, in order to present a general review of the innovative surgical applications, focused on anatomical systems, such as the nervous and craniofacial system, cardiovascular system, digestive system, genitourinary system, and musculoskeletal system.

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Encephaloduroarteriosynangiosis (EDAS) is a promising treatment for cerebral arterial steno-occlusive disorders, with proven efficacy in moyamoya disease and a growing interest in potential application for patients with symptomatic intracranial atherosclerotic disease, given the early results of intermediate development trials showing reduced rates of recurrence stroke and improved clinical outcomes compared with those patients treated with intense medical management (IMM) alone. Although clinical outcomes are the fundamental goal when considering patient care paradigms, a cost-effective analysis is key to obtaining a comprehensive understanding of the impact EDAS may provide to patients with atherosclerotic disease on a larger scale. Here, we evaluate the EDAS + IMM cost-effectiveness over time in the treatment of intracranial atherosclerotic disease compared with IMM alone.

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Background: Encephaloduroarteriosynangiosis (EDAS) is a form of indirect revascularization for cerebral arterial steno-occlusive disorders. EDAS has gained growing interest as a technique applicable to pediatric and adult populations for several types of ischemic cerebral steno-occlusive conditions.

Objective: To present a team-oriented, multidisciplinary update of the EDAS technique for application in challenging adult cases of cerebrovascular stenosis/occlusion, successfully implemented in more than 200 cases.

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Retinoblastoma (RB) is the most common eye neoplasm in childhood, accounting for 2.5% to 4% of all pediatric cancers. Recent approaches to treat RB include localized administration of chemotherapy, such as super-selective ophthalmic artery chemotherapy.

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Article Synopsis
  • Vein of Galen malformations (VGMs) are serious congenital issues that need multiple endovascular treatments due to high blood flow and related complications like heart failure and hydrocephalus.
  • An 8-month-old with VGM showed heart failure symptoms and was treated using a transvenous approach for coil embolization while continuously monitoring venous pressures to assess treatment effectiveness.
  • The successful monitoring revealed increasing pressure gradients correlating with improved blood flow reduction, leading to better patient outcomes post-surgery, suggesting a new method for objectively guiding VGM treatment.
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Background: Cervical spine surgery sometimes necessitates complex ventral/dorsal approaches or osteotomies that place the vertebral artery (VA) at risk of inadvertent injury. Tortuosity of the VA poses increased risk of vessel injury during anterior decompression or placement of posterior instrumentation.

Observations: In this report, the authors describe a patient with degenerative cervical spondylotic myelopathy and focal kyphotic deformity requiring corrective surgery via a combined ventral/dorsal approach.

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Background: Intracranial atherosclerotic disease (ICAD) is one of the leading causes of stroke worldwide. Patients with ICAD who initially present with ischemia in border-zone areas and undergo intensive medical management (IMM) have the highest recurrence rates (37% at 1 yr) because of association with hemodynamic failure and poor collaterals.

Objective: To evaluate the effect of encephaloduroarteriosynagiosis (EDAS) on stroke recurrence in patients with ICAD and border-zone stroke (BDZS) at presentation.

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Background: Intracranial atherosclerotic disease (ICAD) is one of the most challenging stroke etiologies, with frequent recurrences despite optimized medical management. Encephaloduroarteriosynangiosis (EDAS) is an indirect revascularization method that produces extra-cranial collaterals to intracranial vessels. We present the results of a phase-II trial of EDAS in intracranial atherosclerotic disease patients.

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