Publications by authors named "Shahram Majidi"
Background: Ticagrelor, a P2Y12 inhibitor, offers a rapid onset and consistent platelet inhibition, making it a viable alternative for dual antiplatelet therapy (DAPT). The optimal ticagrelor dose for neurointerventional procedures, however, remains unclear. We report our experience with ticagrelor 60 mg twice daily plus aspirin 81 mg daily compared with the standard aspirin and clopidogrel regimen for intracranial stenting.
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- Stroke is a major global health issue, with about one-third of patients facing a second stroke, prompting this study to explore machine learning (ML) algorithms for predicting recurrent strokes.
- The study analyzed 12 research papers involving over 24,000 individuals, revealing that ML models have a sensitivity of 71% and a specificity of 88% for predicting recurrent strokes.
- While the results are promising, indicating that ML could help identify high-risk patients, the study highlights the need for standardized methods and further research to improve the consistency and applicability of these predictive models.
Article Synopsis
- Surgical evacuation of intracerebral hemorrhage (ICH) performed early can lead to better functional outcomes, but doing it too quickly may cause significant risks like postoperative rebleeding.
- The study developed a 5-point grading scale to assess the severity of intraoperative bleeding during minimally invasive endoscopic techniques for ICH evacuation.
- Among 142 patients evaluated, results indicated that while early evacuation is associated with increased bleeding scores, it did not lead to worse long-term outcomes or increased postoperative rebleeding.
Article Synopsis
- Cangrelor, an intravenous P2Y12-receptor inhibitor, is compared to traditional antithrombotic medications like eptifibatide in patients undergoing endovascular thrombectomies (EVTs), with previous data being insufficient for direct comparison.
- A study reviewed clinical data from 1010 EVT patients who received either cangrelor or eptifibatide to assess safety and efficacy, focusing on outcomes like hemorrhagic conversion and functional status using scales like the mRS and NIHSS.
- Results showed that cangrelor was linked to a lower risk of hemorrhagic conversion and better functional outcomes at discharge and follow-up, indicating its potential benefits over GPIs in this specific medical context
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- This study explores the predictive value of certain radiographic features for neurologic outcomes in patients with basilar artery occlusion (BAO) who undergo endovascular therapy, as prior trials only included specific patients based on prognostic scores.
- It analyzes data from a thrombectomy database, correlating various demographic factors and radiographic scoring systems (PCCS, BATMAN, pc-ASPECTS) with 90-day neurologic outcomes, finding that lower scores on PCCS and BATMAN were linked to worse outcomes.
- Results showed that 21.5% of patients had a good neurologic outcome after 90 days, with significant associations found between poor outcomes and existing infarcts in specific brain
Article Synopsis
- A study investigated the safety and effectiveness of placing a large bore guide catheter higher in the brain during endovascular thrombectomy (EVT) for patients with large vessel occlusion.
- Researchers analyzed data from 426 patients across three stroke centers, comparing those with the guide catheter positioned in the petrous carotid area to those with it positioned lower.
- Results showed that higher positioning improved the first-pass effectiveness and reduced the time to achieve final recanalization, while the final success rates for reperfusion were similar in both groups.
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.
Article Synopsis
- Endovascular embolization is used as a supportive treatment for meningioma surgery, but evaluating its effectiveness is complicated because MRI scans are done before embolization and after the tumor is removed.
- Researchers conducted a study using preoperative MRI after embolization to better measure how effective the procedure was, grading the extent of tumor devascularization and analyzing differences based on tumor location and blood supply.
- The study found that the degree of devascularization correlated well with the volumetric extent of embolization, providing a clearer and more quantifiable way to assess the effectiveness of embolization before surgery.
Article Synopsis
- Preoperative embolization is an endovascular procedure that helps in the surgical removal of meningiomas but lacks a standardized system to measure its effectiveness during the procedure.
- Researchers developed an angiographic grading system to help assess and report the level of tumor devascularization achieved through this process, involving a scale from 0 (no embolization) to 4 (complete embolization).
- Analysis of data from 80 patients revealed that tumor location and the type of arterial feeders significantly influenced the success of embolization, with certain tumor types showing higher devascularization grades and a low complication rate of 2.5%.*
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.
Article Synopsis
- Sixty-five percent of cerebrovascular randomized controlled trials (RCTs) do not report participant race and/or ethnicity, highlighting a significant gap in demographic data.
- RCTs conducted in North America are significantly more likely to include race/ethnicity data, with a 14.74-fold higher odds compared to other regions.
- The study suggests that inadequate reporting of race and ethnicity has not improved over time, and minorities are underrepresented among those studies that do report these demographics.
Article Synopsis
- Anesthesia options for endovascular thrombectomy (EVT) in treating distal and medium vessel occlusions were evaluated, comparing general anesthesia (GA) to conscious sedation (CS).
- A study of 279 patients showed that CS was linked to significantly better early neurological improvements and higher successful reperfusion rates than GA.
- The findings suggest that CS is safe and effective for EVT, potentially offering advantages without increasing complications, prompting the need for further randomized studies.
Rescue Therapy for Failed Mechanical Thrombectomy in Acute Ischemic Stroke: A Pooled Analysis of the Society of Vascular and Interventional Neurology Registry.
Aaron Rodriguez-Calienes Fazeel M Siddiqui Milagros Galecio-Castillo Mahmoud H Mohammaden Jaydevsinh N Dolia Shahram Majidi
Ann Neurol
August 2024
Article Synopsis
- This study aimed to compare the effectiveness of rescue therapy (RT) versus medical management (MM) in improving functional outcomes for patients who experienced a failed mechanical thrombectomy (MT).
- Analyzing data from 2011 to 2021, the research focused on patients with large vessel occlusions (LVOs) and assessed disability at 90 days using the modified Rankin Scale (mRS).
- Results showed that RT led to better functional independence, lower rates of symptomatic intracranial hemorrhage, and decreased 90-day mortality compared to MM, suggesting that RT might be a more effective treatment strategy for these patients.
Article Synopsis
- Recurrent intracranial aneurysms pose a significant clinical challenge, and the WEB device has been identified as a promising endovascular treatment option for these complex cases.
- A systematic review of studies evaluated the performance of the WEB device, including occlusion rates and complication rates, using data from multiple databases.
- The analysis showed favorable outcomes, with an adequate occlusion rate of 80% and no reported periprocedural complications, indicating the WEB device's effectiveness in treating recurrent wide-neck intracranial aneurysms.
Article Synopsis
- Machine learning (ML) algorithms can identify unruptured intracranial aneurysms (UIA), potentially saving lives, especially in high-risk groups.
- A systematic review and meta-analysis of 35 studies showed that ML effectively predicts the risk of cerebral aneurysm rupture, with high sensitivity and specificity rates.
- While ML shows promise in predicting aneurysm rupture risks, further research is necessary to improve its accuracy in clinical practice.
Article Synopsis
- * Out of over 10 million AIS patients, about 9.2% had in-hospital dysphagia; for ICH, this was 10.2%, affecting patient outcomes such as mortality and discharge status.
- * The study found that patients with dysphagia had longer hospital stays, were less likely to be discharged home, and incurred higher hospital charges, highlighting significant impacts on healthcare resources and patient recovery.
Article Synopsis
- * Current and former smokers are generally younger and more likely to be male, but their baseline neurological status and initial hematoma size do not differ from nonsmokers.
- * There is no notable difference in death and disability rates at 90 days between smokers and nonsmokers, indicating that while smoking affects hematoma expansion, it does not impact long-term clinical outcomes.
Article Synopsis
- The study investigates vocal fold paralysis (VFP) as a rare complication following acute ischemic stroke (AIS) and intracranial hemorrhage (ICH), aiming to assess its prevalence, characteristics, and in-hospital outcomes.
- Out of over 10 million AIS patients, only 0.1% exhibited VFP, while 0.1% of ICH patients presented with this condition, revealing significant implications for hospital discharge and healthcare costs.
- The findings indicate that patients with VFP post-AIS are less likely to be discharged home and incur higher hospital charges, while those with VFP post-ICH experience lower mortality but longer hospital stays and also face increased medical expenses.
Article Synopsis
- * Among 161,086 patients, 69% were female, and while severity scores were similar across sexes, women had significantly worse clinical outcomes compared to men.
- * Hispanic patients showed better outcomes than White patients, while Black and Hispanic patients experienced lower mortality risks than their White counterparts.
Article Synopsis
- The study explores the use of transradial access (TRA) with a balloon guide catheter (BGC) for carotid artery angioplasty and stenting, as this method hasn't been extensively researched before.
- Researchers analyzed a database of patients who underwent this procedure from January 2021 to June 2022, focusing on demographics, complications, and conversion rates.
- The findings indicate that using the Walrus BGC through an 8-Fr sheath for carotid stenting is both safe and effective, with very few complications and a low need for conversion to femoral access.
Article Synopsis
- * Out of 72 patients, successful recanalization was achieved in 90%, with a median of 2 attempts needed for treatment, and only 16% experienced intracranial hemorrhage.
- * The findings suggest that EVT is a safe and effective procedure for DVO strokes, with over half of the patients showing favorable outcomes at 90 days, although baseline NIHSS scores were identified as a predictor of worse results.
Effects of Dimethyl Fumarate on the Karnofsky Performance Status and Serum S100β Level in Newly Glioblastoma Patients: A Randomized, Phase-II, Placebo, Triple Blinded, Controlled Trial: Effect of DMF On the Serum S100β Level and KPS Score of GBM Patients.
Shafizadeh Milad Jangholi Ehsan Maroufi Seyed Farzad Rostami Mohsen Bereimipour Ahmad Majidi Shahram
Galen Med J
August 2022
Article Synopsis
- Glioblastoma (GBM) is the most prevalent brain tumor, and current treatments have low survival rates with no definitive chemotherapy options established.
- This study investigates the effects of dimethyl fumarate (DMF) on brain injuries from surgery in 36 GBM patients, comparing a group taking DMF with a placebo group before and after surgery.
- Although there was no significant difference in serum S100β levels post-surgery between the groups, the DMF group reported a higher performance status after surgery, suggesting potential benefits but raising questions about its effectiveness in standard GBM treatment.
Article Synopsis
- Randomized clinical trials have proven the effectiveness of endovascular therapy (EVT) for acute strokes caused by large vessel occlusions, but its efficacy for strokes with distal, medium vessel occlusions (DMVO) is still uncertain.
- This study aimed to compare the outcomes of EVT against medical management (MM) in patients with primary DMVO strokes, using data from January 2015 to December 2019.
- Findings revealed no significant difference in 3-month functional independence rates between the EVT and MM groups, despite analyzing a total of 286 DMVO patients, with various demographics and treatment characteristics considered.