Publications by authors named "Vitor Mendes Pereira"
Article Synopsis
- This study analyzed decisions regarding decompressive hemicraniectomy (DHC) and early withdrawal of life-sustaining therapy (WLST) in patients with large vessel occlusion (LVO) and large ischemic strokes from the SELECT2 trial.* -
- Among 352 patients, DHC was utilized in 55 patients, and WLST was chosen for 81, showing no significant differences in usage between those receiving endovascular thrombectomy (EVT) and those treated medically.* -
- About 21% of DHC patients were able to walk independently after one year, indicating that DHC did not negatively impact the benefits of thrombectomy, while WLST generally resulted in poor outcomes.*
Article Synopsis
- The study examined the effectiveness of endovascular therapy (EVT) versus best medical therapy (BMT) for isolated anterior cerebral artery occlusions (ACAo) in acute stroke patients.
- The analysis involved 108 patients from various countries, comparing outcomes like functional independence at 90 days, with results showing no significant difference in success rates between EVT and BMT.
- Conclusions indicate that while EVT had a high success rate in procedures, it did not lead to better functional outcomes or lower mortality compared to BMT, suggesting a need for more randomized trials.
Article Synopsis
- Endovascular thrombectomy (EVT) has proven safe and effective for patients suffering from large core strokes, but the effects of reperfusion quality and procedure details on outcomes are still unclear.
- In the SELECT2 trial, findings indicated that 80% of patients experienced successful reperfusion, which correlates with better clinical outcomes, particularly in those who achieved near-complete reperfusion.
- Longer procedure times negatively impacted patient outcomes, while the method of thrombectomy (aspiration vs stent-retriever) showed no significant differences in reperfusion success or functional recovery.
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.
Article Synopsis
- The study aimed to identify the optimal sizes for middle cerebral artery (MCA) bifurcation aneurysms that are most suitable for treatment with the Woven EndoBridge (WEB) device, focusing on aneurysm width and neck dimensions.
- Using a large retrospective database, the researchers analyzed unruptured MCA bifurcation aneurysms and established ideal cutoff values of 6.1 mm for width and 4.6 mm for neck size regarding treatment effectiveness.
- Findings indicated that aneurysms smaller than these cutoff values had significantly higher rates of occlusion (93% for width and 90% for neck) and lower retreatment rates compared to larger aneurysms, highlighting the importance of
Article Synopsis
- There is a lack of evidence on the safety of flow diversion (FD) for treating aneurysms outside the circle of Willis, leading to a study on the Silk Vista Baby (SVB) device at a single medical center.
- The study involved 57 patients with various types of aneurysms, mostly in the anterior circulation, and found a low complication rate (5.2% symptomatic ischemic) with no hemorrhagic incidents and an overall mortality rate of 1.8%.
- The findings suggest that SVB is a safe option for treating both distal anterior and complex posterior fossa aneurysms, but further multicenter studies are necessary to validate these results.
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.
Article Synopsis
- * Data from 459 patients with vessel perforation showed a 90-day mortality rate of 51.9%, with only 16.3% achieving a favorable recovery (mRS 0-2).
- * The findings indicate that large vessel perforation leads to worse outcomes, while thrombolysis doesn’t worsen prognoses; quick management of bleeding is crucial for survival.
We describe a case of a 22-year-old man with a traumatic occipital artery pseudoaneurysm revealed by a painful expanding neck hematoma after a penetrating knife injury. A neuroendovascular consultation was requested after a computed tomography angiogram showed active pseudoaneurysm bleeding. Anatomical considerations of the upper cervical region including dangerous anastomosis between the vertebral and internal carotid artery are discussed, illustrating how this impacted our treatment strategy.
View Article and Find Full Text PDFCreation of a predictive calculator to determine adequacy of occlusion of the woven endobridge (WEB) device in intracranial aneurysms-A retrospective analysis of the WorldWide WEB Consortium database.
Basel Musmar Nimer Adeeb Julian Gendreau Melanie Alfonzo Horowitz Hamza Adel Salim Vitor Mendes Pereira
Interv Neuroradiol
August 2024
Article Synopsis
- - The study aimed to create a predictive calculator to determine the chances of achieving adequate occlusion (Raymond-Roy classification 1 or 2) when using the woven endobridge (WEB) device for intracranial aneurysms, drawing from a large dataset.
- - Analyzed data from 356 patients across 30 centers worldwide revealed that larger aneurysm neck size and partial thrombosis were linked to lower chances of successful occlusion, while the calculator showed good predictive accuracy.
- - The newly developed tool offers a valuable resource for clinicians to better estimate the success of using the WEB device in treating intracranial aneurysms, helping to enhance patient care.
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.
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: Acute ischemic stroke (AIS) from primary medium vessel occlusions (MeVO) is a prevalent condition associated with substantial morbidity and mortality. Despite the common use of mechanical thrombectomy (MT) in AIS, predictors of poor outcomes in MeVO remain poorly characterized.
Methods: In this prospectively collected, retrospectively reviewed, multicenter, multinational study, data from the MAD-MT (Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy) registry were analyzed.
Article Synopsis
- The Woven EndoBridge (WEB) device is being studied as a new treatment for intracranial aneurysms, particularly its effectiveness for off-label uses which require further investigation.
- A study of 162 patients utilizing machine learning developed predictive models for successful occlusion after off-label WEB treatment, analyzing various factors linked to outcomes.
- Findings indicated that larger neck diameter and the presence of daughter sacs significantly predicted poorer occlusion results, emphasizing the need for further validation to refine patient selection and treatment strategies.
Article Synopsis
- New technologies for treating brain aneurysms, like PED and FRED, are making a big difference in medical care.
- This study looked at different research to compare how safe and effective PED and FRED are for patients.
- Results showed that while both devices worked similarly, FRED had better outcomes, meaning patients with FRED had more chances of doing well after treatment.
Article Synopsis
- A study was conducted to compare the safety and effectiveness of endovascular treatment (EVT) versus best medical management (BMM) for patients with acute ischaemic stroke caused by distal medium vessel occlusion (DMVO).
- The analysis involved 2,125 patients, showing no significant difference in achieving functional independence at 90 days between EVT and BMM, despite EVT being associated with higher rates of hemorrhagic complications.
- The results suggest that EVT does not provide better functional outcomes than BMM in DMVO cases while increasing the risk of bleeding, indicating the need for cautious use of EVT and further research to improve treatment approaches.
Article Synopsis
- - The study compared the effectiveness and safety of four first-generation flow diverters (FDs) used for treating sidewall ICA intracranial aneurysms, which include Pipeline, Silk, FRED, and Surpass devices, using data from 444 patients across 18 institutions from 2009-2016.
- - Analysis revealed no significant differences in retreatment rates or complications among the devices; however, the Surpass device showed the highest probability of achieving effective occlusion at follow-up, followed by FRED, Pipeline, and Silk.
- - Although all devices had good clinical outcomes, the study highlights the need for prospective research to further clarify the differences and long-term effects of these flow diverters.
Purpose: Intracranial aneurysms present significant health risks, as their rupture leads to subarachnoid haemorrhage, which in turn has high morbidity and mortality rates. There are several elements affecting the complexity of an intracranial aneurysm. However, criteria for defining a complex intracranial aneurysm (CIA) in open surgery and endovascular treatment could differ, and actually there is no consensus on the definition of a "complex" aneurysm.
View Article and Find Full Text PDFArticle Synopsis
- Acute ischemic stroke (AIS) from distal medium vessel occlusions (DMVOs) is common, and while IV thrombolysis is standard, mechanical thrombectomy (MT) is becoming more prevalent for treatment.
- A study reviewed data from 1708 DMVO patients treated with MT, finding that 8.7% experienced symptomatic intracerebral hemorrhage (sICH) and identified several risk factors, including older age, distal occlusion location, prior antiplatelet use, lower ASPECT scores, higher pre-op blood glucose, more passes during MT, and successful recanalization status.
- Understanding these risk factors can help healthcare providers better assess and manage the risk of sICH in patients undergoing MT for DM
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
- 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.
Risk of adjacent level fracture after percutaneous vertebroplasty and kyphoplasty vs natural history for the management of osteoporotic vertebral compression fractures: a network meta-analysis of randomized controlled trials.
Muhammed Amir Essibayi Ali Mortezaei Ahmed Y Azzam Ali Haider Bangash Mohammad Mirahmadi Eraghi Vitor Mendes Pereira
Eur Radiol
November 2024
Objectives: Percutaneous vertebroplasty and kyphoplasty are common interventions for osteoporotic vertebral compression fractures. However, there is concern about an increased risk of adjacent-level fractures after treatment. This study aimed to compare the risk of adjacent-level fractures after vertebroplasty and kyphoplasty with the natural history after osteoporotic vertebral compression fractures.
View Article and Find Full Text PDFArticle Synopsis
- Some patients with serious strokes can get better help from special treatments called EVT, but they need to get this treatment quickly.
- New technology is allowing doctors to use robots to help with these treatments from far away, which means care can be given even in places that are not close to big hospitals.
- For this robot help to work well, hospitals need to change how they do things and make sure they have good communication systems ready.
Background: Stroke remains a major health concern globally, with oral anticoagulants widely prescribed for stroke prevention. The efficacy and safety of mechanical thrombectomy (MT) in anticoagulated patients with distal medium vessel occlusions (DMVO) are not well understood.
Methods: This retrospective analysis involved 1282 acute ischemic stroke (AIS) patients who underwent MT in 37 centers across North America, Asia, and Europe from September 2017 to July 2023.