Biomedical subjects

Mahesh V Jayaraman

Publications and source records attributed to Mahesh V Jayaraman.

7 recordsLinked to original sources

PubMed2026

Early Reperfusion in Basilar Artery Occlusion Stroke Managed With Tenecteplase Versus Alteplase Before Endovascular Treatment.

BACKGROUND: Timely reperfusion is a critical determinant of favorable outcomes in basilar artery occlusion (BAO) stroke. We aimed to examine whether the choice of thrombolytic agent predicts early reperfusion (ER) in BAO stroke managed with tenecteplase versus alteplase before endovascular treatment. METHODS: This was a retrospective, multicenter US cohort of consecutive patients with BAO from 14 stroke centers treated with tenecteplase or alteplase within 4.5 hours of last known well before endovascular treatment. The primary end point was ER, defined as angiographic ER (expanded Thrombolysis in Cerebral Infarction grade 2b to 3 on the first diagnostic angiogram), or clinical ER, defined as substantial neurological improvement precluding endovascular treatment and a good functional outcome (modified Rankin Scale score 0-3). RESULTS: Among 163 patients with BAO and a median last known well-to-needle time of 135 minutes (interquartile range, 100-193) and last known well-to-puncture time of 228 minutes (interquartile range, 166-307), ER was observed in 27 (16.6%) patients. Rates of ER were comparable between tenecteplase (14/75, 18.7%) and alteplase (13/88, 14.8%; adjusted odds ratio, 1.082 [95% CI, 0.444-2.631]; P=0.862). In addition, rates of angiographic ER and clinical ER subgroups did not differ between thrombolytic agents. Higher Basilar Artery on Computed Tomography Angiography scores and a nonatherothrombotic cause independently predicted ER. In multivariable analysis, a good functional outcome was associated with younger age, lower stroke burden, and shorter last known well-to-puncture time. CONCLUSIONS: In BAO treated within 4.5 hours of last known well, tenecteplase and alteplase produced comparable early reperfusion rates. Achieving ER did not modify the association between thrombolytic agent and good functional outcome, consistent with rapid thrombectomy in patients with no ER.

basilar artery↗

PubMed2006

Hemorrhage rate in patients with Spetzler-Martin grades IV and V arteriovenous malformations: is treatment justified?

BACKGROUND AND PURPOSE: We sought to examine the prospective annual risk of hemorrhage in patients harboring Spetzler-Martin grades IV and V arteriovenous malformations (AVMs) before and after initiation of treatment. METHODS: Medical records of 61 consecutive patients presenting with Spetzler-Martin grades IV and V AVMs were retrospectively reviewed for demographics, angiographic features, presenting symptom(s), and time of all hemorrhage events, before or after treatment initiation. Pretreatment hemorrhage rates (excluding hemorrhages at presentation) and posttreatment rates were subsequently calculated. Modified Rankin Scale (mRS) scores before and after treatment were recorded. RESULTS: The annual pretreatment hemorrhage rate for all patients was 10.4% per year (95% CI, 2.2 to 15.4%), 13.9% (95% CI, 3.5 to 22.1%) in patients with hemorrhagic presentation and 7.3% (2.6 to 14.3%) in patients with nonhemorrhagic presentation. Posttreatment hemorrhage rates were 6.1% per year (95% CI, 2.5 to 13.2%) for all patients, 5.6% (95% CI, 2.1 to 11.8%) for patients presenting with hemorrhage and 6.4% (95% CI, 1.6 to 10.1%) in patients with nonhemorrhagic presentation. A noninferiority test showed that the posttreatment hemorrhage rate was less than or equal to the pretreatment hemorrhage rate (P<0.0001), with some indication that the reduction was greatest in patients with hemorrhagic presentation. Of the 62 patients, 51 (82%) had an mRS score of 0 to 2 before treatment, and 47 (76%) had an mRS score of 0 to 2 at the last follow-up after treatment. CONCLUSIONS: The annual rate of hemorrhage in grades IV and V AVMs is higher in this series than reported for all AVMs, which may reflect some referral bias in this single-center study. Nevertheless, initiation of treatment does not appear to increase the rate of subsequent hemorrhage. Treatment for these lesions may be warranted, given their poor natural history.

Adolescent↗

PubMed2006

Dissection of the V4 segment of the vertebral artery: clinicoradiologic manifestations and endovascular treatment.

Intracranial vertebral artery (VA) dissection has three clinical presentations: ischemia, hemorrhage, and mass effect. Imaging findings of intracranial VA dissections vary according to clinical presentation. Irregular stenosis or occlusion of the VA is the most common finding in patients with posterior fossa infarction, whereas a dissecting aneurysm is the main feature in those with acute subarachnoid hemorrhage. A chronic, giant, dissecting aneurysm can cause mass effect on the brain stem or cranial nerves, as well as distal embolism. Magnetic resonance imaging is useful for detection of intramural hematomas and intimal flaps, both of which are diagnostic of VA dissection. Multidetector computed tomography angiography is increasingly used for diagnosis of VA dissection. Catheter angiography is still beneficial for evaluation of precise endoluminal morphology of the dissection before surgical or endovascular intervention. Endovascular treatment is now considered a major therapeutic option for patients with a ruptured dissecting aneurysm or a chronic dissecting aneurysm. Anticoagulation therapy is currently considered the initial treatment of choice in patients with posterior circulation ischemic symptoms. Endovascular treatment, such as stent-assisted angioplasty or coil occlusion at the dissection site, can be performed in selected patients with posterior fossa ischemic symptoms.

Adult↗

PubMed2005

Mechanical thrombectomy following intravenous thrombolysis in the treatment of acute stroke.

BACKGROUND: The efficacy of intravenous thrombolytics in acute stroke is limited by low rates of recanalization of occluded arteries. Treatment with intravenous thrombolytics followed by mechanical thrombectomy is a novel approach that may increase recanalization rates without compromising time to initiation of treatment. OBJECTIVES: To report our experience with 2 patients who received this combination therapy and outline plans for a prospective pilot study. DESIGN AND SETTING: Case studies at a university hospital. INTERVENTIONS: Patients treated with intravenous thrombolytics within 3 hours of symptom onset subsequently underwent computed tomographic angiography. If an occlusion of a proximal cerebral vessel was shown by a computed tomographic angiogram, mechanical thrombectomy was performed. Patients were observed for 1 month after treatment. MAIN OUTCOME MEASURES: National Institutes of Health Stroke Scale (NIHSS) score. RESULTS: The computed tomographic angiography of 2 patients showed complete occlusion of the M1 branch of the middle cerebral artery following administration of intravenous thrombolytics. The NIHSS scores were 21 and 13. In both cases, blood flow through the occluded artery was restored with mechanical thrombectomy and dramatic neurologic improvement occurred. There were no complications. The NIHSS scores were 0 and 2 at 1-month follow-up. CONCLUSION: Treatment with intravenous thrombolytics followed by mechanical thrombectomy may improve outcomes in acute stroke patients and a pilot safety trial is warranted.

Combined Modality Therapy↗

PubMed2003

Detection of intracranial aneurysms: multi-detector row CT angiography compared with DSA.

PURPOSE: To prospectively compare the effectiveness of multi-detector row computed tomographic (CT) angiography with that of conventional intraarterial digital subtraction angiography (DSA) used to detect intracranial aneurysms in patients with nontraumatic acute subarachnoid hemorrhage. MATERIALS AND METHODS: Thirty-five consecutive adult patients with acute subarachnoid hemorrhage were recruited into the institutional review board-approved study and gave informed consent. All patients underwent both multi-detector row CT angiography and DSA no more than 12 hours apart. CT angiography was performed with a multi-detector row scanner (four detector rows) by using collimation of 1.25 mm and pitch of 3. Images were interpreted at computer workstations in a blinded fashion. Two radiologists independently reviewed the CT images, and two other radiologists independently reviewed the DSA images. The presence and location of aneurysms were rated on a five-point scale for certainty. Sensitivity and specificity were calculated independently for image interpretation performed by the two CT image readers and the second DSA image reader by using the first DSA reader's interpretation as the reference standard. RESULTS: A total of 26 aneurysms were detected at DSA in 21 patients, and no aneurysms were detected in 14 patients. Sensitivity and specificity for CT angiography were, respectively, 90% and 93% for reader 1 and 81% and 93% for reader 2. The mean diameter of aneurysms detected on CT angiographic images was 4.4 mm, and the smallest aneurysm detected was 2.2 mm in diameter. Aneurysms that were missed at initial interpretation of CT angiographic images were identified at retrospective reading. CONCLUSION: Multi-detector row CT angiography has high sensitivity and specificity for detection of intracranial aneurysms, including small aneurysms, in patients with nontraumatic acute subarachnoid hemorrhage.

Acute Disease↗

PubMed2003

Multiinstitutional computer database for recording nonvascular imaging-guided interventions.

OBJECTIVE: We sought to describe a multiinstitutional database created for tracking CT and sonographically guided interventional procedures. CONCLUSION: The database, created using commercially available software, has been placed on the secure hospital internal network for easy access from two institutions. More than 1,000 separate interventions have been added. The data may be queried and filtered for quality assurance and research purposes.

Computer Systems↗

PubMed2003

Intracanalicular aneurysm of the anterior inferior cerebellar artery revealed by multi-detector CT angiography.

A 62-year-old woman had sudden-onset headache and posterior neck pain, and a subarachnoid hemorrhage was revealed by unenhanced CT. Both multi-detector CT angiography and digital subtraction angiography were performed and revealed a small intracanalicular aneurysm of the left anterior inferior cerebellar artery. The patient underwent successful retrosigmoid craniectomy and trapping of the aneurysm. This case shows the ability of multi-detector CT angiography to indicate bony landmarks that can alter the surgical approach.

Angiography, Digital Subtraction↗