Showing papers by "Rishi Gupta published in 2008"

Atrial fibrillation detected by mobile cardiac outpatient telemetry in cryptogenic TIA or stroke

Abstract: Objective: Atrial fibrillation (AF) may be present within a subset of patients with presumed cryptogenic TIA or stroke and remains undetected by standard diagnostic methods. We hypothesized that AF may be an under-recognized mechanism for cryptogenic TIA/stroke. Methods: A consecutive series of 56 patients with cryptogenic TIA/stroke was analyzed after diagnostic evaluation and Mobile Cardiac Outpatient Telemetry (MCOT) for up to 21 days. Demographic, radiographic, echocardiographic, and MCOT results were reviewed. Predictors of AF detection by MCOT were determined by univariate analysis including Student t test and Fisher exact tests and multivariate analysis. Results: The median MCOT monitoring duration was 21 (range 5–21) days resulting in an AF detection rate of 23% (13/56). AF was first detected after a median of 7 (range 2–19) days of monitoring. Twenty-seven asymptomatic AF episodes were detected in the 13 patients, of which 85% (23/27) were p = 0.024) and multivariate analysis (OR 6.15; 95% CI 1.16 to 32.73; p = 0.033). Conclusions: There is a high rate of atrial fibrillation (AF) detection by Mobile Cardiac Outpatient Telemetry (21 days) in patients with cryptogenic TIA/stroke that may be related to extended monitoring duration, patient selection, and inclusion of all new onset AF episodes. Brief AF episodes (

Interventional Acute Ischemic Stroke Therapy With Intracranial Self-Expanding Stent

Abstract: Background and Purpose— Rapid and safe recanalization of occluded intracranial arteries in acute ischemic stroke (AIS) is challenging. Newly available self-expanding intracranial atherosclerotic stents (SEIS), which can be deployed rapidly and safely, make acute stenting an option for treating AIS. We present the feasibility of this technique. Methods— A retrospective analysis evaluated procedural protocols and clinical response to treatment in patients with AIS treated with SEIS. Descriptive statistics are presented with initial and follow-up National Institutes of Health Stroke Scale and modified Rankin Score. Results— Nine patients with AIS underwent acute SEIS placement. There was successful deployment of the Neuroform (n=4) and Wingspan (n=4/5) stents in the M1/M2 (n=5) and M3 (n=1) middle cerebral artery segments, intracranial internal carotid artery (one of 2), and intracranial vertebrobasilar junction (one). Mean time of SEIS deployment from AIS onset was 5.1 hours. Complete (Thrombolysis in Cereb...

Anatomic results and complications of stent-assisted coil embolization of intracranial aneurysms.

Abstract: Thromboembolism and intra/postoperative aneurysm ruptures were the most common complications and the main causes of procedure-related morbidity and mortality. Patients with poor grade subarachnoid hemorrhage showed poor clinical outcomes. Since most complications were induced by stent manipulation and deployment, it is mandatory to utilize these devices selectively and cautiously. While the follow-up angiographic results are promising, further studies are essential to evaluate safety, efficacy, and durability of the Neuroform stent.

Risk of hemorrhage in combined neuroform stenting and coil embolization of acutely ruptured intracranial aneurysms.

Abstract: Stenting as adjuvant therapy for the coiling of acutely ruptured aneurysms remains controversial due to the necessity of anticoagulation and antiplatelet medications. We report our experience using the Neuroform stent in the management of 41 aneurysms in 40 patients over a period of three years. For aneurysms whose open surgical risk remains excessive with a morphology that would preclude complete embolization, the risks of stenting may be warranted.

Lower pretreatment cerebral blood volume affects hemorrhagic risks after intra-arterial revascularization in acute stroke.

Abstract: OBJECTIVE Intra-arterial therapies are being used more frequently in patients presenting with acute cerebral occlusions, but they have been limited by the potential for hemorrhage. We sought to determine whether pretreatment computed tomography perfusion parameters might help to identify patients at a higher risk of developing intracranial hemorrhage after intra-arterial stroke revascularization treatment. METHODS We retrospectively reviewed all patients at the University of Pittsburgh Medical Center and Michigan State University who underwent computed tomography perfusion imaging of the brain before intra-arterial thrombolysis between January 2006 and June 2007. Demographic information, angiographic variables, and types of endovascular interventions were recorded. The mean transit time and cerebral blood volumes were recorded for the ipsilateral and contralateral middle cerebral artery territories. A binary logistic regression model was constructed to determine the independent predictors of developing intracranial hemorrhage. RESULTS A total of 57 patients (33 from the University of Pittsburgh and 24 from Michigan State University) with a mean age of 66 +/- 13 years and mean National Institutes of Health Stroke Scale scores of 16 +/- 5 were studied. The overall recanalization (Thrombolysis in Myocardial Infarction Trial scale 2 or 3 flow) was 72% for the cohort, and the overall rate of parenchymal hemorrhage was 5 of 57 (9%) patients. The overall hemorrhage rate was 19 of 57 (33%) patients. The only variable found to be predictive of the development of hemorrhage after intervention was reduced pretreatment cerebral blood volume (odds ratio, 0.49; 95% confidence interval, 0.35-0.91; P < 0.022). CONCLUSION A reduced pretreatment ipsilateral cerebral blood volume value before endovascular revascularization of an acute middle cerebral artery or internal carotid artery occlusion significantly increases the risk of an intracranial hemorrhage.

Extensive Brainstem Ischemia on Neuroimaging Does Not Preclude Meaningful Recovery from Locked‐In Syndrome: Two Cases of Endovascularly Managed Basilar Thrombosis

Abstract: We report 2 patients with angiographically demonstrated basilar artery thrombosis who received emergent intra-arterial thrombolysis with successful recanalization of the basilar artery. In the ensuing weeks after the procedure, both patients were in a locked-in state and had sustained large bilateral regions of pontine ischemia on brain imaging. Following aggressive supportive care and rehabilitation, outcomes obtained prospectively revealed that both patients made a remarkable recovery, becoming fully independent with Barthel scores of 20 and modified Rankin scores of 2.

Quantification and assessment of extracranial and intracranial occlusive disease.

Abstract: Background: Treatment planning for vascular occlusive disease depends in part on quantitative assessment of the degree of occlusion. Digital subtraction angiography is the gold standard for quantitative imaging although other modalities can also be used. Discussion: Three different schemes for measuring percent stenosis of an occluded artery are all valid but may produce different results Conclusion: The choise of method for measurement is less important than consistency of application.

"Mid-term," "long-term," and other terms: making sense of clinical follow-up.

Abstract: The recently published article by Abruzzo et al[1][1] describes late midterm clinical outcomes in patients treated with basilar artery stenting and angioplasty. In the first paragraph of the discussion, the authors note that this is the first description of late-midterm follow up for patients