Journal of neurosurgery
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Journal of neurosurgery · Nov 2023
Multicenter StudySafety of discontinuing antiplatelet therapy 12-24 months after stent-assisted coil embolization: a multicenter retrospective study.
Antiplatelet medication is required after stent-assisted coil embolization (SACE) to avoid thromboembolic complications. Currently, there is no consensus on how long the antiplatelet agent should be maintained. The authors investigated clinical outcomes in patients who discontinued their antiplatelet agent 12-24 months after SACE. ⋯ These results suggest that it may be safe to discontinue antiplatelet medication after SACE in patients at low risk for ischemia, and that it appears safe to discontinue the agent at approximately 15 months after the procedure. Large cohort-based prospective studies or randomized clinical trials are warranted to confirm these results.
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Journal of neurosurgery · Nov 2023
Multicenter Study Observational StudyIncidence and risk factors of posttraumatic hydrocephalus and its association with outcome following intensive care unit treatment for traumatic brain injury: a multicenter observational study.
Posttraumatic hydrocephalus (PTH) is a recognized long-term complication of traumatic brain injury (TBI). The authors assessed the incidence and risk factors of PTH and its association with outcome in patients with TBI who were treated in the intensive care unit (ICU). ⋯ PTH is an uncommon long-term complication of TBI, with several risk factors that are identifiable early during neurointensive care. The development of PTH is independently associated with poor functional outcome. Whether earlier detection and treatment of PTH leads to improved outcomes remains unknown, highlighting the importance of adequate follow-up and prompt detection and treatment of the condition.
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Journal of neurosurgery · Oct 2023
Multicenter Study Observational StudyEndovascular treatment as first-line therapy in Spetzler-Martin grade III brain arteriovenous malformations: a multicenter retrospective study.
The management of Spetzler-Martin grade (SMG) III brain arteriovenous malformations (bAVMs) may be challenging, whatever the exclusion treatment modality chosen. The purpose of this study was to evaluate the safety and effectiveness of endovascular treatment (EVT) as a first-line treatment of SMG III bAVMs. ⋯ EVT of SMG III bAVMs provides encouraging results but needs further improvement. When the embolization procedure performed with intent to cure appears difficult and/or risky, a combined technique (with microsurgery or radiosurgery) may be a safer and more effective strategy. In terms of safety and effectiveness, the benefit of EVT (alone or included in a multimodal management strategy) for SMG III bAVMs needs to be confirmed by randomized controlled trials.
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Journal of neurosurgery · Sep 2023
Multicenter StudyAssociation of calcium channel blockers with lower incidence of intracranial aneurysm rupture and growth in hypertensive patients.
Calcium channel blockers (CCBs) are antihypertensive agents with potential vascular protection effects. This study investigated whether CCB usage was associated with a lower incidence of unruptured intracranial aneurysm (UIA) instability (growth and rupture) in patients with hypertension. ⋯ In UIA patients with hypertension, CCB use was associated with a lower incidence of aneurysm instability.
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Journal of neurosurgery · Sep 2023
Randomized Controlled Trial Multicenter StudyCost-effectiveness of thrombectomy alone versus alteplase before thrombectomy in acute ischemic stroke: results from the DIRECT-MT.
The use of thrombectomy alone (endovascular thrombectomy [EVT]) was found to be noninferior to combination therapy (EVT plus intravenous thrombolysis [IVT] with alteplase before thrombectomy [EVT+IVT]) in the DIRECT-MT (Direct Intra-Arterial Thrombectomy in Order to Revascularize AIS Patients With Large Vessel Occlusion Efficiently in Chinese Tertiary Hospitals: A Multicenter Randomized Clinical Trial), yet the economic value of omitting alteplase was unclear. Thus, in this paper the authors assessed the cost-effectiveness of EVT alone versus EVT+IVT in the DIRECT-MT. ⋯ In this economic analysis based on a trial conducted in China, the authors found that EVT alone was not associated with economic dominance over EVT+IVT in patients with anterior circulation large-vessel occlusion.