Aditya Srivatsan

All Publications

• Cognitive outcomes after unruptured intracranial aneurysm treatment with endovascular coiling JOURNAL OF NEUROINTERVENTIONAL SURGERY Srivatsan, A., Mohanty, A., Saleem, Y., Srinivasan, V. M., Wagner, K., Seeley, J., Burkhardt, J., Chen, S. R., Johnnson, J. N., Kan, P. 2021; 13 (5): 430-433

  Abstract

  We aimed to determine the effects of endovascular coiling of unruptured intracranial aneurysms (UIAs) on cognition to inform treatment decisions. We present the first study using the Montreal Cognitive Assessment (MoCA) to determine neurocognitive changes after endovascular coiling.We prospectively collected data on all patients with UIAs undergoing endovascular coiling, primary or assisted. Patients completed the MoCA prior to intervention and 1 month and 6 months' post-procedure. A repeated measures linear mixed effects model was used to compare pre-procedure and post-procedure cognition.Thirty-three patients with 33 aneurysms who underwent coiling from April 2017 to May 2020 were included (mean age 55.5, 81.8% female). All procedures used general anesthesia. There was no difference between baseline and post-procedure MoCA scores at any time interval (P>0.05). Mean MoCA scores at baseline, 1 month post-procedure, and 6 months' post-procedure were 25.4, 26.8, and 26.3 respectively. There was also no difference between pre- and post-procedure scores on any individual MoCA domain (visuospatial, naming, memory, attention, language, abstraction, delayed recall, and orientation) at any time interval (P>0.05). Seventeen patients had follow-up MRI or CT imaging, of which 11.8% showed radiographic changes or ischemia. 77.8% of patients with 6-month angiographic follow-up achieved class I, and 22.2% achieved class II Raymond-Roy Occlusion. Thirty-two out of 33 patients had follow-up mRS ≤2.Our study suggests that endovascular coiling does not diminish neurocognitive function. Patients with UIAs in our cohort also had baseline MoCA scores below the cut-off for mild cognitive impairment despite pre-procedure mRS and NIHSS of 0.

  View details for DOI 10.1136/neurintsurg-2020-016362

  View details for Web of Science ID 000641485900009

  View details for PubMedID 32699175

• Early Postmarket Results with EmboTrap II Stent Retriever for Mechanical Thrombectomy: A Multicenter Experience AMERICAN JOURNAL OF NEURORADIOLOGY Srivatsan, A., Srinivasan, V. M., Starke, R. M., Peterson, E. C., Yavagal, D. R., Hassan, A. E., Alawieh, A., Spiotta, A. M., Saleem, Y., Fargen, K. M., Wolfe, S. Q., de Leacy, R. A., Singh, I. P., Maier, I. L., Johnson, J. N., Burkhardt, J., Chen, S. R., Kan, P. 2021; 42 (5): 904-909

  Abstract

  EmboTrap II is a novel stent retriever with a dual-layer design and distal mesh designed for acute ischemic stroke emergent large-vessel occlusions. We present the first postmarket prospective multicenter experience with the EmboTrap II stent retriever.A prospective registry of patients treated with EmboTrap II at 7 centers following FDA approval was maintained with baseline patient characteristics, treatment details, and clinical/radiographic follow-up.Seventy patients were treated with EmboTrap II (mean age, 69.9 years; 48.6% women). Intravenous thrombolysis was given in 34.3%, and emergent large-vessel occlusions were located in the ICA (n = 18), M1 (n = 38), M2 or M3 (n = 13), and basilar artery (n = 1). The 5 × 33 mm device was used in 88% of cases. TICI ≥ 2b recanalization was achieved in 95.7% (82.3% in EmboTrap II-only cases), and first-pass efficacy was achieved in 35.7%. The NIHSS score improved from a preoperative average of 16.3 to 12.1 postprocedure and to 10.5 at discharge. An average of 2.5 [SD, 1.8] passes was recorded per treatment, including non-EmboTrap attempts. Definitive treatment was performed with an alternative device (aspiration or stent retriever) in 9 cases (12.9%). Some hemorrhagic conversion was noted in 22.9% of cases, of which 4.3% were symptomatic. There were no device-related complications.Initial postmarket results with the EmboTrap II stent retriever are favorable and comparable with those of other commercially available stent retrievers. Compared with EmboTrap II, the first-generation EmboTrap may have a higher first-pass efficacy; however, data are limited by retrospective case analysis, incomplete clinical follow-up, and small sample size, necessitating future trials.

  View details for DOI 10.3174/ajnr.A7067

  View details for Web of Science ID 000644252900001

  View details for PubMedID 33707283

  View details for PubMedCentralID PMC8115375

• Applications of a Novel Microangioscope for Neuroendovascular Intervention AMERICAN JOURNAL OF NEURORADIOLOGY Srinivasan, V. M., Lazaro, T. T., Srivatsan, A., Cooper, P., Phillips, M., Garcia, R., Chen, S. R., Johnson, J. N., Burkhardt, J., Collins, D. E., Kan, P. 2021; 42 (2): 347-353

  Abstract

  Visualization in neuroendovascular intervention currently relies on biplanar fluoroscopy and contrast administration. With the advent of endoscopy, direct visualization of the intracranial intravascular space has become possible with microangioscopes. We analyzed the efficacy of our novel microangioscope to enable direct observation and inspection of the cerebrovasculature, complementary to a standard fluoroscopic technique.Iterations of microangioscopes were systematically evaluated for use in neurodiagnostics and neurointerventions in both live animal and human cadaveric models. Imaging quality, trackability, and navigability were assessed. Diagnostic procedures assessed included clot identification and differentiation, plaque identification, inspection for vessel wall injury, and assessment of stent apposition. Interventions performed included angioscope-assisted stent-retriever thrombectomy, clot aspiration, and coil embolization.The microangioscope was found helpful in both diagnosis and interventions by independent evaluators. Mean ratings of the imaging quality on a 5-point scale ranged from 3.0 (clot identification) to 4.7 (Pipeline follow-up). Mean ratings for clinical utility ranged from 3.0 (aspiration thrombectomy) to 4.7 (aneurysm treatment by coil embolization and WEB device).This fiber optic microangioscope can safely navigate and visualize the intravascular space in human cadaveric and in vivo animal models with satisfactory resolution. It has potential value in diagnostic and neurointerventional applications.

  View details for DOI 10.3174/ajnr.A6900

  View details for Web of Science ID 000640504000029

  View details for PubMedID 33361372

  View details for PubMedCentralID PMC7872190

• Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Multi-Center Experience of 154 Consecutive Embolizations NEUROSURGERY Kan, P., Maragkos, G. A., Srivatsan, A., Srinivasan, V., Johnson, J., Burkhardt, J., Robinson, T. M., Salem, M. M., Chen, S., Riina, H. A., Tanweer, O., Levy, E., Spiotta, A. M., Al Kasab, S., Lena, J., Gross, B. A., Cherian, J., Cawley, C., Howard, B. M., Khalessi, A. A., Pandey, A. S., Ringer, A. J., Hanel, R., Ortiz, R. A., Langer, D., Kelly, C. M., Jankowitz, B. T., Ogilvy, C. S., Moore, J. M., Levitt, M. R., Binning, M., Grandhi, R., Siddiq, F., Thomas, A. J. 2021; 88 (2): 268-277

  Abstract

  Middle meningeal artery (MMA) embolization has emerged as a promising treatment for chronic subdural hematoma (cSDH).To determine the safety and efficacy of MMA embolization.Consecutive patients who underwent MMA embolization for cSDH (primary treatment or recurrence after conventional surgery) at 15 centers were included. Clinical details and follow-up were collected prospectively. Primary clinical and radiographic outcomes were the proportion of patients requiring additional surgical treatment within 90 d after index treatment and proportion with > 50% cSDH thickness reduction on follow-up computed tomography imaging within 90 d. National Institute of Health Stroke Scale and modified Rankin Scale were also clinical outcomes.A total of 138 patients were included (mean age: 69.8, 29% female). A total of 15 patients underwent bilateral interventions for 154 total embolizations (66.7% primary treatment). At presentation, 30.4% and 23.9% of patients were on antiplatelet and anticoagulation therapy, respectively. Median admission cSDH thickness was 14 mm. A total of 46.1% of embolizations were performed under general anesthesia, and 97.4% of procedures were successfully completed. A total of 70.2% of embolizations used particles, and 25.3% used liquid embolics with no significant outcome difference between embolization materials (P > .05). On last follow-up (mean 94.9 d), median cSDH thickness was 4 mm (71% median thickness reduction). A total of 70.8% of patients had >50% improvement on imaging (31.9% improved clinically), and 9 patients (6.5%) required further cSDH treatment. There were 16 complications with 9 (6.5%) because of continued hematoma expansion. Mortality rate was 4.4%, mostly unrelated to the index procedure but because of underlying comorbidities.MMA embolization may provide a safe and efficacious minimally invasive alternative to conventional surgical techniques.

  View details for DOI 10.1093/neuros/nyaa379

  View details for Web of Science ID 000610550900022

  View details for PubMedID 33026434

• Comparison of First-Pass Efficacy Among Four Mechanical Thrombectomy Techniques: A Single-Center Experience WORLD NEUROSURGERY Hafeez, M., Kan, P., Srivatsan, A., Moore, S., Jafari, M., DeLaGarza, C., Hafeez, K., Nascimento, F. A., Srinivasan, V. M., Burkhardt, J., Chen, S., Johnson, J., Saleem, Y. 2020; 144: E533-E540

  Abstract

  First-pass efficacy (FPE) is an established marker of technical and clinical efficacy among mechanical thrombectomy (MT) techniques. It is unclear what the optimal approach is in achieving FPE. We present a single-center experience comparing rates of FPE among 2 MT techniques and evaluate the potential predictors of FPE among other outcomes.A single-center retrospective analysis was carried out of patients with consecutive large-vessel occlusion strokes (LVOS) of anterior circulation from September 2015 to April 2019 who underwent MT and for whom data were available on the status of FPE. Four MT techniques were identified: ADAPT (a direct first-pass aspiration), SrADAPT (stent retriever with aspiration), SRBG (stent retriever with balloon guide catheter), and STRAP (stent retriever-aspiration and proximal flow arrest). The primary outcome was FPE and secondary outcomes included the rate of successful reperfusion.Among 226 patients with LVOS of the anterior circulation who underwent MT, data were available for 164 on FPE for the 4 MT techniques. SRBG was the most prevalent technique. No significant difference was found in rates of FPE among the 4 MT techniques (P = 0.332). No independent predictors of FPE were identified on multivariable analysis. STRAP had the highest rate of successful reperfusion compared with the other techniques (P = 0.049) and was the only independent predictor of that outcome (P = 0.027).Among patients with LVOS of the anterior circulation, the rate of FPE did not differ among the 4 MT techniques. There were no predictors of FPE among the studied variables. STRAP was the only predictor of successful reperfusion.

  View details for DOI 10.1016/j.wneu.2020.08.209

  View details for Web of Science ID 000600668300062

  View details for PubMedID 32891839

• Commentary: Burr Hole-Assisted Direct Transsylvian Venous Catheterization for Carotid-Cavernous Fistula Embolization: A Case Report OPERATIVE NEUROSURGERY Srivatsan, A., Kan, P. 2020; 19 (2): E201-E202

  View details for Web of Science ID 000594000100046

  View details for PubMedID 32016428

• Intra-Arterial Glycoprotein IIb/IIIa Inhibitor Treatment for Symptomatic Intracranial Atherosclerotic Stenosis Presenting as Large Vessel Occlusions CUREUS JOURNAL OF MEDICAL SCIENCE Srivatsan, A., Srinivasan, V. M., Chen, S., Kan, P., Johnson, J. N. 2020; 12 (7): e9243

  Abstract

  Introduction There is no consensus on the optimal treatment for acute ischemic stroke (AIS) large vessel occlusions (LVOs) or near-occlusions with underlying intracranial atherosclerotic stenosis (ICAS). We report the first American series using intra-arterial (IA) glycoprotein IIb/IIIa inhibitors (GPIs) as a stand-alone revascularization technique for ICAS presenting with large vessel ischemic syndromes. Methods Records at two centers of 140 patients presenting with AIS undergoing stroke intervention from January 2017 to June 2019 were retrospectively reviewed. Patients treated with IA GPIs were identified, and baseline factors, imaging, procedural characteristics, hospital course, and outcomes were collected. Six patients with ICAS underlying their acute symptomatic near occlusion or LVO were treated with IA GPI. Four near-occlusions were treated with IA GPI as the first-line therapy, while two LVOs were treated with IA GPI as an adjunct therapy to thrombectomy. Results The mean age was 61.3 years (range 36-79), presentation National Institute of Health Stroke Scale (NIHSS) was 10 (4-18), time from last seen well to treatment was 434.5 minutes (164-1290), and time from groin puncture to revascularization was 67.3 minutes (26-94). Three patients received intravenous (IV) tissue plasminogen activator (tPA), and all patients received an IA weight-based GPI infusion. Five patients had thrombolysis in cerebral ischemia (TICI) 3, and one patient had TICI 2b. The mean discharge NIHSS was 2.5 (0-8). The mean modified Rankin scale was 1.3 (range 0-4) at discharge and .8 at three months. No patients had a postprocedural symptomatic hemorrhage. Conclusion Our results highlight the utility of IA GPI administration as the first-line therapy for symptomatic ICAS near occlusions or as a rescue technique after failed thrombectomy for LVO patients suspected of underlying ICAS.

  View details for DOI 10.7759/cureus.9243

  View details for Web of Science ID 000549855600010

  View details for PubMedID 32821589

  View details for PubMedCentralID PMC7430682

• Immunohistologic comparison and thrombus NET analysis in stroke and myocardial infarction NEUROLOGY Srivatsan, A., Woollard, K. 2020; 94 (22): 955-956

  View details for DOI 10.1212/WNL.0000000000009529

  View details for Web of Science ID 000549941600003

  View details for PubMedID 32434866

• Multicenter Postmarket Analysis of the Neuroform Atlas Stent for Stent-Assisted Coil Embolization of Intracranial Aneurysms AMERICAN JOURNAL OF NEURORADIOLOGY Burkhardt, J., Srinivasan, V., Srivatsan, A., Albuquerque, F., Ducruet, A. F., Hendricks, B., Gross, B. A., Jankowitz, B. T., Thomas, A. J., Ogilvy, C. S., Maragkos, G. A., Enriquez-Marulanda, A., Crowley, R. W., Levitt, M. R., Kim, L. J., Griessenauer, C. J., Schirmer, C. M., Dalal, S., Piper, K., Mokin, M., Winkler, E. A., Abla, A. A., McDougall, C., Birnbaum, L., Mascitelli, J., Litao, M., Tanweer, O., Riina, H., Johnson, J., Chen, S., Kan, P. 2020; 41 (6): 1037-1042

  Abstract

  The Neuroform Atlas is a new microstent to assist coil embolization of intracranial aneurysms that recently gained FDA approval. We present a postmarket multicenter analysis of the Neuroform Atlas stent.On the basis of retrospective chart review from 11 academic centers, we analyzed patients treated with the Neuroform Atlas after FDA exemption from January 2018 to June 2019. Clinical and radiologic parameters included patient demographics, aneurysm characteristics, stent parameters, complications, and outcomes at discharge and last follow-up.Overall, 128 aneurysms in 128 patients (median age, 62 years) were treated with 138 stents. Risk factors included smoking (59.4%), multiple aneurysms (27.3%), and family history of aneurysms (16.4%). Most patients were treated electively (93.7%), and 8 (6.3%) underwent treatment within 2 weeks of subarachnoid hemorrhage. Previous aneurysm treatment failure was present in 21% of cases. Wide-neck aneurysms (80.5%), small aneurysm size (<7 mm, 76.6%), and bifurcation aneurysm location (basilar apex, 28.9%; anterior communicating artery, 27.3%; and middle cerebral artery bifurcation, 12.5%) were common. A single stent was used in 92.2% of cases, and a single catheter for both stent placement and coiling was used in 59.4% of cases. Technical complications during stent deployment occurred in 4.7% of cases; symptomatic thromboembolic stroke, in 2.3%; and symptomatic hemorrhage, in 0.8%. Favorable Raymond grades (Raymond-Roy occlusion classification) I and II were achieved in 82.9% at discharge and 89.5% at last follow-up. mRS ≤2 was determined in 96.9% of patients at last follow-up. The immediate Raymond-Roy occlusion classification grade correlated with aneurysm location (P < .0001) and rupture status during treatment (P = .03).This multicenter analysis provides a real-world safety and efficacy profile for the treatment of intracranial aneurysms with the Neuroform Atlas stent.

  View details for DOI 10.3174/ajnr.A6581

  View details for Web of Science ID 000548058500025

  View details for PubMedID 32467183

  View details for PubMedCentralID PMC7342754

• Commentary: Simultaneous Bilateral Carotid Thrombectomies: A Technical Note OPERATIVE NEUROSURGERY Srivatsan, A., Kan, P. 2020; 18 (5): E149-E150

  View details for DOI 10.1093/ons/opz273

  View details for Web of Science ID 000536033600003

  View details for PubMedID 31529061

• Commentary: A Cohort Comparison Analysis of Fixed Pressure Ventriculoperitoneal Shunt Valves With Programmable Valves for Hydrocephalus Following Nontraumatic Subarachnoid Hemorrhage OPERATIVE NEUROSURGERY Srivatsan, A., Burkhardt, J., Kan, P. 2020; 18 (4): E104-E105

  View details for DOI 10.1093/ons/opz265

  View details for Web of Science ID 000522861300003

  View details for PubMedID 31840759

• Commentary: Antiplatelet Therapy in Flow Diversion NEUROSURGERY Mohanty, A., Srivatsan, A., Kan, P. 2020; 86 (2): E229-E230

  View details for DOI 10.1093/neuros/nyz458

  View details for Web of Science ID 000515122000032

  View details for PubMedID 31844903

• Outcomes after coverage of lenticulostriate vessels by flow diverters: a multicenter experience JOURNAL OF NEUROSURGERY Wagner, K. M., Srinivasan, V. M., Srivatsan, A., Ghali, M. Z., Thomas, A. J., Enriquez-Marulanda, A., Alturki, A. Y., Ogilvy, C. S., Mokin, M., Kuhn, A. L., Puri, A., Grandhi, R., Chen, S., Johnson, J., Kan, P. 2020; 132 (2): 473-480

  Abstract

  OBJECTIVEWith the increasing use of flow diversion as treatment for intracranial aneurysms, there is a concomitant increased vigilance in monitoring complications. The low porosity of flow diverters is concerning when the origins of vessels are covered, whether large circle of Willis branches or critical perforators. In this study, the authors report their experience with flow diverter coverage of the lenticulostriate vessels and evaluate their safety and outcomes.METHODSThe authors retrospectively reviewed 5 institutional databases of all flow diversion cases from August 2012 to June 2018. Information regarding patient presentation, aneurysm location, treatment, and outcomes were recorded. Patients who were treated with flow diverters placed in the proximal middle cerebral artery (MCA), proximal anterior cerebral artery, or distal internal carotid artery leading to coverage of the medial and lateral lenticulostriate vessels were included. Clinical outcomes according to the modified Rankin Scale were reviewed. Univariate and multivariate analyses were performed to establish risk factors for lenticulostriate infarct.RESULTSFifty-two patients were included in the analysis. Postprocedure cross-sectional images were available in 30 patients. Two patients experienced transient occlusion of the MCA during the procedure; one was asymptomatic, and the other had a clinical and radiographic ipsilateral internal capsule stroke. Five patients had transient symptoms without radiographic infarct in the lenticulostriate territory. Two patients experienced in-stent thrombosis, leading to clinical MCA infarcts (one in the ipsilateral caudate) after discontinuing antiplatelet therapy. Discontinuation of dual antiplatelet therapy prior to 6 months was the only variable that was significantly correlated with stroke outcome (p < 0.01, OR 0.3, 95% CI 0-0.43), and this significance persisted when controlled for other risk factors, including age, smoking status, and aneurysm location.CONCLUSIONSThe use and versatility of flow diversion is increasing, and safety data are continuing to accumulate. Here, the authors provide early data on the safety of covering lenticulostriate vessels with flow diverters. The authors concluded that the coverage of these perforators does not routinely lead to clinically significant ischemia when dual antiplatelet therapy is continued for 6 months. Further evaluation is needed in larger cohorts and with imaging follow-up as experience develops in using these devices in more distal circulation.

  View details for DOI 10.3171/2018.8.JNS18755

  View details for Web of Science ID 000518384200016

  View details for PubMedID 30641842

• Commentary: Expanding Indications for Flow Diverters: Distal Aneurysms, Bifurcation Aneurysms, Small Aneurysms, Previously Coiled Aneurysms and Clipped Aneurysms, Carotid Cavernous Fistulas NEUROSURGERY Srivatsan, A., Kan, P. 2020; 86 (2): E227-E228

  View details for DOI 10.1093/neuros/nyz450

  View details for Web of Science ID 000515122000031

  View details for PubMedID 31844902

• Expanding Indications for Flow Diverters: Ruptured Aneurysms, Blister Aneurysms, and Dissecting Aneurysms NEUROSURGERY Kan, P., Sweid, A., Srivatsan, A., Jabbour, P. 2020; 86: S96-S103

  Abstract

  The safety and efficacy of flow diversion (FD) in the treatment of cerebral aneurysms have been reported by many studies. FD has enabled the treatment of complex aneurysms and aneurysms that were previously untreatable by conventional means. It has achieved high rates of obliteration with essentially no recanalization, and its indications have continued to expand, now including ruptured aneurysms, blister aneurysms, and dissecting aneurysms.To provide a review on the outcomes of studies covering the use of FD in the settings of ruptured, blister, and dissecting aneurysms. In addition, to discuss dual antiplatelet therapy (DAPT) used in preparation for FD deployment in these scenarios, including associated complications with DAPT use in the acute rupture setting.References for this topical review were identified by PubMed searches between January 2000 and January 2019. The search terms "aneurysm", "flow diverter", "stent", "pipeline", "ruptured", "blister", and "dissecting aneurysms" were used.FD carries a higher complication rate in the acute rupture setting than for unruptured aneurysms. Patient selection is of paramount importance for achieving good functional and angiographic outcomes. DAPT still remains challenging, especially in ruptured aneurysms. Advancements in surface modification of flow diverters can reduce the risk of thromboembolism and perhaps lead to a safer antiplatelet regimen.In summary, FD shows promise to be an effective treatment for ruptured, blister, and dissecting aneurysms.

  View details for DOI 10.1093/neuros/nyz304

  View details for Web of Science ID 000531536500019

  View details for PubMedID 31838529

• Gastrointestinal stromal tumor with intracranial metastasis: case presentation and systematic review of literature BMC CANCER Prablek, M., Srinivasan, V. M., Srivatsan, A., Holdener, S., Oneissi, M., Heck, K. A., Jalali, A., Mandel, J., Viswanathan, A., Patel, A. J. 2019; 19 (1): 1119

  Abstract

  Intracranial metastasis of Gastrointestinal Stromal Tumors (GISTs) is rare but presents unique treatment challenges. We present a case of intracranial metastasis of GIST with a systematic review of the literature. A literature search using key terms "'gastrointestinal stromal tumor' AND brain AND metastasis"" was conducted through May 2019 via Embase and Pubmed according to PRISMA guidelines. Only cases describing intradural metastases rather than calvarial or intraorbital metastases were included.A 57-year-old woman with history of GIST metastatic to the liver presented with a six-week history of left facial weakness, left hearing loss, and left facial numbness, and a one-week history of headaches, gait disturbance, and dizziness. MRI revealed a contrast-enhancing dural-based left middle cranial fossa mass measuring 2.9 cm × 3.1 cm × 3.4 cm with extension into the internal auditory canal and cerebral edema. A left temporal craniotomy was performed to excise the lesion, and the patient was discharged to a rehabilitation facility at her preoperative baseline. Intraoperative pathology revealed a spindle cell neoplasm, postoperative MRI demonstrated gross total resection of the lesion, and microscopic analysis demonstrated sheets of spindled tumor cells with short ovoid, irregular, hyperchromatic nuclei and scattered large atypical nuclei without extensive necrosis. Immunohistochemical staining was positive for KIT proto-oncogene (CD117, c-KIT), and the patient was put on imatinib (400 mg/day).Of the 18 cases analyzed and our present case, metastasis typically involved the cerebrum with only one in infratentorial elements. The tumors in seven of the cases involved the dura, and one case metastasized to the pituitary. Eight patients died following treatment. Surgery remains the mainstay of intracranial metastatic GIST, however there are many reports of good responses to radiation or chemotherapy alone. More investigation is required to determine the best treatment course for these patients.

  View details for DOI 10.1186/s12885-019-6316-7

  View details for Web of Science ID 000497730800006

  View details for PubMedID 31730471

  View details for PubMedCentralID PMC6858695

• Republished: Rotational carotid insufficiency: an unusual cause of bow hunter's syndrome (Reprinted from BMJ Case Reports, vol 2018, 014210, 2018) JOURNAL OF NEUROINTERVENTIONAL SURGERY Kan, P., Srivatsan, A., Johnnson, J. N., Chen, S. R. 2019; 11 (11)

  Abstract

  We report an unusual case in which physiologic neck rotation impeded perfusion through the internal carotid artery. The patient had a history of prior radical neck surgery and radiation for malignancy. He presented withbow hunter's-like symptoms with transient loss of consciousness and right-sided weakness with left lateral neck rotation. A self-expanding peripheral stent was successfully used to treat the patient by preventing rotatory carotid compression. In select patients with prior neck surgery and radiation, carotid injections should be part of a dynamic cerebral angiogram if the vertebral arteries are unremarkable.

  View details for DOI 10.1136/neurintsurg-2018-014210.rep

  View details for Web of Science ID 000498581500001

  View details for PubMedID 30674638

• Perspective on Safety and Effectiveness of Middle Meningeal Artery Embolization for Chronic Subdural Hematoma WORLD NEUROSURGERY Srivatsan, A., Srinivasan, V. M., Thomas, A., Burkhardt, J., Johnson, J. N., Kan, P. 2019; 127: 97-98

  View details for DOI 10.1016/j.wneu.2019.03.210

  View details for Web of Science ID 000473128300177

  View details for PubMedID 30930325

• In Reply to the Letter to the Editor Regarding "Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: Meta-Analysis and Systematic Review" WORLD NEUROSURGERY Srivatsan, A., Srinivasan, V. M., Thomas, A., Kan, P. 2019; 124: 482

  View details for DOI 10.1016/j.wneu.2019.01.019

  View details for Web of Science ID 000463087800201

  View details for PubMedID 30677577

• A Relative Noncontrast CT Map to Detect Early Ischemic Changes in Acute Stroke JOURNAL OF NEUROIMAGING Srivatsan, A., Christensen, S., Lansberg, M. G. 2019; 29 (2): 182-186

  View details for DOI 10.1111/jon.12593

  View details for Web of Science ID 000460474700002

• Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: Meta-Analysis and Systematic Review WORLD NEUROSURGERY Srivatsan, A., Mohanty, A., Nascimento, F. A., Hafeez, M. U., Srinivasan, V. M., Thomas, A., Chen, S. R., Johnson, J. N., Kan, P. 2019; 122: 613-619

  Abstract

  Chronic subdural hematoma is a very common neurosurgical condition. Although conventional surgical methods, such as burr hole irrigation, have been the mainstay of treatment, middle meningeal artery (MMA) embolization has emerged as a promising adjunctive or alternative treatment. The aim of this article was to present a meta-analysis and systematic review of this topic.A literature search using keywords "chronic subdural hematoma," "chronic subdural hemorrhage," "refractory subdural hematoma," "refractory subdural hemorrhage," and "middle meningeal artery embolization" was conducted through October 2018. Outcome variables of hematoma recurrence, surgical complications, and modified Rankin Scale score were analyzed and compared between MMA embolization and conventional surgery cohorts.Three double-arm studies comparing embolization and conventional surgery groups and 6 single-arm case series were identified and analyzed. Hematoma recurrence rate was significantly lower in the embolization group compared with conventional treatment group (2.1% vs. 27.7%; odds ratio = 0.087; 95% confidence interval, 0.026-0.292; P < 0.001; I2 = 0%); surgical complication rates were similar between groups (2.1% vs. 4.4%; odds ratio = 0.563; 95% confidence interval, 0.107-2.96; P = 0.497; I2 = 27.5%). Number of patients with modified Rankin Scale score >2 in the embolization (12.5%) versus conventional treatment (9.1%) group showed no statistical difference (P = 0.689). A composite hematoma recurrence rate of 3.6% was found after summing the 6 case series. Composite recurrence and complication rates in the embolization cohorts of the double-arm studies and the case series were lower than literature values for conventional surgical treatments.MMA embolization is a promising treatment for chronic subdural hematoma. Future randomized clinical trials are needed.

  View details for DOI 10.1016/j.wneu.2018.11.167

  View details for Web of Science ID 000457328100314

  View details for PubMedID 30481628

• Enhancement of Acute Stroke Lesions on Non-Contrast CT Using Relative Signal Intensity Maps Srivatsan, A., Christensen, S., Lansberg, M. G. LIPPINCOTT WILLIAMS & WILKINS. 2018

  View details for Web of Science ID 000429728400055