Search Results

You are looking at 1 - 10 of 10 items for

  • Author or Editor: Erol Veznedaroglu x
Clear All Modify Search
Restricted access

Erol Veznedaroglu, Elisabeth J. Van Bockstaele and Michael J. O'Connor

Object. Several lines of evidence have demonstrated a number of cellular changes that occur within the hippocampus in patients with temporal lobe epilepsy (TLE). These include aberrant migration of granule cells and sprouting of mossy fibers, processes that have been linked to the hyperexcitability phenomenon observed in cases of TLE. In the present study the authors examined brain tissues obtained in patients undergoing temporal lobectomy surgery and in patients at autopsy (normal human control specimens), and compared the subcellular composition of regions of the hippocampus containing dispersed granule cells.

Methods. Six human hippocampi were obtained in patients undergoing temporal lobectomies for intractable seizures. The patients ranged in age from 24 to 50 years. Two of the six patients had a history of head trauma and one had experienced a febrile seizure during childhood. Immediately following excision from the brain, the tissue was placed in an acrolein—paraformaldehyde fixative. The hippocampi were processed along with six human brain control specimens obtained at autopsy for light and electron microscopic evaluation. The tissues were then labeled for collagen types I through IV. Positive collagen labeling was identified, with the aid of both light and electron microscopy, in the parenchyma of all patients with TLE but not in the control tissues.

Conclusions. The authors report the first localization of collagen outside of the vasculature and meninges in the brains of patients with TLE. Recent evidence of collagen's chemoattractant properties and its role in epileptogenesis in animal models suggests that collagen may play a role in cellular migration and seizure activity in a subset of patients. Further studies with a larger series of patients are warranted.

Restricted access

Rafael Ortiz, Michael Stefanski, Robert Rosenwasser and Erol Veznedaroglu

Object

Aneurysms treated by endovascular coil embolization have been associated with coil compaction, and the rate of recanalization has been reported to be as high as 40%. The authors report the first published evidence of a correlation between aneurysm recanalization correlated with a history of cigarette smoking.

Methods

The authors conducted a retrospective chart review of all cases involving patients admitted to their institution from January 1, 2003, to December 31, 2003, for treatment of a cerebral aneurysm. Cases in which patients were treated with coil embolization were reviewed for inclusion. Coil compaction was defined as change in the shape of the coil mass. Aneurysm recanalization was defined as an increase in inflow to the aneurysm in comparison with baseline. The incidence of coil compaction and the relationship with cigarette smoking history were compared in patients with and without recurrence.

Results

A total of 110 patients qualified for inclusion. The odds ratio (OR) for aneurysm recanalization after endosaccular occlusion with respect to history of cigarette smoking was significant for the entire cohort (OR 4.53, 95% confidence interval [CI] 1.95–10.52) and especially for the female cohort (OR 3.72, 95% CI 1.45–9.54). The male cohort demonstrated a trend toward a direct correlation, but the sample size was not large enough for statistical significance (OR 7.50, 95% CI 1.02–55.00).

Conclusions

There was an increased risk of recanalization especially in patients with low-grade subarachnoid hemorrhage who had a history of cigarette smoking. These data suggest a correlation between cigarette smoking and aneurysm recurrence.

Full access

Christopher J. Koebbe, Kenneth Liebman, Erol Veznedaroglu and Robert Rosenwasser

Object

The use of endovascular management for recurrent carotid artery (CA) stenosis is rapidly expanding due to the increased surgical risk associated with repeated carotid endarterectomy (CEA). Carotid artery angioplasty and stent placement for recurrent CA stenosis offers a less invasive strategy with fewer procedural complications and may provide a more durable treatment. The authors report on their experience with this procedure in the management of recurrent CA stenosis.

Methods

A retrospective review was performed to evaluate clinical and ultrasound imaging outcomes after CA angioplasty and stent placement. Twenty-three vessels in 22 patients with severe recurrent stenosis (> 80%) post-CEA were treated with balloon angioplasty and stent placement without distal protection. There were no perioperative neurological or cardiac complications in this series. Over a mean follow-up period of 36 months, one patient (5%) suffered recurrent stenosis requiring retreatment with angioplasty alone.

Conclusions

The use of CA angioplasty and stent placement provides a safe and effective treatment for recurrent CA stenosis. The use of drug-eluting and/or bioactive stents in the future will likely further improve the efficacy of this procedure for recurrent CA stenosis.

Free access

Mandy Binning, Zakaria Hakma and Erol Veznedaroglu

The patient is a 60-year-old woman who presented to her primary care physician with new onset of headache. She was neurologically intact without cranial nerve deficit. An outpatient CT angiogram (CTA) revealed no subarachnoid hemorrhage, but showed a right-sided posterior communicating artery aneurysm measuring 11 mm by 10 mm. Digitally subtracted cerebral angiography confirmed these measurements and showed that the aneurysm was amenable to endovascular coil embolization. The patient underwent aneurysm coiling without complication and was discharged to home on postoperative Day 1.

The video can be found here: http://youtu.be/MjOc3Zpv2K8.

Full access

Pascal Jabbour, Christopher Koebbe, Erol Veznedaroglu, Ronald P. Benitez and Robert Rosenwasser

Object

The treatment of wide-necked cerebral aneurysms represents a challenging problem for neurosurgeons. The recent development of stents has provided clinicians with the ability to treat these aneurysms while keeping the parent vessel patent. The long-term occlusion rate of aneurysms treated with stent-assisted coil placement has yet to be investigated. The authors report the use of a new intracranial stent—the Neuroform microstent—in the treatment of unruptured wide-necked cerebral aneurysms.

Methods

Thirty-two patients harboring unruptured wide-necked intracranial aneurysms underwent a stent-assisted coil placement procedure. Patients were pretreated with antiplatelet agents, and a stent was positioned across the neck of the aneurysm. The next step was the insertion of coils into the aneurysm cavity. Patients received anticoagulation therapy for 24 hours after the procedure.

All 32 patients with unruptured wide-necked cerebral aneurysms were suitable candidates for this procedure. Occlusion of at least 90% of the aneurysm was achieved in 24 patients (75%) and 0% occlusion was observed in five patients (15%). Two patients experienced thromboembolic events, one of which was directly related to the stent. The overall complication rate was 6.3%.

Conclusions

Intracranial stents will be used more frequently in the new era of endovascular management of wide-necked cerebral aneurysms. With some technical improvements and more data on long-term occlusion rates, this new modality should improve the occlusion of wide-necked cerebral aneurysms while protecting the parent vessel.

Free access

Maxim Mokin, Alexander A. Khalessi, J Mocco, Giuseppe Lanzino, Travis M. Dumont, Ricardo A. Hanel, Demetrius K. Lopes, Richard D. Fessler II, Andrew J. Ringer, Bernard R. Bendok, Erol Veznedaroglu, Adnan H. Siddiqui, L. Nelson Hopkins and Elad I. Levy

Various endovascular intraarterial approaches are available for treating patients with acute ischemic stroke who present with severe neurological deficits. Three recent randomized trials—Interventional Management of Stroke (IMS) III, Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy (MR RESCUE), and Synthesis Expansion: A Randomized Controlled Trial on Intra-Arterial Versus Intravenous Thrombolysis in Acute Ischemic Stroke (SYNTHESIS Expansion)—evaluated the efficacy of endovascular treatment of acute ischemic stroke and, after failing to demonstrate any significant clinical benefit of endovascular therapies, raised concerns and questions in the medical community regarding the future of endovascular treatment for acute ischemic stroke. In this paper, the authors review the evolution of endovascular treatment strategies for the treatment of acute stroke and provide their interpretation of findings and potential limitations of the three recently published randomized trials. The authors discuss the advantage of stent-retriever technology over earlier endovascular approaches and review the current status and future directions of endovascular acute stroke studies based on lessons learned from previous trials.

Full access

Benjamin L. Brown, Demetrius Lopes, David A. Miller, Rabih G. Tawk, Leonardo B. C. Brasiliense, Andrew Ringer, Eric Sauvageau, Ciarán J. Powers, Adam Arthur, Daniel Hoit, Kenneth Snyder, Adnan Siddiqui, Elad Levy, L. Nelson Hopkins, Hugo Cuellar, Rafael Rodriguez-Mercado, Erol Veznedaroglu, Mandy Binning, J Mocco, Pedro Aguilar-Salinas, Alan Boulos, Junichi Yamamoto and Ricardo A. Hanel

OBJECT

The authors sought to determine whether flow diversion with the Pipeline Embolization Device (PED) can approximate microsurgical decompression in restoring function after cranial neuropathy following carotid artery aneurysms.

METHODS

This multiinstitutional retrospective study involved 45 patients treated with PED across the United States. All patients included presented between November 2009 and October 2013 with cranial neuropathy (cranial nerves [CNs] II, III, IV, and VI) due to intracranial aneurysm. Outcome analysis included clinical and procedural variables at the time of treatment as well as at the latest clinical and radiographic follow-up.

RESULTS

Twenty-six aneurysms (57.8%) were located in the cavernous segment, while 6 (13.3%) were in the clinoid segment, and 13 (28.9%) were in the ophthalmic segment of the internal carotid artery. The average aneurysm size was 18.6 mm (range 4–35 mm), and the average number of flow diverters placed per patient was 1.2. Thirty-eight patients had available information regarding duration of cranial neuropathy prior to treatment. Eleven patients (28.9%) were treated within 1 month of symptom onset, while 27 (71.1%) were treated after 1 month of symptoms. The overall rate of cranial neuropathy improvement for all patients was 66.7%. The CN deficits resolved in 19 patients (42.2%), improved in 11 (24.4%), were unchanged in 14 (31.1%), and worsened in 1 (2.2%). Overtime, the rate of cranial neuropathy improvement was 33.3% (15/45), 68.8% (22/32), and 81.0% (17/21) at less than 6, 6, and 12 months, respectively. At last follow-up, 60% of patients in the isolated CN II group had improvement, while in the CN III, IV, or VI group, 85.7% had improved. Moreover, 100% (11/11) of patients experienced improvement if they were treated within 1 month of symptom onset, whereas 44.4% (12/27) experienced improvement if they treated after 1 month of symptom onset; 70.4% (19/27) of those with partial deficits improved compared with 30% (3/10) of those with complete deficits.

CONCLUSIONS

Cranial neuropathy caused by cerebral aneurysm responds similarly when the aneurysm is treated with the PED compared with open surgery and coil embolization. Lower morbidity and higher occlusion rates obtained with the PED may suggest it as treatment of choice for some of these lesions. Time to treatment is an important consideration regardless of treatment modality.

Restricted access

J Mocco, Kenneth V. Snyder, Felipe C. Albuquerque, Bernard R. Bendok, Alan S. Boulos, Jeffrey S. Carpenter, David J. Fiorella, Brian L. Hoh, Jay U. Howington, Brian T. Jankowitz, Kenneth M. Liebma N, Ansaar T. Rai, Rafael Rodriguez-Mercado, Adnan H. Siddiqui, Erol Veznedaroglu, L. Nelson Hopkins and Elad I. Levy

Object

The development of self-expanding stents dedicated to intracranial use has significantly widened the applicability of endovascular therapy to many intracranial aneurysms that would otherwise have been untreatable by endovascular techniques. Recent Food and Drug Administration approval of the Enterprise Vascular Reconstruction Device and Delivery System (Cordis) has added a new option for self-expanding stent-assisted intracranial aneurysm coiling.

Methods

The authors established a collaborative registry across multiple institutions to rapidly provide largevolume results regarding initial experience in using the Enterprise in real-world practice. Ten institutions (University at Buffalo, Thomas Jefferson University, University of Florida, Cleveland Clinic, Northwestern University, West Virginia University, University of Puerto Rico, Albany Medical Center Hospital, the Neurological Institute of Savannah, and the Barrow Neurological Institute) have provided consecutive data regarding their initial experience with the Enterprise.

Results

In total, 141 patients (119 women) with 142 aneurysms underwent 143 attempted stent deployments. The use of Enterprise assistance with aneurysm coiling was associated with a 76% rate of ≥ 90% occlusion. An inability to navigate or deploy the stent was experienced in 3% of cases, as well as a 2% occurrence of inaccurate deployment. Procedural data demonstrated a 6% temporary morbidity, 2.8% permanent morbidity, and 2% mortality (0.8% unruptured, 12% ruptured).

Conclusions

The authors report initial results of the largest series to date in using the Enterprise for intracranial aneurysm treatment. The Enterprise is associated with a high rate of successful navigation and low occurrence of inaccurate stent deployment. The overall morbidity and mortality rates were low; however, caution should be exercised when considering Enterprise deployment in patients with subarachnoid hemorrhage as the authors' experience demonstrated a high rate of associated hemorrhagic complications leading to death.