Outcomes of retreatment for intracranial aneurysms - a meta-analysis

Long term results from the International Subarachnoid Hemorrhage Trial (ISAT) and Barrow Ruptured Aneurysm Trial (BRAT) indicate considerably higher retreatment rates for aneurysms treated with coiling compared to clipping, but do not report the outcome of retreatment. The aim of this meta-analysis was to evaluate retreatment related outcomes.A meta-analysis in accordance with PRISMA guidelines was conducted using Medline search engines PubMed and EMBASE to identify articles describing outcomes after retreatment for intracranial aneurysms. Pooled prevalence rates for complete occlusion rate and mortality were calculated. Outcomes of different treatment and retreatment combinations were not compared because of indication bias. Twenty-five articles that met the inclusion criteria were included in the meta-analysis. Surgery after coiling had a pooled complete occlusion rate of 91.2% (95%-CI: 87.0-94.1) and a pooled mortality rate of 5.6% (95%-CI: 3.7-8.3). Coiling after coiling had a pooled complete occlusion rate of 51.3% (95%-CI: 22.1-78.0) and a pooled mortality rate of 0.8% (95%-CI: 0.15-3.7). Surgery after surgery did not provide a pooled estimate for complete occlusion as only one study was identified but had a pooled mortality rate of 5.9% (95%-CI: 3.1-11.2). Coiling after surgery had a pooled complete occlusion rate of 56.1% (95%-CI: 11.4- 92.7) and a pooled mortality rate of 9.3% (95%-CI: 4.1-19.9). All pooled incidence rates were produced using random-effect models.Conclusion:Surgical retreatment was associated with a high complete occlusion rate but considerable mortality. Conversely, endovascular retreatment was associated with low mortality but also a low complete occlusion rate. Scientific Assessment and Innovation in Neurosurgical Treatment Strategie

Outcomes of retreatment for intracranial aneurysms - a meta-analysis

Long term results from the International Subarachnoid Hemorrhage Trial (ISAT) and Barrow Ruptured Aneurysm Trial (BRAT) indicate considerably higher retreatment rates for aneurysms treated with coiling compared to clipping, but do not report the outcome of retreatment. The aim of this meta-analysis was to evaluate retreatment related outcomes.A meta-analysis in accordance with PRISMA guidelines was conducted using Medline search engines PubMed and EMBASE to identify articles describing outcomes after retreatment for intracranial aneurysms. Pooled prevalence rates for complete occlusion rate and mortality were calculated. Outcomes of different treatment and retreatment combinations were not compared because of indication bias. Twenty-five articles that met the inclusion criteria were included in the meta-analysis. Surgery after coiling had a pooled complete occlusion rate of 91.2% (95%-CI: 87.0-94.1) and a pooled mortality rate of 5.6% (95%-CI: 3.7-8.3). Coiling after coiling had a pooled complete occlusion rate of 51.3% (95%-CI: 22.1-78.0) and a pooled mortality rate of 0.8% (95%-CI: 0.15-3.7). Surgery after surgery did not provide a pooled estimate for complete occlusion as only one study was identified but had a pooled mortality rate of 5.9% (95%-CI: 3.1-11.2). Coiling after surgery had a pooled complete occlusion rate of 56.1% (95%-CI: 11.4- 92.7) and a pooled mortality rate of 9.3% (95%-CI: 4.1-19.9). All pooled incidence rates were produced using random-effect models.Conclusion:Surgical retreatment was associated with a high complete occlusion rate but considerable mortality. Conversely, endovascular retreatment was associated with low mortality but also a low complete occlusion rate. </p

Outcomes of retreatment for intracranial aneurysms - a meta-analysis

Long term results from the International Subarachnoid Hemorrhage Trial (ISAT) and Barrow Ruptured Aneurysm Trial (BRAT) indicate considerably higher retreatment rates for aneurysms treated with coiling compared to clipping, but do not report the outcome of retreatment. The aim of this meta-analysis was to evaluate retreatment related outcomes.A meta-analysis in accordance with PRISMA guidelines was conducted using Medline search engines PubMed and EMBASE to identify articles describing outcomes after retreatment for intracranial aneurysms. Pooled prevalence rates for complete occlusion rate and mortality were calculated. Outcomes of different treatment and retreatment combinations were not compared because of indication bias. Twenty-five articles that met the inclusion criteria were included in the meta-analysis. Surgery after coiling had a pooled complete occlusion rate of 91.2% (95%-CI: 87.0-94.1) and a pooled mortality rate of 5.6% (95%-CI: 3.7-8.3). Coiling after coiling had a pooled complete occlusion rate of 51.3% (95%-CI: 22.1-78.0) and a pooled mortality rate of 0.8% (95%-CI: 0.15-3.7). Surgery after surgery did not provide a pooled estimate for complete occlusion as only one study was identified but had a pooled mortality rate of 5.9% (95%-CI: 3.1-11.2). Coiling after surgery had a pooled complete occlusion rate of 56.1% (95%-CI: 11.4- 92.7) and a pooled mortality rate of 9.3% (95%-CI: 4.1-19.9). All pooled incidence rates were produced using random-effect models.Conclusion:Surgical retreatment was associated with a high complete occlusion rate but considerable mortality. Conversely, endovascular retreatment was associated with low mortality but also a low complete occlusion rate. </p

Design and perceived value of a novel solution for asynchronous communication in radiology

Rationale and Objectives: Communication with and within the Radiology Department is typically initiated over phone, face-to-face or general-purpose chat, causing frequent interruptions, additional mental workload, workflow inefficiencies and diagnostic errors. We developed and evaluated a new communication solution that aims to reduce avoidable interruptions caused by technologist-radiologist communication.Materials and Methods: Following an iterative design process with future end users, a scalable web-based software solution, RadConnect, was developed enabling a chat-based communication workflow between a technologist and a radiologist. As a first experimental implementation, technologists can send categorized tickets to a radiology section account. Radiologists receive the tickets in a worklist that is prioritized by urgency. Consented radiologists and technologists performed scripted tasks in 2 hr sessions and completed a structured questionnaire on perceived value and comparison to standard communication modes.Results: Of 17 participants from three academic European institutes, 65% (11/17) believed they would use RadConnect frequently; 53% (9/17) believed that it reduces phone calls >80%; and 88% (15/17) believed it adds value compared to general-purpose enterprise chat applications.Discussion: Participants recognized the value of RadConnect especially its categorized tickets, prioritized worklist and role-based interaction model. Inter-institute differences in perceived value of RadConnect may have been caused by technologist-radiologist proximity and communication alternatives in the institutions.Conclusion: Chat-based role-based communication might be a viable mode of communication between technologists and radiologists to reduce avoidable inter-ruptions. Tailoring the chat solution to the needs of and tightly integrated with the radiology workflow is valued by future end users after exposure to the tool in a simulated environment. (c) 2023 Elsevier Inc. All rights reserved