Quantitative outcomes of endoscopic strip craniectomy for metopic craniosynostosis in children with severe trigonocephaly

© 2020, Springer-Verlag GmbH Germany, part of Springer Nature. Purpose: To assess intermediate-term (\u3e 3 years) outcomes of endoscopic strip craniectomy with postoperative helmet therapy (ESC + HT) for the treatment of infants with severe trigonocephaly. Methods: This retrospective study examined cranial morphology of consecutive patients with severe trigonocephaly treated with minimally invasive ESC + HT. Preoperative and follow-up clinical parameters were collected from patient charts. Interfrontal divergence angle (IFDA), a validated and accurate measure of forehead narrowing, was measured on preoperative CT scans and on preoperative and postoperative 2D photographs. Results: Seven patients (4 male, 3 female) were included with a mean age at surgery of 2.76 months (range 1.8 to 4.1 months) and mean clinical follow-up of 3.71 years (photographic follow-up 2.73 years). The mean operative time was 91.4 min, with a mean estimated blood loss (EBL) of 57.1 ml and mean hospital length of stay of 1.14 days. IFDA improved from 118.8° to 135.9° (p \u3c 0.01), with the mean final measurement falling within normal limits. The head circumference percentile was not significantly changed in follow-up. There was a statistically significant improvement in the inner-to-outer canthal distance ratio (p = 0.01) in follow-up, showing an improvement in hypotelorism. There were no dural tears, CSF leaks, infections, or other significant surgical morbidities, and there were no serious complications related to the use of helmet therapy. All patients achieved excellent aesthetic results judged by photographic comparison. Conclusion: This study demonstrated that patients treated with ESC + HT for metopic craniosynostosis showed measurable and significant improvement in forehead shape. This technique is a safe and effective alternative to more invasive surgical interventions

Experience With Neuroform Atlas Stenting as Rescue Endovascular Treatment After Failed Mechanical Thrombectomy Secondary to Intracranial Atherosclerosis

Background Patients with emergent large vessel occlusion secondary to intracranial atherosclerotic stenosis who fail mechanical thrombectomy pose a treatment challenge. The aim of this study is to report our single‐center experience using the Neuroform Atlas stent as a potential rescue modality. Methods Data were analyzed from a prospectively maintained database at a Comprehensive Stroke Center between January 2019 and September 2021 of all patients with intracranial atherosclerotic stenosis–emergent large vessel occlusion who underwent mechanical thrombectomy and required rescue stenting with the Neuroform Atlas. We systematically gathered demographic, clinical, procedural, and functional characteristics on patients presenting with emergent large vessel occlusion within 24 hours of last known normal. The primary outcome was the rate of revascularization following stenting. Results Twenty‐six patients met the inclusion criteria, with a mean age of 56.5 years, 34.6% of whom were women. On presentation, the median National Institutes of Health Stroke Scale was 11 and median Alberta Stroke Program Early Computed Tomography Score was 9. Mechanical thrombectomy was performed using a direct aspiration, first‐pass technique in all patients. Following Neuroform Atlas stent placement, 3 patients (11.5%) had moderate in‐stent stenosis, while severe stenosis was encountered in 4 patients (15.4%). The rate of successful revascularization (Thrombolysis in Cerebral Infarction 2B–3) was identified in 92.3% of the patients. On follow‐up vascular images, reocclusion occurred in 2 patients (7.7%) and symptomatic hemorrhage was encountered in 3 patients (11.5%). Excellent outcome at 90 days (modified Rankin scale 0–2) was achieved in 13 of 26 (50%) patients. Conclusion Our series provides preliminary safety and efficacy data regarding the use of the Neuroform Atlas stent as a rescue modality in intracranial atherosclerotic stenosis–emergent large vessel occlusion cases

Combination therapy with once-weekly glucagon like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors in type 2 diabetes: a case series

Background: National treatment guidelines recommend glucagon-like peptide receptor agonists (GLP-1 RAs) as add-on therapy to oral agents. However, GLP-1 RAs in combination with dipeptidyl peptidase-4 (DPP-4) inhibitors is not recommended due to a lack of evidence. Objective: This case series aims to describe the efficacy and safety of once-weekly GLP-1 RAs administered concomitantly with DPP-4 inhibitors in patients with type 2 diabetes. Methods: A retrospective chart review of electronic medical records at a free health clinic was conducted between July 2014 and September 2016. Patients 18 years and older with type 2 diabetes were included if they received concomitant DPP-4 inhibitor and once-weekly GLP-1 RA therapy with at least one glycated hemoglobin A1c (HbA1c) measurement within three to six months of starting the combination. The primary and secondary outcomes included change in HbA1c and weight, and patient reported adverse events. Results: Out of forty-three patients that received combination DPP-4 inhibitor plus GLP-1 RA therapy, only eighteen received once-weekly GLP-1 RA. At 3 months, the median (IQR) HbA1c and weight change was -0.8% (-4.3 to 2%) and -0.4kg (-4.2 to 5.8 kg) respectively. No patients reached an HbA1c below 7% and only three patients (17%) reached a HbA1c less than 8%. Patient reported adverse effects included gastrointestinal disturbances (28%), hypoglycemic symptoms (17%), and injection site reactions (0.6%). Conclusions: Concomitant use of once-weekly GLP-1 RAs and DPP-4 inhibitors provides only modest improvement in glycemic control with minimal weight loss benefits, which is similar to monotherapy with either agent. The combination is unlikely to provide synergistic effects and is not cost effective. These data support the current recommendations against use of combined incretin therapy

E-108 Endovascular management of distal anterior cerebral artery aneurysms: A multi-center experience

IntroductionDistal anterior cerebral artery aneurysms (DACAA) are relatively rare, carry high rate of rupture and are often challenging to treat. The evolution of endovascular techniques has allowed for safe and durable treatment of these aneurysms. The purpose of this study is to investigate the safety, efficacy and long-term outcomes of endovascular treatment of DACAA.MethodsRetrospective review of DACAA endovascularly treated at 5 different institutions across the nation. Data collected included baseline demographics, rupture status, radiographic features, endovascular technique, complication rates, and long-term angiographic and clinical outcomes. Primary endpoint was good clinical outcome (modified Rankin scale 0-2). Secondary endpoints included complications and radiographic occlusion at follow up.Results84 patients were reviewed (table 1). Mean age was 56, and 64 (71.4%) were female. 52 (61.9%) aneurysms were ruptured. 60 (71.4%) aneurysms were treated with primary coiling, and the remaining 24 were treated flow diversion. Adequate occlusion was achieved in 41 (95.3%) aneurysms treated with coiling, and 17 (89.5%) with flow diversion. No patients required retreatment in the flow diversion category versus 16 (29%) in primary coiling. Good functional outcome was achieved in 59 patients (85.5%), and mortality was observed in 2 (2.3%) patients. There were overall 11 (13%) complications. In primary coiling there were 9 (15%) procedural complications: 5 thromboembolic events, 3 intraoperative ruptures and 1 access site hematoma. In flow diversion category there were 2 procedural complications (8.3%), both of which were retroperitoneal hematomas related to femoral access.Abstract E-108 Table 1Patient demographics and aneurysm characteristics Age, mean (SD) 56 (14.1) Females, n (%) 60 (71.4%) Indication, n (%) Subarachnoid hemorrhage 51 (60.7%) Intraparenchymal hemorrhage 1 (1.2%) Elective procedure 32 (38.1%) Treatment technique, n (%) Coiling 60 (71.4%) Flow diversion 24 (28.6%) Complications, n (%) 11 (13%) Months to the first follow up angiogram, mean (SD )* 6.7 (5) Occlusion scale on first follow up angiogram, n (%)* Raymond 1 36 (55.4%) Raymond 2 21 (32.3%) Raymond 3 8 (12.3%) Retreatment required, n (%)** 16 (20.3%) Months to the final follow up angiogram, mean (SD )*** 31.3 (32.1) Occlusion scale on final follow up angiogram, n (%)*** Raymond 1 45 (72.6%) Raymond 2 12 (19.4%) Raymond 3 5 (8.1%) Months to final follow up visit, mean (SD )$23.7 (29.2) mRS 0- 2 on final follow up visit, n ($ 59 (85.5%) Mortality before last follow up visit, n (%)$ 2 (2.9%) ConclusionEndovascular treatment, and in particular, flow diversion for DACAA is safe, feasible and associated with good long-term angiographic and clinical outcomes.Disclosures G. Porto: None. S. Al Kasab: None. M. Sattur: None. E. Almallouhi: None. O. Lajthia: None. M. Casey: None. R. Starke: None. G. Lanzino: None. C. Ogilvy: None. A. Thomas: None. L. Kim: None. R. James: None. M. Levitt: 1; C; Stryker, Medtronic. 2; C; Medtronic, Minnetronix, Metis Innovative. 6; C; Synchron, Cerebrotech. A. Spiotta: 1; C; Penumbra, Stryker, Medtronic, Terumo

Endovascular Management of Distal Anterior Cerebral Artery Aneurysms: A Multicenter Retrospective Review

Distal anterior cerebral artery aneurysms (DACAA) are a rare and difficult entity to manage. Endovascular treatment has evolved for safe and durable treatment of these lesions. The objective of this study is to report the safety, efficacy, and outcomes of endovascular treatment of DACAA. A retrospective review of DACAA endovascularly treated at 5 different institutions was performed. Data included demographics, rupture status, radiographic features, endovascular technique, complication rates, and long-term angiographic and clinical outcomes. A primary endpoint was a good clinical outcome (modified Rankin scale 0–2). Secondary endpoints included complications and radiographic occlusion at follow-up. A total of 84 patients were reviewed. The mean age was 56, and 64 (71.4%) were female. Fifty-two (61.9%) aneurysms were ruptured. A good functional outcome was achieved in 59 patients (85.5%). Sixty (71.4%) aneurysms were treated with primary coiling, and the remaining 24 were treated with flow diversion. Adequate occlusion was achieved in 41 (95.3%) aneurysms treated with coiling, and 17 (89.5%) with flow diversion. There were total 11 (13%) complications. In the flow diversion category, there were 2, both related to femoral access. In the coiling category, there were 9: 5 thromboembolic, 3 ruptures, and 1 related to femoral access. Endovascular treatment, and in particular, flow diversion for DACAA, is safe, feasible, and associated with good long-term angiographic and clinical outcomes