Hamed Asadi

Description:Background: Intrasaccular flow diversion using the woven endobridge device (WEB; MicroVention, Aliso Viejo, CA, USA) for the treatment of intracranial aneurysms has demonstrated large scale safety and efficacy. However, limitations arise from its structural configuration, restricting its application to specific aneurysm sizes and shapes. We introduce the CUPCAKE technique, a combination of conventional coiling followed by WEB intrasaccular flow disruption in select cases of atypical aneurysms with technically challenging morphology not typically treatable by WEB alone. Methods: A retrospective analysis of a prospectively-maintained dataset from three Australian neurovascular tertiary referral centers, identifying patients treated with the CUPCAKE technique between April 2018 and September 2023. Evaluation of patient and aneurysm characteristics, procedure parameters, complications, radiological and clinical outcomes at follow-up was performed. Results: The CUPCAKE technique was used for the treatment of 22 intracranial aneurysms of total 169 treated with WEB. Overall successful immediate flow stagnation was observed in 95.5% (n = 21) of aneurysms with no cases of perforation or intraoperative hemorrhage. Imaging confirmed thromboembolic complications occurred in two patients, one patient had persistent flow requiring re-treatment during initial admission. Follow-up imaging demonstrated 88.2% complete aneurysm conclusion with no delayed aneurysm expansion or rupture. Conclusions: Synergistic use of conventional coiling with WEB intrasaccular flow disruption presents a viable solution for technically difficult aneurysm treatment. In our series, 13% of all patients treated with WEB received CUPCAKE treatment, resulting in high technical success and no increase in thromboembolic complications with the union of two methods.

Description:Background: While gender disparities in the radiology workforce are well-documented, there has been no analysis of outcomes for competitive awards in Australia and New Zealand. As formal recognition is critical for career progression, this study aimed to investigate gender-based differences in application and success rates for grants, prizes and educational fellowships within the Australasian context. Methods: We retrospectively reviewed applications for Royal Australian and New Zealand College of Radiologists' (RANZCR) Faculty of Clinical Radiology grants, prizes and educational fellowships from 2011 to 2024. Application and success rates were stratified by gender and compared to College membership demographics. Significance was assessed using Fisher's exact test. Results: Across 333 total applications, 227 (68.2%) were from males and 106 (31.8%) from females, closely reflecting College membership gender ratios (69.2% male vs. 30.8% female). No significant gender disparity was found in the success rates for grants (40.3% for males vs. 35.0% for females, p = 0.58), prizes (8.8% vs. 11.1%, p = 0.08) or educational fellowships (36.7% vs. 32.1%, p = 0.32). Application rates for each award type also broadly reflected the gender composition of the College membership. Conclusions: This study is the first to examine gender differences in clinical radiology grant, prize and educational fellowship outcomes in Australia and New Zealand. We found no significant disparities in success rates, and application rates generally mirrored College membership, suggesting the award process itself is equitable. However, the continued underrepresentation of women in radiology underscores the need to examine broader structural and sociocultural factors that may impact engagement with competitive academic opportunities.

Description:Background: Contrast induced encephalopathy (CIE) is an increasingly recognized but uncommon complication of endovascular procedures. Despite increased reports, there is limited evidence to guide clinical management. We sought to identify commonly used treatments for CIE and propose management strategies to aid clinical decision making. Methods: A retrospective multicenter study was conducted across 10 neurovascular centers in Australia. Cases were included based on previously proposed diagnostic criteria for CIE. Clinical features, treatments, and outcomes were extracted and analyzed. Descriptive statistics were used to characterize management strategies, and associations with clinical outcomes were assessed using Fisher's exact and χ2 tests. Results: 56 patients were identified (median age 65 years; 80.4% women). Common interventions included corticosteroids (66.1%), intravenous fluids (66.1%), and antiseizure medications (prophylactic 51.8% and therapeutic 12.5%). Half required intensive care admission for neurological monitoring. Complete recovery was achieved in 87.5% of cases. Corticosteroid administration was significantly associated with symptom resolution within 72 hours (OR 4.51, 95% CI 1.19 to 17.85, P=0.022), while intravenous fluids showed a non-significant trend toward shorter symptom duration (OR 2.25, 95% CI 0.64 to 8.15, P=0.170). Conclusions: CIE generally carries a favorable prognosis. Corticosteroids appeared to shorten symptom duration and may be considered in management. Based on our findings and the existing literature, we propose a treatment algorithm to guide clinicians. Prospective validation is warranted.

Description:Background: Contrast-induced encephalopathy (CIE) is an increasingly observed complication following neurointervention, but remains poorly defined with limited evidence for clinical decision-making. We sought to characterize the stereotypical clinical features of CIE in a nationwide, multicenter cohort. Methods: A multicenter cohort study was conducted between 10 neurovascular sites across Australia. Patients were screened according to the previously proposed Australian diagnostic criteria. Descriptive analysis was conducted to characterize the clinical course and outcomes of CIE, and associations between clinical and radiological variables on patient outcomes were analyzed using Fisher's exact and χ2 tests. Results: A total of 56 patients (median age 65 years) were included. The median contrast volume was 170 mL (IQR 140-229). Median time to symptom onset was 6 hours (IQR 1-12), with frequent symptoms including motor deficit (55.4%), dysphasia (39.3%), and confusion (35.7%). Common radiological findings included sulcal effacement (45.5%) and subarachnoid contrast staining (30.9%) on CT. Hemianopia (p=0.001) and cortical blindness (p=0.018) were associated with posterior circulation interventions, while motor deficit was correlated with anterior circulation interventions (p=0.001). At discharge, 87.5% of patients achieved complete resolution of symptoms, of which 69.4% achieved complete recovery within 72 hours. Conclusions: CIE is a recognized complication of neurointervention. Symptoms occur within hours of contrast administration and correlate with the territory of contrast administration. Most patients achieve complete symptom resolution. Ongoing investigation is required to further define CIE as a clinical entity.

Description:Mechanical thrombectomy using stent retrievers is the standard endovascular treatment for acute ischaemic stroke due to large vessel occlusion. With the rapid evolution in device design, this scoping review aims to map the current landscape of stent retriever types used in clinical practice, as well as their application across different sites of vessel occlusion. A comprehensive literature search was conducted using MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to identify primary studies reporting on the safety and efficacy of stent retrievers in mechanical thrombectomy for acute stroke. After screening and data extraction by two independent reviewers, 133 studies were included, encompassing 22 distinct stent retriever devices. Frequencies of thrombectomy procedures were analysed according to device type and occlusion location. The Solitaire and Trevo devices accounted for the majority of cases (57 %), with the most commonly treated occlusion sites being the M1 segment of the middle cerebral artery and the internal carotid artery (51 % and 19 %, respectively). In contrast, anterior cerebral artery and M3 or more distal occlusions were underrepresented, each comprising only 1 % of the data. This review highlights a strong evidence base for conventional stent retrievers in large vessel occlusions, particularly M1, while also revealing a significant gap in knowledge regarding newer generation stent retrievers and their use in distal medium vessel occlusions. Further research is needed to evaluate device safety and effectiveness in these smaller, more challenging vessels.