INR BS radar
875 posts
INR BS radar
@BoomerNeuro
A very sensitive radar to multiple forms of BS.
Katılım Nisan 2022
166 Takip Edilen310 Takipçiler
@Ksao_ Honestly I’m very conservative with retreating UIA, even large neck remnants wouldn’t bother me too much
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Have you ever seen a previously coiled UIA rupture in the course of F/U?
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@DrPatchiz @WBrinjikji Microsurgical shitstorm starting in 3… 2… 1…
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@WBrinjikji Absolutely honest question for the clippers……. How many years do you have left? I would say at most 10 but interested in other perspectives?
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@matiascostamd @ikeafonso1 @VladoKZg @Ksao_ No one tries to refute anything here. The numbers of the trial are as they are.
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New neurologic deficits occurred in 32/143 surgical patients (22%; 95% CI, 16%–30%) compared with 19/148 (12%; 95% CI, 8%–19%) patients allocated to EVT (P = .04).
And at 1 year, more patients post clipping were NOT mRS 0 -although over represented before treatment.
Jacques Morcos MD FRCS FAANS@jacquesmorcosmd
Criticisms aside, J Raymond senior author has always known & said that clipping is of course more durable & effective than coiling. No need for RCT for that but nice to see. I suspect that if FU had been longer than 1 yr, there would have been even more recanaliztn in EVT group.
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@kanachan2020 Intellectually speaking I know how it should be done - in reality in unfortunately only gives me headaches 🤕
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@BoomerNeuro To see 3D image using these paired images, your right eye sees the left image and the left eye sees the right image so that 3D image is created between these two images at the center. You may find how to see stereoscopic images if you seek the topic of stereogram in internet.
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Stereoscopic viewing started far before the discovery of x-ray late 19th century. If you use this in DSA, radiation dose doubles, thus not good for the patients. However, I believe that this technique is still of value to facilitate to understand the complicated vascular anatomy.
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@matiascostamd @ikeafonso1 @Ksao_ I‘m talking about things like this, which are difficult to recognize with the mRS.
pubmed.ncbi.nlm.nih.gov/25119842/
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@SunilAShethMD @TudorGJovin Although you didn’t ask me: correct, for every 10 patients you clip instead of coil (provided equipoise on either treatment for a given aneurysm) you create 1 new neurological deficit.
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@TudorGJovin Professor, correct me if I’m wrong but with an absolute risk increase of 10% for neurological deficits, I calculate a number needed to harm of 10 for clipping vs coiling.
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Enrollment of only < 300 pts @ 7 centers over 10 years reflects serious selection bias.
For UA the relevant primary outcome should be rupture (+/- need for retreatment) combined with failure to return to pre-procedure mRs. mRS >2 is a ridiculously low bar #T2" target="_blank" rel="nofollow noopener">ajnr.org/content/early/…
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@BoomerNeuro @ikeafonso1 The vast majority of unruptured aneurysms that are treated would never rupture if left untreated. Therefore, the risk of post-treatment rupture is negligible.
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@ikeafonso1 Yes, initially ruptured aneurysms, me too. But never an aneurysm that was treated as UIA.
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@BoomerNeuro I saw 2 cases, that coiled a ruptured aneur and lost FU. After 8-10 y had re-rupture
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@NimaE @RealRajkamal @WBrinjikji @jacquesmorcosmd Indeed it’s a balance between benefit and risk.
Please answer the poll!
twitter.com/BoomerNeuro/st…
INR BS radar@BoomerNeuro
Have you ever seen a previously coiled UIA rupture in the course of F/U?
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@RealRajkamal @WBrinjikji @jacquesmorcosmd I agree that the risk is low but it is not 0% and this is irrespective of treatment modalities. They whole point is that, partial treatment , if you decided to treat an UIA - is not the goal of preventive treatment.
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Criticisms aside, J Raymond senior author has always known & said that clipping is of course more durable & effective than coiling. No need for RCT for that but nice to see. I suspect that if FU had been longer than 1 yr, there would have been even more recanaliztn in EVT group.
Nima Etminan@NimaE
The CURES trial is the only RCT comparing microsurgery vs any EVT for unruptured IA. An important fundament for patient centered counseling #neurotwitter @cvsection @vajkoczy@CNS_Update @jacquesmorcosmd @ESOstroke ajnr.org/content/early/…
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@matiascostamd “Studies were generally of poor quality; funnel plots showed heterogeneous results and publication bias, and data on aneurysm occlusion rates were scant. […] The reputed durability of clipping has not been rigorously documented”
pubmed.ncbi.nlm.nih.gov/23012447/
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@matiascostamd To be frank - nobody knows how often aneurysms recur after surgery on a long-term basis because the data quality is incredibly poor.
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@tylcole @jacquesmorcosmd And it’s weird that after >25 years this debate is still fun.
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@BoomerNeuro @jacquesmorcosmd Yes, we all understand that.
I’m just amused by the bickering.
It’s like clockwork as soon as you put “clip” and “coil” in the same paper.
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When another clip vs coil study comes out, the Mortal Kombat theme song automatically plays in my head.
Same with LLIF vs TLIF.
GIF
Nima Etminan@NimaE
The CURES trial is the only RCT comparing microsurgery vs any EVT for unruptured IA. An important fundament for patient centered counseling #neurotwitter @cvsection @vajkoczy@CNS_Update @jacquesmorcosmd @ESOstroke ajnr.org/content/early/…
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@tylcole @jacquesmorcosmd But pragmatically speaking it shows what was clear beforehand: clipping gives a more complete aneurysm occlusion but that comes at a price. Which means patients must be informed about the study results in order to allow them to take their best decision. That’s all.
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@tylcole @jacquesmorcosmd It’s a randomized trial, which always means that a complex topic is simplified to fit in some statistical test. And then the results are as they are, which of course means it makes no sense to stick to them in 100%.
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