The proportion of neurosurgeons facing a malpractice suit each year is highest among all medical and surgical specialties. It is critical for neurosurgeons to understand local malpractice laws because they vary among states. Sovereign immunity, as described in the 11th constitutional amendment, provides absolute immunity to states from being sued by their residents and by other states. A state may waive its sovereign immunity, however, and substitute itself as the defendant in place of a state-employed physician in the court of law. This means that a physician working for a state-funded hospital may not be liable to a malpractice suit. Further provisions of the law allow the state not to pay indemnity beyond a certain limit, which discourages plaintiff attorneys from pursuing indemnity charges against physicians working for state-funded institutions. In this review, the authors describe the concept of sovereign immunity and its implications for the practice of neurosurgery.
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Rimal H. Dossani, Muhammad Waqas, Michael J. Meyer, Felix Chin, Hamid H. Rai, Rameez Dossani, Anshara Munir Dossani, and Muhammad Riaz
Andre Monteiro, Gustavo M. Cortez, Muhammad Waqas, Hamid H. Rai, Ammad A. Baig, Rimal H. Dossani, Justin M. Cappuzzo, Faisal Almayman, Amin Aghaebrahim, Jason M. Davies, Eric Sauvageau, Kenneth V. Snyder, Ricardo A. Hanel, Elad I. Levy, and Adnan H. Siddiqui
OBJECTIVE
Acute basilar artery occlusion (BAO) is a rare large-vessel occlusion associated with high morbidity and mortality. Modern thrombectomy with stent retrievers and large-bore aspiration catheters is highly effective in achieving recanalization, but a direct comparison of different techniques for acute BAO has not been performed. Therefore, the authors sought to compare the technical effectiveness and clinical outcomes of stent retriever–assisted aspiration (SRA), aspiration alone (AA), and a stent retriever with or without manual aspiration (SR) for treatment of patients presenting with acute BAO and to evaluate predictors of clinical outcome in their cohort.
开云体育世界杯赔率
回顾性分析large-ves的数据库sel occlusion treated with endovascular intervention at two US endovascular neurosurgery centers was conducted. Patients ≥ 18 years of age with acute BAO treated between January 2013 and December 2020 with stent retrievers or large-bore aspiration catheters were included in the study. Demographic information, procedural details, angiographic results, and clinical outcomes were extracted for analysis.
RESULTS
Eighty-three patients (median age 67 years [IQR 58–76 years]) were included in the study; 33 patients (39.8%) were female. The median admission National Institutes of Health Stroke Scale (NIHSS) score was 16 (IQR 10–21). Intravenous alteplase was administered to 26 patients (31.3%). The median time from symptom onset to groin or wrist puncture was 256 minutes (IQR 157.5–363.0 minutes). Overall, successful recanalization was achieved in 74 patients (89.2%). The SRA technique had a significantly higher rate of modified first-pass effect (mFPE; 55% vs 31.8%, p = 0.032) but not true first-pass effect (FPE; 45% vs 34.9%, p = 0.346) than non-SRA techniques. Good outcome (modified Rankin Scale [mRS] score 0–2) was not significantly different among the three techniques. Poor outcome (mRS score 3–6) was associated with a higher median admission NIHSS score (12.5 vs 19, p = 0.007), a higher rate of adjunctive therapy usage (9% vs 0%, p < 0.001), and a higher rate of intraprocedural complications (10.7% vs 14.5%, p = 0.006). The admission NIHSS score significantly predicted good outcome (OR 0.98, 95% CI 0.97–0.099; p = 0.032). Incomplete recanalization after thrombectomy significantly predicted mortality (OR 1.68, 95% CI 1.18–2.39; p = 0.005).
CONCLUSIONS
的伊娃luated techniques resulted in high recanalization rates. The SRA technique was associated with a higher rate of mFPE than AA and SR, but the clinical outcomes were similar. A lower admission NIHSS score predicted a better prognosis for patients, whereas incomplete recanalization after thrombectomy predicted mortality.
Jose Danilo Bengzon Diestro, Mahmoud Dibas, Nimer Adeeb, Robert W. Regenhardt, Justin E. Vranic, Adrien Guenego, Sovann V. Lay, Leonardo Renieri, Ali Al Balushi, Eimad Shotar, Kévin Premat, Kareem El Namaani, Guillaume Saliou, Markus A. Möhlenbruch, Ivan Lylyk, Paul M. Foreman, Jay A. Vachhani, Vedran Župančić, Muhammad U. Hafeez, Caleb Rutledge, Hamid Rai, Vincent M. Tutino, Shervin Mirshahi, Sherief Ghozy, Pablo Harker, Naif M. Alotaibi, James D. Rabinov, Yifan Ren, Clemens M. Schirmer, Oded Goren, Mariangela Piano, Anna L. Kühn, Caterina Michelozzi, Stéphanie Elens, Robert M. Starke, Ameer E. Hassan, Arsalaan Salehani, Anh Nguyen, Jesse Jones, Marios Psychogios, Julian Spears, Thomas Marotta, Vitor Pereira, Carmen Parra-Fariñas, Maria Bres-Bullrich, Michael Mayich, Mohamed M. Salem, Jan-Karl Burkhardt, Brian T. Jankowitz, Ricardo A. Domingo, Thien Huynh, Rabih Tawk, Christian Ulfert, Boris Lubicz, Pietro Panni, Ajit S. Puri, Guglielmo Pero, Christoph J. Griessenauer, Hamed Asadi, Adnan Siddiqui, Andrew F. Ducruet, Felipe C. Albuquerque, Nirav Patel, Peter Kan, Vladimir Kalousek, Pedro Lylyk, Srikanth Boddu, Christopher J. Stapleton, Jared Knopman, Pascal Jabbour, Stavropoula Tjoumakaris, Frédéric Clarençon, Nicola Limbucci, Mohammad A. Aziz-Sultan, Hugo H. Cuellar-Saenz, Christophe Cognard, Aman B. Patel, and Adam A. Dmytriw
OBJECTIVE
The Woven EndoBridge (WEB) device is an intrasaccular flow disruptor designed for wide-necked bifurcation aneurysms. These aneurysms may require the use of a concomitant stent. The objective of this study was to determine the clinical and radiological outcomes of patients undergoing stent-assisted WEB treatment. In addition, the authors also sought to determine the predictors of a concomitant stent in aneurysms treated with the WEB device.
开云体育世界杯赔率
The data for this study were taken from the WorldWideWEB Consortium, an international multicenter cohort including patients treated with the WEB device. Aneurysms were classified into two groups based on treatment: stent-assisted WEB and WEB device alone. The authors compared clinical and radiological outcomes of both groups. Univariable and multivariable binary logistic regression analyses were performed to determine factors that predispose to stent use.
RESULTS
The study included 691 intracranial aneurysms (31 with stents and 660 without stents) treated with the WEB device. The adequate occlusion status did not differ between the two groups at the latest follow-up (83.3% vs 85.6%, p = 0.915). Patients who underwent stenting had more thromboembolic (32.3% vs 6.5%, p < 0.001) and procedural (16.1% vs 3.0%, p < 0.001) complications. Aneurysms treated with a concomitant stent had wider necks, greater heights, and lower dome-to-neck ratios. Increasing neck size was the only significant predictor for stent use.
CONCLUSIONS
This study demonstrates that there is no difference in the degree of aneurysm occlusion between the two groups; however, complications were more frequent in the stent group. In addition, a wider aneurysm neck predisposes to stent assistance in WEB-treated aneurysms.
