Paradoxical Trends in the Management of Unruptured Cerebral Aneurysms in the United States

Stroke ◽  
2011 ◽  
Vol 42 (6) ◽  
pp. 1730-1735 ◽  
Author(s):  
Michael C. Huang ◽  
Ali A. Baaj ◽  
Katheryne Downes ◽  
A. Samy Youssef ◽  
Eric Sauvageau ◽  
...  
Keyword(s):  
United States ◽  
Cerebral Aneurysms ◽  
The United States ◽  
Unruptured Cerebral Aneurysms

Evaluation of Cerebral Aneurysm Stent Performance in a Subject-Specific Computational Model

2010 ◽  
Author(s):  
Timothy J. Gundert ◽  
John F. LaDisa
Keyword(s):  
United States ◽  
Blood Flow ◽  
Computational Model ◽  
Cerebral Aneurysm ◽  
Cerebral Aneurysms ◽  
The United States ◽  
Flow Stagnation ◽  
Subject Specific ◽  
Endovascular Devices ◽  
Saccular Aneurysms

Rupture of cerebral aneurysms is the second leading cause of stroke in the United States [1]. Altered hemodynamics is thought to play a role in the progression and subsequent rupture of aneurysms. Blood flow into an aneurysm can be occluded by surgically clipping the aneurysm or using endovascular devices, such as stents or coils. In saccular aneurysms, coiling alone may be a sufficient method of inducing flow stagnation in the aneurysm, causing thrombosis and preventing rupture. When treating wide-necked aneurysms, stenting is often used in conjunction with coiling to prevent the migration of coils. Many investigators have studied the ability of a stent-only treatment to favorably alter flow in aneurysms [2, 3].

Workforce Needs for Endovascular Neurosurgery

Neurosurgery ◽  
2006 ◽  
Vol 59 (suppl_5) ◽  
pp. S3-271-S3-276 ◽  
Author(s):  
Robert D. Ecker ◽  
Elad I. Levy ◽  
L Nelson Hopkins
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Cerebrovascular Disorders ◽  
Cerebral Aneurysms ◽  
The United States ◽  
Endovascular Techniques ◽  
Arteriovenous Fistulae ◽  
The Past ◽  
Workforce Needs ◽  
Lower Morbidity

Abstract DURING THE PAST decade, endovascular techniques and clinical experience have matured to the point that all or a significant part of the treatment of acute ischemic stroke, cerebral aneurysms, brachiocephalic occlusive disease, and arteriovenous fistulae or malformations is performed in angiography suites by neuroradiologists, vascular surgeons, peripheral interventionists, cardiologists, neurologists, and neurosurgeons worldwide. With improvements in technology and lower morbidity rates, the scope of endovascular techniques will only increase. Currently, in the United States alone, this amounts to a volume of more than 500,000 patients annually. Neurosurgeons currently provide only a small portion of the care of these patients. The workforce needs for endovascular surgeons in neurosurgery will be determined by the patients, the willingness of neurosurgeons to embrace endovascular techniques, and the broad scope of cerebrovascular disorders that can be treated.

Abnormal Hemodynamics in Post Communicating Artery After Coil Embolization

2009 ◽  
Author(s):  
Sinjae Hyun ◽  
Erminia Albanese ◽  
Monica Quiroga ◽  
Antonino Russo ◽  
Arthur J. Ulm
Keyword(s):  
United States ◽  
Blood Vessels ◽  
Subarachnoid Space ◽  
Coil Embolization ◽  
Cerebral Aneurysms ◽  
The United States ◽  
Nerve Damage ◽  
Ruptured Aneurysms ◽  
United States Population ◽  
The Brain

Cerebral aneurysms are dilatations, or bulges, in blood vessels of the brain. They can occur in an endless variety of shapes and sizes and some of them can be harmless, while others can rupture and cause bleeding into the subarachnoid space, or the space between the brain and the skull. Once this occurs, a number of complications can develop such as hydrocephalus, vasospasm, stroke, and nerve damage, and the chance of survival is 50% [1]. It is estimated that approximately 2% of the United States population has cerebral aneurysms, and roughly 27,000 patients per year are reported to have ruptured aneurysms [2].

scholarly journals National trends in cerebral bypass surgery in the United States, 2002–2014

2019 ◽  
Vol 46 (2) ◽  
pp. E4 ◽  
Author(s):  
Ethan A. Winkler ◽  
John K. Yue ◽  
Hansen Deng ◽  
Kunal P. Raygor ◽  
Ryan R. L. Phelps ◽  
...  
Keyword(s):  
United States ◽  
Vascular Disease ◽  
Moyamoya Disease ◽  
Cerebral Aneurysms ◽  
The United States ◽  
Occlusive Disease ◽  
Complication Rates ◽  
Occlusive Vascular Disease ◽  
Cerebral Bypass ◽  
Vascular Occlusive Disease

OBJECTIVECerebral bypass procedures are microsurgical techniques to augment or restore cerebral blood flow when treating a number of brain vascular diseases including moyamoya disease, occlusive vascular disease, and cerebral aneurysms. With advances in endovascular therapy and evolving evidence-based guidelines, it has been suggested that cerebral bypass procedures are in a state of decline. Here, the authors characterize the national trends in cerebral bypass surgery in the United States from 2002 to 2014.METHODSUsing the National (Nationwide) Inpatient Sample, the authors extracted for analysis the data on all adult patients who had undergone cerebral bypass as indicated by ICD-9-CM procedure code 34.28. Indications for bypass procedures, patient demographics, healthcare costs, and regional variations are described. Results were stratified by indication for cerebral bypass including moyamoya disease, occlusive vascular disease, and cerebral aneurysms. Predictors of inpatient complications and death were evaluated using multivariable logistic regression analysis.RESULTSFrom 2002 to 2014, there was an increase in the annual number of cerebral bypass surgeries performed in the United States. This increase reflected a growth in the number of cerebral bypass procedures performed for adult moyamoya disease, whereas cases performed for occlusive vascular disease or cerebral aneurysms declined. Inpatient complication rates for cerebral bypass performed for moyamoya disease, vascular occlusive disease, and cerebral aneurysm were 13.2%, 25.1%, and 56.3%, respectively. Rates of iatrogenic stroke ranged from 3.8% to 20.4%, and mortality rates were 0.3%, 1.4%, and 7.8% for moyamoya disease, occlusive vascular disease, and cerebral aneurysms, respectively. Multivariate logistic regression confirmed that cerebral bypass for vascular occlusive disease or cerebral aneurysm is a statistically significant predictor of inpatient complications and death. Mean healthcare costs of cerebral bypass remained unchanged from 2002 to 20014 and varied with treatment indication: moyamoya disease $38,406 ± $483, vascular occlusive disease $46,618 ± $774, and aneurysm $111,753 ± $2381.CONCLUSIONSThe number of cerebral bypass surgeries performed for adult revascularization has increased in the United States from 2002 to 2014. Rising rates of surgical bypass reflect a greater proportion of surgeries performed for moyamoya disease, whereas bypasses performed for vascular occlusive disease and aneurysms are decreasing. Despite evolving indications, cerebral bypass remains an important surgical tool in the modern endovascular era and may be increasing in use. Stagnant complication rates highlight the need for continued interest in advancing available bypass techniques or technologies to improve patient outcomes.

Correlative microscopy in distrubuted (client/server) computing environments: tools for catalyzing the rapid dissemination of information about the cell biology of the human prostate

1995 ◽  
Vol 53 ◽  
pp. 682-683
Author(s):  
A. Hakam ◽  
J.T. Gau ◽  
M.L. Grove ◽  
B.A. Evans ◽  
M. Shuman ◽  
...  
Keyword(s):  
United States ◽  
Cell Biology ◽  
Tissue Bank ◽  
The United States ◽  
Prostate Adenocarcinoma ◽  
Correlative Microscopy ◽  
Client Server ◽  
Critical Elements ◽  
Transplant Organ

Prostate adenocarcinoma is the most common malignant tumor of men in the United States and is the third leading cause of death in men. Despite attempts at early detection, there will be 244,000 new cases and 44,000 deaths from the disease in the United States in 1995. Therapeutic progress against this disease is hindered by an incomplete understanding of prostate epithelial cell biology, the availability of human tissues for in vitro experimentation, slow dissemination of information between prostate cancer research teams and the increasing pressure to “ stretch” research dollars at the same time staff reductions are occurring.To meet these challenges, we have used the correlative microscopy (CM) and client/server (C/S) computing to increase productivity while decreasing costs. Critical elements of our program are as follows:1) Establishing the Western Pennsylvania Genitourinary (GU) Tissue Bank which includes >100 prostates from patients with prostate adenocarcinoma as well as >20 normal prostates from transplant organ donors.

Digital image acquisition, processing, and analysis in a polymer microscopy laboratory

1994 ◽  
Vol 52 ◽  
pp. 454-455
Author(s):  
Vinod K. Berry ◽  
Xiao Zhang
Keyword(s):  
United States ◽  
Image Analysis ◽  
Digital Image ◽  
Image Acquisition ◽  
Image Transmission ◽  
The United States ◽  
Quantitative Image Analysis ◽  
Quantitative Image

In recent years it became apparent that we needed to improve productivity and efficiency in the Microscopy Laboratories in GE Plastics. It was realized that digital image acquisition, archiving, processing, analysis, and transmission over a network would be the best way to achieve this goal. Also, the capabilities of quantitative image analysis, image transmission etc. available with this approach would help us to increase our efficiency. Although the advantages of digital image acquisition, processing, archiving, etc. have been described and are being practiced in many SEM, laboratories, they have not been generally applied in microscopy laboratories (TEM, Optical, SEM and others) and impact on increased productivity has not been yet exploited as well.In order to attain our objective we have acquired a SEMICAPS imaging workstation for each of the GE Plastic sites in the United States. We have integrated the workstation with the microscopes and their peripherals as shown in Figure 1.

Silence of the Land: On the Historical Irrelevance of Territory to Congressional Districting and Political Representation in the United States

2001 ◽  
Vol 15 (01) ◽  
pp. 53-87 ◽  
Author(s):  
Andrew Rehfeld
Keyword(s):  
United States ◽  
House Of Representatives ◽  
Political Representation ◽  
The United States ◽  
Representative Government ◽  
Congressional District ◽  
Congressional Districts ◽  
Communities Of Interest

Every ten years, the United States “constructs” itself politically. On a decennial basis, U.S. Congressional districts are quite literally drawn, physically constructing political representation in the House of Representatives on the basis of where one lives. Why does the United States do it this way? What justifies domicile as the sole criteria of constituency construction? These are the questions raised in this article. Contrary to many contemporary understandings of representation at the founding, I argue that there were no principled reasons for using domicile as the method of organizing for political representation. Even in 1787, the Congressional district was expected to be far too large to map onto existing communities of interest. Instead, territory should be understood as forming a habit of mind for the founders, even while it was necessary to achieve other democratic aims of representative government.

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