Tim E. Darsaut
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View article: Flow diversion versus coiling ± stenting for unruptured wide-neck intracranial aneurysms: a randomized comparison
Flow diversion versus coiling ± stenting for unruptured wide-neck intracranial aneurysms: a randomized comparison Open
FD＝ Flow Diversion; SAC＝Stent-Assisted Coiling; UIAs＝ Unruptured Intracranial Aneurysms.
View article: Non invasive angiographic results of aneurysms treated with Woven EndoBridge (WEB) devices or coils: an inter- and intra-observer reliability study
Non invasive angiographic results of aneurysms treated with Woven EndoBridge (WEB) devices or coils: an inter- and intra-observer reliability study Open
Background: Magnetic resonance angiography (MRA) is a commonly used non-invasive imaging modality for the follow-up of treated intracranial aneurysms. The 3-category Montreal classification system is widely used to evaluate treatment outco…
View article: Flow Diversion for the Treatment of Distal Circulation Aneurysms: A Randomized Comparison
Flow Diversion for the Treatment of Distal Circulation Aneurysms: A Randomized Comparison Open
Distal circulation aneurysms treated with FDs in FIAT showed an encouraging trend, but this analysis was underpowered. Further randomized trials are needed.
View article: REACT: a randomized trial to assess the efficacy and safety of clazosentan for preventing clinical deterioration due to delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage
REACT: a randomized trial to assess the efficacy and safety of clazosentan for preventing clinical deterioration due to delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage Open
OBJECTIVE Ischemic complications account for significant patient morbidity following aneurysmal subarachnoid hemorrhage (aSAH). The Prevention and Treatment of Vasospasm with Clazosentan (REACT) study was designed to assess the safety and …
View article: Endovascular Parent Vessel Occlusion Versus Flow Diversion in the Treatment of Large and Giant Aneurysms: A Randomized Comparison
Endovascular Parent Vessel Occlusion Versus Flow Diversion in the Treatment of Large and Giant Aneurysms: A Randomized Comparison Open
The comparison between PVO and FD was inconclusive. More randomized trials are needed to better determine the role of FD in large aneurysms eligible for PVO.
View article: The Management of Persistent Distal Occlusions after Mechanical Thrombectomy and Thrombolysis: An Inter- and Intrarater Agreement Study
The Management of Persistent Distal Occlusions after Mechanical Thrombectomy and Thrombolysis: An Inter- and Intrarater Agreement Study Open
Individuals did not agree regarding the best management of patients with persistent distal occlusion after mechanical thrombectomy and IV thrombolysis. There is sufficient uncertainty to justify a dedicated randomized trial.
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We thank Drs Arrese and Sarabia for their interest in our study.[1][1] While they “find the extracted data highly useful,” they are concerned that “the analyzed group may represent a small subgroup of the patients we encounter in our clini…
View article: The small trial problem
The small trial problem Open
View article: A Pragmatic Randomized Trial Comparing Surgical Clipping and Endovascular Treatment of Unruptured Intracranial Aneurysms
A Pragmatic Randomized Trial Comparing Surgical Clipping and Endovascular Treatment of Unruptured Intracranial Aneurysms Open
Surgical clipping is more effective than endovascular treatment of unruptured intracranial aneurysms in terms of the frequency of the primary outcome of treatment failure. Results were mainly driven by angiographic results at 1 year.
View article: Stent-Assisted Coiling in the Treatment of Unruptured Intracranial Aneurysms: A Randomized Clinical Trial
Stent-Assisted Coiling in the Treatment of Unruptured Intracranial Aneurysms: A Randomized Clinical Trial Open
The STAT trial did not show stent-assisted coiling to be superior to coiling alone for wide-neck, large, or recurrent unruptured aneurysms.
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Reply: Open
We thank AJNR for sending us the letter of Drs de Winkel and Roozenbeek, which gives us an opportunity to emphasize the most important, patient-oriented motivation behind our approach. Care trials such as Flow Diversion in Intracranial Ane…
View article: Endovascular treatment of brain arteriovenous malformations: clinical outcomes of patients included in the registry of a pragmatic randomized trial
Endovascular treatment of brain arteriovenous malformations: clinical outcomes of patients included in the registry of a pragmatic randomized trial Open
OBJECTIVE The role of endovascular treatment in the management of patients with brain arteriovenous malformations (AVMs) remains uncertain. AVM embolization can be offered as stand-alone curative therapy or prior to surgery or stereotactic…
View article: Surgical or Endovascular Treatment of MCA Aneurysms: An Agreement Study
Surgical or Endovascular Treatment of MCA Aneurysms: An Agreement Study Open
Individual clinicians did not agree regarding the best management of patients with MCA aneurysms. A randomized trial comparing endovascular with surgical management of patients with MCA aneurysms is in order.
View article: Flow Diversion in the Treatment of Intracranial Aneurysms: A Pragmatic Randomized Care Trial
Flow Diversion in the Treatment of Intracranial Aneurysms: A Pragmatic Randomized Care Trial Open
For patients with mostly unruptured, large, anterior circulation (carotid) aneurysms, flow diversion was more effective than the alternative standard management option in terms of angiographic outcome.
View article: Pragmatic trials can address diagnostic controversies: recent lessons from gestational diabetes
Pragmatic trials can address diagnostic controversies: recent lessons from gestational diabetes Open
View article: Flow Diversion in the Treatment of Intracranial Aneurysms: A Pragmatic Randomized Care Trial
Flow Diversion in the Treatment of Intracranial Aneurysms: A Pragmatic Randomized Care Trial Open
View article: The Utility of Superselective Rotational Angiography for Frameless Stereotactic Navigation During Craniotomy for Micro-Arteriovenous Malformation
The Utility of Superselective Rotational Angiography for Frameless Stereotactic Navigation During Craniotomy for Micro-Arteriovenous Malformation Open
Superselective 3-dimensional angiographic images merged to baseline MRI sequences facilitates planning and navigation during surgery for micro-AVMs.
View article: Transcranial Doppler Velocities and Angiographic Vasospasm after SAH: A Diagnostic Accuracy Study
Transcranial Doppler Velocities and Angiographic Vasospasm after SAH: A Diagnostic Accuracy Study Open
In this study, a threshold transcranial Doppler mean flow-velocity value that would accurately diagnose ≥50% angiographic vasospasm remained elusive.
View article: Utility of 4D digital subtraction angiography in operative localization of micro-arteriovenous malformations
Utility of 4D digital subtraction angiography in operative localization of micro-arteriovenous malformations Open
Background: Micro-arteriovenous malformations (mAVM), defined with a nidus smaller than one centimeter, can lead to intracranial hemorrhage. Surgery can be curative, but precise intra-operative localization of the nidus is often challengin…
View article: Noninvasive Angiographic Results of Clipped or Coiled Intracranial Aneurysms: An Inter- and Intraobserver Reliability Study
Noninvasive Angiographic Results of Clipped or Coiled Intracranial Aneurysms: An Inter- and Intraobserver Reliability Study Open
A standardized 3-grade scale was found to be a reliable and clinically meaningful tool to compare the results of clipping and coiling of aneurysms using CTA or MRA.
View article: Ethical care requires pragmatic care research to guide medical practice under uncertainty
Ethical care requires pragmatic care research to guide medical practice under uncertainty Open
View article: Reliability of the Diagnosis of Cerebral Vasospasm Using Catheter Cerebral Angiography: A Systematic Review and Inter- and Intraobserver Study
Reliability of the Diagnosis of Cerebral Vasospasm Using Catheter Cerebral Angiography: A Systematic Review and Inter- and Intraobserver Study Open
Research on cerebral vasospasm would benefit from standardization of definitions and thresholds. Dichotomized decisions by experienced readers are required for the reliable angiographic diagnosis of cerebral vasospasm.
View article: Practicing outcome-based medical care using pragmatic care trials
Practicing outcome-based medical care using pragmatic care trials Open
View article: Changing the Rules of the Game: The Problem of Surrogate Angiographic Outcomes in the Evaluation of Aneurysm Treatments
Changing the Rules of the Game: The Problem of Surrogate Angiographic Outcomes in the Evaluation of Aneurysm Treatments Open
Surrogate outcomes (indicators or signs used in place of the true clinical outcome measure) are often used in the evaluation of neurovascular treatments, but there are many pitfalls.[1][1] The various ways surrogate angiographic outcomes a…
View article: Retreatments must be included in the evaluation of device performance
Retreatments must be included in the evaluation of device performance Open
We would like to comment on the conclusions of the recent paper reporting the 3 year follow-up results of the Webcast studies1: ‘This analysis confirms the high safety profile of WEB…the great stability of aneurysm occlusion in 83.6% of an…
View article: Measuring clinical uncertainty and equipoise by applying the agreement study methodology to patient management decisions
Measuring clinical uncertainty and equipoise by applying the agreement study methodology to patient management decisions Open
View article: Measuring Clinical Uncertainty and Equipoise by Applying the Agreement Study Methodology to Patient Management Decisions
Measuring Clinical Uncertainty and Equipoise by Applying the Agreement Study Methodology to Patient Management Decisions Open
Background : Clinical uncertainty and equipoise are vague notions that play important roles in contemporary problems of medical care and research, including the design and conduct of pragmatic trials. Our goal was to show how the reliabili…
View article: Measuring Clinical Uncertainty and Equipoise by Applying the Agreement Study Methodology to Patient Management Decisions
Measuring Clinical Uncertainty and Equipoise by Applying the Agreement Study Methodology to Patient Management Decisions Open
Background: Clinical uncertainty and equipoise are vague notions that play important roles in contemporary problems of medical care and research, including the design and conduct of pragmatic trials. Our goal was to show how the reliabilit…
View article: Letter to the Editor. Barrow Ruptured Aneurysm Trial 10-year results
Letter to the Editor. Barrow Ruptured Aneurysm Trial 10-year results Open
View article: Measuring Clinical Uncertainty and Equipoise by Applying the Agreement Study Methodology to Patient Management Decisions
Measuring Clinical Uncertainty and Equipoise by Applying the Agreement Study Methodology to Patient Management Decisions Open
Background: Clinical uncertainty and equipoise are vague notions that play important roles in contemporary problems of medical care and research, including the design and conduct of pragmatic clinical trials. Our goal was to show how the r…