ABSTRACT
Introduction PulseRider (Cerenovus, Irvine, CA) is an adjunctive neck bridging device designed to aid in coiling of wide neck bifurcation intracranial aneurysms. We present outcomes of PulseRider assisted coil embolization of brain aneurysms in routine clinical practice included in the STERLING registry. Materials and Methods STERLING (NCT03642639) is a prospective, global registry of endovascular treatment of intracranial aneurysms with Galaxy and MicrusFrame coils (Cerenovus, Irvine, CA). PulseRider cases from STERLING were included in this interim analysis. Primary outcome measures were core-lab assessed modified Raymond-Roy (mRR) occlusion at final procedural angiogram, and where available, at 6 months (+/-3 months) or 1 year (COVID allowed window: -3 months/+1.5 years). Safety outcomes were procedureand device-related adverse events. Results Seventeen subjects (mean age 64.4 ± 8.69 years, 12 female) were treated with the PulseRider device. All cases were unruptured and two were retreatments of previously coiled aneurysms. All aneurysms had saccular morphology, 14/ 15 (93.3%) were wide neck and 13/15 (86.7%) were at a bifurcation. Target aneurysm locations included basilar artery (6/15, 40.0%), MCA bifurcation (4/15, 26.7%), ACA (3/15, 20%), ICA terminus (1/15, 6.7%), and M2 (distal to bifurcation, 1/15, 6.7%), with a mean parent vessel diameter of 2.65 ± 0.440mm. PulseRider was successfully implanted with the ability to retain the coil mass in all cases. Mean packing density was 29.7 ± 11.32%. Adequate occlusion (mRR I or II) was achieved in 86.7% (13/15) cases immediately post procedure, 100% (3/3) at 6 moths, and 75% (3/4) at 1 year. There were no intraprocedural ruptures, no symptomatic thromboembolic events, and no device related SAEs through the maximum follow up. 87.5% (7/8) subjects had mRS 0-2 at 1 year. There were no aneurysm retreatments. Conclusion In this interim analysis of the ongoing STERLING registry, treatment of intracranial aneurysms with the PulseRider device in conjunction with embolization using Galaxy and MicrusFrame coils showed excellent safety outcomes and high rates of adequate occlusion and good clinical outcome.
ABSTRACT
Objective: To describe the growth of #HowToNeuroTwitter, a collaborative social media initiative orienting neurology residency applicants to Twitter as an educational and networking platform. Background: During the initial 6 months of the COVID-19 pandemic and the virtual residency interview season in 2020, a group of medical students, neurology residents, and fellows came together to create a #HowToNeuroTwitter guide and the #NeuroTwitterNetwork. With a continued virtual recruitment in 2021, the guide was expanded to provide more comprehensive and inclusive resources for all types of neurology applicants. Design/Methods: A group of 48 medical students, residents, fellows, and attendings created and promoted the updated guide between May 2021 - August 2021. Twitter was the primary method of promotion and recruitment. Based on feedback from the initial guide, we created new resources to include DO, IMG, and fellowship applicants in addition to residency resources. This was accomplished with the creation of topical subsections. Results: The comprehensive #HowToNeuroTwitter (bit.ly/NeuroTwitterNetwork2) guide was released on August 22nd, 2021 on Twitter, with a tweet that generated 91,082 impressions, 2,739 engagements, 1,137 link clicks to the guide, 180 likes, and 151 retweets as of October 4th, 2021. The guide was broken down into 12 sections including applying to residency, residency program twitter accounts, #MedEd resources, organizations to follow, the #NeuroTwitterNetwork database, child neurology resources, and more. Thirty organizations were catalogued, including subspecialty specific accounts, research journals, and national organizations. There were 111 adult neurology and 18 child neurology residency Twitter accounts included. Conclusions: The #HowToNeuroTwitter Guide 2.0 increased access to high yield information for medical students and residents applying to neurology by developing a centralized resource for trainees at all levels along with a diverse database of neurologists on Twitter.
ABSTRACT
Introduction The STERLING registry is a prospective collection of aneurysms treated with endovascular techniques. The primary intention is to assess the efficacy and safety of Galaxy and MicrusFrame coils (Cerenovus, Irvine, CA). The Covid pandemic has the potential to alter the delivery of medical care or trial enrollment. Changes to regional or hospital specific research infrastructure will likely affect trials for the worse. Methods A retrospective review of STERLING sites and patients was undertaken to better understand regional variation in adapting to the pandemic and how enrollment was affected. Results 45 global sites currently take part in the STERLING registry. 28 sites began enrolling pre-Covid. 34% of U.S. sites were required to halt research, enrollment or elective surgery, whereas only 8% of EU and none of the Japanese sites were required to significantly change their research protocols respectively. At the 10 (9 US, 1 EU) sites required to put a hold on research, rates of enrollment dropped from an average of 0.6 subjects/month in the US (0.5 in EU) to 0 in the first month and 0.1 subjects/month in the second month of Covid-related restrictions. At the time of this analysis (1/ 2021), the average rate of enrollment across those sites partially recovered to 0.2 subjects/month in the US and 0.2 in EU, although 5 of the 10 sites (all US) had not enrolled any subjects post Covid. Overall, mean actual vs. projected enrollment rates decreased more in the U.S. than in the EU and Japan. The percent of ruptured aneurysms in the per-protocol analysis increased from 23% to 40%, while the percent of unruptured aneurysms decreased from 76% to 60%. There were no significant changes to occlusion rates or adverse events pre/ post Covid. Conclusion The Covid pandemic has the potential to dramatically alter how research is conducted worldwide. U.S. sites faced tougher restrictions than their EU and Japan counterparts. Particularly within the U.S., moratoriums on research and elective surgery may be the driving factor in reducing overall enrollment and increasing the percentage of ruptured aneurysm enrollment. Fortunately, these changes did not appear to negatively affect occlusion rates or adverse events.