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RISS 인기검색어
- 검색키워드
- 저자 : Vikram Huded (검색결과 4 건)
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Karan Vivek,Vyas Devashish,Bohra Vikram,Huded Vikram 대한신경중재치료의학회 2019 Neurointervention Vol.14 No.2
Purpose: A safe and efficacious antiplatelet drug is needed for patients with clopidogrel resistance who undergo neuroendovascular procedures. Ticagrelor is a new reversibly binding, oral, direct-acting P2Y receptor antagonist with no known resistance. We describe our clinical experience using ticagrelor for neuroendovascular procedures in Indian patients with clopidogrel resistance at the NH Institute of Neurosciences, Narayana Health City, Bangalore. Materials and Methods: We retrospectively reviewed our endovascular procedure database for all patients with predefined clopidogrel resistance. Clopidogrel resistance was defined as P2Y12 inhibition <40%. Patients were administered ticagrelor along with aspirin prior to the procedure. Results: Of 127 patients, 32 (25%) were non-responders to clopidogrel (22 [69%] males, 10 [31%] females; median age, 54 years [range, 20–75]). All patients were treated with a 180-mg loading dose of ticagrelor, followed by 90 mg twice daily. Twenty patients (63%) underwent endovascular intervention for intracranial aneurysm, two (6%) for dissecting aneurysms, nine (28%) for stenotic lesions, and one (3%) for carotico-cavernous fistula. No patient experienced any adverse effects related to the use of Ticagrelor in the postoperative period. Conclusion: Ticagrelor is an effective alternative to clopidogrel for use in conjunction with aspirin in patients with clopidogrel resistance. None of our patients had adverse effects from ticagrelor. Drug cost, twice-daily dosing, and risk of faster platelet aggregation activation after discontinuation should be taken into consideration prior to its use in such patients.
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REtrospective Multicenter INdian Study of Derivo Embolization Device (REMIND): Periprocedural Safety
Niranjan Prakash Mahajan,Mudasir Mushtaq,Amit Bhatti,Sukalyan Purkayastha,Nitin Dange,Mathew Cherian,Vipul Gupta,Vikram Huded 대한신경중재치료의학회 2021 Neurointervention Vol.16 No.3
Purpose: The treatment of aneurysms with characteristics such as complex morphology, fusiform, blister-like, wide neck, or large size has been revolutionized with the introduction of flow diverters. Though flow diverters have several advantages over coiling, they also have certain important disadvantages such as the lack of immediate protection against rupture, the risk of ischemic stroke, the need for antiplatelet therapy, and long latency for complete effect. The Derivo Embolization Device (DED) is a second-generation self-expanding device that is claimed to be less thrombogenic than conventional devices. We retrospectively evaluated the periprocedural safety and risks associated with the DED across 5 centers in India. Materials and Methods: This is a multicentric, retrospective, observational study of DED, conducted at 5 high volume endovascular therapy centers in India from May 2018 to June 2020. Periprocedural demographic, clinical, and angiographic data were collected from a retrospective review of patient charts. Results: A total of 96 patients, including 56 (58.3%) females, aged between 16–80 years (60±12.7 years) harboring 106 aneurysms were studied. Seven (7.3%) were noted to harbor multiple aneurysms: 6 had 3 aneurysms each, while 1 patient had 5 aneurysms. The following aneurysm characteristics were noted: average size, 9.8±8.2 mm; average neck size, 6.9±8.5 mm; wide-necked (>4 mm), 63 (59.4%); giant (>25 mm), 8 (7.5%); and anterior circulation location, 98 (92.5%). Eighteen (17%) of these were ruptured. Additional balloon angioplasty was performed in 5 (5.2%) patients. Intraprocedural problems were encountered in 3 (3.1%), of which only 1 had clinical implications, the device fish-mouthing with stent thrombosis resulting in a malignant middle cerebral artery territory infarction. The modified Rankin scale at 3 months was worse in 1 patient. Conclusion: DED is a newer generation flow diverter stent with a low periprocedural complication rate.
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Carotid Artery Stenting and Its Impact on Cognitive Function: A Prospective Observational Study
Gupta Avinash N,Bhatti Amit A,Shah Mudasir M,Mahajan Niranjan P,Sadana Divya K,Huded Vikram 대한신경중재치료의학회 2020 Neurointervention Vol.15 No.2
Purpose: Carotid artery stenting (CAS) has evolved as a first-line therapeutic option for carotid revascularization in indicated patients for stroke prevention, but there is still a lack of data on its effect on cognitive function (CF), especially among Indian patients. To determine the effect of CAS on CF and to study the immediate and delayed complications of CAS in Indian patients.Materials and Methods: This was a prospective, observational, single-center study. CF was assessed using Addenbrooke’s cognitive examination version III (ACE) before and 3 months after stenting. The demographic and clinical parameters were also assessed. A follow-up evaluation after 3 months was done to compare CF and to observe the occurrence of any complications.Results: Out of 31 patients, 3 were lost to follow up. There were no immediate or delayed procedure-related complications. There was a statistically significant improvement in overall ACE score and memory before and after stenting. On subgroup analysis of those with and without strokes, there was a significant improvement in visuospatial function and mean ACE score. Those with left CAS had significant improvement in memory, visuospatial, language, and ACE scores than right CAS.Conclusion: CAS was associated with significant improvement in CF in patients.
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Myoclonus-Ataxia Syndrome Associated with COVID-19
Kuldeep Shetty,Atul Manchakrao Jadhav,Ranjith Jayanthakumar,Seema Jamwal,Tejaswini Shanubhogue,Mallepalli Prabhakar Reddy,Gopal Krishna Dash,Radhika Manohar,Vivek Jacob Philip,Vikram Huded 대한파킨슨병및이상운동질환학회 2021 Journal Of Movement Disorders Vol.14 No.2
Neurological manifestations of coronavirus disease (COVID-19) have increasingly been reported since the onset of the pandemic. Herein, we report a relatively new presentation. A patient in the convalescence period following a febrile illness with lower respiratorytract infection (fever, myalgia, nonproductive cough) presented with generalized disabling myoclonus, which is phenotypicallysuggestive of brainstem origin, along with additional truncal cerebellar ataxia. His neurology work-ups, such as brainMRI, electroencephalography, serum autoimmune and paraneoplastic antibody testing, were normal. His CT chest scan revealedright lower lung infiltrates, and serological and other laboratory testing did not show evidence of active infection. COVID-19 titers turned out to be strongly positive, suggestive of post-COVID-19 lung sequelae. He responded partially to antimyoclonicdrugs and fully to a course of steroids, suggesting a para- or postinfectious immune-mediated pathophysiology. Myoclonusataxiasyndrome appears to be a neurological manifestation of COVID-19 infection, and knowledge regarding this phenomenonshould be increased among clinicians for better patient care in a pandemic situation.
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