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Biomedical Journal Sep 2023Peri-intubation cardiac arrest (PICA) is an uncommon yet serious complication of intubation. Although some associated risk factors have been identified, the results have...
BACKGROUND
Peri-intubation cardiac arrest (PICA) is an uncommon yet serious complication of intubation. Although some associated risk factors have been identified, the results have been inconsistent. The aim of this study was to systematically review the relevant research and examine the associated risk factors of PICA through meta-analysis.
METHODS
Studies examining the risk factors for PICA before 1 Nov. 2022 were identified through searches in MEDLINE (OvidSP) and EMBASE. The reported adjusted or unadjusted odds ratios (ORs) and risk ratios (RRs) were recorded. We calculated pooled ORs and created forest plots using a random-effects model to identify the statistically significant risk factors. We assessed the certainty of evidence for each risk factor.
RESULTS
Eight studies were included in the meta-analysis. Pre-intubation hypotension, with a pooled OR of 4.96 (95% confidence interval [C.I.]: 3.75-6.57), pre-intubation hypoxemia, with a pooled OR of 4.43 (95% C.I.: 1.24-15.81), and two or more intubation attempts, with a pooled OR of 1.88 (95% C.I.: 1.09-3.23) were associated with a significantly higher risk of PICA. The pooled incidence of PICA was 2.1% (95% C.I.: 1.5%-3.0%).
CONCLUSIONS
Pre-intubation hypotension, hypoxemia, and more intubation attempts are significant risk factors for PICA. The findings could help physicians identify patients at risk under the acute setting.
PubMed: 37660901
DOI: 10.1016/j.bj.2023.100656 -
Journal of Neurosurgical Sciences Oct 2023Posterior inferior cerebellar artery (PICA) aneurysms are uncommon vascular lesions of the posterior fossa. In addition to aneurysmal morphology, structural anatomic... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Posterior inferior cerebellar artery (PICA) aneurysms are uncommon vascular lesions of the posterior fossa. In addition to aneurysmal morphology, structural anatomic considerations may confer additional procedural risk, and as a result there is currently no consensus as to whether a surgical or endovascular approach offers greater safety and efficacy for patients.
EVIDENCE ACQUISITION
We systematically examined peer-reviewed literature describing PICA aneurysm treatment planning from January 2000 to May 2021 using the PRISMA methodology. A meta-analysis of proportions was performed. Certainty of the evidence was assessed using the GRADE approach.
EVIDENCE SYNTHESIS
Fifty-eight studies including 1673 PICA aneurysms were analyzed. Overall treatment occlusion rate was 97% (95% confidence interval [CI]: 93-100%) for surgery and 85% (95% CI: 78-92%) for endovascular therapy. The recurrence rate was 6% in the endovascular group and 1% for surgery. Overall morbidity and mortality were 16% and 7%, respectively. Intraoperative complications occurred in 9% of the surgical patients.
CONCLUSIONS
Despite a large body of literature, analysis indicates that 62% of studies had moderate or serious risk of bias, suggesting very-low certainty results. Therefore, treatment via either approach should be determined on a case-by-case basis and according to institutional experience.
Topics: Humans; Intracranial Aneurysm; Treatment Outcome; Embolization, Therapeutic; Endovascular Procedures; Vertebral Artery
PubMed: 35416457
DOI: 10.23736/S0390-5616.22.05710-1 -
World Neurosurgery May 2024When traditional therapies are unsuitable, revascularization becomes essential for managing posterior inferior cerebellar artery (PICA) or vertebral artery aneurysms.... (Meta-Analysis)
Meta-Analysis Comparative Study Review
Posterior Inferior Cerebellar Artery-Posterior Inferior Cerebellar Artery Bypass versus Occipital Artery-Posterior Inferior Cerebellar Artery Bypass for Treating Posterior Circulation Aneurysms: A Systematic Review and Comparative Meta-Analysis.
BACKGROUND
When traditional therapies are unsuitable, revascularization becomes essential for managing posterior inferior cerebellar artery (PICA) or vertebral artery aneurysms. Notably, the PICA-PICA bypass has emerged as a promising option, overshadowing the occipital artery-PICA (OA-PICA) bypass. The objective was to compare the safety and efficacy of OA-PICA and PICA-PICA bypasses.
METHODS
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we conducted a systematic review and meta-analysis to evaluate the safety and efficacy of OA-PICA and PICA-PICA bypasses for treating posterior circulation aneurysms.
RESULTS
We analyzed 13 studies for the PICA-PICA bypass and 16 studies on the OA-PICA bypass, involving 84 and 110 patients, respectively. The median average follow-up for PICA-PICA bypass was 8 months (2-50.3 months), while for OA-PICA, it was 27.8 months (6-84 months). The patency rate for OA-PICA was 97% (95% confidence interval [CI]: 92%-100%) and 100% (95% CI: 95%-100%) for PICA-PICA. Complication rates were 29% (95% CI: 10%-47%) for OA-PICA and 12% (95% CI: 3%-21%) for PICA-PICA. Good clinical outcomes were observed in 71% (95% CI: 52%-90%) of OA-PICA patients and 87% (95% CI: 75%-100%) of PICA-PICA patients. Procedure-related mortality was 1% (95% CI: 0%-6%) for OA-PICA and 1% (95% CI: 0%-10%) for PICA-PICA.
CONCLUSIONS
Both procedures have demonstrated promising results in efficacy and safety. PICA-PICA exhibits slightly better patency rates, better clinical outcomes, and fewer complications, but with a lack of substantial follow-up and a smaller sample size. The choice between these procedures should be based on the surgeon's expertise and the patient's anatomy.
Topics: Humans; Cerebellum; Cerebral Revascularization; Intracranial Aneurysm; Treatment Outcome; Vascular Surgical Procedures; Vertebral Artery
PubMed: 38458251
DOI: 10.1016/j.wneu.2024.02.153 -
Neuroradiology Dec 2023A recent meta-analysis on the incidence of iatrogenic injury to the VA has revealed that patients with variant anatomy are more prone to iatrogenic injury. Therefore,... (Review)
Review
BACKGROUND AND OBJECTIVE
A recent meta-analysis on the incidence of iatrogenic injury to the VA has revealed that patients with variant anatomy are more prone to iatrogenic injury. Therefore, this review is designed to investigate the incidence of variations in the suboccipital component of the vertebral artery in different population groups according to the available literature.
METHODS
This systematic review was conducted according to PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The review is based on a comprehensive and extensive search of PubMed, Google Scholar, and ResearchGate. The following search terms were used: "vertebral artery" AND "suboccipital segment" AND "anomalies/anatomical variations of the V3 segment." Reference lists of all extracted articles were also extensively searched for references to any further relevant publications.
RESULTS
A total of 17 papers met the inclusion criteria. The 17 studies corresponded to a total of 10,820 patients. A persistent first intersegmental artery was registered in 1.8% (197 out of 10,820) of the patients. Extradural PICA origin was observed in 1.6% (175 out of 10,820) of the patients. Fenestration was detected in 0.7% (72 out of 10,820) of the patients.
CONCLUSION
The authors summarize the incidence of vascular variation at the suboccipital segment of the VA in different population groups across the Asian, European, American, and African continents. Awareness of the extent of possible anatomical variation will help interpret radiographs, which will enhance the identification of vascular pathologies and reduce the risk of iatrogenic injury.
Topics: Humans; Vertebral Artery; Prevalence; Computed Tomography Angiography; Incidence; Iatrogenic Disease
PubMed: 37878031
DOI: 10.1007/s00234-023-03223-9 -
Frontiers in Neurology 2023For the assessment of patients presenting with acute prolonged vertigo meeting diagnostic criteria for acute vestibular syndrome (AVS), bedside oculomotor examinations...
OBJECTIVES
For the assessment of patients presenting with acute prolonged vertigo meeting diagnostic criteria for acute vestibular syndrome (AVS), bedside oculomotor examinations are essential to distinguish peripheral from central causes. Here we assessed patterns of spontaneous nystagmus (SN) observed in AVS and its diagnostic accuracy at the bedside.
METHODS
MEDLINE and Embase were searched for studies (1980-2022) reporting on the bedside diagnostic accuracy of SN-patterns in AVS patients. Two independent reviewers determined inclusion. We identified 4,186 unique citations, examined 219 full manuscripts, and analyzed 39 studies. Studies were rated on risk of bias (QUADAS-2). Diagnostic data were extracted and SN beating-direction patterns were correlated with lesion locations and lateralization.
RESULTS
Included studies reported on 1,599 patients, with ischemic strokes ( = 747) and acute unilateral vestibulopathy ( = 743) being most frequent. While a horizontal or horizontal-torsional SN was significantly more often found in peripheral AVS (pAVS) than in central AVS (cAVS) patients (672/709 [94.8%] vs. 294/677 [43.4%], < 0.001), torsional and/or vertical SN-patterns were more prevalent in cAVS than in pAVS (15.1 vs. 2.6%, < 0.001). For an (isolated) vertical/vertical-torsional SN or an isolated torsional SN specificity (97.7% [95% CI = 95.1-100.0%]) for a central origin etiology was high, whereas sensitivity (19.1% [10.5-27.7%]) was low. Absence of any horizontal SN was more frequently observed in cAVS than in pAVS (55.2 vs. 7.0%, < 0.001). Ipsilesional and contralesional beating directions of horizontal SN in cAVS were found at similar frequency (28.0 vs. 21.7%, = 0.052), whereas for pAVS a contralesional SN was significantly more frequent (95.2 vs. 2.5%, < 0.001). For PICA strokes presenting with horizontal SN, beating direction was ipsilesional more often than contralesional (23.9 vs. 6.4%, = 0.006), while the opposite was observed for AICA strokes (2.2 vs. 63.0%, < 0.001).
CONCLUSIONS
(Isolated) vertical and/or torsional SN is found in a minority (15.1%) of cAVS patients only. When present, it is highly predictive for a central cause. A combined torsional-downbeating SN-pattern may be observed in pAVS also in cases with isolated lesions of the inferior branch of the vestibular nerve. Furthermore, in cAVS patients the SN beating direction itself does not allow a prediction on the lesion side.
PubMed: 37396773
DOI: 10.3389/fneur.2023.1208902 -
The Pharmacogenomics Journal Oct 2020A systematic review of pharmacogenomic studies capturing adverse drug reactions (ADRs) related to asthma medications was undertaken, and a survey of Pharmacogenomics in...
A systematic review of pharmacogenomic studies capturing adverse drug reactions (ADRs) related to asthma medications was undertaken, and a survey of Pharmacogenomics in Childhood Asthma (PiCA) consortia members was conducted. Studies were eligible if genetic polymorphisms were compared with suspected ADR(s) in a patient with asthma, as either a primary or secondary outcome. Five studies met the inclusion criteria. The ADRs and polymorphisms identified were change in lung function tests (rs1042713), adrenal suppression (rs591118), and decreased bone mineral density (rs6461639) and accretion (rs9896933, rs2074439). Two of these polymorphisms were replicated within the paper, but none had external replication. Priorities from PiCA consortia members (representing 15 institution in eight countries) for future studies were tachycardia (SABA/LABA), adrenal suppression/crisis and growth suppression (corticosteroids), sleep/behaviour disturbances (leukotriene receptor antagonists), and nausea and vomiting (theophylline). Future pharmacogenomic studies in asthma should collect relevant ADR data as well as markers of efficacy.
Topics: Adolescent; Adult; Anti-Asthmatic Agents; Child; Child, Preschool; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Male; Middle Aged; Pharmacogenomic Testing; Pharmacogenomic Variants; Phenotype; Polymorphism, Single Nucleotide; Risk Assessment; Risk Factors; Young Adult
PubMed: 31949291
DOI: 10.1038/s41397-019-0140-y -
Frontiers in Neurology 2022Acute unilateral vestibular hypofunction is characterized by sudden onset of vertigo or dizziness, vomiting/nausea, gait instability, and nystagmus. This is commonly...
INTRODUCTION
Acute unilateral vestibular hypofunction is characterized by sudden onset of vertigo or dizziness, vomiting/nausea, gait instability, and nystagmus. This is commonly described as an acute vestibular syndrome and usually attributed to vestibular neuritis; however, up to 25% of acute vestibular syndrome is caused by a stroke of posterior circulations. The video head impulse test is a recent tool in the vestibular test battery that assesses the vestibule-ocular reflex by measuring the VOR gain and recording overt and covert saccades, these findings have been found to be helpful in the diagnosis of various vestibular disorders.
METHOD
A literature search was conducted in databases, including PubMed Central, PubMed, and Web of Science. All the articles that define video head impulse test (vHIT), acute vestibular hypofunction, and vestibular neuritis were considered for the preliminary search. No limits were placed on the date of publication. The searches were limited to studies with full-text availability, published in English, and including human subjects. Search words such as "head impulse test," "video head impulse test," "vestibular ocular reflex," "acute vestibular syndrome," "acute vestibular hypofunction," "vestibular neuritis," and "vHIT in central vestibular disorders" were entered into different databases in different combinations using boolean operators such as AND, OR, and NOT.
RESULTS
Searches across different databases, including Web of Science, PubMed Central, and PubMed, resulted in a total of 1,790 articles. Title screening was done for all the articles. Out of the 1,790 articles, we found that 245 articles were related to vestibular hypofunction i.e., 1,545 articles were removed at this stage. A further 56 duplicate articles were removed. This led to a final screening of 189 articles. The exclusion criteria included unavailability of full text, studies reported in languages other than English, case reports, reviews, and articles including participants having other comorbid conditions. This final screening led to 133 articles being excluded, which led to the full-text screening of 56 articles. After screening the full-text articles as per the eligibility criteria, 21 articles were found to be eligible for the systematic review. Among the remaining studies, six articles were excluded due to different specific reasons. A total of 15 articles were included in this systematic review. The mean VOR gain for the patients with vestibular neuritis was 0.48 ± 0.14 for the ipsilesional ear, whereas the mean VOR gain was > 0.80 in the contralesional ear for all the patients with acute vestibular neuritis. In patients with PICA lesions, the VOR gain for the ipsilesional ear was 0.90 (range 0.87-0.94) and for the contralesional ear was 0.88 (range 0.84-0.93). In patients with AICA lesions, the mean VOR gain was variable. Based on the above mean VOR gain findings, the authors propose the following adjective description scale of VOR of the lateral canal using vHIT: normal VOR gain above 0.80, mild VOR gain loss for 0.70-0.79, moderate loss for 0.69-0.4, severe loss for 0.39-0.2, and profound loss for < 0.2.
PubMed: 36570452
DOI: 10.3389/fneur.2022.948462 -
British Journal of Neurosurgery Jun 2024Posterior inferior cerebellar artery (PICA) aneurysms are uncommon and are typically found at the origin or proximal segments of the vessel. Giant aneurysms are uncommon...
BACKGROUND
Posterior inferior cerebellar artery (PICA) aneurysms are uncommon and are typically found at the origin or proximal segments of the vessel. Giant aneurysms are uncommon and present unique treatment challenges. Giant distal PICA aneurysms are exceedingly rare and have traditionally been managed via open surgical approaches.
METHODS
A total of 207 studies were assessed, identifying 26 cases of giant distal PICA aneurysms from 26 separate publications. One additional case is described followed by a review of presentation, anatomical characteristics, treatment and outcome.
RESULTS
Presentation was due to local mass effect in 19 (70%), hydrocephalus in 4 (15%) and acute haemorrhage in 5 (19%). All reported cases were partially (86%) or completely (14%) thrombosed. The telovelotonsillar segment was involved in 18/24 (75%) cases. Two cases (7%) were associated with an arteriovenous malformation. Twenty-two (81%) were managed surgically and 5 (19%) managed endovascularly. Outcome was good in 22 (85%) and poor in one (4%).
CONCLUSIONS
Giant distal PICA aneurysms can be managed effectively through a variety of open surgical and endovascular techniques.
Topics: Humans; Intracranial Aneurysm; Cerebellum; Treatment Outcome; Endovascular Procedures; Female; Middle Aged; Male; Adult; Neurosurgical Procedures; Aged
PubMed: 34279172
DOI: 10.1080/02688697.2021.1950631