Browsing by Author "Limaye, Kaustubh"

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    Macrowire for Intracranial Thrombectomy: A Video Description
    (Sage, 2024-12-18) Kumar, Arjun B.; Khan, Usama; Limaye, Kaustubh; Neurology, School of Medicine
    Mechanical thrombectomy has become the cornerstone to achieve reperfusion in large vessel occlusion causing acute ischemic stroke. Since the advent of intracranial thrombectomy, the procedural setup has been to deliver aspiration catheter over microwire and microcatheter to the intracranial occlusion (ADAPT) or to deliver the stent-retriever through the microcatheter (SOLUMBRA) to perform thrombectomy.1 In both these techniques the quintessential aspect is crossing the clot/thrombus, which increases the chances of clot fragmentation or disruption.2 We demonstrate delivering an ultra-large bore (Sofia 0.088, Microvention, Aliso Viejo, CA, USA) to the intracranial occlusion over a macrowire (Aristotle Colossus OD: 0.035' × 200 cm, Scientia Vascular, UT, USA) alone with no use of microcatheter or microwire. The utilization of macrowire to perform thrombectomy provides enough support to guide the large or ultra large bore catheter to the clot interface without the need to cross the clot. As this technique involves no crossing of clot it prevents clot disruption and distal embolization. There are other possible benefits which are under study in MINT Registry3 and include making thrombectomy more time and cost efficient.
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    Macrowire for intracranial thrombectomy: An early experience of a new device and technique for anterior circulation large vessel occlusion stroke
    (Sage, 2024-12-18) Limaye, Kaustubh; Al Kasab, Sami; Dolia, Jaidevsinh; Ezzeldin, Mohamad; Vela Duarte, Daniel; Doss, Vinodh; Lahoti, Sourabh; Hasan, David; Spiotta, Alejandro; Asi, Khaled; Saini, Vasu; Mehta, Tapan; Hassan, Ameer; Haussen, Diogo; Yavagal, Dileep; Jones, Jesse; Tanweer, Omar; Brinjikji, Waleed; Neurology, School of Medicine
    Background and purpose: Mechanical thrombectomy (MT) has become the standard of care for treatment of acute ischemic stroke secondary to large vessel occlusion up to 24 h from the last known normal time. With ADAPT and SOLUMBRA techniques, classically, a large bore aspiration catheter is delivered over a microcatheter and microwire crossing the clot to perform thrombectomy. Recently, a novel macrowire (Colossus 035 in.) has been introduced as a potential alternative to the use of microwire-microcatheter to allow the delivery of the aspiration catheter (ID = 0.070 in. up to 0.088 in.) over a macrowire alone. Objective: To test the feasibility of delivering an aspiration catheter to clot interface over a macrowire alone. Materials and methods: A retrospective evaluation of prospectively maintained Macrowire for Intracranial Thrombectomy (MINT) Registry where this novel technique was utilized for thrombectomy. Consecutive patients undergoing MT using the MINT technique were included. We collected baseline demographics, imaging and clinical characteristics, rate of procedural success, conversion to traditional MT, and complications. Results: Fifty consecutive patients were recruited during the initial 4 months of the larger study duration. The aspiration catheter was able to be advanced to the clot interface successfully in 46/50 (92%) using the MINT technique. Median time from vascular access to the first pass was 11.30 min (IQR = 7.45-14.30 min) and successful thrombectomy was 14 min (IQR = 10-22.15). The modified first-pass effect with this procedure was 71%. One vasospasm was reported as a procedural complication. Conclusions: MINT is safe and feasible for large vessel occlusion recanalization based on our initial clinical experience in this multicenter study.
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    Paravascular fluid dynamics reveal arterial stiffness assessed using dynamic diffusion-weighted imaging
    (Wiley, 2024) Wen, Qiuting; Wright, Adam; Tong, Yunjie; Zhao, Yi; Risacher, Shannon L.; Saykin, Andrew J.; Wu, Yu-Chien; Limaye, Kaustubh; Riley, Kalen; Radiology and Imaging Sciences, School of Medicine
    Paravascular cerebrospinal fluid (pCSF) surrounding the cerebral arteries within the glymphatic system is pulsatile and moves in synchrony with the pressure waves of the vessel wall. Whether such pulsatile pCSF can infer pulse wave propagation-a property tightly related to arterial stiffness-is unknown and has never been explored. Our recently developed imaging technique, dynamic diffusion-weighted imaging (dynDWI), captures the pulsatile pCSF dynamics in vivo and can explore this question. In this work, we evaluated the time shifts between pCSF waves and finger pulse waves, where pCSF waves were measured by dynDWI and finger pulse waves were measured by the scanner's built-in finger pulse oximeter. We hypothesized that the time shifts reflect brain-finger pulse wave travel time and are sensitive to arterial stiffness. We applied the framework to 36 participants aged 18-82 years to study the age effect of travel time, as well as its associations with cognitive function within the older participants (N = 15, age > 60 years). Our results revealed a strong and consistent correlation between pCSF pulse and finger pulse (mean CorrCoeff = 0.66), supporting arterial pulsation as a major driver for pCSF dynamics. The time delay between pCSF and finger pulses (TimeDelay) was significantly lower (i.e., faster pulse propagation) with advanced age (Pearson's r = -0.44, p = 0.007). Shorter TimeDelay was further associated with worse cognitive function in the older participants. Overall, our study demonstrated pCSF as a viable pathway for measuring intracranial pulses and encouraged future studies to investigate its relevance with cerebrovascular functions.