Browsing by Author "Raj, Rahul"
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Rantamo, Anni; Gallé, Camille; Numminen, Jussi; Virta, Jyri; Tanskanen, Päivi; Lindroos, Ann-Christine; Resendiz-Nieves, Julio; Lehecka, Martin; Niemelä, Mika; Haeren, Roel; Raj, Rahul (2024)Background The use of antithrombotic medication following acute flow diversion for a ruptured intracranial aneurysm (IA) is challenging with no current guidelines. We investigated the incidence of treatment-related complications and patient outcomes after flow diversion for a ruptured IA before and after the implementation of a standardized antithrombotic medication protocol. Methods We conducted a single-center retrospective study including consecutive patients treated for acutely ruptured IAs with flow diversion during 2015–2023. We divided the patients into two groups: those treated before the implementation of the protocol (pre-protocol) and those treated after the implementation of the protocol (post-protocol). The primary outcomes were hemorrhagic and ischemic complications. A secondary outcome was clinical outcome using the modified Ranking Scale (mRS). Results Totally 39 patients with 40 ruptured IAs were treated with flow diversion (69% pre-protocol, 31% post-protocol). The patient mean age was 55 years, 62% were female, 63% of aneurysms were in the posterior circulation, 92% of aneurysms were non-saccular, and 44% were in poor grade on admission. Treatment differences included the use of glycoprotein IIb/ IIIa inhibitors (pre-group 48% vs. post-group 100%), and the use of early dual antiplatelets (pre-group 44% vs. 92% postgroup). The incidence of ischemic complications was 37% and 42% and the incidence of hemorrhagic complications was 30% and 33% in the pre- and post-groups, respectively, with no between-group differences. There were three (11%) aneurysm re-ruptures in the pre-group and none in the post-group. There were no differences in mortality or mRS 0–2 between the groups at 6 months. Conclusion We found no major differences in the incidence of ischemic or hemorrhagic complications after the implementation of a standardized antithrombotic protocol for acute flow diversion for ruptured IAs. There is an urgent need for more evidence-based guidelines to optimize antithrombotic treatment after flow diversion in the setting of subarachnoid hemorrhage.
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Holmström, Ester; Efendijev, Ilmar; Raj, Rahul; Pekkarinen, Pirkka; Litonius, Erik; Skrifvars, Markus (2021)Background: Cardiac arrest (CA) is a leading cause of death worldwide. As population ages, the need for research focusing on CA in elderly increases. This study investigated treatment intensity, 12-month neurological outcome, mortality and healthcare-associated costs for patients aged over 75 years treated for CA in an intensive care unit (ICU) of a tertiary hospital. Methods: This single-centre retrospective study included adult CA patients treated in a Finnish tertiary hospital’s ICU between 2005 and 2013. We stratified the study population into two age groups: <75 and ≥75 years. We compared interventions defined by the median daily therapeutic intervention scoring system (TISS-76) between the age groups to find differences in treatment intensity. We calculated cost-effectiveness by dividing the total one-year healthcare-associated costs of all patients by the number of survivors with a favourable neurological outcome. Favourable outcome was defined as a cerebral performance category (CPC) of 1–2 at 12 months after cardiac arrest. Logistic regression analysis was used to identify independent association between age group, mortality and neurological outcome. Results: This study included a total of 1,285 patients, of which 212 (16%) were ≥75 years of age. Treatment intensity was lower for the elderly compared to the younger group, with median TISS scores of 116 and 147, respectively (p < 0.001). The effective cost in euros for patients with a good one-year neurological outcome was €168,000 for the elderly and €120,000 for the younger group. At 12 months after CA 24% of the patients in the elderly group and 47% of the patients in the younger group had a CPC of 1-2 (p < 0.001). Age was an independent predictor of mortality (multivariate OR = 3.36, 95% CI:2.21-5.11, p < 0.001) and neurological outcome (multivariate OR = 3.27, 95% CI:2.12-5.03, p < 0.001). Conclusions: The elderly ICU-treated CA patients in this study had worse neurological outcomes, higher mortality and lower cost-effectiveness than younger patients. Further efforts are needed to recognize the tools for assessing which elderly patients benefit from a more aggressive treatment approach in order to improve the cost-effectiveness of post-CA management.
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Spontaneous Angiogram Negative Subarachnoid Hemorrhage : A Retrospective Single Center Cohort Study Achrén, Alexander; Raj, Rahul; Siironen, Jari; Laakso, Aki; Marjamaa, Johan (2021)Background: Spontaneous angiogram negative subarachnoid hemorrhage (SAH) is considered a benign illness with little of the aneurysmal SAH-related complications. We describe the clinical course, SAH-related complications and outcome of patients with angiogram negative SAH. Methods: We retrospectively reviewed all adult patients admitted to a neurosurgical intensive care unit during 2004–2018 due to spontaneous angiogram negative SAH. Our primary outcome was a dichotomized Glasgow Outcome Scale at three months. We assessed factors that associated with outcome using multivariable logistic regression analysis. Results: Of included 108 patients, 84% had a favorable outcome and mortality was 5% within oneyear. Median age was 58 years, 51% were female, and 93% had a low grade SAH (World Federation of Neurosurgical Societies grading I-III). The median number of angiograms performed per patient was two. Thirty per cent of patients showed radiological signs of acute hydrocephalus, 28% were acutely treated with an external ventricular drain, 13% received active vasospasm treatment and 17% received a permanent shunt. In the multivariable logistic regression model, only acute hydrocephalus associated with unfavorable outcome (odds ratio 4.05, 95% confidence interval 1.05–15.73). Two patients had a new bleeding episode. One of those patients had already suffered a spontaneous angiogram negative SAH prior to the current hospitalization. Conclusion: SAH-related complications such as hydrocephalus and vasospasm are common after angiogram negative SAH. Still, most patients had a favorable outcome. Only acute hydrocephalus was associated with unfavorable outcome. Our findings stress the importance of specialized neurointensive care for these patients.
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Tommiska, Pihla; Lönnrot, Kimmo; Raj, Rahul; Luostarinen, Teemu; Kivisaari, Riku (2019)Background A number of randomized controlled trials have shown the benefit of drain placement in the operative treatment of chronic subdural hematoma (CSDH); however, few reports have described real-life results after adoption of drain placement into clinical practice. We report the results following a change in practice at Helsinki University Hospital from no drain to subdural drain (SD) placement after burr hole craniostomy for CSDH. Methods We conducted a retrospective observational study of consecutive patients undergoing burr hole craniostomy for CSDH. We compared outcomes between a 6- month period when SD placement was arbitrary (July-December 2015) and a period when SD placement for 48 hours was routine (July-December 2017). Our primary outcome of interest was recurrence of CSDH necessitating reoperation within 6 months. Patient outcomes, infections, and other complications were assessed as well. Results A total of 161 patients were included, comprising 71 (44%) in the drain group and 90 (56%) in the non-drain group. There were no significant differences in age, comorbidities, history of trauma, or use of antithrombotic agents between the 2 groups (P>0.05 for all). Recurrence within 6 months occurred in 18% of patients in the non-drain group, compared with 6% in the drain group (odds ratio, 0.28; 95% confidence interval, 0.09-0.87; P=0.028). There were no differences in neurologic outcomes (P=0.72), mortality (P=0.55), infection rate (P=0.96), or other complications (P=0.20). Conclusions The change in practice from no drain to use of an SD after burr hole craniostomy for CSDH effectively reduced the 6-month recurrence rate with no effect on patient outcomes, infections, or other complications.
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