Browsing by Author "Le Feuvre, David"

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    Endovascular cerebral aneurysm treatment : Long-term outcomes
    (2008) Le Feuvre, David; Taylor, Allan
    Endovascular treatment was confirmed by the International Subarachnoid aneurysm Trial1 as the treatment of choice for intracranial “berry” aneurysms. The durability of coiling and the relevance of stable neck remnants next needed to be addressed. Methods We retrospectively assessed the follow-up angiograms of patients, who presented with subarachnoid haemorrhages or IIIrd nerve palsies and had berry aneurysms treated endovascularly between 2002 and 2003, Patients were phoned to assess their wellbeing and to see whether they were back at work or not. Angiograms were assessed to ascertain percentage of aneurysm coiled at initial procedure and then stability was assessed by percentage change in the residual on later angiograms. Results Over a 1-year period 75 patients were treated endovascularly. 100% occlusion was attainable in 52% at the initial procedure and although the number of patients who attended their 3-month and 1year follow-up angiograms were 40 and 34 respectively there was a trend toward progressive thrombosis to 65% and then 82% respectively. In only 1 of the neck remnants was there growth at the 3-month angiogram. One patient bled having missed his 3-month follow-up angiogram. Although only 40% of the patients were contactable at 4 years there was no re-bleeds amongst them. Conclusion Coiling is durable as shown by our results over a 4 year period and while neck remnants may be observed any growth should be viewed as unstable and treated either endovascularly or surgically if required.
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    Outcomes of mechanical thrombectomy at a single-centre tertiary level public health care hospital in South Africa
    (2025) Kiriinya, Martin; Taylor, Allan; Bateman, Kathleen; Le Feuvre, David
    Introduction: Mechanical thrombectomy (MT) is standard of care for acute ischemic stroke from large vessel occlusion following randomized controlled trials performed largely in high-income countries. Limited data exists on its effectiveness in the real-world setting, particularly in low- and middle-income countries. We aimed to evaluate the safety and efficacy of MT in a public hospital in Cape Town, South Africa. Methods: We evaluated acute ischaemic stroke patients presenting consecutively to Groote Schuur Hospital between 01 January 2018 to 01 January 2022 with proximal intracranial occlusion in the anterior circulation treated with MT within 6 hours from onset using CT and CTA imaging-based protocols. Demographic, clinical, radiological and procedural data were obtained from the stroke unit database. Recanalization was evaluated post-procedure by modified Treatment in Cerebral Infarction score (mTICI). We assessed functional independence (modified Rankin scores (mRS) 0-2) and mortality at 90 days. Results: Thrombectomies were performed in 84 patients during the study period. The median age was 56 years and 51% of participants were female. Median National Institute of Health Stroke Score was 18 and median baseline Alberta Stroke Programme Early CT score was 8. Bridging thrombolysis was given to 65% of participants. Median time from symptom onset to reperfusion was 339 minutes. Successful recanalization (mTICI 2b/3) was obtained in 62%. At 90 days, 34 % of participants reached functional independence and mortality was 34% . Conclusions: We achieved similar rates of recanalization and functional independence to that seen in trials in high-income countries using basic imaging despite a higher mortality and longer median time to reperfusion. These data support the effectiveness of MT in a public hospital in south Africa despite the challenges of providing emergent stroke care in a resource-constrained setting.