Jefferson Physicians

JHN Journal - Spring 2018

jhn-journal-spring-2018

The research findings for neurovascular care in the JHN Spring 2018 Journal included: 

  • A Systems Thinking Approach to Redesigning the Patient Experience to Reduce 30 Day Hospital Readmission- The tools of systems thinking were utilized to perform dissolution of an inadequate health care delivery system and to implement and design a new team construct. 
  • Assessing a 600-mg Loading Dose of Clopidogrel 24 Hours Prior to Pipeline Embolization Device Treatment-  In a cohort receiving PED, a 600-mg loading dose of clopidogrel should be safe and efficacious in those off the standard protocol or showing <30% platelet inhibition before treatment. 
  • A Case Report and Overview of Familial Cerebral Cavernous Malformation Pathogenesis in an Adult Patient- The case of a 39 year-old female who was diagnosed and treated for a de novo formation of a symptomatic cavernous malformation, with only one prior cavernous malformation one year prior. Further genetic analysis of this patient and her family could possibly illuminate her mutations and inheritance pattern. 
  • Clinical Applications of the Pipeline Embolization Device- While the PED can allow for treatment of large, wide-necked aneurysms with high efficacy, aneurysm location, previous treatment, patient age and the use of concomitant coiling may influence treatment outcomes.
  • The Use of Prasugrel and Ticagrelor in Pipeline Flow Diversion- The key in assuring clopidogrel resistant patients long term clinical wellbeing is by applying the right anti-aggregation protocol. Approximately 30% of the patients receiving clopidogrel are heterozygote for the CYP2C19 gene and showing a hypo-responsiveness or resistance (<30% platelet inhibition).
  • Functional Recovery and Risk of Readmission in Low-Grade aSAH Patients- Among patients with low-grade SAH (HH 1-3), the risk of delayed neurological complications is low and early discharge is deemed safe in those with an uncomplicated hospitalization.