- Authors:
- Ossama Mansour, Karim Gaber
- Affiliation:
- Alexandria University, Stroke and Neurointervention Center, Egypt
- Section:
- Illustrative Teaching Cases
- Issue:
- Vol. 16 No. 2 (2025): June
- Published:
- September 27, 2025
Background: Cavernous dural arteriovenous fistulas
(CCFs) are rare vascular malformations that can lead to significant
morbidity. This case illustrates a successful intervention for a
patient with bilateral CCFs.
Case Presentation: A 50-year-old male presented with
a progressive headache over four months, accompanied by left proptosis
and chemosis for one week. Clinical evaluation revealed a classic triad
of symptoms: proptosis, chemosis, and orbital bruit, without
neurological deficits.
Conclusion: This case highlights the effectiveness of
unilateral transvenous embolization in managing bilateral CCFs.
Endovascular treatment remains the gold standard for symptomatic
patients and offers a minimally invasive option with favorable outcomes.
Keywords: Cavernous dural arteriovenous fistula, embolization, transvenous approach, endovascular treatment
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- Authors:
- Ossama Mansour, Tamer Hassan, Nada Nasr, Salma Said, Ahmed Ossama, Syed I. Hussain, Maher Saqqur, Atilla Ozcan Ozdemir, Ozlem Aykac, Seby John, Nadia Hammami, Hosam Al-Jehani, Farid Aladham, Yahia Imam, Mostafa Mahmoud, Farouk Hassan, Mohamed Alaa Habib, Abdulrahman Alshamy, Mohamed Ghorbani, Faisal Alghamdi, Mohammed Wasay, Khaled Sobh, Amr Mahmoud, Ibrahim ALNAAMI, Achmad Fidaus Sani, Fritz Sumantri Usman, Anchlee Chourojana, Ehab S Mohamed, Amina El Khamlichi, Erdem Gurkas, Mehdi Farhodi, Ehsan Sharifipour, Ahmad Sobri MUDA, Hany hamadani, Mohamed Hamdy, Amal Al Hashmi, Umair Rashid, Mohamed Khaled Elwia, Hany Zaki eldeen, Ashfaq Shuaib
- Section:
- Original Research Article
- Issue:
- Vol. 16 No. 2 (2025): June
- Published:
- September 4, 2025
Background: Aneurysmal subarachnoid hemorrhage (aSAH)
management across the diverse healthcare landscapes of the Middle East
and North Africa (MENA) region requires evidence-based guidelines
adapted to varying resource levels. The MENA Stroke and Interventional
Neurotherapies Organization (MENA-SINO) developed these guidelines to
address critical regional challenges while maintaining core principles
of care.
Methods: Evidence was adapted from multiple
international guidelines (AHA/ASA, ESO, NICE, Neurocritical Care
Society, Chinese guidelines) using a systematic approach including
comprehensive evidence review, multidisciplinary expert panel input,
regional implementation barrier assessment, and formal consensus
procedures.
Conclusion: These guidelines provide a
resource-stratified framework for aSAH management across the MENA
region, with practical adaptations that address the realities of
diverse healthcare settings while preserving essential care components.
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- Authors:
- Mohan Karki, Girish Rajpal
- Affiliation:
- Max Superspeciality Hospital
- Section:
- Original Research Article
- Issue:
- Vol. 16 No. 1 (2025): March
- Published:
- April 24, 2025
Objective: Carotid artery stenting is presently
universally adopted for treatment of carotid artery stenosis. The
objective of this study was to analyze the outcomes of carotid artery
stenting (CAS) performed in a single institution.
Materials and Method: A retrospective study of 150
cases from January 2015 to January 2024. All patients were symptomatic,
including 66 cases with distal embolic protection device (DEPD) and
84 cases without.
Results: There were 99 males and 51 females with mean
age of 64.2 (range 20–81) years. Maximum incidence was noted in age
group 50–70 years (62%). No mortality and no re-stenosis were reported
at mean follow-up of 11.2 ± 6.7 months.
Conclusions: Carotid artery stenting for severe
stenosis is found to be safe and successful. However, appropriate
precaution should be given to patients who have ulcerated plaque.
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- Authors:
- Ossama Mansour, Tamer Hassan, Nada Nasr, Salma Said, Syed I. Hussain, Maher Saqqur, Atilla Ozcan Ozdemir, Ozlem Aykac, Seby John, Nadia Hammami, Hosam Maher Al-Jehani, Farid Aladham, Yahia Imam, Mostafa Mahmoud, Farouk Hassan, Mohamed Alaa Habib, Abdulrahman Alshamy, Mohamed Ghorbani, Faisal Alghamdi, Mohammed Wasay, Ehab S Mohamed, Anchlee Chourojana, Achmad Fidaus Sani, Fritz Sumantri Usman, Ibrahim ALNAAMI, Amr Mahmoud, Khalid Sobh, Mahmoud Galal, Amina El Khamlichi, Erdem Gurkas, wael khalifa, Amal Al Hashmi, Mehdi Farhodi, abdelmoneom said, Hany Elhamadani, Mohamed Hamdy, Hany Zaki eldeen, Mohamed Khaled Elwia, Ahmad Sobri MUDA, Umair Rashid, Ashfaq Shuaib
- Section:
- Original Research Article
- Issue:
- Vol. 16 No. 1 (2025): March
- Published:
- April 22, 2024
Evidence-based guidelines tailored to the Middle East and North Africa
(MENA) region are critical for improving stroke and neurointerventional
outcomes, given varied epidemiological profiles, resource disparities,
and cultural factors. This manuscript outlines a comprehensive framework
established by the Middle East North Africa Stroke and Interventional
Neurotherapies Organization (MENA-SINO) to develop, adapt, and update
guidelines. The framework incorporates recognized methodologies
(e.g., GRADE), encourages multidisciplinary collaboration, and
addresses region-specific needs through "Resource-Limited" tags and
novel Expert Opinion (EO) processes.
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- Authors:
- Ossama Mansour, Farid Aladham, Ibrahim ALNAAMI, Hosam Al-Jehani, Abdulrahman Alshamy, Faisal Alghamdi, Atilla Ozcan Ozdemir, Tamer Hassan, Hany Zaki eldeen, Mohamed Alaa Habib, Nadia Hammami, Farouk Hassan, Syed I. Hussain, Yahia Imam, Seby John, Adnan Qureshi, Amina El Khamlichi, Ahmed Ossama, Umair Rashid, Maher Saqqur, Khalid Sobh, Ashfaq Shuaib
- Section:
- Original Research Article
- Issue:
- Vol. 16 No. 2 (2025): June
- Published:
- August 25, 2015
Background and Objectives: Neurointerventional
laboratory standards vary significantly worldwide, lacking
comprehensive evidence-based certification frameworks. We developed
and validated a novel 6P Protocol (People, Place, Products, Protocols,
Performance, Protection) encompassing 33 evidence-based standards for
neurointerventional laboratory certification.
Methods: Developed through a modified Delphi process
involving 15 international experts with external validation by 7
independent experts. Systematic evidence review of 33 subsections
using 142 high-quality studies. Evidence classified using GRADE
methodology.
Results: Of 33 subsections, 14 (42.4%) received
Grade A evidence, 12 (36.4%) Grade B, and 7 (21.2%) Grade C.
Protection domain showed highest Grade A evidence proportion (66.7%),
followed by Protocols (50.0%).
Conclusions: The 6P Protocol demonstrates robust
scientific grounding, with over three-quarters of subsections supported
by moderate-to-high quality evidence. This provides the first
comprehensive evidence-based framework for neurointerventional
laboratory certification.
Keywords: Neurointerventional procedures, laboratory certification, 6P Protocol framework, evidence-based medicine, GRADE methodology, systematic review, stroke care, angiography laboratory standards
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