Predictors of Aneurysm Obliteration in Patients Treated with the WEB Device: Results of a Multicenter Retrospective Study.

Humans Intracranial Aneurysm / diagnostic imaging Male Female Middle Aged Embolization, Therapeutic / instrumentation Retrospective Studies Treatment Outcome Aged Risk Factors

Journal

AJNR. American journal of neuroradiology
ISSN: 1936-959X
Titre abrégé: AJNR Am J Neuroradiol
Pays: United States
ID NLM: 8003708

Informations de publication

Date de publication:
08 Jul 2024
Historique:
received: 18 07 2023
accepted: 21 11 2023
medline: 9 7 2024
pubmed: 9 7 2024
entrez: 8 7 2024
Statut: epublish

Résumé

Despite the numerous studies evaluating the occlusion rates of aneurysms following WEB embolization, there are limited studies identifying predictors of occlusion. Our purpose was to identify predictors of aneurysm occlusion and the need for retreatment. This is a review of a prospectively maintained database across 30 academic institutions. We included patients with previously untreated cerebral aneurysms embolized using the WEB who had available intraprocedural data and long-term follow-up. We studied 763 patients with a mean age of 59.9 (SD, 11.7) years. Complete aneurysm occlusion was observed in 212/726 (29.2%) cases, and contrast stasis was observed in 485/537 (90.3%) of nonoccluded aneurysms. At the final follow-up, complete occlusion was achieved in 497/763 (65.1%) patients, and retreatment was required for 56/763 (7.3%) patients. On multivariable analysis, history of smoking, maximal aneurysm diameter, and the presence of an aneurysm wall branch were negative predictors of complete occlusion (OR, 0.5, 0.8, and 0.4, respectively). Maximal aneurysm diameter, the presence of an aneurysm wall branch, posterior circulation location, and male sex increase the chances of retreatment (OR, 1.2, 3.8, 3.0, and 2.3 respectively). Intraprocedural occlusion resulted in a 3-fold increase in the long-term occlusion rate and a 5-fold decrease in the retreatment rate ( Intraprocedural occlusion can be used to predict the chance of long-term aneurysm occlusion and the need for retreatment after embolization with a WEB device. Smoking, aneurysm size, and the presence of an aneurysm wall branch are associated with decreased chances of successful treatment.

Sections du résumé

BACKGROUND AND PURPOSE OBJECTIVE
Despite the numerous studies evaluating the occlusion rates of aneurysms following WEB embolization, there are limited studies identifying predictors of occlusion. Our purpose was to identify predictors of aneurysm occlusion and the need for retreatment.
MATERIALS AND METHODS METHODS
This is a review of a prospectively maintained database across 30 academic institutions. We included patients with previously untreated cerebral aneurysms embolized using the WEB who had available intraprocedural data and long-term follow-up.
RESULTS RESULTS
We studied 763 patients with a mean age of 59.9 (SD, 11.7) years. Complete aneurysm occlusion was observed in 212/726 (29.2%) cases, and contrast stasis was observed in 485/537 (90.3%) of nonoccluded aneurysms. At the final follow-up, complete occlusion was achieved in 497/763 (65.1%) patients, and retreatment was required for 56/763 (7.3%) patients. On multivariable analysis, history of smoking, maximal aneurysm diameter, and the presence of an aneurysm wall branch were negative predictors of complete occlusion (OR, 0.5, 0.8, and 0.4, respectively). Maximal aneurysm diameter, the presence of an aneurysm wall branch, posterior circulation location, and male sex increase the chances of retreatment (OR, 1.2, 3.8, 3.0, and 2.3 respectively). Intraprocedural occlusion resulted in a 3-fold increase in the long-term occlusion rate and a 5-fold decrease in the retreatment rate (
CONCLUSIONS CONCLUSIONS
Intraprocedural occlusion can be used to predict the chance of long-term aneurysm occlusion and the need for retreatment after embolization with a WEB device. Smoking, aneurysm size, and the presence of an aneurysm wall branch are associated with decreased chances of successful treatment.

Identifiants

DOI: 10.3174/ajnr.A8324 PMID: 38977286
pubmed: 38977286
pii: 45/7/906
doi: 10.3174/ajnr.A8324
doi:

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

906-911

Informations de copyright

© 2024 by American Journal of Neuroradiology.

Auteurs

Panagiotis Mastorakos (P)

From the Department of Neurosurgery (P.M., K.E.N., M.L., J. Castiglione, O.K., R.G., M.Z., R.A., A. Amllay, S.I.T., M.R.G., N.A.H., R.H.R., H.Z., R.F.S., P.M.J.), Thomas Jefferson University, Philadelphia, Pennsylvania.
ORCID: 0000-0003-0505-6938

Kareem El Naamani (KE)

From the Department of Neurosurgery (P.M., K.E.N., M.L., J. Castiglione, O.K., R.G., M.Z., R.A., A. Amllay, S.I.T., M.R.G., N.A.H., R.H.R., H.Z., R.F.S., P.M.J.), Thomas Jefferson University, Philadelphia, Pennsylvania.
ORCID: 0000-0001-5294-1003

Nimer Adeeb (N)

Departement of Neurosurgery and Neurointerventional Surgery (N.A., M.D., A. Aslan, H.H.C.-S.), Louisiana State University, Shreveport, Lousiana.
ORCID: 0000-0002-8668-7629

Mathews Lan (M)

From the Department of Neurosurgery (P.M., K.E.N., M.L., J. Castiglione, O.K., R.G., M.Z., R.A., A. Amllay, S.I.T., M.R.G., N.A.H., R.H.R., H.Z., R.F.S., P.M.J.), Thomas Jefferson University, Philadelphia, Pennsylvania.

James Castiglione (J)

From the Department of Neurosurgery (P.M., K.E.N., M.L., J. Castiglione, O.K., R.G., M.Z., R.A., A. Amllay, S.I.T., M.R.G., N.A.H., R.H.R., H.Z., R.F.S., P.M.J.), Thomas Jefferson University, Philadelphia, Pennsylvania.

Omaditya Khanna (O)

From the Department of Neurosurgery (P.M., K.E.N., M.L., J. Castiglione, O.K., R.G., M.Z., R.A., A. Amllay, S.I.T., M.R.G., N.A.H., R.H.R., H.Z., R.F.S., P.M.J.), Thomas Jefferson University, Philadelphia, Pennsylvania.
ORCID: 0000-0002-6062-5382

Ritam Ghosh (R)

From the Department of Neurosurgery (P.M., K.E.N., M.L., J. Castiglione, O.K., R.G., M.Z., R.A., A. Amllay, S.I.T., M.R.G., N.A.H., R.H.R., H.Z., R.F.S., P.M.J.), Thomas Jefferson University, Philadelphia, Pennsylvania.

Jose Danilo Bengzon Diestro (JD)

Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael's Hospital (J.D.B.D., N.M.C., J.S., V.M.P., A.A.D.), University of Toronto, Toronto, Ontario, Canada.
ORCID: 0000-0001-8450-2021

Mahmoud Dibas (M)

Departement of Neurosurgery and Neurointerventional Surgery (N.A., M.D., A. Aslan, H.H.C.-S.), Louisiana State University, Shreveport, Lousiana.
ORCID: 0000-0003-1690-1084

Rachel M McLellan (RM)

Neuroendovascular Program (R.M.M., J.E.V., J.D.R., N.J.P., C.J.S., M.A.A.-S., A.B.P., A.A.D.), Massachusetts General Hospital and Brigham and Women's Hospital, Harvard University, Boston, Massachusetts.

Oktay Algin (O)

Department of Radiology (O.A., M.O.O., G.A.), City Hospital, Bilkent, Medical Faculty of Yıldırım Beyazıt University, Ankara, Turkey.
ORCID: 0000-0002-3877-8366

Sherief Ghozy (S)

Departments of Radiology and Neurosurgery (S.G.), Mayo Clinic, Rochester, Minnesota.
ORCID: 0000-0001-5629-3023

Nicole M Cancelliere (NM)

Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael's Hospital (J.D.B.D., N.M.C., J.S., V.M.P., A.A.D.), University of Toronto, Toronto, Ontario, Canada.
ORCID: 0000-0002-8703-4304

Assala Aslan (A)

Departement of Neurosurgery and Neurointerventional Surgery (N.A., M.D., A. Aslan, H.H.C.-S.), Louisiana State University, Shreveport, Lousiana.

Hugo H Cuellar-Saenz (HH)

Departement of Neurosurgery and Neurointerventional Surgery (N.A., M.D., A. Aslan, H.H.C.-S.), Louisiana State University, Shreveport, Lousiana.

Sovann V Lay (SV)

Service de Neuroradiologie Diagnostique et Thérapeutique (S.V.L.), Centre Hospitalier de Toulouse, Hôpital Purpan, Toulouse, France.
ORCID: 0000-0003-4105-0664

Adrien Guenego (A)

Service de Neuroradiologie Interventionnelle (A.G., S.E., B.T.J., B.L.), Hôpital Universitaire Erasme, Bruxelles, Belgique.
ORCID: 0000-0001-7281-1652

Leonardo Renieri (L)

Interventistica Neurovascolare (L.R., N.L.), Ospedale Careggi di Firenze, Florence, Italy.

Joseph Carnevale (J)

Neurosurgery and Interventional Neuroradiology, Weill Cornell School of Medicine (J. Carnevale, R.W.R., S.B., J.K.), NY Presbyterian Hospital, New York, New York.

Guillaume Saliou (G)

Service de Radiodiagnostic et Radiologie Interventionnelle (G. Saliou), Centre Hospitalier Vaudois de Lausanne, Lausanne, Switzerland.
ORCID: 0000-0003-3832-7976

Eimad Shotar (E)

Department de Neuroradiologie (E.S., K.P., F.C.), Hôpital Pitié-Salpêtrière, Université Sorbonne, Paris, France.
ORCID: 0000-0002-8712-8431

Kevin Premat (K)

Department de Neuroradiologie (E.S., K.P., F.C.), Hôpital Pitié-Salpêtrière, Université Sorbonne, Paris, France.
ORCID: 0000-0003-0705-176X

Markus Möhlenbruch (M)

Sektion Vaskuläre und Interventionelle Neuroradiologie (M. Möhlenbruch, C.U.), Universitätsklinikum Heidelberg, Heidelberg, Germany.
ORCID: 0000-0002-5075-704X

Michael Kral (M)

Department of Neurology/Institute of Neurointervention (M.K., M.K.-O., C.J.G.), Christian Doppler University Hospital and Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria.

Justin E Vranic (JE)

Neuroendovascular Program (R.M.M., J.E.V., J.D.R., N.J.P., C.J.S., M.A.A.-S., A.B.P., A.A.D.), Massachusetts General Hospital and Brigham and Women's Hospital, Harvard University, Boston, Massachusetts.
ORCID: 0000-0002-6000-6709

Charlotte Chung (C)

Departments of Radiology and Neurosurgery (C.C., E.N., E.R., H.A.), NYU Langone Health Center, New York, New York.
ORCID: 0000-0003-0671-4111

Mohamed M Salem (MM)

Department of Neurosurgery (M.M.S., B.T. Jankowitz, J.-K.B.), University of Pennsylvania Medical Center, Philadelphia, Pennsylvania.
ORCID: 0000-0001-8483-2995

Ivan Lylyk (I)

Equipo de Neurocirugía Endovascular y Radiología Intervencionista (I.L., P.L.), Clínica La Sagrada Familia, Buenos Aires, Argentina.
ORCID: 0000-0002-6048-4225

Paul M Foreman (PM)

Neurosurgery Department (P.M.F., J.A.V.), Orlando Health Neuroscience and Rehabilitation Institute, Orlando, Florida.
ORCID: 0000-0001-8743-5119

Jay A Vachhani (JA)

Neurosurgery Department (P.M.F., J.A.V.), Orlando Health Neuroscience and Rehabilitation Institute, Orlando, Florida.
ORCID: 0000-0002-2446-4315

Hamza Shaikh (H)

Departments of Radiology and Neurosurgery (H.S.), Cooper University Health Care, Cooper Medical School of Rowan University, Camden, New Jersey.

Vedran Župančić (V)

Subdivision of Interventional Neuroradiology, Department of Radiology (V.Ž.), Clinical Hospital Center Sisters of Mercy, Zagreb, Croatia.

Muhammad U Hafeez (MU)

Department of Neurosurgery (M.U.H., P.K., V.K.), UTMB and Baylor School of Medicine, Houston, Texas.

Joshua Catapano (J)

Department of Neurosurgery (J. Catapano, A.F.D., F.C.A.), Barrow Neurological Institute, Phoenix, Arizona.

Muhammad Waqas (M)

Department of Neurosurgery (M.W., V.M.T., A.S.), State University of New York at Buffalo, Buffalo, New York.

Vincent M Tutino (VM)

Department of Neurosurgery (M.W., V.M.T., A.S.), State University of New York at Buffalo, Buffalo, New York.

Mohamed K Ibrahim (MK)

Departments of Radiology and Neurosurgery (M.K.I., M.A.M., W.B.), Mayo Clinic, Rochester, Minnesota.

Marwa A Mohammed (MA)

Departments of Radiology and Neurosurgery (M.K.I., M.A.M., W.B.), Mayo Clinic, Rochester, Minnesota.

James D Rabinov (JD)

Neuroendovascular Program (R.M.M., J.E.V., J.D.R., N.J.P., C.J.S., M.A.A.-S., A.B.P., A.A.D.), Massachusetts General Hospital and Brigham and Women's Hospital, Harvard University, Boston, Massachusetts.

Yifan Ren (Y)

Interventional Radiology and Neurointerventional Services, Department of Radiology (Y.R., R.G.T.), Austin Health, Melbourne, Victoria, Australia.

Clemens M Schirmer (CM)

Department of Neurosurgery and Radiology (C.M.S.), Geisinger Hospital, Danville, Pennsylvania.

Mariangela Piano (M)

Interventistica Neurovascolare (M. Piano, P.P., G.P.), Ospedale Niguarda Cà Granda, Milano, Italy.

Maria Bres Bullrich (MB)

Neurointerventional Program, Departments of Medical Imaging and Clinical Neurological Sciences (M.B.B., M. Mayich), London Health Sciences Centre, Western University, London, Ontario, Canada.

Michael Mayich (M)

Neurointerventional Program, Departments of Medical Imaging and Clinical Neurological Sciences (M.B.B., M. Mayich), London Health Sciences Centre, Western University, London, Ontario, Canada.

Anna L Kühn (AL)

Department of Neurointerventional Radiology (A.L.K., A.S.P.), UMass Memorial Hospital, Worcester, Massachusetts.

Caterina Michelozzi (C)

Interventistica Neurovascolare (C.M.), Ospedale San Raffaele Milano, Milano, Italy.

Stéphanie Elens (S)

Service de Neuroradiologie Interventionnelle (A.G., S.E., B.T.J., B.L.), Hôpital Universitaire Erasme, Bruxelles, Belgique.

Robert M Starke (RM)

Department of Neurosurgery (R.M.S.), University of Miami, Miami, Florida.

Ameer E Hassan (AE)

Deparment of Neuroscience (A.E.H.), Valley Baptist Neuroscience Institute, Harlingen, Texas.

Mark Ogilvie (M)

Departments of Neurosurgery and Radiology (M.O., J.J.), University of Alabama at Birmingham, Birmingham, Alabama.

Anh Nguyen (A)

Department of Diagnostic and Interventional Neuroradiology (A.N., M. Psychogios), University Hospital Basel, Basel, Switzerland.

Jesse Jones (J)

Departments of Neurosurgery and Radiology (M.O., J.J.), University of Alabama at Birmingham, Birmingham, Alabama.

Waleed Brinjikji (W)

Departments of Radiology and Neurosurgery (M.K.I., M.A.M., W.B.), Mayo Clinic, Rochester, Minnesota.

Marios Psychogios (M)

Department of Diagnostic and Interventional Neuroradiology (A.N., M. Psychogios), University Hospital Basel, Basel, Switzerland.

Christian Ulfert (C)

Sektion Vaskuläre und Interventionelle Neuroradiologie (M. Möhlenbruch, C.U.), Universitätsklinikum Heidelberg, Heidelberg, Germany.

Julian Spears (J)

Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael's Hospital (J.D.B.D., N.M.C., J.S., V.M.P., A.A.D.), University of Toronto, Toronto, Ontario, Canada.

Brian T Jankowitz (BT)

Department of Neurosurgery (M.M.S., B.T. Jankowitz, J.-K.B.), University of Pennsylvania Medical Center, Philadelphia, Pennsylvania.

Jan-Karl Burkhardt (JK)

Department of Neurosurgery (M.M.S., B.T. Jankowitz, J.-K.B.), University of Pennsylvania Medical Center, Philadelphia, Pennsylvania.

Ricardo A Domingo (RA)

Departments of Radiology & Neurosurgery (R.A.D., T.H.), Mayo Clinic, Jacksonville, Florida.

Thien Huynh (T)

Departments of Radiology & Neurosurgery (R.A.D., T.H.), Mayo Clinic, Jacksonville, Florida.

Rabih G Tawk (RG)

Interventional Radiology and Neurointerventional Services, Department of Radiology (Y.R., R.G.T.), Austin Health, Melbourne, Victoria, Australia.

Boris Lubicz (B)

Service de Neuroradiologie Interventionnelle (A.G., S.E., B.T.J., B.L.), Hôpital Universitaire Erasme, Bruxelles, Belgique.

Marie T Nawka (MT)

Department of Diagnostic and Interventional Neuroradiology (M.T.N.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Pietro Panni (P)

Interventistica Neurovascolare (M. Piano, P.P., G.P.), Ospedale Niguarda Cà Granda, Milano, Italy.

Ajit S Puri (AS)

Department of Neurointerventional Radiology (A.L.K., A.S.P.), UMass Memorial Hospital, Worcester, Massachusetts.

Guglielmo Pero (G)

Interventistica Neurovascolare (M. Piano, P.P., G.P.), Ospedale Niguarda Cà Granda, Milano, Italy.

Erez Nossek (E)

Departments of Radiology and Neurosurgery (C.C., E.N., E.R., H.A.), NYU Langone Health Center, New York, New York.

Eytan Raz (E)

Departments of Radiology and Neurosurgery (C.C., E.N., E.R., H.A.), NYU Langone Health Center, New York, New York.

Monika Killer-Oberpfalzer (M)

Department of Neurology/Institute of Neurointervention (M.K., M.K.-O., C.J.G.), Christian Doppler University Hospital and Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria.

M Ozgur Ozates (MO)

Department of Radiology (O.A., M.O.O., G.A.), City Hospital, Bilkent, Medical Faculty of Yıldırım Beyazıt University, Ankara, Turkey.

Giyas Ayberk (G)

Department of Radiology (O.A., M.O.O., G.A.), City Hospital, Bilkent, Medical Faculty of Yıldırım Beyazıt University, Ankara, Turkey.

Robert W Regenhardt (RW)

Neurosurgery and Interventional Neuroradiology, Weill Cornell School of Medicine (J. Carnevale, R.W.R., S.B., J.K.), NY Presbyterian Hospital, New York, New York.

Christoph J Griessenauer (CJ)

Department of Neurology/Institute of Neurointervention (M.K., M.K.-O., C.J.G.), Christian Doppler University Hospital and Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria.

Hamed Asadi (H)

Departments of Radiology and Neurosurgery (C.C., E.N., E.R., H.A.), NYU Langone Health Center, New York, New York.

Adnan Siddiqui (A)

Department of Neurosurgery (M.W., V.M.T., A.S.), State University of New York at Buffalo, Buffalo, New York.

Andrew F Ducruet (AF)

Department of Neurosurgery (J. Catapano, A.F.D., F.C.A.), Barrow Neurological Institute, Phoenix, Arizona.

Felipe C Albuquerque (FC)

Department of Neurosurgery (J. Catapano, A.F.D., F.C.A.), Barrow Neurological Institute, Phoenix, Arizona.

Nirav J Patel (NJ)

Neuroendovascular Program (R.M.M., J.E.V., J.D.R., N.J.P., C.J.S., M.A.A.-S., A.B.P., A.A.D.), Massachusetts General Hospital and Brigham and Women's Hospital, Harvard University, Boston, Massachusetts.

Christopher J Stapleton (CJ)

Neuroendovascular Program (R.M.M., J.E.V., J.D.R., N.J.P., C.J.S., M.A.A.-S., A.B.P., A.A.D.), Massachusetts General Hospital and Brigham and Women's Hospital, Harvard University, Boston, Massachusetts.

Peter Kan (P)

Department of Neurosurgery (M.U.H., P.K., V.K.), UTMB and Baylor School of Medicine, Houston, Texas.

Vladimir Kalousek (V)

Department of Neurosurgery (M.U.H., P.K., V.K.), UTMB and Baylor School of Medicine, Houston, Texas.

Pedro Lylyk (P)

Equipo de Neurocirugía Endovascular y Radiología Intervencionista (I.L., P.L.), Clínica La Sagrada Familia, Buenos Aires, Argentina.

Srikanth Boddu (S)

Neurosurgery and Interventional Neuroradiology, Weill Cornell School of Medicine (J. Carnevale, R.W.R., S.B., J.K.), NY Presbyterian Hospital, New York, New York.

Jared Knopman (J)

Neurosurgery and Interventional Neuroradiology, Weill Cornell School of Medicine (J. Carnevale, R.W.R., S.B., J.K.), NY Presbyterian Hospital, New York, New York.

Mohammad A Aziz-Sultan (MA)

Neuroendovascular Program (R.M.M., J.E.V., J.D.R., N.J.P., C.J.S., M.A.A.-S., A.B.P., A.A.D.), Massachusetts General Hospital and Brigham and Women's Hospital, Harvard University, Boston, Massachusetts.

Frédéric Clarençon (F)

Department de Neuroradiologie (E.S., K.P., F.C.), Hôpital Pitié-Salpêtrière, Université Sorbonne, Paris, France.

Nicola Limbucci (N)

Interventistica Neurovascolare (L.R., N.L.), Ospedale Careggi di Firenze, Florence, Italy.

Mario Zanaty (M)

From the Department of Neurosurgery (P.M., K.E.N., M.L., J. Castiglione, O.K., R.G., M.Z., R.A., A. Amllay, S.I.T., M.R.G., N.A.H., R.H.R., H.Z., R.F.S., P.M.J.), Thomas Jefferson University, Philadelphia, Pennsylvania.

Juan Carlos Martinez-Gutierrez (JC)

Department of Neurology (J.C.M.-G., S.S., G. Spiegel), UTHealth McGovern Medical School, Houston, Texas.

Sunil Sheth (S)

Department of Neurology (J.C.M.-G., S.S., G. Spiegel), UTHealth McGovern Medical School, Houston, Texas.

Gary Spiegel (G)

Department of Neurology (J.C.M.-G., S.S., G. Spiegel), UTHealth McGovern Medical School, Houston, Texas.

Rawad Abbas (R)

From the Department of Neurosurgery (P.M., K.E.N., M.L., J. Castiglione, O.K., R.G., M.Z., R.A., A. Amllay, S.I.T., M.R.G., N.A.H., R.H.R., H.Z., R.F.S., P.M.J.), Thomas Jefferson University, Philadelphia, Pennsylvania.

Abdelaziz Amllay (A)

From the Department of Neurosurgery (P.M., K.E.N., M.L., J. Castiglione, O.K., R.G., M.Z., R.A., A. Amllay, S.I.T., M.R.G., N.A.H., R.H.R., H.Z., R.F.S., P.M.J.), Thomas Jefferson University, Philadelphia, Pennsylvania.

Stavropoula I Tjoumakaris (SI)

From the Department of Neurosurgery (P.M., K.E.N., M.L., J. Castiglione, O.K., R.G., M.Z., R.A., A. Amllay, S.I.T., M.R.G., N.A.H., R.H.R., H.Z., R.F.S., P.M.J.), Thomas Jefferson University, Philadelphia, Pennsylvania.

Michael R Gooch (MR)

From the Department of Neurosurgery (P.M., K.E.N., M.L., J. Castiglione, O.K., R.G., M.Z., R.A., A. Amllay, S.I.T., M.R.G., N.A.H., R.H.R., H.Z., R.F.S., P.M.J.), Thomas Jefferson University, Philadelphia, Pennsylvania.

Nabeel A Herial (NA)

From the Department of Neurosurgery (P.M., K.E.N., M.L., J. Castiglione, O.K., R.G., M.Z., R.A., A. Amllay, S.I.T., M.R.G., N.A.H., R.H.R., H.Z., R.F.S., P.M.J.), Thomas Jefferson University, Philadelphia, Pennsylvania.

Robert H Rosenwasser (RH)

From the Department of Neurosurgery (P.M., K.E.N., M.L., J. Castiglione, O.K., R.G., M.Z., R.A., A. Amllay, S.I.T., M.R.G., N.A.H., R.H.R., H.Z., R.F.S., P.M.J.), Thomas Jefferson University, Philadelphia, Pennsylvania.

Hekmat Zarzour (H)

From the Department of Neurosurgery (P.M., K.E.N., M.L., J. Castiglione, O.K., R.G., M.Z., R.A., A. Amllay, S.I.T., M.R.G., N.A.H., R.H.R., H.Z., R.F.S., P.M.J.), Thomas Jefferson University, Philadelphia, Pennsylvania.

Richard F Schmidt (RF)

From the Department of Neurosurgery (P.M., K.E.N., M.L., J. Castiglione, O.K., R.G., M.Z., R.A., A. Amllay, S.I.T., M.R.G., N.A.H., R.H.R., H.Z., R.F.S., P.M.J.), Thomas Jefferson University, Philadelphia, Pennsylvania.

Vitor Mendes Pereira (VM)

Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael's Hospital (J.D.B.D., N.M.C., J.S., V.M.P., A.A.D.), University of Toronto, Toronto, Ontario, Canada.

Aman B Patel (AB)

Neuroendovascular Program (R.M.M., J.E.V., J.D.R., N.J.P., C.J.S., M.A.A.-S., A.B.P., A.A.D.), Massachusetts General Hospital and Brigham and Women's Hospital, Harvard University, Boston, Massachusetts.

Pascal M Jabbour (PM)

From the Department of Neurosurgery (P.M., K.E.N., M.L., J. Castiglione, O.K., R.G., M.Z., R.A., A. Amllay, S.I.T., M.R.G., N.A.H., R.H.R., H.Z., R.F.S., P.M.J.), Thomas Jefferson University, Philadelphia, Pennsylvania.

Adam A Dmytriw (AA)

Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael's Hospital (J.D.B.D., N.M.C., J.S., V.M.P., A.A.D.), University of Toronto, Toronto, Ontario, Canada admytriw@mgh.harvard.edu.
Neuroendovascular Program (R.M.M., J.E.V., J.D.R., N.J.P., C.J.S., M.A.A.-S., A.B.P., A.A.D.), Massachusetts General Hospital and Brigham and Women's Hospital, Harvard University, Boston, Massachusetts.

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Effectiveness of Virtual Yoga for Chronic Low Back Pain: A Randomized Clinical Trial.

Hallie Tankha, Devyn Gaskins, Amanda Shallcross et al.
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Humans Yoga Low Back Pain Female Male

Classifications MeSH

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