Safety of intracranial endovascular aneurysm therapy using 3-dimensional rotational angiography: a single-center experience

BACKGROUND: Three-dimensional rotational angiography has recently been implemented in many interventional neuroradiology practices and may assist the endovascular operator in case selection and planning. The end result may be improved safety. METHODS: We retrospectively searched our database for all aneurysms that were treated at our institution since February 1990. We identified 2 groups-those treated before and after the installation of our rotational fluoroscope on April 23, 2003. Patients with extracranial or intracavernous aneurysms were excluded. If multiple treatments were performed, only the first embolizations were considered. We then compared the 2 groups with regard to rates of immediate procedural complications. We further stratified aneurysms by number, size, and neck dimension, and performed subgroup analyses. We also conducted a post hoc comparison between chronological epochs within each group to determine whether improved safety was an epiphenomenon of advances in technology or operator skill. RESULTS: There were a total of 876 patients treated before and 337 after the implementation of 3D-RA (total N = 1213). The overall complication rate in the pre-3D group was 5.9% and 3.0% in the post-3D group (odds ratio, 0.48; 95% CI, 0.24-0.97). Complication rates were also decreased for patients with single aneurysms. Post hoc analysis demonstrated no benefit within chronological subgroups of the pre-3D or post-3D cohorts. This suggests that the improved safety profile after 3D-RA implementation is not an epiphenomenon of factors such as technological advances or experiential improvements in technique. CONCLUSIONS: 3D-RA implemented during endovascular therapy for intracranial aneurysms improves the safety of the procedure. This may be a result of either improved aneurysm analysis and thus case selection, improved working position selection, or both.     

Role of postnatal penicillin prophylaxis in prevention of neonatal group B streptococcus infection

This prospective study was designed to identify the role of postnatal penicillin prophylaxis in the prevention of neonatal group B streptococcus (GBS) infection. We studied 10 998 infants. Of these, 5389 were in the penicillin prophylaxis group (PP) and 5609 infants did not receive penicillin prophylaxis (NPP). Infants were allocated to treatment by month of birth, alternating 3-mo blocks or 2-mo blocks to the two groups after the first block was randomly assigned. The use of PP reduced the incidence of clinical sepsis (1.7% PP versus 2.5% NPP, p < 0.01), GBS infection (0.4% PP versus 0.9% NPP, p < 0.001) and deaths from sepsis (0.1% PP versus 0.3% NPP, p < 0.05). We conclude that the routine use of postnatal penicillin prophylaxis appears to be effective in reducing the incidence of clinical sepsis and death from sepsis in neonates.