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All Journal Althea Medical Journal MNJ (Malang Neurology Journal) Universa Medicina Majalah Kedokteran Neurosains Biomolecular and Health Science Journal Indian Journal of Forensic Medicine & Toxicology AKSONA Journal of Neurointervention and Stroke (JNeViS)
Achmad Firdaus Sani, Achmad Firdaus
Departemen Neurologi, Fakultas Kedokteran, Universitas Airlangga; RSUD Dr. Soetomo, Surabaya, Indonesia
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Two Strikes in the Cath Lab: Lessons from Repeat Aneurysm Ruptures During Endovascular Treatment Vita Kusuma Rahmawati; Achmad Firdaus Sani; Dedy Kurniawan; Faishol Hamdani; Muh. Wildan Yahya
Journal of Neurointervention and Stroke Vol. 2 No. 1: MAY 2026
Publisher : Neurointervention Working Group of Indonesian Neurological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.63937/jnevis-2026.21.19

Abstract

Highlight: Repeat aneurysm rupture during endovascular therapy is rare but often fatal This case highlights the need for careful hydrocephalus management and monitoring Dynamic neurological assessment guides urgent aneurysm repair and improves outcomes ABSTRACT Introduction: Repeat aneurysmal rupture in the catheterization laboratory remains a critical concern, with periprocedural mortality rates reported as high as 63%. Such rebleeding requires rapid multidisciplinary decision-making, particularly in high-grade aneurysmal subarachnoid hemorrhage (aSAH) complicated by hydrocephalus. Case: A 56-year-old hypertensive man presented with sudden-onset headache followed by loss of consciousness (Hunt and Hess grade III). Computed tomography (CT) revealed subarachnoid and intraventricular hemorrhage, and CT angiography identified a left saccular posterior communicating artery aneurysm. During induction in the catheterization laboratory, he developed severe headache, seizures, hypertension, and pupil anisocoria, raising concern for impending cerebral herniation. Owing to a postictal comatose state, his clinical Hunt and Hess grade deteriorated to grade V. Emergent CT confirmed acute hydrocephalus and rebleeding. Endovascular coiling was deferred, and an external ventricular drain was placed, resulting in improved consciousness. Subsequent angiography demonstrated contrast extravasation from the aneurysm dome, confirming rebleeding. The aneurysm ruptured three times over two weeks, including twice during separate catheterization laboratory sessions. Definitive endovascular coiling ultimately achieved near-complete aneurysm packing. Neurological status improved to Hunt and Hess grade II, followed by ventriculoperitoneal shunt placement. At discharge, the modified Rankin Scale score improved from 4 to 3 without new focal neurological deficits. Three-month follow-up confirmed stable neurological recovery. Conclusion: This case highlights the challenges of repeated aSAH rupture in the catheterization laboratory, emphasizing hydrocephalus management and dynamic Hunt and Hess grading to guide aneurysm treatment timing. Urgent endovascular coiling may be warranted despite clinical instability, using individualized strategies to optimize neurological outcomes.
Comparison of Admission ICH Score Between Primary Hypertensive and Secondary Intracerebral Hemorrhage due to Vascular Etiologies Dewi Setyaning Bastiana; Achmad Firdaus Sani; Sita Setyowatie; Jovian Philip Swatan; Atilla Özcan Özdemir
Journal of Neurointervention and Stroke Vol. 2 No. 1: MAY 2026
Publisher : Neurointervention Working Group of Indonesian Neurological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.63937/jnevis-2026.21.35

Abstract

Highlight: Primary hypertensive ICH is the most common etiology of ICH in our study Primary ICH has a higher admission ICH score than secondary ICH Elevated admission BP is associated with higher ICH severity ABSTRACT Introduction: Intracerebral hemorrhage (ICH) is a stroke subtype associated with a high case-fatality rate despite being less prevalent than ischemic stroke. Spontaneous ICH is broadly classified into primary and secondary etiologies, yet clinical evidence remains conflicting regarding which group presents with greater initial severity. Objective: To compare admission ICH scores between primary hypertensive and secondary vascular ICH. Method: This retrospective study included adults with non-traumatic ICH who presented within 48 hours at an Indonesian stroke center. All patients underwent cross-sectional imaging and angiography; those with coagulopathy, anticoagulant use, or recurrent strokes were excluded. The primary outcome was clinical severity, dichotomized using an admission ICH score of ≥3 versus <3. Bivariate tests and multivariate logistic regression were used to identify independent predictors of high severity. Result: Of the 306 patients analyzed, 267 (87.25%) were diagnosed with primary ICH and 39 (12.75%) with secondary ICH. Secondary etiologies included ruptured arteriovenous malformations (n=21), intracranial aneurysms (n=16), and dural arteriovenous fistula (n=2). Patients with primary ICH were significantly older and exhibited higher admission blood pressure and more frequent infratentorial hematoma locations. Conversely, those in the secondary ICH group were typically younger and more likely to present with seizures or concomitant subarachnoid hemorrhage. Primary ICH was independently associated with greater clinical severity, as indicated by an admission ICH score of ≥3 (29.59% vs 7.69%; aOR 5.04, 95% CI 1.51–16.86, p=0.009). Conclusion: Primary ICH exhibits higher admission severity than secondary ICH. Prospective research is required to evaluate long-term functional outcomes.
Study of Thrombolytic r-TPA Alteplase in Ischaemic Stroke Patients at Dr. Soetomo General Academic Hospital Surabaya Diah Utari Madiningrum; Achmad Firdaus Sani; Sumarno Sumarno; Muhammad Thariq Nadhafi
AKSONA Vol. 6 No. 2 (2026): JULY 2026
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/aksona.v6i2.67057

Abstract

Highlight: Alteplase effectiveness depends on efficient in-hospital stroke care. Code Stroke optimization is needed to improve thrombolysis timelines.   ABSTRACT Introduction: Acute ischemic stroke is a leading cause of disability and mortality worldwide. Intravenous thrombolysis with recombinant tissue plasminogen activator (r-TPA, alteplase) is an effective treatment when administered within 3–4.5 hours of stroke onset. However, its utilization remains limited due to delayed hospital arrival, limited early recognition of stroke, and variations in hospital preparedness. Objective: This study provides real data on the use of intravenous alteplase thrombolysis and evaluates implementation by assessing dosing regimen, treatment timelines, potential drug-related problems, and the implementation of the Code Stroke program at Dr. Soetomo General Academic Hospital. Methods: This descriptive observational study analyzed secondary data from the medical records of 17 patients with acute ischemic stroke treated with intravenous alteplase between January 1, 2023 and April 30, 2024. Data collected included demographic characteristics, comorbidities, history of recurrent stroke, and length of hospital stay. Clinical outcomes were evaluated using National Institutes of Health Stroke Scale (NIHSS) scores, therapy timing and dosage, door-to-needle time, and door-to-imaging time. Results: Intravenous alteplase was administered at doses of 0.6 mg/kg (12%), 0.7 mg/k (12%), and 0.9 mg/kg (76%). Although all patients were treated within the recommended 3–4.5-hour therapeutic window after stroke onset, only 23% achieved a door-to-needle time of ≤60 minutes. Adverse events were limited to gingival bleeding (6%) and hematuria (12%). Conclusion: Intravenous alteplase thrombolysis at Dr. Soetomo General Academic Hospital has generally followed established guidelines. However, further optimization of the Code Stroke program is required to improve treatment timeliness.
The Impact of Elevated Mean Arterial Pressure on Mortality in Spontaneous Subarachnoid Hemorrhage Achmad Firdaus Sani; Taurus Laisari; Muh. Wildan Yahya; Vita Kusuma Rahmawati; Faishol Hamdani; Dedy Kurniawan; Sita Setyowatie
Journal of Neurointervention and Stroke Vol. 1 No. 1: MAY 2025
Publisher : Neurointervention Working Group of Indonesian Neurological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.63937/jnevis-2025.11.2

Abstract

Highlight: Elevated MAP is associated with increased in-hospital mortality in SAH patients High MAP increases the risk of rebleeding, cerebral edema, and vasospasm MAP, age, infection, and hydrocephalus are independent predictors of mortality ABSTRACT Introduction: Subarachnoid hemorrhage (SAH) remains a critical neurological emergency with high mortality and morbidity. Mean arterial pressure (MAP) plays an importance role in cerebral perfusion and hemodynamic stability in SAH patients. However, excessive MAP elevation potentially worsening clinical outcomes. This study investigates the impact of elevated MAP on in-hospital mortality among SAH patients. Objective: This study investigates the impact of elevated MAP on in-hospital mortality among SAH patients.  Method: A retrospective cross-sectional study was conducted using medical records of SAH patients admitted to Dr. Soetomo Academic Medical Center Hospital from 2013 to 2021. A total of 360 patients met the inclusion criteria. MAP was calculated upon admission and categorized as ≥125 mmHg or <125 mmHg. The primary outcome was in-hospital mortality. Logistic regression analysis was performed to assess the association between MAP and mortality while adjusting for confounders. Result: Among 360 SAH patients, 44.8% did not survive hospitalization. The mean age was 54 years, with an initial mean MAP of 117.45±21.6 mmHg. Bivariate analysis showed that MAP ≥125 mmHg significantly increased mortality risk (OR = 1.93; 95% CI: 1.24–2.98; p = 0.002). Multivariate logistic regression identified MAP ≥125 mmHg as an independent predictor of mortality (Adjusted OR = 1.795; p = 0.012), alongside age (Adjusted OR = 2.043; p = 0.004), infection (Adjusted OR = 2.442; p = 0.001), and hydrocephalus (Adjusted OR = 2.174; p = 0.003). Conclusion: Elevated MAP (≥125 mmHg) is significantly associated with increased in-hospital mortality in SAH patients. These findings highlight the importance of early hemodynamic management in SAH to improve patient survival.
Indonesian Stroke Management Neurointerventional Services Challenges Fritz Sumantri Usman; Achmad Firdaus Sani; Fitri Octaviana; Merlin Prisilia Kastilong; Leny Kurnia; Theodorus K Hendartono; Andika S Atmadja; Yan Leo Tambunan; Syahrul Syahrul; Dodik Tugasworo Pramukarso
Journal of Neurointervention and Stroke Vol. 1 No. 1: MAY 2025
Publisher : Neurointervention Working Group of Indonesian Neurological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.63937/jnevis-2025.11.3

Abstract

Highlight: Stroke burden in Indonesia Challenges for Indonesian neurointerventionst ABSTRACT Introduction: Stroke is a leading cause of death and disability in Indonesia. Currently, stroke management has become more aggressive, and neurointerventionists are required to optimize acute stroke management. Objective: To determine the distribution of neurointerventionists in Indonesia and identify the obstacles faced in neurointervention services. Method: This cross-sectional study used an online questionnaire distributed to neurointerventionists in Indonesia between October and November 2024. Result: A total of 105 neurointerventionists completed the questionnaires. The distribution of neurointerventionists remains concentrated in Java, especially in Jakarta. The highest ratio of neurointerventionists to stroke cases was observed in Jakarta, while the lowest was in Lampung. West Java identified the largest gap in the number of neurointerventionists compared to Jakarta. Notably, 20.9% of neurointerventionists had not performed any neurointerventional procedures, and 46.8% reported challenges related to the funding of neurointerventional procedures through government insurance. Conclusion: Despite the increasing number of neurointerventionists in Indonesia, their distribution remains concentrated in Java. The main barrier was the funding of neurointerventional procedures through government insurance.
Deferring Angioplasty and Stenting based on Natural Progression in Severe Middle Cerebral Artery Stenosis: An Observation of Two Cases Vita Kusuma Rahmawati; Achmad Firdaus Sani; Dedy Kurniawan; Muh. Wildan Yahya; Faishol Hamdani
Journal of Neurointervention and Stroke Vol. 1 No. 1: MAY 2025
Publisher : Neurointervention Working Group of Indonesian Neurological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.63937/jnevis-2025.11.5

Abstract

Highlight: MCA stenosis may remodel spontaneously or progress to complete occlusion Serial imaging observing progression spots high-risk cases, guiding intervention ABSTRACT Introduction: Severe middle cerebral artery (MCA) stenosis, as one of the intracranial atherosclerotic diseases, is a major cause of ischemic stroke. The role and optimal timing of interventions, such as angioplasty and stenting, remain subjects of debate, particularly due to the variable natural disease progression. While some cases improve spontaneously, others progress to total occlusion, necessitating comprehensive evaluation of individualized treatment approaches. Cases: This case series presents two patients with severe MCA stenosis, each of whom followed a distinct clinical courses. The first patient had 88% stenosis in the M1 segment of the right MCA (NIHSS 3, mRS 2), which spontaneously improved to 57% within days (NIHSS 2, mRS 2), with enhanced distal flow, leading to the decision to defer angioplasty and stenting. In contrast, the second patient initially had severe left MCA stenosis (NIHSS 10, mRS 4), which progressed to total occlusion within three months (NIHSS 10, mRS 4), also resulting in deferred intervention. Serial cerebral digital subtraction angiography (DSA) facilitated the observation of vascular evolution and collateral circulation, guiding decisions about intervention. Conclusion: The clinical outcomes of MCA stenosis range widely, from spontaneous resolution to progressive occlusion. Close serial imaging observation of collateral circulation and natural progression is essential for guiding decisions about angioplasty and stenting.  
Improvement of Hemifacial Spasm Following Palliative Embolization of an Unruptured Cerebellar Arteriovenous Malformation Merlin Prisilia Kastilong; Fritz Sumantri Usman; Achmad Firdaus Sani; Gilang Nispu Saputra; Octavianus Darmawan; Rahmi Muin; Leny Kurnia; Erman Keneddy
Journal of Neurointervention and Stroke Vol. 1 No. 1: MAY 2025
Publisher : Neurointervention Working Group of Indonesian Neurological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.63937/jnevis-2025.11.6

Abstract

Highlight: Cerebellar region's AVM and hemifascial spasm Embolization AVM and hemifacial spasm ABSTRACT Introduction: Posterior fossa arteriovenous malformations (AVMs) are uncommon, accounting for 7–15% of all intracranial AVMs. These malformations typically present with symptoms such as headaches, seizure, and intracerebral hemorrhage. Reports of hemifacial spasm–characterized by involuntary contractions of the facial muscles–as a presenting symptom of AVMs are extremely rare and usually occur only when the facial nerve is compressed. Case: A 35-year-old male presented with worsening left-sided hemifacial spasm, unresponsive to medication for around one year, followed by progressive headache and dizziness. T2-weighted MRI revealed contact between the facial nerve root and a tortuous posterior inferior cerebellar artery (PICA), along with an AVM in the left cerebellar hemisphere. Cerebral angiography demonstrated a left cerebellar AVM with feeding arteries from superior cerebellar artery (SCA) and PICA. The patient underwent successful embolization of the SCA using glue (n-BCA:lipiodol). An intraprocedural thrombus developed but was managed appropriately. Post-procedural cerebral angiography revealed recanalization of the basilar artery and left PICA, with a 30% reduction in nidus size. The hemifacial spasm improved significantly after embolization with an HFS-7 score reduction of six points in the first week post-procedure. Conclusion: Palliative embolization has shown potential in alleviating symptoms associated with hemifacial spasm and improving quality of life. Careful patient selection is essential to rule out secondary causes of hemifacial spasm and to identify underlying neurovascular contacts.
Co-Authors Adrianto, Yudhi Andika S Atmadja Archangela Olivia Eugenia Ardhi, Mohammad Saiful Atilla Özcan Özdemir Basuki, Mudjiani Chandrawati Widya Hartati Darmawan, Ahmad Faisal Dedy Kurniawan Dedy Kurniawan Dewi Setyaning Bastiana Diah Utari Madiningrum Dodik Tugasworo Pramukarso Erman Keneddy Fadil Fadil Faishol Hamdani Faishol Hamdani Fidiana Fidiana, Fidiana Fitri Octaviana Fritz Sumantri Usman Fritz Sumantri Usman, Fritz Sumantri Gilang Nispu Saputra Hermawan Susanto Jongky Hendro Prajitno Jovian Philip Swatan Leny Kurnia Merlin Prisilia Kastilong Mohammad Pratama Jauhar Putra Muh. Wildan Yahya Muh. Wildan Yahya Muhammad Thariq Nadhafi Octavianus Darmawan Puji Lestari Rahmi Muin Ramadhania, Nadya Noor Rizky Hartono Rizky Hartono, Rizky Shakir Husain, Shakir Sita Setyowatie Sita Setyowatie Sita Setyowatie Sumarno Sumarno Syahrul Syahrul Taurus Laisari Taurus Laisari Theodorus K Hendartono Vita Kusuma Rahmawati Yan Leo Tambunan Yusak Maryunianta