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All Journal BALI MEDICAL JOURNAL (BMJ) MNJ (Malang Neurology Journal) Universa Medicina AKSONA Journal of Neurointervention and Stroke (JNeViS) Folia Medica Indonesiana
Fritz Sumantri Usman, Fritz Sumantri
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Safety of cerebral digital subtraction angiography : complication rate analysis Usman, Fritz Sumantri; Sani, Achmad Firdaus; Husain, Shakir
Universa Medicina Vol 31, No 1 (2012)
Publisher : Faculty of Medicine, Trisakti University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2012.v31.27-33

Abstract

Background Cerebral digital subtraction angiography (DSA) continues to be used for the examination of patients with cerebrovascular diseases. In the past decade, safer contrast agents have been used and there have been important technical advances including smaller catheters, hydrophylic guide wires, and digital imaging systems. The objective of this study was to determine the neurological complication rates of cerebral angiography performed for inpatients. MethodsA prospective study was conducted from January 2009 until December 2011. The patient’s demographic characteristics, the procedural details as well as complications appearing during and after the procedure were documented. Neurological complications are classified based on the international classification: (a) transient, disappearing within 24 hours; (b) reversible, lasting more than 24 hours but less than 7 days; (c) permanent, if the complication last for more than 7 days. The complications were examined by a neurologist.ResultsThe patients comprised 82 (41%) women and 118 (59%) men, ranging from 11 to 86 years of age. From 200 patients who underwent the procedure, permanent neurological complications were found in 1 (0.50 %) patient. Neither reversible nor transient neurological complications were found. ConclusionThe cerebral digital subtraction angiography procedure, when conducted by a neuro interventionist, is relatively save, both from the aspect of neurological and non-neurological complications, and from the number of deaths. The overall neurological complication rate fell within the limits recommended by quality improvement and safe practice guidelines.
In connection with the publication in Bali Med J 2016, Volume 5, Number 2: 25-29, entitled "Intra-Arterial Heparin Flushing Increases Manual Muscle Test – Medical Research Councils (MMT-MRC) Score in Chronic Ischemic Stroke Patient " Machfoed, Moh Hasan; Usman, Fritz Sumantri; Barus, Jimmy; Wreksoatmodjo, Budi Riyanto; Gunawan, Dede; Bintang, Andi Kurnia; Tugasworo, Dodik; Subroto, Gatot; Lamsudin, Rusdi; Harsono, H.; Sulthan, Riza
BALI MEDICAL JOURNAL Vol 5 No 2 (2016)
Publisher : BALI MEDICAL JOURNAL

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (425.667 KB)

Abstract

In connection with the publication in Bali Med J 2016, Volume 5, Number 2: 25-29,entitled "Intra-Arterial Heparin Flushing Increases Manual Muscle Test – Medical Research Councils (MMT-MRC) Score in Chronic Ischemic Stroke Patient ", herewith, please allow us to do reviews of the study discussion. By assessing the discussion, it can be proved whether there are references that support the results of study.
INDIRECT CEREBRAL REVASCULARIZATION ON OPTHALMIC ARTERY BY USING A DRUG-ELUTING BALLON FOR SUSPECTED MOYAMOYA DISEASE Alwahdy, Ahmad Sulaiman; Usman, Fritz Sumantri
MNJ (Malang Neurology Journal) Vol. 8 No. 1 (2022): January
Publisher : PERDOSSI (Perhimpunan Dokter Spesialis Saraf Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mnj.2022.008.01.15

Abstract

Moyamoya disease (MMD) is a rare idiopathic progressive vaso-occlusive disease causing multiple occlusion of cerebral vessels lead to ischemic stroke. Asian population is the most common race to be affected. We present a male patient 33-years old with suspected MMD with right hemiparesis and neurocognitive changes. On digital substraction angiography (DSA) there was appearance of ‘puff of smoke’ on his right hemisphere, stenosis middle cerebral arteries M1 bilaterally, stenosis of right opthalmic artery (OA), stenosis of left anterior cerebral artery (ACA) and aplasia of right ACA. Ballon angioplasty was performed on right OA that supply the contralateral symptomatic stenosis area (left A1) indirectly through anterior ethmoidal artery and anterior falcine artery (OA-ACA collateral). While no guidelines for the management of MMD, cerebral revascularization by using drug-eluting ballon (DEB) in right opthalmica artery is potentially effective treatment  that could allow the brain to have good blood supply (gives good collateral to both ACA), reduces burden of the fragile moya-moya vessels to be ruptured followed by  improvement of clinical results. Patient’s selection by understanding the stage, its progressivity and collateral formation are crucial before decision is made.
Successful Management of Bilateral Subdural Hematoma: Combining Bilateral Middle Meningeal Arteries Embolization and Unilateral Burr Hole Craniostomy—A Case Report Soetanto, Gameliel Wibowo; Lilikwatil, Pieter Melchias Jacob; Usman, Fritz Sumantri
AKSONA Vol. 5 No. 1 (2025): JANUARY 2025
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/aksona.v5i1.52439

Abstract

Highlight: The approach to bilateral SDH management was still tailor-made, especially in the elderly, due to the benefit of reducing intracranial pressure and the risk of increased complications and recurrent bleeding. In cases of bilateral SDH, middle meningeal artery (MMA) embolization before surgery may increase the favorable outcome and lower the risk of SDH rebleeding.   ABSTRACT Introduction: Subdural hematoma (SDH) is frequently seen in the elderly population. Although anticoagulant use and traumatic brain injury are recognized risk factors, the exact cause of subdural hematomas in certain cases remains unknown. Furthermore, unilateral or bilateral hemispheres may be involved in SDH, which can occur acutely or gradually. The old age group’s SDH profile, which includes several comorbidities, may complacte surgery, the gold standard for treatment. Embolization of the middle meningeal artery (MMA) may be a treatment option because it is safer and has a higher success rate in terms of improvement compared to complications. It can be done as either a standalone procedure or an adjuvant to surgery. Case: An elderly male patient experienced acute left-sided weakness that worsened over three days. Imaging revealed bilateral SDH, with symptomatic chronic SDH on the right side, asymptomatic acute SDH on the left side, and midline shift. Bilateral MMA embolization was done, followed by burr hole craniostomy, which resulted in clinical and radiological improvement throughout a three-month post-intervention period. Conclusion:MMA embolization can improve clinical outcomes and prevent recurrent bleeding, which makes it a potential treatment option for severe symptomatic SDH, especially in patients with comorbidities.  
Review article: does intra-arterial heparin flushing (iahf) can actually increase manual muscle test (mmt) score in chronic ischemic stroke patients? Machfoed, Moh Hasan; Kurniawan, Mohammad; Usman, Fritz Sumantri
Folia Medica Indonesiana Vol. 52, No. 2
Publisher : Folia Medica Indonesiana

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

Stroke is still a major health problem in the world. Ischemic stroke accounts for 87% of all acute stroke occurrences. In 2013, the American Heart Association (AHA)/American Stroke Association (ASA), published a Guideline for the Early Management of Patients with Acute Ischemic Stroke. The managements consist of the use of recombinant tissue plasminogen activator (rtPA), endovascular treatment, etc. Unlike acute ischemic stroke, until now, no guidelines have been provided about the management of chronic ischemic stroke that approved universally. The result of the study with the title of "Intra Arterial Heparin Flushing Increases Manual Muscle Test – Medical Research Councils (MMT-MRC) Score in Chronic Ischemic Stroke Patient” is very interesting, because it is a new attempt to treat patients with chronic ischemic stroke. The purpose of this article is to review the study mentioned above, in accordance with the applied scientific principles and is based on the standard literatures and guidelines. Our review is limited only to the discussion of the study results. From this discussion can be proved the existing references that support and/or refuse the study results. Based on the discussions and conclusions of this study, there were no references to support that IAHF can improve motor functions (muscles) in patients with chronic ischemic stroke.
Indonesian Stroke Management Neurointerventional Services Challenges Usman, Fritz Sumantri; Sani, Achmad Firdaus; Octaviana, Fitri; Kastilong, Merlin Prisilia; Kurnia, Leny; Hendartono, Theodorus K; Atmadja, Andika S; Tambunan, Yan Leo; Syahrul, Syahrul; Pramukarso, Dodik Tugasworo
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.
Improvement of Hemifacial Spasm Following Palliative Embolization of an Unruptured Cerebellar Arteriovenous Malformation Kastilong, Merlin Prisilia; Usman, Fritz Sumantri; Sani, Achmad Firdaus; Saputra, Gilang Nispu; Darmawan, Octavianus; Muin, Rahmi; Kurnia, Leny; Keneddy, Erman
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 A.A. Ketut Agung Cahyawan W Achmad Firdaus Sani, Achmad Firdaus Alwahdy, Ahmad Sulaiman Andi Kurnia Bintang, Andi Kurnia Atmadja, Andika S Budi Riyanto Wreksoatmodjo, Budi Riyanto Darmawan, Octavianus Dede Gunawan, Dede Dodik Tugasworo Fitri Octaviana H. Harsono, H. Hendartono, Theodorus K Jimmy Barus, Jimmy Kastilong, Merlin Prisilia Keneddy, Erman Kurnia, Leny Kurniawan, Mohammad Lilikwatil, Pieter Melchias Jacob Moh Hasan Machfoed, Moh Hasan Mohammad Hasan Machfoed Muin, Rahmi Pramukarso, Dodik Tugasworo Riza Sulthan, Riza Rusdi Lamsudin, Rusdi Saputra, Gilang Nispu Shakir Husain, Shakir Soetanto, Gameliel Wibowo Syahrul Syahrul Tambunan, Yan Leo