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Achmad Firdaus Sani
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INDONESIA
Journal of Neurointervention and Stroke (JNeViS)
Published by Perhimpunan Dokter Spesialis Neurologi Indonesia
ISSN : -     EISSN : 31236227     DOI : https://doi.org/10.63937/jnevis-2025.12.12
Core Subject : Health, Science,
Medicine & Pharmacology Neuroscience
Journal of Neurointervention and Stroke (JNeViS) is a peer-reviewed journal dedicated to publishing clinical, epidemiological, basic science, and translational research in vascular and interventional neurology. The journal also welcomes contributions on other neurological and neurosurgical conditions that may benefit from minimally invasive and innovative approaches across specialties such as Neurology, Radiology, and Neurosurgery. Suitable submissions for this Journal include Original Article (observational studies, clinical trials, epidemiological research, health services and outcomes studies, basic and translational research, and innovative techniques in vascular and interventional neurology), and Case Reports or Case Series.
Arjuna Subject : Kedokteran - Neurologi Klinis
Articles 15 Documents
 1   2 
Costs of Stroke Treatment Under National Health Insurance at Dr. Mohammad Hoesin General Hospital Pinto Desti Ramadhoni; Achmad Junaidi; Lenny Octavinawaty; Apriyono Apriyono; Ardy Oktaviandi
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-2025.11.1

Abstract

Highlight: Discrepancy in costs hospitalization Prevalence and risk factors ABSTRACT Introduction: Indonesia’s National Health Insurance/Jaminan Kesehatan Nasional (JKN) consider stroke a catastrophic disease due to its high treatment costs and healthcare system burden. Stroke patients need extended hospitalization, advanced procedures, and long-term rehabilitation, making it financially and socially burdensome. Endovascular procedures like mechanical thrombectomy and coiling improve clinical outcomes but are expensive. Objective: To outline the characteristics and hospitalization costs of stroke patients—both ischemic and hemorrhagic—covered by JKN at Dr. Mohammad Hoesin General Hospital, focusing on cost differences among conservative therapy, thrombolysis, mechanical thrombectomy, and coiling.  Method: A descriptive study with retrospective data collection was performed at a Type A hospital in South Sumatra, using patient records from January to April 2024. Result: Ischemic stroke was the most common type, with most patients aged 46-65 and male. Most patients stayed less than ten days on second-class wards. Conservative therapy was the most frequently used treatment. Hypertension and kidney disorders were the biggest risk factors and comorbidities. Hospital charges for mechanical thrombectomy and coiling exceeded INA-CBG (Indonesian Case Based Groups) reimbursement rates, highlighting a substantial gap between actual hospital costs and insurance coverage. For both stroke types, medication costs dominated total expenses. Conclusion: The significant gap actual hospital costs and INA-CBG reimbursement  rates for stroke treatments, especially for mechanical thrombectomy and coiling, may affect hospital policies on these interventions. To ensure long-term stroke management, revisions to reimbursement schemes should take into account the high costs associated with endovascular therapy.
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.
Successful Management of Acute Ischemic Stroke with Intravenous Thrombolysis and Implementation of Prehospital Stroke Ni Made Ayu Candrayuni; Deddy Andaka
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-2025.11.7

Abstract

Highlight: Timely thrombolysis led to major neurological improvement in stroke patient. Early recognition and prehospital care enabled rapid stroke intervention. Case shows value of prehospital stroke systems for thrombolysis success ABSTRACT Introduction: Acute ischemic stroke (AIS) is a leading cause of disability and death worldwide. Timely administration of intravenous thrombolysis (IVT) significantly improves patient outcomes when delivered within the therapeutic window. Prehospital stroke care encompass the period from symptom onset to hospital arrival and includes both patient-to-hospital and inter-hospital transfers. Delays in prehospital stroke care represent a significant barrier to effective treatment. Case: A 68-year-old male presented with sudden left-sided weakness and slurred speech. A CT scan performed one hour after symptom onset showed no acute abnormalities (ASPECTS 10). He was transferred to the hospital 3.5 hours post-onset and received alteplase (67.5 mg). His door-to-needle time was 20 minutes, with an onset-to-needle time of 3 hours and 50 minutes. The patient showed significant improvement, with his NIHSS score decreasing from 11 to 2 within 30 minutes. Conclusion: Integrating IVT with robust prehospital stroke services enhances treatment efficiency and improves functional outcomes, setting a benchmark for optimal stroke management.
Comparison of Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio as a Predictor of Clinical Outcome in Acute Ischemic Stroke Anthony Gunawan; Ashari Bahar; Irbab Hawari; Wijoyo Halim
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-2025.11.8

Abstract

Highlight: NLR and PLR are associated with stroke outcomes They may influence outcomes via thromboinflammatory pathways ABSTRACT Introduction: Stroke is a clinical syndrome characterized by neurological deficits lasting more than 24 hours or resulting in death, caused exclusively by cerebrovascular disease. Stroke is a leading cause of mortality, responsible for 7.8 million deaths worldwide each year and accounting for 13% of all deaths. Several studies have revealed the role of neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in predicting stroke. However, no study has directly compared NLR and PLR levels with the clinical outcomes of acute ischemic stroke (AIS). Objective: This study aims to compare the predictive value of the NLR and PLR with the clinical outcome of AIS based on the Modified Rankin Scale (mRS) and with the incidence of early neurological deterioration (END) based on NIHSS. Method: This was a prospective observational study. NLR and PLR values were obtained from routine blood examinations, and stroke outcome were assessed using the mRS. Result: A total of 125 ischemic stroke patients met the inclusion criteria. Chi-square test showed that NLR was associated with mRS outcomes, with an odds ratio (OR) of 6.1, while PLR was associated with mRS with an OR of 5.6. Fisher's exact test revealed a statistically significant association between NLR and the incidence of END (OR 19.26; p<0.001), as well as between PLR and END (OR 5.9; p=0.003). Conclusion: NLR and PLR have predictive value for both clinical outcome and the incidence of END in patients with acute ischemic stroke.
Anatomical Profile of Vertebrobasilar System Based on Angiographic Studies Gilbert Tangkudung; Finny Warouw; Kennytha Yoesdyanto; Vinson Hartoyo
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-2025.11.9

Abstract

Highlight: Anatomical variations in blood vessels can significantly affect circulatory hemodynamics These variants also pose a risk of developing intracranial pathologies such as aneurysms Early detection can help prevent further complications ABSTRACT Introduction: Variations of cerebral vasculature in vertebrobasilar system (VBS) occur during embryogenesis and may contribute to cerebrovascular events. These anatomical variants occur in approximately 7% of cases with a 91% prevalence noted in the symmetrical caudal fusion variant. Cerebral angiography remains the most sensitive method for diagnosing these anomalies. Objective: This study aimed to identify angiographic variations in the VBS.  Method: This descriptive observational study used a cross-sectional approach, analyzing secondary data from stroke patients who underwent angiographic procedures between December 2017 and August 2020 at Prof. dr. R. D. Kandou Hospital, Manado. The sample size included the total population of stroke patients who met the inclusion criteria. Data were processed using SPSS version 32. Result:  A total of 277 samples were analyzed. The most commonly observed variations were symmetric cranial fusion (81.50%) and asymmetric caudal fusion (15.42%). One case of symmetric caudal fusion had a basilar tip aneurysm. While most patients exhibited normal anatomy, variants of the posterior cerebral artery (PCA) were also observed, including absence (6.17%) and hypoplasia (7.48%). The superior cerebellar artery (SCA) was absent in 1.76% of cases. Absence of the anterior inferior cerebellar artery (AICA) and posterior inferior cerebellar artery (PICA) was observed in 13.56% of cases; however, these were compensated by complex vascular formations involving collateral sources (21.58%). Conclusion: This study concludes that anatomical variations in cerebral vasculature, including perforators and anastomoses, can be effectively observed through angiographic studies.Careful patient selection is essential to rule out secondary causes of hemifacial spasm and to identify underlying neurovascular contacts.
Moyamoya Disease Involving Anterior and Posterior Circulation in Pediatric Ischemic Stroke: Rare Case Report Subandi Subandi; Lothar Matheus Manson Vanende Silalahi
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-2025.11.10

Abstract

Highlight: Moyamoya disease is one of the causes of stroke in children Moyamoya disease typically involves anterior circulation Posterior circulation may also be involved in certain cases of Moyamoya disease ABSTRACT Introduction: Ischemic stroke is frequently observed in adults but may also occur in children. Moyamoya disease (MMD) is one of the causes of ischemic stroke in children. MMD is a progressive steno-occlusive large-vessel cerebral arteriopathy. MMD was initially defined as changes in the carotid artery with an abnormal vascular network, however, the changes were also noted in posterior circulation. Case: We reported the case of a 13-year-old male with right-sided weakness persisting for over 3 years. Magnetic resonance imaging revealed cortical infarction in the left parietal lobe. Digital subtraction angiography (DSA) confirmed moyamoya disease by revealing total occlusion of the bilateral terminal internal carotid artery and bilateral posterior cerebral artery, accompanied  by a puff of smoke appearance. We treated this patient with antiplatelet therapy for secondary stroke prevention. Conclusion: MMD is one of the conditions that can cause ischemic stroke in children. The posterior circulation is another possible site of MMD manifestation, but it is mostly found in cerebral anterior circulation.  
Covered Stent as an Optional Endovascular Approach to Treat Direct Carotid-Cavernous Fistula: A Case Report Annisa Bunga Nafara; Ahmad Sulaiman Alwahdy; Elsa Primadona Sulfana Putri
Journal of Neurointervention and Stroke Vol. 1 No. 2: NOVEMBER 2025
Publisher : Neurointervention Working Group of Indonesian Neurological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.63937/jnevis-2025.12.11

Abstract

Highlight: Direct CCF often mimics neuro-ophthalmic disorders, causing delayed diagnosis Covered stent is effective as a primary endovascular option for dCCF Risks of covered stent placement are stenosis, thrombosis and branch occlusion ABSTRACT Introduction: The use of covered stents has emerged as a treatment option for direct Carotid Cavernous Fistula (dCCF). However, it has not been routinely adopted in Indonesia. We report the first case in Indonesia of direct traumatic CCF successfully treated with a covered stent as the first-line endovascular therapy. Case: A 21-year-old woman with blurred vision, diplopia and swelling in the right eye, cranial nerves III and VI palsy with a history of traumatic fall two months prior. Digital Subtraction Angiography confirmed the presence of a right-sided direct carotid-cavernous fistula. Embolization was performed using a 3.5x16 mm Bentley covered stent at the fistula site. Direct embolization confirmed a type A right CCF resulted in complete obliteration and previous complaints were significantly reduced. Conclusion: Endovascular therapy with covered stents offers a promising treatment option for CCF, providing vessel patency and effective fistula occlusion. But the risk of complications should be considered.

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