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Journal of Neurointerventional Surgery

Rashi I Mehta, Ansaar T Rai, Jeffrey A Vos, Orestes E Solis, Rupal I Mehta
BACKGROUND: Polymer coating embolism due to vascular medical device use is an increasingly recognized iatrogenic complication. This phenomenon has been linked with various adverse effects including neuroinflammation, acute ischemic stroke, cerebral hemorrhage, and death. Notably, procedure- and device-specific risks of this complication are poorly investigated. In this study, we evaluate the detectable frequency of intra-arterial polymer coating delamination among patients who underwent endovascular thrombectomy for treatment of acute ischemic stroke due to large vessel occlusion...
May 18, 2019: Journal of Neurointerventional Surgery
Yasha Kayan, Philip M Meyers, Charles J Prestigiacomo, Peter Kan, Justin F Fraser
BACKGROUND: The aim of this publication is to provide a detailed update on the diagnosis, treatment, and endovascular techniques for posterior circulation emergent large vessel occlusion (pc-ELVO). METHODS: We performed a review of the literature to specifically evaluate this disease and its treatments. RESULTS: Data were analyzed, and recommendations were reported based on the strength of the published evidence and expert consensus. CONCLUSION: While many questions about pc-ELVO remain to be studied, there is evidence to support particular practices in its evaluation and treatment...
May 18, 2019: Journal of Neurointerventional Surgery
Krishnan Ravindran, Lauren A Dalvin, Jose S Pulido, Waleed Brinjikji
BACKGROUND AND PURPOSE: Intra-arterial chemotherapy for retinoblastoma has been adopted as a first-line treatment option by numerous tertiary centers. The effect of intra-arterial chemotherapy on future rates of metastatic disease as well as on globe salvage in advanced eyes remains relatively unknown. METHODS: A search of PubMED, MEDLINE, EMBASE, and Web of Science electronic databases was conducted from inception until January 2019 for studies with a minimum of 10 patients reporting outcomes and complications following intra-arterial chemotherapy for retinoblastoma...
May 18, 2019: Journal of Neurointerventional Surgery
Olivia W Brooks, Robert M King, Erez Nossek, Miklos Marosfoi, Jildaz Caroff, Ju-Yu Chueh, Ajit S Puri, Matthew J Gounis
PURPOSE: To develop a preclinical model of stroke with a large vessel occlusion treated with mechanical thrombectomy. MATERIALS AND METHODS: An ischemic stroke model was created in dogs by the introduction of an autologous clot into the middle cerebral artery (MCA). A microcatheter was navigated to the clot and a stent retriever thrombectomy was performed with the goal to achieve Thrombolysis in Cerebral Ischemia (TICI) 2b/3 reperfusion. Perfusion and diffusion MRI was acquired after clot placement and following thrombectomy to monitor the progression of restricted diffusion as well as changes in ischemia as a result of mechanical thrombectomy...
May 18, 2019: Journal of Neurointerventional Surgery
Ameer E Hassan, Hari Kotta, Leeroy Garza, Laurie Preston, Wondwossen Tekle, Amrou Sarraj, Adnan I Qureshi
OBJECTIVE: To investigate whether significant differences exist in hospital bills and patient outcomes between patients who undergo endovascular thrombectomy (EVT) alone and those who undergo EVT with pretreatment intravenous tissue plasminogen activator (IV tPA). METHODS: We retrospectively grouped patients in an EVT database into those who underwent EVT alone and those who underwent EVT with pretreatment IV tPA (EVT+IV tPA). Hospital encounter charges (obtained via the hospital's charge capture process), final patient bills (ie, negotiated final bills as per insurance/Medicare rates), demographic information, existing comorbidities, admission and discharge National Institutes of Health Stroke Scale (NIHSS) score, and functional independence data (modified Rankin Scale score 0-2) were collected...
May 18, 2019: Journal of Neurointerventional Surgery
Sarah Lee, Jeremy J Heit, Gregory W Albers, Max Wintermark, Bin Jiang, Eric Bernier, Nancy J Fischbein, Michael Mlynash, Michael P Marks, Huy M Do, Robert L Dodd
BACKGROUND: The extended time window for endovascular therapy in adult stroke represents an opportunity for stroke treatment in children for whom diagnosis may be delayed. However, selection criteria for pediatric thrombectomy has not been defined. METHODS: We performed a retrospective cohort study of patients aged <18 years presenting within 24 hours of acute large vessel occlusion. Patient consent was waived by our institutional IRB. Patient data derived from our institutional stroke database was compared between patients with good and poor outcome using Fisher's exact test, t-test, or Mann-Whitney U-test...
May 16, 2019: Journal of Neurointerventional Surgery
Bradley A Gross, Shashvat M Desai, Gregory Walker, Brian Thomas Jankowitz, Ashutosh Jadhav, Tudor G Jovin
INTRODUCTION: Treatment of acute large vessel occlusion (LVO) stroke secondary to intracranial atherosclerotic disease (ICAD) is more nuanced with disparate and infrequently reported outcomes. The deployment of balloon-mounted stents presents an expedient approach with renewed feasibility in the modern era of supple intermediate catheters. METHODS: A prospectively maintained endovascular stroke database was searched for patients undergoing intracranial stenting with balloon-mounted stents for acute LVO...
May 15, 2019: Journal of Neurointerventional Surgery
Jessica Mertens, Raveena Singh, Arno Reich, Sven Dekeyzer, Martin Wiesmann, Omid Nikoubashman
BACKGROUND AND PURPOSE: Despite numerous optimization attempts, time delays are still a relevant problem in endovascular stroke treatment. We hypothesized that public display of the fastest procedural times in our institution would raise awareness, which would result in improved procedural times. METHODS: We established a competition, which lasted 6 months, in which the fastest neurovascular team in terms of procedural times (image to reperfusion) was displayed on a public board in our institution and rewarded with public praise...
May 14, 2019: Journal of Neurointerventional Surgery
Laurent Pierot, Christophe Bannery, Valery Batchinsky-Parrou, Jean-Charles Kleiber, Sebastien Soize, Claude Fabien Litre
BACKGROUND AND PURPOSE: Intrasaccular flow disruption using the Woven EndoBridge (WEB) is a safe and effective method to treat intracranial aneurysms, particularly wide neck bifurcation aneurysms. However mid term and long term follow-up imaging can show aneurysm remnant or recanalization, and retreatment is therefore sometimes necessary. In most cases, retreatment is performed using an endovascular approach. The present series reports and analyzes aneurysm clipping of recanalized or incompletely occluded aneurysms following WEB treatment...
May 14, 2019: Journal of Neurointerventional Surgery
Nitin Goyal, Georgios Tsivgoulis, Abhi Pandhi, Konark Malhotra, Rashi Krishnan, Muhammad F Ishfaq, Balaji Krishnaiah, Christopher Nickele, Violiza Inoa-Acosta, Aristeidis H Katsanos, Daniel Hoit, Lucas Elijovich, Andrei Alexandrov, Adam S Arthur
INTRODUCTION: We sought to evaluate the impact of pretreatment with intravenous thrombolysis (IVT) on the rate and speed of successful reperfusion (SR) in patients with emergent large vessel occlusion (ELVO) treated with mechanical thrombectomy (MT) in a high-volume tertiary care stroke center. METHODS: Consecutive patients with ELVO treated with MT were evaluated. Outcomes were compared between patients who underwent combined IVT and MT (IVT+MT) and those treated with direct MT (dMT)...
May 14, 2019: Journal of Neurointerventional Surgery
Spencer D Christiansen, Junmin Liu, Michael B Boffa, Maria Drangova
BACKGROUND: The efficacy of acute ischemic stroke treatment is affected by thrombus composition and age, yet no diagnostic method capable of quantitative thrombus characterization currently exists. This in vitro study evaluates the use of R2* , quantitative susceptibility mapping (QSM), and proton density fat fraction (FF) maps derived from a single gradient echo (GRE) MRI acquisition for characterizing clot of various hematocrit, as well as added calcified and lipidic components, throughout aging...
May 14, 2019: Journal of Neurointerventional Surgery
Stefan Schob, Karl-Titus Hoffmann, Cindy Richter, Pervinder Bhogal, Katharina Köhlert, Uwe Planitzer, Svitlana Ziganshyna, Dirk Lindner, Cordula Scherlach, Ulf Nestler, Jürgen Meixensberger, Ulf Quäschling
BACKGROUND: Flow diversion (FD) has emerged as superior minimally invasive therapy for cerebral aneurysms. However, aneurysms of small peripheral vessel segments have not yet been adequately treatable. More specifically, currently established devices necessitate large microcatheters which impede atraumatic maneuvering. The Silk Vista Baby (SVB), a novel flow diverter, offers the as yet unique feature of deliverability via a 0.017 inch microcatheter. This study reports our first experience with the SVB in challenging intracranial vessels employing a vessel-specific tailored microcatheter strategy...
May 14, 2019: Journal of Neurointerventional Surgery
Katarina Dakay, Ali Mahta, Shyam Rao, Michael E Reznik, Linda C Wendell, Bradford B Thompson, N Stevenson Potter, Ali Saad, Chirag D Gandhi, Justin Santarelli, Fawaz Al-Mufti, Brian MacGrory, Tina Burton, Mahesh V Jayaraman, Ryan A McTaggart, Karen Furie, Shadi Yaghi, Shawna Cutting
INTRODUCTION: Atraumatic convexity subarachnoid hemorrhage is a subtype of spontaneous subarachnoid hemorrhage that often presents a diagnostic challenge. Common etiologies include cerebral amyloid angiopathy, vasculopathies, and coagulopathy; however, aneurysm is rare. Given the broad differential of causes of convexity subarachnoid hemorrhage, we assessed the diagnostic yield of common tests and propose a testing strategy. METHODS: We performed a single-center retrospective study on consecutive patients with atraumatic convexity subarachnoid hemorrhage over a 2-year period...
May 10, 2019: Journal of Neurointerventional Surgery
Alessandro Sgreccia, Zoé Duchmann, Jean Philippe Desilles, Bertrand Lapergue, Julien Labreuche, Maeva Kyheng, Romain Bourcier, Arturo Consoli
BACKGROUND: Few case reports have considered the chromatic aspect of retrieved clots and the possible association with their underlying etiology. OBJECTIVE: The aim of our study was to analyze the frequency of the TOAST ischemic stroke typical (atrial fibrillation, dissection, atheroma) and atypical (infective endocarditis, cancer-related, valve-related thrombi) etiologies depending on the chromatic aspect of retrieved clots. METHODS: A total of 255 anonymized and standardized clot photos of consecutive patients treated by mechanical thrombectomy for acute ischemic stroke were included...
May 3, 2019: Journal of Neurointerventional Surgery
Gaurav Jindal, Helio De Paula Carvalho, Aaron Wessell, Elizabeth Le, Varun Naragum, Timothy Ryan Miller, Marcella Wozniak, Ravi Shivashankar, Carolyn A Cronin, Chad Schrier, Dheeraj Gandhi
BACKGROUND: The first pass effect has been recently reported as a predictor of good clinical outcome after stroke thrombectomy. We evaluate the first pass effect on outcome and the influence of revascularization in these and other patients. METHODS: We performed a retrospective analysis of a prospectively maintained database on anterior cerebral circulation stroke thrombectomy cases from April 2012 to April 2018. Data compiled included patient demographics, presenting National Institutes of Health Stroke Scale score, vessel occlusion site, thrombectomy procedural details, and 90 day modified Rankin Scale scores...
May 2, 2019: Journal of Neurointerventional Surgery
Syed Uzair Ahmed, J Mocco, Xiangnan Zhang, Michael Kelly, Amish Doshi, Kambiz Nael, Reade De Leacy
BACKGROUND: Treated aneurysms must be followed over time to ensure durable occlusion, as more than 20% of endovascularly treated aneurysms recur. While digital subtraction angiography (DSA) remains the gold standard, magnetic resonance angiography (MRA) is attractive as a non-invasive follow-up technique. Two different MRA techniques have traditionally been used: time-of-flight (TOF) and contrast-enhanced (CE) MRA. We analysed data from studies comparing MRA techniques with DSA for the follow-up of aneurysms undergoing endovascular treatment...
May 2, 2019: Journal of Neurointerventional Surgery
Yoshinori Kadono, Hajime Nakamura, Shunsuke Saito, Takeo Nishida, Masatoshi Takagaki, Tomoyoshi Shigematsu, Katsunori Asai, Tomoaki Murakami, Kenichi Todo, Toshiyuki Fujinaka, Manabu Sakaguchi, Koichi Toda, Yoshiki Sawa, Haruhiko Kishima
BACKGROUND: Embolic stroke with large vessel occlusion (LVO) is a major adverse event during ventricular assist device (VAD) support. In this study we aimed to clarify the efficacy of, and problems associated with, endovascular treatment (EVT) of LVO in patients with VAD support. METHODS: We retrospectively reviewed EVT for LVO in patients with VAD support between 2006 and 2017 at our institute and evaluated baseline characteristics, treatment variables, outcomes, and complications...
May 2, 2019: Journal of Neurointerventional Surgery
Su Hwan Lee, Won-Sang Cho, Hyun-Seung Kang, Jeong Eun Kim, Young Dae Cho, Dong Hyun Yoo, Moon Hee Han
OBJECTIVE: Cranial nerve palsy (CNP) is rarely reported after endovascular intervention for cavernous sinus dural arteriovenous fistulas (CS DAVFs). Our aim was to evaluate the treatment outcomes of CS DAVFs, and the clinical course and risk factors of newly occurring CNPs, with a review of the literature. METHODS: 121 patients with 134 lesions treated in our institution were selected. They were retrospectively analyzed in terms of baseline characteristics, radiologic results, clinical outcome, and newly occurring CNPs after treatment...
May 2, 2019: Journal of Neurointerventional Surgery
Robert M King, Miklos Marosfoi, Jildaz Caroff, Giovanni J Ughi, Dale M Groth, Matthew J Gounis, Ajit S Puri
BACKGROUND: High frequency optical coherence tomography (HF-OCT) is a novel intravascular imaging technology developed for use in the cerebral vasculature. We hypothesize that HF-OCT characterization of intrasaccular device neck coverage can prognosticate exclusion of the aneurysm from the circulation. METHODS: Bifurcation and sidewall aneurysms were made in six dogs. Seven aneurysms were treated with next generation intrasaccular devices (NGID) and four with traditional platinum coils...
April 29, 2019: Journal of Neurointerventional Surgery
Benjamin M Zussman, Daniel A Tonetti, Jeremy Stone, Merritt Brown, Shashvat M Desai, Bradley A Gross, Ashutosh Jadhav, Tudor G Jovin, Brian Thomas Jankowitz
BACKGROUND: Despite growing interest in the transradial approach for neurovascular procedures, prospective data about the learning curve for neurointerventionalists adopting this approach are limited. METHODS: A subsequent prospective series of 50 consecutive right transradial diagnostic cerebral arteriograms was compared with our initial institutional experience using a procedural staging system. The primary outcome was the ability to achieve the predefined procedural goals using the radial approach...
April 27, 2019: Journal of Neurointerventional Surgery
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