Minjae Kim, Seung Chai Jung, Soo Chin Kim, Bum Joon Kim, Woo-Keun Seo, Byungjun Kim
PURPOSE: To propose standardized and feasible imaging protocols for constructing artificial intelligence (AI) database in acute stroke by assessing the current practice at tertiary hospitals in South Korea and reviewing evolving AI models. MATERIALS AND METHODS: A nationwide survey on acute stroke imaging protocols was conducted using an electronic questionnaire sent to 43 registered tertiary hospitals between April and May 2021. Imaging protocols for endovascular thrombectomy (EVT) in the early and late time windows and during follow-up were assessed...
November 2023: Neurointervention
Il Hyung Lee, Taedong Ok, Yo Han Jung, Kyung-Yul Lee, Sang Hyun Suh
We present a case of delayed migration of an open-cell design carotid stent, which is a rare complication following carotid artery stenting (CAS). A 65-year-old patient with carotid artery stenosis underwent CAS with an open-cell stent, initially achieving successful deployment. However, 4 months later, the stent migrated and resulted in restenosis. The patient underwent balloon angioplasty and received an additional stent, leading to improved blood flow. The rarity of stent migration, particularly in the absence of risk factors, highlights the need for clinicians to be vigilant and consider early imaging follow-up for patients at risk of this complication after CAS...
September 19, 2023: Neurointervention
Farid Qoorchi Moheb Seraj, Sajjad Najafi, Hashem Pahlavan, Hossein Organji, Humain Baharvahdat
Ipsilateral mydriasis (IM) is usually not acute. However, the acute occurrence of unilateral dilated pupil may result in acute ischemic stroke. Herein, we present 3 patients with IM, lateral eye deviation, ptosis, and contralateral hemiparesis due to isolated occlusion of the pre-communicating segment of the posterior cerebral artery with preservation of the posterior communicating artery, which was successfully treated by emergent mechanical thrombectomy. In a 3-month follow-up, all patients were independent without any neurological deficits...
August 22, 2023: Neurointervention
Seoiyoung Ahn, Steven G Roth, Jacob Jo, Yeji Ko, Nishit Mummareddy, Matthew R Fusco, Rohan V Chitale, Michael T Froehler
PURPOSE: Low levels of low-density lipoprotein cholesterol (LDL-C) have been suggested to increase the risk of hemorrhagic transformation (HT) following acute ischemic stroke. However, the literature on the relationship between LDL-C levels and post-thrombectomy HT is sparse. The aim of our study is to investigate the association between LDL-C and delayed parenchymal hematoma (PH) that was not seen on immediate post-thrombectomy dual-energy computed tomography (DECT). MATERIALS AND METHODS: A retrospective analysis was conducted on all patients with anterior circulation large vessel occlusion who underwent thrombectomy at a comprehensive stroke center from 2018-2021...
August 11, 2023: Neurointervention
Tetsuya Ioku, Tomotaka Ohshima, Mao Yokota, Naoki Matsuo, Shigeru Miyachi
Transarterial embolization using Onyx is a well-established treatment for dural arteriovenous fistulas (DAVFs). However, complications can arise when Onyx migrates into the venous side, impairing the draining veins. We encountered a case where Onyx, injected through the arterial side, strayed into the jugular vein, forming a hairball-like structure. Our study aimed to investigate the underlying mechanism of this unusual phenomenon. We postulated that Onyx precipitates into thread-like shapes when passing through extremely narrow openings...
July 26, 2023: Neurointervention
Jieun Roh, Seung Kug Baik, Jeong A Yeom, Sang-Won Lee
A ruptured brain arteriovenous malformation (bAVM) presenting with a hematoma may have unseen parts of the shunts in diagnostic angiography in the acute phase, which may lead to innate incomplete evaluation for the whole angioarchitecture of the bAVM. Even though it is generally accepted that the nidus of a ruptured bAVM may be underestimated in angiography during the acute phase due to hematoma compression, documentation of the underestimated parts has not been described in the literature. The authors report 2 cases of ruptured bAVMs in which the obscured segments were cast with liquid embolic material, which suggests a potential presence of obscured segments in bAVMs...
July 2023: Neurointervention
Dae Chul Suh
No abstract text is available yet for this article.
July 2023: Neurointervention
Dae Chul Suh, Yunsun Song, Sang Ik Park, Boseong Kwon
PURPOSE: This study aimed to evaluate the effectiveness, safety, and technical considerations of flow diverter (FD) treatment using a Flow Re-direction Endoluminal Device (FRED) for unruptured intracranial vertebral artery dissecting aneurysms (VADAs). MATERIALS AND METHODS: We conducted a retrospective study of 23 patients with unruptured intracranial VADAs who underwent FD treatment using a FRED between June 2017 and August 2021. Symptoms, imaging findings, treatment strategies, and angiographic and clinical outcomes were evaluated...
July 2023: Neurointervention
Leila Afshar Hezarkhani, Saeed Abdollahifard, Mohammad Hossein Mirbolouk, Shohre Hooshmand, Ashkan Mowla, Humain Baharvahdat
Stroke in children is a rare but devastating disease. Although endovascular treatment has been reported to be safe and effective in the treatment of stroke with large vessel occlusion in this population, there are still limitations and controversies. In this case report, we describe a 12-month-old girl who was admitted to the hospital with acute onset of left-sided hemiplegia and confusion, which turned out to be due to a large infarct in the right middle cerebral artery territory, possibly caused by dissection of the right cervical internal carotid artery...
July 2023: Neurointervention
Brandon A Santhumayor, Timothy G White, Cassidy Werner, Kevin Shah, Henry H Woo
The Woven EndoBridge (WEB) (MicroVention/Terumo) device is a treatment option for wideneck bifurcation aneurysms. An uncommon adverse effect is WEB device migration. While certain bailout strategies for WEB recovery have been described, there is still a paucity of information on optimal strategies to maximize both short and long-term post-operative outcomes. We add 2 cases at our institution to the existing literature of WEBectomy in the setting of complicated intracranial aneurysm treatment. We discuss the long-term imaging outcomes with additional fluoroscopy video demonstrating our technique...
July 2023: Neurointervention
Sung Hyun Baik, Jun Yup Kim, Cheolkyu Jung
Mechanical thrombectomy for acute posterior circulation strokes (PCSs) is recommended based on evidence from anterior circulation strokes (ACSs). Two recent randomized controlled trials showed that endovascular treatment (EVT) leads to better functional outcomes than those of the best medical care. However, many studies have shown that patients undergoing PC-EVT have a higher rate of futile recanalization than those undergoing AC-EVT. The characteristics and outcomes of PC-EVT may differ according to the pathological mechanisms, including cardioembolism, intracranial atherosclerosis, and tandem vertebrobasilar occlusion...
June 2023: Neurointervention
Kwang-Chun Cho
Among the various perspectives on cerebrovascular diseases, hemodynamic analysis-which has recently garnered interest-is of great help in understanding cerebrovascular diseases. Computational fluid dynamics (CFD) analysis has been the primary hemodynamic analysis method, and studies on cerebral aneurysms have been actively conducted. However, owing to the intrinsic limitations of the analysis method, the role of wall shear stress (WSS), the most representative parameter, remains controversial. High WSS affects the formation of cerebral aneurysms; however, no consensus has been reached on the role of WSS in the growth and rupture of cerebral aneurysms...
June 2023: Neurointervention
Adam A Dmytriw, Jerry Ku, Sherief Ghozy, Sahibjot Grewal, Nicole M Cancelliere, Ahmed Y Azzam, Robert W Regenhardt, James D Rabinov, Christopher J Stapleton, Krunal Patel, Aman B Patel, Vitor Mendes Pereira, Michael Tymianski
The management of unruptured brain arteriovenous malformations (ubAVMs) is a complex challenge to neurovascular practitioners. This meta-analysis aimed to identify the optimal management of ubAVMs comparing conservative management, embolization, radiosurgery, microsurgical resection, and multimodality. The search strategy was developed a priori according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched the Ovid Medline, Embase, Web of Science, and Cochrane Library databases to identify relevant papers...
June 2023: Neurointervention
Antonio De Mase, Paolo Candelaresi, Emanuele Spina, Flavio Giordano, Stefano Barbato, Giovanna Servillo, Elio Prestipino, Alessandra Fasolino, Gianluigi Guarnieri, Giuseppe Leone, Massimo Muto, Mario Muto, Vincenzo Andreone
Endovascular thrombectomy is the standard treatment in selected patients with acute ischemic stroke and large vessel occlusion, but continuous improvement in angiographic and clinical outcome is still needed. Intra-arterial thrombolysis has been tested as a possible rescue tool in unsuccessful thrombectomy, or as an adjuvant therapy after the endovascular procedure, to pursue complete recanalization. Here we present a case series analysis of intra-arterial alteplase administration (5 mg bolus, repeated up to 15 mg if Thrombolysis in Cerebral Infarction (TICI) scale ≥2c is not achieved) in 15 consecutive anterior circulation stroke patients after unsuccessful thrombectomy, defined as TICI score ≤2b after at least 3 passes or if unsuitable for further endovascular attempts, with the aim of improving recanalization...
April 18, 2023: Neurointervention
Amnuay Kleebayoon, Viroj Wiwanitkit
No abstract text is available yet for this article.
April 11, 2023: Neurointervention
Gregory B Walker, Alick P Wang, Jeremiah Hadwen, Undrakh-Erdene Erdenebold, Razmik Bebedjian, Patrick Sullivan, Marlise P Santos, Chad Chenier, Stephen Karwaski, Katie Caron, Gabriella Varga, Jennifer Lyon, Howard J Lesiuk, Navraj Heran, Manraj Heran, Aiman Quateen, Brian J Drake, Eduardo Portela De Oliveira, Mario Kontolemos, Robert Fahed
We describe a minimally invasive endovascular approach to treat an arteriovenous fistula of the scalp. We performed a direct puncture of the lesion through the patient's scalp for liquid embolic agent injection along with external compression of the superficial temporal artery to perform a "manual pressure-cooker technique." The combination of these minimally invasive techniques resulted in an excellent clinical and radiographic outcome.
March 2023: Neurointervention
Johannes A R Pfaff, Friedrich Weymayr, Monika Killer-Oberpflazer
In Eagle syndrome, elongated styloid processes may provoke internal carotid dissection and pseudoaneurysm causing stroke and data regarding possible complications or long-term results of pseudoaneurysm treatment using a flow diverter are limited. We report a case of a dissection-related pseudoaneurysm in the left cervical carotid artery treated by implantation of a flow diverter. Follow-up imaging of the flow diverter showed fracture of a continuous radiopaque marker at 3 months and fracture of a second continuous radiopaque marker at 7 months, while contrasting of the vessel was preserved...
March 2023: Neurointervention
Elie Diamandis, Vanessa M Swiatek, Daniel Behme
Contrast-induced encephalopathy (CIE) is a rare complication of coronary and neurointerventional procedures. The condition is believed to arise from endothelial damage secondary to exposure to iodinated contrast media. A wide spectrum of clinical manifestations has been reported including seizures, cortical blindness, and focal neurological deficits. This report details the case of fully reversible CIE mimicking severe anterior circulation stroke in a 55-year-old female following elective endovascular treatment with a flow diverter of a carotid cave aneurysm...
March 2023: Neurointervention
Seong Min Cho, Suh Yeon Park, Hyo Sung Kwak, Seung Bae Hwang
PURPOSE: This study aimed to evaluate angiographic and contrast enhancement (CE) patterns on three-dimensional (3D) black blood (BB) contrast-enhanced MRI in patients with acute medulla infarction. MATERIALS AND METHODS: From January 2020 to August 2021, we retrospectively analyzed stroke 3D BB contrast-enhanced magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) findings of patients visiting the emergency room for symptom evaluation of acute medulla infarction...
February 22, 2023: Neurointervention
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