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Interventional Neurology

Maksim Shapiro, Eytan Raz, Peter Kim Nelson
Background: Variations in aortic arch anatomy have been extensively described from multiple perspectives including gross anatomy, embryology, associated cardiac and other anomalies, early life presentation, and cross-sectional diagnosis. There is however a paucity of literature with an emphasis on safe and timely catheterization, particularly when the variants are found during emergent or other catheter angiographic procedures without benefit of prior cross-sectional vascular imaging...
October 2018: Interventional Neurology
Sunil A Sheth, Konark Malhotra, David S Liebeskind, Conrad W Liang, Albert J Yoo, Reza Jahan, Raul G Nogueira, Vitor Pereira, Jan Gralla, Greg Albers, Mayank Goyal, Jeffrey L Saver
Background and Purpose: The relative contribution of each Alberta Stroke Program Early CT Score (ASPECTS) region to poststroke disability likely varies across regions. Determining the relative weights of each ASPECTS region may improve patient selection for endovascular stroke therapy (EST). Methods: In the combined Solitaire Flow Restoration with the Intention for Thrombectomy (SWIFT), Solitaire Flow Restoration Thrombectomy for Acute Revascularization (STAR), and Solitaire Flow Restoration with the Intention for Thrombectomy as Primary Endovascular Treatment (SWIFT PRIME) databases, we identified patients treated with the Solitaire stent retriever...
October 2018: Interventional Neurology
Nada Elsaid, Ahmed Saied, Krishna Joshi, Jessica Nelson, John Baumgart, Demetrius Lopes
Background and Purpose: Intracranial hemorrhage (ICH) is one of the major adverse events related to the endovascular management of acute ischemic stroke. It is important to evaluate the risk of ICH as it may result in clinical deterioration of the patients. Development of tools which can predict the risk of ICH after thrombectomy can reduce the procedure-related morbidity and mortality. 2D parenchymal blood flow could potentially act as an indicator for ICH. Methods: 2D parenchymal blood flow was used to evaluate pre- and postthrombectomy digital subtraction angiography series of patients with acute ischemic stroke in the anterior circulation...
October 2018: Interventional Neurology
Nuno Martins, Ana Aires, Beatriz Mendez, Sandra Boned, Marta Rubiera, Alejandro Tomasello, Pilar Coscojuela, David Hernandez, Marián Muchada, David Rodríguez-Luna, Noelia Rodríguez, Jesús M Juega, Jorge Pagola, Carlos A Molina, Marc Ribó
Background: Determining the size of infarct extent is crucial to elect patients for reperfusion therapies. Computed tomography perfusion (CTP) based on cerebral blood volume may overestimate infarct core on admission and consequently include ghost infarct core (GIC) in a definitive lesional area. Purpose: Our goal was to confirm and better characterize the GIC phenomenon using CTP cerebral blood flow (CBF) as the reference parameter to determine infarct core. Methods: We performed a retrospective, single-center analysis of consecutive thrombectomies of middle cerebral or intracranial internal carotid artery occlusions considering noncontrast CT Alberta Stroke Program Early CT Score ≥6 in patients with pretreatment CTP...
October 2018: Interventional Neurology
Simone Peschillo, Alejandro Tomasello, Francesco Diana, David Hernandez, Giada Toccaceli, Marta Rosal-Fontana, Marielle Esteves Coelho, Paolo Missori
Objectives: To assess the delayed (15 days) histological and ultrastructural changes occurring following endovascular treatment with a direct aspiration first pass technique (ADAPT) or stent retrievers (SRs) and to compare the findings in order to determine which is the least harmful technique and what changes occur. Materials and Methods: Damage to the wall of swine extracranial arteries was evaluated after ADAPT with the Penumbra system or thrombectomy with various SRs...
October 2018: Interventional Neurology
Hamidreza Saber, Whitfield Lewis, Mahsa Sadeghi, Gary Rajah, Sandra Narayanan
Background: Idiopathic intracranial hypertension (IIH) is characterized by an elevated intracranial pressure without any identifiable causative factor such as an intracranial mass. Dural venous sinus stenosis (DVSS) has been suggested to be associated with IIH. Objective: We performed an updated systematic review and meta-analysis to determine clinical outcomes as well as stent survival and stent-adjacent stenosis rates in patients undergoing DVSS for the management of medically refractory IIH...
October 2018: Interventional Neurology
Krishna Amuluru, Fawaz Al-Mufti, Charles E Romero, Chirag D Gandhi
Background: Although it is well characterized in aneurysmal subarachnoid hemorrhage, vasospasm is exceedingly rare following cerebral arteriovenous malformation (AVM) rupture. Subsequently, this complication is poorly characterized with regard to delayed cerebral ischemia (DCI). We review cases of ruptured AVM to assess the frequency and severity of vasospasm on cerebral angiography, and DCI. Summary: We reviewed our institutional database of acute intracranial hemorrhages between 2005 and 2014...
October 2018: Interventional Neurology
Brenda Johnson, Diane Handler, Victor Urrutia, Anne W Alexandrov
Background: Provision of stroke education to patients is a Centers for Medicare/Medicaid (CMS) requirement. However, little is known about retention of the educational content. Methods: Two pilot studies were conducted: Pilot A delivered CMS-required stroke education during hospitalization in a standardized manner and tested knowledge retention in patients returning to the Stroke Clinic for 1-month follow-up; Pilot B randomized patients to either a control group with standardized education or a test-enhanced learning group (target), with measurement of stroke knowledge retention at hospital discharge...
October 2018: Interventional Neurology
James P Rhudy, Anne W Alexandrov, Joseph Rike, Tomas Bryndziar, Ana Hossein Zadeh Maleki, Victoria Swatzell, Wendy Dusenbury, E Jeffrey Metter, Andrei V Alexandrov
Background: Timely treatment of acute ischemic stroke is crucial to optimize outcomes. Mobile stroke units (MSU) have demonstrated ultrafast treatment compared to standard emergency care. Geospatial analysis of the distribution of MSU cases to optimize service delivery has not been reported. Methods: We aggregated all first-year MSU dispatch occurrences and all cases classified by clinical teams as true stroke by zip code and calculated dispatch and true stroke incidence rates...
October 2018: Interventional Neurology
Dennys Reyes, Victor Becerra, Indiana Alcala, Italo Linfante, Guilherme Dabus
Cone beam computed tomography (CBCT), initially used for evaluation of intraprocedural complications such as hemorrhage, has evolved to provide details of implanted devices such as flow diverters. The study aim is to present our experience in using CBCT with intra-arterial injection and provide a step-by-step approach for postprocessing in a practical protocol for daily use. IRB approval was obtained, and the neurointerventional database was retrospectively reviewed from July 2012 to June 2017. Patients who underwent cone beam intra-arterial CT angiography for evaluation of implanted flow diverter devices were reviewed...
October 2018: Interventional Neurology
Hesham Masoud, Vijaylakshmi Nair, Adekorewale Odulate-Williams, Sameer Sharma, Grahame Gould, Joshua Thatcher, Thanh N Nguyen
Background: The role of general anesthesia in precipitating aneurysm rupture is not clearly defined. In this study, we aimed to assess the natural history of unruptured aneurysms in patients undergoing non-aneurysm-related procedures requiring general anesthesia. Methods: Retrospective review of consecutive patients with untreated intracranial aneurysms that underwent unrelated surgery with operative note documentation of general anesthesia. Events of intraoperative and postoperative subarachnoid hemorrhage were recorded to determine the incidence of rupture...
October 2018: Interventional Neurology
Krishna Amuluru, Fawaz Al-Mufti, Charles E Romero
Background: Acute ischemic stroke due to tandem occlusive lesions of the anterior circulation involves an intracranial large vessel occlusion as well as a concurrent occlusion or high-grade stenosis of the proximal carotid system. The vast majority of proximal lesions in tandem occlusive cases involve the extracranial internal carotid artery, although the lesion can theoretically exist anywhere along the carotid artery pathway, including the common carotid ostium. Summary: To the best of our knowledge, only 1 report describes common carotid artery ostial lesions in the setting of acute ischemic stroke due to tandem occlusions, in which the authors describe an anterograde treatment paradigm...
October 2018: Interventional Neurology
Bharathi D Jagadeesan, Andrew W Grande, Ramachandra P Tummala
Background/Objective: Compliant dual-lumen balloon microcatheters have been used to perform balloon-assisted embolization (BAE) of brain arteriovenous malformations (AVMs) with ethylene vinyl alcohol copolymer (Onyx). However, vessel rupture and microcatheter retention have been reported from BAE using these microcatheters. Using an extra-compliant balloon microcatheter (Scepter XC; Microvention, Tustin, CA, USA) could help avoid pial vessel rupture during BAE. We herein report our experience using this balloon microcatheter for BAE...
October 2018: Interventional Neurology
Andreas Kastrup, Freimuth Brunner, Helmut Hildebrandt, Christian Roth, Michael Winterhalter, Carsten Giessing, Panagiotis Papanagiotou
Background: In patients with large vessel occlusions, endovascular treatment (ET) has been shown to be superior to intravenous thrombolysis (IVT) in recent trials. However, it is currently unclear if patients with mild strokes also benefit from ET. Methods: We compared the discharge rates of good outcome (modified Rankin scale [mRS] ≤2), very good outcome (mRS 0-1), symptomatic intracranial hemorrhages (SICH), and infarct sizes in patients with mild strokes (admission National Institutes of Health Stroke Scale ≤10) and distal intracranial carotid artery, M1, and M2 occlusions during two time periods...
October 2018: Interventional Neurology
Bradley A Gross, Ashutosh P Jadhav, Tudor G Jovin, Brian T Jankowitz
Background: Modern case series often focus on emphasizing low complication rates, "safety," and "efficacy." Although patients may not suffer significant or obviously apparent neurological complications, many lessons are buried in the "no complications" cohort. Methods: The junior author's prospectively maintained caselog was reviewed over a 1-year period for both symptomatic and "minor"/technical complications of neurointerventional cases, the latter referring to an intraprocedural inability to treat a lesion, suboptimal result, or potentially morbid angiographic occurrence/finding that did not result in permanent neurological morbidity - neurointerventional "near morbidity" (NNM)...
October 2018: Interventional Neurology
Diogo C Haussen, Jonathan A Grossberg, Sebastian Koch, Amer Malik, Dileep Yavagal, Benjamin Gory, Wolfgang Leesch, Ameer E Hassan, Anne-Laure Derelle, Sébastien Richard, Clara Barreira, Gustavo Pradilla, Raul G Nogueira
Background: A carotid web (CaW) is a shelf-like lesion in the posterior aspect of the internal carotid bulb and represents an intimal variant of fibromuscular dysplasia. CaW has been associated with recurrent strokes and conventionally treated with surgical excision. We report a multicenter experience of stenting in patients with symptomatic CaWs. Methods: Retrospective review of consecutive patients admitted to 5 comprehensive stroke centers who were identified to have a symptomatic CaW and treated with carotid stenting...
October 2018: Interventional Neurology
Ronen R Leker, Jose E Cohen, David Tanne, David Orion, Gregory Telman, Guy Raphaeli, Jacob Amsalem, Jonathan Y Streifler, Hen Hallevi, Pavel Gavriliuc, Natan M Bornstein, Anat Horev, Nour Eddine Yaghmour
Background and Aims: Patients with emergent large-vessel occlusion (ELVO) that present earlier than 4 h from onset are usually treated with bridging systemic thrombolysis followed by endovascular thrombectomy (EVT). Whether direct EVT (dEVT) could improve the chances of favorable outcome remains unknown. Methods: Consecutively, prospectively enrolled patients with ELVO presenting within 4 h of onset were entered into a National Acute Stroke Registry of patients undergoing revascularization...
October 2018: Interventional Neurology
Mohamad Ezzeldin, Eslam W Youssef, Vibhav Bansal, Ali Sultan Qurraie, Osama Zaidat
No abstract text is available yet for this article.
October 2018: Interventional Neurology
Mehdi Bouslama, Leticia C Rebello, Diogo C Haussen, Jonathan A Grossberg, Aaron M Anderson, Samir R Belagaje, Nicolas A Bianchi, Michael R Frankel, Raul G Nogueira
Background and Purpose: Ethnic disparities in stroke are well described, with a higher incidence of disability and increased mortality in Blacks versus Whites. We sought to compare the clinical outcomes between those ethnic groups after stroke endovascular therapy (ET). Methods: We performed a retrospective review of the prospectively acquired Grady Endovascular Stroke Outcomes Registry between September 1, 2010 and September 30, 2015. Patients were dichotomized into two groups - Caucasians and African-Americans - and matched for age, pretreatment glucose level, and baseline National Institutes of Health Stroke Scale (NIHSS) score...
October 2018: Interventional Neurology
Qasim Bashir, Ammad Anwar Baig
Background: To assess the safety and clinical efficacy of carotid artery stenting with and without an embolic protection device (EPD) in both symptomatic and asymptomatic carotid disease cases. Methods: Retrospective data of 55 symptomatic (≥50% occlusion by digital subtraction angiography [DSA], ≥70% by ultrasound, computed tomography angiography [CTA], and magnetic resonance angiography [MRA]) and asymptomatic (≥60% by DSA, ≥70% by ultrasound, ≥80% by CTA and MRA) carotid disease cases undergoing carotid stenting/angioplasty revascularization from February 2014 to October 2017 was reviewed...
October 2018: Interventional Neurology
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