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Thomas J Sorenson, Patrick J Nicholson, Christopher A Hilditch, Mohammad H Murad, Waleed Brinjikji
PURPOSE: The transfemoral approach is widely utilized by neurointerventionalists for accessing the femoral artery in patients undergoing diagnostic and therapeutic endovascular procedures. In patients with more difficult anatomy, duplex ultrasound (DUS) may be a valuable adjunct for femoral vascular access. We aimed to assess the evidence for the effectiveness of DUS-guided femoral access within interventional neuroradiology. METHODS: We searched MEDLINE; Scopus and EMBASE and included five randomized controlled trials...
March 9, 2019: World Neurosurgery
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: The transradial approach for cardiac catheterization is associated with improved patient safety and satisfaction in comparison with the transfemoral approach. Prospective data for the transradial approach for cerebral arteriography are lacking. OBJECTIVE: To carry out a prospective study of consecutive patients undergoing transradial cerebral arteriography at our institution to evaluate the safety, feasibility, and limitations of this approach. METHODS: Consecutive patients referred for diagnostic cerebral arteriography at an institution with minimal transradial experience were enrolled until 50 right transradial diagnostic cerebral arteriograms were obtained...
March 6, 2019: Journal of Neurointerventional Surgery
Megan Barry, Danial K Hallam, Timothy J Bernard, Catherine Amlie-Lefond
BACKGROUND: Like adults, most children have lifelong morbidity after stroke. Revascularization therapies such as intravenous tissue plasminogen activator and mechanical thrombectomy may be options to decrease this morbidity in selected children, although currently there are no evidence-based recommendations to guide treatment. The utility and safety of mechanical thrombectomy in childhood stroke is unknown because of the lack of safety trials, case-controlled trials, and comprehensive retrospective studies...
January 17, 2019: Pediatric Neurology
J M Ospel, G Gascou, V Costalat, L Piergallini, K A Blackham, D W Zumofen
BACKGROUND AND PURPOSE: The Sim&Size software simulates case-specific intraluminal Pipeline Embolization Device behavior, wall apposition, and device length in real-time on the basis of rotational angiography DICOM data. The purpose of this multicenter study was to evaluate whether preimplantation device simulation with the Sim&Size software results in selection of different device dimensions than manual sizing. MATERIALS AND METHODS: In a multicenter cohort of 74 patients undergoing aneurysm treatment with the Pipeline Embolization Device, we compared apparent optimal device dimensions determined by neurointerventionalists with considerable Pipeline Embolization Device experience based on manual 2D measurements taken from rotational angiography with computed optimal dimensions determined by Sim&Size experts blinded to the neurointerventionalists' decision...
February 7, 2019: AJNR. American Journal of Neuroradiology
Jodi R DeGrote, Elizabeth M Olafson, Alexander Drofa, Evgueni Kouznetzov, Michael Manchak, Nathan D Leedahl, David D Leedahl
Background: Dual antiplatelet therapy with acetylsalicylic acid (ASA) and a P2Y12-receptor antagonist is often used to prevent thrombotic complications after placement of a Pipeline embolization device (PED) for cerebral aneurysm. Although clopidogrel is common in this setting, high rates of nonresponse to this drug have made ticagrelor a potentially attractive alternative. Objective: To describe safety and efficacy outcomes for ticagrelor following PED placement, including measurement of platelet function...
November 2018: Canadian Journal of Hospital Pharmacy
S V Setlur Nagesh, V Fennel, J Krebs, C Ionita, J Davies, D R Bednarek, M Mokin, A H Siddiqui, S Rudin
BACKGROUND AND PURPOSE: Quality of visualization of treatment devices during critical stages of endovascular interventions, can directly impact their safety and efficacy. Our aim was to compare the visualization of neurointerventional procedures and treatment devices using a 194-μm pixel flat panel detector mode and a 76-μm pixel complementary metal oxide semiconductor detector mode (high definition) of a new-generation x-ray detector system using a blinded-rater study. MATERIALS AND METHODS: Deployment of flow-diversion devices for the treatment of internal carotid artery aneurysms was performed under flat panel detector and high-definition-mode image guidance in a neurointerventional phantom simulating patient cranium and tissue attenuation, embedded with 3D-printed intracranial vascular models, each with an aneurysm in the ICA segment...
December 27, 2018: AJNR. American Journal of Neuroradiology
Bhavya Rehani, Yi Zhang, Simon Ammanuel, Wade Smith, Ramon G Gonzalez, Daniel L Cooke, Steven W Hetts, S Andrew Josephson, Anthony Kim, J Claude Hemphill, William Dillon
Stroke is one of the leading causes of death and disability worldwide. Standard treatment for stroke is intravenous (IV) injection of tissue plasminogen activator (t-PA) rapidly after symptom onset. However, there are limitations of IV t-PA treatment, such as a short time window for administration and risk for hemorrhage. Recent trials have demonstrated the benefit of endovascular treatment when added to standard treatment to improve outcomes for patients. Advanced imaging was utilized in some trials to identify patients with proximal intracranial occlusion to target for endovascular reperfusion therapy, and to exclude patients with large infarct cores or poor collateral circulation who would not be expected to benefit from intervention...
December 14, 2018: Emergency Radiology
Marielle Ernst, Levente Kriston, Uta Hanning, Andreas M Frölich, Jens Fiehler, Jan Hendrik Buhk
BACKGROUND AND PURPOSE: To evaluate factors influencing the confidence of management recommendation for unruptured intracranial aneurysms (UIAs) and to assess the ability of neurointerventionalists to predict procedure-related neurological complications compared with a 3-point risk score. MATERIALS AND METHODS: Twenty-eight neurointerventionalists were asked to evaluate digital subtraction angiographies examinations of patients with UIAs by determining the best management approach, their level of confidence in their management recommendation, and estimating the risk of procedure-related neurological complications...
December 4, 2018: Journal of Neurointerventional Surgery
Yuan-Hsiung Tsai, Ho-Fai Wong, Shih-Wei Hsu
BACKGROUND AND PURPOSE: Spontaneous delayed migration of the flow-diverter stent (FD) is an unusual complication that can be fatal. The purpose of this study is to report our experience and review the literature for the management of delayed FD migration. MATERIALS AND METHODS: Between November 2013 and June 2017, 122 patients treated by FD at our institution were enrolled. We also performed a comprehensive review of the literature. RESULTS: Six patients (4...
December 1, 2018: Journal of Neuroradiology. Journal de Neuroradiologie
Brian M Snelling, Samir Sur, Sumedh S Shah, Justin Caplan, Priyank Khandelwal, Dileep R Yavagal, Robert M Starke, Eric C Peterson
BACKGROUND: Despite several studies analyzing the safety of transradial access (TRA) for neurointervention compared to transfemoral approach (TFA), neurointerventionalists are apprehensive about implementing TRA. From our positive institutional experience, we now utilize TRA first line for a majority of our cases. Here, we present our single-institution experience. OBJECTIVE: To determine safety and feasibility of TRA for neurointervention. METHODS: Through retrospective review of patients receiving TRA for anterior and posterior circulation cerebrovascular interventions at our institution between December 2015 and January 2018, we present our experience regarding this transition, while focusing on technique, complications, feasibility, indications, and limitations...
November 28, 2018: Operative Neurosurgery (Hagerstown, Md.)
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
William A Mehan, Christopher J Stapleton, Scott B Raymond
PURPOSE: Neck CT angiography (CTA) is frequently performed in conjunction with head CTA in patients presenting with clinical signs and symptoms concerning for acute intracranial hemorrhage, despite relatively low appropriateness (ACR Appropriateness Criteria 2-6). This decision is sometimes justified by suggesting that CTA neck findings are useful in planning subsequent catheter angiography. METHODS: We investigated the value of neck CTA in patients with suspected acute intracranial hemorrhage by reviewing 220 head and neck CTAs performed in our emergency room over a 24-month period for the indication of hemorrhage or headache...
November 5, 2018: Emergency Radiology
Sumedh S Shah, Brian M Snelling, Marie Christine Brunet, Samir Sur, David J McCarthy, Alan Stein, Priyank Khandelwal, Robert M Starke, Eric C Peterson
BACKGROUND: Acute ischemic stroke in pregnancy is a cause of maternal and fetal morbidity. Optimal treatment strategies for stroke in this population are undefined. Thrombolysis is recommended by guidelines should the benefit outweigh uterine bleeding risk. Alternately, data regarding mechanical thrombectomy (MT) is extremely limited. We present a 37-year-old woman in the first trimester that developed recurrent proximal middle cerebral artery (MCA) occlusion after previous thrombolysis and underwent MT via transradial access...
December 2018: World Neurosurgery
Adam Andrew Dmytriw, Thomas Joseph Sorenson, Jonathan M Morris, Patrick J Nicholson, Christopher Alan Hilditch, Christopher S Graffeo, Waleed Brinjikji
OBJECTIVE: Twitter is a popular social media platform among physicians. Neurointerventionalists frequently document their lifesaving mechanical thrombectomy cases on Twitter with very favorable results. We fear that there may be some social media publication bias to tweeted mechanical thrombectomy cases with neurointerventionalists being more likely to tweet cases with favorable outcomes. We used these publicly documented cases to analyze post-intervention Twitter-reported outcomes and compared these outcomes with the data provided in the gold standard literature...
September 15, 2018: Journal of Neurointerventional Surgery
Dominic Dalip, Joe Iwanaga, Marios Loukas, Rod J Oskouian, R Shane Tubbs
The posterior cerebral artery (PCA) is a branch of the terminal part of the basilar artery and perfuses the temporal lobes, midbrain, thalamus, and the posterior inferior portion of the parietal lobes. It is divided into P1-P4 segments. Variations in the P1 segment of the PCA are important to neurosurgeons when performing surgery, for example, on basilar tip aneurysms. We report bilateral superior cerebellar artery (SCA) arising from the P1 segment of the PCA. Such a configuration appears to be uncommon but should be kept in mind by neurosurgeons, neurointerventionalists, and neuroradiologists...
July 5, 2018: Curēus
Kubilay Aydin, Mehmet Barburoglu, Ozgur Oztop Cakmak, Nilufer Yesilot, Ebru Nur Yavuz Vanli, Sergin Akpek
BACKGROUND: Mechanical thrombectomy using a stent retriever has become the standard of care for acute large-vessel occlusions in the anterior circulation. Clots that are refractory to single stent retriever thrombectomy remain a challenge for neurointerventionalists. OBJECTIVE: To assess the efficacy and safety of double stent retriever (crossing Y-Solitaire) thrombectomy as a rescue treatment for acute middle cerebral artery (MCA) occlusions that are refractory to single stent retriever thrombectomy...
September 7, 2018: Journal of Neurointerventional Surgery
Yusuke Egashira, Yukiko Enomoto, Keita Yamauchi, Masanori Tsujimoto, Shinichi Yoshimura, Toru Iwama
Carotid artery stenting (CAS) has been widely accepted as a valuable therapeutic alternative to carotid endarterectomy (CEA) for high-grade carotid stenosis. Because carotid revascularization including CAS is usually performed in patients with minimal or no neurological deficits, utmost care should be taken to avoid periprocedural complications. The major concerns associated with CAS are embolic stroke, hyperperfusion syndrome (HPS), and perioperative myocardial infarction.Plaque characteristics, cerebral blood flow (CBF) in the affected cerebral hemisphere, and concomitant coronary artery disease prior to CAS are all important to assess the risks of these complications and are routinely evaluated...
2018: Acta Neurochirurgica. Supplement
Kyle M Fargen, Joshua A Hirsch
No abstract text is available yet for this article.
September 2018: Journal of Neurointerventional Surgery
Andreia Carvalho, Mariana Rocha, Marta Rodrigues, Tiago Gregório, Henrique Costa, André Cunha, Sérgio Castro, Miguel Veloso, Manuel Ribeiro, Pedro Jorge Gonçalves Barros
BACKGROUND: A 2013 consensus statement recommended the use of the modified Treatment In Cerebral Ischemia (mTICI) scale to evaluate angiographic revascularization after endovascular treatment (EVT) of acute ischemic stroke due to its higher inter-rater agreement and capacity of clinical outcome prediction. The current definition of successful revascularization includes the achievement of grades mTICI 2b or 3. However, mTICI 2b grade encompasses a large heterogeneity of revascularization states, and prior studies suggested that the magnitude of benefit derived from mTICI 2b and mTICI 3 does not seem to be equivalent...
2018: Cerebrovascular Diseases
Fawaz Al-Mufti, Krishna Amuluru, Megan Lander, Melvin Mathew, Mohammad El-Ghanem, Rolla Nuoman, Seami Park, Vikas Patel, Inder Paul Singh, Gaurav Gupta, Chirag D Gandhi
BACKGROUND: The exact mechanism, incidence, and risk factors for cerebral vasospasm after traumatic intracranial hemorrhage (ICH) continue to be poorly characterized. The incidence of post-traumatic vasospasm (PTV) varies depending on the detection modality. OBJECTIVE: We aimed to shed light on the predictors, associations, and true incidence of cerebral vasospasm after traumatic ICH using digital subtraction angiography (DSA) as the gold standard. METHODS: We examined a prospectively maintained database of traumatic brain injury (TBI) patients to identify patients with ICH secondary to TBI enrolled between 2002 and 2015 at our trauma center...
December 2018: World Neurosurgery
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