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Journal of Neurointerventional Surgery

Dylan N Wolman, Michael Iv, Max Wintermark, Gregory Zaharchuk, Michael P Marks, Huy M Do, Robert L Dodd, Gregory W Albers, Maarten G Lansberg, Jeremy J Heit
BACKGROUND AND PURPOSE: Acute ischemic stroke (AIS) patients who benefit from endovascular treatment have a large vessel occlusion (LVO), small core infarction, and salvageable brain. We determined if diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) alone can correctly identify and localize anterior circulation LVO and accurately triage patients to endovascular thrombectomy (ET). MATERIALS AND METHODS: This retrospective cohort study included patients undergoing MRI for the evaluation of AIS symptoms...
March 19, 2018: Journal of Neurointerventional Surgery
Dominik F Vollherbst, Ruth Otto, Thuy D Do, Andreas von Deimling, Hans U Kauczor, Martin Bendszus, Christof M Sommer, Markus A Möhlenbruch
BACKGROUND: The embolization technique can have significant impact on the success of endovascular embolization. OBJECTIVE: To evaluate the feasibility, embolization characteristics, and embolization extent with a newly developed extra-small micro-balloon catheter in an in vivo and in an in vitro embolization model in comparison with standard microcatheter embolizations. MATERIALS AND METHODS: Twenty-eight embolization procedures were performed in the porcine rete mirabile (RM) and in an in vitro embolization model, using either an extra-small (distal outer diameter 1...
March 19, 2018: Journal of Neurointerventional Surgery
Andreas Kastrup, Freimuth Brunner, Helmut Hildebrandt, Christian Roth, Michael Winterhalter, Panagiotis Papanagiotou
BACKGROUND AND PURPOSE: In patients with large vessel occlusions, endovascular treatment (ET) has been shown to be superior to intravenous thrombolysis (IVT) in recent trials. However, the effectiveness of ET in elderly patients is uncertain. METHODS: Using our stroke database, we compared the rates of good outcome (modified Rankin scale (mRS) ≤2), excellent outcome (mRS 0-1), poor outcome (mRS 5-6) at discharge, in-hospital death, infarct size, and symptomatic intracranial hemorrhage (SICH) in patients aged ≥80 years with distal intracranial carotid artery, M1 and M2 occlusions during two time periods...
March 16, 2018: Journal of Neurointerventional Surgery
Waleed Brinjikji, Bongjae Chung, Ding Yong-Hong, John T Wald, Fernando Mut, Ramanathan Kadirvel, David F Kallmes, Aymeric Rouchaud, Giuseppe Lanzino, Juan R Cebral
BACKGROUND AND PURPOSE: Vertebrobasilar dolichoectatic and fusiform aneurysms (VBDAs) are known to have a poor natural history, with high rates of growth, rupture, and stroke. The purpose of this study was to identify hemodynamic characteristics that differ between VBDAs associated with growth, rupture, and stroke. MATERIALS AND METHODS: VBDAs with CT angiography or MR angiography followed longitudinally without treatment were studied. Unstable aneurysms were defined as those that grew or ruptured during follow-up...
March 16, 2018: Journal of Neurointerventional Surgery
Mitchell P Wilson, Mohammad H Murad, Timo Krings, Vitor M Pereira, Cian O'Kelly, Jeremy Rempel, Christopher A Hilditch, Waleed Brinjikji
BACKGROUND: Optimal technical approaches of large-vessel anterior circulation acute ischemic strokes with concomitant extracranial internal carotid artery tandem occlusions is controversial. PURPOSE: This systematic review and meta-analysis evaluates: the overall outcomes of patients with tandem occlusions treated with second-generation mechanical thrombectomy devices; differences in outcomes of extracranial versus intracranial first approaches; and differences in outcomes of extracranial stenting at time of procedure versus angioplasty alone...
March 9, 2018: Journal of Neurointerventional Surgery
Jildaz Caroff, Takamitsu Tamura, Robert M King, Pedro N Lylyk, Erin T Langan, Olivia W Brooks, Frédéric Clarençon, John Michael Wainwright, Laurent Spelle, Miklos Marosfoi, Matthew J Gounis, Ajit S Puri
BACKGROUND: Optical coherence tomography (OCT) is a high-resolution, intra-vascular diagnostic technique widely used for the characterization of vascular pathologies and optimization of stent implantation during percutaneous coronary intervention. OCT was used to investigate the in vivo vascular response to a new phosphorylcholine surface modified flow diverter (sPED). METHODS: In an in vivo rabbit aneurysmal model, we used two different types of flow diverters (classic Pipeline - cPED; and sPED) with or without dual antiplatelet therapy (four groups, n=10 per group)...
March 6, 2018: Journal of Neurointerventional Surgery
Marc-Antoine Labeyrie, Vittorio Civelli, Peggy Reiner, Armand Aymard, Jean-Pierre Saint-Maurice, Akli Zetchi, Emmanuel Houdart
OBJECTIVE: To identify the prevalence and therapeutic consequences of spontaneous intracranial artery dissection (IAD) at the acute phase of ischemic stroke. METHODS: We reviewed clinical and imaging data of consecutive patients attending our center for mechanical thrombectomy (MT) between January 2012 and November 2017. IAD was defined according to published criteria and our own angiographic criteria (no clot following MT, and normalization of the vessel caliber after stenting)...
March 6, 2018: Journal of Neurointerventional Surgery
Tomonori Iwata, Takahisa Mori, Yuhei Tanno, Shigen Kasakura, Kazuhiro Yoshioka
BACKGROUND: Cerebral hyperperfusion syndrome (CHS) is likely to occur after carotid revascularization in patients with stage 2 hemodynamic failure (st2HF), in whom the oxygen extraction fraction (OEF) increases. OBJECTIVE: The purpose of our study was to investigate whether measurement of the global cerebral OEF (gcOEF) by blood sampling can be used to estimate st2HF and anticipate CHS following carotid artery stenting (CAS). METHODS: The OEF was calculated by blood sampling just before and after elective CAS...
March 6, 2018: Journal of Neurointerventional Surgery
Christopher P Kellner, Eric Sauvageau, Kenneth V Snyder, Kyle M Fargen, Adam S Arthur, Raymond D Turner, Andrei V Alexandrov
INTRODUCTION: Effective triage of patients with emergent large vessel occlusion (ELVO) to endovascular therapy capable centers may decrease time to treatment and improve outcome for these patients. Here we performed a derivation study to evaluate the accuracy of a portable, non-invasive, and easy to use severe stroke detector. METHODS: The volumetric impedance phase shift spectroscopy (VIPS) device was used to assign a bioimpedance asymmetry score to 248 subjects across three cohorts, including 41 subjects presenting as acute stroke codes at a major comprehensive stroke center (CSC), 79 healthy volunteers, and 128 patients presenting to CSCs with a wide variety of brain pathology including additional stroke codes...
March 6, 2018: Journal of Neurointerventional Surgery
David F Kallmes, Kevin Kallmes, Mayank Goyal, Joshua A Hirsch, Alejandro A Rabinsteinr, Waleed Brinjikji, Colin Derdeyn
No abstract text is available yet for this article.
February 27, 2018: Journal of Neurointerventional Surgery
Michael T Froehler, Rohan Chitale, Jordan A Magarik, Matthew R Fusco
PURPOSE: The efficiency of neuroendovascular procedures may partly depend on the time devoted to placement of a radial arterial line (RAL) for intraoperative blood pressure monitoring. An alternative approach is to use a pressure-sensing sheath (PSS) that serves to provide invasive blood pressure monitoring without requiring a separate procedure for placement. We compared the use of a RAL versus PSS and assessed procedure time, anesthetist and patient satisfaction, and cost. METHODS: We performed a single-center, prospective, blockwise, comparative trial of procedure start time using traditional RAL placement versus the EndoPhys PSS for invasive blood pressure monitoring...
February 27, 2018: Journal of Neurointerventional Surgery
Maxim Mokin, Angel Chinea, Christopher T Primiani, Zeguang Ren, Peter Kan, Visish M Srinivasan, Ricardo Hanel, Pedro Aguilar-Salinas, Aquilla S Turk, Raymond D Turner, M Imran Chaudry, Andrew J Ringer, Babu G Welch, Vitor Mendes Pereira, Leonardo Renieri, Mariangela Piano, Lucas Elijovich, Adam S Arthur, Ahmed Cheema, Demetrius Klee Lopes, Ahmed Saied, Blaise W Baxter, Harris Hawk, Ajit S Puri, Ajay K Wakhloo, Hussain Shallwani, Elad I Levy, Adnan H Siddiqui, Guilherme Dabus, Italo Linfante
BACKGROUND: Blood blister aneurysms (BBA) are a rare subset of intracranial aneurysms that represent a therapeutic challenge from both a surgical and endovascular perspective. OBJECTIVE: To report multicenter experience with flow diversion exclusively for BBA, located at non-branching segments along the anteromedial wall of the supraclinoidal internal carotid artery (ICA). METHODS: Consecutive cases of BBA located at non-branching segments along the anteromedial wall of the supraclinoidal ICA treated with flow diversion were included in the final analysis...
February 24, 2018: Journal of Neurointerventional Surgery
Ali Alawieh, M Imran Chaudry, Raymond D Turner, Aquilla S Turk, Alejandro M Spiotta
Infectious intracranial aneurysms (IIAs) are a rare cerebrovascular complication of systemic infections induced by microbial infiltration and degradation of the arterial vessel wall. Studies on the epidemiology and management of IIAs are limited to case reports and retrospective single-center studies, and report a large variability in epidemiological features, management, and outcomes due to the limited sample size. We conducted a systematic review of all published papers on IIAs in the English literature using MEDLINE and SCOPUS database from January 1950 to June 2017...
February 20, 2018: Journal of Neurointerventional Surgery
Aquilla S Turk, Adnan H Siddiqui, J Mocco
BACKGROUND AND OBJECTIVE: Acute ischemic stroke is a potentially devastating condition and leading cause of morbidity and mortality, affecting an estimated 800 000 people per year in the USA. The natural history of untreated or unrevascularized large vessel occlusions in acute stroke patients results in mortality rates approaching 30%, with only 25% achieving good neurologic outcomes at 90 days. Recently, data have demonstrated that early endovascular recanalization of large vessel occlusions results in better outcomes than medical therapy alone...
February 20, 2018: Journal of Neurointerventional Surgery
Krishna Amuluru, Fawaz Al-Mufti, Charles Romero
Isolated intraventricular hemorrhage due to dural arteriovenous fistula (dAVF) is extremely rare and has been reported only a few times in the literature. The pathophysiological cause of isolated intraventricular hemorrhage in these cases was hypothetically attributed to retrograde venous flow into subependymal vessels, although none of these cases demonstrated radiographic evidence of such reflux. We present the first case of a dAVF with radiographic evidence of severe cortical venous reflux into the subependymal venous network causing isolated intraventricular hemorrhage, thus lending proof for the underlying pathophysiology...
February 19, 2018: Journal of Neurointerventional Surgery
Ronan Motyer, John Thornton, Sarah Power, Paul Brennan, Alan O'Hare, Seamus Looby, David J Williams, Barry Moynihan, Sean Murphy
BACKGROUND: Selected patients with proximal anterior circulation ischemic stroke who demonstrate limited infarct and sufficient penumbra may benefit from endovascular thrombectomy (EVT) beyond conventional time limits. OBJECTIVE: To perform a retrospective review of all cases of EVT performed at our institution for proximal anterior circulation acute ischemic stroke with onset >12 hours. MATERIALS AND METHODS: Patients were assessed with non-contrast CT brain and multiphase CT angiography, with Alberta Stroke Program Early CT Score (ASPECTS) and collateral grade informing patient selection...
February 19, 2018: Journal of Neurointerventional Surgery
Yen-Heng Lin, Chung-Wei Lee, Yu-Fen Wang, Chi-Ju Lu, Ya-Fang Chen, Hon-Man Liu
BACKGROUND AND PURPOSE: Engorged medullary vein (EMV) in patients with intracranial dural arteriovenous fistula (DAVF) suggests venous congestion. The aim of this study is to investigate its prevalence, pattern, and correlation with clinical findings. MATERIALS AND METHODS: CT angiography (CTA) raw data of DAVF were used for multiplanar reconstruction and then analyzed for the presence and pattern of EMV, which is defined as a dilated vein in the cerebral white matter...
February 19, 2018: Journal of Neurointerventional Surgery
Justin Bauer, Kartik Kansagra, Kuo H Chao, Lei Feng
Cavernous sinus thrombosis (CST) is a rare condition that can cause death, neurologic disability, and visual loss. A pre-teen with septic CST leading to ocular hypertension and acute visual loss was treated at our institution with thrombectomy and thrombolysis of the cavernous sinuses and superior ophthalmic veins. Successful recanalization of the bilateral cavernous sinuses and superior ophthalmic veins was achieved in two separate procedures without complication. The patient showed immediate symptomatic relief...
February 17, 2018: Journal of Neurointerventional Surgery
Olivier Clerk-Lamalice, Zubin Irani, Marion Growney, Douglas P Beall, Joshua A Hirsch
A 71-year-old man who had a L1/S1 posterior fusion revision surgery complained of increasing back pain 5 weeks after the open surgical procedure. The pain was initially estimated at 9/10 on the visual analog scale (VAS) and thought to be related to a right-sided L2 screw loosening. A right parapedicular vertebroplasty was performed and polymethylmethacrylate cement was instilled around the right pedicle screw, filling the anterior two-thirds of the vertebral body. On postvertebroplasty day 1, the patient had significant improvement in his low back pain...
February 14, 2018: Journal of Neurointerventional Surgery
Pınar Beyaz, Nadia Khan, Gerasimos Baltsavias
Here we report, for the first time, a combination of five-vessel aortic arch, anomalous origin of the right vertebral artery (VA) from the common carotid artery (CCA), an aberrant right subclavian artery (SCA), and bilateral symmetrical segmental agenesis of VAs.In this case report, we present a patient with moyamoya syndrome (MMS) and Down syndrome (DS) who has bilateral symmetrical segmental agenesis of VAs, left VA originating from aortic arch and anomalous origin of right VA arising from CCA in combination with an aberrant right SCA...
February 14, 2018: Journal of Neurointerventional Surgery
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