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Journal of Neurointerventional Surgery

Fiona M Weafer, Sharon Duffy, Ines Machado, Gillian Gunning, Pasquale Mordasini, Ellen Roche, Peter E McHugh, Michael Gilvarry
BACKGROUND: Although it is common practice to wait for an 'embedding time' during mechanical thrombectomy (MT) to allow strut integration of a stentriever device into an occluding thromboembolic clot, there is a scarcity of evidence demonstrating the value or optimal timing for the wide range of thrombus compositions. This work characterizes the behavior of clot analogs of varying fibrin and cellular compositions subject to indentation forces and embedding times representative of those imparted by a stentriever during MT...
January 19, 2019: Journal of Neurointerventional Surgery
Krishnan Ravindran, Dylan Kurda, Julian Maingard, Kevin Phan, Hong Kuan Kok, Vincent Thijs, Joshua A Hirsch, Michael J Lee, Ronil V Chandra, Duncan Mark Brooks, Hamed Asadi
BACKGROUND AND PURPOSE: Endovascular thrombectomy (EVT) has revolutionized the management of acute ischemic stroke. Landmark clinical trials have shown EVT to be one of the most efficacious interventions in clinical medicine over the past 5 years. A method of recognition for an article in the scientific community is to use a citation rank list, in order to identify the seminal works in the academic medical literature. The objective of this study was to characterize the 100 most highly cited articles assessing endovascular management of acute ischemic stroke...
January 17, 2019: Journal of Neurointerventional Surgery
Robert Crossley, Thomas Liebig, Markus Holtmannspoetter, Johan Lindkvist, Pat Henn, Lars Lonn, Anthony Gerald Gallagher
INTRODUCTION: Mechanical thrombectomy (MT) has transformed the treatment of ischemic stroke. However, patient access to MT may be limited due to a shortage of doctors specifically trained to perform MT. The studies reported here were done to (1) develop, operationally define, and seek consensus from procedure experts on the metrics which best characterize a reference procedure for the performance of an MT for ischemic stroke and (2) evaluate their construct validity when implemented in a virtual reality (VR) simulation...
January 17, 2019: Journal of Neurointerventional Surgery
Hyun Ho Choi, Young Dae Cho, Dong Hyun Yoo, Su Hwan Lee, Eung Koo Yeon, Hyun-Seung Kang, Won-Sang Cho, Jeong Eun Kim, Moon Hee Han
BACKGROUND: Recanalization rates after coil embolization are known to be higher in cerebral aneurysms of the posterior (vs anterior) circulation. Although often grouped with anterior lesions, aneurysms of the posterior communicating artery (PcoA) may nevertheless behave differently. OBJECTIVE: We performed a comparative analysis to explore differences in recanalization rates of PcoA and anterior communicating artery (AcoA) aneurysms, both integral to the circle of Willis...
January 17, 2019: Journal of Neurointerventional Surgery
Cristian Mihalea, Jildaz Caroff, Igor Pagiola, Leon Ikka, Gelareh Bani Hashemi, Soheil Naderi, Vanessa Chalumeau, Horia Ples, Bogdan Valeriu Popa, Thomas Yasuda, Joaquin Jose Marenco de la Torre, Marta Iacobucci, Augustin Ozanne, Sophie Gallas, Aymeric Rouchaud, Pr Sorin Pescariu, Pr Jacques Moret, Pr Laurent Spelle
BACKROUND: The treatment of wide neck bifurcation aneurysms remains challenging despite the introduction of new techniques (Y stenting, waffle cone technique, or flow diverter stents). The Woven EndoBridge (WEB) device is an innovative solution for this type of cerebral aneurysm. A new WEB 17 is now available and has been designed to offer smaller sized devices to optimize navigability and delivery. METHODS: Between February 2017 and April 2018 all patients treated with the WEB 17 device in our center were retrospectively reviewed...
January 17, 2019: Journal of Neurointerventional Surgery
Carl B Heilman, Gregory W Basil, Brandon M Beneduce, Adel M Malek
BACKGROUND AND PURPOSE: We evaluated the inferior petrosal sinus (IPS) and adjacent cerebellopontine angle (CPA) cistern as a potential implantation site for a novel venous endovascular transdural CSF shunt concept to treat communicating hydrocephalus. We analyzed the dimensions of the IPS, CPA cistern, and distances to adjacent neurovascular structures. MATERIALS AND METHODS: Gadolinium enhanced T1 weighted brain MRI datasets of 36 randomly selected patients, aged 20-80 years, were analyzed with three-dimensional multiplanar reconstruction to measure IPS diameter and length, CPA cistern depth, and IPS proximity to the vertebrobasilar arteries and brainstem...
January 9, 2019: Journal of Neurointerventional Surgery
Nitin Goyal, Georgios Tsivgoulis, Konark Malhotra, Aristeidis H Katsanos, Abhi Pandhi, Khalid A Alsherbini, Jason J Chang, Daniel Hoit, Andrei V Alexandrov, Lucas Elijovich, David Fiorella, Christopher Nickele, Adam S Arthur
BACKGROUND: We conducted a case-control study to assess the relative safety and efficacy of minimally invasive endoscopic surgery (MIS) for clot evacuation in patients with basal-ganglia intracerebral hemorrhage (ICH). METHODS: We evaluated consecutive patients with acute basal-ganglia ICH at a single center over a 42-month period. Patients received either best medical management according to established guidelines (controls) or MIS (cases). The following outcomes were compared before and after propensity-score matching (PSM): in-hospital mortality; discharge National Institutes of Health Stroke Scale score; discharge disposition; and modified Rankin Scale scores at discharge and at 3 months...
January 7, 2019: Journal of Neurointerventional Surgery
Minerva H Zhou, Akash P Kansagra
BACKGROUND: To compare performance of routing paradigms for patients with acute ischemic stroke using clinical outcomes. METHODS: We simulated different routing paradigms in a system comprising one primary stroke center (PSC) and one comprehensive stroke center (CSC), separated by distances representative of urban, suburban, and rural environments. In the nearest center paradigm, patients are initially sent to the nearest center, while in CSC first, patients are sent to the CSC...
January 4, 2019: Journal of Neurointerventional Surgery
Toshiya Osanai, Yasuhiro Ito, Satoshi Ushikoshi, Takeshi Aoki, Masahito Kawabori, Kensuke Fujiwara, Katsuhiko Ogasawara, Kikutaro Tokairin, Katsuhiko Maruichi, Naoki Nakayama, Ken Kazumata, Kota Ono, Kiyohiro Houkin
BACKGROUND: Outcomes of endovascular treatment for acute ischemic stroke depend on the time interval from onset to reperfusion. Although the centralized 'mothership' method is considered preferable, the required transportation time increases the risk that a patient with a stroke may not receive intravenous or endovascular therapy. In contrast, 'drive and retrieve' describes a system wherein doctors from comprehensive stroke centers travel to primary stroke centers and provide endovascular treatment for acute ischemic stroke...
January 4, 2019: Journal of Neurointerventional Surgery
Wei-Jian Jiang, Ao-Fei Liu, Wengui Yu, Han-Cheng Qiu, Yi-Qun Zhang, Fang Liu, Chen Li, Rong Wang, Yuan-Li Zhao, Jin Lv, Tian-Xiao Li, Ce Liu, Ji Zhou, Ji-Zong Zhao
BACKGROUND: An in situ recanalization procedure of endovascular therapy (ET) or carotid endarterectomy (CEA) has been attempted in patients with symptomatic chronic internal carotid artery occlusions (ICAOs), though the recanalization rates of both are low. OBJECTIVE: To investigate the outcomes of Multimodality In situ Recanalization for ICAOs in a Hybrid Operating Room (MIRHOR) at the same session. METHODS: Symptomatic chronic ICAOs were classified into type A or B (short occlusion with or without a tapered residual root [TRR]), and C or D (long occlusion with or without TRR), and managed in a hybrid operating room with ET, CEA, or both, as needed...
January 4, 2019: Journal of Neurointerventional Surgery
Manuel F Granja, Gustavo M Cortez, Pedro Aguilar-Salinas, Guilherme Jose Agnoletto, Gregory Imbarrato, Alejandra Jaume, Amin Aghaebrahim, Eric Sauvageau, Ricardo A Hanel
BACKGROUND: Bifurcation aneurysms can be treated with stent-assisted coiling using two stents in a Y-configuration. We aim to investigate the angiographic and clinical outcomes of Y-stent constructs for the treatment of intracranial aneurysms. METHODS: A systematic review of PubMed, Ovid MEDLINE, and Ovid EMBASE databases was conducted based on PRISMA guidelines. The study selection was performed using the 'Ryyan' application. Our analysis included 18 studies with 327 patients...
January 4, 2019: Journal of Neurointerventional Surgery
Maxim Mokin, Sameer A Ansari, Ryan A McTaggart, Ketan R Bulsara, Mayank Goyal, Michael Chen, Justin F Fraser
No abstract text is available yet for this article.
January 4, 2019: Journal of Neurointerventional Surgery
Lorenzo Rinaldo, Harry J Cloft, Leonardo Rangel Castilla, Alejandro A Rabinstein, Waleed Brinjikji
OBJECTIVE: Relatively little is known about the effect of malignancy on patient outcomes after acute ischemic stroke (AIS) or utilization rates of stroke interventions in this population. We aimed to assess the effect of underlying malignancy on outcomes and treatment of AIS at a population level. METHODS: Outcomes after AIS between patients with and without malignancy were compared using a national database of hospital reported outcomes. RESULTS: There were 351 institutions reporting the outcomes of 3 18 127 admissions for AIS...
January 2, 2019: Journal of Neurointerventional Surgery
Christina Iosif, Adson Freitas de Lucena, Luiz Gustavo Abreu-Mattos, Victor Hugo Espindola Ala, Amin El-Ghanam, Suzana Saleme, Francois Caire, Charbel Mounayer
BACKGROUND: The treatment of low grade Spetzler-Martin (SM) brain arteriovenous malformations (AVMs) has been debated in unruptured cases. Nevertheless, in clinical practice there are cases where treatment is preferred; in these cases a very low complication rate is mandatory. In ruptured cases, early and complete obliteration of the nidus is the preferred strategy. OBJECTIVE: To achieve curative embolization, ideally in a single session, by dual microcatheterization techniques with arterial and/or venous access, according to the angioarchitecture...
January 2, 2019: Journal of Neurointerventional Surgery
Jan-Karl Burkhardt, Maksim Shapiro, Omar Tanweer, Miguel Litao, Breehan Chancellor, Eytan Raz, Howard A Riina, Peter Kim Nelson
Anatomical vessel obstacles such as an intracranial stenosis in stroke are challenging and may lead to delayed clot access for thrombectomy. We describe a simple and effective technique to overcome the step-off between the intermediate catheter and an intracranial vessel stenosis during thrombectomy. The patient presented with acute embolic left middle cerebral artery occlusion and a favorable penumbral pattern. Clot access was made challenging by focal stenosis in the ipsilateral cavernous segment. The balloon-assisted tracking technique was effective in traversing the step-off to enable TICI 3 aspiration thrombectomy...
December 22, 2018: Journal of Neurointerventional Surgery
David Carrera, Montse Gorchs, Marisol Querol, Sònia Abilleira, Marc Ribó, Mònica Millán, Anna Ramos, Pedro Cardona, Xabier Urra, Ana Rodríguez-Campello, Luis Prats-Sánchez, Francisco Purroy, Joaquín Serena, David Cánovas, Josep Zaragoza-Brunet, Jerzy A Krupinski, Xavier Ustrell, Júlia Saura, Sonia García, Maria Àngela Mora, Xavier Jiménez, Antoni Dávalos, Natalia Pérez de la Ossa
BACKGROUND AND PURPOSE: Our aim was to revalidate the RACE scale, a prehospital tool that aims to identify patients with large vessel occlusion (LVO), after its region-wide implementation in Catalonia, and to analyze geographical differences in access to endovascular treatment (EVT). METHODS: We used data from the prospective CICAT registry (Stroke Code Catalan registry) that includes all stroke code activations. The RACE score evaluated by emergency medical services, time metrics, final diagnosis, presence of LVO, and type of revascularization treatment were registered...
December 22, 2018: Journal of Neurointerventional Surgery
Raoul Pop, Luc Mertz, Annamaria Ilyes, Dan Mihoc, Johann Sebastian Richter, Monica Manisor, Stéphane Kremer, Rémy Beaujeux
BACKGROUND: Initial clinical experience with Squid shows subjectively reduced artifacts on post-embolization CT scans compared with Onyx. To further investigate these observations, we aimed to perform a comparison of artifacts between Squid and Onyx in a controlled in vitro model. MATERIALS AND METHODS: Onyx 18 and all four variants of Squid (Squid 18, Squid 18 low density (LD), Squid 12, Squid 12 LD) were each injected in dimethylsulfoxide (DMSO) compatible test tubes...
December 19, 2018: Journal of Neurointerventional Surgery
Alessandro Cianfoni, Daniela Distefano, Maurizio Isalberti, Michael Reinert, Pietro Scarone, Dominique Kuhlen, Joshua A Hirsch, Giuseppe Bonaldi
OBJECTIVES: To describe a new technique to obtain minimally invasive but efficient vertebral body (VB) reconstruction, augmentation, and stabilization in severe osteoporotic and neoplastic fractures, combining two pre-existing procedures. The implant of vertebral body stents (VBS) is followed by insertion of percutaneous, fenestrated, cement-augmented pedicular screws that act as anchors to the posterior elements for the cement/stent complex. The screws reduce the risk of stent mobilization in a non-intact VB cortical shell and bridge middle column and pedicular fractures...
December 14, 2018: Journal of Neurointerventional Surgery
Pedro Aguilar-Salinas, Guilherme Jose Agnoletto, Leonardo B C Brasiliense, Roberta Santos, Manuel F Granja, Douglas Gonsales, Amin Aghaebrahim, Eric Sauvageau, Ricardo A Hanel
BACKGROUND: Treatment of acute cerebrovascular pathology, such as acute ischemic stroke or intracranial aneurysms, presents a challenge if an extracranial or intracranial stent is required; immediate platelet inhibition is vital. To date, there is no standardized approach for antiplatelet inhibition in an acute setting. OBJECTIVE: To report our preliminary experience and lessons learnt using cangrelor in acute neurointervention. METHODS: A single-arm pilot study was performed to assess the safety and efficacy of cangrelor plus aspirin for platelet inhibition in patients who require acute stenting in the setting of neuroendovascular treatment...
December 14, 2018: Journal of Neurointerventional Surgery
Nathan W Manning, Andrew Cheung, Timothy J Phillips, Jason D Wenderoth
BACKGROUND: The Pipeline Embolisation Device with Shield technology (PED-Shield) is suggested to have reduced thrombogenicity. This reduced thrombogenicity may make it possible to use safely in the acute treatment of aneurysmal subarachnoid haemorrhage (aSAH) on single antiplatelet therapy (SAPT). OBJECTIVE: To evaluate the safety and efficacy of the off-label use of PED-Shield with SAPT for the acute treatment of aSAH. METHODS: Patients who underwent acute treatment of ruptured intracranial aneurysms with the PED-Shield with SAPT were retrospectively identified from prospectively maintained databases at three Australian neurointerventional centres...
December 14, 2018: Journal of Neurointerventional Surgery
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