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Interventional Neurology

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https://www.readbyqxmd.com/read/29765398/epidemiology-of-intracranial-hemorrhage-associated-with-oral-anticoagulants-in-spain-trends-in-anticoagulation-complications-registry-the-tac-2-study
#1
Gustavo Zapata-Wainberg, Sonia Quintas, Álvaro Ximénez-Carrillo Rico, Jaime Masjuán Vallejo, Pere Cardona, Mar Castellanos Rodrigo, Lorena Benavente Fernández, Andrés García Pastor, José Egido, José Maciñeiras, Joaquín Serena, María Del Mar Freijo Guerrero, Francisco Moniche, José Vivancos
Objective: Patients receiving treatment with oral anticoagulants (OACs) are at risk of intracranial hemorrhage (ICH). In this study, we describe the epidemiological and clinical characteristics of patients receiving OACs who experience ICH and compare those receiving vitamin K antagonists (ICH-VKAs) with those receiving direct OACs (ICH-DOACs). Methods: We performed a national, multicenter, descriptive, observational, retrospective study of all adult patients receiving OACs who were admitted to the neurology department with ICH over a 1-year period...
April 2018: Interventional Neurology
https://www.readbyqxmd.com/read/29765397/lvis-jr-device-for-y-stent-assisted-coil-embolization-of-wide-neck-intracranial-aneurysms-a-multicenter-experience
#2
Edgar A Samaniego, Aldo A Mendez, Thanh N Nguyen, Vladimir Kalousek, Waldo R Guerrero, Sudeepta Dandapat, Guilherme Dabus, Italo Linfante, Ameer E Hassan, Alexander Drofa, Evgueni Kouznetsov, David Leedahl, David Hasan, Alberto Maud, Santiago Ortega-Gutierrez
Background and Purpose: Complex wide-neck intracranial aneurysms are challenging to treat. We report a multicenter experience using the LVIS Jr stent for "Y-stent"-assisted coiling embolization of wide-neck bifurcation aneurysms. Methods: Seven centers provided retrospective data on patients who underwent Y-stenting. Technical complications, immediate posttreatment angiographic results, clinical outcomes, and imaging follow-up were assessed. Results: Thirty patients/aneurysms were treated: 15 basilar tip, 8 middle cerebral artery, 4 anterior communicating artery, 1 pericallosal, and 2 posterior inferior cerebellar artery aneurysms...
April 2018: Interventional Neurology
https://www.readbyqxmd.com/read/29765396/acute-in-stent-thrombosis-after-carotid-angioplasty-and-stenting-a-case-report-and-literature-review
#3
Wei Hu, Li Wang, GuoPing Wang
Background: Based on the results of a recent randomized controlled trial, carotid artery stenting (CAS) was regarded as a relatively safe, less invasive treatment of internal carotid artery stenosis. However, cerebral thromboembolic events are the most common complications of CAS. Especially acute stent thrombosis following CAS will be fatal without prompt diagnosis and revascularization. Case Report: We report a case of acute stent thrombosis in whom carotid revascularization was performed successfully via arterial thrombolysis and balloon postdilation...
April 2018: Interventional Neurology
https://www.readbyqxmd.com/read/29765395/progressive-neurological-decline-with-deep-bilateral-imaging-changes-a-protean-presentation-of-dural-arteriovenous-fistulae
#4
Rene A Colorado, Marcelo Matiello, Hyun-Sik Yang, James D Rabinov, Aman Patel, Joshua A Hirsch, Ram Chavali, Thabele M Leslie-Mazwi
Intracranial dural arteriovenous fistulae (DAVF) within the deep cerebral vasculature are diagnostically challenging because of their variable clinical presentation and typical bilateral neuroimaging findings mimicking inflammatory, infectious, and metabolic processes. Increasingly, reports have emerged highlighting the diagnostic and treatment challenges of these lesions and their associated high morbidity and rapid clinical deterioration when untreated. We describe here a case series of 4 patients with deep cerebral DAVF who presented with impaired arousal or memory and behavioral changes...
April 2018: Interventional Neurology
https://www.readbyqxmd.com/read/29765394/mechanical-thrombectomy-in-elderly-stroke-patients-with-mild-to-moderate-baseline-disability
#5
Diana E Slawski, Hisham Salahuddin, Julie Shawver, Cynthia L Kenmuir, Gretchen E Tietjen, Andrea Korsnack, Syed F Zaidi, Mouhammad A Jumaa
Background: The number of elderly patients suffering from ischemic stroke is rising. Randomized trials of mechanical thrombectomy (MT) generally exclude patients over the age of 80 years with baseline disability. The aim of this study was to understand the efficacy and safety of MT in elderly patients, many of whom may have baseline impairment. Methods: Between January 2015 and April 2017, 96 patients ≥80 years old who underwent MT for stroke were selected for a chart review...
April 2018: Interventional Neurology
https://www.readbyqxmd.com/read/29765393/support-of-new-triage-protocol-among-acute-stroke-care-providers
#6
Haitham M Hussein, David C Anderson
Objective: We conducted an online survey to gauge the acceptance of sending acute stroke patients with suspected large vessel occlusion (LVO) directly to an endovascular-capable hospital (ECH) even if that means bypassing a closer alteplase-capable hospital (ACH) without endovascular capability. Methods: The survey was composed of two cases of acute stroke, one with cortical symptoms suggestive of LVO and the other without. In each case, responders were asked to choose between triaging to a closer ACH or an ECH that is further away and to provide an opinion regarding the maximum extra travel time they would tolerate if they chose the ECH...
April 2018: Interventional Neurology
https://www.readbyqxmd.com/read/29765392/carotid-stenting-for-treatment-of-symptomatic-carotid-webs-a-single-center-case-series
#7
Waleed Brinjikji, Ronit Agid, Vitor M Pereira
Background and Purpose: Carotid webs are an increasingly recognized cause of acute is-chemic stroke, particularly in younger adults. The optimal medical and surgical strategies for managing these lesions have not been well established. We report a single-center case series of carotid stenting for treatment of symptomatic carotid webs. Materials and Methods: Consecutive patients undergoing stent placement for treatment of symptomatic carotid webs were included. Carotid webs were defined as a thin intraluminal filling defect along the posterior wall of the carotid bulb just beyond the carotid bifurcation on CTA...
April 2018: Interventional Neurology
https://www.readbyqxmd.com/read/29765391/abciximab-reopro-dosing-strategy-for-the-management-of-acute-intraprocedural-thromboembolic-complications-during-pipeline-flow-diversion-treatment-of-intracranial-aneurysms
#8
Li-Mei Lin, Bowen Jiang, Jessica K Campos, Narlin B Beaty, Matthew T Bender, Rafael J Tamargo, Judy Huang, Geoffrey P Colby, Alexander L Coon
Background: Flow diversion with the Pipeline embolization device (PED) is an effective neuro-endovascular method and increasingly accepted for the treatment of cerebral aneurysms. Acute in situ thrombosis is a known complication of PED procedures. There is limited experience in the flow diversion literature on the use of abciximab (ReoPro) for the management of acute thrombus formation in PED cases. Methods: Data were collected retrospectively on patients who received intra-arterial (IA) ReoPro with or without subsequent intravenous (IV) infusion during PED flow diversion treatment of intracranial aneurysms...
April 2018: Interventional Neurology
https://www.readbyqxmd.com/read/29765390/preclinical-evaluation-of-the-nevatm-stent-retriever-safety-and-efficacy-in-the-swine-thrombectomy-model
#9
Arthur J Ulm, Tigran Khachatryan, Arthur Grigorian, Raul G Nogueira
Background: A novel stent retriever device with an enhanced radial force profile, enlarged offset openings, and a closed distal end has been developed. Objective: Evaluate the safety and effectiveness of the NeVaTM thrombectomy device in animal model of thrombo-occlusive disease. Materials and Methods: Seven swine were used in safety and efficacy studies. Thrombo-occlusive disease was modeled using 4 emboli morphologies; 2 distinct models of autologous whole blood thrombi, plasma-enriched thrombi, and Onyx® emboli...
April 2018: Interventional Neurology
https://www.readbyqxmd.com/read/29719558/pomona-large-vessel-occlusion-screening-tool-for-prehospital-and-emergency-room-settings
#10
Kessarin Panichpisal, Kenneth Nugent, Maharaj Singh, Richard Rovin, Reji Babygirija, Yogesh Moradiya, Karen Tse-Chang, Kimberly A Jones, Katrina J Woolfolk, Debbie Keasler, Bhupat Desai, Parinda Sakdanaraseth, Paphavee Sakdanaraseth, Alimohammad Moalem, Nazli Janjua
Background: Early identification of patients with acute ischemic strokes due to large vessel occlusions (LVO) is critical. We propose a simple risk score model to predict LVO. Method: The proposed scale (Pomona Scale) ranges from 0 to 3 and includes 3 items: gaze deviation, expressive aphasia, and neglect. We reviewed a cohort of all acute stroke activation patients between February 2014 and January 2016. The predictive performance of the Pomona Scale was determined and compared with several National Institutes of Health Stroke Scale (NIHSS) cutoffs (≥4, ≥6, ≥8, and ≥10), the Los Angeles Motor Scale (LAMS), the Cincinnati Prehospital Stroke Severity (CPSS) scale, the Vision Aphasia and Neglect Scale (VAN), and the Prehospital Acute Stroke Severity Scale (PASS)...
April 2018: Interventional Neurology
https://www.readbyqxmd.com/read/29719557/stent-reconstruction-of-carotid-tonsillar-loop-dissection-using-telescoping-peripheral-stents
#11
Benjamin M Zussman, Bradley A Gross, William J Ares, Cynthia L Kenmuir, Gregory M Weiner, David M Panczykowski, Ashutosh P Jadhav, Tudor G Jovin, Brian T Jankowitz
Background: Endovascular treatment options for internal carotid artery (ICA) dissection with tandem intracranial occlusion are evolving. We report 2 cases of stent reconstruction of carotid loop dissections. Methods: Two patients with symptomatic ICA dissections of true 360° tonsillar loops and tandem intracranial occlusions were treated with manual aspiration thrombectomy (MAT) and telescoping Zilver self-expanding peripheral stents. Patient demographics, clinical presentations, endovascular techniques, and clinical outcomes were reviewed...
April 2018: Interventional Neurology
https://www.readbyqxmd.com/read/29719556/association-of-blood-glucose-and-clinical-outcome-after-mechanical-thrombectomy-for-acute-ischemic-stroke
#12
Weston R Gordon, Russell M Salamo, Anit Behera, John Chibnall, Amer Alshekhlee, Richard C Callison, Randall C Edgell
Background: Elevated blood glucose levels following acute ischemic stroke have been associated with adverse clinical outcomes in thrombolytic and nonthrombolytic treated patients. The current study examined multiple blood glucose parameters and their association with modified Rankin Scale (mRS) score at 3 months following mechanical thrombectomy and hospital discharge. Methods: Acute ischemic stroke patients undergoing mechanical thrombectomy with a retrievable stent at two stroke centers were studied...
April 2018: Interventional Neurology
https://www.readbyqxmd.com/read/29719555/a-review-of-pre-intervention-prognostic-scores-for-early-prognostication-and-patient-selection-in-endovascular-management-of-large-vessel-occlusion-stroke
#13
REVIEW
Syed Ali Raza, Srikant Rangaraju
Background: Endovascular therapy (ET) has emerged as a highly effective treatment for acute large vessel occlusion stroke (LVOS). Tools that facilitate optimal patient selection of patients for ET are needed in order to maximize therapeutic benefit in a cost-effective manner. Several pre-intervention prognostic scores for prediction of outcomes in LVOS patients and patient selection for ET have been developed and validated, but their clinical use has been limited. Here, we review existing pre-intervention prognostic scores, compare their prognostic accuracies and levels of validation and identify gaps in current knowledge...
April 2018: Interventional Neurology
https://www.readbyqxmd.com/read/29719554/pipeline-flex-embolization-of-flow-related-aneurysms-associated-with-arteriovenous-malformations-a-case-report
#14
Narlin B Beaty, Jessica K Campos, Geoffrey P Colby, Li-Mei Lin, Matthew T Bender, Risheng Xu, Alexander L Coon
Background: An estimated 0.1% of the population harbors brain arteriovenous malformations (AVMs). Diagnosis and workup of AVMs include thorough evaluation for characterization of AVM angioarchitecture and careful assessment for concomitant aneurysms. The presence of coexisting aneurysms is associated with an increased risk of intracranial hemorrhage, with a published risk of 7% per year compared to patients with AVMs alone with a risk of 3%. Comprehensive AVM management requires recognition of concomitant aneurysms and prioritizes treatment strategies to mitigate the aggregate risk of intracranial hemorrhage associated with AVM rupture in patients with coexisting aneurysms...
April 2018: Interventional Neurology
https://www.readbyqxmd.com/read/29719553/47-consecutive-cases-of-pipeline-flex-flow-diversion-utilizing-a-novel-large-bore-intracranial-intermediate-catheter-nuances-and-institutional-experience-with-the-syphontrak
#15
Li-Mei Lin, Bowen Jiang, Matthew T Bender, Erick M Westbroek, Jessica K Campos, Rafael J Tamargo, Judy Huang, Alexander L Coon, Geoffrey P Colby
Background: The increasing complexity of modern neurointerventions has necessitated a shift in intracranial access techniques towards more robust distal support platforms. Here we present our experience with the Syphontrak Support Catheter (Codman Neuro, Raynham, MA, USA) in the triaxial platform for the implantation of the second-generation Pipeline Flex embolization device (PED Flex; Medtronic Neurovascular, Irvine, CA, USA). Methods: We retrospectively identified patients who underwent PED Flex treatment utilizing the Syphontrak at a single institution...
April 2018: Interventional Neurology
https://www.readbyqxmd.com/read/29719552/direct-aspiration-catheter-fracture-and-retrieval-during-neurothrombectomy
#16
Pouria Moshayedi, Ashutosh P Jadhav
Background: Application of direct aspiration catheters has revolutionized acute stroke care and has led to significant improvement in clinical outcome with a good safety profile. Catheter fracture and retention is a rare but potentially devastating complication. Case Description: Here we present two cases of acute stroke complicated by aspiration catheter fracture and retention. Successful catheter retrieval and revascularization was achieved in both cases. The stenosis or tortuosity of vascular anatomy appears to be the probable contributor to catheter breakage by anchoring the catheter with resultant fracture at the constraint point from catheter withdrawal tensile stress...
April 2018: Interventional Neurology
https://www.readbyqxmd.com/read/29719551/importance-of-reperfusion-status-after-intra-arterial-thrombectomy-for-prediction-of-outcome-in-anterior-circulation-large-vessel-stroke
#17
Luuk Dekker, Victor J Geraedts, Hajo Hund, Suzanne C Cannegieter, Raul G Nogueira, Mayank Goyal, Ido R van den Wijngaard
Background: Reperfusion status after intra-arterial thrombectomy (IAT) is a critical predictor of functional outcome after acute ischemic stroke. However, most prognostic models have not included a detailed assessment of reperfusion status after IAT. Objective: The aim of this work was to assess the association between successful reperfusion and clinical outcome. Methods: Clinical, radiological, and procedural variables of patients treated with IAT were extracted from our prospective stroke registry...
April 2018: Interventional Neurology
https://www.readbyqxmd.com/read/29628951/clinical-and-radiographic-predictors-of-intracerebral-hemorrhage-outcome
#18
REVIEW
Fawaz Al-Mufti, Ahmad M Thabet, Tarundeep Singh, Mohammad El-Ghanem, Krishna Amuluru, Chirag D Gandhi
Background: Intracerebral hemorrhage (ICH) represents 10-15% of all stroke cases in the US annually. Fewer than 40% of these patients ever reach long-term functional independence, and mortality rate is roughly 40% at 1 month. Due to the high morbidity and mortality rates after ICH, early detection of high-risk patients would be beneficial in directing the management course and goals of care. This review aims to discuss relevant clinical and radiographic characteristics that can serve as predictors of poor prognosis and examine their efficacy in predicting patient outcomes after ICH...
February 2018: Interventional Neurology
https://www.readbyqxmd.com/read/29628950/safety-assessment-of-endovascular-treatment-of-cerebral-aneurysms-in-patients-with-fibromuscular-dysplasia
#19
Matthew T Bender, Christopher Hurtado, Bowen Jiang, Jessica K Campos, Judy Huang, Rafael J Tamargo, Li-Mei Lin, Alexander L Coon, Geoffrey P Colby
Background: The prevalence of cerebral aneurysms is increased in fibromuscular dysplasia (FMD). The presence of FMD may serve as discouragement to elective endovascular aneurysm treatment. Outcomes of endovascular intervention for aneurysms through vessels affected by FMD have not been reported. Methods: A prospectively maintained database of patients undergoing intracranial embolization was reviewed for patients with FMD who underwent endovascular aneurysm treatment...
February 2018: Interventional Neurology
https://www.readbyqxmd.com/read/29628949/safety-of-diagnostic-cerebral-and-spinal-digital-subtraction-angiography-in-a-developing-country-a-single-center-experience
#20
Qasim Bashir, Asim Ishfaq, Ammad Anwar Baig
Background: Digital subtraction angiography (DSA) remains the gold standard imaging modality for cerebrovascular disorders. In contrast to developed countries, the safety of the procedure is not extensively reported from the developing countries. Herein, we present a retrospective analysis of the basic technique, indications, and outcomes in 286 patients undergoing diagnostic cerebral and spinal angiography in a developing country, Pakistan. Methods: A retrospective review of patient demographics, procedural technique and complication rates of 286 consecutive patients undergoing the diagnostic cerebral/spinal angiography procedure at one institution from May 2013 to December 2015 was performed...
February 2018: Interventional Neurology
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