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Neurointerventionalist

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https://www.readbyqxmd.com/read/30552527/imaging-in-neurointerventional-stroke-treatment-review-of-the-recent-trials-and-what-your-neurointerventionalist-wants-to-know-from-emergency-radiologists
#1
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
https://www.readbyqxmd.com/read/30514734/confidence-of-treatment-decision-and-perceived-risk-of-procedure-related-neurological-complications-in-the-management-of-unruptured-intracranial-aneurysms
#2
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
https://www.readbyqxmd.com/read/30513289/endovascular-management-of-spontaneous-delayed-migration-of-the-flow-diverter-stent
#3
Yuan-Hsiung Tsai, Shih-Wei Hsu, Ho-Fai Wong
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
https://www.readbyqxmd.com/read/30496537/transradial-approach-for-complex-anterior-and-posterior-circulation-interventions-technical-nuances-and-feasibility-of-using-current-devices
#4
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.)
https://www.readbyqxmd.com/read/30410528/isolated-intraventricular-hemorrhage-associated-with-cerebral-vasospasm-and-delayed-cerebral-ischemia-following-arteriovenous-malformation-rupture
#5
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
https://www.readbyqxmd.com/read/30397815/does-including-neck-cta-in-work-up-of-suspected-intracranial-hemorrhage-add-value
#6
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
https://www.readbyqxmd.com/read/30261390/transradial-mechanical-thrombectomy-for-proximal-middle-cerebral-artery-occlusion-in-a-first-trimester-pregnancy-case-report-and-literature-review
#7
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
https://www.readbyqxmd.com/read/30219792/-fake-news-a-systematic-review-of-mechanical-thrombectomy-results-among-neurointerventional-stroke-surgeons-on-twitter
#8
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
https://www.readbyqxmd.com/read/30197853/superior-cerebellar-arteries-originating-from-the-posterior-cerebral-arteries-but-normal-course-of-the-oculomotor-nerves
#9
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
https://www.readbyqxmd.com/read/30194110/crossing-y-solitaire-thrombectomy-as-a-rescue-treatment-for-refractory-acute-occlusions-of-the-middle-cerebral-artery
#10
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
https://www.readbyqxmd.com/read/30171321/tailored-strategies-in-carotid-artery-stenting-to-avoid-periprocedural-complications
#11
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
https://www.readbyqxmd.com/read/30127070/neurointerventionalists-stroke-and-burnout
#12
Kyle M Fargen, Joshua A Hirsch
No abstract text is available yet for this article.
September 2018: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/30064126/time-to-reset-the-definition-of-successful-revascularization-in-endovascular-treatment-of-acute-ischemic-stroke
#13
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
https://www.readbyqxmd.com/read/30055364/low-glasgow-coma-score-in-traumatic-intracranial-hemorrhage-predicts-development-of-cerebral-vasospasm
#14
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
https://www.readbyqxmd.com/read/30038063/understanding-the-impact-of-cost-under-macra-a-neurointerventional-imperative
#15
REVIEW
Gabriela Spilberg, Gregory N Nicola, Andrew B Rosenkrantz, Ezequiel Silva Iii, Clemens M Schirmer, Brian B Ghoshhajra, Nirmal Choradia, Rose Do, Joshua A Hirsch
The cost of providing healthcare in the United States continues to rise. The Affordable Care Act created systems to test value-based alternative payments models. Traditionally, procedure-based specialists such as neurointerventionalists have largely functioned in, and are thus familiar with, the traditional Fee for Service system. Administrative charge data would suggest that neurointerventional surgery is an expensive specialty. The Medicare Access and CHIP Reauthorization Act consolidated pre-existing federal performance programs in the Merit-based Incentive Payments System (MIPS), including a performance category called 'cost'...
October 2018: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29760013/severity-of-cerebral-vasospasm-associated-with-development-of-collaterals-following-aneurysmal-subarachnoid-hemorrhage
#16
Fawaz Al-Mufti, Jens Witsch, Nathan Manning, Michael Crimmins, Krishna Amuluru, Sachin Agarwal, Soojin Park, Joshua Z Willey, Hooman Kamel, E Sander Connolly, Philip M Meyers, Jan Claassen
INTRODUCTION: Cerebral collateral circulation has been studied extensively in ischemic stroke where it has been shown to be a predictor of reperfusion, final infarct size, and outcome. Little is known about the significance of the collaterals in the setting of aneurysmal subarachnoid hemorrhage (aSAH). We sought to evaluate the effect of cerebral vasospasm on the development of cerebral collaterals following aneurysmal subarachnoid hemorrhage and the effects of the latter on delayed cerebral ischemia (DCI)...
July 2018: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29563208/development-of-an-intracranial-dural-arteriovenous-fistula-after-venous-sinus-stenting-for-idiopathic-intracranial-hypertension
#17
Thomas J Buell, Daniel M Raper, Dale Ding, Ching-Jen Chen, Kenneth C Liu
We report a case in which an intracranial dural arteriovenous fistula (DAVF) developed after endovascular treatment of a patient with idiopathic intracranial hypertension with venous sinus stenting (VSS). The pathogenesis may involve hemodynamic alterations secondary to increased poststenting venous sinus pressure, which may cause new arterial ingrowth into the fistulous sinus wall without capillary interposition. Despite administration of dual antiplatelet therapy, there may also be subclinical cortical vein thrombosis that contributed to DAVF formation...
July 2018: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29533711/clinical-results-of-a-new-concept-of-neurothrombectomy-coverage-at-a-remote-hospital-drive-the-doctor
#18
Fatih Seker, Markus A Möhlenbruch, Simon Nagel, Christian Ulfert, Silvia Schönenberger, Johannes Pfaff, Peter A Ringleb, Thorsten Steiner, Martin Bendszus, Christian Herweh
Background Many tertiary care hospitals cannot provide a continuous thrombectomy service due to the lack of a neurointerventionalist. Aims In this study, we present procedural and clinical results of a new concept in which neuroradiologists of a university hospital provide neurointerventional stroke service to a remote hospital ("drive the doctor"). Methods All consecutive patients with acute ischemic stroke due to large vessel occlusion of the anterior circulation treated with mechanical thrombectomy after hours at a remote hospital (distance of about 100 km) between 2012 and 2016 were analyzed retrospectively...
October 2018: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/29449282/a-patient-dose-reduction-technique-for-neuroendovascular-image-guided-interventions-image-quality-comparison-study
#19
A Sonig, S V Setlur Nagesh, V S Fennell, S Gandhi, L Rangel-Castilla, C N Ionita, K V Snyder, L N Hopkins, D R Bednarek, S Rudin, A H Siddiqui, E I Levy
BACKGROUND AND PURPOSE: The ROI-dose-reduced intervention technique represents an extension of ROI fluoroscopy combining x-ray entrance skin dose reduction with spatially different recursive temporal filtering to reduce excessive image noise in the dose-reduced periphery in real-time. The aim of our study was to compare the image quality of simulated neurointerventions with regular and reduced radiation doses using a standard flat panel detector system. MATERIALS AND METHODS: Ten 3D-printed intracranial aneurysm models were generated on the basis of a single patient vasculature derived from intracranial DSA and CTA...
April 2018: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/29436505/-drip-and-drive-shipping-the-neurointerventionalist-to-provide-mechanical-thrombectomy-in-primary-stroke-centers
#20
Caspar Brekenfeld, Einar Goebell, Holger Schmidt, Henning Henningsen, Christoffer Kraemer, Jörg Tebben, Fabian Flottmann, Götz Thomalla, Jens Fiehler
BACKGROUND: To satisfy the increasing demand of mechanical thrombectomy (MT) for acute ischemic stroke treatment, new organizational concepts for patient care are required. This study evaluates time intervals of acute stroke management in two stroke care models, including one based on transportation of the interventionalist from a comprehensive stroke center (CSC) to treat patients in two primary stroke centers (PSC). We hypothesized that time intervals were not inferior for the 'drip-and-drive' concept compared with the traditional 'drip-and-ship' concept...
February 7, 2018: Journal of Neurointerventional Surgery
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