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Sumedh S Shah, Brian M Snelling, Marie Christine Brunet, Samir Sur, David 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 female in the first trimester that developed recurrent proximal middle cerebral artery (MCA) occlusion after previous thrombolysis and underwent MT via transradial access...
September 24, 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...
July 25, 2018: World Neurosurgery
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
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
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
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
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
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
Wan-Wan Xu, Ying-Ying Zhang, Juan Su, Ao-Fei Liu, Kai Wang, Chen Li, Yun-E Liu, Yi-Qun Zhang, Jin Lv, Wei-Jian Jiang
Ischemia-reperfusion injury (IRI) is an important cause of adverse prognosis after recanalization in patients with acute occlusion of major intracranial artery (AOMIA). Here, we provided data indicating that gradual flow restoration (GFR) would be superior to rapid flow restoration (RFR) in alleviating cerebral IRIs in middle cerebral artery occlusion (MCAO) rats. A total of 94 MCAO rats with 15, 30 and 60-minute occlusion were randomly assigned to receive either GFR or RFR intervention. There were significant differences between GFR and RFR group in mean neurological severity score (1...
January 26, 2018: Scientific Reports
Benjamin Friedrich, Christian Maegerlein, Donald Lobsien, Sebastian Mönch, Maria Berndt, Dennis Hedderich, Silke Wunderlich, Dominik Michalski, Manuel Lehm, Tobias Boeckh-Behrens, Claus Zimmer, Kornelia Kreiser
INTRODUCTION: Endovascular stroke therapy is mostly available in comprehensive stroke centers with state of the art bi-plane angiography suites. The aim of the present study was to analyze if it is justifiable to treat patients with alternative x‑ray machines in the case of capacity constraints, or if it is mandatory to refer patients in such cases. Secondly, we wanted to draw conclusions for the feasibility of different logistic approaches in stroke treatment, such as a "helistroke" concept...
January 2, 2018: Clinical Neuroradiology
Fabio Settecase, David B McCoy, Robert Darflinger, Matthew D Alexander, Daniel L Cooke, Christopher F Dowd, Steven W Hetts, Randall T Higashida, Van V Halbach, Matthew R Amans
Purpose Earlier reperfusion of large-vessel occlusion (LVO) stroke improves functional outcomes. We hypothesize that use of a stroke cart in the angiography suite, containing all commonly used procedural equipment in a mechanical thrombectomy, combined with parallel staff workflows, and use of conscious sedation when possible, improve mechanical thrombectomy time metrics. Methods We identified 47 consecutive LVO patients who underwent mechanical thrombectomy at our center, retrospectively and prospectively from implementation of these three workflow changes (19 pre- and 28 post-)...
April 2018: Interventional Neuroradiology
Michael George Zaki Ghali, Visish M Srinivasan, Jacob Cherian, Louis Kim, Adnan Siddiqui, M Ali Aziz-Sultan, Michael Froehler, Ajay Wakhloo, Eric Sauvageau, Ansaar Rai, Stephen R Chen, Jeremiah Johnson, Sandi K Lam, Peter Kan
BACKGROUND: Pediatric intracranial aneurysms (IAs) are rare. Compared with adult IAs, they are more commonly giant, fusiform, or dissecting. Treatment often proves more complex, and recurrence rate and de novo aneurysmogenesis incidence are higher. A consensus regarding the most appropriate algorithm for following pediatric IAs is lacking. METHODS: We sought to generate recommendations based on the reported experience in the literature with pediatric IAs through a thorough review of the PubMed database, discussion with experienced neurointerventionalists, and our own experience...
January 2018: World Neurosurgery
Scott L Zuckerman, Nikita Lakomkin, Jordan A Magarik, Jan Vargas, Marcus Stephens, Babatunde Akinpelu, Alejandro M Spiotta, Azam Ahmed, Adam S Arthur, David Fiorella, Ricardo Hanel, Joshua A Hirsch, Ferdinand K Hui, Robert F James, David F Kallmes, Philip M Meyers, David B Niemann, Peter Rasmussen, Raymond D Turner, Babu G Welch, J Mocco
BACKGROUND: The angiographic evaluation of previously coiled aneurysms can be difficult yet remains critical for determining re-treatment. OBJECTIVE: The main objective of this study was to determine the inter-rater reliability for both the Raymond Scale and per cent embolization among a group of neurointerventionalists evaluating previously embolized aneurysms. METHODS: A panel of 15 neurointerventionalists examined 92 distinct cases of immediate post-coil embolization and 1 year post-embolization angiographs...
May 2018: Journal of Neurointerventional Surgery
Alexander G Chartrain, Christopher P Kellner, Jacob R Morey, Thomas J Oxley, Hazem Shoirah, J Mocco, Johanna Fifi, Reade A De Leacy
BACKGROUND: As neurointerventionalists aim to treat occlusions in the ever more distal vasculature, off-label catheters (OLCs) have been adapted for aspiration thrombectomy. This may not be without its attendant risks. Recently issued, a letter from the FDA cautioned providers against using OLCs as substitutes for FDA-cleared aspiration thrombectomy catheters, especially in the distal vasculature. In light of this, we evaluated the efficacy and safety of OLCs used for aspiration thrombectomy in the distal vasculature at our institution...
November 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
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