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Neurointerventionalist

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https://www.readbyqxmd.com/read/30064126/time-to-reset-the-definition-of-successful-revascularization-in-endovascular-treatment-of-acute-ischemic-stroke
#1
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...
July 31, 2018: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/30055364/low-glasgow-coma-score-in-traumatic-intracranial-hemorrhage-predicts-development-of-cerebral-vasospasm
#2
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 following traumatic intracranial hemorrhage (ICH) continues 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 following 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
https://www.readbyqxmd.com/read/30038063/understanding-the-impact-of-cost-under-macra-a-neurointerventional-imperative
#3
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'...
July 23, 2018: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29760013/severity-of-cerebral-vasospasm-associated-with-development-of-collaterals-following-aneurysmal-subarachnoid-hemorrhage
#4
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
#5
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
#6
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...
January 1, 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
#7
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
#8
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
https://www.readbyqxmd.com/read/29374244/ischemia-reperfusion-injury-after-gradual-versus-rapid-flow-restoration-for-middle-cerebral-artery-occlusion-rats
#9
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
https://www.readbyqxmd.com/read/29297102/endovascular-stroke-treatment-on-single-plane-vs-bi-plane-angiography-suites-technical-considerations-and-evaluation-of-treatment-success
#10
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
https://www.readbyqxmd.com/read/29145742/improving-mechanical-thrombectomy-time-metrics-in-the-angiography-suite-stroke-cart-parallel-workflows-and-conscious-sedation
#11
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
https://www.readbyqxmd.com/read/28986225/pediatric-intracranial-aneurysms-considerations-and-recommendations-for-follow-up-imaging
#12
REVIEW
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
https://www.readbyqxmd.com/read/28918386/evaluation-of-previously-embolized-intracranial-aneurysms-inter-and-intra-rater-reliability-among-neurosurgeons-and-interventional-neuroradiologists
#13
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
https://www.readbyqxmd.com/read/28864410/aspiration-thrombectomy-with-off-label-distal-access-catheters-in-the-distal-intracranial-vasculature
#14
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
https://www.readbyqxmd.com/read/28862546/angioarchitecture-of-arteriovenous-fistulas-at-the-craniocervical-junction-a-multicenter-cohort-study-of-54-patients
#15
Masafumi Hiramatsu, Kenji Sugiu, Tomoya Ishiguro, Hiro Kiyosue, Kenichi Sato, Keisuke Takai, Yasunari Niimi, Yuji Matsumaru
OBJECTIVE The aim of this retrospective multicenter cohort study was to assess the details of the angioarchitecture of arteriovenous fistulas (AVFs) at the craniocervical junction (CCJ) and to determine the associations between the angiographic characteristics and the clinical presentations and outcomes. METHODS The authors analyzed angiographic and clinical data for patients with CCJ AVFs from 20 participating centers that are members of the Japanese Society for Neuroendovascular Therapy (JSNET). Angiographic findings (feeding artery, location of AV shunt, draining vein) and patient data (age, sex, presentation, treatment modality, outcome) were tabulated and stratified based on the angiographic types of the lesions, as diagnosed by a member of the CCJ AVF study group, which consisted of a panel of 6 neurointerventionalists and 1 spine neurosurgeon...
June 2018: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28752216/improving-mtici2b-reperfusion-to-mtici2c-3-reperfusions-a-retrospective-observational-study-assessing-technical-feasibility-safety-and-clinical-efficacy
#16
Johannes Kaesmacher, Christian Maegerlein, Felix Zibold, Silke Wunderlich, Claus Zimmer, Benjamin Friedrich
BACKGROUND: Recent studies suggested that modified Thrombolysis in Cerebral Infarction grade (mTICI) 3 reperfusions are associated with superior outcome to mTICI2b reperfusions, questioning if neurointerventionalists should generally strive to achieve mTICI3. METHODS: Retrospective analysis of successfully reperfused MCA occlusions (n=246) with available angiography runs between every manoeuvre was performed. Final reperfusion success and those between all single manoeuvres were evaluated applying the modified version of the TICI score (including TICI2c)...
January 2018: European Radiology
https://www.readbyqxmd.com/read/28565987/prolapse-of-the-pipeline-embolization-device-in-aneurysms-incidence-management-and-outcomes
#17
MULTICENTER STUDY
Visish M Srinivasan, Andrew P Carlson, Maxim Mokin, Jacob Cherian, Stephen R Chen, Ajit Puri, Peter Kan
OBJECTIVE The Pipeline embolization device (PED) is frequently used in the treatment of anterior circulation aneurysms, especially around the carotid siphon, with generally excellent results. However, the PED has its own unique technical challenges, including the occurrence of device foreshortening or migration leading to prolapse into the aneurysm. The authors sought to determine the incidence of this phenomenon, the rescue strategies, and outcomes. METHODS Four institutional databases of neuroendovascular procedures were reviewed for cases of intracranial aneurysms treated with PEDs...
June 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28517702/su-e-t-415-dosimetric-measurements-of-an-n-butyl-cyanoacrylate-embolization-material-for-arteriovenous-malformations
#18
Z E Labby, D A Roberts, N Chaudhary, J J Gemmete, A S Pandey
PURPOSE: The therapeutic regimen for cranial arteriovenous malformations (AVMs) often involves both stereotactic radiosurgery and adjunct endovascular embolization. Embolization agents often contain radiopaque contrast to assist the neurointerventionalists, leading to concerns regarding the dosimetric effects of these contrast agents. This study investigated dosimetric properties of n-butyl cyanoacrylate (n-BCA) plus lipiodol (NPL) with and without tantalum powder. METHODS: The NPL was provided cured from the manufacturer (Codman Trufill; Codman & Shurtleff, Inc...
June 2013: Medical Physics
https://www.readbyqxmd.com/read/28495947/mechanical-thrombectomy-with-the-embolus-retriever-with-interlinked-cages-in-acute-ischemic-stroke-eric-the-new-boy-in-the-class
#19
H Steglich-Arnholm, D Kondziella, A Wagner, M E Cronqvist, K Hansen, T C Truelsen, L-H Krarup, J L S Højgaard, S Taudorf, H K Iversen, D W Krieger, M Holtmannspötter
BACKGROUND AND PURPOSE: The Embolus Retriever with Interlinked Cages (ERIC) device is a novel stent retriever for mechanical thrombectomy. It consists of interlinked cages and could improve procedural benchmarks and clinical outcome compared with classic stent retrievers. This study compares the rates of recanalization, favorable clinical outcome, procedural adverse events, and benchmarks between the ERIC device and classic stent retrievers. MATERIALS AND METHODS: From 545 patients treated with thrombectomy between 2012 and 2015, 316 patients were included...
July 2017: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/28465406/helistroke-neurointerventionalist-helicopter-transport-for-interventional-stroke-treatment-proof-of-concept-and-rationale
#20
Ferdinand K Hui, Amgad El Mekabaty, Jacky Schultz, Kelvin Hong, Karen Horton, Victor Urrutia, Imama Naqvi, Shawn Brast, John K Lynch, Zurab Nadareishvili
BACKGROUND AND PURPOSE: It is increasingly recognized that time is one of the key determinants in acute stroke outcome when interventional stroke therapy is applied. With increasing device efficacy and understanding of imaging triage options, reducing pre-treatment time loss may be a critical component of improving interventional stroke outcomes for the population at large. Time sensitive procedures such as organ harvest have transported physicians to the patient site to improve time to procedure...
March 2018: Journal of Neurointerventional Surgery
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