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https://www.readbyqxmd.com/read/28646445/update-on-neurocritical-care-of-stroke
#1
Jason Siegel, Michael A Pizzi, J Brent Peel, David Alejos, Nnenne Mbabuike, Benjamin L Brown, David Hodge, W David Freeman
PURPOSE OF REVIEW: This review will highlight the recent advancements in acute ischemic stroke diagnosis and treatment, with special attention to new features and recommendations of stroke care in the neurocritical care unit. RECENT FINDINGS: New studies suggest that pre-hospital treatment of stroke with mobile stroke units and telestroke technology may lead to earlier stroke therapy with intravenous tissue plasminogen activator (tPA), and recent studies show tPA can be given in previously contraindicated situations...
August 2017: Current Cardiology Reports
https://www.readbyqxmd.com/read/28645586/venous-sinus-stenting-in-the-management-of-patients-with-intracranial-hypertension-manifesting-with-skull-base-cerebrospinal-fluid-leaks
#2
Rajiv R Iyer, David Solomon, Abhay Moghekar, C Rory Goodwin, Charles M Stewart, Masaru Ishii, Philippe Gailloud, Gary L Gallia
BACKGROUND: A subset of patients with skull base cerebrospinal fluid (CSF) leaks are found to have elevated intracranial pressure (ICP). In these patients, elevated ICP is thought to contribute to both the pathophysiology of the leak as well as postoperative leak recurrences. Current strategies for post-operative ICP control include medical therapy and shunting procedures. The aim of this study is to report the use of venous sinus stenting (VSS) in the management of patients with skull base CSF leaks due to elevated ICP...
June 20, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28637822/pattern-of-pressure-gradient-alterations-after-venous-sinus-stenting-for-idiopathic-intracranial-hypertension-predicts-stent-adjacent-stenosis-a-proposed-classification-system
#3
Daniel Raper, Thomas J Buell, Dale Ding, Ching-Jen Chen, Robert M Starke, Kenneth C Liu
OBJECTIVE: Venous sinus stenting (VSS) is a safe and effective treatment for idiopathic intracranial hypertension (IIH) with angiographic venous sinus stenosis. However, predictors of stent-adjacent stenosis (SAS) remain poorly defined. METHODS: We performed a retrospective review of 47 patients with IIH and intracranial venous stenosis who underwent VSS with pre- and post-stent venography. Patient characteristics, treatments and outcomes were reviewed. Changes in pressure gradient after VSS were classified according to pattern of gradient resolution into types I-III...
June 21, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28637237/long-term-evolutionary-change-in-the-lumen-of-intracranial-atherosclerotic-stenosis-following-angioplasty-and-stenting
#4
Simon C H Yu, Tiffany W W Lau, Simon S M Wong, Kwok T Lee, Lawrence K S Wong, Thomas W H Leung
BACKGROUND: Angioplasty and stenting is a recognized treatment option for patients with intracranial atherosclerosis. OBJECTIVE: To evaluate the long-term evolutionary luminal changes of intracranial atherosclerosis after angioplasty and stenting. METHODS: This was a retrospective study with patient consent. Eighty-two patients presenting with acute and minor cerebral ischemia due to stenosis ≥70%, who had received medical therapy with or without stenting (Wingspan), were invited...
June 14, 2017: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/28630664/overlapping-stent-assisted-coil-embolization-for-a-ruptured-intracranial-vertebral-artery-dissection
#5
Katsunori Asai, Hajime Nakamura, Takeo Nishida, Shayne Morris, Takayuki Sakaki
Ruptured intracranial vertebral artery dissection is a cause of non-traumatic subarachnoid hemorrhage. Urgent intervention should be considered to prevent fatal rebleeding. Endovascular parent artery occlusion, which is the initial treatment of choice, is not suitable for patients with a hypoplastic or occlusive contralateral vertebral artery. We report a case of ruptured vertebral artery dissection, which was successfully treated with double overlapping stent-assisted coiling.
June 2017: Journal of Surgical Case Reports
https://www.readbyqxmd.com/read/28626262/a-case-of-anterior-communicating-artery-aneurysm-successfully-treated-after-a-stent-migration-during-stent-assisted-endovascular-coil-embolization
#6
Tomotaka Ohshima, Andrey Belayev, Shunsaku Goto, Taiki Yamamoto, Kojiro Ishikawa, Yoko Kato
Stent migration is a complication associated with endovascular coil embolization of intracranial aneurysms. We report a case of anterior communicating artery (ACoA) aneurysm that was successfully treated after stent migration during endovascular coil embolization without retrieval of the stent. A 47-year-old man presented with sudden onset severe headache. Patient was noted to have subarachnoid hemorrhage from a ruptured ACoA aneurysm. Emergency endovascular coil embolization was performed. The second coil embolization was scheduled for the neck-remnant portion with a stent after 16 days from the initial operation...
February 2017: Nagoya Journal of Medical Science
https://www.readbyqxmd.com/read/28604183/treatment-of-an-internal-carotid-artery-aneurysm-with-a-flow-diverter-through-a-double-lumen-balloon-catheter
#7
José M Amorim, Santiago Rosati, Ronit Agid, Vítor Mendes Pereira, Timo Krings
Background Double lumen balloon catheters (DLBCs) are currently used in the treatment of intracranial aneurysms, especially when involving balloon or stent-assisted coiling. The existing DLBCs allow the delivery of self-expandable stents but do not offer the possibility to deploy flow-diverters. Despite the increasing use and success of flow-diverters, there have been numerous reports of procedural complications such as early in-stent thrombosis or delayed distal embolization. It seems that these complications can be avoided by correct stent positioning and adequate wall apposition, achieved either by manoeuvres with the microguidewire and/or microcatheter or by performing balloon angioplasty following an exchange guidewire manoeuvre...
June 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/28598274/evaluation-of-ischemic-lesion-prevalence-after-endovascular-treatment-of-intracranial-aneurysms-as-documented-by-3-t-diffusion-weighted-imaging-a-2-year-single-center-cohort-study
#8
Christina Iosif, Jean-Christophe Lecomte, Eduardo Pedrolo-Silveira, George Mendes, Marie-Paule Boncoeur Martel, Suzana Saleme, Charbel Mounayer
OBJECTIVE Even though published data exist concerning the prevalence of ischemic lesions detected by diffusion-weighted imaging (DWI) following endovascular treatment of intracranial aneurysms, a single-center cross-evaluation of the different endovascular techniques has been lacking. The authors sought to prospectively evaluate the prevalence and clinical significance of ischemic lesions occurring after endovascular treatment of intracranial aneurysms and to compare the safety and effectiveness of a broad spectrum of currently accepted endovascular techniques in a single-center setting...
June 9, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28595811/acute-distal-migration-of-a-flow-diverting-stent
#9
David Dornbos, Ciarán J Powers
The introduction of flow diverting stents, particularly for treatment of petrous to supraclinoid internal carotid artery aneurysms, has greatly impacted endovascular treatment of intracranial aneurysms. Despite their high efficacy, complications, such as ischemic events, distal hemorrhage, or problems with stent deployment, remain a significant concern. We present the first reported case of acute distal migration of a Pipeline Embolization Device (PED). A 24-year old female underwent elective placement of a PED for treatment of a left paraclinoid internal carotid artery aneurysm...
June 5, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28592484/analysis-of-neointima-development-in-flow-diverters-using-optical-coherence-tomography-imaging
#10
Yoshikazu Matsuda, Joonho Chung, Demetrius K Lopes
BACKGROUND: Flow diverters are used for the treatment of intracranial aneurysms. Surface modification may decrease the thrombogenicity of flow diverters but the details are unknown. Optical coherence tomography (OCT) is an intravascular imaging test with high resolution which identifies neointimal growth over stents. We compared the development of neointima in a flow diverter and stents with and without surface modification in a swine model. METHODS: In this study we implanted four devices (two in each carotid artery) in four pigs...
June 7, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28589250/histopathological-and-bacteriological-analysis-of-thrombus-material-extracted-during-mechanical-thrombectomy-in-acute-stroke-patients
#11
Francisco Hernández-Fernández, Laura Rojas-Bartolomé, Jorge García-García, Óscar Ayo-Martín, Juan David Molina-Nuevo, Rosa Angélica Barbella-Aponte, Gemma Serrano-Heras, Enrique Juliá-Molla, María José Pedrosa-Jiménez, Tomás Segura
PURPOSE: Management of stroke secondary to septic emboli (SE) remains challenging, due to both the lack of specific recommendations and the gravity of the underlying pathology.The aim of this study is to describe the presence of SE in a series of mechanical thrombectomies (MT), analyzing technical complexity and outcomes with respect to the patients by means of histological analysis and microbiological study of the clot. METHODS: All the retrieved clots were studied under an established protocol, including histopathological and bacteriological study with hematoxylin-eosin, Gram and Gomori trichrome staining...
June 6, 2017: Cardiovascular and Interventional Radiology
https://www.readbyqxmd.com/read/28587530/endovascular-treatment-of-wide-neck-intracranial-bifurcation-aneurysms-with-y-configuration-double-neuroform%C3%A2-stents-assisted-coiling-technique-experience-in-a-single-center
#12
C Castaño, M Terceño, S Remollo, M R García-Sort, C Domínguez
Background Intracranial wide-neck aneurysms at the arterial bifurcations, especially in the aneurysms where the bifurcating branches emanate directly from the base of the aneurysm, have been particularly difficult on which to perform endovascular treatment. The 'Y'-configuration, double stent-assisted coil embolization is an option for the treatment of these difficult aneurysms, allowing the closure of the aneurysm, preserving the parent arteries. Material and methods In a nine-year period, 546 intracranial aneurysms in 493 patients were treated at our center by endovascular approach...
January 1, 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/28585672/a-trial-for-an-evaluation-of-perianeurysmal-arterial-pressure-change-during-carotid-artery-stenting-in-patients-with-concomitant-severe-extracranial-carotid-artery-stenosis-and-ipsilateral-intracranial-aneurysm
#13
Daisuke Wajima, Ichiro Nakagawa, Takeshi Wada, Hiroyuki Nakase
Concomitant occurrence of severe extracranial large vessel stenosis and an ipsilateral intracranial aneurysm is often detected incidentally, but the optimal therapeutic strategy is not clear. Several reports have investigated whether simultaneous carotid artery stenting and coil embolization, or multi-stage therapy is better. These treatment strategies are still controversial because simultaneous therapy will decrease the risk of aneurysm rupture, but may also increase the risk of thromboembolic complications...
April 27, 2017: Turkish Neurosurgery
https://www.readbyqxmd.com/read/28584947/mechanical-recanalization-using-solitaire-ab-device-for-severe-thromboembolic-events-in-endovascular-treatment-of-intracranial-aneurysms
#14
Qiuji Shao, Liangfu Zhu, Tianxiao Li, Li Li, Yingkun He, Kaitao Chang, Xiaodong Liang
INTRODUCTION: Severe thromboembolism with complete occlusion of the proximal arteries during or after coil embolization can cause serious neurologic deficits. The study aimed to assess the effectiveness and safety of Solitaire AB device as a rescue therapy for severe thromboembolic complications in the endovascular treatment of intracranial aneurysms. MATERIALS AND METHODS: Between February 2013 and April 2016, 1047 intracranial aneurysms treated with endovascular procedures were retrospectively reviewed in our center...
June 5, 2017: Cardiovascular and Interventional Radiology
https://www.readbyqxmd.com/read/28583043/intracranial-stenting-for-nilotinib-treatment-associated-cerebrovascular-stenosis-in-chronic-myeloid-leukemia
#15
Tomohiko Ozaki, Hajime Nakamura, Nobuyuki Izutsu, Hiroaki Masaie, Jun Ishikawa, Manabu Kinoshita
One of the second-generation tyrosine kinase inhibitors (TKIs), nilotinib, is increasingly used for imatinib-resistant or intolerant chronic myeloid leukemia (CML). Nilotinib is considered well tolerated with few side effects including hyperglycemia, hyperbilirubinemia and elevated levels of pancreatic enzymes. However, there is growing evidence that nilotinib accelerates atherosclerosis and causes peripheral arterial occlusive disease such as stroke, transient ischemic attack (TIA) and cardiovascular diseases...
January 1, 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/28576622/haemodynamic-effects-of-stent-diameter-and-compaction-ratio-on-flow-diversion-treatment-of-intracranial-aneurysms-a-numerical-study-of-a-successful-and-an-unsuccessful-case
#16
Mingzi Zhang, Yujie Li, Xi Zhao, David I Verrelli, Winston Chong, Makoto Ohta, Yi Qian
BACKGROUND: Compacting a flow-diverting (FD) stent is an emerging technique to create a denser configuration of wires across the aneurysm ostium. However, quantitative analyses of post-stenting haemodynamics affected by the compaction level of different stent sizes remain inconclusive. OBJECTIVE: To compare the aneurysmal haemodynamic alterations after virtual FD treatments with different device diameters at different compaction ratios. METHODS: We virtually implanted three sizes of FD stent, with each size deployed at four compaction ratios, into two patient aneurysms previously treated with the Silk+FD-one successful case and the other unsuccessful...
May 16, 2017: Journal of Biomechanics
https://www.readbyqxmd.com/read/28567180/bilateral-persistent-primitive-hypoglossal-arteries-associated-with-unilateral-symptomatic-carotid-thromboembolism
#17
Riddhi Patira, Christopher Kyper, Pallav Shah, Kadir Erkmen
We report the fifth case of bilateral persistent primitive hypoglossal arteries in the literature. This is also the first such case to be demonstrated on computerized tomography angiogram (CTA) and the first case to be associated with a symptomatic carotid thrombus. The sub-occlusive thrombus was distal to the take-off of the dominant persistent hypoglossal artery (PHA) from the internal carotid artery, thus sparing involvement of posterior circulation. Timely identification of the internal carotid artery thromboembolism in the setting of a PHA is important to allow for thrombectomy...
April 2017: Journal of Radiology Case Reports
https://www.readbyqxmd.com/read/28565993/use-of-the-pipeline-embolization-device-in-the-treatment-of-iatrogenic-intracranial-vascular-injuries-a-bi-institutional-experience
#18
Julius Griauzde, Vijay M Ravindra, Neeraj Chaudhary, Joseph J Gemmete, Marcus D Mazur, Christopher D Roark, William T Couldwell, Min S Park, Philipp Taussky, Aditya S Pandey
OBJECTIVE Flow-diverting devices have been used for the treatment of complex intracranial vascular pathology with success, but the role of these devices in treating iatrogenic intracranial vascular injuries has yet to be clearly defined. Here, the authors report their bi-institutional experience with the use of the Pipeline embolization device (PED) for the treatment of iatrogenic intracranial vascular injuries. METHODS The authors reviewed a retrospective cohort of patients with iatrogenic injuries to the intracranial vasculature that were treated with the PED between 2012 and 2016...
June 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28565984/novel-use-of-flow-diversion-for-the-treatment-of-aneurysms-associated-with-arteriovenous-malformations
#19
Craig Kilburg, Philipp Taussky, M Yashar S Kalani, Min S Park
The use of flow-diverting stents for intracranial aneurysms has become more prevalent, and flow diverters are now routinely used beyond their initial scope of approval at the proximal internal carotid artery. Although flow diversion for the treatment of cerebral aneurysms is becoming more commonplace, there have been no reports of its use to treat flow-related cerebral aneurysms associated with arteriovenous malformations (AVMs). The authors report the cases of 2 patients whose AVM-associated aneurysms were managed with flow diversion...
June 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28560568/outcome-of-carotid-artery-stenting-in-the-hands-of-vascular-surgeons
#20
Carola Marie Wieker, S Demirel, N Attigah, M Hakimi, U Hinz, D Böckler
OBJECTIVES: To analyze the procedural and clinical outcomes of carotid artery stenting (CAS) in the hands of endovascular trained vascular surgeons. METHODS: Between April 2008 to May 2013, 1197 patients were treated for extracranial internal carotid artery (ICA) stenosis. The proportion of endovascular treated patients was 5.0% (CAS n = 60 vs. carotid endarterectomy (CEA) n = 1137). All patients in the CAS group (44 males, median age 70 years) were treated by two senior vascular surgeons experienced in endovascular methods...
May 30, 2017: Langenbeck's Archives of Surgery
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