-
Usefulness of Cone Beam Intra-Arterial CTA for Evaluation of Flow Diverters: A Practical Approach for Daily Use. Intervent. Neurol. Pub Date : 2018-11-10 Dennys Reyes,Victor Becerra,Indiana Alcala,Italo Linfante,Guilherme Dabus
Cone beam computed tomography (CBCT), initially used for evaluation of intraprocedural complications such as hemorrhage, has evolved to provide details of implanted devices such as flow diverters. The study aim is to present our experience in using CBCT with intra-arterial injection and provide a step-by-step approach for postprocessing in a practical protocol for daily use. IRB approval was obtained
-
Cervical Origin of the Right Subclavian Artery with a Nonbifurcating Left Cervical Carotid Artery. Intervent. Neurol. Pub Date : 2018-11-10 Mohamad Ezzeldin,Eslam W Youssef,Vibhav Bansal,Ali Sultan Qurraie,Osama Zaidat
-
A Serpiginous Pericallosal Anterior Cerebral Artery. Intervent. Neurol. Pub Date : 2018-11-10 Mohamad Ezzeldin,Eslam W Youssef,Ali Sultan-Qurraie,Eugene Lin,Osama O Zaidat
The anterior cerebral artery (ACA) is a unique artery with many important variations with substantial clinical significance. Tortuous intracranial arteries usually occur in basilar, communicating, anterior, posterior cerebral arteries and in the white matter arterioles. This could happen for many reasons including but not limited to ageing, hypertension, patients with Moyamoya disease, congenital malformation
-
Transvenous Embolization of Dural Arteriovenous Fistulas of the Hypoglossal Canal: Report of Three Cases and Review of the Literature. Intervent. Neurol. Pub Date : 2018-11-10 Alejandro Santillan,Justin Schwarz,Athos Patsalides
In this article, we report three cases of dural arteriovenous fistulas of the hypoglossal canal treated via transvenous approach. We also perform a review of the literature on the endovascular management of this type of lesions with particular attention to the dangerous extracranial-intracranial anastomoses that can occur at this level.
-
Aortic Arch Variants: A Practical Guide to Safe and Timely Catheterization. Intervent. Neurol. Pub Date : 2018-09-13 Maksim Shapiro,Eytan Raz,Peter Kim Nelson
BACKGROUND Variations in aortic arch anatomy have been extensively described from multiple perspectives including gross anatomy, embryology, associated cardiac and other anomalies, early life presentation, and cross-sectional diagnosis. There is however a paucity of literature with an emphasis on safe and timely catheterization, particularly when the variants are found during emergent or other catheter
-
Regional Contributions to Poststroke Disability in Endovascular Therapy. Intervent. Neurol. Pub Date : 2018-09-03 Sunil A Sheth,Konark Malhotra,David S Liebeskind,Conrad W Liang,Albert J Yoo,Reza Jahan,Raul G Nogueira,Vitor Pereira,Jan Gralla,Greg Albers,Mayank Goyal,Jeffrey L Saver
BACKGROUND AND PURPOSE The relative contribution of each Alberta Stroke Program Early CT Score (ASPECTS) region to poststroke disability likely varies across regions. Determining the relative weights of each ASPECTS region may improve patient selection for endovascular stroke therapy (EST). METHODS In the combined Solitaire Flow Restoration with the Intention for Thrombectomy (SWIFT), Solitaire Flow
-
2D Parametric Parenchymal Blood Flow as a Predictor of the Hemorrhagic Events after Endovascular Treatment of Acute Ischemic Stroke: A Single-Center Retrospective Study. Intervent. Neurol. Pub Date : 2018-08-31 Nada Elsaid,Ahmed Saied,Krishna Joshi,Jessica Nelson,John Baumgart,Demetrius Lopes
BACKGROUND AND PURPOSE Intracranial hemorrhage (ICH) is one of the major adverse events related to the endovascular management of acute ischemic stroke. It is important to evaluate the risk of ICH as it may result in clinical deterioration of the patients. Development of tools which can predict the risk of ICH after thrombectomy can reduce the procedure-related morbidity and mortality. 2D parenchymal
-
Ghost Infarct Core and Admission Computed Tomography Perfusion: Redefining the Role of Neuroimaging in Acute Ischemic Stroke. Intervent. Neurol. Pub Date : 2018-08-31 Nuno Martins,Ana Aires,Beatriz Mendez,Sandra Boned,Marta Rubiera,Alejandro Tomasello,Pilar Coscojuela,David Hernandez,Marián Muchada,David Rodríguez-Luna,Noelia Rodríguez,Jesús M Juega,Jorge Pagola,Carlos A Molina,Marc Ribó
BACKGROUND Determining the size of infarct extent is crucial to elect patients for reperfusion therapies. Computed tomography perfusion (CTP) based on cerebral blood volume may overestimate infarct core on admission and consequently include ghost infarct core (GIC) in a definitive lesional area. PURPOSE Our goal was to confirm and better characterize the GIC phenomenon using CTP cerebral blood flow
-
Comparison of Subacute Vascular Damage Caused by ADAPT versus Stent Retriever Devices after Thrombectomy in Acute Ischemic Stroke: Histological and Ultrastructural Study in an Animal Model. Intervent. Neurol. Pub Date : 2018-08-31 Simone Peschillo,Alejandro Tomasello,Francesco Diana,David Hernandez,Giada Toccaceli,Marta Rosal-Fontana,Marielle Esteves Coelho,Paolo Missori
OBJECTIVES To assess the delayed (15 days) histological and ultrastructural changes occurring following endovascular treatment with a direct aspiration first pass technique (ADAPT) or stent retrievers (SRs) and to compare the findings in order to determine which is the least harmful technique and what changes occur. MATERIALS AND METHODS Damage to the wall of swine extracranial arteries was evaluated
-
Stent Survival and Stent-Adjacent Stenosis Rates following Venous Sinus Stenting for Idiopathic Intracranial Hypertension: A Systematic Review and Meta-Analysis. Intervent. Neurol. Pub Date : 2018-07-31 Hamidreza Saber,Whitfield Lewis,Mahsa Sadeghi,Gary Rajah,Sandra Narayanan
BACKGROUND Idiopathic intracranial hypertension (IIH) is characterized by an elevated intracranial pressure without any identifiable causative factor such as an intracranial mass. Dural venous sinus stenosis (DVSS) has been suggested to be associated with IIH. OBJECTIVE We performed an updated systematic review and meta-analysis to determine clinical outcomes as well as stent survival and stent-adjacent
-
Isolated Intraventricular Hemorrhage Associated with Cerebral Vasospasm and Delayed Cerebral Ischemia following Arteriovenous Malformation Rupture. Intervent. Neurol. Pub Date : 2018-07-31 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
-
Retention of Stroke Education Provided during Hospitalization: Does Provision of Required Education Increase Stroke Knowledge? Intervent. Neurol. Pub Date : 2018-07-26 Brenda Johnson,Diane Handler,Victor Urrutia,Anne W Alexandrov
BACKGROUND Provision of stroke education to patients is a Centers for Medicare/Medicaid (CMS) requirement. However, little is known about retention of the educational content. METHODS Two pilot studies were conducted: Pilot A delivered CMS-required stroke education during hospitalization in a standardized manner and tested knowledge retention in patients returning to the Stroke Clinic for 1-month follow-up;
-
Geospatial Visualization of Mobile Stroke Unit Dispatches: A Method to Optimize Service Performance. Intervent. Neurol. Pub Date : 2018-07-24 James P Rhudy,Anne W Alexandrov,Joseph Rike,Tomas Bryndziar,Ana Hossein Zadeh Maleki,Victoria Swatzell,Wendy Dusenbury,E Jeffrey Metter,Andrei V Alexandrov
BACKGROUND Timely treatment of acute ischemic stroke is crucial to optimize outcomes. Mobile stroke units (MSU) have demonstrated ultrafast treatment compared to standard emergency care. Geospatial analysis of the distribution of MSU cases to optimize service delivery has not been reported. METHODS We aggregated all first-year MSU dispatch occurrences and all cases classified by clinical teams as true
-
Incidence of Aneurysmal Subarachnoid Hemorrhage with Procedures Requiring General Anesthesia in Patients with Unruptured Intracranial Aneurysms. Intervent. Neurol. Pub Date : 2018-07-18 Hesham Masoud,Vijaylakshmi Nair,Adekorewale Odulate-Williams,Sameer Sharma,Grahame Gould,Joshua Thatcher,Thanh N Nguyen
BACKGROUND The role of general anesthesia in precipitating aneurysm rupture is not clearly defined. In this study, we aimed to assess the natural history of unruptured aneurysms in patients undergoing non-aneurysm-related procedures requiring general anesthesia. METHODS Retrospective review of consecutive patients with untreated intracranial aneurysms that underwent unrelated surgery with operative
-
Acute Ischemic Stroke due to Common Carotid Ostial Disease with Tandem Intracranial Occlusions Treated with Thrombectomy and Staged Retrograde Stenting. Intervent. Neurol. Pub Date : 2018-07-13 Krishna Amuluru,Fawaz Al-Mufti,Charles E Romero
BACKGROUND Acute ischemic stroke due to tandem occlusive lesions of the anterior circulation involves an intracranial large vessel occlusion as well as a concurrent occlusion or high-grade stenosis of the proximal carotid system. The vast majority of proximal lesions in tandem occlusive cases involve the extracranial internal carotid artery, although the lesion can theoretically exist anywhere along
-
Safety and Feasibility of Balloon-Assisted Embolization with Onyx of Brain Arteriovenous Malformations Revisited: Personal Experience with the Scepter XC Balloon Microcatheter. Intervent. Neurol. Pub Date : 2018-07-13 Bharathi D Jagadeesan,Andrew W Grande,Ramachandra P Tummala
BACKGROUND/OBJECTIVE Compliant dual-lumen balloon microcatheters have been used to perform balloon-assisted embolization (BAE) of brain arteriovenous malformations (AVMs) with ethylene vinyl alcohol copolymer (Onyx). However, vessel rupture and microcatheter retention have been reported from BAE using these microcatheters. Using an extra-compliant balloon microcatheter (Scepter XC; Microvention, Tustin
-
Endovascular Therapy versus Thrombolysis in Patients with Mild Strokes and Large Vessel Occlusions within the Anterior Circulation. Intervent. Neurol. Pub Date : 2018-07-11 Andreas Kastrup,Freimuth Brunner,Helmut Hildebrandt,Christian Roth,Michael Winterhalter,Carsten Giessing,Panagiotis Papanagiotou
BACKGROUND In patients with large vessel occlusions, endovascular treatment (ET) has been shown to be superior to intravenous thrombolysis (IVT) in recent trials. However, it is currently unclear if patients with mild strokes also benefit from ET. METHODS We compared the discharge rates of good outcome (modified Rankin scale [mRS] ≤2), very good outcome (mRS 0-1), symptomatic intracranial hemorrhages
-
Neurointerventional "Near Morbidity": A Candid Appraisal of an Early Case Series. Intervent. Neurol. Pub Date : 2018-07-11 Bradley A Gross,Ashutosh P Jadhav,Tudor G Jovin,Brian T Jankowitz
BACKGROUND Modern case series often focus on emphasizing low complication rates, "safety," and "efficacy." Although patients may not suffer significant or obviously apparent neurological complications, many lessons are buried in the "no complications" cohort. METHODS The junior author's prospectively maintained caselog was reviewed over a 1-year period for both symptomatic and "minor"/technical complications
-
Multicenter Experience with Stenting for Symptomatic Carotid Web. Intervent. Neurol. Pub Date : 2018-07-11 Diogo C Haussen,Jonathan A Grossberg,Sebastian Koch,Amer Malik,Dileep Yavagal,Benjamin Gory,Wolfgang Leesch,Ameer E Hassan,Anne-Laure Derelle,Sébastien Richard,Clara Barreira,Gustavo Pradilla,Raul G Nogueira
BACKGROUND A carotid web (CaW) is a shelf-like lesion in the posterior aspect of the internal carotid bulb and represents an intimal variant of fibromuscular dysplasia. CaW has been associated with recurrent strokes and conventionally treated with surgical excision. We report a multicenter experience of stenting in patients with symptomatic CaWs. METHODS Retrospective review of consecutive patients
-
Direct Thrombectomy versus Bridging for Patients with Emergent Large-Vessel Occlusions. Intervent. Neurol. Pub Date : 2018-07-04 Ronen R Leker,Jose E Cohen,David Tanne,David Orion,Gregory Telman,Guy Raphaeli,Jacob Amsalem,Jonathan Y Streifler,Hen Hallevi,Pavel Gavriliuc,Natan M Bornstein,Anat Horev,Nour Eddine Yaghmour
BACKGROUND AND AIMS Patients with emergent large-vessel occlusion (ELVO) that present earlier than 4 h from onset are usually treated with bridging systemic thrombolysis followed by endovascular thrombectomy (EVT). Whether direct EVT (dEVT) could improve the chances of favorable outcome remains unknown. METHODS Consecutively, prospectively enrolled patients with ELVO presenting within 4 h of onset
-
Endovascular Therapy and Ethnic Disparities in Stroke Outcomes. Intervent. Neurol. Pub Date : 2018-06-19 Mehdi Bouslama,Leticia C Rebello,Diogo C Haussen,Jonathan A Grossberg,Aaron M Anderson,Samir R Belagaje,Nicolas A Bianchi,Michael R Frankel,Raul G Nogueira
BACKGROUND AND PURPOSE Ethnic disparities in stroke are well described, with a higher incidence of disability and increased mortality in Blacks versus Whites. We sought to compare the clinical outcomes between those ethnic groups after stroke endovascular therapy (ET). METHODS We performed a retrospective review of the prospectively acquired Grady Endovascular Stroke Outcomes Registry between September
-
Carotid Revascularization with and without the Use of an Embolic Protection Device: A Single-Center Experience from Pakistan. Intervent. Neurol. Pub Date : 2018-06-11 Qasim Bashir,Ammad Anwar Baig
BACKGROUND To assess the safety and clinical efficacy of carotid artery stenting with and without an embolic protection device (EPD) in both symptomatic and asymptomatic carotid disease cases. METHODS Retrospective data of 55 symptomatic (≥50% occlusion by digital subtraction angiography [DSA], ≥70% by ultrasound, computed tomography angiography [CTA], and magnetic resonance angiography [MRA]) and
-
Active Reperfusion Hemorrhage during Thrombectomy: Angiographic Findings and Real-Time Correlation with the CT "Spot Sign". Intervent. Neurol. Pub Date : 2018-06-08 Diogo C Haussen,Ivan M Ferreira,Clara Barreira,Jonathan A Grossberg,Francesco Diana,Simone Peschillo,Raul G Nogueira
INTRODUCTION Symptomatic intracranial hemorrhage represents one of the most feared complications of endovascular reperfusion. We aim to describe a series of patients that experienced immediate reperfusion injury with active intraprocedural extravasation within the territory of the deep penetrating arteries and provide real-time correlation with CT "spot sign." METHODS This was a retrospective analysis
-
Pipeline Embolization for Salvage Treatment of Previously Stented Residual and Recurrent Cerebral Aneurysms. Intervent. Neurol. Pub Date : 2018-06-01 Matthew T Bender,Chau D Vo,Bowen Jiang,Jessica K Campos,David A Zarrin,Risheng Xu,Erick M Westbroek,Justin M Caplan,Judy Huang,Rafael J Tamargo,Li-Mei Lin,Geoffrey P Colby,Alexander L Coon
INTRODUCTION This study assessed the safety and effectiveness of the Pipeline embolization device (PED) for persistent and recurrent aneurysms previously treated with either a vascular reconstruction device (VRD) or a flow diverter (FD). METHODS A prospective, IRB-approved database was analyzed for patients treated with PED for aneurysms previously treated with a stent. RESULTS Twenty procedures were
-
Review of the Mobile Stroke Unit Experience Worldwide. Intervent. Neurol. Pub Date : 2018-05-31 Victoria J Calderon,Brittany M Kasturiarachi,Eugene Lin,Vibhav Bansal,Osama O Zaidat
BACKGROUND The treatment of stroke is dependent on a narrow therapeutic time window that requires interventions to be emergently pursued. Despite recent "FAST" initiatives that have underscored "time is brain," many patients still fail to present within the narrow time window to receive maximum treatment benefit from advanced stroke therapies, including recombinant tissue plasminogen activator (tPA)
-
Seeing Is Believing: Headway27 as a Highly Visible and Versatile Microcatheter with Ideal Dimensions for Stroke Thrombectomy. Intervent. Neurol. Pub Date : 2018-05-31 William J Ares,Benjamin M Zussman,Cynthia L Kenmuir,Gregory M Weiner,Habibullah Ziayee,Devin Burke,Ashutosh P Jadhav,Tudor G Jovin,Brian T Jankowitz,Bradley A Gross
INTRODUCTION Microcatheter selection is an infrequent focus of stroke thrombectomy technique evaluation. The Headway27 microcatheter strikes an excellent balance of microcatheter dimensions (156 cm length, 2.6 Fr distal OD, ID 0.027 inches) and visibility, making it ideal for stroke thrombectomy. METHODS We evaluated a prospectively maintained acute stroke thrombectomy database containing 50 consecutive
-
Progressive Neurological Decline with Deep Bilateral Imaging Changes: A Protean Presentation of Dural Arteriovenous Fistulae. Intervent. Neurol. Pub Date : 2018-05-17 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
-
Automated CT Perfusion Prediction of Large Vessel Acute Stroke from Intracranial Atherosclerotic Disease. Intervent. Neurol. Pub Date : 2018-05-17 Diogo C Haussen,Mehdi Bouslama,Seena Dehkharghani,Jonathan A Grossberg,Nicolas Bianchi,Meredith Bowen,Michael R Frankel,Raul G Nogueira
BACKGROUND AND PURPOSE We have observed that large vessel occlusion acute strokes (LVOS) due to intracranial atherosclerotic disease (ICAD) present with more benign CT perfusion (CTP) profiles, which we presume to potentially represent enhanced collateralization compared to embolic LVOS. We aim to determine if CTP profiles can predict ICAD in LVOS. METHODS Retrospective review of a prospectively collected
-
Endovascular Acute Ischemic Stroke Treatment with FlowGate Balloon Guide Catheter: A Single-Center Observational Study of FlowGate Balloon Guide Catheter Use. Intervent. Neurol. Pub Date : 2018-05-16 Mohamed S Teleb
BACKGROUND Treatment of large vessel occlusion acute ischemic stroke with mechanical thrombectomy has become the standard of care after recent clinical trials. However, the degree of recanalization with stent retrievers remains very important in overall outcomes. We sought to review the utility of a new balloon guide catheter (BGC) in improving the degree of recanalization in conjunction with mechanical
-
5-French SOFIA: Safe Access and Support in the Anterior Cerebral Artery, Posterior Cerebral Artery, and Insular Middle Cerebral Artery. Intervent. Neurol. Pub Date : 2018-05-03 Bradley A Gross,William J Ares,Cynthia L Kenmuir,Ashutosh P Jadhav,Tudor G Jovin,Brian T Jankowitz
INTRODUCTION Distal access catheters are an infrequent focus of technical notes in neurointervention. The 5-French SOFIA's unique design allows for compatibility with 6-French guide catheters, while its supple construction allows for remarkably distal access for a catheter with a 0.055-inch inner diameter. METHODS The authors reviewed a prospectively maintained endovascular database for cases utilizing
-
High-Risk Features of Delayed Clinical Progression in Cerebral Venous Thrombosis: A Proposed Prediction Score for Early Intervention. Intervent. Neurol. Pub Date : 2018-04-20 Saif A Bushnaq,Fares Qeadan,Tapan Thacker,Mohammad Abbas,Andrew P Carlson
BACKGROUND Anticoagulation is the mainstay treatment for cerebral venous thrombosis (CVT). A subset of patients might deteriorate despite anticoagulation, and in such cases, endovascular therapy is recommended. METHODS A retrospective review was performed on subjects with CVT from January 2005 to October 2016. The primary outcome was clinical deterioration. Bivariate analysis, multiple logistic regression
-
Balloon-Assisted Cannulation for Difficult Anterior Cerebral Artery Access. Intervent. Neurol. Pub Date : 2018-04-10 Varun Naragum,Mohamad AbdalKader,Thanh N Nguyen,Alexander Norbash
The anterior communicating artery is a common location for intracranial aneurysms. Compared to surgical clipping, endovascular coiling has been shown to improve outcomes for patients with ruptured aneurysms and we have seen a paradigm shift favoring this technique for treating aneurysms. Access to the anterior cerebral artery can be challenging, especially in patients with tortuous anatomy or subarachnoid
-
Spontaneous Resolution of Post-Traumatic Direct Carotid-Cavernous Fistula. Intervent. Neurol. Pub Date : 2018-04-10 Varun Naragum,Glenn Barest,Mohamad AbdalKader,Katharine M Cronk,Thanh N Nguyen
Post-traumatic carotid-cavernous fistulas are due to a tear in the wall of the cavernous carotid artery, leading to shunting of blood into the cavernous sinus. These are generally high-flow fistula and rarely resolve spontaneously. Most cases require endovascular embolization. We report a case of Barrow type A carotid-cavernous fistula which resolved spontaneously.
-
Epidemiology of Intracranial Hemorrhage Associated with Oral Anticoagulants in Spain: Trends in Anticoagulation Complications Registry - The TAC 2 Study. Intervent. Neurol. Pub Date : 2018-04-04 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
-
LVIS Jr Device for Y-Stent-Assisted Coil Embolization of Wide-Neck Intracranial Aneurysms: A Multicenter Experience. Intervent. Neurol. Pub Date : 2018-04-03 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
-
Acute In-Stent Thrombosis after Carotid Angioplasty and Stenting: A Case Report and Literature Review. Intervent. Neurol. Pub Date : 2018-04-03 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
-
Mechanical Thrombectomy in Elderly Stroke Patients with Mild-to-Moderate Baseline Disability. Intervent. Neurol. Pub Date : 2018-03-20 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
-
Support of New Triage Protocol among Acute Stroke Care Providers. Intervent. Neurol. Pub Date : 2018-03-14 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
-
Abciximab (ReoPro) Dosing Strategy for the Management of Acute Intraprocedural Thromboembolic Complications during Pipeline Flow Diversion Treatment of Intracranial Aneurysms. Intervent. Neurol. Pub Date : 2018-02-27 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
-
Carotid Stenting for Treatment of Symptomatic Carotid Webs: A Single-Center Case Series. Intervent. Neurol. Pub Date : 2018-02-22 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
-
Pomona Large Vessel Occlusion Screening Tool for Prehospital and Emergency Room Settings. Intervent. Neurol. Pub Date : 2018-02-13 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
-
Preclinical Evaluation of the NeVaTM Stent Retriever: Safety and Efficacy in the Swine Thrombectomy Model. Intervent. Neurol. Pub Date : 2018-02-13 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
-
Stent Reconstruction of Carotid Tonsillar Loop Dissection Using Telescoping Peripheral Stents. Intervent. Neurol. Pub Date : 2018-02-07 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
-
A Review of Pre-Intervention Prognostic Scores for Early Prognostication and Patient Selection in Endovascular Management of Large Vessel Occlusion Stroke. Intervent. Neurol. Pub Date : 2018-02-07 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
-
Association of Blood Glucose and Clinical Outcome after Mechanical Thrombectomy for Acute Ischemic Stroke. Intervent. Neurol. Pub Date : 2018-02-06 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
-
47 Consecutive Cases of Pipeline Flex Flow Diversion Utilizing a Novel Large-Bore Intracranial Intermediate Catheter: Nuances and Institutional Experience with the Syphontrak. Intervent. Neurol. Pub Date : 2018-02-06 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
-
Pipeline Flex Embolization of Flow-Related Aneurysms Associated with Arteriovenous Malformations: A Case Report. Intervent. Neurol. Pub Date : 2018-02-03 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
-
Importance of Reperfusion Status after Intra-Arterial Thrombectomy for Prediction of Outcome in Anterior Circulation Large Vessel Stroke. Intervent. Neurol. Pub Date : 2018-01-25 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
-
Direct Aspiration Catheter Fracture and Retrieval during Neurothrombectomy. Intervent. Neurol. Pub Date : 2018-01-25 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
-
Clinical and Radiographic Predictors of Intracerebral Hemorrhage Outcome. Intervent. Neurol. Pub Date : 2018-01-12 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
-
Safety Assessment of Endovascular Treatment of Cerebral Aneurysms in Patients with Fibromuscular Dysplasia. Intervent. Neurol. Pub Date : 2017-12-16 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
-
Safety of Diagnostic Cerebral and Spinal Digital Subtraction Angiography in a Developing Country: A Single-Center Experience. Intervent. Neurol. Pub Date : 2017-11-30 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
-
Clinical and Imaging Outcomes of Endovascular Therapy in Patients with Acute Large Vessel Occlusion Stroke and Mild Clinical Symptoms. Intervent. Neurol. Pub Date : 2017-11-23 Meredith T Bowen,Leticia C Rebello,Mehdi Bouslama,Diogo C Haussen,Jonathan A Grossberg,Nicolas A Bianchi,Samir Belagaje,Aaron Anderson,Michael R Frankel,Raul G Nogueira
BACKGROUND The minimal stroke severity justifying endovascular intervention remains elusive. However, a significant proportion of patients presenting with large vessel occlusion stroke (LVOS) and mild symptoms go untreated and face poor outcomes. We aimed to evaluate the clinical outcomes of patients presenting with LVOS and low symptom scores (National Institutes of Health Stroke Scale [NIHSS] score
-
Recommendations for Endovascular Care of Stroke Patients. Intervent. Neurol. Pub Date : 2017-11-17 Michelle Hill,Brenda A Glenn,Brenda J Reese,Benjamin Morrow
The field of neurointerventional radiology (NIR) therapy, including acute ischemic stroke intervention, endovascular intracranial aneurysm management, and treatment of intra- and extracranial large-vessel disease, has evolved over the past 18 years. To support this specialized advanced care requires nursing standards of care for staff to provide direct patient care in NIR suites and intensive management
-
A Prospective Multicenter Trial of the TransForm Occlusion Balloon Catheter: Trial Design and Results. Intervent. Neurol. Pub Date : 2017-11-15 M Asif Taqi,Syed A Quadri,Ajit S Puri,Brian F Fitzsimmons,Jianhua Nancy Jin,Ansaar T Rai,Curtis A Given,Javier Masso,Ciaran J Powers,Joey D English,Osama O Zaidat
BACKGROUND AND PURPOSE Adjunctive treatments like balloon-assisted coil embolization (BACE) and stent-assisted coil embolization play a major role in the treatment of wide-neck and large intracranial aneurysms. The TransForm™ Occlusion Balloon Catheter (TOBC) registry is intended to evaluate the safety, efficacy, and efficiency of BACE using the TOBC. METHOD AND STUDY DESIGN The TOBC registry is a
-
Hybrid Retrograde-Antegrade Recanalization of Acute Basilar Artery Occlusion. Intervent. Neurol. Pub Date : 2017-11-10 James D Rossen,Edgar A Samaniego,Mishelle Paullus,Santiago Ortega-Gutierrez
Acute basilar artery (BA) occlusion has a very poor prognosis. Recanalization can be challenged by bilateral vertebral artery (VA) occlusions, arterial dissection, or advanced atherosclerotic disease. We describe a case in whom the BA was accessed and recanalized through a retrograde-antegrade approach from the anterior circulation using a large posterior communicating artery (PCOM). Once the BA had
-
Optional Endovascular Therapy of Dissecting Posterior Cerebral Artery Aneurysm. Intervent. Neurol. Pub Date : 2017-11-10 Mohamed Wael Osman,Krzysztof Kadziolka,Laurent Peirot
BACKGROUND Posterior cerebral artery aneurysms are uncommon, with an occurrence rate of less than 1% of intracranial aneurysms. They have various shapes, including saccular and fusiform. Dissecting aneurysms may occur in distal posterior cerebral artery and they may affect the whole artery. Endovascular therapy is considered as a safe method of treatment and there are different techniques for endovascular
-
Safety and Efficacy of Low-Profile, Self-Expandable Stents for Treatment of Intracranial Aneurysms: Initial and Midterm Results - A Systematic Review and Meta-Analysis. Intervent. Neurol. Pub Date : 2017-11-10 Su-Yeon Park,Jae-Sang Oh,Hyuk-Jin Oh,Seok-Mann Yoon,Hack-Gun Bae
Low-profile stents seem to be associated with a higher incidence of thromboembolic events compared with preexisting stents. We conducted a systematic review of 11 eligible reports and a meta-analysis of 7 reports with respect to the clinical efficacy and safety of low-profile stents. There were 217 intracranial aneurysms reported; 22% were ruptured aneurysms. In all, 72% were treated using single stenting
-
Is the Efficacy of Endovascular Treatment for Acute Ischemic Stroke Sex-Related. Intervent. Neurol. Pub Date : 2017-11-10 Andreia Carvalho,André Cunha,Tiago Gregório,Ludovina Paredes,Henrique Costa,Miguel Veloso,Sérgio Castro,Manuel Ribeiro,Pedro Jorge Gonçalves Barros
BACKGROUND Several reports refer to differences in stroke between females and males, namely in incidence and clinical outcome, but also in response to treatments. Driven by a recent analysis of the MR CLEAN trial, which showed a higher benefit from acute stroke endovascular treatment (EVT) in males, we intended to determine if clinical outcomes after EVT differ between sexes, in a real-world setting
-
Provocative Testing Prior to Anterior Cerebral Artery Fusiform Aneurysm Embolization. Intervent. Neurol. Pub Date : 2017-11-08 Pouria Moshayedi,Dan-Victor Giurgiutiu,Andrew F Ducruet,Brian T Jankowitz,Ashutosh P Jadhav
We report 2 cases of parent artery occlusion (PAO) for anterior cerebral artery (ACA) fusiform aneurysm embolization after superselective provocative testing was performed to confirm distal territory viability. The first case involves a patient in the second decade of life who presented with subarachnoid hemorrhage and underwent PAO after a balloon test occlusion in the distal ACA revealed no neurophysiology